Uma unesifo se-sentinel sisho ukuthi udokotela wakho wezinambuzane noma i-oncologist kungenzeka ukuthi ukhulume nge-micrometastases. Eqinisweni, i-micrometastases ibaluleke kakhulu cishe cishe kunoma yiluphi uhlobo lomdlavuza futhi yisisusa salokho okubizwa ngokuthi "ukwelashwa kwe-adjuvant."
Yiziphi ngempela i-micrometastases futhi kusho ukuthini uma une-micrometastases kumalini wakho we-lymph nodes?
Sibutsetelo
I-Micrometastases yiqoqo elincane lamangqamuzana omdlavuza oye wachithwa kusuka kwesisu esidala futhi asakazeka kwenye ingxenye yomzimba. Azikwazi ukubonwa nganoma yiziphi izivivinyo zokucabanga njenge-mammogram, i-MRI, i-ultrasound, i-PET, noma i-CT. Lezi zingqamuzana zomdlavuza zihamba ndawonye bese zakha isisu sesibili, esincane kangangokuthi singabonakala kuphela ngaphansi kwe-microscope.
Ukubaluleka
Ukuba khona kwe-micrometastases kubaluleke kakhulu. Ngokuvamile akuyona umdlavuza oyinhloko (kungaba emathunjini, emaphashini, noma kwezinye izifunda zomzimba) okulimaza kakhulu. Eqinisweni, yilapho umdlavuza usakazeka khona (kwezinye izifunda zomzimba uma wenza umonakalo omkhulu). Abantu abangamaphesenti angu-90 abafa ngenxa yomdlavuza bafa ngesifo se-metastatic.
Lapho umdlavuza usakazeka kuqala, uqala ukuhlala njengeqoqo elincane lamangqamuzana omdlavuza. Iqoqo elincanyana lamangqamuzana omdlavuza liyaziwa ngokuthi i-micrometastasis (i-metastasis encane).
Leli qembu lamangqamuzana omdlavuza lincane kakhulu ukuze lizwe futhi lingabonakala ngokucacile ngaphansi kwe-microscope. Leziqoqo azibonakali kunoma yiziphi izivivinyo zokucabanga esizitholile namuhla. Ngamanye amazwi, indlela kuphela yokukwazi ukuthi i-micrometastases ikhona yini ukususa izicubu lapho zitholakala khona futhi zibheke izintwana zezicubu ngaphansi kwe-microscope.
Nge-lymph node biopsy, kungenzeka ukwenze lokhu, kodwa akunakwenzeka ukususa zonke izilonda ze-lymph. Akunakwenzeka futhi ukususa ezinye izitho zomzimba ukuze zibheke ukusakazeka. Asikwazi ukukhipha amaphaphu omuntu, isibindi namathambo ukuze sibheke noma yibuphi ubufakazi be-tumor. Lona umcabango we-adjuvant chemotherapy noma i-adjuvant rayation therapy. Uma isisu sinesayizi esithile noma uma sisakaze kuma-lymph nodes, kucatshangwa ukuthi kungase kube nezinsizakalo ezincane kwenye indawo emzimbeni ongenakutholakali okwamanje. Kunomuzwa wokuthi izicubu ezithintekayo futhi zihluke ngaphandle kwe-tumor yokuqala ziqala njengalezi ziqoqo ezincane zamangqamuzana omdlavuza.
I-Micrometastases yimbangela yezokwelapha ezifana ne- adjuvant chemotherapy noma i-adjuvant rayation therapy. Lezi zindlela zokwelapha zisetshenziswa ngemuva kokuba isisu esiyisisekelo sisusiwe "ukuhlanza" nanoma iyiphi i-micrometastases eduze nomsuka wesifo (nge-radiation) noma ngabe ikuphi emzimbeni lapho kungenzeka khona ukuhamba (nge-radiation).
Ama-Micrometastases vs Amaseli E-Tumor Isisulu
Uma isetshenziswe ekusetshenzisweni kwamanqamu amaningi, ama-micrometastase abhekisela kulawa maseli okusolakala ukuthi aye ahamba (asemthethweni) avela kulesi sifo kodwa ayitholakali yizifundo ze-imaging esitholakalayo njengamanje.
Ukuhlelwa okunye kwalezi zindawo ezincane zokusabalalisa kusetshenziswe ekukhulumeni nge-reninel node biopsies nomdlavuza webele. Kuleso simo, i-micrometastases ichazwa njengamaqoqo amangqamuzana omdlavuza aphakathi kuka-0.2 mm (millimeters) ububanzi no-2.0 mm ububanzi. Ngokuphambene nalokho, "amangqamuzanzana amancane" angamaqenqana omdlavuza omncane okwamanje; ngaphansi kuka-0.2 mm ububanzi.
