Inkcazo, Ukuxilongwa, Ukunyanga, kunye neNgcebiso
Ukuxilongwa kweyiphi na isigaba somhlaza wesisu kunokubangela ukwesaba nokwesaba. Nangona unokuqinisekiswa ukuba unesiqalo sokuqala somhlaza wesifuba unokuvaloyika kwaye uphazamiseke. Siye safunda ukuba iimpendulo zethu zengqondo kwi-diagnostic zifana noko kungakhathaliseki ukuba kuthethwa njani. Iyintoni intsingiselo yesigaba se-tumor, yintoni na ukhetho lwezokwelapha olukhoyo, kwaye yintoni na ukugxekwa kwakho?
Ngelixa singenako ukuthembisa ukuba ukuzifundisa kuya kunciphisa konke ukwesaba kwakho, kunokukunceda udibanise kwisihlalo somqhubi kwaye uzive unamandla ngakumbi ekunyamekeleni kwakho.
Inkcazo
Isigaba se-1 somhlaza wesifuba sisona sigaba sokuqala "somhlaza" webele. Ukubona igama elingenangxaki liloyiko, kodwa igama elingenayo malunga nesigaba alithethi ukuba umhlaza uphathwe kwezinye iindawo zomzimba. Ukumangalisa kuthetha ukuba iiseli kwisisu sakho sichitha into ehamba phambili ebizwa ngokuba ngumgca wendlu. Yiyo le ntsholongwane esedlulileyo kwisigxina esisezantsi esichaza into njengomhlaza.
Xa kuqala umhlaza wesifuba, awukade ukhule kule membrane. Ukuxhamla kweli nqanaba akubheki njengomhlaza, kodwa kunokuba i- carcinoma-in-situ . Ziyakuthi zibhekiswe njengezithuba ze-0 zezidumbu. I-carcinoma-in-situ i-100 yeepesenti ephilisa ngokuhlinzwa ngenxa yokuba iiseli ziqulethe ngokupheleleyo. Akukho ithuba lokuba linokusasazeka.
Isigaba se-1 izibilini ziqalo lokuqala lomhlaza webele webele. Ezi zicubu zincinci, kwaye ukuba zisasazeka nantoni zonke ukuba i-lymph nodes i-spreads i-microscopic kuphela.
Udidi lweStell and TNM
Ukuqonda ukuba ugqirha wakho ugqibe njani isigaba somhlaza wakho, kwaye ukuba unesigaba soku-1A okanye isigaba se-1B isisu, kunceda ukwazi okufutshane malunga ne-TNM ye-classification.
Kule ndlela:
- T ibonisa ubukhulu be-tumor: Amanqaku e-T1 athetha ukuba i-tumor yakho i-2 cm (ubuncinane intshi) okanye ngaphantsi ububanzi. Ngokuqhelekileyo, izicubu ze-T2 zikhulu kunama-2 cm kwaye zincinci kune-5 cm, kunye ne-T3 izikhumba zikhulu kunama-5 cm.
- I-N imele iinqununu: I- N0 ithetha ukuba umhlaza awusasazekanga nakweyiphi i-lymph nodes. I-N1 ithetha ukuba umhlaza usasazeke kwii-lymph nodes kufuphi, kwaye i-N2 ithetha ukuba isasazeke kwii-lymph nodes kude. Ngama-tumors esigaba se-1, elinye ixesha liba luleke. Ixesha elithi micrometastases lithetha ukuba umdlavuza usasazeke kwi-lymph node kodwa ibonakala kuphela phantsi kwe-microscope. I-Micrometastases ikhona xa iiseli zomhlaza zifumaneka kwi-lymph node kwaye zikhulu kune-0.2 mm ububanzi kodwa zingaphantsi kwe-2 mm (0.2 cm) ububanzi. Umhlaza onamacrometastases kwi-lymph node eseduze iya kuchazwa njengeT1mi. I-Macrometastases, ngokuchaseneyo, ibhekisela kumdlavuza kwi-lymph node ephezulu kune-2 mm ububanzi (kwaye inokuthi, kubonakala, kwimbono).
- M imelela i-metastase: M0 ithetha ukuba umhlaza awuzange ulungelelanise (umzekelo, amathambo, ingqondo, okanye isibindi). I-M1 ithetha ukuba ifakwe.
