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Unyango loMhlaza webele ngexesha lokukhulelwa

Ulwazi ngokubanzi malunga nonyango lomhlaza webele ngexesha lokukhulelwa

IINGONGOMA EZIPHAMBILI

• Umhlaza wamabele sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizicubu zesifuba.

• Ngamanye amaxesha umhlaza webele uvela kwabasetyhini abakhulelweyo okanye abasandula ukubeleka.

• Iimpawu zomhlaza wamabele zibandakanya iqhuma okanye utshintsho kwibele.

• Kunokuba nzima ukufumanisa (ukufumana) umhlaza webele kwangoko kwabasetyhini abakhulelweyo okanye abahlengikazi.

• Iimviwo zebele kufuneka zibe yinxalenye yokhathalelo lwangaphambi kokubeleka nasemva kokubeleka.

• Uvavanyo oluvavanya amabele lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa umhlaza webele.

• Ukuba umhlaza ufumanekile, kwenziwa iimvavanyo ukuze kufundwe iiseli zomhlaza.

• Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

Umhlaza wamabele sisifo apho iiseli ezibi (zomhlaza) zeeseli zenzeka kwizicubu zesifuba.

Isifuba senziwe ngamanqatha kunye nemibhobho. Isifuba ngasinye sinamacandelo ali-15 ukuya kwangama-20 abizwa ngokuba ngamalobes. I-lobe nganye inamacandelo amaninzi amancinci abizwa ngokuba zii-lobules. IiLobules ziphelela kwiibhalbhu ezincinci ezinokwenza ubisi. I-lobes, i-lobules, kunye ne-bulbs zidibene neetyhubhu ezincinci ezibizwa ngokuba yimibhobho.

I-Anatomy yebele labasetyhini. Ingono kunye ne-areola ziboniswa ngaphandle kwebele. Iimpawu ze-lymph, i-lobes, i-lobules, i-ducts kunye nezinye iindawo zangaphakathi zesifuba nazo zibonisiwe.

Isifuba ngasinye sineemithambo yegazi kunye nemithambo ye-lymph. Iinqanawa ze-lymph zithwala i-fluid engenambala, engenamanzi ebizwa ngokuba yi-lymph. Imikhumbi ye-lymph ithwala i-lymph phakathi kwe-lymph nodes. Ii-lymph node zincinci, zinemilo yeembotyi ezifumaneka emzimbeni wonke. Bacoca i-lymph kwaye bagcina iiseli ezimhlophe zegazi ezinceda ukulwa usulelo kunye nezifo. Amaqela ee-lymph node afunyanwa kufutshane nebele kwi-axilla (phantsi kwengalo), ngaphezulu kwekhola, nasesifubeni.

Ngamanye amaxesha umhlaza webele uvela kwabasetyhini abakhulelweyo okanye abasandula ukubeleka.

Umhlaza webele uvela phantse kube kanye kuma-3 000 abakhulelweyo. Kwenzeka rhoqo kubasetyhini abaneminyaka engama-32 ukuya kuma-38 ubudala. Kuba uninzi lwabasetyhini bakhetha ukulibazisa ukuba nabantwana, kunokwenzeka ukuba inani lamatyala amatsha omhlaza webele ngexesha lokukhulelwa liya kwanda.

Iimpawu zomhlaza wamabele zibandakanya iqhuma okanye utshintsho kwibele.

Ezi kunye neminye imiqondiso inokubangelwa ngumhlaza wamabele okanye ngezinye iimeko. Jonga ugqirha wakho ukuba unayo nayiphi na kwezi zinto zilandelayo:

• Isigaxa okanye ukuqina ngaphakathi okanye kufutshane nebele okanye kwindawo engaphantsi.

• Utshintsho kubukhulu okanye imilo yebele.

• Ukuntywila okanye ukuntywila kulusu lwebele.

• Ingono yajika yangena ebeleni.

• Ulwelo, ngaphandle kobisi lwebele, oluvela kwingono, ingakumbi ukuba inegazi.

• Isikhumba esibomvu, esibomvu, okanye esidumbileyo esifubeni, kwingono, okanye kwi-areola (indawo emnyama yesikhumba ejikeleze ingono).

• Izidumbu ebeleni ezibonakala ngathi lulusu lweorenji, olubizwa ngokuba yipeau d'orange.

Kunokuba nzima ukufumanisa (ukufumana) umhlaza webele kwangoko kwabasetyhini abakhulelweyo okanye abahlengikazi.

Amabele ahlala esiba makhulu, ethambile, okanye enamaqhuma kwabasetyhini abakhulelweyo, abongikazi, okanye abasandula ukubeleka. Oku kwenzeka ngenxa yeenguqu eziqhelekileyo zehomoni ezenzeka ngexesha lokukhulelwa. Olu tshintsho lunokwenza amaqhuma amancinci kube nzima ukuwabona. Amabele nawo angangqindilili. Kunzima ukufumanisa umhlaza wamabele kwabasetyhini abanamabele ashinyeneyo besebenzisa i-mammography. Ngenxa yokuba olu tshintsho lwebele lunokulibazisa ukuxilongwa, umhlaza webele uhlala ufumaneka kamva kwaba bafazi.

Iimviwo zebele kufuneka zibe yinxalenye yokhathalelo lwangaphambi kokubeleka nasemva kokubeleka.

Ukufumanisa umhlaza webele, abasetyhini abakhulelweyo nabancancisayo kufuneka bawahlole ngokwabo amabele. Abasetyhini kufuneka bafumane iimviwo zeklinikhi ngexesha lokuhlolwa rhoqo kokubeleka nasemva kokubeleka. Thetha nogqirha wakho ukuba ubona naluphi na utshintsho emabeleni wakho ongalulindelanga okanye olukhathazayo.

Uvavanyo oluvavanya amabele lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa umhlaza webele.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa:

• Uvavanyo lomzimba kunye nembali: Uvavanyo lomzimba ukukhangela iimpawu zempilo ngokubanzi, kubandakanya nokujonga iimpawu zesifo, ezinje ngamaqhuma okanye nayiphi na into ebonakala ingaqhelekanga. Imbali yemikhwa yempilo yesigulana kunye nezifo zangaphambili kunye nonyango ziya kuthathwa.

