Types/breast/patient/pregnancy-breast-treatment-pdq

Chithandizo cha Khansa ya M'mawere Munthawi Ya Mimba

Zambiri Zokhudza Chithandizo cha Khansa ya M'mawere Mimba

MFUNDO ZOFUNIKA

• Khansa ya m'mawere ndimatenda momwe ma cell owopsa (khansa) amapangika m'matumba a m'mawere.

• Nthawi zina khansa ya m'mawere imapezeka mwa amayi omwe ali ndi pakati kapena angobereka kumene.

• Zizindikiro za khansa ya m'mawere zimaphatikizapo chotupa kapena kusintha kwa m'mawere.

• Kungakhale kovuta kuzindikira (kupeza) khansa ya m'mawere kumayambiriro kwa amayi apakati kapena oyamwitsa.

• Mayeso am'mawere ayenera kukhala gawo la chisamaliro chobereka komanso chobereka.

• Kuyesa komwe kumayesa mawere kumagwiritsidwa ntchito kuzindikira (kupeza) ndikuzindikira khansa ya m'mawere.

• Ngati khansa ipezeka, amayesedwa kuti aphunzire za maselo a khansa.

• Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Khansa ya m'mawere ndimatenda momwe ma cell owopsa (khansa) amapangika m'matumba a m'mawere.

Chifuwacho chimapangidwa ndi lobes ndi ducts. Chifuwa chilichonse chili ndi magawo 15 mpaka 20 otchedwa lobes. Lobe iliyonse ili ndi zigawo zing'onozing'ono zambiri zotchedwa lobules. Ma Lobules amatha ndi mababu ang'onoang'ono angapo omwe amatha kupanga mkaka. Maloboti, lobulu, ndi mababu amalumikizidwa ndi machubu owonda otchedwa ducts.

Anatomy ya bere lachikazi. Nipple ndi areola amawonetsedwa kunja kwa bere. Ma lymph node, lobes, lobules, ducts, ndi mbali zina zamkati mwa bere zimawonetsedwanso.

Chifuwa chilichonse chimakhalanso ndi mitsempha yamagazi ndi zotengera zamitsempha. Mitsempha ya mitsempha imakhala ndi madzi opanda mtundu, amadzi otchedwa lymph. Zombo zamagulu zimanyamula ma lymph pakati pa ma lymph node. Ma lymph lymph ndi ang'onoang'ono, mawonekedwe a nyemba omwe amapezeka mthupi lonse. Amasefa ma lymph ndikusunga maselo oyera amwazi omwe amathandiza kulimbana ndi matenda ndi matenda. Magulu a ma lymph node amapezeka pafupi ndi bere mu axilla (pansi pa mkono), pamwamba pa kolala, komanso pachifuwa.

Nthawi zina khansa ya m'mawere imapezeka mwa amayi omwe ali ndi pakati kapena angobereka kumene.

Khansa ya m'mawere imachitika kamodzi pa mimba 3,000 zilizonse. Amapezeka nthawi zambiri mwa azimayi azaka 32 mpaka 38. Chifukwa amayi ambiri akusankha kuchedwa kukhala ndi ana, zikuwoneka kuti kuchuluka kwa odwala khansa ya m'mawere nthawi yomwe ali ndi pakati kudzawonjezeka.

Zizindikiro za khansa ya m'mawere zimaphatikizapo chotupa kapena kusintha kwa m'mawere.

Zizindikiro izi ndi zina zimatha chifukwa cha khansa ya m'mawere kapena zina. Funsani dokotala ngati muli ndi izi:

• Kutupa kapena kukhathamira mkati kapena pafupi ndi bere kapena malo okhala ndi mikono.

• Kusintha kukula kapena mawonekedwe a bere.

• Kukhazikika pakhungu la m'mawere.

• Nipple anatembenukira mkati mwa bere.

• Zamadzimadzi, kupatula mkaka wa m'mawere, kuchokera pamabele, makamaka ngati ali ndimagazi.

• Khungu lofiira, lofiira, kapena lotupa pachifuwa, nipple, kapena areola (mdima wakhungu mozungulira nsonga).

• Zofooka m'chifuwa zomwe zimawoneka ngati khungu la lalanje, lotchedwa peau d'orange.

Kungakhale kovuta kuzindikira (kupeza) khansa ya m'mawere kumayambiriro kwa amayi apakati kapena oyamwitsa.

Mabere nthawi zambiri amakula, ofewa, kapena otupa mwa amayi omwe ali ndi pakati, akuyamwitsa, kapena angobereka kumene. Izi zimachitika chifukwa cha kusintha kwa mahomoni komwe kumachitika panthawi yapakati. Kusintha kumeneku kumatha kupanga zotupa zazing'ono zovuta kuzizindikira. Mabere amathanso kukula. Zimakhala zovuta kudziwa khansa ya m'mawere mwa amayi omwe ali ndi mabere owirira omwe amagwiritsa ntchito mammography. Chifukwa kusintha kwa mawere kumeneku kumachedwetsa kuzindikira, khansa ya m'mawere imapezeka nthawi zambiri mwa amayiwa.

Mayeso am'mawere ayenera kukhala gawo la chisamaliro chobereka komanso chobereka.

Kuti azindikire khansa ya m'mawere, amayi apakati ndi oyamwitsa ayenera kudzifufuza okha mabere. Amayi ayeneranso kulandira mayeso a m'mawere akamayesedwa asanabadwe komanso atabadwa. Lankhulani ndi dokotala ngati muwona zosintha m'mabere anu zomwe simukuyembekezera kapena zomwe zikukudetsani nkhawa.

Kuyesa komwe kumayesa mawere kumagwiritsidwa ntchito kuzindikira (kupeza) ndikuzindikira khansa ya m'mawere.

