Types/breast/paget-breast-fact-sheet

Isifo SePaget Sesifuba

Siyini isifo sePaget sesifuba?

Isifo se-Paget sesifuba (esaziwa nangokuthi isifo se-Paget sesingono kanye nesifo se-mammary Paget) wuhlobo lomdlavuza olungavamile olubandakanya isikhumba sengono futhi, imvamisa, isiyingi esimnyama sesikhumba esisizungezile, esibizwa nge-areola. Iningi labantu abanesifo sePaget sesifuba nabo banesicubu esisodwa noma ngaphezulu ngaphakathi kwesifuba esifanayo. Lezi zicubu zesifuba zingaba yi-ductal carcinoma in situ noma umdlavuza webele ongenayo (1-3).

Isifo sePaget sesifuba siqanjwa ngodokotela waseBrithani wekhulu le-19 uSir James Paget, okwathi, ngo-1874, waphawula ubudlelwano phakathi kokushintshwa kwengono nomdlavuza webele. (Ezinye izifo eziningana ziqanjwe ngoSir James Paget, kufaka phakathi isifo sePaget samathambo kanye nesifo se-extramammary Paget, esihlanganisa isifo sePaget sesitho sangasese kanye nesifo sePaget sowesilisa. Lezi ezinye izifo azihlobene nesifo sePaget sebele. Leli qiniso Ishidi likhuluma ngesifo sePaget kuphela sesifuba.)

Amaseli amabi abizwa ngamaseli wePaget awuphawu olutshelayo lwesifo sePaget sesifuba. Lawa maseli atholakala ku-epidermis (ungqimba ongaphezulu) wesikhumba sengono kanye ne-areola. Amaseli we-Paget avame ukubonakala enkulu, eyindilinga ngaphansi kwesibonakhulu; zingatholwa njengamaseli angashadile noma njengamaqembu amancane amaseli ngaphakathi kwe-epidermis.

Ngubani othola isifo sePaget sesifuba?

Isifo sePaget sesifuba senzeka kwabesifazane nakwabesilisa, kepha izimo eziningi zenzeka kwabesifazane. Cishe iphesenti eli-1 kuye kwele-4 lazo zonke izimo zomdlavuza webele nazo zibandakanya isifo sePaget sesifuba. Isilinganiso seminyaka yokuxilongwa siyiminyaka engama-57, kepha lesi sifo sitholakale kwabasakhulayo nakubantu abaseminyakeni yabo yama-80s (2, 3).

Yini ebangela isifo sePaget sesifuba?

Odokotela abaqondi ngokugcwele ukuthi yini ebanga isifo sePaget sesifuba. Umbono owamukelwa kakhulu ukuthi amangqamuzana omdlavuza asuka isimila ngaphakathi kwesifuba ahamba ngemigudu yobisi aye engonweni nase-areola. Lokhu kuzochaza ukuthi kungani isifo sePaget sesifuba nezicubu ngaphakathi kwesifuba esifanayo cishe kutholakala njalo ndawonye (1, 3).

Umbono wesibili ukuthi amaseli engonweni noma e-areola aba nomdlavuza ngokwawo (1, 3). Lokhu kuzochaza ukuthi kungani abantu abambalwa besiba nesifo sePaget sesifuba ngaphandle kokuthola isimila esifubeni esifanayo. Ngaphezu kwalokho, kungenzeka ukuthi isifo sePaget sesifuba nezicubu ngaphakathi kwebele elifanayo zikhule ngokuzimela (1).

Ziyini izimpawu zesifo sePaget sesifuba?

Izimpawu zesifo se-Paget sesifuba zivame ukuphutha ngenxa yezimo ezithile zesikhumba ezinobungozi, njenge-dermatitis noma i-eczema (1-3). Lezi zimpawu zingafaka okulandelayo:

• Ukulunywa, ukuncinza, noma ubomvu engonweni kanye / noma ku-areola

• Isikhumba esishubile, esigaxekile, noma esijiyile on noma ezungeze ingono

• Ingono eyisicaba

• Ukukhishwa engonweni okungenzeka kube phuzi noma kunegazi

Ngoba izimpawu zokuqala zesifo sePaget sesifuba zingaphakamisa isimo sesikhumba esibi, futhi ngoba lesi sifo asivamile, singase singatholakali kahle ekuqaleni. Abantu abanesifo sePaget sesifuba bavame ukuba nezimpawu ezinyangeni ezimbalwa ngaphambi kokutholakala kahle.

Sitholakala kanjani isifo sePaget sesifuba?