• Uviwo lwebele lwezonyango (i-CBE): Uvavanyo lwebele ngugqirha okanye yingcali yezempilo. Ugqirha uya kuva ngononophelo amabele naphantsi kweengalo zamaqhuma okanye nayiphi na into ebonakala ingaqhelekanga.

• Uvavanyo lwe-Ultrasound: Inkqubo apho amaza esandi aphembelela amandla aphezulu (i-ultrasound) akhutshelwa ngaphandle kwizicubu zangaphakathi okanye kwizitho zokwenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram. Umfanekiso unokuprintwa ukujonga kamva.

• Isisombululo: X-reyi yebele. I-mammogram inokwenziwa ngaphandle komngcipheko kusana olungekazalwa. I-Mammograms kwabasetyhini abakhulelweyo banokubonakala bengekho nokuba umhlaza ukhona.

Imigrafi. Isifuba sicinezelwe phakathi kwamacwecwe amabini. IX-reyi isetyenziselwa ukuthatha imifanekiso yeethishu zamabele.

• Biopsy: Ukususwa kweeseli okanye izicwili ukuze zijongwe ngemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza. Ukuba kufunyaniswe ukuba kukho isigaxa esifubeni, kungenziwa i-biopsy.

Zintathu iintlobo zebhayoloji yebele:

• I-biopsy ekhethekileyo: Ukususwa kwesigaxa sezicubu.

• I-biopsy engundoqo: Ukususwa kwezicubu kusetyenziswa inaliti ebanzi.

• Fine-inaliti aspiration (FNA) biopsy: Ukususwa kwethishu okanye ulwelo, kusetyenziswa inaliti ebhityileyo.

Ukuba umhlaza ufumanekile, kwenziwa iimvavanyo ukuze kufundwe iiseli zomhlaza.

Izigqibo malunga nonyango olungcono zixhomekeke kwiziphumo zolu vavanyo kunye nobudala bosana olungekazalwa. Iimvavanyo zinika ulwazi malunga:

• Ukukhula ngokukhawuleza komhlaza.

• Kungenzeka kangakanani ukuba umhlaza usasazeke kwamanye amalungu omzimba.

• Olunye unyango lunokusebenza njani.

• Kungenzeka njani ukuba umhlaza uphinde ubuye (ubuye).

Uvavanyo lunokubandakanya oku kulandelayo:

• Uvavanyo lwe-Estrogen kunye neprogesterone receptor: Uvavanyo lokulinganisa inani le-estrogen kunye neprogesterone (iihormone) receptors kwizicubu zomhlaza. Ukuba zininzi ii-estrogen okanye ii-progesterone receptors kunesiqhelo, umhlaza ubizwa ngokuba yi-estrogen receptor okanye i-progesterone receptor. Olu hlobo lomhlaza webele lunokukhula ngokukhawuleza. Iziphumo zovavanyo zibonisa ukuba ngaba unyango lokuthintela i-estrogen kunye neprogesterone enikezwe emva kokuba usana luzelwe inokuwunqanda umhlaza ekukhuleni.

• Uhlobo lokukhula komntu kwisifo esikhulayo uhlobo lwe-2 receptor (HER2 / neu): Uvavanyo lwelebhu ukujonga ukuba zingaphi ii-HER2 / neu zofuzo ezikhoyo kwaye zingakanani iiprotein ze-HER2 / neu ezenziwe kwisampulu yethishu. Ukuba zininzi ii-HER2 / neu zofuzo okanye amanqanaba aphezulu e-HER2 / neu protein kunesiqhelo, umhlaza ubizwa ngokuba yi-HER2 / neu positive. Olu hlobo lomhlaza webele lunokukhula ngokukhawuleza kwaye kunokwenzeka ukuba lusasazeke kwamanye amalungu omzimba. Umhlaza unokunyangwa ngamachiza ajolise kwi-HER2 / neu protein, enje nge-trastuzumab kunye ne-pertuzumab, emva kokuba umntwana ezelwe.

• Uvavanyo lweMultigene: Uvavanyo ekufundwa kulo iisampulu zethishu ukujonga ukwenzeka kwezinto ezininzi ngexesha elinye. Olu vavanyo lunokunceda ukuqikelela ukuba umhlaza uya kusasazeka na kwamanye amalungu omzimba okanye uphinde ubuye (ubuye).

• I-Oncotype DX: Olu vavanyo luyanceda ukuqikelela ukuba inqanaba I okanye isigaba II somhlaza webele esine-estrogen receptor elungileyo kunye ne-node-negative iya kusasazeka kwamanye amalungu omzimba. Ukuba umngcipheko wokusasazeka komhlaza uphezulu, i-chemotherapy inokunikwa ukunciphisa umngcipheko.

• Ushicilelo lweMamma: Uvavanyo lwaselebhu apho kujongwa khona ii-70 ezahlukeneyo zofuzo kumhlaza womhlaza webele wabasetyhini abanesifo somhlaza webele esaqala ukusasazeka kwii-lymph node okanye esisasazeke kwii-lymph node ezi-3 okanye ezimbalwa. Inqanaba lomsebenzi wale mfuza linceda ukuqikelela ukuba umhlaza webele uza kusasazeka kwamanye amalungu omzimba okanye ubuye. Ukuba uvavanyo lubonisa ukuba umngcipheko wokuba umhlaza uzosasazeka okanye ubuye uphezulu, ichemotherapy inokunikwa ukunciphisa umngcipheko.

Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

Ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango luxhomekeke koku kulandelayo:

• Inqanaba lomhlaza (ubungakanani besisu kunye nokuba sikusifuba kuphela okanye sinwenwele kwamanye amalungu omzimba).

• Uhlobo lomhlaza wamabele.

• Ubudala bosana olungekazalwa.

• Nokuba zikhona iimpawu okanye iimpawu.

• Impilo yomguli ngokubanzi.

