Izinhlobo / isifuba / isiguli / umuntu omdala / ukwelashwa kwamabele-pdq

Inguqulo Ye-Cancer Treatment (Adult)

Imininingwane Jikelele Ngomdlavuza Webele

AMAPHUZU ASEMQOKA

• Umdlavuza webele yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zesifuba.

• Umlando womndeni womdlavuza webele nezinye izinto zandisa ingozi yomdlavuza webele.

• Umdlavuza webele kwesinye isikhathi ubangelwa ukushintshwa kwezakhi zofuzo (izinguquko).

• Ukusetshenziswa kwemithi ethile nezinye izinto kunciphisa ingozi yomdlavuza webele.

• Izimpawu zomdlavuza webele zifaka phakathi isigaxa noma ushintsho ebeleni.

• Ukuhlolwa okuhlola amabele kusetshenziselwa ukuthola (ukuthola) nokuthola umdlavuza webele.

• Uma umdlavuza utholakala, ukuhlolwa kuyenziwa ukutadisha amangqamuzana omdlavuza.

• Izici ezithile zithinta ukubikezela (ithuba lokululama) kanye nezinketho zokwelashwa.

Umdlavuza webele yisifo lapho amangqamuzana abulalayo (umdlavuza) akha izicubu zesifuba.

Isifuba sakhiwe ngama-lobes namapayipi. Ibele ngalinye linezigaba eziyi-15 kuya kwezingu-20 ezibizwa ngama-lobes. I-lobe ngayinye inezigaba eziningi ezincane ezibizwa ngama-lobules. AmaLobules aphela ngama-bulb amancane amaningi angenza ubisi. Ama-lobes, ama-lobules, nama-bulb axhumene namashubhu amancane abizwa ngokuthi ama-ducts.

I-anatomy yesifuba sowesifazane. Ingono ne-areola kuboniswa ngaphandle kwebele. Ama-lymph node, ama-lobes, ama-lobules, ama-ducts, nezinye izingxenye zangaphakathi zesifuba nazo ziyaboniswa.

Isifuba ngasinye sinemithambo yegazi nemithambo yegazi. Izitsha ze-lymph zithwala uketshezi olungenambala, olunamanzi olubizwa ngokuthi i-lymph. Imikhumbi ye-lymph ithwala i-lymph phakathi kwama-lymph node. Ama-lymph node mancane, amise okwenziwe ngobhontshisi atholakala emzimbeni wonke. Bahlunga ama-lymph bese begcina amaseli amhlophe egazi asiza ukulwa nokutheleleka nezifo. Amaqembu ama-lymph node atholakala eduze kwesifuba ku-axilla (ngaphansi kwengalo), ngenhla kokhololo, nasesifubeni.

Uhlobo oluvame kakhulu lomdlavuza webele yi-ductal carcinoma, eqala kumaseli wamapayipi. Umdlavuza oqala kuma-lobes noma ama-lobules ubizwa ngokuthi yi-lobular carcinoma futhi uvame ukutholakala kuwo womabili amabele kunezinye izinhlobo zomdlavuza webele. Umdlavuza webele wokuvuvukala wuhlobo lomdlavuza webele ongajwayelekile lapho isifuba sifudumele, sibomvu, futhi sivuvukile.

Bona izifinyezo ezilandelayo ze- ukuthola eminye imininingwane ngomdlavuza webele:

• Ukuvimbela Umdlavuza Webele

• Ukuhlolwa Komdlavuza Webele

• Ukwelashwa Komdlavuza Webele Ngesikhathi Sokukhulelwa

• Ukwelashwa Komdlavuza Webele Wesilisa

• Ukwelashwa Komdlavuza Webele Wengane

Umlando womndeni womdlavuza webele nezinye izinto zandisa ingozi yomdlavuza webele.

Noma yini eyandisa amathuba akho okuthola isifo ibizwa ngokuthi ingozi. Ukuba nengcuphe akusho ukuthi uzothola umdlavuza; ukungabi nezici zobungozi akusho ukuthi ngeke uthole umdlavuza. Khuluma nodokotela wakho uma ucabanga ukuthi ungaba sengozini yomdlavuza webele.

Izici ezinobungozi zomdlavuza webele zifaka okulandelayo:

• Umlando womuntu siqu wesifo somdlavuza webele, i-ductal carcinoma in situ (DCIS), noma i-lobular carcinoma in situ (LCIS).

• Umlando womuntu siqu wesifo sesifuba esingenabisi (esingenomdlavuza).

• Umlando womndeni womdlavuza webele esihlotsheni sokuqala (umama, indodakazi, noma udadewabo).

• Izinguquko ezizuzwe njengefa kuzakhi zofuzo ze-BRCA1 noma ze-BRCA2 noma kwezinye izakhi zofuzo ezandisa ingozi yomdlavuza webele.

• Izicubu zamabele eziminyene ku-mammogram.

• Ukuvezwa kwezicubu zesifuba ku-estrogen eyenziwe ngumzimba. Lokhu kungabangelwa:

• Ukuya esikhathini usemncane.

• Ubudala ekuzalweni kokuqala noma ungakaze ubelethe.

• Ukuqala ukuya esikhathini esikhathini esizayo.

• Ukuthatha ama-hormone afana ne-estrogen ahlanganiswe ne-progestin yezimpawu zokunqamuka kokuya esikhathini.

• Ukwelashwa ngemithi yokwelashwa ngemisebe esifubeni / esifubeni.

• Ukuphuza utshwala.

• Ukukhuluphala ngokweqile.

Ukuguga kuyisici esiyinhloko sengozi yomdlavuza amaningi. Ithuba lokuthola umdlavuza liyakhula njengoba ukhula.

Ithuluzi Lokuhlola Ubungozi Bomdlavuza Webele le-NCI lisebenzisa izici zobungozi besifazane ukulinganisa ubungozi bomdlavuza webele phakathi neminyaka emihlanu ezayo kuze kufike eminyakeni engama-90. Leli thuluzi eliku-inthanethi lenzelwe ukuthi lisetshenziswe ngumhlinzeki wezokunakekelwa kwempilo. Ukuthola eminye imininingwane ngengozi yomdlavuza webele, shayela ku-1-800-4-CANCER.

Umdlavuza webele kwesinye isikhathi ubangelwa ukushintshwa kwezakhi zofuzo (izinguquko).

Izakhi zofuzo ezisemangqamuzaneni ziphethe imininingwane etholwe kubazali bomuntu. Umdlavuza webele owenziwe ngefa wenza cishe u-5% kuya ku-10% wawo wonke umdlavuza webele. Ezinye izakhi zofuzo eziguquliwe ezihlobene nomdlavuza webele zivame kakhulu emaqenjini athile ezinhlanga.

Abesifazane abanezinguquko ezithile zofuzo, njengokuguquka kwe-BRCA1 noma i-BRCA2, banengozi eyengeziwe yomdlavuza webele. Laba besifazane futhi banengozi eyengeziwe yomdlavuza we-ovari, futhi bangaba nengozi eyengeziwe yamanye umdlavuza. Amadoda anesakhi sofuzo esiguqukile esihlobene nomdlavuza webele nawo anengozi eyengeziwe yomdlavuza webele. Ngeminye imininingwane, bheka isifinyezo se- mayelana nokwelashwa komdlavuza webele wesilisa.

Kukhona izivivinyo ezingathola (thola) izakhi zofuzo eziguquliwe. Lezi zivivinyo zofuzo kwesinye isikhathi zenzelwa amalungu emindeni anengozi enkulu yomdlavuza. Bona isifinyezo se- ku-Genetics of Breast and Gynecologic Cancers ukuthola eminye imininingwane.

Ukusetshenziswa kwemithi ethile nezinye izinto kunciphisa ingozi yomdlavuza webele.

Noma yini enciphisa ithuba lakho lokuthola isifo ibizwa ngokuthi yisici sokuvikela.

Izici zokuvikela umdlavuza webele zifaka okulandelayo:

• Ukuthatha noma ikuphi kokulandelayo:

• Ukwelashwa kwe-hormone kuphela kwe-estrogen ngemuva kwe-hysterectomy.

• Ama-modulators we-estrogen receptor akhethiwe (ama-SERM).

• I-Aromatase inhibitors.

• Ukuvezwa okuncane kwezicubu zesifuba ku-estrogen eyenziwe ngumzimba. Lokhu kungaba umphumela we:

• Ukukhulelwa kwasekuqaleni.

• Ukuncelisa ibele.

• Ukuzivocavoca umzimba ngokwanele.

• Ukuba nanoma iyiphi yalezi zinqubo ezilandelayo:

• I-Mastectomy ukunciphisa ingozi yomdlavuza.

• I-Oophorectomy ukunciphisa ingozi yomdlavuza.

• Ukukhishwa kwe-ovari.

Izimpawu zomdlavuza webele zifaka phakathi isigaxa noma ushintsho ebeleni.

Lezi kanye nezinye izimpawu zingabangelwa umdlavuza webele noma ezinye izimo. Buza nodokotela wakho uma unokunye kwalokhu okulandelayo:

• Isigaxa noma ukuqina esifubeni noma eduze kwaso noma endaweni engaphansi.

• Ushintsho kusayizi noma ekubunjweni kwebele.

• I-dimple noma i-puckering esikhumbeni sebele.

• Ingono yajika yangena ebeleni.

• Uketshezi, ngaphandle kobisi lwebele, oluvela engonweni, ikakhulukazi uma kunegazi.

• Isikhumba esibomvu, esibomvu, noma esivuvukele esifubeni, engonweni, noma e-areola (indawo emnyama yesikhumba ezungeze ingono).

• Ama-dimples esifubeni abukeka njengesikhumba se-orange, okuthiwa i-peau d'orange.

Ukuhlolwa okuhlola amabele kusetshenziselwa ukuthola (ukuthola) nokuthola umdlavuza webele.

Buza nodokotela wakho uma ubona noma yiziphi izinguquko emabeleni akho. Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

• Ukuhlolwa komzimba kanye nomlando wezempilo: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi nokuhlola izimpawu zezifo, njengezigaxa noma yini enye ebonakala ingajwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.

• Ukuhlolwa kwebele lomtholampilo (i-CBE): Ukuhlolwa kwesifuba ngudokotela noma omunye uchwepheshe wezempilo. Udokotela uzokuzwa ngokucophelela amabele nangaphansi kwezingalo ukuthola izigaxa noma yini enye ebonakala ingajwayelekile.

• I-Mammogram: I-x-ray yebele.

Isimame. Isifuba sicindezelwe phakathi kwamapuleti amabili. Ama-X-ray asetshenziselwa ukuthatha izithombe zezicubu zamabele.

• Ukuhlolwa kwe-Ultrasound: Inqubo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi noma izitho bese enza ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Isithombe singaphrintwa ukuze sibhekwe ngokuhamba kwesikhathi.

• I-MRI (imaging resonance imaging): Inqubo esebenzisa uzibuthe, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yawo womabili amabele. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

• Izifundo ze-chemistry yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho nezicubu zomzimba. Inani elingavamile (eliphakeme noma eliphansi kunokujwayelekile) lezinto kungaba uphawu lwesifo.

• I-Biopsy: Ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuhlola izimpawu zomdlavuza. Uma kutholakala isigaxa esifubeni, kungenziwa i-biopsy.

