Ukuba unayo i-nodeinel node biopsy yakho yebele okanye u-oncologist unokuthetha nge-micrometastases. Ngokwenyani, i-micrometastases ibaluleke kakhulu malunga naluphi na uhlobo lomhlaza kwaye iyona nto ibangela ukuba kuthiwa "unyango olushushu."
Yiyiphi i-micrometastase kwaye yintoni ekuthethwa ngayo ukuba unayo micrometastase kwii-lymph nodes?
Sibanzi
I-Micrometastases yinkqoqo encinci yeeseli zomhlaza eziye zachithwa zisuka kwi-tumor yokuqala kwaye zisasazeka kwenye inxalenye yomzimba. Abakwazi ukubonwa naluphina iimvavanyo zokucinga ezifana ne-mammogram, i-MRI, i-ultrasound, i-PET, okanye i-CT. Ezi zintsholongwane zesifo somhlaza zingabelana ndawonye kwaye zenze i-tumor yesibili, into encinci kangangokuthi ibonakala kuphela phantsi kwe-microscope.
Ukubaluleka
Ubukho be micrometastases bubaluleke kakhulu. Akuqhelekanga umdlavuza oyintloko (nokuba unesifuba, imiphunga, okanye enye imimandla yomzimba) eyona monakalo omkhulu. Enyanisweni, yinto xa umdlavuza usasazeka (i- metastasizes ) kwenye imimandla yomzimba xa yenza umonakalo omkhulu. Amaphesenti angama-90 abantu abafa ngesifo somhlaza bayafa ngenxa yesifo se-metastatic.
Xa umhlaza kuqala usasazeka, kuthatha indawo yokuhlala njengecandelo elincinane lomhlaza weseli. Iqoqo elincinci leeseli zomhlaza libizwa ngokuba yi-micrometastasis (i-microscopic metastasis).
Eli qela leeseli zomhlaza lincinci kakhulu kwaye lingabonakala ngokucacileyo phantsi kwe-microscope. Ezi ziqoqo azibonakali kuyo nayiphi na imvavanyo yokucinga esiyifumane namhlanje. Ngamanye amazwi, yindlela kuphela yokukwazi ukuba i-micrometastases ikhona ukuba isuse iisununu apho zikhona kwaye zijonge kwiingcezu zeetyhusi phantsi kwe-microscope.
Nge-lymph node biopsy, kunokwenzeka ukwenza oku, kodwa akunakwenzeka ukususa zonke i-lymph node. Kwakhona akunakwenzeka ukususa ezinye izitho zomzimba ukuba zikhangele ukusasazeka. Asikwazi ukukhupha umphunga womntu, isibindi, namathambo ukuba abuke naziphi na ubungqina be-tumor. Le ngcamango i-chemotherapy ene-adjuvant okanye unyango lwe-radijuji. Xa i-tumor ibukhulu becala okanye ukuba isasazeka kwii-lymph nodes, kucingwa ukuba kukho i-metastases encinci kwenye indawo emzimbeni ongenakunakwenzeka. Kuvakalelwa ukuba izicubu ezinqabileyo kunye nokukhula kunye ne-tumor yokuqala ziqala njengalezi ziqoqo ezincinci zeseli zomhlaza.
I-Micrometastase yilezi zizathu zonyango ezifana ne- chemotherapy ene-adjuvant okanye unyango lwe-radijuji. Ezi zonyango zisetyenziselwa emva kokuba i-tumor yokuqala isusiwe "kuhlambulule" nayiphi na i-micrometastase kufuphi nomvelaphi wesisu (nge-radiation) okanye naphi na emzimbeni apho bahamba khona (nge-radiation).
I-Micrometastases ne-Isolated Tumor Cells
Xa isetyenziswe kwisimo samanomdla amaninzi, i-micrometastases ibhekisela kule seliyi ezikhankanywe ukuba zihambile (ezidityanisiweyo) ukusuka kwidumbu kodwa zingabonakali zifundo zophando esizifumanayo ngoku.
Ukwahlula okunye kwezi ndawo ezincinci zokusasaza kusetshenziselwa ukuthetha nge-nodeel neodetic biopsies kunye nomhlaza wesifuba. Ngaloo ndlela, i-micrometastases ichazwa njengamaqoqo eeseli zomhlaza eziphakathi kwe-0.2 mm (millimeters) ububanzi kunye no-2.0 mm ububanzi. Ngokwahlukileyo, "amangqamuzana anesifo somzimba" ahlukeneyo ngamaseli omhlaza okona amancinane; ngaphantsi kwe-0.2 mm ububanzi.