Ingono ye-biopsy ivumela odokotela ukuthi bahlolisise kahle isifo sePaget sesifuba. Kunezinhlobo eziningana ze-biopsy yengono, kufaka phakathi izinqubo ezichazwe ngezansi.

• I-Surface biopsy: Isilayidi sengilazi noma elinye ithuluzi lisetshenziselwa ukuklwebha ngobumnene amaseli ebusweni besikhumba.

• Shave biopsy: Ithuluzi elifana nensingo lisetshenziselwa ukususa ungqimba oluphezulu lwesikhumba.

• I-Punch biopsy: Ithuluzi lokusika eliyindilinga, elibizwa ngokuthi i-punch, lisetshenziselwa ukususa isicubu esime njenge-disk.

• I-Wedge biopsy: I-scalpel isetshenziselwa ukususa isigaxa esincane sezicubu.

Kwezinye izimo, odokotela bangasusa yonke ingono (1). Isazi sezifo bese sihlola amaseli noma izicubu ngaphansi kwesibonakhulu ukubheka amaseli wePaget.

Iningi labantu abanesifo sePaget sesifuba naso sinesicubu esisodwa noma ngaphezulu ngaphakathi kwesifuba esifanayo. Ngaphezu koku-oda i-biopsy yengono, udokotela kufanele enze ukuhlolwa kwebele lomtholampilo ukuze ahlole izigaxa noma olunye ushintsho lwebele. Abantu abangamaphesenti angama-50 abanesifo sePaget sesifuba banesigaxa sesifuba esizwakala ekuhlolweni kwebele lomtholampilo. Udokotela anga-oda ezinye izivivinyo zokuxilonga, njenge-mammogram yokuxilonga, ukuhlolwa kwe-ultrasound, noma ukuskena kwe-imagination resonance imaging ukubheka izicubu ezingenzeka (1, 2).

Selashwa kanjani isifo sePaget sesifuba?

Sekuyiminyaka eminingi i-mastectomy, ngokususwa noma ngaphandle kwama-lymph node ngaphansi kwengalo ngasohlangothini olufanayo lwesifuba (esaziwa njenge-axillary lymph node dissection), ibithathwa njengokuhlinzwa okujwayelekile kwesifo sePaget sesifuba (3, 4). Lolu hlobo lokuhlinzwa lwenziwa ngoba iziguli ezinesifo sePaget sesifuba zazitholakala cishe njalo zinesifo esisodwa noma eziningi ngaphakathi esifubeni esifanayo. Noma ngabe bekukhona isimila esisodwa kuphela, leso simila besingatholwa ngamasentimitha amaningana kude nengono kanye ne-areola futhi besingasuswa ngokuhlinzwa kungono kanye nase-areola kuphela (1, 3, 4).

Ucwaningo lukhombisile, nokho, ukuthi ukuhlinzekwa kokugcina amabele okubandakanya ukususwa kwengono kanye ne-areola, kulandelwe ukwelashwa ngemisebe yebele lonke, kuyindlela ephephile kubantu abanesifo sePaget sesifuba abangenaso isigaxa esibambekayo emabeleni abo futhi ama-mammograms akhe angavezi isimila (3-5).

Abantu abanesifo sePaget sesifuba abane-tumor yesifuba futhi abane-mastectomy kufanele banikezwe i-sentinel lymph node biopsy ukubona ukuthi umdlavuza ususabalele kuma-lymph node e-axillary. Uma amangqamuzana omdlavuza atholakala kuma-lymph node (s) e-sentinel, kungadingeka ukuhlinzekwa kwe-lymph node ebanzi (1, 6, 7). Ngokuya ngesiteji nezinye izici zesimila sesifuba esingaphansi (ngokwesibonelo, ukuba khona noma ukungabikhona kokubandakanyeka kwe-lymph node, i-estrogen ne-progesterone receptors kumaseli wesimila, kanye ne-HER2 protein overexpression kumaseli we-tumor), ukwelashwa okunciphisayo, okubandakanya i-chemotherapy kanye / noma ukwelashwa kwamahomoni, nakho kunganconywa.

Siyini isibikezelo kubantu abane-Paget isifo sesifuba?

Isibikezelo, noma umbono wabantu abanezifo zesifuba sePaget kuncike ezintweni ezahlukahlukene, kufaka phakathi okulandelayo:

• Noma ngabe isimila sikhona noma cha esifubeni esithintekile

• Uma kukhona izicubu esisodwa noma eziningi esifubeni esithintekile, noma ngabe lezo zicubu ziyi-ductal carcinoma in situ noma umdlavuza webele

• Uma umdlavuza webele owonakalisayo ukhona esifubeni esithintekile, isigaba salowo mdlavuza

Ukuba khona komdlavuza ongenayo esifubeni esithintekile nokusabalala komdlavuza kuma-lymph node aseduze kuhlotshaniswa nokusinda okunciphile.

