Incazelo, Ukuhlonza, Ukwelapha, Nokuguqulwa
Ukuxilongwa kwanoma isiphi isigaba somdlavuza webele kungabangela ukwesaba nokwesaba. Ngisho noma ungaqinisekiswa ukuthi unesiqalo sokuqala somdlavuza webele ungase ukwesabeke futhi ukhululeke. Siye safunda ukuthi ukusabela kwethu ngokomzwelo ekuxilongweni kufana naphezu kwanoma yikuphi ukuchazwa. Iyini incazelo yesiguli se-stage 1, yiziphi izinketho zokwelapha ezitholakalayo, futhi yikuphi ukugomela kwakho?
Ngenkathi singeke sithembise ukuthi ukuzifundisa kuzokwenyusa konke ukwesaba kwakho, kungakusiza ukufaka isilayidi esihlalweni somshayeli futhi uzizwe unamandla kakhulu ekunakekeleni kwakho.
Incazelo
Umdlavuza webele we-Stage 1 yisigaba sokuqala se-"invasive" umdlavuza webele. Ukubona igama elimangalisa liyesabeka, kodwa igama elimangalisa mayelana nesigaba akusho ukuthi umdlavuza uhlaselwe kwezinye izindawo zomzimba. Okumangalisa kusho ukuthi amaseli e-tumor yakho ahlasele okuthile okudlule okubizwa ngokuthi i-membrane engaphansi. Lokhu ukuhlasela kudlule isikhumba esingaphansi esichaza okuthile njengomdlavuza.
Uma umdlavuza webele usuqala kuqala, awusakhulile lesi sithombeni. Izicubu kulesi sigaba azibhekwa njengomdlavuza, kodwa kunalokho i- carcinoma-in-situ . Zibizwa nangokuthi izidumbu ezingu-0 zesiteji. I-carcinoma-in-situ ingamaphesenti angu-100 okuphulukiswayo ngokuhlinza kusukela amangqamuzana akhona ngokuphelele. Ayikho ithuba elingasakazeka.
Amathumba e-Stage 1 yisigaba sokuqala somdlavuza webele weqiniso. Lezi zicubu zincane, futhi uma zisakazeke nakancane ukuze lymph nodes i-spreads i-microscopic kuphela.
Ukufakwa kwesiteji kanye ne-TNM
Ukuqonda ukuthi udokotela wakho unquma kanjani isiteleka somdlavuza wakho, futhi uma unesiteji se-1A noma isigaba se-1B, kuyasiza ukwazi kancane mayelana nesistimu ye-"TNM" yokuhlukaniswa.
Kulesi silungiselelo:
- I-T imelela ubukhulu be-tumor: I-score ye-T1 isho ukuthi isisu sakho singu-2 cm (cishe u-inch) noma ngaphansi ububanzi. Ngokuvamile, izicubu ze-T2 zikhulu kunama-2 cm futhi zincane kune-5 cm, kanti izicubu ze-T3 zikhulu kunama-5 cm.
- I-N imelela ama-node: N0 kusho ukuthi umdlavuza awusakazeki kunoma yiziphi izilonda zamagciwane. I-N1 isho ukuthi umdlavuza usakaze kuma-lymph nodes esiseduzane, futhi i-N2 isho ukuthi isakazeke kuma-lymph nodes kancane. Ngesisu sesi-1, elinye igama libalulekile. Igama elithi micrometastases lisho ukuthi umdlavuza usakaze kuma-lymph nodes kodwa ungabonakala kuphela ngaphansi kwe-microscope. Ama-Micrometastases akhona lapho amangqamuzana omdlavuza atholakele ku-lymph node futhi angaphezu kuka-0.2 mm ububanzi kodwa angaphansi kuka-2 mm (0.2 cm) ububanzi. Umdlavuza one-micrometastases endaweni ye-lymph node eseduze izochazwa njenge-T1mi. Ama-Macrometastases, ngokuphambene, abhekisela emdlalweni emagqabeni amancane angaphezu kuka-2 mm ububanzi (futhi angabonwa ngeso lengqondo).
- I-M imelela ama-metastases: I- M0 isho ukuthi umdlavuza awunakulinganiswa (isibonelo, amathambo, ubuchopho, noma isibindi). I-M1 isho ukuthi ifinyelele.