Kunezinhlobo ezine ze-biopsy ezisetshenziselwa ukuhlola umdlavuza webele:

• I-Biopsy e-Excisional: Ukususwa kwesigaxa sonke sezicubu.

• I-incisional biopsy: Ukususwa kwengxenye yesigaxa noma isampula lezicubu.

• I-Core biopsy: Ukususwa kwezicubu kusetshenziswa inaliti ebanzi.

• I-Fine-needle aspiration (FNA) biopsy: Ukususwa kwezicubu noma uketshezi, kusetshenziswa inaliti ezacile.

Uma umdlavuza utholakala, ukuhlolwa kuyenziwa ukutadisha amangqamuzana omdlavuza.

Izinqumo mayelana nokwelashwa okuhle zisuselwa emiphumeleni yalezi zivivinyo. Ukuhlolwa kunikeza imininingwane mayelana:

• usheshe ukhule umdlavuza.

• maningi kangakanani amathuba okuthi umdlavuza uzosabalala emzimbeni wonke.

• ukuthi ukwelashwa okuthile kungasebenza kanjani.

• kungenzeka kanjani ukuthi umdlavuza uphinde ubuye (ubuye).

Ukuhlolwa kufaka okulandelayo:

• Ukuhlolwa kwe-Estrogen ne-progesterone receptor: Isivivinyo sokulinganisa inani le-estrogen ne-progesterone (hormone) receptors ezicutshini zomdlavuza. Uma kukhona ama-estrogen amaningi ne-progesterone receptors kunokujwayelekile, umdlavuza ubizwa nge-estrogen kanye / noma i-progesterone receptor positive. Lolu hlobo lomdlavuza webele lungakhula ngokushesha okukhulu. Imiphumela yokuhlolwa ikhombisa ukuthi ukwelashwa ukuvimba i-estrogen ne-progesterone kungamisa umdlavuza ekukhuleni.

• Ukuhlolwa kwe-human epidermal factor factor 2 receptor (HER2 / neu) test: Ukuhlolwa kwelabhoratri ukukala ukuthi zingaki izakhi zofuzo ze-HER2 / neu nokuthi amaprotheni we-HER2 / neu angakanani enziwa kusampula lesicubu. Uma kunezakhi zofuzo eziningi ze-HER2 / neu noma amazinga aphezulu we-HER2 / neu protein kunokujwayelekile, umdlavuza ubizwa nge-HER2 / neu positive. Lolu hlobo lomdlavuza webele lungakhula ngokushesha futhi lunamathuba amaningi okusabalala kwezinye izingxenye zomzimba. Umdlavuza ungaphathwa ngemithi ekhomba amaprotheni we-HER2 / neu, njenge-trastuzumab ne-pertuzumab.

• Ukuhlolwa kwe-Multigene: Ukuhlolwa lapho kufundwa amasampula wezicubu ukubheka ukusebenza kofuzo oluningi ngasikhathi sinye. Lezi zivivinyo zingasiza ukuqagula ukuthi umdlavuza uzosabalala uye kwezinye izingxenye zomzimba noma uphinde ubuye (ubuye).

Kunezinhlobo eziningi zokuhlolwa kwe-multigene. Ukuhlolwa okulandelayo okuhlukahlukene kuye kwafundwa ezivivinyweni zokwelashwa:

• I-Oncotype DX: Lokhu kuhlolwa kusiza ukubikezela ukuthi ngabe umdlavuza webele webanga lokuqala okuyi-estrogen receptor omuhle futhi we-node negative uzosakazeka kwezinye izingxenye zomzimba. Uma ingozi yokuthi umdlavuza uzosakazeka uphezulu, i-chemotherapy inganikezwa ukwehlisa ubungozi.

• I-MammaPrint: Isivivinyo selabhorethri lapho umsebenzi wezakhi zofuzo ezahlukahlukene ezingama-70 ubhekwa kuzicubu zomdlavuza webele zabesifazane abanomdlavuza webele wesifo sokuqala ongakasakazeli kuma-lymph node noma osabalale kuma-lymph node amathathu noma ambalwa. Izinga lomsebenzi walezi zofuzo lisiza ukubikezela ukuthi umdlavuza webele uzosabalala uye kwezinye izingxenye zomzimba noma ubuye. Uma ukuhlolwa kukhombisa ukuthi ubungozi bokuthi umdlavuza uzosabalala noma ubuye buphezulu, i-chemotherapy inganikezwa ukwehlisa ubungozi.

Ngokuya ngalezi zivivinyo, umdlavuza webele uchazwa njengenye yezinhlobo ezilandelayo:

• I-Hormone receptor positive (i-estrogen kanye / noma i-progesterone receptor positive) noma i-hormone receptor negative (i-estrogen kanye / noma i-progesterone receptor engeyona).

• I-HER2 / neu positive noma i-HER2 / neu negative.

• I-Triple negative (i-estrogen receptor, i-progesterone receptor, ne-HER2 / neu negative).

Lolu lwazi lusiza udokotela ukuthi anqume ukuthi imiphi imishanguzo ezosebenza kangcono kakhulu kumdlavuza wakho.

Izici ezithile zithinta ukubikezela (ithuba lokululama) kanye nezinketho zokwelashwa.

Izinketho zokubikezela nokwelashwa zincike kokulandelayo:

• Isigaba somdlavuza (ubukhulu besimila nokuthi ngabe sisesifubeni kuphela noma sisabalalele kuma-lymph node noma kwezinye izindawo emzimbeni).

• Uhlobo lomdlavuza webele.

• Ama-receptor e-estrogen ne-progesterone receptor ezicutshini zesimila.

• Izinga lomuntu lokukhula kohlobo lwe-2 epidermal factor (HER2 / neu) kuzicubu zesimila.

• Noma ngabe izicubu zesimila zinama-negative amathathu (amaseli angenawo ama-estrogen receptors, ama-progesterone receptors, noma amazinga aphezulu we-HER2 / neu).

• Sikhula ngokushesha kangakanani isimila.

• Kungenzeka kanjani ukuthi isimila siphinde sibuye (sibuyele emuva).

• Iminyaka yowesifazane, impilo ejwayelekile, kanye nesimo sokuya esikhathini (noma ngabe owesifazane usaya esikhathini yini).

• Ukuthi umdlavuza usanda kutholakala noma usuphindile (buyela emuva).

Izigaba Zomdlavuza Webele

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala komdlavuza webele, kwenziwa ukuhlolwa ukuze kutholakale ukuthi ngabe amangqamuzana omdlavuza asabalele ebeleni noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

• Emdlavuzeni webele, isigaba sisekelwe ebungwini nasendaweni yesimila sokuqala, ukusabalala komdlavuza kuma-lymph node aseduze noma kwezinye izingxenye zomzimba, ebangeni lesimila, nokuthi ngabe kukhona ama-biomarker athile.

• Uhlelo lwe-TNM lusetshenziselwa ukuchaza ubukhulu besimila sokuqala nokusabalala komdlavuza kuma-lymph node aseduze noma kwezinye izingxenye zomzimba.

• Isimila (iTrojan). Usayizi nendawo yesimila.

• I-Lymph Node (N). Usayizi nendawo yama-lymph node lapho umdlavuza usabalale khona.

• I-Metastasis (M). Ukusabalala komdlavuza kwezinye izingxenye zomzimba.

• Uhlelo lokulinganisa lusetshenziselwa ukuchaza ukuthi isimila sesifuba singakhula futhi sisakazeke ngokushesha okungakanani.

• Ukuhlolwa kwe-Biomarker kusetshenziselwa ukuthola ukuthi ngabe amangqamuzana omdlavuza webele anama-receptors athile.

• Uhlelo lwe-TNM, uhlelo lokugreda, kanye nesimo se-biomarker kuhlanganisiwe ukuthola isigaba somdlavuza webele.

• Khuluma nodokotela wakho ukuthola ukuthi yisiphi isigaba sakho somdlavuza webele nokuthi sisetshenziswa kanjani ukukuhlelela ukwelashwa okungcono kakhulu.

• Ukwelashwa komdlavuza webele kuncike esigabeni sesifo.

Ngemuva kokutholakala komdlavuza webele, kwenziwa ukuhlolwa ukuze kutholakale ukuthi ngabe amangqamuzana omdlavuza asabalele ebeleni noma kwezinye izingxenye zomzimba.

Inqubo esetshenzisiwe ukuthola ukuthi umdlavuza ususabalele ngaphakathi kwebele noma kwezinye izingxenye zomzimba ibizwa ngokuthi yi-staging. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa. Imiphumela yolunye uvivinyo olusetshenziselwa ukuxilonga umdlavuza webele nayo isetshenziselwa ukufaka lesi sifo. (Bheka isigaba semininingwane ejwayelekile.)

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa kunqubo yokubeka iziteji:

• I-Sentinel lymph node biopsy: Ukususwa kwe-sentinel lymph node ngesikhathi sokuhlinzwa. I-sentinel lymph node iyisakhi sokuqala se-lymph eqenjini lama-lymph node ukuthola i-lymphatic drainage evela ku-tumor yokuqala. Kuyi-lymph node yokuqala umdlavuza ongahle usabalale uye kusukela kusimila sokuqala. Kufakwa into enemisebe kanye / noma udayi oluhlaza okwesibhakabhaka eduze kwesimila. Into noma udayi ugeleza ngemigudu ye-lymph uye kuma-lymph node. I-lymph node yokuqala yokwamukela into noma udayi iyasuswa. Isazi sezifo sibheka izicubu ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza. Uma amangqamuzana omdlavuza engatholakali, kungahle kungadingeki ukususa ama-lymph node amaningi. Kwesinye isikhathi, i-sentinel lymph node itholakala eqenjini elingaphezu kwelilodwa lama-node.

• I-x-ray yesifuba: I-x-ray yezitho namathambo ngaphakathi kwesifuba. I-x-ray uhlobo lwesigongolo samandla esingangena emzimbeni nasefilimini, lwenze isithombe sezindawo ezingaphakathi komzimba.

• I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, ezithathwe ezinhlangothini ezahlukene. Izithombe zenziwa yikhompyutha exhunywe kumshini we-x-ray. Idayi ingajovwa emthanjeni noma igwinywe ukusiza izitho noma izicubu zivele kahle. Le nqubo ibizwa nangokuthi i-computed tomography, i-computerized tomography, noma i-computer axial tomography.

• Ukuskena kwamathambo: Inqubo yokubheka ukuthi kunamaseli ahlukanisa ngokushesha yini, njengamaseli womdlavuza, ethanjeni. Inani elincane kakhulu lezinto ezinomsakazo lifakwa emthanjeni futhi lihambe phakathi kwegazi. Izinto ezinemisebe eqoqa emathanjeni ezinomdlavuza futhi zitholwa isithwebuli.

• I-PET scan (i-positron emission tomography scan): Inqubo yokuthola amangqamuzana abulalayo omzimba emzimbeni. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni. Isithwebuli se-PET sizungeza umzimba futhi senze isithombe lapho i-glucose isetshenziswa khona emzimbeni. Amaseli amathumba amabi abonakala ekhanya esithombeni ngoba ayasebenza futhi athatha i-glucose eningi kunamaseli avamile.

Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

Umdlavuza ungasakazeka ngezicubu, uhlelo lwe-lymph, kanye negazi:

• Izicubu. Umdlavuza usakazeka lapho uqale khona ngokukhulela ezindaweni eziseduze.

• Uhlelo lweLymph. Umdlavuza usakazeka lapho uqale khona ngokungena ohlelweni lwe-lymph. Umdlavuza udabula imithambo ye-lymph uye kwezinye izingxenye zomzimba.

• Igazi. Umdlavuza usakazeka lapho uqale khona ngokungena egazini. Umdlavuza uhamba ngemithambo yegazi uye kwezinye izingxenye zomzimba.

Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

Lapho umdlavuza usakazekela kolunye uhlangothi lomzimba, ubizwa ngokuthi yi-metastasis. Amaseli womdlavuza aqhamuka lapho aqale khona (isimila sokuqala) futhi ahamba ngohlelo lwe-lymph noma igazi.

• Uhlelo lweLymph. Umdlavuza ungena ohlelweni lwe-lymph, udabule emithanjeni ye-lymph, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.

• Igazi. Umdlavuza ungena egazini, udabule emithanjeni yegazi, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.

Isigaxa se-metastatic luhlobo olufanayo lomdlavuza njengesimila sokuqala. Isibonelo, uma umdlavuza webele usakazekela ethanjeni, amangqamuzana omdlavuza asethanjeni empeleni angamaseli omdlavuza webele. Lesi sifo umdlavuza webele we-metastatic, hhayi umdlavuza wethambo.

Emdlavuzeni webele, isigaba sisekelwe ebungwini nasendaweni yesimila sokuqala, ukusabalala komdlavuza kuma-lymph node aseduze noma kwezinye izingxenye zomzimba, ebangeni lesimila, nokuthi ngabe kukhona ama-biomarker athile.

Ukuhlela ukwelashwa okuhle kakhulu futhi uqonde ukubikezelwa kwakho, kubalulekile ukwazi isigaba somdlavuza webele.

Kunezinhlobo ezintathu zamaqembu esigaba somdlavuza webele:

• I-Clinical Prognostic Stage isetshenziswa kuqala ukwaba isigaba sazo zonke iziguli ngokususelwa kumlando wezempilo, ukuhlolwa ngokomzimba, ukuhlolwa kwe-imaging (uma kwenziwe), kanye nama-biopsies. Isigaba seClinical Prognostic Stage sichazwa ngohlelo lwe-TNM, grade tumor, kanye nesimo se-biomarker (ER, PR, HER2). Esigabeni somtholampilo, i-mammography noma i-ultrasound isetshenziselwa ukuhlola ama-lymph node ukuthola izimpawu zomdlavuza.

• I-Pathological Prognostic Stage isetshenziselwa iziguli ezihlinzwa njengokwelashwa kwazo kokuqala. IPathological Prognostic Stage isuselwe kulo lonke ulwazi lomtholampilo, isimo se-biomarker, kanye nemiphumela yokuhlolwa kwelabhorethri etholakala kwizicubu zesifuba kanye nezitho zomzimba ezisuswe ngesikhathi sokuhlinzwa.

• I-Anatomic Stage isuselwe kusayizi nasekusabalaleni komdlavuza njengoba kuchazwe uhlelo lwe-TNM. I-Anatomic Stage isetshenziswa ezingxenyeni zomhlaba lapho ukuhlolwa kwe-biomarker kungatholakali. Ayisetshenziswa e-United States.

Uhlelo lwe-TNM lusetshenziselwa ukuchaza ubukhulu besimila sokuqala nokusabalala komdlavuza kuma-lymph node aseduze noma kwezinye izingxenye zomzimba. Ngomdlavuza webele, uhlelo lwe-TNM luchaza isimila ngale ndlela elandelayo:

Isimila (iTrojan). Usayizi nendawo yesimila.

Osayizi bezicubu bavame ukulinganiswa ngamamilimitha (mm) noma amasentimitha. Izinto ezijwayelekile ezingasetshenziswa ukukhombisa usayizi wesimila ku-mm zifaka: ipensela ebukhali (1 mm), iphoyinti elisha lekhrayoni (2 mm), i-eraser ephezulu-ipensela (5 mm), ipea (10 mm), iphenathi (20 mm), kanye ne-lime (50 mm).

• I-TX: Isigaxa sokuqala asikwazi ukuhlolwa.

• I-T0: Akunasibonakaliso sesimila sokuqala ebeleni.

• I-Tis: I-Carcinoma in situ. Kunezinhlobo ezi-2 zesifuba se-carcinoma in situ:

• I-Tis (DCIS): I-DCIS yisimo lapho kutholakala khona amangqamuzana angajwayelekile emgqeni wethambo lamabele. Amaseli angajwayelekile awasakazekanga ngaphandle komsele aya kwezinye izicubu esifubeni. Kwezinye izimo, i-DCIS ingahle ibe ngumdlavuza webele owonakalisayo okwazi ukusabalala nakwezinye izicubu. Ngalesi sikhathi, ayikho indlela yokwazi ukuthi iziphi izilonda ezingaba yingozi.

• I-Tis (Isifo se-Paget): Isifo se-Paget sengono yisimo lapho kutholakala khona amaseli angajwayelekile kumaseli esikhumba sengono futhi angasakazeka e-areola. Akuhleliwe ngokwenqubo ye-TNM. Uma isifo sePaget KANYE nomdlavuza webele ongafuneki ukhona, uhlelo lwe-TNM lusetshenziselwa ukufaka umdlavuza webele owonakalisayo.

• I-T1: Isimila singamamilimitha angama-20 noma sincane. Kunezinhlayiyana ezi-4 zesimila se-T1 ngokuya ngosayizi wesimila:

• I-T1mi: isimila singamamilimitha ayi-1 noma sincane.

• I-T1a: isimila sikhulu kune-1 millimeter kepha asisikhulu kune-5 millimeter.

• I-T1b: isimila sikhulu kunamamilimitha ayi-5 kepha asisikhulu kunamamilimitha ayi-10.

• I-T1c: isimila sikhulu kunamamilimitha ayi-10 kepha asisikhulu kunamamilimitha ayi-20.

• I-T2: Isigaxa sikhulu kunamamilimitha ayi-20 kepha asisikhulu kunamamilimitha ayi-50.

• I-T3: Isigaxa sikhulu kunamamilimitha angama-50.

• I-T4: I-tumor ichazwa njengenye yezinto ezilandelayo:

• I-T4a: isimila sikhule saba udonga lwesifuba.

• I-T4b: isimila sesikhule saba isikhumba — isilonda sesakhiwe ebusweni besikhumba esifubeni, amaqhubu amancane wesigaxa akhiwe esifubeni esifanayo nesimila sokuqala, kanye / noma kukhona ukuvuvukala kwesikhumba esifubeni .

• I-T4c: isimila sikhule saba udonga lwesifuba nesikhumba.

• I-T4d: umdlavuza webele wokuvuvukala — ingxenye eyodwa kwezintathu noma ngaphezulu yesikhumba esifubeni ibomvu futhi iyavuvukala (ibizwa ngokuthi yi-peau d'orange).

I-Lymph Node (N). Usayizi nendawo yama-lymph node lapho umdlavuza usabalale khona.

Lapho ama-lymph node esuswa ngokuhlinzwa futhi efundwa ngaphansi kwesibonakhulu ngudokotela wezifo, isiteji se-pathologic sisetshenziselwa ukuchaza ama-lymph node. Ukuhlelwa kwesifo se-lymph node kuchazwe ngezansi.

• I-NX: Ama-lymph node awakwazi ukuhlolwa.

• I-N0: Akunasibonakaliso somdlavuza kuma-lymph node, noma amaqoqo amancane amaseli omdlavuza angabi ngaphezu kwamamilimitha ayi-0.2 kuma-lymph node.

• I-N1: Umdlavuza uchazwa njengokunye kokulandelayo:

• I-N1mi: umdlavuza usabalalele kwi-axillary (armpit area) lymph node futhi inkulu kune-0.2 millimeters kepha ayinkulu kune-2 millimeters.
• I-N1a: umdlavuza usabalalele ku-1 kuya ku-3 i-axillary lymph node futhi umdlavuza okungenani kwelinye lama-lymph node likhulu kunamamilimitha ama-2.
• I-N1b: umdlavuza usabalalele kuma-lymph node eduze kwesifuba ngasohlangothini olufanayo lomzimba njengesimila sokuqala, kanti umdlavuza mkhulu kune-0.2 millimeters futhi utholakala yi-sentinel lymph node biopsy. Umdlavuza awutholakali kuma-lymph node axillary.

• I-N1c: umdlavuza usabalalele ku-1 kuya ku-3 i-axillary lymph node futhi umdlavuza okungenani kwelinye lama-lymph node likhulu kunamamilimitha amabili.

Umdlavuza uphinde utholwe yi-sentinel lymph node biopsy kuma-lymph node eduze kwesifuba esifubeni ngasohlangothini olufanayo lomzimba njengesimila sokuqala.

• I-N2: Umdlavuza uchazwa njengokunye kokulandelayo:

• I-N2a: umdlavuza usabalalele kuma-lymph node angama-4 kuya kwangu-9 kanti umdlavuza okungenani kwelinye lama-lymph node ukhulu kunamamilimitha amabili.
• I-N2b: umdlavuza usabalalele kuma-lymph node eduze kwesifuba sesifuba kanti umdlavuza utholakala ngokuhlolwa kwe-imaging. Umdlavuza awutholakali kuma-lymph node e-axillary yi-sentinel lymph node biopsy noma i-lymph node dissection.

• I-N3: Umdlavuza uchazwa njengokunye kokulandelayo:

• I-N3a: umdlavuza usabalalele kuma-lymph node ayi-10 noma ngaphezulu kanti umdlavuza okungenani kwelinye lama-lymph node ukhulu kunamamilimitha ama-2, noma umdlavuza usabalele kuma-lymph node ngaphansi kwe-collarbone.

• I-N3b: umdlavuza usabalalele ku-1 kuya ku-9 i-axillary lymph node futhi umdlavuza okungenani kwelinye lama-lymph node likhulu kunamamilimitha ama-2. Umdlavuza ubuye wasabalalela kuma-lymph node eduze kwesifuba sesifuba kanti umdlavuza utholakala ngokuhlolwa kwe-imaging;

noma

umdlavuza usabalalele kuma-lymph node angama-4 kuya kwayi-9 kanye nomdlavuza okungenani kwelinye lama-lymph node likhulu kunamamilimitha amabili. Umdlavuza ubuye wasabalalela kuma-lymph node eduze kwesifuba ngasohlangothini olufanayo lomzimba njengesimila sokuqala, kanti umdlavuza mkhulu kune-0.2 millimeters futhi utholakala yi-sentinel lymph node biopsy.

• I-N3c: umdlavuza usabalalele kuma-lymph node ngaphezulu kokhololo ohlangothini olufanayo lomzimba njengesimila sokuqala.

Lapho ama-lymph node ehlolwa kusetshenziswa i-mammography noma i-ultrasound, kubizwa ngokuthi isiteji somtholampilo. Ukuhlelwa kwemitholampilo kwama-lymph node akuchazwa lapha.