Amanqanaba omhlaza webele

IINGONGOMA EZIPHAMBILI

• Emva kokuba kufunyaniswe isifo somhlaza wamabele, kwenziwa iimvavanyo zokufumanisa ukuba ingaba iiseli zomhlaza zisasazekile esifubeni okanye kwamanye amalungu omzimba.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

• Kumhlaza webele, inqanaba lisekwe kubungakanani kunye nendawo yethumba ephambili, ukusasazeka komhlaza kwii-lymph node ezikufuphi okanye kwamanye amalungu omzimba, inqanaba lesisu, nokuba ngaba kukho ii-biomarker ezithile ezikhoyo.

• Inkqubo ye-TNM isetyenziselwa ukuchaza ubungakanani besisu sokuqala kunye nokusasazeka komhlaza kwii-lymph node ezikufutshane okanye kwezinye iindawo zomzimba.

• Ithumba (T). Ubungakanani kunye nendawo yethumba.

• I-Lymph Node (N). Ubungakanani kunye nendawo ye-lymph node apho umhlaza usasazeke khona.

• Imetastasis (M). Ukusasazeka komhlaza kwamanye amalungu omzimba.

• Inkqubo yokuhlela isetyenziselwa ukuchaza ukuba ngokukhawuleza njani ukuba ithumba lesifuba likhule kwaye lisasazeke.

• Uvavanyo lwe-Biomarker lusetyenziselwa ukufumanisa ukuba ingaba iiseli zomhlaza webele zinee-receptors ezithile.

• Inkqubo ye-TNM, inkqubo yokuhlela, kunye nenqanaba le-biomarker zidityanisiwe ukufumana inqanaba lomhlaza wamabele.

• Thetha nogqirha wakho ukufumana ukuba leliphi inqanaba lomhlaza wamabele kwaye lisetyenziswa njani ukucwangcisa olona nyango lulungileyo kuwe.

Emva kokuba kufunyaniswe isifo somhlaza wamabele, kwenziwa iimvavanyo zokufumanisa ukuba ingaba iiseli zomhlaza zisasazekile esifubeni okanye kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba ngaba umhlaza usasazekile ngaphakathi kwebele okanye kwamanye amalungu omzimba kuthiwa yi-staging. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango.

Ezinye iinkqubo zinokubeka umntwana ongekazalwa kwimitha okanye idayi eyingozi. Ezi nkqubo zenziwa kuphela xa kunyanzelekile. Amanyathelo athile anokuthathwa ukubhenca usana olungekazalwa kwimitha emincinci kangangoko kunokwenzeka, njengokusebenzisa ikhaka elineelothe zokugubungela isisu.

Ezi mvavanyo zilandelayo kunye neenkqubo zingasetyenziselwa ukubeka umhlaza webele ngexesha lokukhulelwa:

• I-x-ray yesifuba: IX-reyi yamalungu namathambo ngaphakathi kwesifuba. IX-reyi luhlobo lwe-beam yamandla enokuhamba emzimbeni nakwifilimu, yenza umfanekiso weendawo ezingaphakathi komzimba.

• Ukuskena amathambo: Inkqubo yokujonga ukuba ngaba kukho iiseli ezahlula ngokukhawuleza, ezinje ngeeseli zomhlaza, emathanjeni. Inani elincinci kakhulu lezinto ezisasazeka ngemitha lifakwa emthanjeni kwaye lihamba ngokuhamba kwegazi. Izinto ezinemitha eqhumayo ziqokelela emathanjeni anomhlaza kwaye zifunyenwe siskena.

• Uvavanyo lwe-Ultrasound: Inkqubo apho amaza esandi aphembelela amandla aphezulu (i-ultrasound) akhutshelwa ngaphandle kwizicubu zangaphakathi okanye kwizitho, ezinjengesibindi, kwaye zenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram. Umfanekiso unokuprintwa ukuze ujongwe kamva.

• I-MRI (imaging resonance imaging): Inkqubo esebenzisa umazibuthe, amaza erediyo kunye nekhompyuter ukwenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezinjengengqondo. Le nkqubo ikwabizwa ngokuba yimifanekiso yenyukliya yokujonga umfanekiso (i-NMRI).

Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

Umhlaza unokusasazeka ngezicubu, inkqubo ye-lymph, kunye negazi:

• Izicubu. Umhlaza usasazeka ukusuka apho waqala ngokukhula waya kwiindawo ezikufuphi.

• Inkqubo yeLymph. Umhlaza usasazeka ukusuka apho waqala ngokungena kwinkqubo ye-lymph. Umhlaza uhamba ngemithambo ye-lymph ukuya kwamanye amalungu omzimba.

• Igazi. Umhlaza usasazeka ukusuka apho waqala ngokungena egazini. Umhlaza uhamba ngemithambo yegazi uye kwamanye amalungu omzimba.

Umhlaza unokusasazeka ukusuka apho waqala khona kwamanye amalungu omzimba.

Xa umhlaza usasazeka kwelinye ilungu lomzimba, ubizwa ngokuba yi-metastasis. Iiseli zomhlaza ziyaphuma apho ziqale khona (ithumba lokuqala) kwaye zihamba ngenkqubo ye-lymph okanye igazi.

• Inkqubo yeLymph. Umhlaza ungena kwinkqubo ye-lymph, uhamba kwiinqanawa ze-lymph, kwaye wenze i-tumor (i-metastatic tumor) kwenye indawo yomzimba.

• Igazi. Umhlaza ungena egazini, uhambe kwimithambo yegazi, kwaye wenze ithumba (metastatic tumor) kwelinye ilungu lomzimba.

I-tumor ye-metastatic yinto efanayo yomhlaza njenge-tumor yokuqala. Umzekelo, ukuba umhlaza wamabele usasazeka uye emathanjeni, iiseli zomhlaza ezisethanjeni ziiseli zomhlaza wamabele. Esi sifo ngumhlaza webele we-metastatic, hayi umhlaza wethambo.

Kumhlaza webele, inqanaba lisekwe kubungakanani kunye nendawo yethumba ephambili, ukusasazeka komhlaza kwii-lymph node ezikufuphi okanye kwamanye amalungu omzimba, inqanaba lesisu, nokuba ngaba kukho ii-biomarker ezithile ezikhoyo.

