Ukuvimbela Umdlavuza Webele

Ulwazi Olujwayelekile Ngomdlavuza Webele

Umdlavuza webele yisifo lapho amaseli ayingozi (umdlavuza) akheka khona ezicutshini zebele.

Isifuba sakhiwe ama-lobes namapayipi.Ibele ngalinye linezingxenye ezingu-15 kuya kwezingu-20 ezibizwa ngokuthi ama-lobes, ezinezingxenye eziningi ezincane ezibizwa ngokuthi ama-lobules.Ama-lobules agcina ngama-bulbs amancane angenza ubisi.Ama-lobes, ama-lobules, nama-bulb axhunywe ngamashubhu amancane abizwa ngokuthi ama-ducts.

Ibele ngalinye linemithambo yegazi kanye nemithambo ye-lymph.Imithambo ye-lymph ithwala uketshezi olungenambala, olunamanzi olubizwa ngokuthi i-lymph.Imikhumbi ye-lymph ithwala i-lymph phakathi kwama-lymph nodes.Ama-lymph nodes amancane, amise okwebhontshisi izakhiwo ezihlunga i-lymph futhi zigcine amangqamuzana egazi amhlophe asiza ukulwa nezifo kanye nezifo.Amaqembu ama-lymph nodes atholakala eduze kwebele ku-axilla (ngaphansi kwengalo), ngaphezu kwe-collarbone, nasesifubeni.

Umdlavuza webele uwuhlobo lwesibili oluvame kakhulu lomdlavuza kwabesifazane baseMelika.

Abesifazane e-United States bathola umdlavuza wamabele ngaphezu kwanoma yiluphi olunye uhlobo lomdlavuza ngaphandle komdlavuza wesikhumba.Umdlavuza webele ungowesibili kumdlavuza wamaphaphu njengembangela yokufa komdlavuza kwabesifazane baseMelika.Kodwa-ke, ukubulawa komdlavuza webele kwehle kancane kancane njalo ngonyaka phakathi kuka-2007 no-2016. Umdlavuza webele uyenzeka futhi emadodeni, kodwa inani labantu abasha lincane.

Ukuvimbela Umdlavuza Webele

Ukugwema izici eziyingozi nokwandisa izici zokuzivikela kungasiza ekuvimbeleni umdlavuza.

Ukugwema izici eziyingozi zomdlavuza kungasiza ekuvimbeleni umdlavuza othile.Izinto eziyingozi zihlanganisa ukubhema, ukukhuluphala, nokungawuvivinyi ngokwanele umzimba.Ukwandisa izici zokuzivikela njengokuyeka ukubhema nokuzivocavoca kungase kusize ekuvimbeleni eminye imidlavuza.Khuluma nodokotela wakho noma omunye uchwepheshe wezempilo mayelana nokuthi ungawehlisa kanjani amathuba okuba nomdlavuza.

Okulandelayo yizici eziyingozi zomdlavuza webele:

1. Iminyaka yobudala

Ukuguga kuyisici esiyinhloko esiyingozi kumdlavuza omningi.Amathuba okuthola umdlavuza ayanda njengoba ukhula.

2. Umlando womuntu siqu womdlavuza webele noma isifo sesifuba esiyingozi (esingenawo umdlavuza).

Abesifazane abananoma yikuphi kokulandelayo banamathuba amaningi okuba nomdlavuza webele:

• Umlando womuntu siqu womdlavuza webele ohlaselayo, i-ductal carcinoma in situ (DCIS), noma i-lobular carcinoma in situ (LCIS).
• Umlando womuntu siqu wesifo sesifuba esiyingozi (esingenawo umdlavuza).

3. Ingozi ezuzwe njengefa yomdlavuza webele

Abesifazane abanomlando womndeni onomdlavuza webele esihlotsheni sezinga lokuqala (umama, udadewabo, noma indodakazi) banengozi eyengeziwe yomdlavuza webele.

Abesifazane abazuze izinguquko kuzakhi zofuzo noma kwezinye izakhi zofuzo basengozini enkulu yomdlavuza webele.Ingozi yomdlavuza webele ebangelwa ukushintsha kwezakhi zofuzo kuncike ohlotsheni lokuguqulwa kwezakhi zofuzo, umlando womndeni womdlavuza, nezinye izici.