Mayeso ndi njira zotsatirazi zitha kugwiritsidwa ntchito:

• Kuwunika kwakuthupi ndi mbiri: Kuyesedwa kwa thupi kuti muwone zizindikiritso zaumoyo, kuphatikiza kuyang'ana ngati pali matenda, monga zotupa kapena china chilichonse chomwe chikuwoneka chachilendo. Mbiri yokhudzana ndi thanzi la wodwalayo komanso matenda am'mbuyomu komanso chithandizo chamankhwala adzachitidwanso.

• Clinical breast test (CBE): Kuyesedwa kwa bere ndi dokotala kapena katswiri wina wazachipatala. Dokotala amamva mosamala mabere ndi pansi pa mikono chifukwa cha zotumphukira kapena china chilichonse chomwe chimawoneka chachilendo.

• Kuyesa kwa Ultrasound: Njira yomwe mafunde amawu amphamvu (ultrasound) amachotsedwa pamatumba kapena ziwalo zamkati ndikupanga mawonekedwe. Zolembawo amapanga chithunzi cha matupi amthupi otchedwa sonogram. Chithunzicho chimatha kusindikizidwa kuti chidzayang'anenso mtsogolo.

• Mammogram: X-ray ya m'mawere. Mammogram ikhoza kuchitidwa popanda chiopsezo chachikulu kwa mwana wosabadwa. Mammograms mwa amayi apakati amatha kuwoneka opanda chiyembekezo ngakhale khansa ilipo.

Zolemba pamanja. Chifuwa chimakanikizidwa pakati pa mbale ziwiri. X-ray amagwiritsidwa ntchito kujambula zithunzi za minofu ya m'mawere.

• Biopsy: Kuchotsa kwa maselo kapena ziphuphu kotero kuti amatha kuwonedwa ndi microscope ndi wodwalayo kuti aone ngati ali ndi khansa. Ngati chotupa cha m'mawere chikupezeka, kafukufuku amatha kuchitidwa.

Pali mitundu itatu yamatenda a m'mawere:

• Chisankho chodabwitsa: Kuchotsa mtanda wonse wa minofu.

• Core biopsy: Kuchotsa minofu pogwiritsa ntchito singano yayikulu.

• Chotsatira cha singano yabwino (FNA) biopsy: Kuchotsa minofu kapena madzi, pogwiritsa ntchito singano yopyapyala.

Ngati khansa ipezeka, amayesedwa kuti aphunzire za maselo a khansa.

Zosankha zamankhwala abwino kwambiri zimachokera ku zotsatira za mayeso awa komanso msinkhu wa mwana wosabadwa. Mayesowa amapereka chidziwitso cha:

• Khansara imatha kukula msanga.

• Ndizotheka bwanji kuti khansara ifalikire mbali zina za thupi.

• Mankhwala ena angagwire ntchito bwino.

• Khansa imatha kubwereranso (kubwerera).

Mayeso atha kuphatikizira izi:

• Mayeso a Estrogen ndi progesterone receptor: Kuyesa kuyeza kuchuluka kwa zotengera za estrogen ndi progesterone (mahomoni) mumisempha ya khansa. Ngati pali zowonjezera za estrogen kapena progesterone kuposa zachilendo, khansara amatchedwa estrogen receptor positive kapena progesterone receptor positive. Khansara yamtunduwu imatha kukula msanga. Zotsatira za kuyezetsa zikuwonetsa ngati mankhwala oletsa estrogen ndi progesterone omwe amaperekedwa atabadwa mwana angalepheretse khansa kukula.

• Chiyeso cha epidermal kukula kwa mtundu wa 2 receptor (HER2 / neu): Kuyesa kwa labotale kuti mupeze kuchuluka kwa majini a HER2 / neu komanso kuchuluka kwa mapuloteni a HER2 / neu omwe amapangidwa munthupi. Ngati pali mitundu yambiri ya HER2 / neu kapena kuchuluka kwa mapuloteni a HER2 / neu kuposa mwakale, khansara amatchedwa HER2 / neu positive. Khansara yamtunduwu imatha kukula msanga ndipo imatha kufalikira mbali zina za thupi. Khansara imatha kuchiritsidwa ndi mankhwala omwe amalimbana ndi HER2 / neu protein, monga trastuzumab ndi pertuzumab, mwana atabadwa.

• Mayeso a Multigene: Kuyesa komwe zitsanzo zamatenda zimawerengedwa kuti ziwone momwe majini ambiri amagwirira ntchito nthawi imodzi. Mayeserowa atha kuthandiza kudziwitsa ngati khansa idzafalikira mbali zina za thupi kapena kubwereranso.

• Oncotype DX: Kuyesaku kumathandizira kudziwa ngati khansa yoyamba ya m'mawere I kapena gawo II lomwe ndi estrogen receptor positive komanso node-hasi lidzafalikira mbali zina za thupi. Ngati chiopsezo chofalikira cha khansa nchachikulu, chemotherapy itha kuperekedwa kuti ichepetse ngozi.

• MammaPrint: Kuyesa kwa labotale komwe zochitika za majini osiyanasiyana 70 zimayang'aniridwa mu minofu ya khansa ya m'mawere ya azimayi omwe ali ndi khansa ya m'mawere yoyambilira yomwe siyinafalikire ku ma lymph node kapena yafalikira ku ma lymph node atatu kapena ochepa. Magwiridwe antchito amtunduwu amathandizira kudziwa ngati khansa ya m'mawere idzafalikira mbali zina za thupi kapena kubwerera. Ngati kuyesaku kukuwonetsa kuti chiwopsezo choti khansa ifalikire kapena kubwerera ndi chachikulu, chemotherapy itha kuperekedwa kuti ichepetse ngozi.

Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Kulosera (mwayi wochira) ndi njira zamankhwala zimadalira izi:

• Gawo la khansa (kukula kwa chotupacho komanso ngati chili m'mawere kokha kapena chafalikira mbali zina za thupi).

• Mtundu wa khansa ya m'mawere.

• Zaka za mwana wosabadwa.

• Kaya pali zizindikiro kapena zizindikiro.

• Thanzi labwino la wodwalayo.

Magawo a Khansa ya m'mawere

MFUNDO ZOFUNIKA

• Khansa ya m'mawere itapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mkati mwa bere kapena mbali zina za thupi.

• Pali njira zitatu zomwe khansa imafalikira mthupi.

• Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

• Mu khansa ya m'mawere, gawo limadalira kukula ndi malo omwe ali ndi chotupacho, kufalikira kwa khansa kumalo am'mimba oyandikira kapena ziwalo zina za thupi, kalasi yamatenda, komanso ngati pali ma biomarker ena.

• Njira ya TNM imagwiritsidwa ntchito pofotokoza kukula kwa chotupa choyambirira komanso kufalikira kwa khansa kumatope oyandikira kapena ziwalo zina za thupi.

• Chotupa (T). Kukula ndi malo a chotupacho.

• Lymph mfundo (N). Kukula ndi malo am'mimba momwe khansa yafalikira.

• Metastasis (M). Kufalikira kwa khansa kumadera ena a thupi.

• Njira yoyikirayo imagwiritsidwa ntchito pofotokozera momwe chotupa cha m'mawere chingakule ndikufalikira mofulumira.

• Kuyesa kwa biomarker kumagwiritsidwa ntchito kuti mudziwe ngati maselo a khansa ya m'mawere ali ndi zolandilira.

• Ndondomeko ya TNM, dongosolo loyika, komanso mawonekedwe a biomarker amaphatikizidwa kuti apeze gawo la khansa ya m'mawere.

• Lankhulani ndi dokotala wanu kuti mudziwe momwe khansa yanu ya m'mawere ilili komanso momwe amagwiritsidwira ntchito pokonzekera chithandizo chabwino kwambiri kwa inu.

Khansa ya m'mawere itapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mkati mwa bere kapena mbali zina za thupi.

Njira yomwe imagwiritsidwa ntchito pofufuza ngati khansara yafalikira mkati mwa bere kapena mbali zina za thupi imatchedwa staging. Zomwe amapeza kuchokera pakukonzekera zimatsimikizira gawo la matendawa. Ndikofunikira kudziwa siteji kuti mukonzekere chithandizo.

Njira zina zitha kupatsira mwana wosabadwayo ma radiation kapena utoto wowopsa. Njirazi zimachitika pokhapokha ngati kuli kofunikira. Zinthu zina zitha kuchitidwa kuti mwana wosabadwa awonongeke pang'ono, monga kugwiritsa ntchito chikopa chotsegulira pamimba.

Mayesero ndi njira zotsatirazi zitha kugwiritsidwa ntchito poyambitsa khansa ya m'mawere mukakhala ndi pakati:

• X-ray pachifuwa : X-ray ya ziwalo ndi mafupa mkati mwa chifuwa. X-ray ndi mtundu wa mphamvu yamphamvu yomwe imatha kupyola thupi ndikupita mufilimu, ndikupanga chithunzi cha madera omwe ali mthupi.

• Kujambula mafupa: Njira yowunika ngati pali magawo omwe amagawa mwachangu, monga maselo a khansa, m'mafupa. Katundu wocheperako kwambiri wa jakisoni amalowetsedwa mumtsempha ndikuyenda m'magazi. Zinthu zowulutsa nyukiliya zimasonkhanitsa m'mafupa omwe ali ndi khansa ndipo amadziwika ndi sikani.

• Kuyesa kwa Ultrasound: Njira yomwe mafunde amawu amphamvu (ultrasound) amachotsedwa pamatumba kapena ziwalo zamkati, monga chiwindi, ndikupanga mawonekedwe. Zolembawo amapanga chithunzi cha matupi amthupi otchedwa sonogram. Chithunzicho chimatha kusindikizidwa kuti chiwonedwe pambuyo pake.

• MRI (magnetic resonance imaging): Njira yomwe imagwiritsa ntchito maginito, mafunde a wailesi, ndi kompyuta kuti ipange zithunzi zingapo za magawo amkati mwa thupi, monga ubongo. Njirayi imatchedwanso nuclear magnetic resonance imaging (NMRI).

Pali njira zitatu zomwe khansa imafalikira mthupi.

Khansa imatha kufalikira kudzera mu minofu, ma lymph system, ndi magazi:

• Minofu. Khansara imafalikira kuchokera pomwe idayamba ndikukula kupita kumadera oyandikana nawo.

• Lymph dongosolo. Khansara imafalikira kuchokera pomwe idayamba polowa m'mitsempha. Khansara imadutsa m'mitsempha yamafuta kupita mbali zina za thupi.

• Magazi. Khansara imafalikira kuchokera pomwe idayamba ndikulowa m'magazi. Khansara imadutsa m'mitsempha yamagazi kupita mbali zina za thupi.

Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

Khansa ikafalikira mbali ina ya thupi, imatchedwa metastasis. Maselo a khansa amachoka pomwe adayamba (chotupa choyambirira) ndikuyenda mumitsempha kapena magazi.

• Lymph dongosolo. Khansara imalowa mumitsempha, imadutsa m'mitsempha yamafuta, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

• Magazi. Khansara imalowa m'magazi, imadutsa m'mitsempha yamagazi, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

Chotupa cha metastatic ndi khansa yofanana ndi chotupa chachikulu. Mwachitsanzo, ngati khansa ya m'mawere imafalikira mpaka fupa, maselo a khansa omwe ali m'mafupawo ndi maselo a khansa ya m'mawere. Matendawa ndi khansa ya m'mawere, osati khansa ya m'mafupa.