I-Metastasis (M). Ukusabalala komdlavuza kwezinye izingxenye zomzimba.

• M0: Akunasibonakaliso sokuthi umdlavuza ususabalele nakwezinye izingxenye zomzimba.

• I-M1: Umdlavuza usabalalele kwezinye izingxenye zomzimba, imvamisa amathambo, amaphaphu, isibindi noma ubuchopho. Uma umdlavuza usabalalele kuma-lymph node akude, umdlavuza kuma-lymph node mkhulu kune-0.2 millimeters. Umdlavuza ubizwa ngokuthi yi-metastatic cancer cancer.

Uhlelo lokulinganisa lusetshenziselwa ukuchaza ukuthi isimila sesifuba singakhula futhi sisakazeke ngokushesha okungakanani.

Uhlelo lokugreda luchaza isimila ngokuya ngendlela okungavamile ngayo amangqamuzana omdlavuza nezicubu ezibukeka ngaphansi kwesibonakhulu nokuthi amangqamuzana omdlavuza kungenzeka ukuthi akhule futhi asakazeke ngokushesha kangakanani. Amaseli womdlavuza osezingeni eliphansi abukeka njengamaseli ajwayelekile futhi athambekele ekukhuleni nasekusabalaleni kancane kakhulu kunamaseli omdlavuza osezingeni eliphakeme. Ukuchaza ukuthi amangqamuzana omdlavuza nezicubu zawo angajwayelekile kangakanani, udokotela wezifo zengqondo uzohlola lezi zici ezintathu ezilandelayo:

• Zingakanani izicubu zesimila ezinamapayipi webele ajwayelekile.

• Usayizi nokuma kwe-nuclei kumaseli wesimila.

• Mangaki amangqamuzana ahlukanisayo akhona, okuyisilinganiso sokuthi amangqamuzana ezimila akhula futhi ahlukane ngokushesha kangakanani.

Kwisici ngasinye, udokotela wezifo unikeza amaphuzu ayi-1 kuye kwayi-3; ukuthola u- “1” kusho ukuthi amaseli nezicubu zomzimba kubukeka kufana namaseli nezicubu ezijwayelekile, kanti amaphuzu “3” asho ukuthi amaseli nezicubu kubukeka njengokungajwayelekile. Amaphuzu esici ngasinye afakwa ndawonye ukuthola amaphuzu aphelele phakathi kuka-3 no-9.

Amabanga amathathu kungenzeka:

• Ingqikithi yamaphuzu we-3 kuye ku-5: I-G1 (Ibanga eliphansi noma lihlukaniswe kahle).

• Ingqikithi yamaphuzu we-6 kuye ku-7: I-G2 (Ibanga eliPhakathi noma lihlukaniswe ngokulingene).

• Ingqikithi yamaphuzu we-8 kuye ku-9: I-G3 (Ibanga eliphakeme noma ehlukaniswe kabi).

Ukuhlolwa kwe-Biomarker kusetshenziselwa ukuthola ukuthi ngabe amangqamuzana omdlavuza webele anama-receptors athile.

Amaseli webele aphilile, namanye amangqamuzana omdlavuza webele, anama-receptors (ama-biomarkers) anamathisela kuma-hormone estrogen ne-progesterone. La mahomoni adingeka kumaseli aphilile, namanye amangqamuzana omdlavuza webele, ukuze akhule futhi ahlukane. Ukuhlola lawa ma-biomarkers, amasampula wezicubu eziqukethe amangqamuzana omdlavuza webele ayasuswa ngesikhathi se-biopsy noma sokuhlinzwa. Amasampuli ahlolwa elabhorethri ukubona ukuthi amaseli womdlavuza webele anama-estrogen noma ama-progesterone receptors.

Olunye uhlobo lwe-receptor (i-biomarker) olutholakala ebusweni bawo wonke amangqamuzana omdlavuza webele lubizwa nge-HER2. Ama-receptors e-HER2 ayadingeka ukuze amangqamuzana omdlavuza webele akhule futhi ahlukane.

Ngomdlavuza webele, ukuhlolwa kwe-biomarker kufaka okulandelayo:

• I-Estrogen receptor (ER). Uma amangqamuzana omdlavuza webele enama-estrogen receptors, amangqamuzana omdlavuza abizwa nge-ER positive (ER +). Uma amangqamuzana omdlavuza webele engenawo ama-estrogen receptors, amangqamuzana omdlavuza abizwa nge-ER negative (ER-).

• I-Progesterone receptor (PR). Uma amangqamuzana omdlavuza webele enama-progesterone receptors, amangqamuzana omdlavuza abizwa nge-PR positive (PR +). Uma amangqamuzana omdlavuza webele engenawo ama-progesterone receptors, amangqamuzana omdlavuza abizwa nge-PR negative (PR-).

• Uhlobo lwe-epidermal growth factor type 2 receptor (HER2 / neu noma i-HER2). Uma amangqamuzana omdlavuza webele enamanani amakhulu kunokujwayelekile ama-receptors we-HER2 ebusweni bawo, amangqamuzana omdlavuza abizwa nge-HER2 positive (HER2 +). Uma amangqamuzana omdlavuza webele enenani elijwayelekile le-HER2 ebusweni bawo, amangqamuzana omdlavuza abizwa nge-HER2 negative (HER2-). Umdlavuza webele we-HER2 + kungenzeka ukhule futhi uhlukane ngokushesha kunomdlavuza webele we-HER2.

Kwesinye isikhathi amangqamuzana omdlavuza webele angachazwa njengophikisayo kathathu noma omuhle kathathu.

• Ukuphindaphinda kathathu. Uma amangqamuzana omdlavuza webele engenawo ama-estrogen receptors, ama-progesterone receptors, noma inani elikhulu ukwedlula elejwayelekile lama-HER2 receptors, amangqamuzana omdlavuza abizwa ngokuphindwe kathathu.

• Ukuphindaphinda kathathu. Uma amangqamuzana omdlavuza webele enama-estrogen receptors, ama-progesterone receptors, nenani elikhulu kunalelejwayelekile lama-HER2 receptors, amangqamuzana omdlavuza abizwa ngokuthi ama-triple positive.

Kubalulekile ukwazi i-estrogen receptor, i-progesterone receptor, nesimo se-HER2 receptor ukukhetha ukwelashwa okungcono kakhulu. Kunemithi engavimba ama-receptors ukuthi anamathele kuma-hormone i-estrogen ne-progesterone bese evimba umdlavuza ukuthi ungakhuli. Eminye imishanguzo ingasetshenziswa ukuvimba ama-HER2 receptors ebusweni bamaseli omdlavuza webele futhi ayeke umdlavuza ukuthi ungakhuli.

Uhlelo lwe-TNM, uhlelo lokugreda, kanye nesimo se-biomarker kuhlanganisiwe ukuthola isigaba somdlavuza webele.

Nazi izibonelo ezi-3 ezihlanganisa uhlelo lwe-TNM, uhlelo lokugreda, kanye nesimo se-biomarker ukuthola isigaba sePathological Prognostic somdlavuza webele womuntu wesifazane owelashwa okokuqala.

Uma usayizi wesimila ungamamilimitha angama-30 (T2), ungakasakazeki kuma-lymph node (N0) aseduze, awusakazekanga ezingxenyeni ezikude zomzimba (M0), futhi uthi:

• Ibanga 1

• HER2 +

• ER-

• PR-

Umdlavuza isigaba IIA.

Uma usayizi wesimila ungama-millimitha angama-53 (T3), ususabalele kuma-lymph node (N2) ayi-4 kuya kwayi-9, awusakazekanga kwezinye izingxenye zomzimba (M0), futhi uthi:

• Ibanga 2

• HER2 +

• I-ER +

• PR-

Isimila yisigaba IIIA.

Uma usayizi wesimila ungamamilimitha angama-65 (T3), ususabalele kuma-lymph node (N1a) ama-3, usabalalele emaphashini (M1), futhi uthi:

• Ibanga 1

• HER2 +

• ER-

• PR-

Umdlavuza yisigaba IV (umdlavuza webele we-metastatic).

Khuluma nodokotela wakho ukuthola ukuthi yisiphi isigaba sakho somdlavuza webele nokuthi sisetshenziswa kanjani ukukuhlelela ukwelashwa okungcono kakhulu.

Ngemuva kokuhlinzwa, udokotela wakho uzothola umbiko we-pathology ochaza ubukhulu nendawo yesimila sokuqala, ukusabalala komdlavuza kuma-lymph node aseduze, ibanga le-tumor, nokuthi ngabe kukhona ama-biomarker athile. Umbiko we-pathology neminye imiphumela yokuhlola isetshenziselwa ukuthola isigaba sakho somdlavuza webele.

Kungenzeka ube nemibuzo eminingi. Buza udokotela wakho ukuthi akuchaze ukuthi kusetshenziswa kanjani isiteji ukunquma izindlela ezingcono zokwelapha umdlavuza wakho nokuthi ngabe kukhona yini ukuhlolwa kokwelapha okungakulungela.

Ukwelashwa komdlavuza webele kuncike esigabeni sesifo.

Ngezinketho zokwelashwa ze-ductal carcinoma in situ (DCIS), bheka iDuctal Carcinoma eSitu.

Ngezindlela zokwelashwa zesigaba I, isigaba II, isigaba IIIA, kanye nomdlavuza webele wesigaba IIable osebenzayo, bheka Umdlavuza Webele Wasekuqaleni, Wendawo, noma Osebenzayo.

Ngezinketho zokwelashwa zesigaba IIIB, isigaba IIIC esingasebenzi, kanye nomdlavuza webele wokuvuvukala, bheka Umdlavuza Webele Othuthukile Nendawo.

Ukuze uthole izinketho zokwelashwa komdlavuza obuye wabuya eduze kwendawo lapho uqale khona, bheka i-Locoregional Recurrent Breast Cancer.

Ukuze uthole izinketho zokwelashwa komdlavuza webele wesigaba IV (metastatic) noma umdlavuza webele obuye wavela kwezinye izingxenye zomzimba, bheka i-Metastatic Breast Cancer.

Umdlavuza Webele Wokuvuvukala

Emdlavuzeni webele wokuvuvukala, umdlavuza usabalele esikhunjeni sesifuba futhi isifuba sibukeka sibomvu futhi sivuvukile futhi sizizwa sifudumele. Ububomvu nokufudumala kwenzeka ngoba amangqamuzana omdlavuza avimba izitsha ze-lymph esikhumbeni. Isikhumba sebele singakhombisa nokubonakala okushintshiwe okubizwa ngokuthi yi-peau d'orange (njengesikhumba se-orange). Kungenzeka kungabi khona izigaxa ebeleni ezingazwakala. Umdlavuza webele wokuvuvukala ungaba isigaba IIIB, isigaba IIIC, noma isigaba IV.

Umdlavuza webele wokuvuvukala webele langakwesobunxele obonisa i-peau d'orange nengono eguquliwe.

Umdlavuza Webele Ophindaphindiwe

Umdlavuza webele ophindaphindiwe wumdlavuza obuye wabuya (ubuye) ngemuva kokuba welashwe. Umdlavuza ungabuya ebeleni, esikhunjeni sesifuba, odongeni lwesifuba, noma kuma-lymph node aseduze.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukene zokwelashwa kweziguli ezinomdlavuza webele.

