Umdlavuza wesifuba ungenye yezona zinto zixhaphakileyo eziyingozi, eyona nto ibangela kakhulu ukufa kwabantu. Nangona kunjalo, ngokungafani nezinye iindidi zeentlungu, ezifana nomdlavuza wamaphaphu okanye i-pancreatic, ezikhokelela ngokukhawuleza ekufeni kwesininzi sezigulane, kumhlaza wesifuba, unyango lunokwenzeka kwisibini kwiigulane. Kwinqaku ethi "I-Cancer Breast in Women's Young" uya kufumana ulwazi oluncedo kakhulu kuwe.
Iqela leengozi
Ngokuchasene neenkolelo ezithandwayo, umdlavuza webele usakhula ikakhulukazi kwabasetyhini abadala, ngokuqhelekileyo emva kokuphuma kwesisu. Ubunokwenzeka bokuvela kwesi sifo ukuya kwiminyaka engama-35 malunga ne-1: 2500. Ngeminyaka engama-50 ubudala, lo mngcipheko ukhuphukela ku-1:50, kwaye iminyaka eyi-80 ifinyelela kwi-1:10. Nangona kunjalo kwiimeko ezininzi akunakwenzeka ukucacisa isizathu esona sizathu somhlaza wesifuba, izinto ezinobungozi bokuphuhliswa kwesi sifo ziyaziwa ngokuqinisekileyo:
• ubudala;
• anamnesis yesifo kwintsapho okanye isiguli;
• izidumbu zesifuba zangaphambili;
• Imiphumo eyingozi kakhulu ye-sex hormone estrogen (ukuhamba kwesantya kunye nokuqala kokuphuma kwesisu), kunye nokusetyenziswa kwe-hormone yonyango (HRT);
• iimpawu zesondlo kunye nokusetyenziswa kotywala.
Ibhinqa, enentsapho enamalungu athile, ikakhulukazi izalamane zokuqala (oomama, oodade kunye neentombi), abanomdlavuza, usengozini enkulu yokuphuhlisa eso sifo. Oku kubangelwa ilifa lomdlavuza wesifo somhlaza. Iingcali zenzululwazi zichonge ezimbini izityalo ezijongene nomhlaza, i-BRCA1 ne-BRCA2. Umngcipheko wokuhlamba isisu esiswini esibi kubantu abathintela la majethi ku-87%. Ngenxa yoko, kubaluleke kakhulu ukufumanisa ezo ntsapho kunye nokuziphatha kweengcebiso zomzimba. Umzimba wesifo somhlaza wesifuba esivela kumfazi ogulayo uyadluliselwa kwinzala enokwenzeka ukuba i-50%. Amalungu entsapho azuze ilifa lalo mfuzo basengozini enkulu yokuphuhlisa isisu.
Ezinye izinto
Nangona ubukho beengcambu zesifo somhlaza sisona sizathu esibalulekileyo sokuphuhliswa kwesi sifo, kubalulekile ukuba siqonde ukuba kuzo zonke iimeko zomhlaza wesifuba, inani lezigulane ezinentsapho zazo ezifunyenweyo zingaphantsi kwe-10%. Kukho iindlela ezininzi zokuthintela isisu sebele. Ukusetyenziswa kwabo kubaluleke kakhulu kubasetyhini abasemngciphekweni, kwaye ngokukodwa kubathwali benxalenye yesifo somdlavuza webele.
