Uthintelo loMhlaza webele

Ulwazi Olubanzi Malunga Nomhlaza Webele

Umhlaza webele sisifo apho iiseli ezinobungozi (umhlaza) zenzeka khona kwizicwili zebele.

Ibele lenziwe ngamaqhekeza kunye nemijelo. Ibele ngalinye linamacandelo ali-15 ukuya kwangama-20 abizwa ngokuba zii-lobes, aneendawo ezininzi ezincinci ezibizwa ngokuba zii-lobules. Ii-lobules ziphela ngeebhalbhu ezincinci ezininzi ezinokwenza ubisi. Iibhalbhu, ii-lobules, kunye neebhalbhu zidityaniswa ziityhubhu ezincinci ezibizwa ngokuba zii-ducts.

Ibele ngalinye linemithambo yegazi kunye nemithambo ye-lymph. Imithambo ye-lymph ithwala ulwelo oluphantse lungabi nambala, olubizwa ngokuba yi-lymph. Imithambo ye-lymph ithwala i-lymph phakathi kwe-lymph nodes. I-lymph nodes zizakhiwo ezincinci, ezimile okweembotyi ezihluza i-lymph kwaye zigcina iiseli ezimhlophe zegazi ezinceda ekulweni nosulelo kunye nezifo. Amaqela e-lymph nodes afumaneka kufutshane nebele kwi-axilla (phantsi kwengalo), ngaphezulu kwe-collarbone, nakwisifuba.

Umhlaza webele lolona hlobo lwesibini oluxhaphakileyo lomhlaza kubafazi baseMelika.

Abafazi eMelika bafumana umhlaza webele ngaphezu kwalo naluphi na olunye uhlobo lomhlaza ngaphandle komhlaza wesikhumba. Umhlaza webele ngowesibini emva komhlaza wemiphunga njengonobangela wokufa komhlaza kubafazi baseMelika. Nangona kunjalo, ukufa ngenxa yomhlaza webele kuye kwehla kancinci minyaka le phakathi kowama-2007 nowama-2016. Umhlaza webele uyenzeka nakumadoda, kodwa inani lamatyala amatsha lincinci.

Uthintelo loMhlaza webele

Ukuphepha izinto ezinobungozi kunye nokwandisa izinto zokukhusela kunokunceda ukuthintela umhlaza.

Ukuphepha izinto ezinobungozi bomhlaza kunokunceda ukuthintela ezinye iintlobo zomhlaza. Izinto ezinobungozi ziquka ukutshaya, ukutyeba kakhulu, kunye nokungazilolongi ngokwaneleyo. Izinto ezikhuselayo ezinjengokuyeka ukutshaya nokuzilolonga zinokunceda ukuthintela ezinye iintlobo zomhlaza. Thetha nogqirha wakho okanye omnye uchwepheshe wezempilo malunga nendlela onokunciphisa ngayo umngcipheko wakho womhlaza.

Nazi izinto ezibangela umhlaza webele:

1. Ukwaluphala

Ukwaluphala yeyona nto iphambili ebangela umhlaza. Amathuba okufumana umhlaza ayanda njengoko ukhula.

2. Imbali yobuqu yomhlaza webele okanye isifo sebele esingengomhlaza (esingengomhlaza)

Abafazi abanezinye zezi zilandelayo banomngcipheko ophezulu wokuba nomhlaza webele:

• Imbali yobuqu yomhlaza webele ohlaselayo, i-ductal carcinoma in situ (DCIS), okanye i-lobular carcinoma in situ (LCIS).
• Imbali yobuqu yesifo sebele esingengomhlaza (esingesomhlaza).

3. Umngcipheko womhlaza wamabele ozuzwe njengelifa

Abafazi abanembali yosapho yomhlaza webele kwizalamane zabo (umama, udade wabo, okanye intombi yabo) banomngcipheko omkhulu womhlaza webele.

Abafazi abafumene utshintsho kwi-gene okanye kwezinye ii-genes basengozini enkulu yokuba nomhlaza webele. Umngcipheko womhlaza webele obangelwa lutshintsho kwi-genes olufunyenweyo uxhomekeke kuhlobo lotshintsho kwi-gene, imbali yosapho lomhlaza, kunye nezinye izinto.

