Umdlavuza Webele Omubi Kathathu

Umdlavuza webele we-Triple-negative (TNBC) uthinta cishe u-15% wazo zonke iziguli ezinomdlavuza webele futhi uletha izinselele eziyingqayizivele ekwelapheni nasekulawuleni. Lesi sihloko esibanzi sihlola izimbangela, izimpawu, kanye nezigaba zomdlavuza webele onenegayo kathathu, kanye nezindlela zokwelashwa zamanje nezindlela zokuvimbela. Uzofunda futhi ngezinqubo zokuxilonga, ukwelashwa okutholakalayo komdlavuza webele okuphindwe kathathu, kanye nezici ezibalulekile ezithonya amazinga okusinda kanye nemiphumela yokululama.

Iyini I-Triple Negative Breast Cancer?

Umdlavuza webele one-triple-negative umele uhlobo oluhlukile, olunolaka, futhi oluyinselele umdlavuza webele ebonakala ngokungabikho kwama-receptors amathathu athile kumaseli omdlavuza. Lapho odokotela bezifo behlola izimila zamabele, babheka ngokukhethekile amaprotheni angabhebhezela ukukhula komdlavuza. Umdlavuza webele uthola ukuxilonga okuphindwe kathathu lapho amangqamuzana omdlavuza etholakala engenawo:

• Ama-Estrogen receptors (ER)
• I-progesterone receptors (PR)
• I-Human Epidermal Growth Factor Receptor 2 (HER2)

Lesi sici esiyingqayizivele senza umdlavuza webele onegayo kathathu kube yinselele ikakhulukazi ukuwelapha, njengoba amangqamuzana omdlavuza engenazo izinhloso ezijwayelekile ezihloswe ngazo izindlela eziningi zokwelapha umdlavuza webele. 

Izimbangela Nezingozi Zomdlavuza Webele Ongalungile Kathathu

Izici zofuzo zidlala indima ebalulekile ekuthuthukisweni kwe-TNBC. Isixhumanisi sofuzo esibaluleke kakhulu ubukhona bokuguqulwa kofuzo lwe-BRCA1, cishe ama-70% omdlavuza webele kwabesifazane abanokuguqulwa kwe-BRCA1 kube negethivu kathathu. Iphesenti elincane lezimo lihlotshaniswa nokuguqulwa kwe-BRCA2.

Izinto ezimbalwa zezibalo zabantu nezomuntu siqu zandisa ubungozi be-TNBC:

• Ubudala obungaphansi kweminyaka engama-40
• I-African American noma i-Hispanic uhlanga
• Umlando womndeni womdlavuza webele
• Izicubu zesifuba eziminyene
• Ukuchayeka emisebeni yangaphambilini
• Ukusetshenziswa okwandisiwe kwamaphilisi okulawula ukuzalwa (ngaphezulu kweminyaka eyi-10)
• Ukuchayeka kumakhemikhali athile, okuhlanganisa i-polychlorinated biphenyl (PCB)
• Ukukhuluphala kwabesifazane be-postmenopausal 
• Ukuntuleka kokuzivocavoca umzimba

Izimpawu Ze-Triple Negative Breast Cancer

Izimo eziningi zitholwa ngesikhathi sokuhlolwa kwe-mammogram ngaphambi kokuba izimpawu zomzimba zibonakale.

Iziguli ezine-TNBC zingase zibe nezinguquko ezihlukahlukene zomzimba kuzicubu zazo zamabele. Okulandelayo ezinye izimpawu ezivamile ze-TNBC:

• Isigaxa esisha noma inqwaba ebeleni
• Izinguquko kusayizi webele noma ukuma
• Ukuvuvukala ingxenye noma lonke ibele
• I-skin dimpling noma i-pitting (ukudala ukuthungwa "kwekhasi lewolintshi")
• Ubuhlungu bebele noma ukufudumala
• Ubomvu noma ukuqina kwesikhumba sebele
• Izimbali ezivuvukala ze-lymph ngaphansi kwekhwapha noma eduze kwe-collarbone
• Izinguquko ekubukekeni kwengono, okuhlanganisa:
  • Ukuguqula (ukujikela ngaphakathi)
  • Ukuphuma (hhayi ubisi lwebele)
  • Isikhumba esivulekayo noma esixebukayo
  • Ubuhlungu noma ukuzwela 

Yiziphi Izigaba Ezihlukene Ze-Triple Negative Breast Cancer?

Izazi ze-Oncologists zisebenzisa i-TNM staging system, emele i-Tumor, Node, kanye ne-Metastasis. Isiza amaqembu ezokwelapha ukuthi akhe amakhambi afanelekile omdlavuza webele ongenayo kathathu.

