Types/breast/patient/male-breast-treatment-pdq

Inguqulo Yokwelapha Umdlavuza Webele Wesilisa

Imininingwane ejwayelekile mayelana Nomdlavuza Webele Wesilisa

AMAPHUZU ASEMQOKA

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

• Umlando womndeni womdlavuza webele nezinye izinto kungakhuphula ubungozi bendoda yomdlavuza webele.

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

• Abesilisa abanomdlavuza webele bavame ukuba nezigaxa ezingazwakala.

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

• Uma umdlavuza utholakala, ukuhlolwa kuyenziwa ukutadisha amangqamuzana omdlavuza.

• Ukusinda kwabesilisa abanomdlavuza webele kufana nokusinda kwabesifazane abanomdlavuza webele.

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

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

Umdlavuza webele kungenzeka emadodeni. Umdlavuza webele ungavela emadodeni nganoma yisiphi isikhathi, kepha uvame ukwenzeka emadodeni aphakathi kweminyaka engama-60 nengama-70 ubudala. Umdlavuza webele wesilisa wenza ngaphansi kwe-1% lawo wonke amacala omdlavuza webele.

Izinhlobo ezilandelayo zomdlavuza webele zitholakala emadodeni:

• Ukungena ngaphakathi kwe-ductal carcinoma: Umdlavuza osabalele ngaphesheya kwamaseli abambe amapayipi esifubeni. Lolu uhlobo oluvame kakhulu lomdlavuza webele emadodeni.

• I-Ductal carcinoma in situ: Amaseli angajwayelekile atholakala kulayini womgudu; okubizwa nangokuthi i-intraductal carcinoma.

• Umdlavuza webele ovuthayo: Uhlobo lomdlavuza lapho ibele libukeka libomvu futhi livuvukile futhi lizizwa lifudumele.

• Isifo se-Paget sengono: Isigaxa esikhule sisuka emapayipini ngaphansi kwengono ebusweni bengono.

I-Lobular carcinoma in situ (amaseli angajwayelekile atholakala kwelinye lama-lobes noma izingxenye zesifuba), kwesinye isikhathi esenzeka kubantu besifazane, awubonwanga emadodeni.

I-anatomy yesifuba sowesilisa. Ingono ne-areola kuboniswa ngaphandle kwebele. Ama-lymph node, izicubu ezinamafutha, amapayipi, nezinye izingxenye ezingaphakathi kwesifuba nazo ziyaboniswa.

Umlando womndeni womdlavuza webele nezinye izinto kungakhuphula ubungozi bendoda yomdlavuza webele.

Noma yini enyusa ubungozi bokuthola 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. Izici zobungozi zomdlavuza webele emadodeni zingafaka okulandelayo:

• Ukwelashwa ngemithi yokwelashwa ngemisebe esifubeni / esifubeni sakho.

• Ukuba nesifo esixhunyaniswe namazinga aphezulu e-estrogen emzimbeni, njenge-cirrhosis (isifo sesibindi) noma i-Klinefelter syndrome (isifo sofuzo).

• Ukuba nezihlobo zesifazane esisodwa noma eziningi ezike zaba nomdlavuza webele.

• Ukuba nokuguquka kwezakhi zofuzo (izinguquko) kuzakhi zofuzo ezifana ne-BRCA2.

Umdlavuza webele wesilisa 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, njenge-BRCA2, zivame kakhulu emaqenjini athile ezinhlanga. Abesilisa abanofuzo oluguqukile oluhlobene nomdlavuza webele banengozi eyengeziwe yalesi sifo.

Kukhona izivivinyo ezingathola (thola) izakhi zofuzo eziguquliwe. Lezi zivivinyo zofuzo kwesinye isikhathi zenzelwa amalungu emindeni anengozi enkulu yomdlavuza. Bona izifinyezo ezilandelayo ze- ukuthola eminye imininingwane:

• Izakhi zofuzo zomdlavuza webele nowabesifazane

• Ukuvimbela Umdlavuza Webele

• Ukuhlolwa Komdlavuza Webele

Abesilisa abanomdlavuza webele bavame ukuba nezigaxa ezingazwakala.

Izigaxa nezinye izimpawu zingabangelwa umdlavuza wesilisa wesilisa 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 oluvela engonweni, ikakhulukazi uma lunegazi.

• 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 emadodeni.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

• Ukuhlolwa komzimba kanye nomlando: 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.

• 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. Kunezinhlobo ezine zama-biopsies wokuhlola 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:

• Umdlavuza ungakhula ngokushesha kangakanani.

• Kungenzeka kangakanani ukuthi umdlavuza usabalale emzimbeni wonke.

• Kungasebenza kanjani kahle ukwelashwa okuthile.

