Umdlavuza womthondo

**Umdlavuza womthondo** kuwumdlavuza owakheka esikhumbeni noma izicubu zomthondo.Izimpawu zingafaka ukukhula okungajwayelekile, isilonda noma isilonda esikhunjeni sowesilisa, kanye nokopha noma ukukhipha okunuka kabi. 

 

Izici zobungozi zibandakanya i-phimosis (ukungakwazi ukuhoxisa ijwabu lobudoda), ukuvuvukala okungapheli, ukubhema, ukutheleleka nge-HPV, i- condylomata acuminate, ukuba nabalingani abaningi bezocansi, kanye nokuya ocansini usemncane. 

Cishe ama-95% omdlavuza we-penile angama- squamous cell carcinomas .Ezinye izinhlobo zomdlavuza we-penile njenge- Merkel cell carcinoma, i- cell cell carcinoma, ne- melanoma ngokuvamile azivamile. Ku-2018, kwenzeka emadodeni angama-34,000 futhi kwabangela ukufa kwabantu abayi-15,000. 

## Izimpawu
Umdlavuza wePenile ungabonakala njengokubomvu nokucasula epeni ngesikhumba esijiyile ku-glans noma ijwabu langaphakathi noma isilonda, ukukhula kwangaphandle ( exophytic ) noma ukukhula okufana "nomunwe" (papillary). Umdlavuza wePenile ungahambisana nokukhishwa kwe-penile noma ngaphandle kobunzima noma ukushisa noma ukuhayiza ngenkathi uchama (i- dysuria ) nokuphuma kwegazi endodeni.  

## Izici zobungozi

### Izifo

* Ukutheleleka nge-HIV —amadoda ane-HIV anengozi ephindwe kasishiyagalombili yokuthola umdlavuza we-penile kunamadoda angenayo i-HIV. 
* I-human papillomavirus -HPV iyingozi ekuthuthukiseni umdlavuza we-penile.  Ngokusho kweCentre for Disease Control and Prevention (CDC), i-HPV ibhekele cishe i-800 (cishe i-40%) yamacala we-1,570 womdlavuza we-penile otholakala minyaka yonke e-United States.Kunezinhlobo ezingaphezu kuka-120 ze-HPV. 
* Ama-genital warts -Izinsumpa zangasese noma ze-perianal zandisa ubungozi besifo somdlavuza we-penile ongahlaseli cishe izikhathi ezingama-3.7 uma kwenzeka ngaphezulu kweminyaka emibili ngaphambi kosuku lokubhekiswa. Cishe uhhafu wamadoda anomdlavuza we-penile nawo anezinsumpa zangasese, ezibangelwa i-HPV. 

## I-Pathogenesis
Kuphakama umdlavuza Penile kusuka eyandulela izilonda, okuyinto ngokuvamile bathuthuke kusukela ephansi kulibanga ephezulu grade izilonda.Kumdlavuza we-penile ohlobene ne-HPV lokhu kulandelana kanje: 

# I-squplus hyperplasia ;
# I-penile intraepithelial neoplasia esezingeni eliphansi (i-PIN);
# I-PIN esezingeni eliphakeme (i-carcinoma in situ— Isifo sikaBowen, i- Erythroplasia yaseQueyrat ne- bowenoid papulosis (BP));
# I-carcinoma ehlaselayo yomthondo.

Kodwa-ke, kwezinye izimo izilonda ezingezona eze-dysplastic noma ezinesizungu ezingadlulela ngqo zingaba nomdlavuza.Izibonelo zifaka izilonda ze-penile flat (FPL) ne- *condylomata acuminata* . 

Ku- HPV umdlavuza ongemuhle isilonda esandulele kakhulu yi- lichen sclerosus (LS). 

## Ukuxilongwa
I-International Society of Urological Pathology (ISUP) incoma ukusetshenziswa kwe- p16 INK4A immunostain for the diagnostic and classification of HPV-related penile cancer. 