Kungaba ukudideka (futhi kuyesabeka kakhulu) uma ufunda umbiko wakho we-pathology futhi uqaphele ukuthi uthi umdlavuza "uhlose ukwenziwa kwe-lymph nodes." Lokhu akusho ukuthi unomdlavuza wesifuba we-metastatic (umdlavuza wesifuba wesigaba se-4).
Ungaba nama-lymph node metastases ngisho nezifo zakuqala.
Ukusebenzisa uhlelo lwe-TNM, isigaba se-khansa yesigaba se-1 sihlukaniswe ngokwengeziwe:
- Isigaba 1A: T1N0M0. I-tumor ingaphansi kuka-20 mm (2 cm) ngobukhulu futhi ayikho isakazwa kuma-lymph nodes
- Isigaba 1B: T1N1miM0 noma T0N1miM0. Ngenhlanganisela yokuqala, i-tumor ingaphansi kuka-20 mm (2 cm) ngobukhulu futhi kunezinyamu ze-micrometastases endaweni ye-lymph node eseduze. Esinye isimo asivamile kakhulu futhi sikhona uma kungekho ubufakazi besisu esiyisisekelo esibelethweni kodwa kunezinyunyana ze-micrometastase ku-lymph node (ngokuvamile e-armpit).
Ngokuvamile, izicubu zesigaba 1 yizona ezincane kune-intshi (2 cm) ububanzi futhi zingenayo ukubandakanyeka kwe-lymph node noma zisakaze kuma-lymph nodes eseduze kodwa kuphela ngezinga elincane.
Uma wazi isiteji somdlavuza wakho webele kuneminye imininingwane eminingi oyodinga ukwazi ngaphambi kokukhetha ukhetho olungcono kakhulu lwezokwelapha.
Izinhlobo
Kunezinhlobo eziningana ezahlukene zomdlavuza webele. I-ductal carcinomas evamile ilandelwa kakhulu yi-cardiotic lobular invasive. Okunye, izinhlobo ezingavamile kakhulu zomdlavuza webele zihlanganisa umdlavuza wesifuba wokuvuvukala, i-medullary carcinoma, i-carcinoma ye-tubular, nokuningi.
I-Tumor Grade
I-tumor grade yinomboro echaza ukuhlukumeza kwesisu. I-pathologists ibuka amangqamuzana omdlavuza we-biopsy kanye / noma ukuhlinzwa ngaphansi kwe-microscope ukuthola izinto ezifana nokuthi amaseli ahlukana kanjani. I-Tumor inikezwa ibanga le-1, 2, noma le-3, ne-1 ibe yinto encane kakhulu futhi i-3 ibe yizicubu ezinonya kakhulu. Ibanga lakho le-tumor akutshelanga ukuthi yini okuzokwenza ngayo, kodwa kunokusiza wena nodokotela wakho ukhethe ukwelashwa okungcono kakhulu.
I-MultigeneIkuhlola
Eminyakeni eyishumi edlule noma sesiye safunda ukuthi zonke izicubu zihluke kanjani ezingeni lemangqamuzana. Ngamanye amazwi, izicubu ezimbili ezisezingeni lesithathu ze-carcinomas kanye ne-grade 2 ye-tumor zingaziphatha ngendlela ehlukile. Uma ungenayo i-lymph nodes enhle ne-tumor encane, i-oncologist yakho ingancoma ukuthi ubuke lokhu kuhlolwa ukuze ubone ukuthi imithi e-adjuvant efana ne-chemotherapy iyadingeka. Izivivinyo ze-Multigene ezifana ne-Oncotype DX kanye ne-MammaPrint zingasetshenziswa ukucacisa ukuthi i-chemotherapy iyadingeka yini kumdlavuza wesifuba we-node-negative.
Isimo seReceptor
Uma ukhetha ukwelashwa okungcono kakhulu kumdlavuza wakho webele, udokotela wakho uzofuna ukuhlola isimo se-receptor yomdlavuza wakho. Amamukeli amaphrotheni atholakele emangqamuzaneni omdlavuza futhi abalulekile ekukhuleni kwamaseli.
I-Estrogen Receptors
I-Estrogen receptors yizinhlelo zamaprotheni (receptors) ezitholakala ebusweni bamangqamuzana omdlavuza. Amagciwane okubeletha okuyi-estrogen-receptor positive akhuthazwa ukuba akhule lapho i-estrogen ihlanganisa nalezi zitholampilo.