4. Amabele axineneyo

Ukuba nezicubu zebele ezixineneyo kwi-mammogram yinto ebangela umngcipheko womhlaza webele. Ubungakanani bomngcipheko buxhomekeke ekubeni zixinene kangakanani izicubu zebele. Abafazi abanamabele axineneyo kakhulu banomngcipheko omkhulu womhlaza webele kunabafazi abanamabele axineneyo.

Ukwanda koxinano lwamabele kudla ngokuba luphawu oluzuzwa njengelifa, kodwa lunokwenzeka nakubafazi abangazange babe nabantwana, abakhulelwe okokuqala besebancinci, abathatha iihomoni emva kokuya exesheni, okanye abasela utywala.

5. Ukuvezwa kwezicubu zebele kwi-estrogen eyenziwe emzimbeni

I-estrogen yi-hormone eyenziwa ngumzimba. Inceda umzimba uphuhlise kwaye ugcine iimpawu zesini zabasetyhini. Ukuvezwa kwi-estrogen ixesha elide kunokunyusa umngcipheko womhlaza webele. Amanqanaba e-estrogen aphezulu kakhulu kwiminyaka umfazi esexesheni.

Ukuvezwa kwe-estrogen kumfazi kwandiswa ngezi ndlela zilandelayo:

• Ukuya exesheni kwangethuba: Ukuqala ukuya exesheni xa uneminyaka eli-11 okanye ngaphantsi kwandisa inani leminyaka izicubu zebele ezivezwa ngayo yi-estrogen.
• Ukuqala xa umfazi esiya exesheni iminyaka emininzi, kokukhona izicubu zebele lakhe zichatshazelwa yi-estrogen ixesha elide.
• Ukwaluphala ekuzalweni kokuqala okanye ukungazali: Ngenxa yokuba amanqanaba e-estrogen esezantsi ngexesha lokukhulelwa, izicubu zebele zichatshazelwa yi-estrogen eninzi kubafazi abakhulelwa okokuqala emva kweminyaka engama-35 okanye abangazange bakhulelwe.

6. Ukuthatha unyango lweehomoni kwiimpawu zokuya exesheni

Iihormone, ezifana ne-estrogen kunye ne-progesterone, zinokwenziwa zibe yifom yepilisi kwilebhu. I-estrogen, i-progestin, okanye zombini zinokunikwa ukuze zithathe indawo ye-estrogen engasenziwanga zii-ovari kubafazi abasele beyekile ukuya exesheni okanye kubafazi abaye basuswa ii-ovari zabo. Oku kubizwa ngokuba yi-hormone replacement therapy (HRT) okanye i-hormone therapy (HT). I-Combination HRT/HT yi-estrogen edityaniswe ne-progestin. Olu hlobo lwe-HRT/HT lunyusa umngcipheko womhlaza webele. Izifundo zibonisa ukuba xa abafazi beyeka ukuthatha i-estrogen edityaniswe ne-progestin, umngcipheko womhlaza webele uyancipha.

7. Unyango lwemitha esifubeni okanye esifubeni

Unyango lwemitha esifubeni ukuze kunyangwe umhlaza lunyusa umngcipheko womhlaza webele, luqala emva kweminyaka eli-10 emva konyango. Umngcipheko womhlaza webele uxhomekeke kwidosi yemitha kunye nobudala obunikwayo. Umngcipheko uphezulu ukuba unyango lwemitha lusetyenziswe ngexesha lokufikisa, xa amabele esakha.

Unyango lwemitha yokunyanga umhlaza kwelinye ibele alubonakali luyonyusa umngcipheko womhlaza kwelinye ibele.

Kwabasetyhini abaye bazuza utshintsho kwi-BRCA1 kunye ne-BRCA2 genes, ukuvezwa kwimitha yelanga, efana naleyo ivela kwi-x-ray yesifuba, kunokunyusa umngcipheko womhlaza webele, ingakumbi kwabasetyhini abaye bajongwa i-x-ray ngaphambi kokuba bafikelele kwiminyaka engama-20 ubudala.

8. Ukutyeba kakhulu

Ukutyeba kakhulu kwandisa umngcipheko womhlaza wamabele, ingakumbi kubafazi asele beyekile ukuya exesheni abangakhange basebenzise unyango lokutshintshwa kweehomoni.

9. Ukusela utywala

Ukusela utywala kwandisa umngcipheko womhlaza wamabele. Inqanaba lomngcipheko liyanda njengoko isixa sotywala esisetyenziswayo sisanda.

