Ukuvimbela Umdlavuza Webele

Ulwazi Olujwayelekile Mayelana Nomdlavuza Webele

Umdlavuza webele yisifo lapho amangqamuzana abulalayo (umdlavuza) akheka khona ezicutshini zebele.

Isifuba sakhiwe ngama-lobes nama-ducts. Isifuba ngasinye sinezingxenye ezingu-15 kuya kwezingu-20 ezibizwa ngokuthi ama-lobes, anezingxenye eziningi ezincane ezibizwa ngokuthi ama-lobules. Ama-lobules aphela ngama-bulbs amaningi amancane angenza ubisi. Ama-lobes, ama-lobules, nama-bulbs axhunywe ngamapayipi amancane abizwa ngokuthi ama-ducts.

Ibele ngalinye linemithambo yegazi kanye nemithambo ye-lymph. Imithambo ye-lymph ithwala uketshezi olumanzi olucishe lungabi nombala olubizwa ngokuthi i-lymph. Imithambo ye-lymph ithwala i-lymph phakathi kwama-lymph node. Ama-lymph node ayizakhiwo ezincane, ezimise okwebhontshisi ezihlunga i-lymph futhi zigcine amangqamuzana amhlophe egazi asiza ekulweni nokutheleleka kanye nezifo. Amaqembu ama-lymph node atholakala eduze kwebele e-axilla (ngaphansi kwengalo), ngaphezu kwe-collarbone, kanye nasesifubeni.

Umdlavuza webele uhlobo lwesibili oluvame kakhulu lomdlavuza kwabesifazane baseMelika.

Abesifazane e-United States bathola umdlavuza webele kakhulu kunanoma yiluphi olunye uhlobo lomdlavuza ngaphandle komdlavuza wesikhumba. Umdlavuza webele ungowesibili ngemva komdlavuza wamaphaphu njengembangela yokufa komdlavuza kwabesifazane baseMelika. Kodwa-ke, ukufa okubangelwa umdlavuza webele kuye kwehla kancane minyaka yonke phakathi kuka-2007 no-2016. Umdlavuza webele uyenzeka nakwabesilisa, kodwa inani lamacala amasha lincane.

Ukuvimbela Umdlavuza Webele

Ukugwema izici eziyingozi nokwandisa izici zokuzivikela kungasiza ekuvimbeleni umdlavuza.

Ukugwema izici eziyingozi zomdlavuza kungasiza ekuvimbeleni umdlavuza othile. Izici eziyingozi zifaka phakathi ukubhema, ukukhuluphala ngokweqile, nokungawuvivinyi umzimba ngokwanele. Ukwandisa izici zokuzivikela njengokuyeka ukubhema nokuzivocavoca kungasiza nasekuvimbeleni ezinye izinhlobo zomdlavuza. Khuluma nodokotela wakho noma omunye uchwepheshe wezempilo mayelana nendlela ongayinciphisa ngayo ingozi yakho yomdlavuza.

Okulandelayo yizinto ezibangela umdlavuza webele:

1. Ukuguga

Ukuguga kuyisici esiyinhloko esibangela umdlavuza omningi. Amathuba okuthola umdlavuza ayanda njengoba ukhula.

2. Umlando womuntu siqu womdlavuza webele noma isifo sebele esingenabungozi (esingesona umdlavuza)

Abesifazane abananoma yikuphi kwalokhu okulandelayo basengozini enkulu yokuthola umdlavuza 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 esingenabungozi (esingesona umdlavuza).

3. Ingozi yomdlavuza webele ezuzwe njengefa

Abesifazane abanomlando womndeni womdlavuza webele esihlotsheni sokuqala (umama, udadewabo, noma indodakazi) banengozi enkulu yokuba nomdlavuza webele.

Abesifazane abazuze izinguquko ezizakhini zofuzo noma kwezinye izakhi zofuzo basengozini enkulu yokuba nomdlavuza webele. Ingozi yomdlavuza webele ebangelwa izinguquko ezizakhi zofuzo ezizuzwe njengefa incike ohlotsheni lokuguquka kwezakhi zofuzo, umlando womndeni womdlavuza, nezinye izici.

