Iindidi / isifuba / ibc-sheet-sheet

Ukudumba komhlaza webele

Yintoni umhlaza webele wokukrala?

Umhlaza webele odumbisayo sisifo esinqabileyo nesinoburharha apho iiseli zomhlaza zivimba izitya ze-lymph kulusu lwebele. Olu hlobo lomhlaza wamabele lubizwa ngokuba “kukudumba” kuba ibele lidla ngokubonakala ngathi lidumbile kwaye libomvu, okanye lidumbile.

Umhlaza webele odumbisayo unqabile, ubala iipesenti ezi-1 ukuya kwezi-5 zazo zonke iintlobo zomhlaza webele ezifunyenwe eUnited States. Uninzi lwee-cancer zomhlaza ezivuthayo zii-ductal carcinomas, oko kuthetha ukuba bakhula ukusuka kwiiseli ezihambelana nobisi lwebele kwaye zisasazeka ngaphaya kwemijelo.

Umhlaza webele odumbisayo uqhubela phambili ngokukhawuleza, rhoqo kwimicimbi yeeveki okanye iinyanga. Xa kufunyaniswa isifo, umhlaza webele odumbisayo nokuba kukwinqanaba lesithathu okanye lesine isifo, kuxhomekeke ekubeni iiseli zomhlaza zisasazeke kuphela kwii-lymph node ezikufuphi okanye kwezinye izicwili.

Iimpawu ezongezelelweyo zomhlaza webele wokukrala zibandakanya oku kulandelayo:

• Xa kuthelekiswa nezinye iintlobo zomhlaza wamabele, isifo somhlaza webele esidumbisayo sithambekele ekufumanekeni sisemncinci.

• Umhlaza webele odumbisayo uqheleke kakhulu kwaye ufunyaniswa uneminyaka encinci kwabasetyhini base-Afrika baseMelika kunabafazi abamhlophe.

• Amathumba amabele atyhafayo ahlala engenayo i-hormone receptor, oko kuthetha ukuba abanakunyangwa ngamayeza e-hormone, anjenge tamoxifen, aphazamisa ukukhula kweeseli zomhlaza ezibangelwa yi-estrogen.

• Umhlaza webele odumbisayo uxhaphake kakhulu kubafazi abatyebe ngakumbi kunabafazi abanobunzima obuqhelekileyo.

Njengezinye iintlobo zomhlaza wamabele, umhlaza webele odumbisayo unokuvela emadodeni, kodwa ihlala ikhulile kunabasetyhini.

Zithini iimpawu zomhlaza webele wokudumba?

Iimpawu zomhlaza webele wokudumba zibandakanya ukudumba (i-edema) kunye nokubomvu (i-erythema) echaphazela isithathu okanye nangaphezulu kwebele. Ulusu lwebele lunokubonakala ngathi lupinki, bomvu-bumfusa, okanye lityumkileyo. Ukongeza, ulusu lunokuba nemithambeka okanye lubonakale ludibene, njengesikhumba seorenji (esibizwa ngokuba yipeau d'orange). Ezi mpawu zibangelwa kukukhula kolwelo (ulusu) kulusu lwebele. Olu lwakhiwo lwamanzi lwenzeka ngenxa yokuba iiseli zomhlaza zivimbile iimpahla ze-lymph kulusu, kuthintela ukuhamba okuqhelekileyo kwe-lymph kwizicubu. Ngamanye amaxesha ibele linokuba nethumba eliqinileyo elinokuviwa ngexesha lovavanyo lomzimba, kodwa rhoqo ithumba alinakuva.

Ezinye iimpawu zomhlaza webele wokukrala zibandakanya ukwanda okukhawulezayo kubungakanani besifuba; uvakalelo lobunzima, ukutshisa, okanye ukuthamba kwebele; okanye ingono eguqulweyo (ejonge ngaphakathi). I-lymph node ezidumbileyo zinokubakho phantsi kwengalo, kufutshane nekhola, okanye zombini.

Kubalulekile ukuba uqaphele ukuba ezi mpawu zinokuba zimpawu zezinye izifo okanye iimeko, ezinjengosulelo, ukonzakala, okanye olunye uhlobo lomhlaza webele oqhubele phambili ekuhlaleni. Ngesi sizathu, abasetyhini abanesifo somhlaza webele esidumbisayo bahlala bechaphazeleka ukufumanisa isifo.

Ufumanisa njani umhlaza webele?

