Umdlavuza wesibeletho ungenye yezinto ezivame ukonakala, okuyinto ebangela kakhulu ukufa phakathi kwabantu besifazane. Kodwa-ke, ngokungafani nezinye izinhlobo eziningi zezifo, ezifana nomdlavuza wamaphaphu noma i-pancreatic, okusheshayo okuholela ekufeni kweziningi zeziguli, emdlalweni webele webele, ukwelashwa kungenzeka ezingxenyeni ezimbili kwezintathu zeziguli. Esihlokweni esithi "I-Cancer Breast in Women Young" uzothola ulwazi oluwusizo kakhulu kuwe.
Iqembu eliyingozi
Ngokuphambene nenkolelo evamile, umdlavuza wamabele uqala ikakhulukazi kwabesifazane asebekhulile, kaningi ngemva kokuya esikhathini. Amathuba okutholakala kwesifo kuya eminyakeni engama-35 cishe cishe 1: 2500. Lapho uneminyaka engama-50 ubudala, le ngozi ingena ku-1:50, futhi eminyakeni engu-80 ifinyelela kumvuthwandaba ka-1:10. Nakuba ezimweni eziningi kungenakwenzeka ukucacisa imbangela eqondile yomdlavuza webele, izimbangela eziningi ezinobungozi ekuthuthukiseni lesi sifo ziyaziwa ngokwethembeka:
• iminyaka;
• anamnesis wesifo emndenini noma esigulini;
• izidumbu zesifuba esedlule;
• Imiphumela engavamile ye-sex hormone estrogen (ukuya esikhathini nokuqala kokuya esikhathini), kanye nokusetshenziswa kwe-hormone replacement therapy (HRT);
• izici zokudla nokuphuza utshwala.
Owesifazane, omndeni wakhe amalungu amaningana, ikakhulukazi izihlobo (omama, odadewabo kanye namadodakazi), abhekene nomdlavuza, engozini enkulu kakhulu yokuthuthukisa lesi sifo. Lokhu kubangelwa ifa lomdlavuza webelevuza webele. Ososayensi baveza izakhi zofuzo ezimbili ezibhekene nomdlavuza, i-BRCA1 ne-BRCA2. Ingozi yokuhlambalaza isifuba esiswini esibulalayo kulabo abathwala lezi zakhi zofuzo ingama-87%. Ngenxa yalesi sizathu, kubaluleke kakhulu ukuhlonza leyo miindeni nokuziphatha kokwelulekwa kwezakhi zofuzo. Igciwane lesifo somdlavuza wesifuba esisuka kumama ogulayo sithunyelwa enzalweni enamathuba angama-50%. Amalungu omndeni azuze leli gama ifa engozini enkulu yokuthuthukisa isisu.
Ezinye izici
Nakuba ukutholakala kwezakhi zofuzo zomdlavuza webele kuyisisusa esibaluleke kakhulu ekuthuthukiseni lesi sifo, kubalulekile ukuqonda ukuthi phakathi kwazo zonke izimo zomdlavuza webele, inani leziguli emndenini wazo lezi zakhi zofuzo ezitholakalayo zingaphansi kuka-10%. Kunezindlela eziningana zokuvimbela isisu sebele. Ukusetshenziswa kwabo kubalulekile kubantu besifazane abasengozini, ikakhulukazi kubathwali besinye sezakhi zofuzo zomdlavuza webele.
I-Tamoxifen
Ngaphambili, ekuvimbeleni umdlavuza webele, umuthi we-anti-tungsten we-tamoxifen wasetshenziswa. Ucwaningo oluqhutshwa e-United States lubonise ukuthi abesifazane abawuthatha imithi iminyaka emihlanu, bahlaselwa isifo somdlavuza wesifuba kaningi kunelabo abangazange bayithathe. Ngakolunye uhlangothi, ukusebenzisa i-tamoxifen kwandisa ingozi yokuthuthukisa umdlavuza we-endometrial (i-membrane ye-mucous of the uterus) kanye ne-thromboembolism (ukwakheka kwe-thrombi emithanjeni yemilenze engezansi kanye nokufuduka kwabo emithonjeni yemaphaphu). Ngaphezu kwalokho, kwenzeka ukuthi ukusetshenziswa komuthi akuzange kunciphise izinga lokufa kusuka emdlalweni webele. Imiphumela yokuthoma yezifundo zanamuhla eqenjini labesifazane abanomlando womndeni wamancelisi webele akuqinisekisi ukwelulekwa kwe-tamoxifen. Imiphumela ephikisanayo iholele ekutheni kubekho uhlelo lwezokwelapha oluhlangene. Abesifazane abacabangela ukuthi kungenzeka ukuthi i-chemoprophylaxis yomdlavuza webele kufanele uthole ulwazi oluningiliziwe kumchwepheshe ofanelekile.
