Ulwazi oluphangaleleyo malunga noMhlaza wamabele
Umhlaza wamabele sisifo apho iiseli ezinobungozi (umhlaza) zenza kwizicubu zebele.
Isifuba senziwe ngeelobes kunye nemigudu.Ibele ngalinye linamacandelo ali-15 ukuya kwangama-20 abizwa ngokuba ziilobes, anamacandelo amaninzi amancinane abizwa ngokuba yi-lobules.Ii-lobules ziphela kwiibhalbhu ezininzi ezincinci ezinokwenza ubisi.I-lobes, ii-lobes, kunye ne-bulbs zidityaniswe ngamatyhubhu amancinci abizwa ngokuba yi-ducts.
Ibele ngalinye linemithambo yegazi kunye nemithambo ye-lymph.Imithambo ye-lymph ithwala ulwelo oluphantse lungenambala, olunamanzi olubizwa ngokuba yi-lymph.Iinqanawa ze-lymph zithwala i-lymph phakathi kwe-lymph nodes.I-lymph nodes zincinci, izakhiwo ezimile okwembotyi ezihluza i-lymph kwaye zigcine iiseli ezimhlophe zegazi ezinceda ukulwa nosulelo kunye nezifo.Amaqela e-lymph nodes afunyanwa kufuphi nesifuba kwi-axilla (phantsi kwengalo), ngaphezu kwe-collarbone, kunye nesifuba.
Umhlaza wamabele lolona hlobo lwesibini luxhaphakileyo kubasetyhini baseMelika.
Amabhinqa aseUnited States aba nomhlaza wamabele ngaphezu kwalo naluphi na olunye uhlobo lomhlaza ngaphandle komhlaza wolusu.Umhlaza wamabele ungowesibini kumhlaza wemiphunga njengonobangela wokufa komhlaza kwabasetyhini baseMelika.Nangona kunjalo, ukusweleka ngenxa yomhlaza wamabele kuye kwehla kancinci rhoqo ngonyaka phakathi kuka-2007 kunye no-2016. Umhlaza webele uyenzeka nakumadoda, kodwa inani leemeko ezintsha lincinci.
UThintelo loMhlaza wamabele
Ukuphepha izinto ezinobungozi kunye nokwandisa izinto ezikhuselayo kunokunceda ukukhusela umhlaza.
Ukuphepha imiba esemngciphekweni yomhlaza kunokunceda ukuthintela umhlaza othile.Imingcipheko iquka ukutshaya, ukutyeba ngokugqithiseleyo, nokungazilolongi ngokwaneleyo.Ukwandisa izinto ezikhuselayo ezinjengokuyeka ukutshaya kunye nokwenza umthambo nako kunokunceda ukuthintela eminye imihlaza.Thetha nogqirha wakho okanye enye ingcali yezempilo malunga nokuba ungawuthoba njani umngcipheko wokuba nomhlaza.
Oku kulandelayo yimiba esemngciphekweni womhlaza wamabele:
1. Ubudala
Ubudala ngoyena nobangela womngcipheko kuninzi lomhlaza.Amathuba okufumana umhlaza ayanda njengoko ukhula.
2. Imbali yobuqu yomhlaza webele okanye i-benign (noncancer) isifo sebele
Abasetyhini abanayo nayiphi na kwezi zilandelayo banomngcipheko owongeziweyo womhlaza wamabele:
- Imbali yobuqu yomhlaza webele ohlaselayo, iductal carcinoma in situ (DCIS), okanye lobular carcinoma in situ (LCIS).
- Imbali yobuqu yesifo sebele esinobungozi (esingenawo umhlaza).
3. Umngcipheko ozuzwe njengelifa lomhlaza wamabele
Abasetyhini abanembali yosapho yomhlaza wamabele kwisihlobo sokuqala (umama, udade, okanye intombi) banomngcipheko owongeziweyo womhlaza wamabele.
Abasetyhini abafumene utshintsho kwimizila yemfuza okanye kwezinye iiseli zemfuza basengozini enkulu yomhlaza wamabele.Umngcipheko wokuba nomhlaza wamabele obangelwa kukutshintsha kwemizila yemfuza ixhomekeke kuhlobo lokuguqulwa kwemfuza, imbali yentsapho yomhlaza, kunye nabanye oothunywashe.