Ingangokudideka (kwaye iyatshitshisa kakhulu) ukuba ufunda ingxelo yakho yokugula kwaye uqaphele ukuba ithi umhlaza uye "ulungelelanisa kwi-lymph nodes." Oku akuthethi ukuba unomdlavuza webele we-metastatic (isigaba somhlaza wesifuba se-4).
Unako ukufumana i-lymph node metastases nangona izifo zesantya.
Ukusebenzisa inkqubo ye-TNM, isigaba 1 somdlavuza uhlukaniswe ngakumbi:
- Isigaba 1A: T1N0M0. I-tumor ingaphantsi kwe-20 mm (2 cm) ngobukhulu kwaye akukho nzekayo kwi-lymph nodes
- Isigaba 1B: T1N1miM0 okanye T0N1miM0. Ngomxube wokuqala, i-tumor ingaphantsi kwe-20 mm (2 cm) ngobukhulu kwaye kukho i-micrometastase kwi-lymph node eseduze. Olunye uhlobo aluqhelekanga kakhulu kwaye lukhoyo ukuba akukho bungqina besikhumba esiyinhloko esiswini kodwa kukho i-micrometastase kwi-lymph node (ngokuqhelekileyo kwi-armpit).
Ngokubanzi, isigaba se-1 se-tumors zizinto ezincinci kune-inch (2 cm) ububanzi kwaye ingaba zingenayo i-lymph node okanye zifakelele kwii-lymph nodes ezikufutshane kodwa kuphela kwizinga elincinci.
Emva kokuba wazi isigaba somhlaza wakho webele kukho izinto ezininzi eziza kufuneka uzenze ngaphambi kokuba ukhethe okukhethwa kukho unyango olungcono.
Iintlobo
Kukho iintlobo ezahlukeneyo zomhlaza wesibele. I-carcinomas i-ductal carcinomas ixhaphakile yalandelwa i-lobular carcinomas. Okunye, iintlobo ezingaphantsi kweesifo somhlaza wesifuba ziquka umdlavuza webele ovuzayo, i-medullary carcinoma, i-carcinoma ye-tubular, kunye nokunye.
Iphunga leBakala
Ibanga le-tumor liyinombolo echaza ukutshatyalaliswa kwesisu. I-pathologists ijonge iiseli zomhlaza kwi-biopsy kunye / okanye utyando ngaphantsi kwe-microscope ukuchonga izinto ezifana nendlela ezenziwa ngayo iiseli. Izibilini ziya kunikwa ibakala eli-1, 2, okanye le-3, kunye ne-1 ibe yincinci kwaye i-3 ibe yilezi zicubu ezinamandla. Ibanga lakho le-tumor alinakukuxelela oko kuhlaselwa kwakho, kodwa kunokukunceda wena kunye nodokotela wakho ukhethe unyango olungcono.
MultigeneTesting
Kwiminyaka elishumi elidlulileyo okanye kunjalo sifunde ukuba zonke izicubu zihluke njani kwiqondo leey molecular. Ngamanye amazwi, izicubu ezimbini eziphambili ze-carcinomas ze-stroke kunye ne-grade grade ye-2 zikwazi ukuziphatha ngokwahlukileyo. Ukuba awunayo i-lymph nodes kunye ne-tumor encinci, i-oncologist yakho ingancoma ukukhangela olu vavanyo ukuze ubone ukuba ngaba unyango olunjalo olunjenge-chemotherapy luyimfuneko. Izilingo ze-Multigene ezifana ne-Oncotype DX kunye ne-MammaPrint zingasetyenziselwa ukuchonga ukuba i-chemotherapy iyadingeka kwisifo somhlaza webele.
Isimo seReceptor
Xa ukhetha unyango olungcono kumdlavuza wakho webele, ugqirha wakho uya kufuna ukuvavanya imeko yesifo somdlavuza wakho. Ama-receptors ayenamaprotheni atholakala kummandla weeseli zomhlaza kwaye zibalulekile ekukhuleni kweeseli.