4. Amabele aminyene

Ukuba nezicubu zebele eziqinile ku-mammogram kuyisici esibangela ingozi yomdlavuza webele. Izinga lengozi lincike ekutheni izicubu zebele ziqine kangakanani. Abesifazane abanamabele aqinile kakhulu basengozini enkulu yokuba nomdlavuza webele kunabesifazane abanamabele aqinile.

Ukwanda kokuqina kwamabele kuvame ukuba yisici esizuzwe njengefa, kodwa kungenzeka nakwabesifazane abangazange babe nabantwana, abakhulelwe okokuqala besebancane, abathatha ama-hormone asebekhulile, noma abaphuza utshwala.

5. Ukuchayeka kwezicubu zebele ku-estrogen eyenziwe emzimbeni

I-estrogen iyi-hormone ekhiqizwa ngumzimba. Isiza umzimba ukuthi uthuthukise futhi ulondoloze izici zobulili zabesifazane. Ukuchayeka ku-estrogen isikhathi eside kungandisa ingozi yomdlavuza webele. Amazinga e-estrogen aphezulu kakhulu phakathi neminyaka owesifazane esesikhathini.

Ukuchayeka kowesifazane ku-estrogen kwandiswa ngezindlela ezilandelayo:

• Ukuya esikhathini ekuqaleni: Ukuqala ukuya esikhathini uneminyaka engu-11 noma ngaphansi kwandisa inani leminyaka izicubu zebele ezithola ngayo i-estrogen.
• Ukuqala ebudaleni obusha: Uma owesifazane eya esikhathini iminyaka eminingi, kulapho izicubu zebele lakhe zivezwa khona isikhathi eside ku-estrogen.
• Ukuguga ekuzalweni kokuqala noma ukungazali: Ngenxa yokuthi amazinga e-estrogen aphansi ngesikhathi sokukhulelwa, izicubu zebele zivezwa ku-estrogen eningi kwabesifazane abakhulelwa okokuqala ngemva kweminyaka engu-35 noma abangakaze bakhulelwe.

6. Ukuthatha ukwelashwa ngama-hormone ngezimpawu zokunqamuka kokuya esikhathini

Ama-hormone, njenge-estrogen ne-progesterone, angenziwa abe ifomu lephilisi elabhorethri. I-estrogen, i-progestin, noma kokubili kunganikezwa ukuze kuthathelwe indawo i-estrogen engasakhiwanga ama-ovari kwabesifazane asebekhulile noma kwabesifazane asebesusiwe ama-ovari abo. Lokhu kubizwa ngokuthi ukwelashwa kokushintsha ama-hormone (HRT) noma ukwelashwa kwama-hormone (HT). Inhlanganisela ye-HRT/HT iyi-estrogen ehlanganiswe ne-progestin. Lolu hlobo lwe-HRT/HT lwandisa ingozi yomdlavuza webele. Izifundo zibonisa 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, kuqala eminyakeni eyi-10 ngemva kokwelashwa. Ingozi yomdlavuza webele incike kumthamo wemisebe kanye nobudala obunikezwayo. Ingozi inkulu kakhulu uma ukwelashwa ngemisebe kusetshenziswa ngesikhathi sokuthomba, lapho amabele eqala ukwakheka.

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

Kwabesifazane abazuze izinguquko ezizakhini zofuzo ze-BRCA1 kanye ne-BRCA2, ukuchayeka emisebeni, njengaleyo evela kuma-x-ray esifuba, kungandisa kakhulu ingozi yomdlavuza webele, ikakhulukazi kwabesifazane abahlolwe ama-x-ray ngaphambi kweminyaka engama-20 ubudala.

8. Ukukhuluphala ngokweqile

Ukukhuluphala ngokweqile kwandisa ingozi yomdlavuza webele, ikakhulukazi kwabesifazane asebekhulile abangazange basebenzise ukwelashwa kokushintsha ama-hormone.