4. Amabele axineneyo
Ukuba nezicubu zebele ezixineneyo kwi-mammogram ngumba womngcipheko womhlaza wamabele.Inqanaba lomngcipheko lixhomekeke kwindlela exinene ngayo izicubu zesifuba.Abasetyhini abanamabele axinene kakhulu basemngciphekweni omkhulu wokuba nomhlaza wamabele kunabasetyhini abanoxinano oluphantsi lwamabele.
Ukwanda kokuxinana kwamabele kudla ngokuba luphawu oluzuzw’ ilifa, kodwa kusenokubakho nakwabasetyhini abangekabi nabantwana, abanokukhulelwa okokuqala kade ebomini, bathathe iihomoni ze-postmenopausal, okanye basele utywala.
5. Ukuvezwa kwezicubu zamabele kwi-estrogen eyenziwe emzimbeni
I-Estrogen yihomoni eyenziwe ngumzimba.Inceda umzimba ukuba uphuhlise kwaye ugcine iimpawu zesini zesini.Ukuba sesichengeni se-estrogen ixesha elide kunokonyusa umngcipheko womhlaza wamabele.Amanqanaba e-Estrogen aphezulu ngexesha leminyaka umfazi esexesheni.
Ukuchaneka kowesifazane kwi-estrogen kwandiswa ngezi ndlela zilandelayo:
- Ukuya exesheni kwangethuba: Ukuqala ukuya exesheni kwiminyaka eyi-11 okanye ngaphantsi kwandisa inani leminyaka izicubu zebele zichaneke kwi-estrogen.
- Ukuqala kwiminyaka yamva: Okukhona owasetyhini esiya exesheni, kokukhona izicubu zakhe zebele zichanabeka kwi-estrogen.
- Ubudala ekuzalweni kokuqala okanye ungazange ubeleke: Ngenxa yokuba amanqanaba e-estrogen esezantsi ngexesha lokukhulelwa, izicubu zamabele zichanabeka kwi-estrogen engakumbi kubasetyhini abakhulelwa okokuqala emva kweminyaka engama-35 ubudala okanye abangazange bakhulelwe.
6. Ukuthatha unyango lwe-hormone kwiimpawu zokuyeka ukuya exesheni
IiHormones, ezifana ne-estrogen neprogesterone, zinokwenziwa zibe yifomu yepilisi elabhoratri.Iestrogen, iprogestin, okanye zombini zisenokunikelwa ukuze zithabathel’ indawo i-estrogen engasenakwenziwa ziziyilelo-maqanda kumabhinqa asemva kokuyeka ukuya exesheni okanye amabhinqa asuswe iziyilelo-maqanda.Oku kubizwa ngokuba yi-hormone replacement therapy (HRT) okanye unyango lwehomoni (HT).Ukudibanisa i-HRT/HT yi-estrogen edityaniswe neprogestin.Olu hlobo lwe-HRT / HT lwandisa umngcipheko womhlaza webele.Uhlolisiso lubonisa ukuba xa amabhinqa eyeka ukusebenzisa i-estrogen neprogestin, amathuba okuba nomhlaza wamabele ayancipha.
7. Unyango lwemitha kwibele okanye esifubeni
Ukunyanga ngemitha esifubeni kunyango lomhlaza kwandisa umngcipheko womhlaza wamabele, ukuqala kweminyaka eyi-10 emva konyango.Umngcipheko womhlaza wamabele uxhomekeke kwithamo lemitha yemitha kunye neminyaka enikwa ngayo.Umngcipheko uphezulu ukuba unyango lwemitha lusetyenziswe ngexesha lokufikisa, xa amabele esakha.
Unyango ngemitha ukunyanga umhlaza kwelinye ibele akubonakali kwandisa ingozi yomhlaza kwelinye ibele.
Kwabasetyhini abafumene utshintsho kwiijini ze-BRCA1 kunye ne-BRCA2, ukuvezwa kwimitha, efana naleyo ivela kwi-x-ray yesifuba, kunokunyusa ngakumbi umngcipheko womhlaza webele, ngakumbi kubasetyhini ababenziwe nge-x-ray ngaphambi kweminyaka engama-20 ubudala.
8. Ukutyeba ngokugqithiseleyo
Ukutyeba ngokugqithiseleyo kwandisa umngcipheko womhlaza wamabele, ngakumbi kwabasetyhini abasemva kokuya exesheni abangalusebenzisanga unyango lokubuyisela ihomoni.