Abamukelayo be-Progesterone
Ama-receptor ama-progesterone avame ukuhambisana nama-receptors e-estrogen.
HER2 Cancers Positive
Amanye amakhemikhali ebelethwe abizwa ngokuthi yi-HER2 enhle. I-HER2 iyiprotheni ebusweni bamangqamuzana omdlavuza. Izici zokukhula zibopha nale receptor ukukhuthaza ukukhula. Wonke amaseli wesifuba avamile anemitholampilo ye-HER2, kodwa nge-cancer ye-HER2 enhle, kunama-receptors angama-100 amaningi (ungabona imibandela efana ne-HER2 amplification ebhekisela kumajezi engeziwe atholakala ku-protein noma i-HER2 ngokweqile, ngokubhekisela ezinombolweni ezikhulayo of receptors on amangqamuzana omdlavuza).
Kunezinhlobo ezithile zokwelashwa ezingabhekisela kulawa ma-receptors anganciphisa ingozi yokuphindaphindiwe. Uma wonke ama-receptors akho "engalungile" ekuhlolweni, isisu sakho sizobhekwa njengesifo somdlavuza webele wesithathu.
Ukwelapha
Ukwelashwa kuqala kwehlelwa ngaphansi kwezigaba ezimbili eziyinhloko:
- Ukwelashwa kwendawo: Ukwelapha kwendawo kulapha umdlavuza endaweni, futhi kuhlanganisa ukuhlinzwa kanye nokwelashwa kwemisebe
- Imithi yokwelapha: Izindlela zokwelashwa ezihlelekile zilapha umdlavuza ngokomzimba noma kuwo wonke umzimba. Lezi zihlanganisa amakhemikhali, i-hormonal therapy, ukwelashwa okuhlosiwe, kanye ne-immunotherapy.
Uma isisu sincane kakhulu, ukwelashwa kwendawo ngokuvamile kuyadingeka. Uma lesi sifo sikhulu, sinobudlova (sinebanga eliphakeme le-tumor), lisakaze kuma-lymph nodes, noma sinephrofayli yamangqamuzana ebonisa ukuthi umdlavuza uzoba amathuba okusabalala, izifo zokwelapha ngokuvamile ziphakanyiswa. Ngesiteji 1 isifuba sezinyosi ukusetshenziswa kwe-systemic therapy kubhekwa njengokwelashwa kwe-adjuvant (ukwengeza ukwelashwa) futhi umgomo ukuqeda noma yimaphi amangqamuzana omdlavuza asakazeke ngaphezu kwebele kodwa amancane kakhulu ukuthi angabonwa ngokuhlola izithombe esinazo okwamanje.
Izinketho ezithile zokwelapha zingafaka:
Ukuhlinzwa
Ukuhlinzwa kokuhlinzwa kunconywa iningi lamagciwane e-stage 1. Izinketho zihlanganisa noma i- lumpectomy noma i- mastectomy . Kunezizathu eziningi zokuthi abantu bakhethe omunye komunye, futhi kungaba yisinqumo somuntu siqu. Uma kukhethwe i-lumpectomy, ukwelashwa kwama-radiation kuya kwezicubu zesifuba esele kuvame ukuphakanyiswa. Uma une-mastectomy, udokotela wakho uzokhuluma nawe mayelana nokhetho lokuvuselelwa kwebele. Ukuhlinzeka ngokuhlinzwa kwesikhumba sekuvame kakhulu, futhi ngale nqubo, ukufakelwa noma okungenani i-expander ijwayele ukufakwa ngesikhathi esifanayo ne-mastectomy yakho.
Ngokuhlinzwa, i- sentinel node biopsy ingenziwa. Esikhathini esedlule, izakhi eziningana zamasondo omzimba zazivame ukukhishwa bese zihlolwe ngaphansi kwe-microscope, kodwa manje singakwazi ukuthola ukuthi iziphi i-lymph nodes umdlavuza zizosabalalisa kuqala, futhi isampuli kuphela lezo nodes. Uma i-lymph nodes yakho ihamba kahle kusho ukuthi umdlavuza usuke usho ngokucacile ukuthi uhlose ukusakazeka.