Ama-Micrometastases ku-Sentinel Lymph Node Biopsy
Kulabo besifazane abanomdlavuza wesifuba abangenayo ubufakazi bokuthi i-lymph node iqhaza ekuhlolweni noma nge-ultrasound, i- lymph node biopsy isine -standard yokunakekelwa.
Kule nqubo, idayi elihlaza okwesibhakabhaka (eliphinde likhishwe ngakho-ke lingatholakala ku-radiographically) lijoqwe ku-tumor futhi livunyelwe ukuhamba. Lapho umdlavuza usakazeka kusuka emathunjini uvame ukusabalala emaphethini omzimba.
Ngokwenza i-biopsy ye-sentinel node noma ama-node-ama-nodes ambalwa okuqala umdlavuza ozohamba kuwo-abesifazane abaningi abasindiswa ngokugcwele kwe-lymph node dissection (ukususwa kwazo zonke noma eziningi ze-lymph nodes emgqeni). Njengoba ukuxubana okugcwele kwe-axillary kungabangela izinkinga ezifana ne- lymphedema , le nqubo ingase ibeke abanye besifazane lokhu ukucindezeleka.
Ukucwaninga kuqhubeka ukucacisa ukubaluleka kwama-micrometastases ku-node sentinel. Kuze kube manje kwaziwa ukuthi ama-macrometastases (amamitha ayisithupha aphezulu kune-2.0 mm) ahlukumeza ukuchaza kwesifo. Kuye kwafunyanwa ukuthi ukuchazwa kwabantu besifazane abane-micrometastases ku-node sentinel banokuhlushwa okubi kakhulu kunabesifazane abangenayo ubufakazi bokuthi i-tumor kulezi zinhlanzi. Ngokuphambene nalokho, abesifazane abaye bahlukanisa amangqamuzana amathumba emzimbeni we-sentinel (ngokuchaza indawo yamangqamuzana amathumba angaphansi kuka-0.2 mm ububanzi) abanakho ukubikezela okunye okubi kakhulu kunowesifazane ongenakho ubufakazi bokuthi i-metastases i-node sentel.
Ukuba nalolu lwazi kungasiza abacwaningi bafunde kabanzi ukuthi yiziphi abesifazane abazodinga ukuhlukaniswa kwe-lymph node full axillary, nokuthi abesifazane kufanele babheke ukwelashwa kwe-adjuvant yomdlavuza wabo webele.
Ngaphansi
Ngaphakathi kokubekwa komdlavuza webele, ukutholakala kwama-micrometastases kubalulekile ekukhetheni ukwelashwa okufanele. Amagciwane okubeletha aseqalile ukuhamba ukuze amaqoqo amangqamuzana omdlavuza atholakale ema-lymph nodes cishe ayosakazeka kwezinye izifunda zomzimba. Ngakho-ke ngokuvamile kubalulekile ukuba nobudlova futhi basebenzise i-adjuvant chemotherapy kanye / noma imithi yokwelashwa (ukuqeda amaqoqo angama-cancer amangqamuzana hhayi kuphela ezakhiweni zamalulini eziseduze, kodwa lezo okungenzeka ziye emathambo, isibindi, noma kwezinye izindawo).
Kodwa i-micrometastases ibaluleke kakhulu cishe cishe noma yimuphi umdlavuza. Yilawa maqoqo okuqala emangqamuzana omdlavuza ahamba kusukela ku-tumor yangempela, evame ukuya kuma-lymph nodes, bese eya kwezinye izingxenye zomzimba ezinjengamaphaphu, amathambo, isibindi, ubuchopho, noma ezinye izifunda. Uma singathola futhi siphume ama-micrometastases singakwazi ukuqeda imbangela yamaphesenti angu-90 okufa komdlavuza.
> Imithombo:
> Mayer, E., noL. Dominici. Isifo somdlavuza Isisu se-Axillary: I-Ado Eningi Ngezifo ZikaMacrometastatic. I-Journal ye-Clinical Oncology . 2015. 33 (10): 1095-7.
> National Cancer Institute. Ukwelashwa Kwemdlavuza Webele (PDQ) -Health Professional Version. Kubuyekezwe ngo-10/13/17.
> Tvedskov, T., Meretoia, T., Jensen, B., Leidenius, M., noN. Kroman. Ukuqinisekiswa Kwesiphambano Kwezinguquko Ezintathu Zokubikezela Amathambo Endlela Ye-Non-Sentinel ku-Breast Cancer Patients. I-European Journal of Oncology Yokuhlinza . 2014. 40 (4): 435-41.