Ukuhlinzwa okuvimbela
- I-mastectomy. Indlela ephumelela kakhulu yokuvimbela nemiphumela emihle yi-mastectomy ye-bilateral (noma i-mastectomy ezigulini ezivele ziphathwe umdlavuza webele). Ukususa izilonda ezincelisayo ezinomsoco kuyinto isinqumo esiyinkimbinkimbi esidinga ukucatshangisisa ngokucophelela nokulinganisa ezinye izindlela. Ukunciphisa ingozi yomdlavuza webele kuhlobene ngokuqondile nomthamo wezicubu ezisuswe glandular. Ngenxa yalesi sizathu, i-mastectomy engaphansi komzimba nokugcinwa kwengono ngokuvamile ayinconywa, ngoba ishiya cishe u-10% webele, uma kuqhathaniswa no-1% ngemuva kokusebenza kwendabuko.
- I-ovariectomy. Abathwali bezakhi zofuzo ze-BRCA basengozini ephakeme futhi umdlavuza we-ovarian, ngakho-ke, kufanele uthathwe ngokungathí sina njengendlela yokuvimbela i-ovariectomy (ukususwa kwama-ovari).
I-ovariectomy inciphisa ingozi yokuthuthukisa i-tumor yebele ngokunciphisa izinga lokukhiqizwa kwe-estrogen, kufaka phakathi kwabesifazane abathwele amagciwane e-BRCA. Ukusola komdlavuza webele kungenzeka ezimweni ezilandelayo:
• ukutholakala kokwakhiwa kwamathambo ekuhloleni i-mammography;
• ukubona isisu ngesiguli.
Izimpawu ezivame kakhulu zomdlavuza webele zihlanganisa ukutholakala kwezemfundo, ushintsho ekubunjweni kwegundane, ukukhubazeka kwesikhumba kanye nengono, ukukhishwa kwimbimbo. Ukuxilongwa kwe-tumor kusekelwe ekuhlolweni kwemitholampilo, ukuphefumula kanye nesiphetho se-puncture biopsy. Kulaba besifazane abathile, ikakhulukazi kwabesifazane abasebasha, i-mammography ayifundisi kahle ngenxa yobuningi besisindo somzimba, ezimweni ezinjalo, okunye okusetshenziselwa ukuhlolwa kwe-ultrasound noma ukucabanga kwe-resonance magnetic. Eziguli eziningi ezine-tumor ezibulalayo, umdlavuza webele awuqinisekisiwe. Ngesiphetho esihle, owesifazane uthola ukwelashwa. Kudinga isu lokuhlinzekwa ngezigaba ezibandakanya udokotela ohlinzayo, oncologist, physiotherapist kanye nabanye ochwepheshe. Indima ebalulekile idlalwe ngabasebenzi bezokwelapha abajwayelekile, abaqeqeshwe ngokukhethekile ukuze banakekele iziguli ezinomdlavuza wesifuba, ukuze bazisize ngezinye izikhathi izinqubo ezinkulu zezokwelapha. Izindlela ezintsha zokwelapha umdlavuza webele zivunyelwe ukunciphisa izinga lokufa kwalesi sifo ngo-30%. Uhlelo lokwelapha lungase lubandakanye ukuhlinzwa, i-radiotherapy, i-hormonal noma i-chemotherapy.
Eziningi iziguli, indlela yokuqala yokuphatha umdlavuza webele isukuhlinzwa - ukususwa kwe-tumor yokuqala.