Ukucwangcisa olona nyango lulungileyo kunye nokuqonda isifo sakho, kubalulekile ukuba wazi inqanaba lomhlaza wamabele.

Zintathu iintlobo zamaqela esigaba somhlaza wamabele:

• Inqanaba lesibhengezo seklinikhi lisetyenziswa kuqala ukunika inqanaba lazo zonke izigulana ngokusekwe kwimbali yezempilo, kuvavanyo lomzimba, kuvavanyo lokucinga (ukuba lwenziwe), kunye ne-biopsies. Inqanaba lokuchazwa kweKlinikhi lichazwa yinkqubo ye-TNM, inqanaba lesisu, kunye nenqanaba le-biomarker (ER, PR, HER2). Kwiklinikhi yokubeka, i-mammography okanye i-ultrasound isetyenziselwa ukujonga ii-lymph node zeempawu zomhlaza.

• I-Pathological Prognostic Stage isetyenziselwa izigulana ezenziwa unyango njengonyango lwabo lokuqala. Isigaba sePathological Prognostic Stage sisekwe kulo lonke ulwazi lweklinikhi, imeko ye-biomarker, kunye neziphumo zovavanyo lwelabhoratri ezivela kwizicubu zamabele kunye ne-lymph node ezisuswe ngexesha lotyando.

• I-Anatomic Stage isekwe kubungakanani kunye nokusasazeka komhlaza njengoko kuchaziwe yinkqubo ye-TNM. Inqanaba le-Anatomic lisetyenziswa kwiindawo zehlabathi apho uvavanyo lwe-biomarker alufumaneki. Ayisetyenziswa eUnited States.

Inkqubo ye-TNM isetyenziselwa ukuchaza ubungakanani besisu sokuqala kunye nokusasazeka komhlaza kwii-lymph node ezikufutshane okanye kwezinye iindawo zomzimba.

Ngomhlaza wamabele, inkqubo ye-TNM ichaza ithumba ngolu hlobo lulandelayo:

Ithumba (T). Ubungakanani kunye nendawo yethumba.

Ubungakanani beethumba zihlala zilinganiswa ngeemilimitha (mm) okanye iisentimitha. Izinto eziqhelekileyo ezinokusetyenziselwa ukubonisa ubungakanani be-tumor kwi-mm zibandakanya: indawo ebukhali yepensile (1 mm), indawo entsha yekhrayoni (2 mm), ipeyinti ephezulu yepensile (5 mm), ipea (10 mm), a ipeanut (20 mm), kunye nekalika (50 mm).

• I-TX: Ithumba lokuqala alinakuvavanywa.

• I-T0: Akukho phawu lwesisu sokuqala ebeleni.

• I-Tis: iCarcinoma in situ. Zimbini iintlobo ze-carcinoma yebele ese-situ:

• I-Tis (DCIS): I-DCIS yimeko apho iiseli ezingaqhelekanga zifumaneka kuludwe lwendlela yobisi. Iiseli ezingaqhelekanga azisasazekanga ngaphandle kwendlela ukuya kwezinye izicwili esifubeni. Ngamanye amaxesha, i-DCIS inokuba ngumhlaza wamabele ongenayo onako ukusasazeka kwezinye izicwili. Ngeli xesha, akukho ndlela yokwazi ukuba zeziphi izilonda ezinokungenela.

• I-Tis (Isifo se-Paget): Isifo se-Paget sengono yimeko apho iiseli ezingaqhelekanga zifumaneka khona kwiiseli zolusu lwengono kwaye zinokusasazeka kwi-areola. Ayimiselwanga ngokwenkqubo ye-TNM. Ukuba isifo sePaget KUNYE nomhlaza webele ongenayo ukhona, inkqubo ye-TNM isetyenziselwa ukubeka umhlaza wamabele oselwayo.

• I-T1: I-tumor i-20 millimeters okanye encinci. Kukho ii-subtypes ezi-4 zethumba elixhomekeke kubungakanani bethumba:

• I-T1mi: I-tumor i-1 millimeter okanye encinci.

• I-T1a: Ithumba likhulu kune-1 millimeter kodwa alikho likhulu kuneemilimitha ezi-5.

• I-T1b: Ithumba likhulu kuneemilimitha ezi-5 kodwa alikho likhulu kuneemilimitha ezili-10.

• I-T1c: Ithumba likhulu kuneemilimitha ezili-10 kodwa alikho ngaphezulu kweemilimitha ezingama-20.

• I-T2: Ithumba likhulu kuneemilimitha ezingama-20 kodwa alikho ngaphezu kweemilimitha ezingama-50.

• I-T3: Ithumba likhulu kuneemilimitha ezingama-50.

• I-T4: I-tumor ichazwa njengenye yezi zinto zilandelayo:

• I-T4a: ithumba likhule laba ludonga lwesifuba.

• I-T4b: ithumba likhule laba lulusu-isilonda senziwe kumphezulu wolusu esifubeni, amaqhuqhuvana amancinci amathumba abunjwe kwisifuba esinye kunye nethumba lokuqala, kunye / okanye kukho ukudumba kolusu ebeleni. .

• I-T4c: ithumba likhule laba ludonga lwesifuba kunye nesikhumba.

• I-T4d: umhlaza wamabele odumbayo-isinye kwisithathu okanye ngaphezulu kwesikhumba esifubeni sibomvu kwaye sidumbile (sibizwa ngokuba yi-peau d'orange).

I-Lymph Node (N). Ubungakanani kunye nendawo ye-lymph node apho umhlaza usasazeke khona.

Xa ii-lymph node zisuswe ngotyando kwaye zifundwa phantsi kwemicroscope ngugqirha wezifo, isifo se-pathologic sisetyenziselwa ukuchaza ii-lymph node. Isigaba se-pathologic of lymph node sichazwe ngezantsi.

• I-NX: I-lymph node ayinakuvavanywa.

• I-N0: Akukho phawu lomhlaza kwii-lymph node, okanye amaqela amancinci eeseli zomhlaza angaphezulu kwe-0.2 millimeter kwii-lymph node.