• 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-HER2: Ukuhlolwa kwelabhorethri ukukala ukuthi mangaki ama-HER2 / neu genes akhona nokuthi mangaki amaprotheni we-HER2 / neu enziwe kusampula lezicubu. 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.

Ukusinda kwabesilisa abanomdlavuza webele kufana nokusinda kwabesifazane abanomdlavuza webele.

Ukusinda kwabesilisa abanomdlavuza webele kuyafana nokwabesifazane abanomdlavuza webele lapho isigaba sabo sokuxilongwa sifana. Umdlavuza webele emadodeni, noma kunjalo, uvame ukutholakala ngokuhamba kwesikhathi. Umdlavuza otholakala ngokuhamba kwesikhathi kungenzeka ungalapheki.

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

Isibikezelo (ithuba lokululama) nezinketho zokwelashwa zincike kokulandelayo:

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

• Uhlobo lomdlavuza webele.

• Amazinga we-Estrogen-receptor kanye ne-progesterone-receptor kuzicubu zesimila.

• Ukuthi umdlavuza utholakala nakwelinye ibele.

• Iminyaka yomuntu nempilo ejwayelekile.

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

Izigaba Zomdlavuza Webele Wesilisa

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 wamabele wesilisa kuncike ngokwengxenye esigabeni sesifo.

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

Ngemuva kokutholakala komdlavuza webele, kwenziwa ukuhlolwa ukuze kutholakale ukuthi ngabe amangqamuzana omdlavuza asabalele ebeleni noma kwezinye izingxenye zomzimba. Le nqubo ibizwa ngokuthi isiteji. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa. Umdlavuza webele emadodeni uhlelwe ngokufanayo nakwabesifazane. Ukusabalala komdlavuza kusuka esifubeni kuya kuma-lymph node nakwezinye izingxenye zomzimba kubonakala kufana nakwabesilisa nabesifazane.

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.

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 usesigabeni IV.

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 wamabele wesilisa kuncike ngokwengxenye esigabeni sesifo.

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

Ukuze uthole izinketho zokwelashwa komdlavuza obuye wabuya eduze nendawo lapho uqale khona, bheka umdlavuza webele wesilisa waseLocoregional.

Ukuze uthole izinketho zokwelashwa komdlavuza webele wesigaba IV noma umdlavuza webele obuye wavela kwezinye izingxenye zomzimba, bheka iMetastatic Breast Cancer in Men.

Umdlavuza Webele Wokuvuvukala Wabesilisa

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 Wesilisa Ojwayelekile

Umdlavuza webele ophindaphindiwe wumdlavuza obuye wabuya (ubuye) ngemuva kokuba welashwe. Umdlavuza ungabuyela esifubeni, odongeni lwesifuba, noma kwezinye izingxenye zomzimba.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukene zokwelashwa kwabesilisa abanomdlavuza webele.

• Izinhlobo ezinhlanu zokwelashwa okujwayelekile zisetshenziselwa ukwelapha amadoda anomdlavuza webele:

• Ukuhlinzwa

• Ukwelashwa ngamakhemikhali

• Ukwelashwa kweHormone

• Ukwelashwa ngemisebe

• Ukwelashwa okuhlosiwe

• Ukwelashwa komdlavuza webele wesilisa kungadala imiphumela emibi.

Kunezinhlobo ezahlukene zokwelashwa kwabesilisa abanomdlavuza webele.

Izinhlobo ezahlukene zokwelashwa ziyatholakala kwabesilisa abanomdlavuza 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.

Kwezinye iziguli, ukubamba iqhaza esivivinyweni somtholampilo kungaba yindlela engcono kakhulu yokwelashwa. 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.

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 iyatholakala kuwebhusayithi ye-NCI. Ukukhetha ukwelashwa komdlavuza okufanele kunazo zonke kuyisinqumo esithinta kahle isiguli, umndeni kanye neqembu lokunakekelwa kwezempilo.

Izinhlobo ezinhlanu zokwelashwa okujwayelekile zisetshenziselwa ukwelapha amadoda anomdlavuza webele:

Ukuhlinzwa

Ukuhlinzwa kwabesilisa abanomdlavuza webele kuvame ukuba yi-radical mastectomy (ukususwa kwesifuba, ama-lymph node amaningi ngaphansi kwengalo, ulwelwesi olungaphezulu kwemisipha yesifuba, futhi kwesinye isikhathi kube yingxenye yemisipha yodonga lwesifuba).

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

Ukuhlinzwa okulondoloza amabele, ukuhlinzwa okususa umdlavuza kodwa hhayi ibele uqobo, kuyasetshenziswa nakwamanye amadoda anomdlavuza webele. I-lumpectomy yenziwa ukususa isimila (isigaxa) nenani elincane lezicubu ezijwayelekile ezisizungezile. Ukwelashwa ngemisebe kunikezwa ngemuva kokuhlinzwa ukubulala noma yimaphi amangqamuzana omdlavuza asele.