Nazi izinto ezikhusela umhlaza webele:

1. Ukungabikho kwe-estrogen emzimbeni kwizicubu zebele

Ukunciphisa ixesha elichithwa yi-estrogen kwizicwili zebele zomfazi kunokunceda ekuthinteleni umhlaza webele. Ukuvezwa kwi-estrogen kuncitshiswa ngezi ndlela zilandelayo:

• Ukukhulelwa kwangethuba: Amanqanaba e-estrogen aphantsi ngexesha lokukhulelwa. Abafazi abakhulelwe ixesha elizeleyo ngaphambi kweminyaka engama-20 ubudala banomngcipheko ophantsi wokuba nomhlaza webele kunabafazi abangazange babe nabantwana okanye abazala umntwana wabo wokuqala emva kweminyaka engama-35 ubudala.
• Ukuncancisa: Amanqanaba e-estrogen anokuhlala ephantsi ngelixa umfazi encancisa. Abafazi abancancisa ibele banomngcipheko omncinci wokuba nomhlaza webele kunabafazi abaye baba nabantwana kodwa abangazange bancancise ibele.

2. Ukuthatha unyango lwe-hormone ye-estrogen kuphela emva kokususwa kwesisu, ii-selective estrogen receptor modulators, okanye ii-aromatase inhibitors kunye nee-inactivators

Unyango lwe-hormone olusebenzisa i-estrogen kuphela emva kokususwa kwe-hysterectomy

Unyango lweehomoni olusebenzisa i-estrogen kuphela lunokunikwa abafazi abaye bakhutshwa i-hysterectomy. Kula mabhinqa, unyango lwe-estrogen kuphela emva kokuya exesheni lunokunciphisa umngcipheko womhlaza webele. Kukho umngcipheko okhulayo westroke kunye nesifo sentliziyo kunye nemithambo yegazi kubafazi asebeye exesheni abathatha i-estrogen emva kokususwa kwe-hysterectomy.

Iimodulators ze-estrogen receptor ezikhethiweyo

I-Tamoxifen kunye ne-raloxifene ziyinxalenye yosapho lwamayeza abizwa ngokuba zii-selective estrogen receptor modulators (SERMs). Ii-SERM zisebenza njenge-estrogen kwezinye izicwili zomzimba, kodwa zithintela impembelelo ye-estrogen kwezinye izicwili.

Unyango nge-tamoxifen lunciphisa umngcipheko womhlaza webele one-estrogen receptor-positive (ER-positive) kunye ne-ductal carcinoma in situ kubasetyhini abangaphambi kokuya exesheni kunye nabasetyhini abasemva kokuya exesheni abasengozini enkulu. Unyango nge-raloxifene lukwanciphisa umngcipheko womhlaza webele kubasetyhini abasemva kokuya exesheni. Ngalo naliphi na iyeza, umngcipheko onciphileyo uhlala iminyaka eliqela okanye ngaphezulu emva kokuba unyango luyekisiwe. Amanani aphantsi amathambo aphukileyo aqatshelwe kwizigulana ezithatha i-raloxifene.

Ukusebenzisa i-tamoxifen kwandisa umngcipheko wobushushu, umhlaza we-endometrial, isifo sohlangothi, i-cataracts, kunye nokuqhekeka kwegazi (ingakumbi emiphungeni nasemilenzeni). Umngcipheko wokuba nezi ngxaki uyanda kakhulu kubasetyhini abaneminyaka engaphezu kwama-50 xa kuthelekiswa nabasetyhini abancinci. Abafazi abaneminyaka engaphantsi kwama-50 abanomngcipheko omkhulu womhlaza webele banokuzuza kakhulu ngokuthatha i-tamoxifen. Umngcipheko wokuba nezi ngxaki uyancipha emva kokuba i-tamoxifen iyekiwe. Thetha nogqirha wakho malunga neengozi kunye neenzuzo zokusebenzisa eli yeza.

Ukusela i-raloxifene kwandisa umngcipheko wokuqhekeka kwegazi emiphungeni nasemilenzeni, kodwa akubonakali ngathi kuyandisa umngcipheko womhlaza we-endometrial. Kubafazi abasele beyekile ukuya exesheni abane-osteoporosis (ubunzima bamathambo obunciphileyo), i-raloxifene yehlisa umngcipheko womhlaza webele kubafazi abanomngcipheko ophezulu okanye ophantsi womhlaza webele. Akwaziwa ukuba i-raloxifene ingaba nefuthe elifanayo nakwabasetyhini abangenayo i-osteoporosis. Thetha nogqirha wakho malunga neengozi kunye neenzuzo zokusebenzisa eli yeza.