Tamoxifen
Ngaphambili, ukuthintela umdlavuza webele, isistim se-tungsten esilwa ne-tamoxifen sisetyenzisiwe. Izifundo ezenziwa eUnited States zabonisa ukuba amabhinqa athabatha iyeza iminyaka emi-5, agule ngesifo somhlaza wesifuba kaninzi kunokuba abo bangathathi. Ngakolunye uhlangothi, ukusebenzisa i-tamoxifen kwandisa umngcipheko wokuvelisa umdlavuza we-endometrial (i-membrane ye-uterus) kunye ne-thromboembolism (ukubunjwa kwe-thrombi kwimifuno yamagqabi angaphantsi kunye nokufuduka kwabo kwimikhapha). Ukongeza koko, ukusetyenziswa kwesilwanyana akuzange kunciphise izinga lokufa kumdlavuza wesibele. Iziphumo zokuqala zezifundo zanamhlanje kwiqela labesetyhini abaneembali zeentsholongwane zentsapho aziqinisekisi ukulungiswa kwe-tamoxifen. Iziphumo eziphikisanayo zikhokelela ekunqongopheni kwenkqubo yokwenziwa komanyano. Abasetyhini bacinga ukuba kungenzeka ukuba i-chemoprophylaxis yomhlaza wesifuba kufuneka ifumane ingcaciso echanekileyo kwingcali efanelekileyo.
Ukuhlinzwa okukhuselweyo
- Mastectomy. Indlela efanelekileyo kakhulu yokuthintela iziphumo eziphambili zi-mastectomy (okanye i-mastectomy kwizigulane esele zanyangwa ngumhlaza wesisu). Ukususa izilonda ezinobulunga obuphilileyo kuyisigqibo esisigxina esicinga ukuba siqwalaselwe ngokucopheleleyo kwaye sinomlinganiselo weendlela ezingezinye. Ukunciphisa umngcipheko wesifo somhlaza wesisu kuhambelana ngokuthe ngqo nomthamo wesisindo esisusayo. Ngenxa yalesi sizathu, i-mastectomy yangaphantsi kunye nokugcinwa kwengxowa kaninzi ayinconywanga, ekubeni ihamba malunga ne-10% yesifuba, kuthelekiswa ne-1% emva kokusebenza kwendabuko.
- Ovariectomy. Abathwali bee-gene ze-BRCA basengozini ephezulu kunye nomhlaza wesi-ovari, ngoko ke, kufuneka kuthathelwe ingqalelo njengendlela yokukhusela i-ovariectomy (ukususwa kwama-ovari).
I-ovariectomy inciphisa umngcipheko wokuhlamba isisu sebele ngokunciphisa izinga lokuveliswa kwe-estrogen, kubandakanywa nabasetyhini abathwala iigleji ze-BRCA. Ukumiswa kwesifo somhlaza webele kunokwenzeka kwezi zilandelayo:
• ukufumanisa ukwakheka kwamathambo ekuboniseni i-mammography;
• ukufumanisa isisu ngesigulane.
Iimpawu eziqhelekileyo zomhlaza wesifuba ziquka ubukho bemfundo, utshintsho kwimilo yesiganeko, iimpazamo zesikhumba nentsimbi, ukukhutshwa kwimbalo. Ukuxilongwa kwe-tumor kusekelwe kwiimviwo zeklinikhi, i-mammography kunye nesiphelo sesigxina se-puncture. Kwamanye amabhinqa, ingakumbi kubasetyhini abasebancinci, i-mammography ayikho into ecacileyo ngenxa yokuxinwa kweethambo ezinobungqingili, kwiimeko ezinje, iindawo zokuhlaziya i-ultrasound ukuhlolwa okanye i-imagination magontic resonance. Kwizona zigulane ezine-tumor ezikrakrayo, umdlavuza webele awuqinisekisi. Ngesiphelo esifanelekileyo, ibhinqa lifumana unyango. Ifuna isicwangciso sonyango esingaphakathi kwamanye amazwe esichapha ugqirha, oncologist, physiotherapist kunye nezinye iingcali. Indima ebalulekileyo idlalwe ngabasebenzi bezonyango abaqhelekileyo, abaqeqeshwe ngokukodwa ukuba banakekele izigulane zomhlaza wesifuba, ukwenzela ukuba bancede ngezinye iinkqubo zonyango iinkqubo ezinzima. Izindlela ezintsha zonyango lomhlaza wesifuba zivumelekile ukunciphisa izinga lokufa kwesi sifo ngo-30%. Inkqubo yokonyango ingaquka ukuhlinzwa, i-radiotherapy, i-hormonal okanye i-chemotherapy.