Mu khansa ya m'mawere, gawo limadalira kukula ndi malo omwe ali ndi chotupacho, kufalikira kwa khansa kumalo am'mimba oyandikira kapena ziwalo zina za thupi, kalasi yamatenda, komanso ngati pali ma biomarker ena.

Kuti mukonzekere chithandizo chabwino kwambiri ndikumvetsetsa momwe mungadziwire, ndikofunikira kudziwa gawo la khansa ya m'mawere.

Pali mitundu itatu yamagulu a khansa ya m'mawere:

• Clinical Prognostic Stage imagwiritsidwa ntchito koyamba kupangira gawo la odwala onse kutengera mbiri yazaumoyo, kuyesa thupi, kuyerekezera kulingalira (ngati kwachitika), ndi ma biopsies. The Clinical Prognostic Stage ikufotokozedwa ndi dongosolo la TNM, grade grade, ndi biomarker status (ER, PR, HER2). Pazipatala, mammography kapena ultrasound amagwiritsidwa ntchito poyang'ana ma lymph node ngati ali ndi khansa.

• Gawo lodziwitsa za matendawa limagwiritsidwa ntchito kwa odwala omwe akuchitidwa opaleshoni ngati chithandizo chawo choyamba. Gawo la Pathological Prognostic Stage limakhazikitsidwa pazidziwitso zonse zamankhwala, momwe zimakhalira ndi biomarker, komanso zotsatira zoyesa zasayansi kuchokera kumatumba am'mimba ndi ma lymph node omwe amachotsedwa pakuchita opaleshoni.

• Gawo la Anatomic limatengera kukula ndi kufalikira kwa khansa monga momwe tafotokozera ndi dongosolo la TNM. Anatomic Stage imagwiritsidwa ntchito m'malo ena padziko lapansi komwe kuyesa kwa biomarker sikupezeka. Sigwiritsidwe ntchito ku United States.

Njira ya TNM imagwiritsidwa ntchito pofotokoza kukula kwa chotupa choyambirira komanso kufalikira kwa khansa kumatope oyandikira kapena ziwalo zina za thupi.

Kwa khansa ya m'mawere, dongosolo la TNM limafotokoza chotupacho motere:

Chotupa (T). Kukula ndi malo a chotupacho.

Makulidwe a zotupa nthawi zambiri amayesedwa mu milimita (mm) kapena masentimita. Zinthu zomwe zingagwiritsidwe ntchito posonyeza kukula kwa chotupa mu mm ndi monga: cholembera chakuthwa (1 mm), cholembera chatsopano (2 mm), chofufutira pamwamba pensulo (5 mm), nsawawa (10 mm), a chiponde (20 mm), ndi mandimu (50 mm).

• TX: Chotupa choyambirira sichingayesedwe.

• T0: Palibe chizindikiro cha chotupa choyambirira m'mawere.

• Matenda: Carcinoma in situ. Pali mitundu iwiri ya bere carcinoma in situ:

• Tis (DCIS): DCIS ndi momwe ma cell osazolowereka amapezeka m'mbali mwa bere. Maselo achilendo sanafalikire kunja kwa ngalandeyo kumatenda ena a m'mawere. Nthawi zina, DCIS imatha kukhala khansa ya m'mawere yomwe imatha kufalikira kumatenda ena. Pakadali pano, palibe njira yodziwira kuti ndi zilonda ziti zomwe zitha kuwononga.

• Tis (Matenda a Paget): Matenda a paget a nipple ndimavuto omwe khungu lachilendo limapezeka m'maselo a khungu ndipo amatha kufalikira ku areola. Sichikonzedwa molingana ndi dongosolo la TNM. Ngati matenda a Paget NDI khansa ya m'mawere yomwe ilipo, njira ya TNM imagwiritsidwa ntchito poyambitsa khansa ya m'mawere.

• T1: Chotupacho chili ndi mamilimita 20 kapena ochepera. Pali magawo anayi a chotupa cha T1 kutengera kukula kwa chotupacho:

• T1mi: chotupacho ndi 1 millimeter kapena ocheperako.

• T1a: chotupacho ndi chachikulu kuposa 1 millimeter koma osaposa 5 millimeter.

• T1b: chotupacho chimakhala chachikulu kuposa mamilimita 5 koma osaposa mamilimita 10.

• T1c: chotupacho ndi chachikulu kuposa mamilimita 10 koma osaposa 20 millimeters.

• T2: Chotupacho chimakhala chachikulu kuposa mamilimita 20 koma osaposa mamilimita 50.

• T3: Chotupacho ndi chachikulu kuposa mamilimita 50.

• T4: Chotupacho chimafotokozedwa kuti ndi chimodzi mwa izi:

• T4a: chotupacho chakula mpaka kukhoma pachifuwa.

• T4b: chotupacho chakula mpaka pakhungu — chilonda chakhazikika pamwamba pakhungu pa bere, timinatumba tating'onoting'ono tomwe timapanga pachifuwa chimodzimodzi ndi chotupa choyambirira, ndipo / kapena pali kutupa kwa khungu pabere .

• T4c: chotupacho chakula mpaka kukhoma pachifuwa komanso pakhungu.

• T4d: Khansa ya m'mawere yotupa-gawo limodzi mwa magawo atatu kapena kuposerapo pakhungu pa bere ndi lofiira komanso lotupa (lotchedwa peau d'orange).

Lymph mfundo (N). Kukula ndi malo am'mimba momwe khansa yafalikira.

Pamene ma lymph node amachotsedwa ndi opareshoni ndikuphunziridwa ndi microscope ndi katswiri wamatenda, njira yamagwiritsidwe ntchito imagwiritsa ntchito kufotokozera ma lymph node. Magawo am'magazi amfotokozedwe pansipa.

