Types/breast/patient/pregnancy-breast-treatment-pdq

Ukwelashwa Komdlavuza Webele Ngesikhathi Sokukhulelwa

Imininingwane ejwayelekile mayelana nokwelashwa komdlavuza webele ngesikhathi sokukhulelwa

AMAPHUZU ASEMQOKA

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

• Kwesinye isikhathi umdlavuza wamabele uvela kwabesifazane abakhulelwe noma abasanda kubeletha.

• Izimpawu zomdlavuza webele zifaka phakathi isigaxa noma ushintsho ebeleni.

• Kungaba nzima ukuthola (ukuthola) umdlavuza webele ekuqaleni kwabesifazane abakhulelwe noma abahlengikazi.

• Ukuhlolwa kwamabele kufanele kube yingxenye yokunakekelwa ngaphambi kokubeletha nangemva kokubeletha.

• 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.

Kwesinye isikhathi umdlavuza wamabele uvela kwabesifazane abakhulelwe noma abasanda kubeletha.

Umdlavuza webele uvela cishe kanye kokukhulelwa okungu-3 000. Kwenzeka kakhulu kwabesifazane abaneminyaka engama-32 kuya kwengu-38 ubudala. Ngenxa yokuthi abesifazane abaningi bakhetha ukubambezeleka ukuthola izingane, kungenzeka ukuthi inani lamacala amasha omdlavuza webele ngesikhathi sokukhulelwa lizokhula.

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.

Kungaba nzima ukuthola (ukuthola) umdlavuza webele ekuqaleni kwabesifazane abakhulelwe noma abahlengikazi.

Amabele avame ukuba makhulu, athambile, noma abe nesigaxa kwabesifazane abakhulelwe, abahlengikazi, noma abasanda kubeletha. Lokhu kwenzeka ngenxa yezinguquko ezijwayelekile zehomoni ezenzeka ngesikhathi sokukhulelwa. Lezi zinguquko zingenza kube nzima ukuthola izigaxa ezincane. Amabele nawo angaqina kakhulu. Kunzima kakhulu ukuthola umdlavuza webele kwabesifazane abanamabele aminyene besebenzisa i-mammography. Ngoba lezi zinguquko zebele zingabambezela ukuxilongwa, umdlavuza webele uvame ukutholakala ngokuhamba kwesikhathi kulaba besifazane.

Ukuhlolwa kwamabele kufanele kube yingxenye yokunakekelwa ngaphambi kokubeletha nangemva kokubeletha.

Ukuthola umdlavuza webele, abesifazane abakhulelwe nabancelisayo kufanele bazihlolisise amabele abo. Abesifazane kufanele futhi bathole izivivinyo zomtholampilo ngesikhathi behlolwa njalo ngaphambi kokubeletha nangemva kokubeletha. Khuluma nodokotela wakho uma ubona noma yiziphi izinguquko emabeleni akho ongazilindele noma ezikukhathazayo.

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

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.

• 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 sisibheke kamuva.

• I-Mammogram: I-x-ray yebele. I-mammogram ingenziwa ngengozi encane enganeni engakazalwa. Ama-mammograms kwabesifazane abakhulelwe angahle abonakale engemuhle yize umdlavuza ukhona.

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

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

Kunezinhlobo ezintathu zama-biopsies webele:

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

• 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 kanye neminyaka yengane engakazalwa. Ukuhlolwa kunikeza imininingwane mayelana:

• Umdlavuza ungakhula ngokushesha kangakanani.

• Kungenzeka kangakanani ukuthi umdlavuza usabalalele nakwezinye izingxenye zomzimba.

• Kungasebenza kanjani kahle ukwelashwa okuthile.

• Kungenzeka kanjani ukuthi umdlavuza uphinde ubuye (ubuye).

Ukuhlolwa kungafaka okulandelayo:

• Ukuhlolwa kwe-Estrogen ne-progesterone receptor: Isivivinyo sokulinganisa inani le-estrogen ne-progesterone (hormone) receptors ezicutshini zomdlavuza. Uma kukhona ama-estrogen amaningi noma ama-progesterone receptors kunokujwayelekile, umdlavuza ubizwa nge-estrogen receptor omuhle noma owamukela i-progesterone Lolu hlobo lomdlavuza webele lungakhula ngokushesha okukhulu. Imiphumela yokuhlolwa ikhombisa ukuthi ukwelashwa ukuvimba i-estrogen ne-progesterone enikezwa ngemuva kokuzalwa kwengane 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 ungalashwa ngemithi ekhomba i-HER2 / neu protein, efana ne-trastuzumab ne-pertuzumab, ngemuva kokuzalwa kwengane.

• 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).