I-Chemotherapy
I-Chemotherapy yomdlavuza wesifuba ngezinye izikhathi isetshenziselwa ukwelashwa kwe-adjuvant nesigaba sesiguli 1, nakuba sekuye kwaba nzima ukukhetha ukuthi ubani ozozuza. Kulabo abane-micrometastases kuma-lymph nodes, i-chemotherapy ivame ukuphakanyiswa. Inhloso ye-chemotherapy iwukuba ukhethe noma yimaphi amangqamuzana omdlavuza okungenzeka ukuthi asuke ekhanda lakho ngaphambi kokuba akhule ibe yi-metastases. Amanqamu asakazekile (ngisho nangesincane) ama-lymph nodes asememezele ukuthi ahlose ukusabalalisa.
Ngomdlavuza wesifuba we-node-negative onamamitha ayi-2 cm ububanzi noma ngaphansi (isigaba 1) akucaci kancane. I-Oncotype Dx Recurrence Score noma i-MammaPrint iyivivinyo lezinhlobonhlobo ze-genomic elingasiza. Labo abafaka amaphuzu aphezulu ekuvivinyeni kuye kwanda izinga lokusinda uma i-chemotherapy inikezwa. Labo abanamazinga aphansi angeke bazuze kusuka kumakhemikhali. Njengoba i-chemotherapy inemiphumela emibi (ukuhluleka kwenhliziyo kanye ne-secondary leukemia nakuba kungavamile) kubalulekile ukukala izingozi nezinzuzo ezikhona nomuntu ngamunye ngabanye.
I-Radiation Therapy
Uma une-lumpectomy, ukwelapha imisebe kusetshenziselwa ukuphatha izicubu zakho zesifuba ezisele. Njengoba isifo somdlavuza webele sesiteji 1, imishanguzo ye-radiation ngokuvamile ayidingekile ngemuva kwe-mastectomy.
I-Hormone Therapies
Uma isisu sakho singama-estrogen receptor, i- hormonal therapy ngokuvamile iphakanyiswa ngokulandela ukwelashwa okuyinhloko ngokuhlinzwa kanye nokwelashwa kwamakhemikhali / imithi. Inhloso ukunciphisa ingozi ukuthi umdlavuza uzobuya. I-Estrogen receptor tumorous positive cishe kungenzeka ukuba ibuyele emuva kwesikhathi (ngemva kweminyaka emihlanu nangaphezulu). Kwabesifazane be-premenopausal, i-tamoxifen ivame ukusetshenziswa. Kwabesifazane be-postmenopausal, ukwelashwa ngokuvamile kuyisimo se-aromatase inhibitor efana ne-Aromasin (i-exemestane), i-Arimidex (i-anastrozole), noma i-Femara (i-letrozole).
HER2 Ukwelashwa Okuhloswe
Uma i-tumor yakho i-HER2 enhle, imithi ehlosiwe ye-HER2 efana ne-Herceptin (trastuzumab) ivame ukuqala ngemuva kokwelashwa okuyisisekelo.
Izivivinyo zemitholampilo
Indlela kuphela eyenziwa ngayo ekwelapheni umdlavuza webele ngokufunda izidakamizwa ezintsha nezinqubo ezivivinyweni zomtholampilo. Kunezinkolelo eziningi mayelana nokuhlolwa kwemitholampilo , kodwa iqiniso liwukuthi yonke imithi esisebenzisayo manje yafundwa esikhathini esivivinyweni somtholampilo.
Ukukhetha indlela yokwelashwa engcono kakhulu
Ngesiteji 1 somdlavuza webele isinye sezinqumo ezinkulu kunazo zonke ukuthi yiluphi uhlobo lokuhlinzeka. Kukhona izinzuzo nokuqapha ekuhlinzeni ngalunye, futhi izici eziningi kufanele zibhekwe njengomlando wakho womndeni (ithuba uzokwakha omunye umdlavuza webele), lapho uhlaya lwakho lukhona esifubeni sakho, nokuthi yini ongayilindela ngokuzithokozisa ngenqubo ngayinye. Kubalulekile ukukhetha ukwelashwa okungcono kuwe, kungakhathaliseki ukuthi omunye umuntu angakhetha. Kubaluleke kakhulu ukuba ube ngummeli wakho siqu ekunakekeleni umdlavuza wakho . Iziguli nodokotela basebenza ngokubambisana kakhulu ukuthi esikhathini esidlule futhi uyilungu elibalulekile leqembu lakho lomdlavuza.