Ukudumba komhlaza webele kunokuba nzima ukuwuchonga. Rhoqo, akukho siqhuma sinokuthi sive ngexesha lovavanyo lomzimba okanye lubonwe kwimammogram yovavanyo. Ukongeza, uninzi lwabasetyhini oluchongwe ukuba lunomhlaza webele wokudumba lunezihlunu zamabele ezixineneyo, ezenza ukuba ukubonwa komhlaza kuvavanyo lwe-mammogram kube nzima ngakumbi. Kwakhona, ngenxa yokuba umhlaza webele odumbisayo unochuku, unokuvela phakathi kokucwangciswa kweemammograms kunye nenkqubela phambili ngokukhawuleza. Iimpawu zomhlaza webele wokukrala zinokuphazanyiswa zezo zesifo sokukrala kwebele, esisifo esifubeni, okanye olunye uhlobo lomhlaza webele oqhubela phambili.

Ukunceda ukuthintela ukulibaziseka ekuchongeni nasekunyangeni olona nyango luphambili, iphaneli yamazwe aphesheya yeengcali yapapasha izikhokelo malunga nendlela ogqirha abanokuthi bawuhlolisise kwaye bawenze njani umhlaza webele wokudumba ngokuchanekileyo. Iingcebiso zabo zishwankathelwe apha ngezantsi.

Ubuncinci beekhrayitheriya zokuchongwa komhlaza webele wokukrala kubandakanya oku kulandelayo:

• Ukuqala okukhawulezayo kwe-erythema (ubomvu), i-edema (ukudumba), kunye nembonakalo ye-peau d'orange (isikhumba esirhabaxa okanye esirhabaxa) kunye / okanye ukufudumala kwebele okungaqhelekanga, kunye okanye ngaphandle kwesigaqa esinokuviwa.

• Ezi mpawu zikhankanywe apha ngasentla bezikho ngaphantsi kweenyanga ezi-6.

• I-erythema igubungela ubuncinci isithathu sesifuba.

• Iisampulu zokuqala ze-biopsy ezivela kwibele echaphazelekayo zibonisa i-carcinoma ehlaselayo.

Olunye uvavanyo lweethishu kwibele echaphazelekayo kufuneka lubandakanye ukuvavanywa ukubona ukuba iiseli zomhlaza zinee-receptors ze-hormone (i-estrogen kunye ne-progesterone receptors) okanye ukuba zinemali engaphezulu kwesiqhelo kuhlobo lwe-HER2 kunye / okanye iprotein ye-HER2 (umhlaza webele u-HER2-positive ).

Ukulinganisa kunye nokuvavanya indawo kubandakanya oku kulandelayo:

• I-mammogram yokuxilonga kunye ne-ultrasound yebele kunye nengingqi (ekufutshane) ne-lymph nodes

• I-PET scan okanye i-CT scan kunye nokuvavanywa kwethambo ukubona ukuba umhlaza usasazekile na kwamanye amalungu omzimba

Ukuchongwa ngokuchanekileyo kunye nokuhlelwa komhlaza webele wokudumba kunceda oogqirha ukuba baphuhlise esona sicwangciso sonyango sihle kunye nokuqikelela iziphumo zesifo. Izigulana ezifunyaniswe zinomhlaza webele wokudumba zinokufuna ukudibana nogqirha ogxile kwesi sifo.

Unyangwa njani umhlaza webele?

Umhlaza wamabele odumbayo uqhele ukunyangwa kuqala ngenkqubo ye-chemotherapy ukunceda ukunciphisa ithumba, emva koko ngoqhaqho ukususa ithumba, kulandele unyango lwemitha. Le ndlela kunyango ibizwa ngokuba yindlela yeemodemodal. Izifundo zifumanise ukuba abasetyhini abanomhlaza webele wokudumba abanyangwa ngendlela ye-multimodal baneempendulo ezingcono kunyango kunye nokuphila ixesha elide. Unyango olusetyenziswa ngendlela ye-multimodal lunokubandakanya ezo zichazwe ngezantsi.

• I-Neoadjuvant chemotherapy: Olu hlobo lwe-chemotherapy lunikwa ngaphambi kotyando kwaye luhlala lubandakanya zombini iziyobisi ze-anthracycline kunye nezeeteksi. Ngokuqhelekileyo oogqirha bancomela ukuba ubuncinane imijikelezo emithandathu ye-neoadjuvant chemotherapy inikwe ixesha elingangeenyanga ezi-4 ukuya kwezi-6 ngaphambi kokuba kususwe ithumba, ngaphandle kokuba esi sifo siqhubeka siqhubeka ngeli xesha kwaye oogqirha bathatha isigqibo sokuba utyando akufuneki lubambezeleke.