Izigaba ezinhlanu eziyinhloko ze-TNBC yilezi:

• Isiteji 0: Amangqamuzana omdlavuza ahlala evaleleke emiseleni yamabele futhi awakaze ahlasele
• Isigaba I: Izimila ezincane (ezingaphansi kwamasentimitha angu-2) ngaphandle kokubandakanyeka kwe-lymph node
• Isigaba II: Izimila phakathi kwamasentimitha angu-2-5 ezingase zithinte ama-lymph nodes aseduze
• Isigaba III: Umdlavuza wesifunda othuthukile osusabalele ezicutshini ezizungezile nama-lymph nodes
• Isigaba IV: Isimila sesisakazekele ezithweni ezikude njengamaphaphu, isibindi, amathambo, noma ubuchopho

Izilinganiso zokusinda ezihlobene zeminyaka engu-5 zomdlavuza webele ongenayo kathathu ziyahlukahluka ngezigaba. 

• Ngomdlavuza wendawo (ovalelwe ebeleni), izinga lokusinda lingama-91%. 
• Amacala okusabalala kwesifunda akhombisa izinga lokusinda elingama-66%.
• Izigameko ezisabalele kude zinezinga lokusinda elingu-12%.

Izinkinga

Ukuphatha izinkinga kuveza enye yezinselelo ezinkulu ekwelapheni umdlavuza webele one-triple-negative (TNBC). Izici eziyingqayizivele zalolu hlobo lomdlavuza zidala izinselele ezithile iziguli nodokotela okufanele babhekane nazo kulo lonke uhambo lokwelashwa.

I-TNBC ibonisa izinkinga eziningana ezihlukene:

• Ukukhula ngokushesha okukhulu nokusabalala uma kuqhathaniswa neminye imidlavuza yebele
• Amathuba aphezulu okusabalalisa ekuxilongweni kokuqala
• Izinketho zokwelashwa ezinomkhawulo ngenxa yokuntuleka kwama-hormone receptors
• Amathuba akhulayo okuphindaphinda, ikakhulukazi eminyakeni yokuqala emi-5
• Ukuthambekela kokusakazeka ezithweni ezithile, kubandakanya nobuchopho, isibindi, Futhi amaphaphu
• Amazinga aphansi okusinda ngemva kokuvela futhi uma kuqhathaniswa nezinye izinhlobo zomdlavuza webele

Sifo

Ukuxilongwa kuhilela izinyathelo ezimbili eziyinhloko:

• Ukuhlolwa Kokuqala Kwesithombe:
  • I-Mammogram: Isebenzisa imisebe enedosi ephansi ukuze idale izithombe zebele ezinemininingwane
  • I-Breast Ultrasound: Isiza ukuhlukanisa phakathi kwama-cyst agcwele uketshezi kanye nezimila eziqinile
  • Ukufaniswa kwe-Magnetic Resonance (MRI): Iwusizo kakhulu ezigulini ezisengozini enkulu kanye nokutholwa kusenesikhathi
• Isidumbu: Kwenziwa ukuqoqa amasampula ezicubu. Lawa masampuli ahlolwa i-immunohistochemistry (IHC), ehlola amangqamuzana omdlavuza ukuze athole amaprotheni athile amathathu: ama-estrogen receptors, ama-progesterone receptors, kanye ne-HER2 protein. Ukuxilongwa komdlavuza webele ongenayo kathathu kuqinisekiswa lapho zonke izivivinyo ezintathu zibuyisela imiphumela engemihle.

Ukwelapha Umdlavuza Webele Ongalungile Kathathu

Izinketho zokwelapha umdlavuza webele onegayo kathathu seziguquke kakhulu, odokotela manje sebesebenzisa izindlela eziningi zokulwa nalolu hlobo lomdlavuza webele oluyingozi. Isu lokwelapha ngokuvamile lihlanganisa izindlela ezimbalwa ukuze kuzuzwe imiphumela engcono kakhulu.

Odokotela ngokuvamile batusa izindlela zokwelapha eziyinhloko ezilandelayo:

• Ukwelashwa ngamakhemikhali: Ihlala iyisisekelo sokwelashwa kwe-TNBC, okuvamise ukunikezwa ngaphambi kokuhlinzwa ukuze kunciphe izimila nangemuva kokuhlinzwa ukuze kuqedwe amaseli omdlavuza asele.
• Ukuhlinzwa: Kubandakanya ukuhlinzwa okonga ibele noma i-mastectomy, kuye ngosayizi wesimila nendawo
• I-Radiotherapy: Isetshenziswa ngemuva kokuhlinzwa ukukhomba noma yimaphi amaseli omdlavuza asele
• immunotherapy: Imithi ethile isiza amasosha omzimba ukubona futhi alwe namaseli omdlavuza
• Ukwelapha Okuhlosiwe: Imithi ethile yeziguli ezinoguquko oluthile lwezakhi zofuzo, kuhlanganise ne-PARP inhibitors kulabo abanokuguqulwa kwe-BRCA

Uzoyibona Nini Udokotela

Ukunakekelwa kwezempilo kuyadingeka ngokushesha lapho iziguli ziba:

• Imfiva engaphezu kuka-38.05°C (100.5°F)
• Persistent amakhaza
• Ukukhwehlela okukhiqizayo noma okumanzi
• Ubuhlungu obukhulu besisu
• Uhudo oluqhubekayo
• Ukucanuzela kwenhliziyo nokuhlanza okuqhubekayo

Prevention

Nakuba ingekho indlela eqinisekisiwe yokuvimbela umdlavuza webele ophindwe kathathu, ucwaningo lubonisa ukuthi ukuguqulwa okuthile kwendlela yokuphila kungasiza ekunciphiseni ingozi. 