• Izinhlobo eziyisithupha zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Ukwelashwa kweHormone

• Ukwelashwa okuhlosiwe

• I-Immunotherapy

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa komdlavuza webele kungadala imiphumela emibi.

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

• Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

• Ukuhlolwa kokulandelela kungadingeka.

Kunezinhlobo ezahlukene zokwelashwa kweziguli ezinomdlavuza webele.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezinomdlavuza webele. Ezinye izindlela zokwelapha zijwayelekile (indlela esetshenziswa njengamanje), kanti ezinye ziyahlolwa ezivivinyweni zokwelashwa. Isivivinyo somtholampilo wokwelashwa isifundo socwaningo esihloselwe ukusiza ukuthuthukisa ukwelashwa kwamanje noma ukuthola ulwazi ngezindlela zokwelashwa ezintsha zeziguli ezinomdlavuza. Lapho izivivinyo zokwelashwa zibonisa ukuthi ukwelashwa okusha kungcono kunokwelashwa okujwayelekile, ukwelashwa okusha kungaba ukwelashwa okujwayelekile. Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Izinhlobo eziyisithupha zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Iningi leziguli ezinomdlavuza webele ziyahlinzwa ukuze kususwe umdlavuza.

I-Sentinel lymph node biopsy ukususwa kwe-sentinel lymph node ngesikhathi sokuhlinzwa. I-sentinel lymph node iyisakhi sokuqala se-lymph eqenjini lama-lymph node ukuthola i-lymphatic drainage evela ku-tumor yokuqala. Kuyi-lymph node yokuqala umdlavuza ongahle usabalale uye kusukela kusimila sokuqala. Kufakwa into enemisebe kanye / noma udayi oluhlaza okwesibhakabhaka eduze kwesimila. Into noma udayi ugeleza ngemigudu ye-lymph uye kuma-lymph node. I-lymph node yokuqala yokwamukela into noma udayi iyasuswa. Isazi sezifo sibheka izicubu ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza. Uma amangqamuzana omdlavuza engatholakali, kungahle kungadingeki ukususa ama-lymph node amaningi. Kwesinye isikhathi, i-sentinel lymph node itholakala eqenjini elingaphezu kwelilodwa lama-node. Ngemuva kwe-sentinel lymph node biopsy, udokotela ohlinzayo ususa isimila esebenzisa ukuhlinzekwa kokugcina amabele noma i-mastectomy. Uma kutholakala amangqamuzana omdlavuza, ama-lymph node amaningi azosuswa ngokusikwa okuhlukile. Lokhu kubizwa ngokuthi yi-lymph node dissection.

Izinhlobo zokuhlinzwa zifaka okulandelayo:

• Ukuhlinzwa okonga amabele kungukuhlinzwa okususa umdlavuza nezicubu ezithile eziwuzungezile, kodwa hhayi isifuba uqobo. Ingxenye yolwelwesi lodonga lwesifuba nayo ingasuswa uma umdlavuza useduze kwayo. Lolu hlobo lokuhlinzwa lungabizwa nangokuthi i-lumpectomy, i-mastectomy eyingxenye, i-segmental mastectomy, i-quadrantectomy, noma ukuhlinzwa kokuncelisa amabele.

Ukuhlinzwa okulondoloza amabele. Kususwa isimila nezinye izicubu ezijwayelekile ezisizungezile, kodwa hhayi isifuba uqobo. Amanye ama-lymph node ngaphansi kwengalo angasuswa. Ingxenye yolwelwesi lodonga lwesifuba nayo ingasuswa uma umdlavuza useduze kwayo.

• Ingqikithi yemastectomy: Ukuhlinzwa ukukhipha lonke ibele elinomdlavuza. Le nqubo ibizwa nangokuthi i-mastectomy elula. Amanye ama-lymph node angaphansi kwengalo angasuswa ahlolwe umdlavuza. Lokhu kungenziwa ngasikhathi sinye nokuhlinzwa kwebele noma ngemuva. Lokhu kwenziwa ngokusika okuhlukile.

Ingqikithi (elula) ye-mastectomy. Umugqa onamachashazi ukhombisa lapho kukhishwa lonke ibele. Amanye ama-lymph node ngaphansi kwengalo nawo angasuswa.

• I-radical mastectomy eguquliwe: Ukuhlinzwa kususwe lonke ibele elinomdlavuza, ama-lymph node amaningi ngaphansi kwengalo, ulwelwesi olungaphezulu kwemisipha yesifuba, futhi kwesinye isikhathi, ingxenye yemisipha yodonga lwesifuba.

Kushintshwe i-mastectomy enamandla. Umugqa onamachashazi ukhombisa lapho kukhishwa lonke ibele namanye ama-lymph node. Ingxenye yemisipha yodonga lwesifuba nayo ingasuswa.

I-Chemotherapy inganikezwa ngaphambi kokuhlinzwa ukuze kususwe isimila. Uma unikezwa ngaphambi kokuhlinzwa, i-chemotherapy izonciphisa isimila futhi yehlise inani lezicubu ezidinga ukususwa ngesikhathi sokuhlinzwa. Ukwelashwa okunikezwa ngaphambi kokuhlinzwa kubizwa ngokuthi i-preoperative therapy noma i-neoadjuvant therapy.

Ngemuva kokuthi udokotela awususe wonke umdlavuza ongabonakala ngesikhathi sokuhlinzwa, ezinye iziguli zinganikezwa ukwelashwa ngemisebe, i-chemotherapy, i-targeted therapy, noma i-hormone therapy ngemuva kokuhlinzwa, ukubulala noma yimaphi amangqamuzana omdlavuza asele. Ukwelashwa okunikezwe ngemuva kokuhlinzwa, ukwehlisa ubungozi bokuthi umdlavuza uzobuya, kubizwa ngokuthi yi-postoperative therapy noma i-adjuvant therapy.

Uma isiguli sizoba ne-mastectomy, ukwakhiwa kabusha kwesifuba (ukuhlinzekelwa ukwakhiwa kabusha kwesifuba ngemuva kwe-mastectomy) kungacatshangelwa. Ukwakhiwa kabusha kwesifuba kungenziwa ngesikhathi se-mastectomy noma ngesikhathi esithile ngemuva. Isifuba esakhiwe kabusha singenziwa ngezicubu zesiguli uqobo (ezingezona ezesibeletho) noma ngokusebenzisa okufakelwa okugcwele i-saline noma i-gel abicah. Ngaphambi kokuba kuthathwe isinqumo sokufakelwa, iziguli zingashayela isikhungo samadivayisi ne-Radiologic Health ku-1-888-INFO-FDA (1-888-463-6332) noma vakashela iwebhusayithi ye-FDA imininingwane eminingi ngokufakwa kwamabele.

Ukwelashwa ngemisebe

Ukwelashwa ngemisebe ukwelashwa komdlavuza okusebenzisa amandla amakhulu ama-x-ray noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza noma ukuwagcina ekukhuleni. Kunezinhlobo ezimbili zokwelashwa ngemisebe:

• Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke emdlavuzeni.

• Ukwelashwa kwemisebe kwangaphakathi kusebenzisa into enemisebe eboshwe ngezinaliti, izimbewu, izintambo, noma ama-catheters abekwe ngqo noma eduze komdlavuza.

Indlela okunikezwa ngayo ukwelashwa ngemisebe kuya ngohlobo nesigaba somdlavuza owelashwa. Ukwelashwa kwemisebe yangaphandle kusetshenziselwa ukwelapha umdlavuza webele. Ukwelashwa kwemisebe kwangaphakathi nge-strontium-89 (i-radionuclide) kusetshenziselwa ukuqeda ubuhlungu bamathambo obudalwa umdlavuza webele osabalele emathanjeni. IStrontium-89 ijojowe emthanjeni bese iya ebusweni bamathambo. Imisebe iyadedelwa futhi ibulale amangqamuzana omdlavuza emathanjeni.

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuwavimba ekuhlukaniseni. Lapho i-chemotherapy ithathwa ngomlomo noma ifakwa emthanjeni noma emisipheni, izidakamizwa zingena egazini futhi zingafinyelela kumaseli womdlavuza emzimbeni wonke (systemic chemotherapy). Lapho i-chemotherapy ifakwa ngqo ku-cerebrospinal fluid, isitho, noma umgodi womzimba njengesisu, izidakamizwa zithinta kakhulu amangqamuzana omdlavuza kulezo zindawo (i-chemotherapy yesifunda).

Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni nesigaba somdlavuza owelashwa. I-chemotherapy ejwayelekile isetshenziswa ekwelapheni umdlavuza webele.

Bheka Izidakamizwa ezivunyelwe umdlavuza webele ukuthola eminye imininingwane.

Ukwelashwa kweHormone

Ukwelashwa kweHormone ukwelashwa komdlavuza okususa ama-hormone noma kuvimbe isenzo sabo futhi kumise amangqamuzana omdlavuza ukuthi angakhuli. AmaHormone yizinto ezenziwe yizindlala emzimbeni futhi zisatshalaliswa egazini. Amanye ama-hormone angadala ukuthi umdlavuza othile ukhule. Uma ukuhlolwa kukhombisa ukuthi amangqamuzana omdlavuza anezindawo lapho ama-hormone anganamathisela khona (ama-receptors), izidakamizwa, ukuhlinzwa, noma ukwelashwa ngemisebe kusetshenziselwa ukunciphisa ukukhiqizwa kwamahomoni noma ukuwavimba ekusebenzeni. I-hormone estrogen, eyenza amanye umdlavuza webele ukhule, yenziwa ikakhulu ama-ovari. Ukwelashwa kokumisa ama-ovari ekwenzeni i-estrogen kubizwa ngokuthi yi-ovarian ablation.

Ukwelashwa ngehormone nge-tamoxifen kuvame ukunikezwa iziguli ezinomdlavuza webele owenziwe kusenesikhathi ongasuswa ngokuhlinzwa nalabo abanomdlavuza webele we-metastatic (umdlavuza osabalalele kwezinye izingxenye zomzimba). Ukwelashwa kweHormone nge-tamoxifen noma ama-estrogens kungasebenza kumaseli emzimbeni wonke futhi kungakhuphula amathuba okuba nomdlavuza we-endometrium. Abesifazane abathatha i-tamoxifen kufanele bahlolwe okhalo minyaka yonke ukubheka noma yiziphi izimpawu zomdlavuza. Noma yikuphi ukuphuma kwegazi esithweni sangasese, ngaphandle kokuphuma esikhathini, kufanele kubikwe kudokotela ngokushesha okukhulu.

Ukwelashwa ngehormone nge-luteinizing hormone-releasing hormone (LHRH) agonist kunikezwa abanye besifazane be-premenopausal abasanda kutholakala ukuthi banomdlavuza webele we-hormone receptor omuhle. Ama-agonist e-LHRH anciphisa i-estrogen yomzimba ne-progesterone.

Ukwelashwa kweHormone nge-aromatase inhibitor kunikezwa abanye besifazane be-postmenopausal abanomdlavuza webele we-hormone receptor omuhle. Ama-aromatase inhibitors anciphisa i-estrogen yomzimba ngokuvimba i-enzyme ebizwa nge-aromatase ekuguquleni i-androgen ibe yi-estrogen. I-Anastrozole, i-letrozole, ne-exemestane yizinhlobo ze-aromatase inhibitors.