9. Ukusela utywala
Ukusela utywala kwandisa ingozi yomhlaza wamabele.Inqanaba lomngcipheko liyenyuka njengoko isixa sotywala obusetyenzisiweyo sinyuka.
Oku kulandelayo yimiba yokukhusela umhlaza wamabele:
1. Ukutyhileka okuncinci kwezicubu zamabele kwi-estrogen eyenziwe ngumzimba
Ukunciphisa ubude bexesha izicubu zebele zomfazi zichanabeke kwi-estrogen kusenokunceda ekuthinteleni umhlaza wamabele.Ukubonakaliswa kwe-estrogen kuncitshiswa ngezi ndlela zilandelayo:
- Ukukhulelwa kwangethuba: Amanqanaba e-Estrogen aphantsi ngexesha lokukhulelwa.Abasetyhini abakhulelwe ixesha elipheleleyo ngaphambi kweminyaka engama-20 ubudala banomngcipheko omncinci womhlaza webele kunabasetyhini abangenabantwana okanye ababele umntwana wabo wokuqala emva kweminyaka engama-35.
- Ukuncancisa: Amanqanaba e-Estrogen asenokuhlala esezantsi ngelixa ibhinqa lincancisa.Abasetyhini abancancisayo banomngcipheko omncinci wokuba nomhlaza wamabele kunabafazi abanabantwana kodwa abancancisi.
2. Ukuthatha unyango lwe-hormone ye-estrogen kuphela emva kwe-hysterectomy, i-modulators ye-estrogen ekhethiweyo, okanye i-aromatase inhibitors kunye ne-inactivators.
Unyango lwe-Estrogen-kuphela kwehomoni emva kwe-hysterectomy
Unyango lwehomoni nge-estrogen kuphela lunokunikwa abasetyhini abaye baqhawukelwa yi-hysterectomy.Kwaba basetyhini, unyango lwe-estrogen kuphela emva kokuyeka ukuya exesheni kunokunciphisa umngcipheko womhlaza wamabele.Kukho ingozi eyongeziweyo ye-stroke kunye nesifo senhliziyo kunye nesifo segazi kubasetyhini be-postmenopausal abathatha i-estrogen emva kwe-hysterectomy.
Iimodyuli ezikhethiweyo ze-estrogen receptor
I-Tamoxifen kunye ne-raloxifene yintsapho yamachiza ebizwa ngokuba yi-selective estrogen receptor modulators (SERMs).Ii-SERM zisebenza njenge-estrogen kwezinye izicubu emzimbeni, kodwa zithintele umphumo we-estrogen kwezinye izihlunu.
Unyango nge-tamoxifen kunciphisa umngcipheko we-estrogen receptor-positive (ER-positive) umhlaza webele kunye ne-ductal carcinoma in situ kwi-premenopausal kunye nabasetyhini be-postmenopausal abasengozini enkulu.Unyango nge-raloxifene lunciphisa umngcipheko womhlaza webele kubasetyhini be-postmenopausal.Ngalo naliphi na iyeza, umngcipheko ocuthiweyo uhlala iminyaka emininzi okanye ngaphezulu emva kokuba unyango luyekiwe.Amazinga aphantsi amathambo aphukileyo aqatshelwe kwizigulane ezithatha i-raloxifene.
Ukuthatha i-tamoxifen kwandisa umngcipheko wokutshisa okutshisa, umhlaza we-endometrial, ukubetha, i-cataracts, kunye namahlule egazi (ingakumbi kwimiphunga kunye nemilenze).Umngcipheko wokuba nezi ngxaki unyuka ngokuphawulekayo kubasetyhini abaneminyaka engaphezu kwama-50 xa kuthelekiswa nabasetyhini abancinci.Abasetyhini abangaphantsi kweminyaka engama-50 abasengozini enkulu yomhlaza wamabele banokuzuza kakhulu ngokuthatha i-tamoxifen.Umngcipheko wokuba nezi ngxaki uyancipha emva kokuba i-tamoxifen imisiwe.Thetha nogqirha wakho malunga neengozi kunye neenzuzo zokuthatha eli chiza.