• I-Oncotype DX: Lokhu kuhlolwa kusiza ukubikezela ukuthi ngabe isigaba sokuqala noma umdlavuza webele wesigaba II okuyi-estrogen receptor enhle ne-node-negative izosakazeka kwezinye izingxenye zomzimba. Uma ingozi yokusabalalisa umdlavuza iphezulu, 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.

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 sisabalale kwezinye izingxenye zomzimba).

• Uhlobo lomdlavuza webele.

• Iminyaka yengane engakazalwa.

• Noma ngabe kukhona izimpawu noma izimpawu.

• Impilo ejwayelekile yesiguli.

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.

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

Inqubo esetshenziswayo 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.

Ezinye izinqubo zingachaya ingane engakazalwa emisebeni eyingozi noma odayi. Lezi zinqubo zenziwa kuphela uma kunesidingo. Izinyathelo ezithile zingenziwa ukudalula umntwana ongakazalwa emisebeni emincane ngangokunokwenzeka, njengokusebenzisa isihlangu esinezintambo zokuhola ukumboza isisu.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziselwa ukubeka umdlavuza webele ngesikhathi sokukhulelwa:

• 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.

• 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.

• Ukuhlolwa kwe-Ultrasound: Inqubo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi noma izitho, njengesibindi, futhi enze 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 yezindawo ezingaphakathi komzimba, njengobuchopho. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

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.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Izinketho zokwelashwa kwabesifazane abakhulelwe zincike esigabeni sesifo kanye neminyaka yengane engakazalwa.

• Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Ukuqeda ukukhulelwa akubonakali kuthuthukisa ithuba likamama lokusinda.

• Ukwelashwa komdlavuza webele kungadala imiphumela emibi.

Izinketho zokwelashwa kwabesifazane abakhulelwe zincike esigabeni sesifo kanye neminyaka yengane engakazalwa.

Izinhlobo ezintathu zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

Iningi labesifazane abakhulelwe abanomdlavuza webele bayahlinzwa ukuze kukhishwe isifuba. Amanye ama-lymph node ngaphansi kwengalo angasuswa ukuze ahlolwe ngaphansi kwe-microscope ngudokotela wezifo ukuthola izimpawu zomdlavuza.

Izinhlobo zokuhlinzwa ukususa umdlavuza zifaka:

• 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. Lolu hlobo lokuhlinzwa luvame kakhulu kwabesifazane abakhulelwe.

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 ukukhipha umdlavuza nezicubu ezijwayelekile ezizungezile, 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.

Ngemuva kokuthi udokotela awususe wonke umdlavuza ongabonakala ngesikhathi sokuhlinzwa, ezinye iziguli zinganikezwa i-chemotherapy noma i-radiation therapy ngemuva kokuhlinzwa ukubulala noma yimaphi amangqamuzana omdlavuza asele. Kwabesifazane abakhulelwe abanomdlavuza webele osezingeni lokuqala, ukwelashwa ngemisebe nokwelashwa kwamahomoni kunikezwa ngemuva kokuzalwa kwengane. Ukwelashwa okunikezwa ngemuva kokuhlinzwa, ukwehlisa ubungozi bokuthi umdlavuza uzobuya, kubizwa ngokuthi yi-adjuvant therapy.

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 kunganikezwa abesifazane abakhulelwe abanomdlavuza webele wesigaba sokuqala (isigaba I noma II) ngemuva kokuzalwa kwengane. Abesifazane abanomdlavuza webele wesigaba sekwephuzile (isigaba III noma IV) banganikezwa ukwelashwa ngemisebe yangaphandle ngemuva kwezinyanga ezintathu zokuqala zokukhulelwa noma, uma kungenzeka, ukwelashwa ngemisebe kubambezeleka kuze kube ngemuva kokuzalwa kwengane.

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuvimba amaseli ukuthi angahlukani. 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 ngesikhathi sokukhulelwa.

I-Chemotherapy imvamisa ayinikezwa ezinyangeni ezintathu zokuqala zokukhulelwa. Ukwelashwa ngamakhemikhali okunikezwa ngemuva kwalesi sikhathi akuvamisile ukulimaza ingane engakazalwa kepha kungadala ukusikwa ngaphambi kwesikhathi noma isisindo esiphansi sokuzalwa.

Bheka Izidakamizwa ezivunyelwe umdlavuza webele ukuthola eminye imininingwane.

Ukuqeda ukukhulelwa akubonakali kuthuthukisa ithuba likamama lokusinda.

Ngoba ukuqeda ukukhulelwa kungenzeka kungathuthukisi ithuba likamama lokusinda, imvamisa akuyona inketho yokwelashwa.

Ukwelashwa komdlavuza webele kungadala imiphumela emibi.