### Ukuhlukaniswa
Cishe ama-95% omdlavuza we-penile angama- squamous cell carcinomas .Zihlukaniswe ngezinhlobo ezilandelayo:

* i-basaloid (4%)
* insumpa (6%)
* i-warty-basaloid exubile (17%)
* i-verrucous (8%)
* i-papillary (7%)
* enye i-SCC ixubile (7%)
* i-sarcomatoid carcinomas (1%)
* akuchaziwe ngenye indlela (49%)

Ezinye izinhlobo ze-carcinomas azivamile futhi zingafaka iseli elincane, i- Merkel cell, i- cell ecacile, i-sebaceous cell noma i- basal cell tumors.Izilonda ezingekho epithelial ezifana nama- melanomas nama- sarcomas zivame kakhulu. 

#### Isiteji
Njengamakhemikhali amaningi amabi, umdlavuza we-penile ungasakazekela kwezinye izitho zomzimba.Ngokuvamile kuyisifo esiyinhloko, indawo yokuqala lapho umdlavuza usakazeka khona emzimbeni.Kancane kancane kuyisifo esibuhlungu sesibili, lapho umdlavuza usabalalele khona endondeni kusuka kwenye indawo.Ukufakwa komdlavuza we-penile kunqunywa ubukhulu bokuhlasela kwesimila, i-nodal metastasis, kanye ne-metastasis ekude. 

Ingxenye ye-T yemihlahlandlela yesiteji ye-AJCC TNM ingeyesimila sokuqala ngokulandelayo: 

* I-TX: Isigaxa sokuqala asikwazi ukuhlolwa.
* I-T0: Akunabufakazi besimila esiyinhloko.
* I-Tis: I-Carcinoma *in situ* .
* I-Ta: I-carcinoma engabonakali ehlaselayo.
* I-T1a: Isimila sihlasela izicubu ezihlangene ezingaphansi kwe-lymph vascular invasion futhi asihlukaniswanga kahle (okungukuthi, ibanga lesi-3-4).
* I-T1b: Isimila sihlasela izicubu ezixhuma ngaphansi kwe-lymph ngokuhlasela kwe-lymph vascular noma sihlukaniswe kabi.
* I-T2: Isimila sihlasela i-corpus spongiosum noma i-cavernosum.
* I-T3: I-tumor ihlasela i-urethra noma i-prostate.
* I-T4: Isimila sihlasela ezinye izakhiwo eziseduze.

I-Anatomic Stage noma Amaqembu Okuqagela umdlavuza we-penile ami kanjena: 

* Isigaba 0 — I-Carcinoma *in situ* .
* Isigaba I-Umdlavuza uhlukaniswe ngokulingene noma kahle futhi uthinta kuphela izicubu ezixhumene ne-subepithelial.
* Isigaba II — Umdlavuza wehlukaniswe kabi, uthinta ama-lymphatics, noma uhlasela i-corpora noma i-urethra.
* Isigaba IIIa — Kunokuhlasela okujulile ethweni lobudoda nakwe-metastasis ku-lymph node eyodwa.
* Isigaba IIIb — Kunokuhlasela okujulile ethweni lobudoda nakwe-metastasis kuma-lymph node amaningi we-inguinal.
* Isigaba IV — Umdlavuza uhlasele ezakhiweni ezincikene nepipi, kufakwa imastastas node ye-pelvic, noma i-metastasis ekude ikhona.

#### Izimila ezinhle ze-HPV
Ukudlanga kwabantu i-papillomavirus kumdlavuza we-penile kuphakeme cishe ngama-40%. I-HPV16 yi-genotype ebaluleke kakhulu ebala cishe izicubu ezingama-63% zama-HPV-positive.Phakathi komdlavuza we-warty / basaloid ukwanda kwe-HPV kungama-70-100% kanti kwezinye izinhlobo kucishe kube ngu-30%. 