• NX: Ma lymph node sangayesedwe.

• N0: Palibe chizindikiro cha khansa m'matumba am'mimba, kapena timagulu tating'onoting'ono ta maselo a khansa osaposa mamilimita 0,2 m'matumba am'mimba.

• N1: Khansa imanenedwa kuti ndi imodzi mwazinthu izi:

• N1mi: khansara yafalikira ku axillary (armpit area) lymph node ndipo ndi yayikulu kuposa mamilimita 0.2 koma osaposa 2 millimeters.

• N1a: khansara yafalikira mpaka 1 mpaka 3 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters.

• N1b: khansa yafalikira ku ma lymph node pafupi ndi chifuwa cha bere mbali yomweyo ya thupi ngati chotupa choyambirira, ndipo khansayo ndi yayikulu kuposa milimita 0.2 ndipo imapezeka ndi sentinel lymph node biopsy. Khansa sichipezeka mu ma axillary lymph node.

• N1c: khansara yafalikira mpaka 1 mpaka 3 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters. Khansara imapezekanso ndi sentinel lymph node biopsy mu ma lymph node pafupi ndi chifuwa cha bere mbali yomweyo ya thupi ngati chotupa choyambirira.

• N2: Khansa imanenedwa kuti ndi imodzi mwazinthu izi:

• N2a: khansara yafalikira ku ma 4 mpaka 9 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters.

• N2b: khansa yafalikira ku ma lymph node pafupi ndi chifuwa cha m'mawere ndipo khansa imapezeka poyesa kujambula. Khansa sichipezeka m'mazira am'mimba mwa sentinel lymph node biopsy kapena lymph node dissection.

• N3: Khansa imanenedwa kuti ndi imodzi mwazinthu izi:

• N3a: khansara yafalikira mpaka ma 10 kapena kuposa ma axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters, kapena khansa yafalikira ku ma lymph node pansi pa kolala.

• N3b: khansara yafalikira mpaka 1 mpaka 9 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters. Khansa yafalikiranso ku ma lymph node pafupi ndi chifuwa cha m'mawere ndipo khansa imapezeka poyesa kujambula;

kapena

khansara yafalikira ku ma 4 mpaka 9 axillary lymph node ndi khansa mulimodzi mwamatenda akulu kuposa 2 millimeter. Khansara yafalikiranso ku ma lymph node pafupi ndi chifuwa cha bere mbali yomweyo ya thupi ngati chotupa choyambirira, ndipo khansayo ndi yayikulu kuposa milimita 0.2 ndipo imapezeka ndi sentinel lymph node biopsy.

• N3c: khansa yafalikira ku ma lymph node pamwamba pa kolala mbali yomweyo ya thupi ngati chotupa choyambirira.

Ma lymph node akafufuzidwa pogwiritsa ntchito mammography kapena ultrasound, amatchedwa staging staging. Magawo azam'mimba samatchulidwa pano.

Metastasis (M). Kufalikira kwa khansa kumadera ena a thupi.

• M0: Palibe chisonyezo chakuti khansara yafalikira mbali zina za thupi.

• M1: Khansa yafalikira mbali zina za thupi, nthawi zambiri mafupa, mapapo, chiwindi, kapena ubongo. Ngati khansara yafalikira kumatenda akutali, khansa yomwe imapezeka m'mimba imaposa mamilimita 0,2. Khansara amatchedwa khansa ya m'mawere ya metastatic.

Njira yoyikirayo imagwiritsidwa ntchito pofotokozera momwe chotupa cha m'mawere chingakule ndikufalikira mofulumira.

Dongosolo loyikiramo limafotokoza chotupa potengera momwe ma cell a khansa ndi minofu zimawonekera pansi pa microscope komanso momwe ma cell a khansa amatha kukula ndikufalikira mwachangu. Maselo a khansa otsika kwambiri amawoneka ngati maselo abwinobwino ndipo amakula ndikufalikira pang'onopang'ono kuposa ma cell apamwamba a khansa. Pofotokoza momwe maselo a khansa ndi minofu yake ilili yovuta, wodwalayo adzaunika zinthu zitatu izi:

• Kuchuluka kwa chotupacho kumakhala ndi timitsempha ta m'mawere.

• Kukula ndi mawonekedwe a mtima m'maselo otupa.

• Maselo akugawana omwe alipo, omwe ndi muyeso wa momwe ma chotupa a chotupa amakulira ndikugawana mwachangu.

Pa chilichonse, wodwalayo amapatsa 1 mpaka 3; mphambu wa "1" amatanthauza kuti maselo ndi zotupa zimawoneka ngati maselo abwinobwino ndi minofu, ndipo mphambu wa "3" amatanthauza kuti ma cell ndi minofu zimawoneka zachilendo kwambiri. Zotsatira zachigawo chilichonse zimaphatikizidwa kuti mupeze zigoli zonse pakati pa 3 ndi 9.

Sukulu zitatu ndizotheka:

• Chiwerengero chonse cha 3 mpaka 5: G1 (Gulu lotsika kapena kusiyanitsidwa bwino).

• Chiwerengero chonse cha 6 mpaka 7: G2 (Gulu lapakatikati kapena kusiyanitsidwa pang'ono).

• Chiwerengero chonse cha 8 mpaka 9: G3 (Gulu lapamwamba kapena losiyanitsidwa bwino).

Kuyesa kwa biomarker kumagwiritsidwa ntchito kuti mudziwe ngati maselo a khansa ya m'mawere ali ndi zolandilira.