Ukwelashwa komdlavuza webele owenziwe ekuqaleni ongasuswa ngokuhlinzwa, ama-aromatase inhibitors athile angasetshenziswa njengokwelashwa kwe-adjuvant esikhundleni se-tamoxifen noma ngemuva kweminyaka emibili kuya kwemi-3 yokusebenzisa i-tamoxifen. Ekwelapheni umdlavuza webele we-metastatic, ama-aromatase inhibitors ahlolwa ekuhlolweni kwemitholampilo ukuze uwaqhathanise nokwelashwa kwama-hormone ne-tamoxifen.

Kwabesifazane abanomdlavuza webele we-hormone receptor positive, okungenani iminyaka engu-5 yokwelashwa kwe-adjuvant hormone kunciphisa ubungozi bokuthi umdlavuza uzophinda ubuye (ubuye).

Ezinye izinhlobo zokwelashwa kwamahomoni zifaka i-megestrol acetate noma i-anti-estrogen therapy efana ne-fulvestrant.

Bheka Izidakamizwa ezivunyelwe umdlavuza webele ukuthola eminye imininingwane.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana omdlavuza athile ngaphandle kokulimaza amaseli ajwayelekile. Ama-antibody e-monoclonal, i-tyrosine kinase inhibitors, i-cyclin-dependent kinase inhibitors, i-mammalian target ye-rapamycin (mTOR) inhibitors, kanye ne-PARP inhibitors yizinhlobo zezindlela zokwelapha eziqondiwe ezisetshenziswa ekwelapheni umdlavuza webele.

I-monoclonal antibody therapy iyindlela yokwelapha umdlavuza esebenzisa amasosha omzimba enziwe elebhu, evela ohlotsheni olulodwa lwamaseli omzimba. La ma-antibody angakhomba izinto kumaseli womdlavuza noma ezintweni ezijwayelekile ezingasiza amangqamuzana omdlavuza ukuthi akhule. Amasosha omzimba anamathela ezintweni futhi abulale amangqamuzana omdlavuza, avimbe ukukhula kwawo, noma awagcine ekusakazekeni. Ama-antibody e-monoclonal anikezwa ngokumnika. Zingasetshenziswa zodwa noma ukuphatha izidakamizwa, ubuthi, noma okokukhipha imisebe ngqo emangqamuzaneni omdlavuza. Ama-antibody e-monoclonal angasetshenziswa ngokuhlangana ne-chemotherapy njengokwelashwa okunezelayo.

Izinhlobo zokwelashwa kwe-monoclonal antibody zihlanganisa okulandelayo:

• I-Trastuzumab i-anti-monoclonal antibody evimba imiphumela ye-protein factor HER2, ethumela izimpawu zokukhula kumaseli womdlavuza webele. Kungasetshenziswa nezinye izindlela zokwelapha umdlavuza webele we-HER2.

• I-Pertuzumab iyi-anti-monoclonal antibody engahlanganiswa ne-trastuzumab ne-chemotherapy yokwelapha umdlavuza webele. Ingasetshenziselwa ukwelapha iziguli ezithile ezinomdlavuza webele we-HER2 omuhle osetshenzisiwe (osakazeka kwezinye izingxenye zomzimba). Ingasetshenziswa futhi njengokwelashwa kwe-neoadjuvant ezigulini ezinomdlavuza webele othuthukile endaweni, owokuvuvukala noma wokuqala. Ingasetshenziswa futhi njengokwelashwa kwe-adjuvant ezigulini ezithile ezinomdlavuza webele omuhle we-HER2.

• I-Ado-trastuzumab emtansine i-anti-monoclonal antibody exhunywe nomuthi we-anticancer. Lokhu kubizwa ngokuthi yi-anti-drug conjugate. Isetshenziselwa ukwelapha umdlavuza webele omuhle we-HER2 osabalalele kwezinye izingxenye zomzimba noma waphinde wabuya (buyela). Iphinde isetshenziswe njengokwelashwa okunciphisayo ukwelapha umdlavuza webele omuhle we-HER2 ezigulini ezinesifo esisele ngemuva kokuhlinzwa.

• I-Sacituzumab govitecan i-anti-monoclonal antibody ethwala umuthi we-anticancer esihlahleni. Lokhu kubizwa ngokuthi yi-anti-drug conjugate. Kufundelwa ukwelapha abesifazane abanomdlavuza webele onezinhliziyo eziphindwe kathathu abathole okungenani izinhlobo zemithi yokwelashwa ngamakhemikhali okungenani emibili.

I-Tyrosine kinase inhibitors yimithi yokwelashwa ebhekiswe kuyo evimba amasiginali adingekayo ukuze izicubu zikhule. I-Tyrosine kinase inhibitors ingasetshenziswa nezinye izidakamizwa ze-anticancer njenge-adjuvant therapy. I-Tyrosine kinase inhibitors ifaka okulandelayo:

• ILapatinib iyi-tyrosine kinase inhibitor evimba imiphumela yeprotheni ye-HER2 namanye amaprotheni angaphakathi kwamangqamuzana e-tumor. Kungasetshenziswa nezinye izidakamizwa ukwelapha iziguli ezinomdlavuza webele we-HER2 omuhle osuthuthukile ngemuva kokwelashwa nge-trastuzumab.

• INeratinib iyi-tyrosine kinase inhibitor evimba imiphumela yeprotheni ye-HER2 namanye amaprotheni angaphakathi kwamangqamuzana e-tumor. Ingasetshenziselwa ukwelapha iziguli ezinesifo sokuqala somdlavuza webele we-HER2 ngemuva kokwelashwa nge-trastuzumab.

Ama-cyclin-dependent kinase inhibitors yimithi yokwelapha ehlosiwe evimba amaprotheni abizwa ngama-cyclin-dependent kinases, abangela ukukhula kwamangqamuzana omdlavuza. I-cyclin-dependent kinase inhibitors ifaka okulandelayo:

• I-Palbociclib iyi-cyclin-dependent kinase inhibitor esetshenziswe ne-letrozole yezidakamizwa ukwelapha umdlavuza webele ongena nge-estrogen receptor ne-HER2 negative futhi ususabalale kwezinye izingxenye zomzimba. Isetshenziswa kwabesifazane be-postmenopausal abanomdlavuza ongazange welashwe nge-hormone therapy. IPalbociclib nayo ingasetshenziswa ne-fulvestrant kwabesifazane abanesifo esibe sibi kakhulu ngemuva kokwelashwa nge-hormone therapy.

• I-Ribociclib iyi-cyclin-dependent kinase inhibitor esetshenziswa ne-letrozole ukwelapha umdlavuza webele oyi-hormone receptor positive ne-HER2 negative futhi ibuyile noma yasakazeka kwezinye izingxenye zomzimba. Isetshenziswa kwabesifazane be-postmenopausal abanomdlavuza ongazange welashwe nge-hormone therapy. Iphinde isetshenziswe nge-fulvestrant kwabesifazane be-postmenopausal abane-hormone receptor positive kanye nomdlavuza webele we-HER2 ongemuhle osabalele kwezinye izingxenye zomzimba noma ophindekile. Iphinde isetshenziswe kwabesifazane be-premenopausal abane-hormone receptor positive kanye nomdlavuza webele we-HER2 ongemuhle osabalalele kwezinye izingxenye zomzimba noma ophindekile.

• I-Abemaciclib iyi-cyclin-dependent kinase inhibitor esetshenziselwa ukwelapha i-hormone receptor positive kanye nomdlavuza webele we-HER2 ongemuhle othuthukile noma osabalale kwezinye izingxenye zomzimba. Ingasetshenziswa yodwa noma nezinye izidakamizwa.

• I-Alpelisib iyi-kinin-dependent kinase inhibitor esetshenziswa ne-fulvestrant yezidakamizwa ukwelapha umdlavuza webele we-hormone receptor positive kanye ne-HER2 onoshintsho oluthile lwezakhi zofuzo futhi othuthukile noma osabalalele kwezinye izingxenye zomzimba. Isetshenziswa kwabesifazane be-postmenopausal abanomdlavuza webele oye waba mubi kakhulu ngesikhathi noma ngemuva kokwelashwa nge-hormone therapy.

Umgomo waseMammalia we-rapamycin (mTOR) inhibitors uvimba iprotheni ebizwa nge-mTOR, engagcina amangqamuzana omdlavuza angakhuli futhi avimbele ukukhula kwemithambo yegazi emisha okudingeka ukuthi izicubu zikhule. I-mTOR inhibitors ifaka okulandelayo:

• I-Everolimus iyi-mTOR inhibitor esetshenziswa kwabesifazane be-postmenopausal abanomdlavuza webele we-hormone receptor omuhle futhi obuye ube ne-HER2 ongemuhle futhi ongakatholi ngcono ngenye indlela yokwelashwa.

Ama-PARP inhibitors awuhlobo lwezokwelapha ezihlosiwe ezivimbela ukulungiswa kwe-DNA futhi zingadala ukuthi amangqamuzana omdlavuza afe. I-PARP inhibitors ifaka okulandelayo:

• I-Olaparib iyi-PARP inhibitor esetshenziselwa ukwelapha iziguli ezinezinguquko kuhlobo lwe-BRCA1 noma i-BRCA2 kanye nomdlavuza webele we-HER2 ongemuhle osakaze kwezinye izingxenye zomzimba. Ukwelashwa kwe-PARP inhibitor kuyacutshungulwa ukwelashwa kweziguli ezinomdlavuza webele webele ophindwe kathathu.

• I-Talazoparib iyi-inhibitor ye-PARP esetshenziselwa ukwelapha iziguli ezinokushintshwa kwezakhi zofuzo ku-BRCA1 noma i-BRCA2 zofuzo kanye nomdlavuza webele we-HER2 ongemuhle osezingeni eliphezulu endaweni noma osabalalele kwezinye izingxenye zomzimba.

Bheka Izidakamizwa ezivunyelwe umdlavuza webele ukuthola eminye imininingwane.

I-Immunotherapy

I-Immunotherapy yimithi esebenzisa amasosha omzimba esiguli ukulwa nomdlavuza. Izinto ezenziwe ngumzimba noma ezenziwe elabhoratri zisetshenziselwa ukukhulisa, ukuqondisa, noma ukubuyisa izivikelo zemvelo zomzimba kumdlavuza. Lolu hlobo lokwelashwa komdlavuza lubizwa nangokuthi i-biotherapy noma i-biologic therapy.

Kunezinhlobo ezahlukene ze-immunotherapy:

• Ukwelashwa kwe-inhibitor yokuhlola amasosha omzimba: I-PD-1 yiprotheni ebusweni bamaseli we-T asiza ukugcina izimpendulo zomzimba wokuzivikela. Lapho i-PD-1 inamathela kwenye iprotheni ebizwa nge-PDL-1 kuseli lomdlavuza, iyeka i-T cell ekubulaleni iseli lomdlavuza. Ama-PD-1 inhibitors anamathisela ku-PDL-1 futhi avumela amaseli we-T ukuthi abulale amangqamuzana omdlavuza. I-Atezolizumab iyi-PD-1 inhibitor esetshenziselwa ukwelapha umdlavuza webele osakaze kwezinye izingxenye zomzimba.