Kwizigulane ezininzi, indlela yokuqala yokunyanga umdlavuza webele uya kutyunjwa - ukususwa kwe-tumor yokuqala.
Ukusebenza
Kwizigulane ezine-tumor enkulu, kululeka kakhulu ukwenza umastectomy (ukususwa kwebele lonke), emva koko ukulungiswa kweplastiki kunokwenzeka. Ngomlinganiselo omncinci we-tumor, ukuphindaphinda kwamacandelo kusetyenziswa rhoqo, apho inxalenye yengcambu isuswe. Ukungenelela okunjalo kulungile kakhulu kwiindawo zokuzibona. Ngethuba lo msebenzi, njengomthetho, inxalenye okanye zonke i-lymph nodes zesithili se-axillary isuswa. Emva koko, ukulungiswa kuhlolwe phantsi kwe-microscope, emva koko i-pathologist inika isigqibo sokuba iinkcukacha zobungakanani be-tumor, uhlobo lwayo lwe-hertological, inani le-lymph nodes echaphazelekayo kunye ne-concentration ye-estrogen receptors. Ukuxilongwa kwengxaki yesigulane ngokuqhelekileyo kubandakanya isifuba se-X-ray ukucacisa ukusasazeka kwe-tumor, ukuhlolwa kwegazi, kwaye, ukuba unqatshelwe ukuba usebenze, ukukhangela amathambo okanye ukuhlolwa kwe-ultrasound yesibindi. Ngokusekelwe kulo lonke le nkcukacha, isicwangciso sonyango olongezelelweyo senziwa.
Radiotherapy
I-radiotherapy engaphantsi komsebenzi ithathwa njengelungu elinyanisekileyo lonyango kwizigulana ezithatha ukuthengiswa kwamacandelo; Ukuxiliswa komzila we-axilary ingaba yinto echasayo ekukhutshweni kogqirha kwee-lymph nodes. Kuyaziwa ukuba i-radiotherapy yomsebenzi wendawo ebomvu, izicubu ezincinci kunye nommandla we-axillary kunciphisa umngcipheko wokuphindaphinda, oye wanciphise ukufa. I-Chemotherapy kunye ne-hormone therapy inqunywe kwangaphakathi okanye ngomlomo emva kokuhlinzwa. Oku kuyimfuneko yokutshatyalaliswa kwe-micrometastases - iinqununu ezincinci zezicubu zesisu eziye zahlula kwiinjongo eziphambili kwaye zisasazeka ngomzimba. I-foci enjalo yokuhlola i-tumor iyimingcipheko yokuphindaphinda kwesi sifo.
Hormonotherapy
Utshintsho lwe-cyclic kwiisisu zebele luphantsi kolawulo lwe-estrogens. Kwi-60% yamatyala, i-estrogen receptors ifumaneka kwisisu sebele, ngoko ke i-tamoxifen, ebangela ukuba la ma-receptors kumaseli omhlaza, angasetyenziselwa unyango. Oku kunciphisa umngcipheko wokusasazeka nokuphindaphinda kwesisu. Uphando olutshanje lubonisa ukuba abafazi abanesifo se-estrogen esiswini esithatha i-tamoxifen iminyaka emihlanu emva kokuhlinzwa, banesiprofeto esihle kakhulu.
I-Chemotherapy regimens
Kwizigulane ezingaphantsi kweminyaka engama-50 ubudala kunye nomhlaza wesibele, isiphumo esihle se-acjuvant (ezongezelelweyo) i-chemotherapy yaboniswa. Isicelo esilungileyo solu hlobo lwenyango kwizigulane ezinobungozi obuphezulu bokuphindaphinda. Kuye kwaphuhliswa iindidi ze-chemotherapy regimens ezibonakaliswe ukunciphisa umngcipheko wokuphindaphinda umthamo. I-regimen enye esetyenziswa ngokubanzi ibizwa ngokuba yi-CMF kwaye inxulumene ne-cyclophosphamide, methotrexate kunye ne-5-furouracil. Ukongeza izidakamizwa zanamhlanje njenge doxorubicin kunye ne-paclitaxel, kunceda ukuphucula iziphumo ze-chemotherapy.