• I-N1: Umhlaza uchazwa njengenye yezi zinto zilandelayo:

• I-N1mi: umhlaza usasazekile kwi-axillary (indawo ye-armpit) ye-lymph node kwaye inkulu kune-0.2 millimeters kodwa ayinkulu kune-2 millimeters.

• I-N1a: umhlaza usasazeke kwi-1 ukuya kwi-3 i-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ezinkulu kune-2 millimeters.

• I-N1b: umhlaza usasazeke kwii-lymph node kufutshane nethambo lesifuba kwicala elifanayo lomzimba njenge-tumor yokuqala, kwaye umhlaza mkhulu kune-0.2 millimeters kwaye ufunyanwa yi-sentinel lymph node biopsy. Umhlaza awufumaneki kwii-lymph node ze-axillary.

• I-N1c: umhlaza usasazeke kwi-1 ukuya kwi-3 i-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ukhulu kuneemilimitha ezi-2. Umhlaza ukwafunyanwa yi-sentinel lymph node biopsy kwii-lymph node kufutshane nethambo lesifuba kwicala elifanayo lomzimba njenge-tumor yokuqala.

• I-N2: Umhlaza uchazwa njengenye yezi zinto zilandelayo:

• I-N2a: umhlaza usasazeke kwi-4 ukuya kwi-9 ye-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ukhulu kuneemilimitha ezi-2.

• I-N2b: umhlaza usasazeke kwii-lymph node kufutshane nesifuba kwaye umhlaza ufunyanwa ngovavanyo lokucinga. Umhlaza awufumaneki kwii-axillary lymph node yi-sentinel lymph node biopsy okanye i-lymph node dissection.

• I-N3: Umhlaza uchazwa njengenye yezi zinto zilandelayo:

• I-N3a: umhlaza usasazeke kwi-10 okanye ngaphezulu kwe-lymph nodes kwaye umhlaza ubuncinci kwi-lymph node mkhulu kune-2 millimeters, okanye umhlaza usasazeke kwii-lymph node ezantsi kwe-collarbone.

• I-N3b: umhlaza usasazeke kwi-1 ukuya kwi-9 ye-axillary lymph node kwaye umhlaza ubuncinci kwi-lymph node ukhulu kuneemilimitha ezi-2. Umhlaza ukwasasazekile nakwindawo ezalukeleyo kufutshane nethambo lesifuba kwaye umhlaza ufunyanwa kuvavanyo lokucinga;

okanye

Umhlaza usasazeke kwi-4 ukuya kwi-9 ye-axillary lymph node kunye nomhlaza ubuncinci kwi-lymph node enye enkulu kune-2 millimeters. Umhlaza ukwasasazekile kwii-lymph node kufutshane nesifuba secala elinye kwicala lomzimba njenge-tumor yokuqala, kwaye umhlaza mkhulu kune-0.2 millimitha kwaye ufunyanwa yi-sentinel lymph node biopsy.

• I-N3c: umhlaza usasazekile kwii-lymph node ngaphezulu kwesangqa secala lomzimba kwicala elinye lomzimba njenge-tumor yokuqala.

Xa ii-lymph node zijongwa kusetyenziswa i-mammography okanye i-ultrasound, ibizwa ngokuba yinkqubo yezonyango. Ukuqwalaselwa kweklinikhi kwee-lymph node akuchazwa apha.

Imetastasis (M). Ukusasazeka komhlaza kwamanye amalungu omzimba.

• M0: Akukho mqondiso wokuba umhlaza usasazeke nakwamanye amalungu omzimba.

• I-M1: Umhlaza usasazeke kwamanye amalungu omzimba, ubukhulu becala amathambo, imiphunga, isibindi, okanye ingqondo. Ukuba umhlaza uye wasasazeka kwii-lymph node ezikude, umhlaza kwii-lymph node mkhulu kune-0.2 millimeters. Umhlaza ubizwa ngokuba ngumhlaza wamabele.

Inkqubo yokuhlela isetyenziselwa ukuchaza ukuba ngokukhawuleza njani ukuba ithumba lesifuba likhule kwaye lisasazeke.

Inkqubo yokuhlela ichaza ithumba ngokusekwe kwindlela engaqhelekanga ngayo iiseli zomhlaza kunye nezicubu ezijongeka phantsi kwemicroscope kunye nokuba iiseli zomhlaza zinokukhula ngokukhawuleza kwaye zisasazeke njani. Iiseli zomhlaza ezikumgangatho ophantsi zijongeka njengeeseli eziqhelekileyo kwaye zihlala zikhula kwaye zisasazeka ngokuthe chu kuneeseli zomhlaza ezikumgangatho ophezulu. Ukuchaza indlela ezingaqhelekanga ngayo iiseli zomhlaza kunye nezicubu, ugqirha wezifo uya kuvavanya ezi zinto zintathu zilandelayo:

• Zingaphi izihlunu zethumba ezinemibhobho eqhelekileyo yebele.

• Ubungakanani kunye nokumila kwe-nuclei kwiiseli zethumba.

• Zingaphi iiseli ezahlulayo ezikhoyo, oko kungumlinganiso wokuba iiseli zethumba zikhula ngokukhawuleza kwaye zahlule.

Kwimpawu nganye, ugqirha wezifo unikezela inqaku eli-1 ukuya kwele-3; inqaku lika "1" lithetha ukuba iiseli kunye nezicubu zethumba zikhangeleka zifana neeseli kunye nethishu, kwaye amanqaku ka "3" athetha ukuba iiseli kunye nethishu kujongeka njengokungaqhelekanga. Amanqaku enkalo nganye adityaniswa kunye ukufumana amanqaku apheleleyo phakathi kwe-3 kunye ne-9.

Amabakala amathathu anokwenzeka:

• Amanqaku ewonke e-3 ukuya kwi-5: i-G1 (inqanaba eliphantsi okanye lahlulwe kakuhle).

• Amanqaku ewonke ka-6 ukuya ku-7: i-G2 (iBanga eliPhakathi okanye umahluko ophakathi).