Ukuhlinzwa okulondoloza amabele. Olayini abanamachashazi babonisa indawo equkethe isimila esisusiwe namanye ama-lymph node angasuswa.

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 isetshenziselwa ukwelapha umdlavuza webele emadodeni.

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.

Ukwelashwa kwehormone nge-tamoxifen kuvame ukunikezwa iziguli ezine-estrogen-receptor kanye ne-progesterone-receptor umdlavuza webele omuhle kanye neziguli ezinomdlavuza webele we-metastatic (umdlavuza osakaze kwezinye izingxenye zomzimba).

Ukwelashwa kweHormone nge-aromatase inhibitor kunikezwa amadoda athile anomdlavuza webele we-metastatic. 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 ngeHormone nge-luteinizing hormone-releasing hormone (LHRH) agonist kunikezwa amadoda athile anomdlavuza webele we-metastatic. Ama-agonist e-LHRH athinta i-pituitary gland, elawula ukuthi i-testosterone yenziwa ngamasende angakanani. Emadodeni athatha ama-agonist e-LHRH, indlala yesibeletho itshela amasende ukuthi enze i-testosterone encane. I-Leuprolide ne-goserelin yizinhlobo zama-agonists e-LHRH.

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 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 wamabele wesilisa.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lwezokwelapha olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana athile omdlavuza ngaphandle kokulimaza amaseli ajwayelekile. Ukwelashwa kwe-monoclonal antibody, i-tyrosine kinase inhibitors, i-cyclin-dependent kinase inhibitors, kanye ne-mammalian target ye-rapamycin (mTOR) inhibitors yizinhlobo zezindlela zokwelashwa eziqondisiwe ezisetshenziselwa ukwelapha amadoda anomdlavuza webele.

I-monoclonal antibody therapy isebenzisa 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 nawo asetshenziswa ngamakhemikhali njenge-adjuvant therapy (ukwelashwa okunikezwa ngemuva kokuhlinzwa ukwehlisa ubungozi bokuthi umdlavuza uzobuya).

Izinhlobo zokwelashwa kwe-monoclonal antibody zihlanganisa okulandelayo:

• I-Trastuzumab i-anti-monoclonal antibody evimba imiphumela ye-protein factor HER2.

• I-Pertuzumab iyi-anti-monoclonal antibody engahlanganiswa ne-trastuzumab ne-chemotherapy yokwelapha umdlavuza webele.

• I-Ado-trastuzumab emtansine i-anti-monoclonal antibody exhunywe nomuthi we-anticancer. Lokhu kubizwa ngokuthi yi-anti-drug conjugate. Ingasetshenziselwa ukwelapha amadoda anomdlavuza webele we-hormone receptor omuhle osakaze kwezinye izingxenye zomzimba.

I-Tyrosine kinase inhibitors yimithi yokwelashwa ebhekiswe kuyo evimba amasiginali adingekayo ukuze izicubu zikhule. ILapatinib iyi-tyrosine kinase inhibitor engasetshenziswa ukwelapha amadoda anomdlavuza webele we-metastatic.

Ama-cyclin-dependent kinase inhibitors yimithi yokwelapha ehlosiwe evimba amaprotheni abizwa ngama-cyclin-dependent kinases, abangela ukukhula kwamangqamuzana omdlavuza. I-Palbociclib iyi-cyclin-dependent kinase inhibitor esetshenziselwa ukwelapha amadoda anomdlavuza webele we-metastatic.

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.

Bheka Izidakamizwa ezivunyelwe umdlavuza webele ukuthola eminye imininingwane.

Ukwelashwa komdlavuza webele wesilisa kungadala imiphumela emibi.

Ngemininingwane ngemiphumela engemihle ebangelwe ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

Izinketho Zokwelapha Umdlavuza Webele Wesilisa

Kulesi Sigaba

• Umdlavuza Webele Wesilisa Wasekuqaleni / Wendawo / Osebenzisekayo

• Umdlavuza Webele Wesilisa Wokuhlala Wenzeka Njalo

• I-Metastatic Breast Cancer Emadodeni

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

Umdlavuza webele emadodeni uphathwa ngokufana nomdlavuza webele kwabesifazane. (Bheka isifinyezo se- se-Breast Cancer Treatment (Adult) ukuthola eminye imininingwane.)

Umdlavuza Webele Wesilisa Wasekuqaleni / Wendawo / Osebenzisekayo

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

Ukuhlinzwa Kokuqala

Ukwelashwa kwabesilisa abatholakala benomdlavuza webele kuvame ukuguqulwa nge-radical mastectomy.