Maselo abere athanzi, ndi ma cell ena a khansa ya m'mawere, ali ndi ma receptors (biomarkers) omwe amalumikizana ndi mahomoni a estrogen ndi progesterone. Mahomoni amenewa amafunika kuti maselo athanzi, komanso maselo ena a khansa ya m'mawere, kuti akule ndikugawana. Kuti muwone ngati opangira ma biomarkers, zitsanzo za minofu yomwe ili ndi maselo a khansa ya m'mawere amachotsedwa panthawi yopanga opaleshoni kapena opaleshoni. Zitsanzozo zimayesedwa mu labotale kuti ziwone ngati ma cell a khansa ya m'mawere ali ndi estrogen kapena progesterone receptors.

Mtundu wina wa receptor (biomarker) womwe umapezeka pamwamba pamaselo onse a khansa ya m'mawere umatchedwa HER2. Ma HER2 receptors amafunika kuti maselo a khansa ya m'mawere akule ndikugawana.

Pa khansa ya m'mawere, kuyesa kwa biomarker kumaphatikizapo izi:

• Estrogen receptor (ER). Ngati maselo a khansa ya m'mawere ali ndi zotengera za estrogen, ma cell a khansa amatchedwa ER positive (ER +). Ngati ma cell a khansa ya m'mawere alibe ma estrogen receptors, ma cell a khansa amatchedwa ER negative (ER-).

• Progesterone receptor (PR). Ngati maselo a khansa ya m'mawere ali ndi mapulogalamu a progesterone, maselo a khansa amatchedwa PR positive (PR +). Ngati maselo a khansa ya m'mawere alibe ma progesterone receptors, ma cell a khansa amatchedwa PR negative (PR-).

• Kukula kwa khungu kwa anthu kwamtundu wa 2 receptor (HER2 / neu kapena HER2). Ngati maselo a khansa ya m'mawere ali ndi zikuluzikulu kuposa zolandirira za HER2 pamtunda wawo, maselo a khansa amatchedwa HER2 positive (HER2 +). Ngati maselo a khansa ya m'mawere ali ndi HER2 yofanana pamtunda, maselo a khansa amatchedwa HER2 negative (HER2-). Khansa ya m'mawere ya HER2 + imatha kukula ndikugawana mwachangu kuposa khansa ya m'mawere ya HER2.

Nthawi zina maselo a khansa ya m'mawere amatha kufotokozedwa kuti ndi opanda chiyembekezo kapena katatu.

• Katatu kolakwika. Ngati maselo a khansa ya m'mawere alibe zotengera za estrogen, progesterone receptors, kapena zokulirapo kuposa zolandirira za HER2, ma cell a khansa amatchedwa katatu katatu.

• Katatu katsimikizika. Ngati maselo a khansa ya m'mawere ali ndi zotengera za estrogen, progesterone receptors, komanso zokulirapo kuposa zolandirira za HER2, ma cell a khansa amatchedwa katatu katatu.

Ndikofunikira kudziwa kuti estrogen receptor, progesterone receptor, ndi HER2 receptor status kuti asankhe mankhwala abwino kwambiri. Pali mankhwala omwe amatha kuyimitsa olandila kuti asamangirire mahomoni a estrogen ndi progesterone ndikuletsa khansa kukula. Mankhwala ena atha kugwiritsidwa ntchito kutsekereza ma HER2 receptors pamwambapa maselo a khansa ya m'mawere ndikuletsa khansa kukula.

Ndondomeko ya TNM, dongosolo loyika, komanso mawonekedwe a biomarker amaphatikizidwa kuti apeze gawo la khansa ya m'mawere.

Nazi zitsanzo zitatu zomwe zimaphatikiza dongosolo la TNM, dongosolo loyika, komanso mawonekedwe a biomarker kuti mupeze gawo la khansa ya m'mawere ya Pathological Prognostic ya mayi yemwe chithandizo chake choyamba chinali opaleshoni:

Ngati chotupacho chili ndi mamilimita 30 (T2), sichinafalikire ku ma lymph node (N0), sichinafalikire kumadera akutali a thupi (M0), ndipo ndi:

• Gulu 1

• HER2 +

• ER-

• PR-

Khansara ndi gawo IIA.

Ngati chotupacho chili ndi mamilimita 53 (T3), chafalikira mpaka 4 mpaka 9 axillary lymph node (N2), sichinafalikire mbali zina za thupi (M0), ndipo ndi:

• Gulu 2

• HER2 +

• ER +

• PR-

Chotupacho ndi gawo IIIA.

Ngati chotupacho chili ndi mamilimita 65 (T3), chafalikira ku 3 axillary lymph nodes (N1a), chafalikira m'mapapu (M1), ndipo ndi:

• Gulu 1

• HER2 +

• ER-

• PR-

Khansara ndi gawo IV (khansa ya m'mawere).

Lankhulani ndi dokotala wanu kuti mudziwe momwe khansa yanu ya m'mawere ilili komanso momwe amagwiritsidwira ntchito pokonzekera chithandizo chabwino kwambiri kwa inu.

Pambuyo pa opareshoni, dokotala wanu alandila lipoti laza matenda lomwe limafotokoza kukula ndi malo a chotupacho, kufalikira kwa khansa kumalo am'mimba apafupi, chotupa, komanso ngati kuli ma biomarkers. Lipoti la kudwala ndi zotsatira zina zoyesedwa zimagwiritsidwa ntchito kuti mudziwe khansa yanu ya m'mawere.

Muyenera kuti muli ndi mafunso ambiri. Funsani dokotala wanu kuti akufotokozereni momwe masitepe amagwiritsidwira ntchito posankha njira zabwino zochizira khansa yanu komanso ngati pali mayesero azachipatala omwe angakhale oyenera kwa inu.

Chithandizo Chosankha Mwachidule

MFUNDO ZOFUNIKA

• Chithandizo cha amayi apakati chimadalira gawo la matenda komanso msinkhu wa mwana wosabadwa.