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

Izinketho zokwelashwa zomdlavuza webele ngesikhathi sokukhulelwa

Kulesi Sigaba

• Umdlavuza Webele Wasesiteji Sokuqala

• Umdlavuza Webele Wamuva-Esiteji

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

Umdlavuza Webele Wasesiteji Sokuqala

Abesifazane abakhulelwe abanomdlavuza webele besigaba sokuqala (isigaba I nesigaba II) bavame ukuphathwa ngendlela efanayo neziguli ezingakhulelwe, kube nezinguquko ezithile ukuvikela umntwana ongakazalwa. Ukwelashwa kungafaka okulandelayo:

• Kushintshwe i-mastectomy enamandla, uma umdlavuza webele utholwe ekuqaleni kokukhulelwa.

• Ukuhlinzwa okulondoloza amabele, uma umdlavuza webele utholakala kamuva ekukhulelweni. Ukwelashwa ngemisebe kunganikezwa ngemuva kokuzalwa kwengane.

• Kushintshwe i-radical mastectomy noma ukuhlinzekwa kokugcina amabele ngesikhathi sokukhulelwa. Ngemuva kwezinyanga ezintathu zokuqala zokukhulelwa, izinhlobo ezithile ze-chemotherapy zinganikezwa ngaphambi noma ngemuva kokuhlinzwa.

Ukwelashwa kwehormone kanye ne-trastuzumab akufanele kunikezwe ngesikhathi sokukhulelwa.

Umdlavuza Webele Wamuva-Esiteji

Akukho ukwelashwa okujwayelekile kweziguli ezinomdlavuza webele wesikhathi esedlule (isigaba III noma isigaba IV) ngesikhathi sokukhulelwa. Ukwelashwa kungafaka okulandelayo:

• Ukwelashwa ngemisebe.

• Ukwelashwa ngamakhemikhali.

Ukwelashwa ngemisebe nokwelashwa ngamakhemikhali akufanele kunikezwe phakathi nezinyanga ezintathu zokuqala zokukhulelwa.

Izinkinga Ezikhethekile Ngomdlavuza Webele Ngesikhathi Sokukhulelwa

AMAPHUZU ASEMQOKA

• Ukuncelisa ubisi lwebele (ukukhiqiza ubisi lwebele) kanye nokuncelisa ibele kufanele kumiswe uma kuhlelwe ukuhlinzwa noma ukwelashwa ngamakhemikhali.

• Umdlavuza webele awubonakali ulimaza umntwana ongakazalwa.

• Ukukhulelwa akubonakali kukuthinta ukusinda kwabesifazane abake baba nomdlavuza webele esikhathini esedlule.

Ukuncelisa ubisi lwebele (ukukhiqiza ubisi lwebele) kanye nokuncelisa ibele kufanele kumiswe uma kuhlelwe ukuhlinzwa noma ukwelashwa ngamakhemikhali.

Uma kuhlelwe ukuhlinzwa, ukuncelisa ibele kufanele kumiswe ukunciphisa ukugeleza kwegazi emabeleni futhi kuwenze amancane. Izidakamizwa eziningi ze-chemotherapy, ikakhulukazi i-cyclophosphamide ne-methotrexate, zingavela emazingeni aphezulu ebisi lwebele futhi zingalimaza ingane encelayo. Abesifazane abathola ukwelashwa ngamakhemikhali akufanele bancelise ibele.

Ukumisa i-lactation akuthuthukisi ukubikezelwa komama.

Umdlavuza webele awubonakali ulimaza umntwana ongakazalwa.

Amaseli omdlavuza webele akubonakali ngathi asuka kumama aye enganeni engakazalwa.

Ukukhulelwa akubonakali kukuthinta ukusinda kwabesifazane abake baba nomdlavuza webele esikhathini esedlule.

Kwabesifazane abake baba nomdlavuza webele, ukukhulelwa akubonakali kuthinta impilo yabo. Kodwa-ke, abanye odokotela bancoma ukuthi owesifazane alinde iminyaka emi-2 ngemuva kokwelashwa komdlavuza webele ngaphambi kokuzama ukuba nengane, ukuze noma yikuphi ukubuya komdlavuza kusenesikhathi kutholakale. Lokhu kungathinta isinqumo sowesifazane sokukhulelwa. Ingane engakazalwa kubonakala sengathi ayithinteki uma umama eye waba nomdlavuza webele.

Ukuze ufunde kabanzi Ngomdlavuza webele ngesikhathi sokukhulelwa

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

• Ikhasi Lasekhaya Lomdlavuza Webele

• Ukuvimbela Umdlavuza Webele

• Ukuhlolwa Komdlavuza Webele

• Izinketho Zokuhlinzwa Kwabesifazane abane-DCIS noma Umdlavuza Webele

• Amabele Aminyene: Izimpendulo Zemibuzo Evame Ukubuzwa

• Izidakamizwa zivunyelwe umdlavuza webele

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