4. Amabele aminyene

Ukuba nezicubu zamabele eziminyene ku-mammogram kuyisici esisengozini yomdlavuza webele.Izinga lobungozi lincike ekutheni izicubu zesifuba ziminyene kangakanani.Abesifazane abanamabele aminyene kakhulu basengozini enkulu yokuba nomdlavuza webele kunabesifazane abanezinga eliphansi lamabele.

Ukwanda kokuminyana kwamabele ngokuvamile kuyisici esizuzwe njengefa, kodwa kungase kwenzeke nakwabesifazane abangakabi nabantwana, abakhulelwe okokuqala sekwephuzile, abathatha amahomoni angemva kokuya esikhathini, noma abaphuze utshwala.

5. Ukuchayeka kwezicubu zamabele ku-estrogen eyenziwa emzimbeni

I-Estrogen iyi-hormone eyenziwe ngumzimba.Isiza umzimba ukuthuthukisa nokugcina izici zobulili besifazane.Ukuchayeka ku-estrogen isikhathi eside kungase kwandise ingozi yomdlavuza webele.Amazinga e-Estrogen aphezulu phakathi neminyaka lapho owesifazane esesikhathini.

Ukuchayeka kowesifazane ku-estrogen kwanda ngalezi zindlela ezilandelayo:

• Ukuya esikhathini ngaphambi kwesikhathi: Ukuqala ukuya esikhathini lapho uneminyaka engu-11 noma ngaphansi kwandisa inani leminyaka lapho izicubu zebele zivezwe ku-estrogen.
• Kusukela eminyakeni yakamuva: Lapho owesifazane eya esikhathini, iminyaka eminingi izicubu zakhe zebele zichayeka ku-estrogen.
• Iminyaka yobudala ekuzalweni kokuqala noma engakaze ibelwe: Ngenxa yokuthi amazinga e-estrogen aphansi ngesikhathi sokukhulelwa, izicubu zamabele zichayeka ku-estrogen eyengeziwe kwabesifazane abakhulelwa okokuqala ngemva kweminyaka engu-35 noma abangakaze bakhulelwe.

6. Ukuthatha i-hormone therapy ngezimpawu zokunqamuka kokuya esikhathini

Amahomoni, njenge-estrogen ne-progesterone, angenziwa abe uhlobo lwephilisi elabhorethri.I-Estrogen, i-progestin, noma kokubili kungase kunikezwe ukuze kuthathelwe indawo i-estrogen engasenziwa amaqanda kwabesifazane abangemva kokuya esikhathini noma abesifazane abakhishwe izindlala ezikhiqiza amaqanda.Lokhu kubizwa ngokuthi i-hormone replacement therapy (HRT) noma i-hormone therapy (HT).Inhlanganisela HRT/HT iyi-estrogen ehlanganiswe ne-progestin.Lolu hlobo lwe-HRT/HT lwandisa ingozi yomdlavuza webele.Ucwaningo lubonisa ukuthi lapho abesifazane beyeka ukuthatha i-estrogen ehlanganiswe ne-progestin, ingozi yomdlavuza webele iyancipha.

7. Ukwelashwa ngemisebe ebeleni noma esifubeni

Ukwelashwa ngemisebe esifubeni ukuze kwelashwe umdlavuza kwandisa ingozi yomdlavuza webele, kusukela eminyakeni eyi-10 ngemva kokwelashwa.Ingozi yomdlavuza webele incike kumthamo wemisebe kanye neminyaka onikezwa ngayo.Ingozi inkulu kakhulu uma ukwelashwa ngemisebe kwasetshenziswa ngesikhathi sokuthomba, lapho amabele akha.

Ukwelashwa ngemisebe yokwelapha umdlavuza kwelinye ibele akubonakali kwandisa ingozi yomdlavuza kwelinye ibele.

Kwabesifazane abathole izinguquko kuzakhi zofuzo ze-BRCA1 kanye ne-BRCA2, ukuchayeka emisebeni, njengalokho okuvela kuma-x-ray esifuba, kungase kukhulise ingozi yomdlavuza webele, ikakhulukazi kwabesifazane abakhishwa i-x-ray ngaphambi kweminyaka engu-20 ubudala.

8. Ukukhuluphala ngokweqile

Ukukhuluphala ngokweqile kwandisa ingozi yomdlavuza webele, ikakhulukazi kwabesifazane abadlule kokuya esikhathini abangasebenzisanga ukwelashwa kokubuyisela ama-hormone.