• Unyango olujolise kuko: Umhlaza webele onokudumba uhlala uvelisa ngaphezulu kwexabiso eliqhelekileyo leprotheni ye-HER2, oko kuthetha ukuba iziyobisi ezinje nge-trastuzumab (Herceptin) ejolise kule protein ingasetyenziselwa ukuzinyanga. Unyango lwe-anti-HER2 lunokunikwa zombini njengenxalenye yonyango lwe-neoadjuvant nasemva kotyando (unyango oluncedisayo).

• Unyango lweHormone: Ukuba iiseli zomhlaza webele womfazi wokuvuvukala ziqulathe iihormone receptors, unyango lwehomoni lolunye unyango. Iziyobisi ezinje nge-tamoxifen, ethintela i-estrogen ekubambeni kwi-receptor yayo, kunye ne-aromatase inhibitors ezinje nge-letrozole, ethintela amandla omzimba okwenza i-estrogen, inokubangela ukuba iiseli zomhlaza ezixhomekeke kwi-estrogen ziyeke ukukhula nokufa.

• Ugqirha: Utyando oluqhelekileyo lomhlaza webele wokudumba luguqulwe ngokugqibeleleyo. Olu tyando lubandakanya ukususwa kwebele lonke elichaphazelekayo kwaye uninzi okanye zonke ii-lymph node phantsi kwengalo esondeleyo. Rhoqo, ulwelwesi ngaphezulu kwezihlunu zesifuba ezingaphantsi luyasuswa, kodwa izihlunu zesifuba ziyagcinwa. Ngamanye amaxesha, nangona kunjalo, izihlunu zesifuba esincinci (i-pectoralis encinci) zinokususwa, nazo.

• Unyango ngemitha: unyango lwasemva kwemastectomy radiation eludongeni lwesifuba phantsi kwebele olususwe yinxalenye esemgangathweni yonyango lwe-multimodal yomhlaza webele wokudumba. Ukuba umfazi ufumene i-trastuzumab ngaphambi kotyando, unokuqhubeka nokuyifumana ngexesha lonyango lwasemva kwemitha. Ukwakhiwa kwakhona kwesifuba kunokwenziwa kwabasetyhini abanomdlavuza wesifuba ovuthayo, kodwa, ngenxa yokubaluleka kwonyango lwe-radiation ekunyangeni lesi sifo, iingcali ngokubanzi zicebisa ukulungiswa kokulibaziseka.

• Unyango oluncedisayo: Unyango lwenkqubo yeAdjuvant lunokunikwa emva kotyando ukunciphisa ithuba lokuphindaphinda komhlaza. Olu nyango lunokubandakanya i-chemotherapy eyongezelelweyo, unyango lwehomoni, unyango ekujolise kulo (njenge-trastuzumab), okanye indibaniselwano yonyango.

Yintoni isigxina sezigulana ezinomhlaza webele wokudumba?

Ukuxela kwangaphambili, okanye isiphumo esinokwenzeka, somguli ofunyaniswe ukuba unomhlaza kuhlala kujongwa njengethuba lokuba umhlaza unyangwe ngempumelelo kwaye isigulana siya kuchacha ngokupheleleyo. Zininzi izinto ezinokuba nefuthe kwisifo somhlaza, kubandakanya uhlobo kunye nomhlaza, inqanaba lesifo, ubudala besigulana kunye nempilo ngokubanzi, kunye nokuba isifo sesigulana siphendula njani kunyango.

Ngenxa yokuba umhlaza webele odumbisayo uhlala ukhula ngokukhawuleza kwaye usasazeka ngolunya kwamanye amalungu omzimba, abasetyhini abafunyaniswa benesi sifo, ngokubanzi, abaphili ixesha elide njengabafazi abafunyaniswa benolunye uhlobo lomhlaza wamabele.

Kubalulekile ukuba ugcine engqondweni, nangona kunjalo, ukuba amanani okusinda asekwe kumanani amakhulu ezigulana kwaye ukuba isifo somfazi ngamnye sinokuba ngcono okanye sibi, ngokuxhomekeke kwiimpawu zethumba kunye nembali yezonyango. Abasetyhini abanomhlaza webele wokudumba bayakhuthazwa ukuba bathethe nogqirha wabo malunga nesifo sabo sengqondo, ngenxa yemeko yabo ethile.