• Amanqaku ewonke ka-8 ukuya ku-9: i-G3 (inqanaba eliphezulu okanye umahluko omdaka).

Uvavanyo lwe-Biomarker lusetyenziselwa ukufumanisa ukuba ingaba iiseli zomhlaza webele zinee-receptors ezithile.

Iiseli zamabele ezisempilweni, kunye neeseli ezithile zomhlaza wamabele, zinee-receptors (ii-biomarkers) ezinamathela kwihomoni ye-estrogen kunye neprogesterone. Ezi hormone ziyafuneka kwiiseli ezisempilweni, kwaye ezinye iiseli zomhlaza wamabele, ukukhula kunye nokwahlulahlula. Ukujonga ezi biomarkers, iisampulu zethishu eneseli yomhlaza wamabele ziyasuswa ngexesha le-biopsy okanye utyando. Iisampulu ziyavavanywa elebhu ukubona ukuba iiseli zomhlaza wamabele zine-estrogen okanye i-progesterone receptors.

Olunye uhlobo lwe-receptor (i-biomarker) efumaneka kumphezulu wazo zonke iiseli zomhlaza wamabele kuthiwa yi-HER2. Ii-receptors ze-HER2 ziyafuneka ukuze iiseli zomhlaza wamabele zikhule kwaye zahlule.

Ngomhlaza webele, uvavanyo lwe-biomarker lubandakanya oku kulandelayo:

• I-Estrogen receptor (ER). Ukuba iiseli zomhlaza webele zinee-estrogen receptors, iiseli zomhlaza zibizwa ngokuba zi-ER positive (ER +). Ukuba iiseli zomhlaza wamabele azinayo i-estrogen receptors, iiseli zomhlaza zibizwa ngokuba yi-ER negative (ER-).

• Iprogesterone receptor (PR). Ukuba iiseli zomhlaza webele zinee-progesterone receptors, iiseli zomhlaza zibizwa ngokuba zi-PR positive (PR +). Ukuba iiseli zomhlaza wamabele azinazo ii-progesterone receptors, iiseli zomhlaza zibizwa ngokuba zi-PR negative (PR-).

• Uhlobo lokukhula komntu kwi-epidermal yohlobo lwe-2 receptor (HER2 / neu okanye i-HER2). Ukuba iiseli zomhlaza wamabele zinamanani amakhulu kunesiqhelo ze-HER2 receptors kumphezulu wazo, iiseli zomhlaza zibizwa ngokuba zi-HER2 positive (HER2 +). Ukuba iiseli zomhlaza wamabele zinesixa esiqhelekileyo se-HER2 kumphezulu wazo, iiseli zomhlaza zibizwa ngokuba yi-HER2 negative (HER2-). Umhlaza webele we-HER2 + kunokwenzeka ukuba ukhule kwaye wahlule ngokukhawuleza kune-HER2- umhlaza webele.

Ngamanye amaxesha iiseli zomhlaza wamabele ziya kuchazwa njengeziphindwe kathathu ezimbi okanye zibe zintathu ezilungileyo.

• Ukuphindaphindeka kathathu. Ukuba iiseli zomhlaza wamabele azinayo i-estrogen receptors, iiprogesterone receptors, okanye inani elikhulu kunexabiso eliqhelekileyo le-HER2 receptors, iiseli zomhlaza zibizwa ngokuba zibi kathathu.

• Ukuphindaphindeka kathathu. Ukuba iiseli zomhlaza webele zinee-estrogen receptors, iiprogesterone receptors, kunye nenani elikhulu kuneliqhelekileyo le-HER2 receptors, iiseli zomhlaza zibizwa ngokuba zintathu ezilungileyo.

Kubalulekile ukwazi i-estrogen receptor, iprogesterone receptor, kunye nenqanaba le-HER2 receptor ukukhetha olona nyango lulungileyo. Kukho iziyobisi ezinokuthintela ii-receptors ekubeni zinamathele kwihomoni ye-estrogen kunye neprogesterone kwaye zinqande umhlaza ekukhuleni. Amanye amachiza anokusetyenziselwa ukuvimba ii-HER2 receptors kumphezulu weeseli zomhlaza wamabele kwaye umise umhlaza ekukhuleni.

Inkqubo ye-TNM, inkqubo yokuhlela, kunye nenqanaba le-biomarker zidityanisiwe ukufumana inqanaba lomhlaza wamabele.

Nayi imizekelo emi-3 edibanisa inkqubo ye-TNM, inkqubo yokuhlela, kunye nenqanaba le-biomarker yokufumana isigaba sePathological Prognostic somhlaza webele womfazi owenzelwe unyango lokuqala:

Ukuba ubukhulu be-tumor yi-30 millimeters (T2), ayizange isasazeke kwii-lymph nodes ezikufutshane (N0), ayisasazeki kwiindawo ezikude zomzimba (M0), kwaye:

• IBakala 1

• HER2 +

• ER-

• PR-

Umhlaza linqanaba IIA.

Ukuba ubukhulu be-tumor yi-53 millimeters (T3), sele isasazeke kwi-4 ukuya kwi-9 i-axillary lymph nodes (N2), ayizange isasazeke kwezinye iindawo zomzimba (M0), kwaye:

• IBakala 2

• HER2 +

• ER +

• PR-

Ithumba likwinqanaba IIIA.

Ukuba ubukhulu be-tumor yi-65 millimeters (T3), isasazeke kwi-3 i-axillary lymph nodes (N1a), isasazeka kwimiphunga (M1), kwaye:

• IBakala 1

• HER2 +

• ER-

• PR-

Umhlaza sisigaba IV (umhlaza webele we-metastatic).

Thetha nogqirha wakho ukufumana ukuba leliphi inqanaba lomhlaza wamabele kwaye lisetyenziswa njani ukucwangcisa olona nyango lulungileyo kuwe.

Emva kotyando, ugqirha wakho uya kufumana ingxelo ye-pathology echaza ubungakanani kunye nendawo yethumba lokuqala, ukusasazeka komhlaza kwii-lymph node ezikufuphi, inqanaba lesisu, nokuba ngaba kukho ii-biomarker ezithile ezikhoyo. Ingxelo yezifo kunye nezinye iziphumo zovavanyo zisetyenziselwa ukumisela inqanaba lomhlaza wamabele.