9. Ukuphuza utshwala

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

Okulandelayo yizici zokuvikela umdlavuza webele:

1. Ukuchayeka okuncane kwezicubu zebele ku-estrogen eyenziwa ngumzimba

Ukunciphisa isikhathi izicubu zebele zowesifazane ezithola i-estrogen kungasiza ekuvimbeleni umdlavuza webele. Ukuchayeka ku-estrogen kunciphisa ngezindlela ezilandelayo:

• Ukukhulelwa kusenesikhathi: Amazinga e-estrogen aphansi ngesikhathi sokukhulelwa. Abesifazane abakhulelwe isikhathi esigcwele ngaphambi kweminyaka engama-20 basengozini encane yokuthola umdlavuza webele kunabesifazane abangazange babe nezingane noma abazala ingane yabo yokuqala ngemva kweminyaka engama-35.
• Ukuncelisa: Amazinga e-estrogen angase ahlale ephansi ngesikhathi owesifazane encelisa. Abesifazane abancelisa ibele basengozini encane yokuthola umdlavuza webele kunabesifazane abaye baba nezingane kodwa abangazange bancelise.

2. Ukuthatha ukwelashwa kwama-hormone e-estrogen kuphela ngemva kokususwa kwesibeletho, ama-selective estrogen receptor modulator, noma ama-aromatase inhibitors kanye nama-inactivator

Ukwelashwa ngama-hormone e-estrogen kuphela ngemva kokususwa kwesisu

Ukwelashwa ngama-hormone nge-estrogen kuphela kunganikezwa abesifazane abake bakhishwa i-hysterectomy. Kulaba besifazane, ukwelashwa nge-estrogen kuphela ngemva kokunqamuka kokuya esikhathini kunganciphisa ingozi yomdlavuza webele. Kukhona ingozi eyengeziwe yokushaywa yisifo sohlangothi kanye nesifo senhliziyo nemithambo yegazi kwabesifazane asebekhulile abathatha i-estrogen ngemva kokususwa i-hysterectomy.

Ama-modulator e-estrogen receptor akhethiwe

I-Tamoxifen ne-raloxifene ziyingxenye yomndeni wemithi ebizwa ngokuthi ama-selective estrogen receptor modulators (ama-SERM). Ama-SERM asebenza njenge-estrogen kwezinye izicubu zomzimba, kodwa avimba umphumela we-estrogen kwezinye izicubu.

Ukwelashwa nge-tamoxifen kunciphisa ingozi yomdlavuza webele one-estrogen receptor (ER-positive) kanye ne-ductal carcinoma in situ kwabesifazane abangakayi ukuya esikhathini kanye nabesifazane asebekhulile abasengozini enkulu. Ukwelashwa nge-raloxifene kunciphisa nengozi yomdlavuza webele kwabesifazane asebekhulile. Nganoma yimuphi umuthi, ingozi encishisiwe ihlala iminyaka eminingana noma ngaphezulu ngemva kokumiswa kokwelashwa. Amanani aphansi amathambo aphukile aphawulwe ezigulini ezithatha i-raloxifene.

Ukuthatha i-tamoxifen kwandisa ingozi yokushisa, umdlavuza we-endometrial, isifo sohlangothi, ama-cataract, kanye nama-blood clots (ikakhulukazi emaphashini nasemilenzeni). Ingozi yokuba nalezi zinkinga iyanda kakhulu kwabesifazane abaneminyaka engaphezu kwengu-50 uma kuqhathaniswa nabesifazane abasebasha. Abesifazane abaneminyaka engaphansi kwengu-50 abasengozini enkulu yomdlavuza webele bangazuza kakhulu ngokuthatha i-tamoxifen. Ingozi yokuba nalezi zinkinga iyancipha ngemva kokuyeka i-tamoxifen. Khuluma nodokotela wakho ngezingozi nezinzuzo zokuthatha lo muthi.

Ukuthatha i-raloxifene kwandisa ingozi yokuqhekeka kwegazi emaphashini nasemilenzeni, kodwa kubonakala sengathi akwandisi ingozi yomdlavuza we-endometrial. Kwabesifazane asebekhulile abane-osteoporosis (ukwehla kobuningi bamathambo), i-raloxifene yehlisa ingozi yomdlavuza webele kwabesifazane abanengozi ephezulu noma ephansi yomdlavuza webele. Akwaziwa ukuthi i-raloxifene ingaba nomphumela ofanayo yini kwabesifazane abangenayo i-osteoporosis. Khuluma nodokotela wakho ngezingozi nezinzuzo zokuthatha lo muthi.