Uphando oluqhubekayo, ngakumbi kwinqanaba leemolekyuli, luyonyusa ukuqonda kwethu malunga nokuba umhlaza webele wokudumba uqala kwaye uqhubeka njani. Olu lwazi kufuneka lwenze ukuba kuphuculwe unyango olutsha kunye nokuchazwa ngokuchanekileyo kwabafazi abafunyaniswe sesi sifo. Kubalulekile, ke ngoko, ukuba abantu ababhinqileyo abafunyaniswe benomhlaza webele wokudumba bathethe nogqirha malunga nokukhetha ukuthatha inxaxheba kuvavanyo lweklinikhi.

Zeziphi iimvavanyo zonyango ezifumanekayo kwabasetyhini abanomhlaza webele wokudumba?

I-NCI ixhasa iimvavanyo zeklinikhi zonyango olutsha kuzo zonke iintlobo zomhlaza, kunye nezilingo ezivavanya iindlela ezingcono zokusebenzisa unyango esele lukhona. Ukuthatha inxaxheba kuvavanyo lweklinikhi lukhetho kwizigulana ezininzi ezinomhlaza webele wokudumba, kwaye zonke izigulana ezinesi sifo ziyakhuthazwa ukuba ziqwalasele unyango kuvavanyo lweklinikhi.

Iinkcazo zovavanyo oluqhubekayo lweklinikhi kubantu abanomhlaza webele wokuvuvukala unokufikelelwa ngokukhangela uluhlu lwe-NCI lovavanyo lomhlaza kwiklinikhi. Uluhlu lwe-NCI lwezilingo zeklinikhi lubandakanya zonke iimvavanyo zeklinikhi ezixhaswa yi-NCI ezenzeka e-United States nase-Canada, kubandakanya ne-NIH Clinical Centre eBethesda, MD. Ngolwazi malunga nendlela yokukhangela uluhlu, khangela Uncedo ekufumaneni iiMvavanyo zeKlinikhi eziXhaswayo zeKlinikhi.

Abantu abanomdla wokuthatha inxaxheba kuvavanyo lweklinikhi kufuneka bathethe nogqirha wabo. Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiNkonzo yeNgcaciso yoMhlaza yeNCI ngo-1-800–4-CANCER (1–800–422–6237) nakwincwadana yeNCI ethi Ukuthatha Inxaxheba kwizifundo zoPhando lweCancer Treatment. Ulwazi olongezelelekileyo malunga novavanyo lweklinikhi luyafumaneka kwi-Intanethi.