Kwizigulane ezinomdlavuza webele we-metastatic - ukusasazeka kwe-tumor kuwo wonke umzimba - unyango awukwazi. Nangona kunjalo, kukho iindlela zokwelapha ezijolise ekunciphiseni iimpawu, kwaye ukuphuhliswa kwexesha lanamhlanje kuye kwandisa amathuba okuphila. Ngelishwa, nangona uphuhliso olubalulekileyo olwenziwe kunyango lomhlaza wesifuba kwiminyaka yamva nje, akusiyo yonke isigulane inethuba lokubuyisela. Izigulane ezinobungqina be-metastases ngexesha lokuxilongwa komhlaza okanye abo bavela kumaziko okuphuka emva kokuba unyango lokuqala lugqithisekile. Iindawo eziqhelekileyo zendawo yokuhlaziywa kwamathambo zithathwa ngamathambo, isibindi, imiphunga, izicubu zesikhumba kunye nezincinci, kunye nengqondo.
Iinjongo zonyango
Ukunyangwa kwezi zigulane kuhloswe ukwandisa ixesha elide kunye nokunciphisa impawu (unyango olusisigxina). Nangona ezinye izigulane ezinezigaba eziphambili zomhlaza zingasinda kwaye zingaphi iminyaka, ukuthetha malunga nokunyanga kwiimeko ezinjalo akudingekile. Ukwenza uphando kunye ne-radiotherapy phambi kwe-metastases ayibalulekanga kangcono kune-chemo kunye ne-hormone yokwelapha, ekubeni iziyobisi zingonakalisa iiseli zesisu kuwo wonke umzimba. Okukuphela kwendawo ye-boneastases, eyona nto ibaluleke kakhulu kwi-radiotherapy. Ukunciphisa umngcipheko wamathambo kunye neengxaki ezinxulumene nazo, kubandakanywa iziqhekeza, sebenzisa iqela leziyobisi ezibizwa ngokuba yi-bisphosphonates. Ukukhethwa kwendlela yokonyango kuxhomekeke kwindawo yonyango lomhlaza, unyango lwangaphambili, iimpawu zesisu kunye nesimo sempilo yesigulane.
Umgangatho wobomi
Xa beyila isicwangciso sonyango, bathabatha indlela nganye kwisigulane ngasinye, ngokugxininisa ekuphuculeni umgangatho wobomi. Ukuze kube lula ukunciphisa impawu zesifo, kucetyiswa ukuba kubandakanye amagqirha kunye nabahlengikazi abaqeqeshwe ngokufanelekileyo ukubonelela ngononophelo. Ukulawulwa kwesifo sesifo kunye nezinye iindlela ezisekelayo kweli nqanaba zibe zibaluleke kakhulu. Izazinzulu kunye noogqirha kwihlabathi lonke bekunzima ukwenza iindlela ezintsha zokulwa nomhlaza, kwaye izigulane zivame ukuba zithatyathwe ukuba zithathe inxaxheba ekuphandweni kliniki. Ngokuqhelekileyo kwiimeko ezinjalo, uhlalutyo olulinganisiweyo lokusebenza kweziyobisi ezikhoyo kwaye zihlolwe. Ezinye izifundo, ngokuthelekiswa nokusetyenziswe ngokubanzi, ukuvavanya ithuluzi elitsha, ukuvavanya umsebenzi walo nobutyhefu.
Uvavanyo lwezonyango
Uphando lwezonyango lubonelela ngonyango olululo kwaye lunikezela ulwazi olufunekayo ukutyalisa amachiza amatsha kwii-teknoloji ezibiza. Imiba ibonisa iziphumo eziphambili zonyango kulawo gulane abathatha inxaxheba kwiimvavanyo. Iimpawu zamva nje zibonakaliswa ngokuhamba kwi-chemotherapy yendabuko ekusebenziseni iziyobisi ezincinci ezihlangabezana neemfuno zesigulane esithile.