Ukusebenza
Ezigulini ezine-tumor enkulu, kunconywa kakhulu ukwenza i-mastectomy (ukususwa kwesifuba sonke), emva kwalokho ukulungiswa kwepulasitiki kunokwenzeka. Ngomumo omncane we-tumor, ukuthengiswa komkhakha kuvame ukwenziwa, lapho ingxenye yegland iqedwa khona. Ukungenelela okufanayo kunomusa kakhulu endaweni yokubuka izimonyo. Ngesikhathi sokusebenza, njengomthetho, ingxenye noma yonke i-lymph nodes yesifunda se-axillary isusiwe. Ngemuva kwalokho, ukulungiswa kuhlolwa ngaphansi kwe-microscope, emva kwalokho isifo sezinkinga senza isiphetho sokuthi imininingwane yobukhulu be-tumor yokuqala, uhlobo lwayo lwe-hertological, inani lezinhlanzi ezithintekile kanye nokuhlushwa kwe-receroor e-estrogen. Ukuxilongwa kwesiguli sesiguli ngokuvamile kufaka phakathi i-X-ray esifubeni ukuze kunqume ukusakazeka kwesisu, ukuhlolwa kwegazi, futhi, uma kubhekwa ukuthi kusebenza, ukukhipha amathambo noma ukuhlolwa kwe-ultrasound kwesibindi. Ngokusekelwe kulo lonke lolu datha, uhlelo lokuthola ukwelashwa oluthe xaxa lwakhiwe.
Radiotherapy
I-radiotherapy engama-postoperative ibhekwa njengento eyimpoqo yokwelapha ezigulini ezenza ukuthengiswa komkhakha; I-irradiation yesifunda se-axillary ingase ibe yindlela yokukhishwa kwe-lymph nodes. Kuyaziwa ukuthi i-radiotherapy ye-postoperative yendawo yesikhumba, izicubu ezingaphansi kanye nesifundazwe se-axillary kunciphisa ingozi yokuphindaphinda, okubuye kube nciphisa ukufa. I-Chemotherapy ne-hormone therapy imiswe ngokuqondile noma ngomlomo emva kokuhlinzwa. Lokhu kuyadingeka ekubhujisweni kwe-micrometastases - izingxenyana ezincane zezicubu zomzimba ezihlukaniswe nokugxila okuyinhloko futhi zisakaze emzimbeni. I-foci enjalo yokuhlola i-tumor ibonisa ukusongela kwesifo.
I-Hormonotherapy
Izinguquko ze-Cyclic ezithombeni zesifuba zilawulwa yi-estrogens. Emaphesenti angama-60%, ama-estrogen receptors atholakalayo esiswini sebele, ngakho-ke i-tamoxifen, evimbela lezi zamukeli emangqamuzaneni omdlavuza, angasetshenziselwa ukwelashwa. Lokhu kunciphisa ingozi yokusakaza nokuphindaphinda kwesisu. Ucwaningo lwamuva lubonisa ukuthi abesifazane abanesisu se-estrogen-sensitive sensitive bathatha i-tamoxifen iminyaka emihlanu emva kokuhlinzwa bane-prognosis engcono kakhulu.
I-Chemotherapy regimens
Kuziguli ezingaphansi kweminyaka engama-50 ubudala nomdlavuza wesifuba, umphumela omuhle we-adjuvant (okungeziweko) we-chemotherapy waboniswa. Isicelo esilungile kakhulu sale ndlela yokwelashwa ezigulini ezinengozini enkulu yokuphindaphindiwe. Kuye kwakhiwa izinhlobo ezihlukahlukene ze-chemotherapy ezibonakaliswa ukunciphisa ingozi yokuphindaphinda kwesisu. Umshini owodwa osetshenzisiwe kabanzi ubizwa ngokuthi i-CMF futhi inhlanganisela ye-cyclophosphamide, methotrexate ne-5-furouracil. Ukwengeza izidakamizwa zanamuhla njenge doxorubicin ne-paclitaxel, kusiza ukuthuthukisa imiphumela ye-chemotherapy.