Ukuhlinzwa okonga amabele nge-lumpectomy okulandelwa ukwelashwa ngemisebe kungasetshenziswa kwamanye amadoda.

Ukwelashwa Kwe-Adjuvant

Ukwelashwa okunikezwa ngemuva kokuhlinzwa lapho amangqamuzana omdlavuza engasabonwa kubizwa ngokuthi yi-adjuvant therapy. Noma udokotela ewususa wonke umdlavuza ongabonakala ngesikhathi sokuhlinzwa, isiguli singanikezwa ukwelashwa ngemisebe, i-chemotherapy, i-hormone therapy, kanye / noma ukwelashwa okuhlosiwe ngemuva kokuhlinzwa, ukuzama ukubulala noma yimaphi amangqamuzana omdlavuza angahle abe kwesokunxele.

• I-Node-negative: Kwabesilisa abanomdlavuza ongenayo i-node-negative (umdlavuza awusakazekanga kuma-lymph node), ukwelashwa kwe-adjuvant kufanele kubhekwe ngesisekelo esifanayo nowesifazane onomdlavuza webele ngoba abukho ubufakazi bokuthi impendulo ekwelashweni yehlukile kwabesilisa nabesifazane.

• I-Node-positive: Kwabesilisa abanomdlavuza ongenayo i-node-positive (umdlavuza usakazekele kuma-lymph node), i-adjuvant therapy ingafaka okulandelayo:

• Ukwelashwa ngamakhemikhali.

• Ukwelashwa kwehormone nge-tamoxifen (ukuvimba umphumela we-estrogen) noma ngaphansi kaningi, i-aromatase inhibitors (ukunciphisa inani le-estrogen emzimbeni).

• Ukwelashwa okuqondisiwe nge-anti-monoclonal antibody (trastuzumab noma i-pertuzumab).

Lezi zindlela zokwelashwa zibonakala zikhulisa ukusinda emadodeni njengoba kwenzeka kwabesifazane. Impendulo yesiguli ekwelashweni kwamahomoni incike ekutheni kukhona yini ama-hormone receptors (amaprotheni) ku-tumor. Iningi lomdlavuza webele emadodeni unalezi zitholampilo. Ukwelashwa kweHormone kuvame ukunconywa kwiziguli ezinomdlavuza webele wesilisa, kepha kungaba nemiphumela engemihle eminingi, kufaka phakathi ukushisa nokungabi namandla (ukungakwazi ukwakhiwa okwanele ukuya ocansini).

Umdlavuza Webele Wesilisa Wokuhlala Wenzeka Njalo

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

Kwabesilisa abanesifo esiphindayo sendawo (umdlavuza obuyile endaweni elinganiselwe ngemuva kokwelapha), izinketho zokwelashwa zifaka:

• Ukuhlinzwa.

• Ukwelashwa ngemisebe kuhlangene nokwelashwa ngamakhemikhali.

I-Metastatic Breast Cancer Emadodeni

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

Ukwelashwa kweHormone

Emadodeni asanda kutholakala ukuthi anomdlavuza webele we-metastatic okuyi-hormone receptor enhle noma uma isimo se-hormone receptor singaziwa, ukwelashwa kungafaka:

• Ukwelashwa kweTamoxifen.

• Ukwelashwa kwe-Aromatase inhibitor (i-anastrozole, i-letrozole, noma i-exemestane) nge-agonist ye-LHRH noma ngaphandle kwayo. Kwesinye isikhathi kunikezwa futhi i-cyclin-dependent kinase inhibitor therapy (palbociclib).

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

• Ukwelashwa kwe-Aromatase inhibitor nge-agonist ye-LHRH noma ngaphandle kwayo.

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

Ukwelashwa okuhlosiwe

Emadodeni anomdlavuza 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) kuhlanganiswe ne-letrozole.

Emadodeni anomdlavuza webele we-metastatic ongu-HER2 / neu omuhle, ukwelashwa kungafaka:

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

Ukwelashwa ngamakhemikhali

Kubesilisa 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.

Ukuhlinzwa

• Ingqikithi yemastectomy yamadoda anezilonda 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.)

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

Ukuze ufunde kabanzi Ngomdlavuza Webele Wesilisa

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

• Ikhasi Lasekhaya Lomdlavuza Webele

• Izidakamizwa zivunyelwe umdlavuza webele

• Ukwelashwa KweHormone Komdlavuza Webele

• Izindlela Zokwelapha Zomdlavuza

• Ukuhlolwa Kofuzo Kwezifo Ezizuzwayo Zokuthola Umdlavuza

• Izinguquko ze-BRCA: Ubungozi Bomdlavuza Nokuhlolwa Kofuzo

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