Kusenokwenzeka ukuba unemibuzo emininzi. Buza ugqirha wakho ukuba achaze indlela esetyenziswa ngayo isiteji ukugqiba ezona ndlela zintle zokunyanga umhlaza wakho nokuba kukho izilingo zeklinikhi ezinokuba zilungele wena.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Ukhetho kunyango lwabasetyhini abakhulelweyo luxhomekeke kwinqanaba lesifo kunye nobudala bosana olungekazalwa.

• Zintathu iintlobo zonyango olusetyenziswayo:

• Ugqirha

• Unyango ngemitha

• Unyango ngamayeza

• Ukuphelisa ukukhulelwa kubonakala kungaphuculi ithuba likamama lokusinda.

• Unyango lomhlaza webele lunokubangela iziphumo ebezingalindelekanga.

Ukhetho kunyango lwabasetyhini abakhulelweyo luxhomekeke kwinqanaba lesifo kunye nobudala bosana olungekazalwa.

Zintathu iintlobo zonyango olusetyenziswayo:

Ugqirha

Uninzi lwabasetyhini abakhulelweyo abanomhlaza wamabele banokwenza utyando ukususa ibele. Ezinye zee-lymph node phantsi kwengalo zinokususwa ukuze zijongwe phantsi kwemicroscope ngugqirha wezifo ukufumana iimpawu zomhlaza.

Iindidi zotyando ukususa umhlaza zibandakanya:

• Uhlengahlengiso olukhulu lwe-mastectomy: Utyando lokususa lonke ibele elinomhlaza, uninzi lwee-lymph node phantsi kwengalo, ulungelelwaniso ngaphezulu kwezihlunu zesifuba, kwaye ngamanye amaxesha, yinxalenye yezihlunu zodonga lwesifuba. Olu hlobo lotyando luxhaphake kakhulu kwabasetyhini abakhulelweyo.

Ilungiswe ngokugqibeleleyo imastectomy. Umgca ochokoziweyo ubonisa apho lisuswe lonke ibele kunye nezinye ii-lymph node. Inxalenye yemisipha yodonga lwesifuba nayo inokususwa.

• Utyando olugcina ibele: Utyando lokususa umhlaza kunye nezicubu eziqhelekileyo ezijikelezileyo, kodwa hayi ibele ngokwalo. Inxalenye yodonga lwesifuba esifubeni lunokususwa kwakhona ukuba umhlaza ukufutshane nayo. Olu hlobo lotyando lunokubizwa ngokuba yi-lumpectomy, i-mastectomy engaphelelanga, i-segmental mastectomy, i-quadrantectomy, okanye utyando lokonga amabele.

Utyando olugcina amabele. Kususwe ithumba kunye nezinye izihlunu eziqhelekileyo, kodwa hayi ibele ngokwalo. Ezinye i-lymph nodes phantsi kwengalo zingasuswa. Inxalenye yodonga lwesifuba esifubeni lunokususwa kwakhona ukuba umhlaza ukufutshane nayo.

Emva kokuba ugqirha ewususile wonke umhlaza onokubonwa ngexesha lotyando, ezinye izigulana zinokunikwa ichemotherapy okanye unyango lweradiation emva kotyando lokubulala naziphi na iiseli zomhlaza ezisele. Kwabafazi abakhulelweyo abanomhlaza wamabele wamanqanaba okuqala, unyango ngemitha kunye nonyango lwehomoni zinikezelwa emva kokuba umntwana ezelwe. Unyango olunikezwe emva kotyando, ukunciphisa umngcipheko wokuba umhlaza ubuye kwakhona, lubizwa ngokuba lunyango oluncedisayo.

Unyango ngemitha

Unyango ngemitha lunyango olusebenzisa amandla e-x-reyi okanye ezinye iintlobo zemitha yokubulala iiseli zomhlaza okanye ukuzigcina zikhula. Zimbini iintlobo zonyango lwe-radiation:

• Unyango lwangaphandle lwemitha lusebenzisa umatshini ngaphandle komzimba ukuthumela imitha kumhlaza.

• Unyango lwangaphakathi lwemitha lusebenzisa into enemitha ye-radio etywinwe kwiinaliti, iimbewu, iingcingo, okanye iicatheters ezibekwe ngqo okanye kufutshane nomhlaza.

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo.

Unyango lwangaphandle lwemitha lunokunikwa abasetyhini abakhulelweyo kwinqanaba lokuqala (inqanaba I okanye II) umhlaza wamabele emva kokuba umntwana ezelwe. Abasetyhini abanesigaba sokugqibela (isigaba se-III okanye se-IV) somhlaza wamabele banokunikwa unyango lwangaphandle lwasemva kwemitha emva kweenyanga ezintathu zokuqala zokukhulelwa okanye, ukuba kunokwenzeka, unyango ngemitha lubambezelekile kude kube emva kokuba umntwana ezelwe.

Unyango ngamayeza

I-Chemotherapy yonyango lomhlaza olusebenzisa iziyobisi ukunqanda ukukhula kweeseli zomhlaza, nokuba kungokubulala iiseli okanye kukumisa iiseli zahlule. Xa i-chemotherapy ithathwa ngomlomo okanye ifakwe kwi-vein okanye kwimisipha, amachiza angena kwigazi kwaye anokufikelela kwiiseli zomhlaza kuwo wonke umzimba (systemic chemotherapy). Xa i-chemotherapy ibekwa ngqo kwi-cerebrospinal fluid, ilungu, okanye indawo yomzimba efana nesisu, iziyobisi zichaphazela kakhulu iiseli zomhlaza kwezo ndawo (chemotherapy yengingqi).

Indlela i-chemotherapy enikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo. I-chemotherapy yenkqubo isetyenziselwa ukunyanga umhlaza webele ngexesha lokukhulelwa.