Ezinye ii-SERM ziyafundwa kwiimvavanyo zeklinikhi.

Izithinteli zeAromatase kunye nezithinteli

Ii-Aromatase inhibitors (i-anastrozole, i-letrozole) kunye nee-inactivators (i-exemestane) zinciphisa umngcipheko wokuphinda ubuye kunye nomhlaza omtsha wamabele kubafazi abanembali yomhlaza wamabele. Ii-Aromatase inhibitors zikwanciphisa umngcipheko womhlaza wamabele kubafazi abanezi meko zilandelayo:

• Abafazi abasele beyekile ukuya exesheni abanembali yomhlaza webele.
• Abafazi abangenayo imbali yomhlaza wamabele abaneminyaka engama-60 nangaphezulu, abanembali ye-ductal carcinoma abakhe batyandwa i-mastectomy, okanye abanomngcipheko ophezulu womhlaza wamabele ngokusekelwe kwisixhobo semodeli yeGail (isixhobo esisetyenziselwa ukuqikelela umngcipheko womhlaza wamabele).

Kwabasetyhini abanomngcipheko ophezulu wokuba nomhlaza webele, ukuthatha i-aromatase inhibitors kunciphisa ubungakanani be-estrogen eyenziwa ngumzimba. Ngaphambi kokuya exesheni, i-estrogen yenziwa zii-ovari kunye nezinye izicubu emzimbeni womfazi, kubandakanya ingqondo, izicubu zamafutha, kunye nolusu. Emva kokuya exesheni, ii-ovari ziyeka ukuvelisa i-estrogen, kodwa ezinye izicubu azenzi njalo. I-Aromatase inhibitors iyayithintela intshukumo ye-enzyme ebizwa ngokuba yi-aromatase, esetyenziselwa ukwenza yonke i-estrogen yomzimba. I-Aromatase inactivators iyayithintela i-enzyme ukuba ingasebenzi.

Iingozi ezinokubakho ngokusebenzisa izithinteli ze-aromatase ziquka iintlungu zemisipha kunye namalungu, i-osteoporosis, ubushushu obuphezulu, kunye nokudinwa kakhulu.

3. Ukususwa kwebele okuncitshisa umngcipheko

Abanye abafazi abasengozini enkulu yokuba nomhlaza webele banokukhetha ukususwa kwamabele omabini xa kungekho zimpawu zomhlaza. Umngcipheko womhlaza webele uphantsi kakhulu kwaba bafazi kwaye uninzi lwabo aluziva luxhalabile kangako ngomngcipheko wabo wokuba nomhlaza webele. Nangona kunjalo, kubaluleke kakhulu ukuba novavanyo lomngcipheko womhlaza kunye neengcebiso malunga neendlela ezahlukeneyo zokuthintela umhlaza webele ngaphambi kokuba wenze esi sigqibo.

4. Ukususwa kwesibeleko

Ii-ovari zenza uninzi lwe-estrogen eyenziwa ngumzimba. Unyango oluyekisa okanye olunciphisa ubungakanani be-estrogen eyenziwa zii-ovari lubandakanya utyando lokususa ii-ovari, unyango lwe-radiation, okanye ukuthatha amayeza athile. Oku kubizwa ngokuba yi-ovarian ablation.

Abafazi abangaphambi kokuya exesheni abasengozini enkulu yokuba nomhlaza webele ngenxa yotshintsho oluthile kwi-BRCA1 kunye ne-BRCA2 genes banokukhetha ukwenza i-oophorectomy enciphisa umngcipheko (ukususwa kwama-ovari omabini xa kungekho zimpawu zomhlaza). Oku kunciphisa ubungakanani be-estrogen eyenziwa ngumzimba kwaye kunciphisa umngcipheko womhlaza webele. I-oophorectomy enciphisa umngcipheko ikwanciphisa umngcipheko womhlaza webele kubafazi abaqhelekileyo abangaphambi kokuya exesheni nakubafazi abanomngcipheko ophezulu womhlaza webele ngenxa yemitha ephuma esifubeni. Nangona kunjalo, kubaluleke kakhulu ukuba novavanyo lomngcipheko womhlaza kunye neengcebiso ngaphambi kokuba wenze esi sigqibo. Ukwehla ngequbuliso kwamanqanaba e-estrogen kunokubangela ukuba iimpawu zokuya exesheni ziqale. Oku kubandakanya ubushushu, ubunzima bokulala, ixhala, kunye nokudakumba. Iziphumo zexesha elide ziquka ukuncipha kwenkanuko yesini, ukoma kwesitho sangasese sowesifazane, kunye nokuncipha koxinano lwamathambo.