• Mitundu itatu yamankhwala ogwiritsidwa ntchito imagwiritsidwa ntchito:

• Opaleshoni

• Thandizo la radiation

• Chemotherapy

• Kutha mimba sikuwoneka ngati kukupangitsa mwayi wamayi wopulumuka.

• Chithandizo cha khansa ya m'mawere chingayambitse mavuto.

Chithandizo cha amayi apakati chimadalira gawo la matenda komanso msinkhu wa mwana wosabadwa.

Mitundu itatu yamankhwala ogwiritsidwa ntchito imagwiritsidwa ntchito:

Opaleshoni

Amayi ambiri apakati omwe ali ndi khansa ya m'mawere amachitidwa opaleshoni kuti achotse bere. Zina mwa zotupa zomwe zili m'manja zingathe kuchotsedwa kotero kuti zimatha kuyang'aniridwa ndi microscope ndi wodwala ngati ali ndi khansa.

Mitundu ya opaleshoni yochotsa khansa ndi iyi:

• Kusintha kwakukulu kwa mastectomy: Opaleshoni yochotsa bere lonse lomwe lili ndi khansa, ma lymph node ambiri pansi pa mkono, kulumikizana paminyewa ya chifuwa, ndipo nthawi zina, gawo la minofu yapachifuwa. Opaleshoni yotereyi imafala kwambiri kwa amayi apakati.

Kusintha kwakukulu kwa mastectomy. Mzere wokhala ndi madontho umawonetsa komwe mawere onse ndi ma lymph node amachotsedwa. Gawo lina la chifuwa cholumikizira pachifuwa amathanso kuchotsedwa.

• Opaleshoni yosunga bere: Kuchita maopaleshoni kuti muchotse khansa ndi ziwalo zina zozungulira, koma osati bere lomwe. Gawo lina la khoma pachifuwa amathanso kuchotsedwa ngati khansara ili pafupi nayo. Kuchita opaleshoni kotereku kungathenso kutchedwa lumpectomy, pang'ono mastectomy, segmental mastectomy, quadrantectomy, kapena opaleshoni yoletsa mawere.

Opaleshoni yosunga bere. Chotupacho ndi minofu yabwinobwino pozungulira pake zimachotsedwa, koma osati bere lomwe. Ma lymph node ena pansi pa mkono atha kuchotsedwa. Gawo lina la khoma pachifuwa amathanso kuchotsedwa ngati khansara ili pafupi nayo.

Dokotala atachotsa khansa yonse yomwe imawonekera panthawi yochitidwa opaleshoni, odwala ena amatha kupatsidwa chemotherapy kapena radiation pochita opaleshoni kuti aphe maselo aliwonse a khansa omwe atsala. Kwa amayi apakati omwe ali ndi khansa ya m'mawere koyambirira, chithandizo cha radiation ndi mankhwala a mahomoni amaperekedwa mwana akabadwa. Chithandizo chomwe chimaperekedwa atachitidwa opareshoni, kuti muchepetse chiopsezo kuti khansayo ibwereranso, amatchedwa adjuvant therapy.

Thandizo la radiation

Thandizo la radiation ndi chithandizo cha khansa chomwe chimagwiritsa ntchito ma x-ray amphamvu kapena mitundu ina ya radiation kuti iphe ma cell a khansa kapena kuti asakule. Pali mitundu iwiri ya mankhwala a radiation:

• Mankhwala ochiritsira akunja amagwiritsa ntchito makina kunja kwa thupi kuti atumize cheza chaku khansa.

• Njira yothandizira poizoniyu yamkati imagwiritsa ntchito mankhwala a radioactive otsekedwa ndi singano, njere, mawaya, kapena ma catheters omwe amayikidwa mwachindunji kapena pafupi ndi khansa.

Momwe mankhwala a radiation amaperekedwera zimadalira mtundu ndi gawo la khansa yomwe ikuthandizidwa.

Mankhwala ochokera kunja angaperekedwe kwa amayi apakati omwe ali ndi khansa ya m'mawere (gawo I kapena II) khansa ya m'mawere mwana atabadwa. Amayi omwe ali ndi khansa ya m'mawere (gawo lachitatu kapena lachinayi) khansa ya m'mawere atha kupatsidwa chithandizo chama radiation pakatha miyezi itatu yoyambira kapena ngati kuli kotheka, mankhwala a radiation amachedwa mpaka atabadwa.

Chemotherapy

Chemotherapy ndi chithandizo cha khansa chomwe chimagwiritsa ntchito mankhwala kuletsa kukula kwa maselo a khansa, mwina popha ma cell kapena poyimitsa ma cell kuti asagawane. Chemotherapy ikamamwa pakamwa kapena kulowetsedwa mumtsempha kapena minofu, mankhwalawa amalowa m'magazi ndipo amatha kufikira ma cell a khansa mthupi lonse (systemic chemotherapy). Chemotherapy ikaikidwa molunjika m'matumbo a cerebrospinal, chiwalo, kapena thupi ngati pamimba, mankhwalawa amakhudza kwambiri ma cell a khansa m'malo amenewo (chemotherapy am'madera).

Momwe chemotherapy imaperekedwa imadalira mtundu ndi gawo la khansa yomwe ikuchitidwa. Chithandizo champhamvu kwambiri chimagwiritsidwa ntchito pochiza khansa ya m'mawere nthawi yapakati.

Chemotherapy nthawi zambiri samaperekedwa m'miyezi itatu yoyambirira ya mimba. Chemotherapy yomwe imaperekedwa pambuyo pa nthawi ino sichimavulaza mwana wosabadwa koma imatha kubweretsa nthawi yoyambira kapena kuchepa.

Onani Mankhwala Ovomerezeka a Khansa ya m'mawere kuti mumve zambiri.