I-Estrogen Receptors
I-Estrogen receptors iiprotheni (i-receptors) efunyenwe kummandla weeseli zomhlaza. Amanomdla okubeletha esiswini e-estrogen-receptor positive avuselelwe ukuba akhule xa i-estrogen idibanisa nala ma-receptors.
Abamkeli beProgesterone
Ama-receptors ama-progesterone ahlala ehamba kunye nama-receptors.
HER2 Khancer Positive
Ezinye izikhensi zebele zithunyelwa njenge-HER2 enhle. I-HER2 iyiprotheyini ephezulu kumaseli omhlaza. Izinto zokukhula zibophelela kule receptor ukukhuthaza ukukhula. Zonke iiseli zesifuba eziqhelekileyo zifumana i-HER2 receptors, kodwa ngee-cancer ze-H2 ezintle, zikho ngezihlandlo ezili-100 ezi zihlandlo zezi-receptors (ungabona imibandela efana ne-HER2 ukukhulisa ngokubhekiselele kwiijethi ezongezelelweyo ezibhalwe kwiprotheni okanye i-HER2 yokunyusa, ngokubhekiselele kumanani akhulayo zamkeli kwiiseli zomhlaza).
Kukho iindlela ezithile zonyango ezingabhekisela kula ma-receptors anokunciphisa umngcipheko wokuphindaphinda. Ukuba zonke i-receptors zakho "ziphazamisekile" ekuvavanyeni, i-tumor yakho iya kuthathwa njengengxaki yomhlaza wesifuba.
Unyango
Unyango luye lwaphulwa kuqala kwiiklasi ezibalulekileyo:
- Uonyango lwengingqi: Iipilisi zendawo zingaphatha umdlavuza ngaphakathi kwendawo, kwaye zibandakanya unyango kunye neyeza
- Ionyango zonyango: Iinkqubo zonyango zilawula unyango lomzimba okanye kuwo wonke umzimba. Ezi ziquka ukhemotherapy, unyango lwe-hormonal, unyango olujoliswe kuyo, kunye ne-immunotherapy.
Ukuba isifo sincinci kakhulu, unyango lwendawo luhlala lukho konke okufunekayo. Ukuba i-tumor ikhudlwana, ininzi enobudlova (inezinga eliphezulu le-tumor grade), isasazeka kwii-lymph nodes, okanye iprofile yecalamente ebonisa ukuba umhlaza uya kubakho ukusasazeka, unyango lweenkqubo luhlala lunconywa. Ngesigaba sokuqala se-articular therapy (i-add-on therapy) kunye nenjongo yokuphelisa iiseli zegazi ezisasaze ngaphaya kwesifuba kodwa zincinci kakhulu ukuba zingabonwa ngophando lwangoku.
Izinketho ezithile zonyango zingabandakanya:
Ukuhlinzwa
Uphando luyacetyiswa ininzi yesigaba se-cancer. Izinketho ziquka i- lumpectomy okanye i- mastectomy . Kukho izizathu zokuba abantu bakhethe omnye komnye, kwaye unokuzikhethela. Ukuba ukhethwa i-lumpectomy, unyango lwe-radiation kwiisisifu zesifuba esiseleyo luvame ukucetyiswa. Ukuba unomastectomy, ugqirha wakho uya kuthetha nawe malunga nokukhethwa kwebele. Utyando olusesikhumba luya kuba luqhelekileyo, kwaye ngale nkqubo, ukufakelwa okanye ubuncinane i-expander idla ngokufakwa ngexesha elifanayo njenge-mastectomy yakho.
Ngokuhlinzwa, i- nodeinel node biopy inokwenziwa. Kwixesha elidlulileyo, i-lymph node ezininzi zazikhutshwe kwaye zihlolwe phantsi kwe-microscope, kodwa ngoku sinokukwazi ukuba yiyiphi i-lymph nodes yomhlaza eya kuqala, kwaye isampula kuphela loo nodes. Ukuba i-lymph nodes zakho zithembekileyo kuthetha ukuba umhlaza uye wachaza injongo yawo yokusasazeka.