I-Micrometastases kwi-Sentinel Lymph Node Biopsy
Kubafazi abanomdlavuza wesibeleko abangenayo ubungqina bokuba lymph node ukubandakanyeka kwi-test okanye i-ultrasound, i- lymph node biopsy i- sentinel i-standard yonyango.
Kule nkqubo, idayi eluhlaza okwesibhakabhaka (ekwabiwe ngoko ke iyafumaneka kwi-radiographically) ifakwe kwi-tumor kwaye ivunyelwe ukuhamba. Xa umdlavuza usasazeka kwiimvama kaninzi usasazeka kwi-lymph nodes kumzekelo oqikelelweyo.
Ngokwenza i-biopsy ye-sentinel node okanye i-nodes-amanani ambalwa okuqala ukuba umhlaza uya kuhamba-a maninzi a mabhinqa akhuselekanga i-lymph node dissection epheleleyo (ukususwa kwayo yonke into okanye amaninzi e-lymph nodes kwi-armpit). Ekubeni i-dissection egcwele i-axillary ingabangela iingxaki ezifana ne- lymphedema , le nkqubo inokulondoloza abanye abafazi kule nkcenkceshela.
Uphando luyaqhubeka ukuqinisekisa ukubaluleka kwe-micrometastases kwi-node sentinel. Ngaloo ndlela kuyaziwa ukuba i-macrometastases (i-metastases ezikhulu kune-2.0 mm) zibuhlungu ngakumbi ukuhlaselwa kwesifo. Kuye kwafumanisa ukuba ukunyeliswa kwabasetyhini abanamacrometastases kwi-node sentinel banesichengululo esincinci kunabesifazana abangenayo ibungqina be-tumor kula ma-lymph node. Ngokwahlukileyo, abafazi abaye bahlula iiseli zesisu kwi-node sentel (ngencazelo yendawo yesifo se-tumor esingaphantsi kwe-0.2 mm ububanzi) abanalo ukuhlawula okubi ngaphezu komfazi ongenalo ubungqina beemastastases kwi-node sentel.
Ukuba le ngcaciso inokunceda abaphandi bafunde ngakumbi ukuba ngubani na oya kubafazi abaya kufuna i-lymph node dissection egcwele i-axillary, kunye nawaphi na a mabhinqa abamele bafumane unyango lwe-adjuvant wesibeletho sabo sebele.
Okukwintsusa
Ngokwempawu zesifo somhlaza webele, ukufumana i-micrometastases kubalulekile xa ukhetha unyango olufanelekileyo. Amagciwane okubeleka aqalise ukuhamba ukuze amaqoqo eesifo somhlaza atholakale kwii-lymph nodes zisasazeka nakweminye imimandla yomzimba. Ngako oko kubalulekile ukuba ube nobudlova kwaye usebenzise i-adjuvant chemotherapy kunye / okanye unyango lwe-radiation (ukuphelisa amaqoqo angama-cell cell kamsomali hhayi kuphela kwii-lymph nodes ezikufutshane, kodwa ezo ziye zahamba amathambo, isibindi okanye ezinye iindawo).
Nangona kunjalo i-micrometastase ibaluleke kakhulu malunga nayo nayiphi na umhlaza. Zizo ziqela zokuqala zomhlaza wesibeleko ezihamba ukusuka kwi-tumor yangaphambili, ngokuqhelekileyo ukuya kwi-lymph nodes, ize ibe kwezinye iindawo zomzimba ezifana nemiphunga, amathambo, isibindi, ingqondo okanye enye imimandla. Ukuba sinokuyifumana size siphinde siphume i-micrometastases singakwazi ukuyiqhelisa i-90% yesifo somhlaza.
> Imithombo:
> IMeyile, E., noL. Dominici. I-Cancer yaBestile I-Axillary Isistim: I-Ado eninzi Ngezifo zeMicrometastatic. Umbhalo we-Clinical Oncology . 2015. 33 (10): 1095-7.
> INational Cancer Institute. Ukwelashwa kweNtsholongwane kaBestile (PDQ) -Ingxelo yeNgcali yezobuNtu. Ukuhlaziywa 10/13/17.
> Tvedskov, T., Meretoia, T., Jensen, B., Leidenius, M., kunye noN. Kroman. Ukuqinisekiswa koMnqamlezo weZithathu zokuThengisa izixhobo zeMetastase ezingekho nge-Sentinel kwiNetastases kwiBatter Cancer Patients. I-European Journal ye-Oncology yokugulisa . 2014. 40 (4): 435-41.