Ukubhekana nokusekela
Enye yezinto ezinhle kakhulu ongayenza ngokwakho emva kokuxilongwa kwakho ukuqoqa inethiwekhi yokusekela. Ungathanda ngisho ukubhala uhlu lwabangani abanganikeza ukusekelwa. Ngisho noma uzizwa kahle ngokusebenzisa ukwelashwa kwakho kungase kube nzima ukufaka lezi zokwelapha ohlelweni lwethu lonke lokulungele-kumatasa. Cela usizo futhi uvumele abantu ukuba basize.
Ungase ufise ukusetha isayithi le-CaringBridge noma omunye umuntu akwenzele lokhu. Lena yindlela enhle kakhulu yokugcina wonke umndeni wakho nabangani bakho bahambisane nesimo sakho ngaphandle kokuchitha amahora amaningi ngosuku ngalunye efonini. Abangani bakho bayakwazisa ithuba lokuphawula nokubhala amanothi ngaphandle kokukhathazeka ngokuphazamisa ukuphumula kwakho. Kukhona futhi amasayithi avumela abantu ukuba babhalisele ukuletha ukudla, bakunikele ekuvakashelweni kwemisebe, nakwezinye izinsiza ezifana ne-Take Them Meal and Lotsa Ukusiza Amandla.
Emotionally ungase uzizwe sengathi ukhononda ngezinye izikhathi. Izifundo zisitshela ukuthi abantu basabela ngendlela efanayo emva kokuthola ukuthi unomdlavuza yini futhi akukhathaleki uma kusenesikhathi noma phambili. Ungavumeli noma ubani enze uzizwe uzihlekisa ngokuthi "kuyisiteji kuphela." Umdlavuza, nomdlavuza uyabesabeka! Imizwelo yakho ingase ikwazi ukubhekana nokwesaba ukwesaba ukudideka ukwesaba-ngezinye izikhathi ngendlela ethile. Akufanele ngaso sonke isikhathi ube nesimo esihle futhi kubalulekile ukuveza imizwelo yakho emibi.
Ukubandakanyeka eqenjini lezokusekela noma umphakathi wokusekela inthanethi kungaba yigugu kakhulu. Kukhona into ekhethekile kakhulu ngokukhuluma nabanye ababhekana nezinselele ezifanayo. Lemiphakathi iphinde inikeze ithuba lokufunda ngokucwaninga kwakamuva ngomdlavuza webele, ngoba akekho okhuthazwa njengalabo abaphila nalesi sifo.
Isibikezelo
Isibikezelo sesigaba 1 somdlavuza webele sihle. Kulabo abathola ukwelashwa ngokuhlinzwa kanye ne-chemotherapy noma ukwelashwa kwama-radiation, uma kunconywa, izinga lokusinda iminyaka emihlanu lingaphezulu kwamaphesenti angu-100. Lokho kusho ukuthi ukwelashwa ngesifo somdlavuza webele we-stage 1 akulula. Imiphumela emibi iyavame, ikakhulukazi nge-chemotherapy, futhi ukukhathala cishe cishe yonke indawo.
Izwi elivela
Ukuxilongwa kwesigaba 1 somdlavuza webele kunesabisa. Ngisho noma izinga lokusinda lihle kakhulu, kungaba yinselele ukucabanga ngakho konke okudingeka ukwenze ukuze ufike lapho. Ncika kwabanye futhi uvumele ukuba bakusize. Izikhungo eziningi zomdlavuza zinamaqembu asekela noma abaqondisi kulabo abasanda kutholakala. Ukuthatha isikhathi sokuvakashela abantu abaye baphelelwa ukwelashwa futhi baphuma hhayi nje ukusinda, kodwa ephumelelayo, kungaba isikhuthazo ngalezo zinsuku lapho ukukhathala komdlavuza kuhlasela.
> Imithombo
> McVeigh, T., noMerin Kerin. Ukusetshenziswa Kwemitholampilo Ye-Oncotype DX Genomic Test Yokuqondisa Ukwelapha Izinqumo zeziguli ezinomdlavuza webele wesibindi. I-Cancer Med Press) . 2017. 9: 393-400.
> National Cancer Institute. Ukwelashwa Kwemdlavuza Webele (PDQ) -Health Professional Version.