Isithiyo sokuhlola izivikeli mzimba. Amaprotheni wokuhlola, njenge-PD-L1 kumaseli we-tumor ne-PD-1 kumaseli we-T, asiza ukugcina izimpendulo ze-immune zihlolwe. Ukubopha kwe-PD-L1 kuya ku-PD-1 kugcina amaseli we-T ekubulaleni amangqamuzana omzimba emzimbeni (iphaneli engakwesobunxele). Ukuvimba ukubopha kwe-PD-L1 kuya ku-PD-1 nge-immune checkpoint inhibitor (i-anti-PD-L1 noma i-anti-PD-1) ivumela amaseli we-T ukuthi abulale amangqamuzana wesimila (iphaneli elifanele).

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa komdlavuza webele kungadala imiphumela emibi.

Ngemininingwane ngemiphumela emibi eqala ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

Ezinye izindlela zokwelashwa komdlavuza webele zingadala imiphumela emibi eqhubekayo noma evela izinyanga noma iminyaka ukwelashwa kuphelile. Lokhu kubizwa ngemiphumela yesikhathi esedlule.

Imiphumela yamuva yokwelashwa ngemisebe ayijwayelekile, kepha ingafaka:

• Ukuvuvukala kwamaphaphu ngemuva kokwelashwa ngemisebe esifubeni, ikakhulukazi lapho kunikezwa i-chemotherapy ngasikhathi sinye.

• I-lymphedema yengalo, ikakhulukazi lapho ukwelashwa ngemisebe kunikezwa ngemuva kokuhlukaniswa kwe-lymph node.

• Kwabesifazane abangaphansi kweminyaka engama-45 abathola ukwelashwa ngemisebe odongeni lwesifuba ngemuva kwe-mastectomy, kungaba nengozi enkulu yokuba nomdlavuza webele kwelinye ibele.

Imiphumela yamuva yokwelashwa ngamakhemikhali incike emithini esetshenzisiwe, kepha ingafaka:

• Ukwehluleka kwenhliziyo.

• Amahlule egazi.

• Ukunqamuka kokuya esikhathini ngaphambi kwesikhathi.

• Umdlavuza wesibili, njenge-leukemia.

Imiphumela engemuva yokwelashwa okuqondisiwe nge-trastuzumab, i-lapatinib, noma i-pertuzumab ingafaka:

• Izinkinga zenhliziyo njengokuhluleka kwenhliziyo.

Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

Kwezinye iziguli, ukubamba iqhaza esivivinyweni somtholampilo kungaba yindlela engcono kakhulu yokwelashwa. Ukuhlolwa kwemitholampilo kuyingxenye yenqubo yocwaningo lomdlavuza. Ukuhlolwa komtholampilo kuyenziwa ukuthola ukuthi ngabe ukwelashwa komdlavuza okusha kuphephile futhi kuyasebenza yini noma kungcono kunokwelashwa okujwayelekile.

Eziningi zezindlela zokwelashwa ezijwayelekile zomdlavuza zisuselwa ekuhlolweni kokuqala komtholampilo. Iziguli ezibamba iqhaza esivivinyweni somtholampilo zingathola ukwelashwa okujwayelekile noma zibe phakathi kwabokuqala ukuthola ukwelashwa okusha.

Iziguli ezibamba iqhaza ezivivinyweni zokwelashwa zisiza nokwenza ngcono indlela umdlavuza ozophathwa ngayo ngokuzayo. Noma izilingo zomtholampilo zingaholeli ekwelashweni okusha okusebenzayo, zivame ukuphendula imibuzo ebalulekile futhi zisize ukuqhubela phambili ucwaningo.

Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

Ezinye izivivinyo zokwelashwa zifaka kuphela iziguli ezingakatholi ukwelashwa. Ezinye izilingo zivivinya ukwelashwa kweziguli ezinomdlavuza ongakabi ngcono. Kukhona nokuhlolwa komtholampilo okuhlola izindlela ezintsha zokunqanda umdlavuza ukuthi ungaphindi (ubuye) noma kunciphise imiphumela emibi yokwelashwa komdlavuza.

Ukuhlolwa kwemitholampilo kuyenzeka ezingxenyeni eziningi zezwe. Imininingwane mayelana nokuhlolwa kwemitholampilo esekelwa yi-NCI ingatholakala ekhasini lewebhu le-NCI lokuhlolwa kokuhlolwa kwemitholampilo. Izivivinyo zomtholampilo ezisekelwa ezinye izinhlangano zingatholakala kuwebhusayithi yeClinicalTrials.gov.

Ukuhlolwa kokulandelela kungadingeka.

Olunye uvivinyo olwenziwe ukuxilonga umdlavuza noma ukuthola isigaba somdlavuza lungaphindwa. Olunye uvivinyo luzophindwa ukuze kubonakale ukuthi umuthi usebenza kanjani. Izinqumo mayelana nokuthi uqhubeke, ushintshe, noma umise ukwelashwa zingasuselwa emiphumeleni yalezi zivivinyo.

Ezinye zezivivinyo zizoqhubeka ukwenziwa ngezikhathi ezithile ngemuva kokuphela kokwelashwa. Imiphumela yalezi zivivinyo ingakhombisa ukuthi ngabe isimo sakho sishintshile noma uma umdlavuza ubuyile (buyela emuva). Lezi zivivinyo kwesinye isikhathi zibizwa ngokuthi izivivinyo zokulandelela noma ukuhlolwa.

Izinketho Zokwelapha Umdlavuza Webele

Kulesi Sigaba

• Umdlavuza Webele Wasekuqaleni, Wendawo, noma Osetshenziswayo

• Umdlavuza Webele Othuthukile noma Wokuvuvukala Endaweni

• Umdlavuza Webele Ophindaphindwayo Wendawo

• I-Metastatic Breast Cancer

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Umdlavuza Webele Wasekuqaleni, Wendawo, noma Osetshenziswayo

Ukwelashwa komdlavuza webele owenziwe kusenesikhathi, okwenziwe endaweni noma ongasebenza kungahle kufake okulandelayo:

Ukuhlinzwa

• Ukuhlinzwa okonga amabele kanye ne-sentinel lymph node biopsy. Uma umdlavuza utholakala kuma-lymph node, kungenziwa ukuhlukaniswa kwe-lymph node.

• Kushintshwe i-mastectomy enamandla. Ukuhlinzwa okwakhiwa kabusha kwamabele nakho kungenziwa.

Ukwelashwa kwemisebe ngemuva kokusebenza

Kwabesifazane abahlinzwa okonga ibele, ukwelashwa ngemisebe kunikezwa lonke ibele ukunciphisa amathuba okuthi umdlavuza ubuye. Ukwelashwa ngemisebe kunganikezwa futhi kuma-lymph node endaweni.

Kwabesifazane ababene-radical mastectomy eguquliwe, ukwelashwa ngemisebe kunganikezwa ukunciphisa ithuba lokuthi umdlavuza uzobuya uma kukhona okunye kwalokhu okuyiqiniso:

• Umdlavuza utholakale kuma-lymph node ama-4 noma ngaphezulu.

• Umdlavuza wawususabalele ezicutshini ezizungeze ama-lymph node.

• Isimila besisikhulu.

• Kukhona isimila esiseduze noma esisele ezicutshini eziseduze nemiphetho lapho kususwe khona isimila.

Ukwelashwa okuhlelekile kwangemva kokuhlinzwa

Ukwelashwa okuhleliwe ukusetshenziswa kwezidakamizwa ezingangena egazini futhi zifinyelele kumaseli omdlavuza emzimbeni wonke. Ukwelashwa kwangemva kokuhlinzwa kunikezwa ukunciphisa amathuba okuthi umdlavuza ubuye emuva kokuhlinzwa ukuze kususwe isimila.

Ukwelashwa kwe-postoperative systemic kunikezwa ngokuya ngokuthi:

• Isimila siyi-receptor receptor negative noma enhle.

• Isimila sine-HER2 / neu esingesihle noma esihle.

• Isimila siyi-hormone receptor negative ne-HER2 / neu negative (i-negative ephindwe kathathu).

• Usayizi wesimila.

Kwabesifazane be-premenopausal abanezicubu ze-receptor receptor ezinhle, akusekho ukwelashwa okungadingeka noma ukwelashwa ngemuva kokuhlinzwa kungafaka:

• Ukwelashwa kwe-Tamoxifen nge-chemotherapy noma ngaphandle kwayo.

• Ukwelashwa kwe-Tamoxifen nokwelashwa ukumisa noma kwehlise ukuthi ingakanani i-estrogen eyenziwe ngama-ovari. Ukwelashwa kwezidakamizwa, ukuhlinzekwa ukususa ama-ovari, noma ukwelashwa ngemisebe kuma-ovari kungasetshenziswa.

• Ukwelashwa kwe-Aromatase inhibitor nokwelashwa ukumisa noma ukwehlisa ukuthi ingakanani i-estrogen eyenziwe ngama-ovari. Ukwelashwa kwezidakamizwa, ukuhlinzekwa ukususa ama-ovari, noma ukwelashwa ngemisebe kuma-ovari kungasetshenziswa.

Kwabesifazane be-postmenopausal abanezicubu ezinhle ze-hormone receptor, akusekho ukwelashwa okungadingeka noma ukwelashwa ngemuva kokuhlinzwa kungafaka:

• Ukwelashwa kwe-Aromatase inhibitor nge-chemotherapy noma ngaphandle kwayo.

• I-Tamoxifen ilandelwa ukwelashwa kwe-aromatase inhibitor, nge-chemotherapy noma ngaphandle kwayo.

Kwabesifazane abanezicubu ezingekho emthethweni ze-hormone receptor, akusekho ukwelashwa okungadingeka noma ukwelashwa kwangemva kokuhlinzwa kungafaka:

• Ukwelashwa ngamakhemikhali.

Kwabesifazane abanezicubu ezingezinhle ze-HER2 / neu, ukwelashwa ngemuva kokuhlinzwa kungafaka:

• Ukwelashwa ngamakhemikhali.

Kwabesifazane abanezicubu ezinhle ze-HER2 / neu, futhi abanawo umdlavuza kuma-lymph node, akusekho ukwelashwa okungadingeka. Uma kunomdlavuza kuma-lymph node, noma isimila sikhulu, ukwelashwa ngemuva kokuhlinzwa kungafaka:

• I-Chemotherapy kanye nokwelashwa okuhlosiwe (trastuzumab).

• Ukwelashwa kweHormone, okufana ne-tamoxifen noma i-aromatase inhibitor therapy, yamathumba nawo ane-receptor receptor enhle.

• Ukwelashwa kwe-Antibody-drug conjugate nge-ado-trastuzumab emtansine.

Kwabesifazane abanezicubu ezincane ezingenayo i-hormone receptor ne-HER2 / neu negative (kathathu okungekuhle) futhi abanawo umdlavuza kuma-lymph node, akusazodingeka ukwelashwa. Uma kunomdlavuza kuma-lymph node noma isimila sikhulu, ukwelashwa ngemuva kokuhlinzwa kungafaka:

• Ukwelashwa ngamakhemikhali.