Kuziguli ezine nomdlavuza webele we-metastatic - ukusakazeka kwesisu emzimbeni wonke - ukwelashwa akunakwenzeka. Noma kunjalo, kunezinqubo zokwelashwa ezihloswe ukunciphisa izimpawu, futhi ukuthuthukiswa kwanamuhla kuvame ukwandisa amathuba okuphila. Ngeshwa, naphezu kwentuthuko ephawulekayo eyenziwa ekwelapheni umdlavuza webele emashumini eminyaka amuva nje, akuzona zonke iziguli ezinethuba lokubuyiselwa. Iziguli ezinesifo se-metastase ngesikhathi sokuxilongwa komdlavuza noma labo abavela kuzo izikhungo zokuqhamuka ngemuva kokwelashwa kokuqala banesimo esibi. Izindawo ezivame ukujwayele ukutholakala kwamathambo isifo samathambo, isibindi, amaphaphu, isikhumba kanye nezicubu ezingaphansi, kanye nobuchopho.
Izinhloso zokwelapha
Ukwelashwa kweziguli ezinjalo kuhloswe ukwandisa isikhathi eside kanye nokunciphisa izimpawu (ukwelashwa kwe-palliative). Nakuba ezinye iziguli ezinezigaba ezithuthukisiwe zomdlavuza zingaphila futhi iminyaka eminingana, ukukhuluma ngomuthi ezimweni ezinjalo akudingekile. Ukwenza ukuhlinzwa kanye ne-radiotherapy phambi kwe-metastases akubalulekile kangcono kunokwelashwa kwe-chemo ne-hormone, ngoba izidakamizwa zingabhubhisa amangqamuzana e-tumor kuwo wonke umzimba. Okuwukuphela kokuphela kwamathambo ayisifo se-bone, okuyinto ezwela kakhulu kwi-radiotherapy. Ukunciphisa ingozi yamathambo kanye nezinkinga ezihlobene, kufaka phakathi ukuhlukunyezwa, sebenzisa iqembu lezidakamizwa ezaziwa ngokuthi i-bisphosphonates. Ukukhethwa kwendlela yokwelashwa kuncike endaweni ye-foci yomdlavuza, ukwelashwa kwangaphambilini, izici zesisu kanye nesimo jikelele sempilo yesiguli.
Ikhwalithi yokuphila
Lapho behlelwa uhlelo lwezokwelapha, bathatha indlela eyodwa kwesiguli ngasinye, ngokugcizelela ekuthuthukiseni ikhwalithi yokuphila. Ukuze kunciphise kakhulu izimpawu zesifo, kunconywa ukuthi kuhileleke odokotela nabahlengikazi abaqeqeshwe ngokukhethekile ukuze banikeze ukunakekelwa ngokucophelela. Ukulawulwa kwesifo sobuhlungu kanye nezinye izinyathelo ezisekelayo kulesi sigaba ziba ezibaluleke kakhulu. Ososayensi nodokotela emhlabeni jikelele basuke bekhandleka ukuthuthukisa izindlela ezintsha zokulwa nomdlavuza, futhi iziguli zivame ukuba zihlanganyele ocwaningweni lwezokwelapha. Ngokuvamise kakhulu ezimweni ezinjalo, ukuhlaziywa okuqhathaniswa nokusebenza komuthi okhona kakade futhi ovivinywe. Ezinye izifundo, ukungafani nokusetshenziswa kakade kakhulu, ukuhlola ithuluzi elisha, ukuhlola umsebenzi walo kanye nobuthi.
Izivivinyo zemitholampilo
Ucwaningo lwezokwelapha luveza imithi ephumelela kakhulu futhi lunikeze idatha edingekayo ukutshala izidakamizwa ezintsha kubuchwepheshe obubizayo. Ukubheka kubonisa imiphumela engcono kakhulu yokwelapha kulabo abagulayo abahlanganyela ekuhlolweni. Izitayela zakamuva zibhekene nokuhamba kwamakhemikhali amasiko ajwayelekile ekusetshenzisweni kwezidakamizwa ezinobuthi obuhambisana nezidingo zesiguli esithile.