9. Ukuphuza utshwala

Ukuphuza utshwala kwandisa ingozi yomdlavuza webele.Izinga lengozi liyakhuphuka njengoba inani lotshwala eliphuzwayo likhuphuka.

Okulandelayo yizici ezivikela umdlavuza webele:

1. Ukuchayeka kancane kwezicubu zamabele ku-estrogen eyenziwa umzimba

Ukunciphisa ubude besikhathi izicubu zebele zowesifazane zichayeke ku-estrogen kungase kusize ekuvimbeleni umdlavuza wamabele.Ukuchayeka ku-estrogen kuncishiswa ngalezi zindlela ezilandelayo:

• Ukukhulelwa kwangaphambi kwesikhathi: Amazinga e-Estrogen aphansi ngesikhathi sokukhulelwa.Abesifazane abakhulelwe isikhathi esigcwele ngaphambi kweminyaka engama-20 basengozini ephansi yokuba nomdlavuza webele kunabesifazane abangakabi nabantwana noma abathola ingane yabo yokuqala ngemva kweminyaka engu-35.
• Ukuncelisa: Amazinga e-Estrogen angase ahlale ephansi ngenkathi owesifazane encela ibele.Abesifazane abancelisayo banamathuba amancane okuba nomdlavuza webele kunabesifazane abake bathola izingane kodwa abangazincelisanga.

2. Ukuthatha ukwelashwa kwe-hormone ye-estrogen kuphela ngemva kokuhlinzwa, ama-modulators e-estrogen receptor akhethiwe, noma ama-aromatase inhibitors nama-inactivators

Ukwelashwa kwe-Estrogen-kuphela kwe-hormone ngemva kwe-hysterectomy

Ukwelashwa ngama-hormone nge-estrogen kungase kunikezwe kuphela abesifazane abaye bahlinzwa.Kulaba besifazane, ukwelashwa nge-estrogen kuphela ngemva kokunqamuka kokuya esikhathini kungase kunciphise ingozi yomdlavuza webele.Kukhona ingozi eyengeziwe yokushaywa unhlangothi kanye nesifo senhliziyo nesemithambo yegazi kwabesifazane abangemva kokuya esikhathini abathatha i-estrogen ngemva kokukhishwa kwesibeletho.

Amamojula we-estrogen receptor akhethiwe

I-Tamoxifen ne-raloxifene ziyingxenye yomndeni wezidakamizwa ezibizwa ngokuthi i-selective estrogen receptor modulators (SERMs).Ama-SERM enza njenge-estrogen kwezinye izicubu zomzimba, kodwa avimbe umphumela we-estrogen kwezinye izicubu.

Ukwelashwa nge-tamoxifen kwehlisa ubungozi bomdlavuza webele we-estrogen receptor-positive (ER-positive) kanye ne-ductal carcinoma in situ kwabesifazane abangaphambi kokumenopausal nabangemva kokuya esikhathini abasengozini enkulu.Ukwelashwa nge-raloxifene kwehlisa futhi ingozi yomdlavuza webele kwabesifazane abangemva kokuya esikhathini.Nganoma yimuphi umuthi, ingozi encishisiwe ihlala iminyaka eminingana noma ngaphezulu ngemva kokuyekiswa kokwelashwa.Amazinga aphansi amathambo aphukile aphawulwe ezigulini ezithatha i-raloxifene.

Ukuthatha i-tamoxifen kwandisa ingozi yokushisa okushisayo, umdlavuza we-endometrial, unhlangothi, ama-cataract, namahlule egazi (ikakhulukazi emaphashini nasemilenzeni).Ingozi yokuba nalezi zinkinga ikhula ngokuphawulekayo kwabesifazane abadala kuneminyaka engama-50 uma kuqhathaniswa nabesifazane abasebasha.Abesifazane abaneminyaka engaphansi kwengama-50 abasengozini enkulu yokuba nomdlavuza webele bangazuza kakhulu ngokuthatha i-tamoxifen.Ingozi yokuba nalezi zinkinga iyancipha ngemva kokumiswa kwe-tamoxifen.Khuluma nodokotela wakho mayelana nezingozi nezinzuzo zokuthatha lesi sidakamizwa.