## Ukuvimbela

* Imishanguzo ye-HPV efana neGardasil noma iCervarix inganciphisa ubungozi be-HPV futhi, ngenxa yalokho, umdlavuza we-penile.  
* Ukusetshenziswa kwamakhondomu kucatshangwa ukuthi kuyazivikela emdlavuzeni ophathelene ne-HPV penile. 
* Ukuhlanzeka okuhle kwezitho zobulili, okubandakanya ukugeza ipipi, isikhumba, nejwabu nsuku zonke ngamanzi, kungavimbela i-balanitis nomdlavuza we-penile. Noma kunjalo, insipho enezithako ezinzima kufanele igwenywe.
* Ukuphela kokubhema kunganciphisa ingozi yomdlavuza we-penile. 
* Ukusoka ngesikhathi sobuntwana noma ebuntwaneni kungahlinzeka ngokuvikelwa okuyingxenye kumdlavuza we-penile. Ababhali abaningana baphakamise ukusoka njengecebo elingenzeka lokuvikela umdlavuza we-penile;    kodwa-ke, i-American Cancer Society ikhomba ukuthi lesi sifo siyivelakancane futhi iphawula ukuthi i-American Academy of Pediatrics noma iCanada Academy of Pediatrics ayikukhuthazi ukusoka okwenzeka njalo ngaphambi kokubeletha. 
* I-Phimosis ingavinjelwa ngokwenza inhlanzeko efanele nokubuyisa ijwabu njalo. 
* I-Paraphimosis ingavinjelwa ngokungashiyi ijwabu lihoxiswe isikhathi eside. 

## Ukwelashwa
Ukwelashwa komdlavuza we-penile kuzohluka ngokuya ngesigaba somtholampilo sesimila ngesikhathi sokuxilongwa.Kunezinketho eziningi zokwelashwa komdlavuza we-penile, kuya ngesiteji.Kubandakanya ukuhlinzwa, ukwelashwa ngemisebe, ukwelashwa ngamakhemikhali kanye nokwelashwa kwezinto eziphilayo.Ukwelashwa okuvame kakhulu kungenye yezinhlobo ezinhlanu zokuhlinzwa:

* Ukusikwa kwendawo yonke — isisu nezinye izicubu ezinempilo ezizungezile ziyasuswa
* I- microsurgery —ukuhlinzwa okwenziwa ngesibonakhulu kusetshenziselwa ukususa isimila nezicubu ezincane ezinempilo ngangokunokwenzeka
* Ukuhlinzwa nge-Laser —isibani selaser sisetshenziselwa ukushisa noma ukusika amaseli anomdlavuza
* Ukusoka — ijwabu elinomdlavuza liyasuswa
* Ukunqunywa (i- penectomy) —ukususwa kwesitho sangasese ngokuphelele noma ngokuphelele, futhi mhlawumbe nama- lymph node ahambisanayo.

Indima yokwelashwa ngemisebe ifaka phakathi indlela yokulondolozwa komzimba yomdlavuza wepenile osezingeni lokuqala ezikhungweni ezikhethekile.Ngaphezu kwalokho, i-adjuvant therapy isetshenziselwa iziguli ezinesifo esithuthukile endaweni noma ukuphatha izimpawu. 

## Isibikezelo
Isibikezelo singahluka kakhulu ezigulini, kuya ngokuthi sikalwe kuphi.Ngokuvamile, lapho umdlavuza utholakala ngokushesha, kungcono ukubikezelwa.Izinga lokusinda leminyaka emihlanu yonke yazo zonke izigaba zomdlavuza we-penile cishe liyi-50%. 

## I-Epidemiology
Umdlavuza wePenile wumdlavuza ongajwayelekile emazweni athuthukile okwenzeka minyaka yonke okuhluka kusuka ku-0.3 kuye ku-1 kwabangu-100,000 ngonyaka kubalwa cishe i-0.4-0.6% yazo zonke izifo ezimbi. I-annual kwesifo cishe 1 ezingabantu 100,000 e-United States,  e-1 250,000 e-Australia,  kanye 0,82 ngamunye 100,000 eDenmark. E-United Kingdom, abesilisa abangaphansi kwama-500 abatholakala benomdlavuza we-penile minyaka yonke. 

Kodwa-ke, emazweni asathuthuka umdlavuza we-penile uvame kakhulu.Isibonelo, eParaguay, e- Uruguay, e- Uganda naseBrazil izehlakalo eziyi-4.2, 4.4, 2.8 no-1.5-3.7 ku-100,000 ngamunye, ngokulandelana.  Kwamanye amazwe aseNingizimu Melika, e-Afrika, nase-Asia, lolu hlobo lomdlavuza lwenza kufinyelela ku-10% wezifo ezibulalayo emadodeni. 

Ingozi yokuphila konke ilinganiselwa ku-1 kwabangu-1,437 e-United States naku-1 kwabangu-1,694 eDenmark. 

## Izinkomba