Izinyathelo ezibalulekile zokuvimbela zihlanganisa:

• Ukugcina isisindo somzimba esinempilo ngokudla okufanele
• Ukuzivivinya umzimba njalo
• Ukunciphisa noma ukugwema ukuphuza utshwala
• Ukuqapha impilo yebele ngokuhlola njalo
• Kubhekwa ukuhlolwa kofuzo uma kukhona umlando womndeni womdlavuza
• Kubandakanya ukusetshenziswa kwetiye le-herbal njengengxenye yempilo enempilo

Isiphetho

Ulwazi lunikeza iziguli amandla okuthi zilawule impilo yazo yamabele ngokuhlolwa okuvamile nokushintsha indlela yokuphila. Izinguquko ezilula njengokuzivocavoca okuvamile, imikhuba yokudla enempilo, kanye nokunakekelwa kwezokwelapha ngokushesha lapho izimpawu zivela kungenza umehluko omkhulu emiphumeleni. Iziguli eziqonda izici ze-TNBC nezici zobungozi zikuhlomele kangcono ukusebenzisana nodokotela bazo, okuholela kumasu okwelapha asebenza ngempumelelo kanye nezinga lempilo elithuthukisiwe phakathi nohambo lwazo lomdlavuza.

Imibuzo Evame Ukubuzwa

1. Uvame kangakanani umdlavuza webele onenegative kathathu?

Umdlavuza webele we-Triple-negative (TNBC) wenza i-10-15% yakho konke ukuxilonga umdlavuza webele. Lokhu kuhumusha cishe i-15 kuzo zonke izimo zomdlavuza webele we-100. Lesi simo sithinta izinkulungwane zabantu ngonyaka, ngezinga eliphezulu lokuvama phakathi kwamaqembu athile abantu (abantu base-Afrika baseMelika noma base-Hispanic).

2. Ungakwazi yini ukwelulama ngokugcwele kumdlavuza webele onenegative kathathu?

Amazinga okubuyisela ayahluka futhi ancike esigabeni sokuxilongwa. Izilinganiso zokusinda ezihlobene zeminyaka emi-5 yilezi:

• Ama-91% omdlavuza wendawo (uvalelwe ebeleni)
• 66% ukusatshalaliswa kwesifunda
• I-12% yokusabalalisa kude

3. Yini okungafanele uyidle ngomdlavuza webele owu-triple-negative?

Izincomo zokudla ziphakamisa ukukhawulela ukudla okungase kube nomthelela ekusebenzeni kokwelashwa. Ucwaningo lukhombisa ukugwema:

• Ukudla okugayiwe okunamafutha amaningi
• Ukudla inyama ebomvu ngokweqile
• Ukudla okunoshukela omningi

Esikhundleni salokho, iziguli kufanele zigxile ekudleni okucebile nge-omega-3 fatty acids, izithelo, imifino, nokusanhlamvu.

4. Iyini imbangela yomdlavuza webele onenegative kathathu?

Ososayensi bahlonze izakhi zofuzo ze-BRCA1 ezinephutha njengengxenye ebalulekile ekuthuthukisweni kwe-TNBC. Lapho zisebenza kahle, lezi zakhi zofuzo zisiza ukuvimbela ukukhula komdlavuza. Kodwa-ke, ukuguqulwa kwezakhi zofuzo kungenza amangqamuzana abe lula ekuguquleni izakhi zofuzo, okuholela ekwakhekeni komdlavuza.

5. Ubani othola umdlavuza webele one-triple-negative?

I-TNBC ithinta kakhulu amaqembu athile abantu:

• Abesifazane abangaphansi kweminyaka engama-40 ubudala
• Abantu abamnyama nabamaSpanishi
• Abantu abanezinguquko zofuzo ze-BRCA1
• Labo abanokukhuluphala ngokweqile ngemva kokuya esikhathini

6. Ingabe i-triple-negative ibuya njalo?

Nakuba i-TNBC inezinga eliphezulu lokuphindaphinda kunezinye izinhlobo zomdlavuza wamabele, ayibuyi njalo. Cishe u-40% weziguli ezinesigaba 1-3 se-TNBC zithola ukuphindaphinda, ngokuvamile phakathi neminyaka emithathu yokuqala ngemva kokwelashwa. Ingozi yokuphinda yehla kakhulu ngemva kweminyaka emihlanu.

UDkt. Satish Pawar

MBBS, MS (General Surgery), DNB (Surgical Oncology), FMAS, FAIS, MNAMS, Fellowship GI Oncology
CARE Medical Center, Tolichowki, Hyderabad, CARE Hospitals, HITEC City, Hyderabad, CARE Hospitals, Banjara Hills, Hyderabad

Ukuze Ubhukhe Isikhathi, shayela:

+ 91 40-68106529