Amanye ama-SERM ayafundwa ezivivinyweni zemitholampilo.

Ama-inhibitors e-Aromatase kanye nama-inactivators

Ama-Aromatase inhibitors (i-anastrozole, i-letrozole) kanye nama-inactivators (i-exemestane) anciphisa ingozi yokuphinda avele kanye nomdlavuza omusha webele kwabesifazane abanomlando womdlavuza webele. Ama-Aromatase inhibitors nawo anciphisa ingozi yomdlavuza webele kwabesifazane abanezimo ezilandelayo:

• Abesifazane asebedlulile esikhathini sokuya esikhathini abanomlando womdlavuza webele.
• Abesifazane abangenawo umlando womdlavuza webele abaneminyaka engu-60 nangaphezulu, abanomlando we-ductal carcinoma in situ lapho behlinzwa i-mastectomy, noma abanengozi ephezulu yomdlavuza webele ngokusekelwe kuthuluzi lemodeli ye-Gail (ithuluzi elisetshenziselwa ukulinganisa ingozi yomdlavuza webele).

Kwabesifazane abasengozini enkulu yokuba nomdlavuza webele, ukuthatha ama-aromatase inhibitors kunciphisa inani le-estrogen elenziwa ngumzimba. Ngaphambi kokunqamuka kokuya esikhathini, i-estrogen yenziwa ama-ovari nezinye izicubu emzimbeni wowesifazane, okuhlanganisa ubuchopho, izicubu zamafutha, kanye nesikhumba. Ngemva kokunqamuka kokuya esikhathini, ama-ovari ayayeka ukukhiqiza i-estrogen, kodwa ezinye izicubu azenzi. Ama-aromatase inhibitors avimba isenzo se-enzyme ebizwa ngokuthi i-aromatase, esetshenziselwa ukwenza yonke i-estrogen yomzimba. Ama-Aromatase inactivators avimba i-enzyme ukuthi ingasebenzi.

Izingozi ezingaba khona zokusebenzisa izivimbeli ze-aromatase zifaka phakathi ubuhlungu bemisipha namalunga, i-osteoporosis, ukushisa okukhulu, kanye nokuzizwa ukhathele kakhulu.

3. Ukususwa kwebele okunciphisa ubungozi

Abanye besifazane abasengozini enkulu yokuba nomdlavuza webele bangakhetha ukuhlinzwa kwe-mastectomy okunciphisa ubungozi (ukususwa kwamabele womabili uma kungekho zimpawu zomdlavuza). Ingozi yomdlavuza webele iphansi kakhulu kulaba besifazane futhi abaningi bazizwa bengakhathazeki kangako ngengozi yabo yokuba nomdlavuza webele. Kodwa-ke, kubaluleke kakhulu ukuba nokuhlolwa kwengozi yomdlavuza kanye nokwelulekwa ngezindlela ezahlukene zokuvimbela umdlavuza webele ngaphambi kokwenza lesi sinqumo.

4. Ukususwa kwesibeletho

Ama-ovari enza iningi le-estrogen ekhiqizwa ngumzimba. Ukwelashwa okumisa noma okwehlisa inani le-estrogen enziwa ama-ovari kufaka phakathi ukuhlinzwa kokususa ama-ovari, ukwelashwa ngemisebe, noma ukuthatha imithi ethile. Lokhu kubizwa ngokuthi i-ovarian ablation.