Ukuthatha i-raloxifene kwandisa umngcipheko wegazi kwimiphunga kunye nemilenze, kodwa akubonakali ukwandisa umngcipheko womhlaza we-endometrial.Kwabasetyhini be-postmenopausal abane-osteoporosis (ukuncipha kwamathambo), i-raloxifene yehlisa umngcipheko womhlaza webele kubasetyhini abanomngcipheko ophezulu okanye ophantsi womhlaza webele.Ayaziwa ukuba i-raloxifene iya kuba nefuthe elifanayo kubasetyhini abangenayo i-osteoporosis.Thetha nogqirha wakho malunga neengozi kunye neenzuzo zokuthatha eli chiza.
Ezinye ii-SERM ziyaphononongwa kulingo lwezonyango.
I-Aromatase inhibitors kunye ne-inactivators
I-aromatase inhibitors (i-anastrozole, i-letrozole) kunye nee-inactivators (i-exemestane) zehlisa umngcipheko wokuphinda uqalise kunye nomhlaza wamabele amatsha kubasetyhini abanembali yomhlaza wamabele.I-Aromatase inhibitors ikwanciphisa umngcipheko womhlaza wamabele kwabasetyhini abanezi meko zilandelayo:
- Abasetyhini abaPostmenopausal abanembali yobuqu yomhlaza wamabele.
- Abasetyhini abangenambali yobuqu yomhlaza wamabele abaneminyaka engama-60 nangaphezulu, banembali ye-ductal carcinoma in situ nge-mastectomy, okanye basengozini enkulu yomhlaza wamabele ngokusekwe kwimodeli yesixhobo seGail (isixhobo esisetyenziselwa ukuqikelela umngcipheko webele umhlaza).
Kwabasetyhini abanomngcipheko owongezelelweyo womhlaza webele, ukuthatha i-aromatase inhibitors kunciphisa inani le-estrogen eyenziwa ngumzimba.Ngaphambi kokuyeka ukuya exesheni, i-estrogen yenziwa ngamaqanda kunye nezinye izihlunu kumzimba womfazi, kuquka ingqondo, izicubu ezinamafutha kunye nolusu.Emva kokuyeka ukuya exesheni, ii-ovari ziyayeka ukwenza i-estrogen, kodwa ezinye izicwili azikwenzi.I-Aromatase inhibitors ivala isenzo se-enzyme ebizwa ngokuba yi-aromatase, esetyenziselwa ukwenza yonke i-estrogen yomzimba.I-aromatase inactivators inqanda i-enzyme ekusebenzeni.
Ubungozi obunokwenzeka bokuthatha i-aromatase inhibitors bubandakanya iintlungu zemisipha kunye namalungu, i-osteoporosis, ukukhanya okutshisa, kunye nokuziva udiniwe kakhulu.
3. I-mastectomy yokunciphisa umngcipheko
Abanye abasetyhini abasengozini enkulu yomhlaza wamabele banokukhetha ukwenza i-mastectomy yokunciphisa umngcipheko (ukususwa kwamabele omabini xa kungekho zimpawu zomhlaza).Umngcipheko womhlaza wamabele usezantsi kakhulu kwaba basetyhini kwaye uninzi baziva bengaxhalabi kangako malunga nomngcipheko womhlaza wamabele.Nangona kunjalo, kubaluleke kakhulu ukuba ube novavanyo lomngcipheko womhlaza kunye neengcebiso malunga neendlela ezahlukeneyo zokuthintela umhlaza wamabele ngaphambi kokuba wenze esi sigqibo.
4. Ukukhutshwa kwe-ovarian
Ii-ovari zenza uninzi lwe-estrogen eyenziwa ngumzimba.Unyango oluyekisayo okanye oluthoba isixa se-estrogen olwenziwa ziziyilelo-maqanda luquka utyando lokukhupha amaqanda, unyango ngemitha, okanye ukusebenzisa amayeza athile.Oku kubizwa ngokuba yi-ovarian ablation.