• Ukwelashwa ngemisebe.

• Isivivinyo somtholampilo sohlobo olusha lwe-chemotherapy regimen.

• Isivivinyo somtholampilo sokwelashwa kwe-PARP inhibitor.

Ukwelashwa kwangaphambi kokuhlinzwa

Ukwelashwa okuhleliwe ukusetshenziswa kwezidakamizwa ezingangena egazini futhi zifinyelele kumaseli omdlavuza emzimbeni wonke. Ukwelashwa kwangaphambi kokuhlinzwa kunikezwa ukunciphisa isimila ngaphambi kokuhlinzwa.

Kwabesifazane be-postmenopausal abanezicubu ezinhle ze-hormone receptor, i-preoperative therapy ingafaka:

• Ukwelashwa ngamakhemikhali.

• Ukwelashwa kweHormone, njenge-tamoxifen noma i-aromatase inhibitor therapy, yabesifazane abangakwazi ukuthola i-chemotherapy.

Kwabesifazane be-premenopausal abanezicubu ezinhle ze-hormone receptor, i-preoperative therapy ingafaka:

• Isivivinyo somtholampilo sokwelapha i-hormone, njenge-tamoxifen noma i-aromatase inhibitor therapy.

Kwabesifazane abanezicubu ezinhle ze-HER2 / neu, i-preoperative therapy ingafaka:

• I-Chemotherapy kanye nokwelashwa okuhlosiwe (trastuzumab).

• Ukwelashwa okuhlosiwe (pertuzumab).

Kwabesifazane abanezicubu ezingezinhle ze-HER2 / neu noma izicubu ezingezinhle eziphindwe kathathu, i-preoperative therapy ingafaka:

• Ukwelashwa ngamakhemikhali.

• Isivivinyo somtholampilo sohlobo olusha lwe-chemotherapy regimen.

• Isivivinyo somtholampilo sokwelashwa kwe-antioclonal antibody.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Umdlavuza Webele Othuthukile noma Wokuvuvukala Endaweni

Ukwelashwa komdlavuza webele osuthuthukile noma ovuvukalayo kuyinhlanganisela yezindlela zokwelapha ezingafaka okulandelayo:

• Ukuhlinzwa (ukuhlinzekwa kokugcina amabele noma i-mastectomy ephelele) nge-lymph node dissection.

• I-Chemotherapy ngaphambi kanye / noma ngemuva kokuhlinzwa.

• Ukwelashwa ngemisebe ngemuva kokuhlinzwa.

• Ukwelashwa kweHormone ngemuva kokuhlinzwa kwezicubu okungaziwa ukuthi yi-estrogen receptor noma i-estrogen receptor.

• Izilingo zomtholampilo zihlola imishanguzo emisha yokulwa nomdlavuza, inhlanganisela yezidakamizwa ezintsha, nezindlela ezintsha zokunikeza ukwelashwa.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Umdlavuza Webele Ophindaphindwayo Wendawo

Ukwelashwa komdlavuza webele ophindaphindwayo (umdlavuza obuyile ngemuva kokwelashwa esifubeni, odongeni lwesifuba, noma kuma-lymph node aseduze), kungafaka okulandelayo:

• Ukwelashwa ngamakhemikhali.

• Ukwelashwa kweHormone kwezimila ezamukela i-hormone receptor.

• Ukwelashwa ngemisebe.

• Ukuhlinzwa.

• Ukwelashwa okubhekiswe (trastuzumab).

• Isivivinyo somtholampilo sokwelapha okusha.

Bheka isigaba seMetastatic Breast Cancer ukuthola imininingwane mayelana nezindlela zokwelashwa zomdlavuza webele osakaze ezingxenyeni zomzimba ngaphandle kwesifuba, udonga lwesifuba, noma ama-lymph node aseduze.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

I-Metastatic Breast Cancer

Izinketho zokwelashwa komdlavuza webele we-metastatic (umdlavuza osakazekele ezingxenyeni ezikude zomzimba) zingafaka okulandelayo:

Ukwelashwa kweHormone

Kwabesifazane be-postmenopausal abasanda kutholakala ukuthi banomdlavuza we-metastatic webele we-hormone receptor omuhle noma uma isimo se-hormone receptor singaziwa, ukwelashwa kungafaka:

• Ukwelashwa kweTamoxifen.

• Ukwelashwa kwe-Aromatase inhibitor (i-anastrozole, i-letrozole, noma i-exemestane). Kwesinye isikhathi kunikezwa i-cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, abemaciclib, noma i-alpelisib).

Kwabesifazane be-premenopausal abasanda kutholakala ukuthi banomdlavuza we-metastatic webele we-hormone receptor omuhle, ukwelashwa kungafaka:

• UTamoxifen, i-agonist ye-LHRH, noma kokubili.

• Ukwelashwa kwe-cyclin-dependent kinase inhibitor therapy (ribociclib).

Kwabesifazane abanezicubu ezine-hormone receptor positive noma i-hormone receptor engaziwa, esakazeka ethanjeni noma izicubu ezithambile kuphela, futhi abaphathwe nge-tamoxifen, ukwelashwa kungafaka:

• Ukwelashwa kwe-Aromatase inhibitor.

• Olunye ukwelashwa kwamahomoni njenge-megestrol acetate, i-estrogen noma i-androgen therapy, noma i-anti-estrogen therapy efana ne-fulvestrant.

Ukwelashwa okuhlosiwe

Kwabesifazane abanomdlavuza webele we-metastatic okuyi-hormone receptor positive futhi ongaphendulanga kwezinye izindlela zokwelashwa, izinketho zingafaka ukwelashwa okuqondisiwe okufana nalokhu:

• I-Trastuzumab, i-lapatinib, i-pertuzumab, noma i-mTOR inhibitors.

• Ukwelashwa kwe-Antibody-drug conjugate nge-ado-trastuzumab emtansine.

• Ukwelashwa kwe-cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, noma abemaciclib) engahlanganiswa nokwelashwa kwehomoni.

Kwabesifazane abanomdlavuza webele we-metastatic ongu-HER2 / neu omuhle, ukwelashwa kungafaka:

• Ukwelashwa okuhlosiwe okufana ne-trastuzumab, i-pertuzumab, i-ado-trastuzumab emtansine, noma i-lapatinib.

Kwabesifazane abanomdlavuza webele we-metastatic ongu-HER2 ongemuhle, ngokushintshwa kwezakhi zofuzo ze-BRCA1 noma ze-BRCA2, futhi abaphathwe nge-chemotherapy, ukwelashwa kungafaka:

• Ukwelashwa okuqondisiwe nge-PARP inhibitor (olaparib noma i-talazoparib).

Ukwelashwa ngamakhemikhali

Kwabesifazane abanomdlavuza webele we-metastatic okuyi-hormone receptor negative, ongaphendulanga ekwelashweni kwe-hormone, usabalale kwezinye izitho noma ubangele izimpawu, ukwelashwa kungafaka:

• I-Chemotherapy ngomuthi owodwa noma ngaphezulu.

I-Chemotherapy ne-immunotherapy

Kwabesifazane abanomdlavuza webele we-metastatic okuyi-hormone receptor negative ne-HER2 negative, ukwelashwa kungafaka:

• I-Chemotherapy ne-immunotherapy (atezolizumab).

Ukuhlinzwa

• I-mastectomy ephelele yabesifazane abanezilonda zamabele ezivulekile noma ezibuhlungu. Ukwelashwa ngemisebe kunganikezwa ngemuva kokuhlinzwa.

• Ukuhlinzwa ukukhipha umdlavuza osudlulele ebuchosheni noma emgogodleni. Ukwelashwa ngemisebe kunganikezwa ngemuva kokuhlinzwa.

• Ukuhlinzwa ukukhipha umdlavuza osusabalele emaphashini.

• Ukuhlinzwa ukulungisa noma ukusiza ukusekela amathambo abuthakathaka noma aphukile. Ukwelashwa ngemisebe kunganikezwa ngemuva kokuhlinzwa.

• Ukuhlinzwa ukususa uketshezi oluqoqane emaphashini noma enhliziyweni.

Ukwelashwa ngemisebe

• Ukwelashwa ngemisebe emathanjeni, ebuchosheni, emgogodleni, esifubeni, noma esifubeni odongeni ukukhulula izimpawu nokuthuthukisa ikhwalithi yempilo.

• I-Strontium-89 (i-radionuclide) yokuqeda izinhlungu zomdlavuza osulele emathanjeni emzimbeni wonke.

Ezinye izindlela zokwelashwa

Ezinye izinketho zokwelashwa komdlavuza webele we-metastatic zifaka:

• Ukwelashwa kwezidakamizwa ngama-bisphosphonates noma i-denosumab ukunciphisa isifo samathambo nobuhlungu lapho umdlavuza ususakazekele ethanjeni. (Bheka isifinyezo se- ku-Cancer Pain ukuthola eminye imininingwane ngama-bisphosphonates.)

• Isivivinyo somtholampilo se-chemotherapy ephezulu ene-stem cell transplant.

• Isivivinyo somtholampilo se-anti-drug conjugate (sacituzumab).

• Izilingo zomtholampilo zihlola imishanguzo emisha yokulwa nomdlavuza, inhlanganisela yezidakamizwa ezintsha, nezindlela ezintsha zokunikeza ukwelashwa.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Izinketho Zokwelashwa zeDuctal Carcinoma In Situ (DCIS)

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-ductal carcinoma in situ kungafaka okulandelayo:

• Ukuhlinzwa okulondoloza amabele nokwelashwa ngemisebe, nge-tamoxifen noma ngaphandle kwayo.

• Ingqikithi ye-mastectomy ene-tamoxifen noma ngaphandle kwayo. Ukwelashwa ngemisebe nakho kunganikezwa.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Ukufunda Okwengeziwe Ngomdlavuza Webele

Ukuthola eminye imininingwane ngeNational Cancer Institute mayelana nomdlavuza webele, bheka okulandelayo:

• Ikhasi Lasekhaya Lomdlavuza Webele

• Izinketho Zokuhlinzwa Kwabesifazane abane-DCIS noma Umdlavuza Webele

• Ukuhlinzwa Ukunciphisa Ubungozi Bomdlavuza Webele

• Ukwakhiwa Kwamabele Ngemuva Kwe-Mastectomy

• ISentinel Lymph Node Biopsy

• Amabele Aminyene: Izimpendulo Zemibuzo Evame Ukubuzwa

• Izidakamizwa zivunyelwe umdlavuza webele

• Ukwelashwa KweHormone Komdlavuza Webele

• Izindlela Zokwelapha Zomdlavuza

• Umdlavuza Webele Wokuvuvukala

• Izinguquko ze-BRCA: Ubungozi Bomdlavuza Nokuhlolwa Kofuzo

• Ukuhlolwa Kofuzo Kwezifo Ezizuzwayo Zokuthola Umdlavuza

Ngemininingwane ejwayelekile yomdlavuza nezinye izinsiza ezivela ku-National Cancer Institute, bheka okulandelayo:

• Mayelana Nomdlavuza

• Isiteji

• I-Chemotherapy kanye Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukwelashwa Kwemisebe Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukubhekana Nomdlavuza

• Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza

• Kwabasindile Nabanakekeli