Abesifazane abangakayi ukuya esikhathini abasengozini enkulu yokuba nomdlavuza webele ngenxa yezinguquko ezithile ku-BRCA1 kanye ne-BRCA2 gene bangakhetha ukuhlinzwa kwe-oophorectomy okunciphisa ingozi (ukususwa kwama-ovari womabili uma kungekho zimpawu zomdlavuza). Lokhu kunciphisa inani le-estrogen elenziwa ngumzimba futhi kunciphisa ingozi yomdlavuza webele. Ukuhlinzwa kwe-oophorectomy okunciphisa ingozi kunciphisa nengozi yomdlavuza webele kwabesifazane abavamile abangakayi ukuya esikhathini kanye nakwabesifazane abanengozi enkulu yomdlavuza webele ngenxa yokukhishwa kwemisebe esifubeni. Kodwa-ke, kubaluleke kakhulu ukuba nokuhlolwa kwengozi yomdlavuza kanye nokwelulekwa ngaphambi kokwenza lesi sinqumo. Ukwehla okungazelelwe kwamazinga e-estrogen kungabangela izimpawu zokunqamuka kokuya esikhathini. Lokhu kufaka phakathi ukushisa okukhulu, ubunzima bokulala, ukukhathazeka, kanye nokucindezeleka. Imiphumela yesikhathi eside ifaka phakathi ukwehla kwesifiso sobulili, ukoma kwesitho sangasese sowesifazane, kanye nokwehla kobuningi bamathambo.

5. Ukuzivocavoca okwanele

Abesifazane abavivinya umzimba amahora amane noma ngaphezulu ngesonto basengozini encane yokuthola umdlavuza webele. Umphumela wokuzivocavoca engcupheni yomdlavuza webele ungaba mkhulu kakhulu kwabesifazane abangakayi ukuya esikhathini abanesisindo somzimba esijwayelekile noma esiphansi.

Akucaci ukuthi okulandelayo kuyayithinta yini ingozi yomdlavuza webele:

1. Izindlela zokuvimbela inzalo zamahomoni

Izindlela zokuvimbela inzalo zama-hormone ziqukethe i-estrogen noma i-estrogen kanye ne-progestin. Ezinye izifundo zibonise ukuthi abesifazane abasebenzisa izindlela zokuvimbela inzalo zama-hormone njengamanje noma abasanda kusebenzisa bangase babe nokwanda okuncane kwengozi yomdlavuza webele. Ezinye izifundo azibonisanga ingozi eyengeziwe yomdlavuza webele kwabesifazane abasebenzisa izindlela zokuvimbela inzalo zama-hormone.

Kokunye ukuhlola, ingozi yomdlavuza webele yanda kancane uma owesifazane esebenzisa isikhathi eside izindlela zokuvimbela inzalo zama-hormone. Olunye ucwaningo lubonise ukuthi ukwanda okuncane kwengozi yomdlavuza webele kwehla ngokuhamba kwesikhathi lapho abesifazane beyeka ukusebenzisa izindlela zokuvimbela inzalo zama-hormone.

Kudingeka izifundo ezengeziwe ukuze kwaziwe ukuthi izindlela zokuvimbela inzalo zamahomoni ziyayithinta yini ingozi yowesifazane yomdlavuza webele.

2. Indawo ezungezile

Izifundo azikafakazeli ukuthi ukuchayeka ezintweni ezithile endaweni ezungezile, njengamakhemikhali, kwandisa ingozi yomdlavuza webele.

Ucwaningo lubonise ukuthi ezinye izici azinawo umthelela omkhulu noma azinawo nhlobo umthelela engcupheni yomdlavuza webele.

Lokhu okulandelayo kunomthelela omncane noma akunawo nhlobo umthelela engcupheni yomdlavuza webele:

• Ukukhipha isisu.
• Ukwenza izinguquko ekudleni njengokudla amafutha amancane noma izithelo nemifino eminingi.
• Ukuthatha amavithamini, okuhlanganisa i-fenretinide (uhlobo lwe-vitamin A).
• Ukubhema ugwayi, kokubili okusebenzayo kanye nokungenzi lutho (ukuphefumula intuthu yomuntu obhemayo).
• Ukusebenzisa i-deodorant engaphansi kwekhwapha noma i-antiperspirant.
• Ukuthatha ama-statin (imithi yokwehlisa i-cholesterol).
• Ukuthatha ama-bisphosphonates (izidakamizwa ezisetshenziselwa ukwelapha i-osteoporosis kanye ne-hypercalcemia) ngomlomo noma ngokufaka i-intravenous.
• Izinguquko ku-circadian rhythm yakho (izinguquko zomzimba, zengqondo, nezokuziphatha ezithintwa kakhulu ubumnyama nokukhanya emijikelezweni yamahora angama-24), ezingase zithintwe ukusebenza ebusuku noma inani lokukhanya ekamelweni lakho lokulala ebusuku.

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