Kutha mimba sikuwoneka ngati kukupangitsa mwayi wamayi wopulumuka.

Chifukwa kuthetsa mimba sikungathandize kuti mayi akhale ndi mwayi wokhala ndi moyo, nthawi zambiri si njira yothandizira.

Chithandizo cha khansa ya m'mawere chingayambitse mavuto.

Kuti mumve zambiri zamankhwala obwera chifukwa cha khansa, onani tsamba lathu la Zotsatira Zotsatira.

Njira Zothandizira Kuchiza Khansa Ya M'mawere Mimba

M'chigawo chino

• Khansa Yoyambira M'mawere

• Khansa Ya m'mawere Yotsika-Gawo

Kuti mumve zambiri zamankhwala omwe atchulidwa pansipa, onani gawo la Chisankho Chachidule.

Khansa Yoyambira M'mawere

Amayi apakati omwe ali ndi khansa ya m'mawere koyambirira (gawo I ndi gawo lachiwiri) nthawi zambiri amathandizidwa mofananamo ndi odwala omwe alibe mimba, amasintha kuti ateteze mwana wosabadwa. Chithandizo chingaphatikizepo izi:

• Kusinthidwa kwakukulu mastectomy, ngati khansa ya m'mawere idapezeka msanga pomwe ali ndi pakati.

• Opaleshoni yosunga bere, ngati khansa ya m'mawere imapezeka pambuyo pake. Thandizo la radiation lingaperekedwe mwana akabadwa.

• Kusintha kwakukulu kwa mastectomy kapena opaleshoni yosamalira bere panthawi yapakati. Pambuyo pa miyezi itatu yoyambirira ya mimba, mitundu ina ya chemotherapy imatha kuperekedwa musanachite opaleshoni kapena pambuyo pake.

Thandizo la mahomoni ndi trastuzumab sayenera kuperekedwa panthawi yapakati.

Khansa Ya m'mawere Yotsika-Gawo

Palibe mankhwala ochiritsira kwa odwala omwe ali ndi khansa ya m'mawere mochedwa (gawo lachitatu kapena gawo IV) panthawi yapakati. Chithandizo chingaphatikizepo izi:

• Thandizo la radiation.

• Chemotherapy.

Mankhwala a radiation ndi chemotherapy sayenera kuperekedwa m'miyezi itatu yoyambirira ya mimba.

Nkhani Zapadera Zokhudza Khansa ya M'mawere Mimba

MFUNDO ZOFUNIKA

• Kuyamwa mkaka (kuyamwa mkaka wa m'mawere) ndi kuyamwitsa kuyenera kuyimitsidwa ngati opaleshoni kapena chemotherapy ikukonzekera.

• Khansa ya m'mawere sikuwoneka ngati ikupweteka mwana wosabadwa.

• Mimba sikuwoneka kuti ikukhudza kupulumuka kwa azimayi omwe adachitapo khansa ya m'mawere m'mbuyomu.

Kuyamwa mkaka (kuyamwa mkaka wa m'mawere) ndi kuyamwitsa kuyenera kuyimitsidwa ngati opaleshoni kapena chemotherapy ikukonzekera.

Ngati akukonzekera opaleshoni, kuyamwitsa kuyenera kuyimitsidwa kuti magazi achepetse kuyenda m'mabere ndikuwachepetsa. Mankhwala ambiri a chemotherapy, makamaka cyclophosphamide ndi methotrexate, amatha kupezeka kwambiri mumkaka wa m'mawere ndipo atha kuvulaza mwana woyamwitsa. Azimayi omwe amalandira chemotherapy sayenera kuyamwitsa.

Kuletsa mkaka wa m'mawere sikumapangitsa kuti amayi azikhala ochepa.

Khansa ya m'mawere sikuwoneka ngati ikupweteka mwana wosabadwa.

Maselo a khansa ya m'mawere samawoneka kuti akuchoka kwa mayi kupita kwa mwana wosabadwa.

Mimba sikuwoneka kuti ikukhudza kupulumuka kwa azimayi omwe adachitapo khansa ya m'mawere m'mbuyomu.

Kwa amayi omwe akhala ndi khansa ya m'mawere, kutenga mimba sikuwoneka kuti kumakhudza moyo wawo. Komabe, madotolo ena amalimbikitsa kuti mayi adikire zaka ziwiri atalandira chithandizo cha khansa ya m'mawere asanayese kubereka, kuti kubweranso kwa khansa koyambirira kukadziwika. Izi zingakhudze chisankho cha mayi chotenga pakati. Khanda losabadwa likuwoneka kuti silikukhudzidwa ngati mayi adadwala khansa ya m'mawere.

Kuti mudziwe zambiri za khansa ya m'mawere nthawi yapakati

Kuti mumve zambiri kuchokera ku National Cancer Institute yokhudza khansa ya m'mawere mukakhala ndi pakati, onani izi:

• Khansa ya m'mawere Tsamba

• Kuteteza Khansa ya m'mawere

• Kuyeza Khansa Ya m'mawere

• Zosankha Opaleshoni kwa Akazi omwe ali ndi DCIS kapena Khansa ya m'mawere

• Mabere Olimba: Mayankho a Mafunso Ofunsidwa Kawirikawiri

• Mankhwala Ovomerezeka a Khansa Ya m'mawere

Kuti mumve zambiri za khansa ndi zinthu zina zochokera ku National Cancer Institute, onani izi:

• Za Khansa

• Kusinthana

• Chemotherapy and You: Kuthandiza Anthu Omwe Ali Ndi Khansa

• Thandizo la Radiation ndi Inu: Thandizo kwa Anthu Omwe Ali ndi Khansa

• Kulimbana ndi khansa

• Mafunso oti mufunse dokotala wanu za khansa

• Kwa Opulumuka ndi Owasamalira