Chirwere chemukombomu ndicho chinonyanya kuipa chakaumbwa chechikadzi yekuberekwa kwenyika yose; iye ndiye wechipiri kupfuura vose kuvakadzi mushure mekenza yemazamu. Inowanikwa kakawanda mumadzimai kubva kune makore makumi mashanu kusvika kune makumi mashanu, asi inogonawo kuitika pazera remakore. Nharaunda yacho yakakwirira munyika dzichiri kusimukira. Somuenzaniso, muIndia, chirwere chemukondombera ndicho chinonyanya kukonzera rufu pakati pevakadzi vane makore 35 kusvika ku45. MuRussia, kuwedzera kwenharaunda inenge inenge 11 mamiriyoni evanhu 100 000. Kuongororwa kwekenza yemucheche - iyo nyaya yenyaya yacho.
Maitiro ekuderedza
Kune kusiyana kwezviitiko zvekenza yemukomana mukati mezvikamu zvakasiyana-siyana zvehupfumi mune imwe nyika. Somuenzaniso, muUnited States, vakadzi vemazuva makumi maviri vanogona kutambura nemukenza wechibereki kupfuura vakadzi vachena, asi izvi zvinoratidza zviratidzo zvehupenyu hwavo hwakaderera uye vasingakwanisi kuwana hutano hwehutano kunze kwehutano hwemadzinza. Mune zvidzidzo zvakaitwa kuScotland, zviitiko zvakafanana zvakawanikwa: pakati pevakadzi vane mari shoma, pangozi yemukenza wechibereki yakawedzera katatu kana ichienzaniswa nevakadzi vakawanda vane hutano.
Mhando dzechirwere chekervical
Squamous cell carcinoma ndiyo inowanzojairika yemukenza wechibereki, kuverenga kwemapurisa anopfuura 90%. Inogadzirisa masero epa epithelium yakapoteredza mubereki. Zvisinei, panguva ino, adenocarcinoma (tumorori inobva epithelium yakavanzika) iri kuwedzera. Icho chikamu chechirwere, uye kwete iyo yakagadzirwa nemagetsi echirwere, iyo inosarudza mugumisiro wechirwere chechirwere.
Kuongorora Kukosha
Munyika dzakabudirira, chiitiko che squamous cell carcinoma chechirvix chakaramba mumakore achangobva kupfuura, zvichienderana nekuonekwa kwokutanga munguva yekuongorora uye kubudirira kwehutano hwezvakaitika. Kuongorora hakusi kushanda pakuona adenocarcinoma; zvichida izvi ndeimwe yezvikonzero zvekuwedzera kwechiitiko chezviitiko zvechirwere ichi. Iyo hutachiona hwechibereko chechibereko chinogona kuonekwa panguva yekuongorora gynecological. Izvo kare kare kenza inoonekwa, iyo yakakwirira kuponeswa kwemu murwere. Zvikonzero zvekusimudzirwa kwekenza yemukondombera hazvina kunyatsojekeswa zvachose, zvisinei, ukama hwayo nepapillomavirus yevanhu (HPV) yakatsigirwa zvakavimbika. Kune marudzi anopfuura makumi manomwe anozivikanwa ehutachiona. Mhando 16,18, 31 uye 33 dziri oncogenic (inogona kukonzera kusvibisa kushandiswa kwesero) uye inobatanidzwa nekukura kwekenza yemukomana.
Basa repabonde
Kutanga kwekutanga kwepabonde, uye kuchinja kwevanhu vanoita zvepabonde kakawanda kunowedzera mukana wekuva nekenza yemukomana munguva yemberi. Pa electron microscopy, chirwere chepilloma yevanhu chinoratidza maitiro. Mimwe yemhando dzayo inobatanidzwa nekenza yemukomana. Mukuwedzera, huwandu hwake huri hwakanyanya kana mudiwa wake ane hutano hwepabonde nevamwe vakadzi. Zvinotendwa kuti kusvuta kunobatanidzawo nehuwandu hwekuwedzera kenza yemukomana.
Immunosuppression
Vakadzi vane hutachiwana hwekuzvidzivirira vane kambani yakanyanya yekugadzira preinvasive cervical carcinoma (cervical intraepithelial neoplasia - CIN). Varwere vanowana mishonga inokonzerwa nemishonga inokonzerwa nemishonga, somuenzaniso, nokuda kwetsvo yokugadziriswa, inowedzera ngozi. Utachiona hweHIV, huchitungamirirwa nekudzingwa kwemuviri wechirwere chemuviri, unowedzerawo mikana yekuvandudza chirwere chacho. Zvinonyatsozivikanwa kuti chirwere chemucheche chinotanga kuburikidza nekuzivikanwa kusati kwaitika (precancerous) kuchinja mu mucosa. Panguva iyi, pathological foci mune epithelium yepamusoro yemukati mhenyu ine nzvimbo yakananga panzvimbo yechinzvimbo chekushanduka kwe ectocervix (kubatana kwechikadzi chechibereko chechibereko chemuviri) muchechi yengarava. Kuchinja uku kunogona kushandurwa kuva vane kenza mukushaya kurapa.