Ukuthatha i-raloxifene kwandisa ingozi yamahlule egazi emaphashini nasemilenzeni, kodwa akubonakali kwandisa ingozi yomdlavuza we-endometrial.Kwabesifazane be-postmenopausal abane-osteoporosis (ukuncipha kwamathambo), i-raloxifene yehlisa ingozi yomdlavuza webele kwabesifazane abasengozini enkulu noma ephansi yomdlavuza webele.Akwaziwa ukuthi i-raloxifene ingaba nomphumela ofanayo yini kwabesifazane abangenawo i-osteoporosis.Khuluma nodokotela wakho mayelana nezingozi nezinzuzo zokuthatha lesi sidakamizwa.

Amanye ama-SERM ayafundwa ezivivinyweni zomtholampilo.

I-Aromatase inhibitors kanye nama-inactivators

I-Aromatase inhibitors (i-anastrozole, i-letrozole) nama-inactivator (i-exemestane) anciphisa ingozi yokuphinda futhi yomdlavuza wamabele omusha kwabesifazane abanomlando womdlavuza webele.I-Aromatase inhibitors iphinde inciphise ingozi yomdlavuza webele kwabesifazane abanezimo ezilandelayo:

• Abesifazane bePostmenopausal abanomlando womuntu siqu womdlavuza webele.
• Abesifazane abangenawo umlando womuntu siqu womdlavuza webele abaneminyaka engu-60 nangaphezulu, banomlando we-ductal carcinoma in situ nge-mastectomy, noma abasengozini enkulu yokuba nomdlavuza webele ngokusekelwe kumodeli yethuluzi le-Gail (ithuluzi elisetshenziselwa ukulinganisa ingozi yebele umdlavuza).

Kwabesifazane abasengozini enkulu yomdlavuza webele, ukuthatha ama-aromatase inhibitors kunciphisa inani le-estrogen elenziwa ngumzimba.Ngaphambi kokunqamuka kokuya esikhathini, i-estrogen yenziwa ama-ovaries nezinye izicubu zomzimba wowesifazane, kuhlanganise nobuchopho, izicubu ezinamafutha, nesikhumba.Ngemva kokunqamuka kokuya esikhathini, ama-ovari ayayeka ukwenza i-estrogen, kodwa ezinye izicubu azikwenzi.I-Aromatase inhibitors ivimba ukusebenza kwe-enzyme ebizwa ngokuthi i-aromatase, esetshenziselwa ukwenza yonke i-estrogen yomzimba.Ama-inactivators e-Aromatase avimba i-enzyme ekusebenzeni.

Izingozi ezingaba khona ngokuthatha ama-aromatase inhibitors zihlanganisa ubuhlungu bemisipha namalunga, i-osteoporosis, ukushisa okushisa, nokuzizwa ukhathele kakhulu.

3. I-mastectomy enciphisa ubungozi

Abanye besifazane abasengozini enkulu yomdlavuza webele bangase bakhethe ukwenza i-mastectomy enciphisa ubungozi (ukususwa kwawo womabili amabele lapho zingekho izimpawu zomdlavuza).Amathuba okuthola umdlavuza webele aphansi kakhulu kulaba besifazane futhi iningi lizizwa lingakhathazeki kakhulu ngengozi yabo yomdlavuza webele.Kodwa-ke, kubaluleke kakhulu ukuba nokuhlolwa kwengozi yomdlavuza kanye nokwelulekwa mayelana nezindlela ezahlukene zokuvimbela umdlavuza webele ngaphambi kokuthatha lesi sinqumo.

4. Ukukhishwa kwesibeletho

Amaqanda enza ingxenye enkulu ye-estrogen eyenziwa umzimba.Ukwelashwa okumisa noma okwehliswe inani le-estrogen okwenziwa ama-ovari kuhlanganisa ukuhlinzwa ukuze kukhishwe ama-ovari, ukwelapha ngemisebe, noma ukuthatha imithi ethile.Lokhu kubizwa nge-ovarian ablation.