Izalathiso ezikhethiweyo

1. UAnderson WF, uSchairer C, u-Chen BE, uHance KW, uLeviine PH. I-Epidemiology yomhlaza webele wokudumba (IBC). Izifo zebele 2005; 22: 9-23. [PubMed Abstract]
2. UBertucci F, Ueno NT, uFinetti P, et al. Imbonakalo ye-Gene yeeprofayili zomhlaza webele wokudumba: unxibelelwano kunye nokuphendula kwi-neoadjuvant chemotherapy kunye nokusinda kwasimahla kwe-metastasis. Izibhengezo zeOncology 2014; 25 (2): 358-365. [PubMed Abstract]
3. I-Chang S, iParker SL, iPham T, iBuzdar AU, eyenzakeleyo ye-SD. Isifo sokudumba se-carcinoma izehlo kunye nokusinda: ukubekwa kweliso, isifo esibulalayo, kunye neenkqubo zokugqibela zeNational Cancer Institute, ngo-1975-1992. Umhlaza 1998; 82 (12): 2366-2372. [PubMed Abstract]
4. UDawood S, Cristofanilli M. Umhlaza webele odumbisayo: yeyiphi inkqubela esele siyenzile? I-Oncology (iWilliston Park) ngo-2011; 25 (3): 264-270, 273. [Ipapashwe kwi-Abstract]
5. UDawood S, Merajver SD, Viens P, et al. Iphaneli yengcali yamanye amazwe malunga nomhlaza webele wokudumba: isitetimenti semvumelwano yokufumanisa isifo kunye nonyango. Izibhengezo zeOncology 2011; 22 (3): 515-523. [PubMed Abstract]
6. UFouad TM, uKogawa T, uRuben JM, u-Ueno NT. Indima yokudumba komhlaza webele odumbayo. Inkqubela phambili yoNyango lwezeMpilo kunye neBiology 2014; 816: 53-73. [PubMed Abstract]
7. IHance KW, Anderson WF, Devesa SS, Young HA, uLevine PH. Imikhwa yokuqhambuka kwesisu se-carcinoma izehlo kunye nokusinda: ukubekwa kweliso, isifo esibulalayo, kunye neenkqubo zokugqibela kwiZiko loMhlaza weSizwe. Ijenali yeZiko loMhlaza weSizwe 2005; I-97 (13): 966-975. [PubMed Abstract]
8. U-Li BD, uSicard MA, u-Ampil F, kunye no-al. Unyango lwe-trimodal yomhlaza wamabele ovuthayo: umbono wotyando. I-Oncology 2010; 79 (1-2): 3-12. [PubMed Abstract]
9. UMasuda H, uBrewer TM, uLiu DD, et al. Ukusebenza kwexesha elide kunyango olusisiseko somhlaza webele nge-hormone receptor- kunye ne-HER2-echazwe ngamacandelwana. Izibhengezo zeOncology 2014; 25 (2): 384-91. [PubMed Abstract]
10. Imerajver SD, iSabel MS. Umhlaza webele odumbisayo. Ku: Harris JR, Lippman ME, Morrow M, Osborne CK, abahleli. Izifo zesifuba. Ngomhla wesi-3. IPhiladelphia: U-Lippincott Williams kunye noWilkins, ngo-2004.
11. Ries LAG, JL omncinci, Keel GE, et al (abahleli). I-SEER Survival Monograph: Ukuphila komhlaza phakathi kwabantu abadala: Inkqubo ye-US SEER, ngo-1988-2001, izigulane kunye ne-Tumor Characteristics. I-Bethesda, MD: Inkqubo ye-NCI SEER; 2007. INIH Pub. Inombolo 07-6215. Ibuyiswe ngo-Epreli 18, 2012.
12. URobertson FM, uBondy M, uYang W, et al. Umhlaza webele odumbisayo: isifo, ibhayoloji, unyango. I-CA: Ijenali yoMhlaza yeeKlinikhi ka-2010; 60 (6): 351-375. [PubMed Abstract]
13. Umgaqo NM, Lin HY, Bedrosian I, et al. Ukusetyenziswa gwenxa kwonyango lwe-trimodality kuchaphazela ukusinda kwizigulana ezinomhlaza webele wokudumba: Uhlalutyo lonyango kunye neendlela zokusinda ezivela kuVimba weSizwe woMhlaza. Ijenali ye-Clinical Oncology 2014; Ngama-32 (19): 2018-24. [PubMed Abstract]
14. Schairer C, Li Y, Frawley P, Graubard BI, okqhubekayo. Imiba yomngcipheko womhlaza webele wokudumba kunye neminye imihlaza yomhlaza yamabele. Ijenali yeZiko loMhlaza leSizwe 2013; 105 (18): 1373-1384. [PubMed Abstract]
15. Tsai CJ, Li J, Gonzalez-Angulo AM, okqhubekayo. Iziphumo emva kokunyanga ngeendlela ezahlukeneyo zomhlaza webele wokudumba ngexesha le-neoadjuvant yonyango olujolise ngqo kwi-HER2. Ijenali yaseMelika ye-Oncology yonyango 2015; 38 (3): 242-247. [PubMed Abstract]
16. UVan Laere SJ, Ueno NT, uFinetti P, et al. Ukutyhila iimfihlelo zeemolekyuli zebhayoloji yomhlaza wamabele yokuvuvukala: Uhlalutyo oludibeneyo lwee-data ezintathu ezahlukileyo ze-affymetrix expression expression. Uphando ngomhlaza weklinikhi 2013; 19 (17): 4685-96. [PubMed Abstract]
17. Yamauchi H, Ueno NT. Unyango ekujoliswe kulo kumhlaza webele wokudumba. Umhlaza 2010; 116 (11 Suppl): 2758-9. [PubMed Abstract]
18. U-Yamauchi H, uWoodward WA, uValero V, et al. Umhlaza webele odumbisayo: into esiyaziyo kunye nento ekufuneka siyifundile. Oncologist 2012; Ishumi elinesixhenxe (7): 891-9. [PubMed Abstract]