Kutanga kuziva
Kuchinja kwepakutanga mumushonga wepervical epithelium uye matanho okutanga ekenza, izvo zvinowanzoitika zvisingaenzaniswi, zvinoratidzwa panguva yekuongorora smear kubva mumuviri wechidiki panguva yekuongorora. Izvozvo zvinokonzerwa nekervical epithelial cells dzinotumirwa ku-cytological study (cell structure analysis). Pamusoro pekugadzirira kwechirevo chake, mapoka emasero emuchechi epithelium anooneka. Panguva yekuongorora, masero ose anoongororwa nekuchinja kwehutano. Kana zviitiko zvechirwere chegenderedzwa yekuongorora smear zvinowanikwa, murwere anotumidzwa kuti colposcopy.
Colposcopy
Colposcopy inoratidzika kuongororwa kwechirwere uye chikadzi chepamusoro nechigadziriso chekupedzisira. Izvo zvinoshandiswa zvekorojekiti zvekolposcopy zvinokubvumira kuti uongorore chibereko chechivharo pasi pekuwedzera uye usabvisa kuvapo kwezvinhu zvinoratidzika, zverosi kana zvionda zvepamusoro. Panguva yekudzidza, zvinobvira kubudisa biopsies yemaviri yekuongorora. Nekubatsirwa kwecolposcope, unogona kuvhenekera chibereko chemuviri uye unotarisa pasi pasi nekukudzwa kuitira kuti uone kuti kenza inoshanduka pakutanga. Kuti uone kuwanda kwehutachiona huripo, bimanual (maviri-ruoko) zvepabonde kana rectal kuongorora kunoitwa. Mune zvimwe zviitiko, kutarisa ukuru uye kupararira kwehutano hwehutachiona, kuongorora kunoitwa pasi peanesthesia. Kuenzaniswa kwekenza yemukomana kunoratidza kupararira kwemarara. Kusarudza nzvimbo yekenza kunokosha pakusarudza nzira yekurapa uye kufungidzira. Kune zvikamu zvina (MV), rimwe nerimwe rayo rakakamurwa kuva zvikamu zvitanhatu a uye b. Matanho a uye b akaparadzaniswa kuva 1 ne2. Maererano nehuwandu hweFIGO (International Federation of Obstetricians naGynecologists), danho 0 rinofananidzwa nekushandura kwakanyanyisa, uye IVb danho ndiro rakaoma zvikuru. Nhamba yekubatanidzwa kwepelvic uye para-aortic (yakapoteredza aorta) lymph nodes inowedzera nekuwedzera mumutambo.
Preinvasive carcinoma
Kanzera inopararira, inogumira kumuromo wechibereko. Kanzera inopararira, inongororwa chete nekunyora microscopy. Kanzera inokura maruva emuviri wechiremera chemafuro asingasviki 5 mm uye nehupamhi hwusingaverenge 7 mm.Kenza inokonzera stroma kusvika yakadzika kupfuura 3 mm uye upamhi hunopfuura 7 mm. Kudzika kwekumera mu stroma kubva 3 kusvika 5 mm uye upamhi kwete kupfuura 7 mm. Makondombera anooneka muchipatara mukati memukati kana chiono chinonzi microscopically chikuru chinopfuura chigamba. Chirwere chechipatara chinenge chisina kupfuura masendimita 4. Chirwere chinoratidzika chechipatara chinopfuura 4 cm. Kanzera inopararira kunze kwechirwere kumukadzi kana kumativi akabatana. Kanzira inopararira kunze kwechirwere kusvika kumakamuri maviri ezvitatu zvemukadzi. Kanzira yakapararira kunze kwechirwere ichi kumativi akabatana. Kanzira inopararira kumadziro emadziro emapapiro kana kumucheto wechitatu wemudzimai. Chirwere ichi chinokanganisa chikamu chechitatu chemukadzi, asi hachirevi kumadziro emadziro emapuranga. Kanzira inopararira kumadziro emadziro emapapiro kana ureter. Kanzira inopararira mberi kwemapapiro kana kubatanidzwa kwechidzitiro uye / kana rectum. Kanzira ine kupararira kune nhengo dzomukati
Cervical
Preinvasive cervical carcinoma inoenderana nechikamu chakaoma chechibereki intraepithelial neoplasia (CIN). CIN inotsanangurwa maererano nekudzika kwekupararira kwemararamiro emupendelium, uyewo nehuwandu hwekusiyanisa kwemarara masero:
• CIN I - shanduko haitoreri kupfuura 1/3 yehupamhi hwe epithelial layer;
• CIN II - shanduko inotora 1/2 kuwanda kwe epithelial layer;
• CIN III - inokanganisa kuwanda kwe epithelium.
Apo masero asina kukwana anomera bhudziro remberi ye epithelium, taura nezvekuchinja kwechirwere chekenza inoparadza. Mu20% yevarwere vose vane CIN III, musina kubatwa kwemakore gumi anotevera, kenza yemukomana inowedzera.