Abasetyhini be-Premenopausal abasengozini enkulu yomhlaza wamabele ngenxa yotshintsho oluthile kwi-BRCA1 kunye ne-BRCA2 yemfuza basenokukhetha ukuba ne-oophorectomy yokunciphisa ingozi (ukususwa kwee-ovari zombini xa kungekho zimpawu zomhlaza).Oku kunciphisa ubungakanani be-estrogen eyenziwa ngumzimba kwaye yehlisa umngcipheko womhlaza wamabele.I-oophorectomy yokunciphisa umngcipheko ikwayithoba ingozi yomhlaza wamabele kumabhinqa aqhelekileyo angaphambi kokuya exesheni kunye nakumabhinqa asengozini yokufumana umhlaza wamabele ngenxa yemitha yemitha yesifuba.Nangona kunjalo, kubaluleke kakhulu ukuba ube novavanyo lomngcipheko womhlaza kunye neengcebiso phambi kokuba wenze esi sigqibo.Ukwehla ngequbuliso kumanqanaba e-estrogen kunokubangela ukuba iimpawu zokuyeka ukuya exesheni ziqale.Oku kuquka ukutshisa, ukungalali kakuhle, ukuxhalaba nokudandatheka.Iziphumo zexesha elide ziquka ukunciphisa isondo, ukoma kwelungu lobufazi, kunye nokuncipha kwamathambo.
5. Ukwenza umthambo owaneleyo
Abasetyhini abenza umthambo iiyure ezine nangaphezulu ngeveki basengozini encinane yokuba nomhlaza wamabele.Umphumo wokuzilolonga kumngcipheko womhlaza wamabele unokuba mkhulu kwabasetyhini abangaphambi kokuya esikhathini abanobunzima bomzimba obuqhelekileyo okanye obuphantsi.
Akukacaci ukuba ngaba oku kulandelayo kuchaphazela umngcipheko womhlaza wamabele:
1. Izicwangcisi zeHormonal
Izicwangcisi zeHormonal ziqulethe i-estrogen okanye i-estrogen kunye neprogestin.Olunye uphando lubonise ukuba abasetyhini abangabasebenzisi bangoku okanye abasandul 'ukusebenzisa izithinteli zehomoni banokunyuka okuncinci kumngcipheko womhlaza wamabele.Olunye uphononongo alukhange lubonise umngcipheko owongeziweyo womhlaza wamabele kubasetyhini abasebenzisa izicwangcisi zehomoni.
Kolunye uphononongo, umngcipheko womhlaza wamabele wonyuka kancinane ixesha elide owasetyhini esebenzisa izicwangcisi zehomoni.Olunye uphononongo lubonise ukuba ukonyuka okuncinci kumngcipheko womhlaza webele kuye kwehla ngokuhamba kwexesha xa abasetyhini beyeka ukusebenzisa izicwangcisi zehomoni.
Uphononongo olongezelelweyo luyafuneka ukwazi ukuba ingaba izicwangcisi zehomoni ziyawuchaphazela na umngcipheko womhlaza webele wowasetyhini.
2. Okusingqongileyo
Uphononongo alukhange lubonakalise ukuba ukuvezwa kwizinto ezithile ezingqongileyo, ezinje ngeekhemikhali, kwandisa umngcipheko womhlaza webele.
Uhlolisiso luye lwabonisa ukuba ezinye izinto zinempembelelo encinane okanye azinayo kwaphela kumngcipheko womhlaza wamabele.
Oku kulandelayo kunempembelelo encinci okanye akukho nto kumngcipheko womhlaza wamabele:
- Ukukhupha isisu.
- Ukwenza utshintsho kwindlela yokutya njengokutya amanqatha amancinci okanye iziqhamo ezininzi kunye nemifuno.
- Ukuthatha iivithamini, kuquka i-fenretinide (uhlobo lwevithamini A).
- Ukutshaya umdiza, kokubini okusebenzayo kunye nokwenziwa (ukusezela umsi ophuma kumntu otshayayo).
- Ukusebenzisa i-underarm deodorant okanye i-antiperspirant.
- Ukuthatha i-statins (iziyobisi ezinciphisa i-cholesterol).
- Ukuthatha i-bisphosphonates (iziyobisi ezisetyenziselwa ukunyanga i-osteoporosis kunye ne-hypercalcemia) ngomlomo okanye nge-intravenous infusion.
- Utshintsho kwisigqi sakho se-circadian (utshintsho lomzimba, lwengqondo, kunye nokuziphatha oluchatshazelwa kakhulu bubumnyama kunye nokukhanya kwimijikelezo yeeyure ze-24), ezinokuchaphazeleka ngokusebenza ebusuku okanye ubuninzi bokukhanya kwigumbi lakho lokulala ebusuku.
Umthombo:http://www.chinancpcn.org.cn/cancerMedicineClassic/guideDetail?sId=CDR257994&type=1
Ixesha lokuposa: Aug-28-2023