Abesifazane abangaphambi kokuya esikhathini abasengozini enkulu yokuba nomdlavuza webele ngenxa yezinguquko ezithile kuzakhi zofuzo ze-BRCA1 ne-BRCA2 bangakhetha ukuba ne-oophorectomy enciphisa ubungozi (ukususwa kwawo womabili ama-ovari lapho zingekho izimpawu zomdlavuza).Lokhu kunciphisa inani le-estrogen eyenziwa umzimba futhi kwehlisa ingozi yomdlavuza webele.I-oophorectomy enciphisa ingozi iphinde yehlise ingozi yomdlavuza wamabele kwabesifazane abavamile abangaphambi kokuya esikhathini kanye nakwabesifazane abasengcupheni eyengeziwe yokuba nomdlavuza wamabele ngenxa yokukhishwa kwemisebe esifubeni.Kodwa-ke, kubaluleke kakhulu ukuba nokuhlolwa kwengozi yomdlavuza kanye nokwelulekwa ngaphambi kokwenza lesi sinqumo.Ukwehla kungazelelwe kwamazinga e-estrogen kungase kubangele ukuba kuqale izimpawu zokunqamuka kokuya esikhathini.Lokhu kuhlanganisa ukushisa, ukungakwazi ukulala, ukukhathazeka nokucindezeleka.Imiphumela yesikhathi eside ihlanganisa ukuncipha komdlandla wocansi, ukoma kwesitho sangasese sowesifazane, nokuncipha kokuminyana kwamathambo.

5. Ukuzivocavoca ngokwanele

Abesifazane abavivinya umzimba amahora amane noma ngaphezulu ngesonto banamathuba amancane okuba nomdlavuza webele.Umthelela wokuzivocavoca engcupheni yomdlavuza webele ungase ube mkhulu kwabesifazane abangaphambi kokuya esikhathini abanesisindo somzimba esivamile noma esiphansi.

Akukacaci ukuthi okulandelayo kuyayithinta yini ingozi yomdlavuza webele:

1. Izivimbela-nzalo zeHormonal

Imithi yokuvimbela inzalo yama-hormone iqukethe i-estrogen noma i-estrogen ne-progestin.Olunye ucwaningo lubonise ukuthi abesifazane abangabasebenzisi bamanje noma bakamuva bezivimbe-nzalo ezingamahomoni bangase babe nokwenyuka okuncane engozini yomdlavuza webele.Olunye ucwaningo aluzange lubonise ingozi eyengeziwe yomdlavuza webele kwabesifazane abasebenzisa izivimbela-nzalo ezingamahomoni.

Kolunye ucwaningo, ingozi yomdlavuza webele yanda kancane ngesikhathi owesifazane esebenzisa izivimbe-nzalo ezingamahomoni.Olunye ucwaningo lwabonisa ukuthi ukwanda kancane kwengozi yomdlavuza webele yehla ngokuhamba kwesikhathi lapho abesifazane beyeka ukusebenzisa izinto zokuvimbela inzalo ezingamahomoni.

Kudingeka ucwaningo olwengeziwe ukuze kwaziwe ukuthi izivimbe-nzalo ezingamahomoni ziyayithinta yini ingozi yomdlavuza webele wowesifazane.

2. Imvelo

Ucwaningo aluzange lufakazele ukuthi ukuchayeka ezintweni ezithile endaweni ezungezile, njengamakhemikhali, kwandisa ingozi yomdlavuza webele.

Ucwaningo luye lwabonisa ukuthi ezinye izici zinethonya elincane noma alinawo nhlobo engozini yomdlavuza webele.

Okulandelayo kunomthelela omncane noma akukho nhlobo engcupheni yomdlavuza webele:

• Ukukhipha isisu.
• Ukwenza izinguquko zokudla njengokudla amafutha amancane noma izithelo nemifino eminingi.
• Ukuthatha amavithamini, kuhlanganise ne-fenretinide (uhlobo lwevithamini A).
• Ukubhema ugwayi, kokubili okusebenzayo nokungenzi lutho (ukuhogela intuthu kagwayi).
• Kusetshenziswa isiqedaphunga esingaphansi kwekhwapha noma isinqamuleli sokuphefumula.
• Ukuthatha ama-statins (izidakamizwa ezinciphisa i-cholesterol).
• Ukuthatha ama-bisphosphonates (izidakamizwa ezisetshenziselwa ukwelapha i-osteoporosis kanye ne-hypercalcemia) ngomlomo noma ngokufaka i-intravenous.
• Izinguquko kusigqi sakho sokujikeleza (izinguquko zomzimba, zengqondo, nezokuziphatha ezithintwa kakhulu ubumnyama nokukhanya emijikelezweni yamahora angu-24), ezingase zithonywe amashifu okusebenza ebusuku noma inani lokukhanya ekamelweni lakho ebusuku.

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