5. Ukuzilolonga ngokwaneleyo

Abafazi abenza umthambo iiyure ezine nangaphezulu ngeveki banomngcipheko omncinci wokuba nomhlaza webele. Impembelelo yokuzilolonga kwingozi yomhlaza webele inokuba nkulu kubafazi abangaphambi kokuya exesheni abanobunzima obuqhelekileyo okanye obuphantsi bomzimba.

Akucaci nokuba ezi zinto zilandelayo ziyayichaphazela na ingozi yomhlaza webele:

1. Izithinteli zokukhulelwa zehomoni

Izithinteli zokukhulelwa ezisebenzisa iihomoni ziqulathe i-estrogen okanye i-estrogen kunye ne-progestin. Ezinye izifundo zibonise ukuba abafazi abasebenzisa izithinteli zokukhulelwa ezisebenzisa iihomoni ngoku okanye abasandula ukuzisebenzisa banokuba nomngcipheko wokwanda komhlaza webele. Ezinye izifundo azibonisanga umngcipheko wokwanda komhlaza webele kubafazi abasebenzisa izithinteli zokukhulelwa ezisebenzisa iihomoni.

Kolunye uphando, umngcipheko womhlaza webele wanda kancinci xa umfazi ethatha ixesha elide esebenzisa izithinteli zokukhulelwa ezisebenzisa iihomoni. Olunye uphando lubonise ukuba ukunyuka okuncinci komngcipheko womhlaza webele kwehla ngokuhamba kwexesha xa abafazi beyeka ukusebenzisa izithinteli zokukhulelwa ezisebenzisa iihomoni.

Kufuneka uphando olongezelelekileyo ukuze kwaziwe ukuba ngaba izithintelo zokukhulelwa ezisebenzisa iihomoni ziyayichaphazela na ingozi yokuba nomhlaza wamabele kumfazi.

2. Okusingqongileyo

Izifundo azikabonisi ukuba ukuvezwa kwizinto ezithile ezikwindalo esingqongileyo, ezifana neekhemikhali, kwandisa umngcipheko womhlaza webele.

Izifundo zibonise ukuba ezinye izinto azinampembelelo ingako okanye azinampembelelo kwaphela kwingozi yomhlaza wamabele.

Ezi zilandelayo azinampembelelo ingako okanye azinampembelelo kwaphela kumngcipheko womhlaza webele:

• Ukukhupha isisu.
• Ukwenza utshintsho kwindlela otya ngayo njengokutya amafutha amancinci okanye iziqhamo nemifuno emininzi.
• Ukuthatha iivithamini, kuquka i-fenretinide (uhlobo lwe-vitamin A).
• Ukutshaya icuba, kokubini okusebenzayo nokungasebenzisiyo (ukuphefumla umsi osetyenziswa ngomnye umntu).
• Ukusebenzisa i-deodorant engaphantsi kwekhwapha okanye i-antiperspirant.
• Ukuthatha ii-statins (amayeza okwehlisa i-cholesterol).
• Ukuthatha ii-bisphosphonates (amayeza asetyenziselwa ukunyanga i-osteoporosis kunye ne-hypercalcemia) ngomlomo okanye ngokufaka i-intravenous infusion.
• Utshintsho kwisigqi sakho se-circadian (utshintsho lomzimba, lwengqondo, nolwendlela yokuziphatha oluchaphazeleka kakhulu bubumnyama nokukhanya kwimijikelo yeeyure ezingama-24), olunokuchaphazeleka kukusebenza ebusuku okanye ubungakanani bokukhanya kwigumbi lakho lokulala ebusuku.

Umthombo:http://www.chinancpcn.org.cn/cancerMedicineClassic/guideDetail?sId=CDR257994&type=1