Chemotherapy
Ngezinye iinkqubo isifo se- Chemotherapy somhlaza wesifuba sisetyenziselwa unyango oluxhasayo kunye nesigaba soku-1, nakuba sele kunzima ukufumanisa ukuba ngubani oza kuzuza. Kulabo abanamacrometastase kwiimfayili, i-chemotherapy ihlala ikhuthazwa. Injongo yokwenza i-chemotherapy kukunyanga nawuphi na amangqamuzana omhlaza ongase alahleke kwibele yakho ngaphambi kokuba akhule abe ngama-metastases. Iintsholongwane eziye zasasazeka (nakwixabiso elincinci) kwii-lymph nodes ziye zavakalisa ukuba zifuna ukusabalalisa phambili.
Ngomdlavuza webele ongena-node ongama-2 cm ububanzi okanye ngaphantsi (isigaba 1) akucaci kakuhle. I-Oncotype Dx I-Score Recurrence okanye iMammaPrint iyimvavanyo ye-genomic eninzi eya kuba luncedo. Abo bafumana amanqanaba aphakamileyo kwiimvavanyo baye bandisa izinga lokusinda xa i-chemotherapy inikezelwa. Abo bafumana amanqaku aphantsi awanakuzuza kwi-chemotherapy. Ekubeni i-chemotherapy ineempembelelo ezinokuthi zenzeke (ezinjalo ukungaphumeleli kwentliziyo kunye ne-secondary leukemia nakuba kungaqhelekanga) kubalulekile ukulinganisa ingozi kunye neenzuzo ngamnye ngomntu ngamunye.
Utyando lweyeza
Ukuba une-lumpectomy, unyango lwe-radiation lisetyenziselwa ukuphatha izicubu zakho zesifuba esisele. Ngesigaba 1 somhlaza wesifuba, unyango lwe-radiation alufanekiyo emva kwe-mastectomy.
IHormone Therapies
Ukuba i-tumor yakho i-estrogen receptor echanekileyo, unyango lwe-hormone ngokuqhelekileyo lunconywa lulandelayo unyango oluphambili kunye nokuhlinzwa kunye ne-chemotherapy / unyango lwe-radiation. Injongo kukunciphisa umngcipheko wokuba umhlaza uza kubuya. I-Estrogen receptor i-tumors ezihle ziyakwazi ukuphindaphinda ngokukhawuleza (emva kweminyaka emi-5 nangaphezulu). Kubafazi be-premenopausal, i-tamoxifen isetyenziswa rhoqo. Kubafazi besimo se-postmenopausal, unyango luvame ukuba yi-aromatase inhibitor njenge-Aromasin (i-exemestane), i-Arimidex (i-anastrozole), okanye i-Femara (i-letrozole).
HER2 Ulwaphulo olulindelekileyo
Ukuba i-tumor yakho i-HER positive, iyeza ezijoliswe ku-HER2 ezifana ne-Herceptin (trastuzumab) iqala ngokuqala emva kokonyango oluphambili.
Uvavanyo lweZliniki
Indlela kuphela yenkqubela phambili eyenziwa kunyango lomhlaza wesifuba ngokufunda iilitsha zamatyala kunye neenkqubo kwiimvavanyo zeclini. Kukho iinkolelo ezininzi malunga nokuhlolwa kweeklinikhi , kodwa inyaniso kukuba yonke into esetyenziswayo ngoku yayiye yafundwa kwilingo lonyango.
Ukukhetha unyango olungcono
Ngesigaba 1 somhlaza wesifuba esinye sezigqibo ezinkulu kunjani uhlobo lotyando olunalo. Kukho ubuchule kunye nokuqhafaza kwindlela nganye yokuhlinzwa, kwaye izinto ezininzi kufuneka ziqwalaselwe njengembali yakho yentsapho (ithuba loya kuhlakulela omnye umhlaza wesifuba), apho i-tumor yakho ikhona kwifuba lakho, kwaye unokulindela ukuthatha i-cosmetically kwinkqubo nganye. Kubalulekile ukukhetha unyango olulungileyo kuwe, kungakhathaliseki ukuba ubani onokukhetha. Kubaluleke kakhulu ukuba ube ngummeli wakho kumnonophelo wakho womhlaza . Izigulane kunye noogqirha basebenza ngokubambisana ngokugqithiseleyo ukuba ngaphambili kwaye uyilungu elibalulekileyo leqela lakho lomdlavuza.