I-Chemotherapy ihlala inganikwa kwiinyanga ezintathu zokuqala zokukhulelwa. I-Chemotherapy enikezwe emva kweli xesha ayixhaphazi umntwana ongekazalwa kodwa inokubangela ukubeleka kwangoko okanye ubunzima bokuzalwa obuphantsi.

Jonga iziyobisi ezivunyiweyo zomhlaza webele ngolwazi oluthe kratya.

Ukuphelisa ukukhulelwa kubonakala kungaphuculi ithuba likamama lokusinda.

Kuba ukuphelisa ukukhulelwa akunakuliphucula ithuba lokusinda kukamama, ayisoloko iyindlela yokonyango.

Unyango lomhlaza webele lunokubangela iziphumo ebezingalindelekanga.

Ngolwazi malunga neziphumo ebezingalindelekanga ezibangelwa lunyango lomhlaza, jonga iphepha lethu Iziphumo ezingalunganga.

Ukhetho kunyango lomhlaza webele ngexesha lokukhulelwa

Kweli Candelo

• Umhlaza webele wamanqanaba okuqala

• Umhlaza webele emva kwexesha

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

Umhlaza webele wamanqanaba okuqala

Abafazi abakhulelweyo abanesifo somhlaza webele kwangethuba (inqanaba I kunye nenqanaba II) bahlala bephathwa ngendlela efanayo nezigulana ezingakhulelwanga, notshintsho oluthile ukukhusela usana olungekazalwa. Unyango lunokubandakanya oku kulandelayo:

• Uhlengahlengiso olukhulu lwe-mastectomy, ukuba umhlaza webele wafunyaniswa kwangoko xa ukhulelwe.

• Utyando olugcina amabele, ukuba ngaba umhlaza webele ufunyaniswe kamva xa ukhulelwe. Unyango ngemitha lunokunikwa emva kokuba umntwana ezelwe.

• Uhlengahlengiso olukhulu lwe-mastectomy okanye utyando lokugcina amabele ngexesha lokukhulelwa. Emva kweenyanga ezintathu zokuqala zokukhulelwa, iintlobo ezithile zekhemotherapy zinokunikwa ngaphambi okanye emva kotyando.

Unyango lwehormone kunye ne-trastuzumab akufuneki ukuba unikwe ngexesha lokukhulelwa.

Umhlaza webele emva kwexesha

Akukho lunyango lusemgangathweni kwizigulana ezinomhlaza webele osekupheleni kwexesha (inqanaba lesithathu okanye inqanaba IV) ngexesha lokukhulelwa. Unyango lunokubandakanya oku kulandelayo:

• Unyango ngemitha.

• Unyango ngamayeza.

Unyango lwe-radiation kunye ne-chemotherapy akufuneki ukuba lunikezwe kwiinyanga ezintathu zokuqala zokukhulelwa.

Imiba ekhethekileyo malunga nomhlaza webele ngexesha lokukhulelwa

IINGONGOMA EZIPHAMBILI

• Ukuncancisa (ukuvelisa ubisi lwebele) kunye nokuncancisa kufuneka kuyekwe ukuba kucwangcisiwe ngotyando okanye ichemotherapy.

• Umhlaza webele awubonakali ukulimaza usana olungekazalwa.

• Ukukhulelwa kubonakala ngathi akuchaphazeli ukuhlala kwabasetyhini abanomhlaza webele ngaphambili.

Ukuncancisa (ukuvelisa ubisi lwebele) kunye nokuncancisa kufuneka kuyekwe ukuba kucwangcisiwe ngotyando okanye ichemotherapy.

Ukuba kucwangcisiwe ukuba kwenziwe utyando, ukuncancisa kufuneka kuyekwe ukunciphisa ukuhamba kwegazi emabeleni kwaye kuwenze amancinci. Uninzi lweziyobisi ze-chemotherapy, ngakumbi i-cyclophosphamide kunye ne-methotrexate, zinokwenzeka kumanqanaba aphezulu kubisi lwebele kwaye zinokwenzakalisa umntwana owanyayo. Abasetyhini abafumana ichemotherapy akufuneki bancancise.

Ukuyeka i-lactation akuphuculi ukuxela kwangaphambili kukamama.

Umhlaza webele awubonakali ukulimaza usana olungekazalwa.

Iiseli zomhlaza webele zibonakala zingadluli kumama ziye kosana olungekazalwa.

Ukukhulelwa kubonakala ngathi akuchaphazeli ukuhlala kwabasetyhini abanomhlaza webele ngaphambili.

Kubafazi abanomhlaza wamabele, ukukhulelwa kubonakala ngathi akuchaphazeli ukuhlala kwabo. Nangona kunjalo, abanye oogqirha bacebisa ukuba owasetyhini makalinde iminyaka emi-2 emva konyango lomhlaza wamabele ngaphambi kokuzama ukuba nomntwana, ukuze nakuphi na ukubuya komhlaza kwangoko kufumaneke. Oku kunokuchaphazela isigqibo somfazi sokukhulelwa. Usana olungekazalwa alubonakali luchaphazeleka ukuba umama wakhe wayenomhlaza wamabele.

Ukufunda ngakumbi ngoMhlaza weSifuba ngexesha lokukhulelwa

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga nomhlaza webele ngexesha lokukhulelwa, bona oku kulandelayo:

• Umhlaza webele iphepha lasekhaya

• Uthintelo loMhlaza webele

• Uvavanyo lomhlaza webele

• Ukhetho lotyando lwabasetyhini abane-DCIS okanye umhlaza webele

• IiDense Breast: Iimpendulo zemibuzo edla ngokubuzwa

• Iziyobisi ezivunyiweyo kuMhlaza weSifuba

Ngolwazi lomhlaza ngokubanzi kunye nezinye izixhobo ezivela kwiNational Cancer Institute, jonga oku kulandelayo:

• Malunga noMhlaza

• Ukuqokelela

• I-Chemotherapy kunye nawe: Inkxaso yabantu abanomdlavuza

• Unyango ngemitha kunye nawe: Inkxaso yabantu abanomhlaza

• Ukujamelana noMhlaza

• Imibuzo yokubuza ugqirha wakho malunga neCancer

• Abasindileyo kunye nabaNonopheli