Ngokusho kohlelo lwe-NCI's Surveillance, Epidemiology, ne-End Results, ukusinda kweminyaka emihlanu kubo bonke abesifazane base-United States abatholakala ukuthi bane-Paget isifo sesifuba phakathi kuka-1988 no-2001 kwakungamaphesenti angama-82.6. Lokhu kuqhathaniswa nokusinda kwesihlobo seminyaka emihlanu kwamaphesenti angama-87.1 kwabesifazane abatholakala benanoma yiluphi uhlobo lomdlavuza webele. Kwabesifazane abanezifo zombili zePaget zesifuba kanye nomdlavuza ongenayo esifubeni esifanayo, ukusinda kwesihlobo kweminyaka emihlanu kwehle ngesigaba esandayo somdlavuza (isigaba I, 95.8%; isigaba II, 77.7%; isigaba III, 46.3%; isigaba IV, amaphesenti ayi-14.3) (1, 3, 8, 9).

Yiziphi izifundo zocwaningo eziqhubekayo ngesifo sePaget sesifuba?

Izivivinyo zomtholampilo ezilawulwa ngokungahleliwe, ezibhekwa njenge "standard yegolide" ocwaningweni lomdlavuza, kunzima ukwenzelwa isifo sePaget sesifuba ngoba bambalwa kakhulu abantu abanalesi sifo (4, 10). Kodwa-ke, abantu abanesifo sePaget sesifuba bangafanelekela ukubhalisa ezivivinyweni zomtholampilo ukuze bahlole ukwelashwa okusha komdlavuza webele ngokujwayelekile, izindlela ezintsha zokusebenzisa ukwelashwa komdlavuza webele okukhona, noma amasu okuvimbela ukuphindeka komdlavuza webele.

Imininingwane mayelana nokwelashwa komdlavuza wamabele ukuhlolwa kwamakliniki iyatholakala ngokusesha uhlu lwe-NCI lokuhlolwa komdlavuza komdlavuza. Ngenye indlela, shayela Isikhungo Sokuxhumana se-NCI ku-1-800-4-CANCER (1-800-422-6237) ukuthola ulwazi mayelana nokuhlolwa kwemitholampilo kubantu abane-Paget isifo sesifuba.

Izinkomba ezikhethiwe

1. Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
2. Caliskan M, Gatti G, Sosnovskikh I, et al. Paget's disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Research and Treatment 2008;112(3):513–521. [PubMed Abstract]
3. Kanitakis J. Mammary and extramammary Paget's disease. Journal of the European Academy of Dermatology and Venereology 2007;21(5):581–590. [PubMed Abstract]
4. Kawase K, Dimaio DJ, Tucker SL, et al. Paget's disease of the breast: there is a role for breast-conserving therapy. Annals of Surgical Oncology 2005;12(5):391–397. [PubMed Abstract]
5. Marshall JK, Griffith KA, Haffty BG, et al. Conservative management of Paget disease of the breast with radiotherapy: 10- and 15-year results. Cancer 2003;97(9):2142–2149. [PubMed Abstract]
6. Sukumvanich P, Bentrem DJ, Cody HS, et al. The role of sentinel lymph node biopsy in Paget's disease of the breast. Annals of Surgical Oncology 2007;14(3):1020–1023. [PubMed Abstract]
7. Laronga C, Hasson D, Hoover S, et al. Paget's disease in the era of sentinel lymph node biopsy. American Journal of Surgery 2006;192(4):481–483. [PubMed Abstract]
8. Ries LAG, Eisner MP. Cancer of the Female Breast. In: Ries LAG, Young JL, Keel GE, et al., editors. SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988–2001, Patient and Tumor Characteristics. Bethesda, MD: National Cancer Institute, SEER Program, 2007. Retrieved April 10, 2012.
9. Chen CY, Sun LM, Anderson BO. Isifo sePaget sesifuba: ukushintsha amaphethini ezehlakalo, ukwethulwa komtholampilo, kanye nokwelashwa e-US Cancer 2006; 107 (7): 1448-1458. [I-PubMed Abstract]
10. UJoseph KA, Ditkoff BA, Estabrook A, et al. Izinketho zokwelashwa kwesifo sikaPaget: isikhungo esisodwa isifundo sokulandela isikhathi eside. I-Breast Journal 2007; 13 (1): 110-111. [I-PubMed Abstract]