Ukunyamezela kunye nenkxaso
Enye yezinto ezintle ongayenza wena emva kokuxilongwa kwakho ukuqokelela inethiwekhi yenkxaso. Unokunqwenela ukubhala phantsi uluhlu lwabahlobo abanokunika inkxaso. Nangona uvakalelwa kakuhle ngonyango lwakho, unokuba nzima ukongeza ezi zonyango kwiishedyuli zethu ezilungiselelwe zonke. Cela uncedo uze uvumele abantu ukuba bancede.
Unokuba unqwenela ukumisa isayithi leCaringBridge okanye umntu enze oku kuwe. Le yindlela enhle kakhulu yokugcina yonke intsapho yakho kunye nabahlobo bakho bengazi kakuhle imeko yakho ngaphandle kokuchitha iiyure ezingapheliyo ngosuku ngalunye kwifowuni. Abahlobo bakho bayakuxabisa ithuba lokubeka izimvo baze babhale amanqaku ngaphandle kokukhathazeka ngokuphazamisa ukuphumla kwakho. Kukho neendawo ezivumela abantu ukuba batyikitye ukuze badle ukutya, bakuqhubelele ekutyeleleni ama-radiation, kunye nenye incedo efana ne-Take Them Meal and Lotsa.
Emotionally unokuba uzive ngathi udibana ngamanye amaxesha. Izifundo zisitshela ukuba abantu basabela ngendlela efanayo emva kokuxilongwa komhlaza kwaye akunandaba nokuba kusekuqaleni okanye kusephambili. Musa ukuvumela umntu ukuba azive ehlekisayo ngokuthi "yinqanaba elilodwa kuphela". Ingumdlavuza, kwaye umdlavuza uyatshisa! Iimvakalelo zakho zinokuthi zixakeke kwiinkwenkwezi ngenxa yokwesaba ukuxhalabisa ukudideka-ukwesaba-ngamanye amaxesha ngendlela ethile. Awunasoloko uhlala ulungile kwaye kubalulekile ukuvakalisa iimvakalelo zakho ezimbi.
Ukubandakanyeka kwiqela lokuxhasa okanye uluntu lwenkxaso yoluntu lunokuba luxabisekileyo. Kukho into ekhethekileyo ngokuthetha nabanye abajongene nemingeni efanayo. Ezi ndawo zinika ithuba lokufunda malunga nophando olusandul 'isifo somhlaza wesifuba, njengoko kungekho mntu ukhuthazwayo njengabo abaphila nesifo.
Prognosis
Isigulana sokuqala kwisigaba 1 somhlaza wesifuba sihle. Kulabo bafumana unyango kunye nokuhlinzwa kunye ne-chemotherapy okanye unyango lwe-radiation, ukuba lunconywa, isilinganiso seminyaka emihlanu yokusondeza sisondele kuma-100 ekhulwini. Oko kwathiwa, ukwenziwa ngonyango kwisigaba 1 somhlaza wesifuba akulula. Iziphumo eziqhelekileyo ziqhelekileyo, ingakumbi nge-chemotherapy, kwaye ukukhathala kubangele yonke indawo.
ILizwi
Ukuxilongwa kwesigaba 1 somhlaza webele kunesabisa. Nangona izinga lokusinda lihle kakhulu, kunokuba nzima ukucinga malunga nawo onke amanyathelo okufuneka uwathathe ukuze ufike khona. Uncike kwabanye kwaye uvumele ukuba bancede. Amanqanaba omhlaza amaninzi anamaqela okuxhasa okanye abacebisi kulabo abasandul Ukuthatha ixesha lokutyelela abantu abaye baphuhliswa unyango kwaye baphuma bengagcini nje, kodwa bekhula, banokukhuthazwa ngaloo mihla xa ukuphelelwa ngumhlaza kugula.
> Imithombo
> McVeigh, T., kunye noMr. Kerin. Ukusetyenziswa kwezonyango ze-Oncotype DX Genomic Test yoLawulo lweZonyango Izigqibo zabagulane abaneCatalcer Breast. I-Cancer Med Press (i-Dove Med Press) . 2017. 9: 393-400.
> INational Cancer Institute. Ukwelashwa kweNtsholongwane kaBestile (PDQ) -Ingxelo yeNgcali yezobuNtu.