Kana iwe uine node yeininel inoshandura chibereko chako chechiremba kana oncologist inogona kunge yakataura micrometastases. Muzvokwadi, micrometastases inokosha zvikuru ne inenge chero rudzi rwekenza uye ndiyo chikonzero chezvinhu zvinonzi "adjuvant therapy."
Ndeipi chaizvo micrometastases uye zvinorevei kana iwe une micrometastases mumakirini ako?
Overview
Micrometastases idiki shoma rekenza masero ayo akateurwa kubva pachirwere chepakutanga uye anopararira kune imwe chikamu chemuviri. Haikwanisi kuonekwa nemuedzo wekufungidzira wakadai semammogram, MRI, ultrasound, PET, kana CT sc scans. Izvi zvinokonzerwa nekenza masero zvinogona kuungana pamwe nekugadzira chirwere chechipiri, icho chiduku zvokuti chinogona kuonekwa chete pasi pekroscope.
Kukosha
Kuvapo kwe micrometastases kunokosha zvikuru. Haisi kazhinji kenza yepamusoro (ingava muzamu, mapapu, kana dzimwe nzvimbo dzomuviri) iyo inonyanya kukuvadza. Kutaura zvazviri, iyo apo kenza inopararira ( metastasizes ) kune dzimwe nzvimbo dzomuviri kana ichiita zvakanyanya kukanganisa. Zvinenge 90 kubva muzana yevanhu vanofa nekenza vanofa nehosha yemastast.
Kana kenza inotanga kupararira, inotanga kugara semusana muduku wekenza masero. Ichi chikamu chiduku chemasero emukenza chinozivikanwa se micrometastasis (microscopic metastasis).
Ichi chikamu chemasero emukenza hachina kunyanya kunzwika uye chinogona kuonekwa zviri pachena pasi pema microscope. Aya masumbu haazviratidze pane mimwe miedzo yekufungidzira yatinayo nhasi. Mune mamwe mazwi, nzira chete yekuziva kana micrometastase iripo ndeyekubvisa mavara mavari uye anotarisa zvidimbu zveiviri pasi pe microscope.
Neine lymph node biopsy, zvinokwanisika kuita izvi, asi hazvibviri kubvisa lymph node yose. Zvisingakwanisi kubvisa dzimwe nhengo dzomuviri kutarisa kupararira. Hatigoni kutora mapapu emunhu, chiropa, uye mapfupa kuti atsvake hupi hupi uchapupu hwomukaka. Uyu ndiwo pfungwa inotevera adjuvant chemotherapy kana chirwere chemaawa adjuvant. Kana chiremera chiri chechimiro chakasiyana kana kana chakapararira kune lymph nodes, zvinofungidzirwa kuti panogona kunge kune zviduku zvishoma mune imwe nzvimbo mumuviri izvo zvisingagoni kuonekwa. Zvinonzwa kuti zvipembenene zvinokonzera uye zvinokura zvakasiyana nedumbu rekutanga zvinotanga sezvikamu zviduku zvekenza masero.
Micrometastases ndiyo chikonzero chekurapa kwakadai seAdjuvant chemotherapy kana kuti chirongwa chemaawa chinonzi adjuvant. Izvi zvinoshandiswa mushure mekutanga kwechirwere chakabviswa kuti "chichenese" chero micrometastases iri pedyo nekubva kwechirwere (kuburikidza nemirairo) kana kupi zvako mumuviri umo vangangodaro (kuburikidza nemirairo).
Micrometastases vs Isolated Tumor Cells
Kana inoshandiswa mukugadzikana kwekenza yakawanda, micrometastase inotaura nezvemasero aya anofungidzirwa kuti akafamba (metastasized) kubva pachirwere asi haaonekwe nekuongorora kwekufungidzira kwatiri kuwanikwa iye zvino.
Chimwe chikwata chezvikamu zviduku zvekupararira ndezvekushandiswa mukutaura nezve sentinel node biopsies nekenza yemazamu. Muchigadziro ichocho, micrometastase inotsanangurwa se masumbu emakirini emukenza ari pakati pe 0,2 mm (millimeters) akaenzana uye 2.0 mm muhupamhi. Kusiyana neizvi, "masero emakumbo anenge ari oga" masumbu emukenza mashoma zvakare; pasi pe 0,2 mm muhupamhi.
Micrometastases mu Sentinel Lymph Node Biopsy
Kune vakadzi vane kenza yemazamu avo vasina ruzivo rwemuviri wecymph node kuongorora kana ultrasound, a sentinel lymph node biopsy yava mamiriro ekutarisira.
Munzira iyi, dhayi yebhuruu (iyo yakaiswawo kuitira kuti inogona kuonekwa muruzivo rwemagetsi) inorohwa mukati mouturu uye inobvumirwa kufamba. Kana kenza inopararira kubva mumakumbo inowanzopararira kune lymph nodes mumutambo unofanotaurwa.
Nekuita bhidhiyo yemutambo wekambani kana nodes-nhamba dzishoma dzakatanga kuti kenza ingatungamira kune-vakadzi vakawanda havatombogadziriswi nhengo dzese dzedystyodode dissection (kubviswa kwevose kana akawanda emakirini epamusoro muArmpit). Sezvo hutachiona hwema-axillary huchigona kukonzera matambudziko akadai se- lymphedema , izvi zvinogona kudzivirira vamwe vakadzi izvi zvinetso.
Kutsvakurudza kuri kupfuurira kunzwisisa kukosha kwemakrometastases mumutsetse wekutenderera. Kusvika parizvino inozivikanwa kuti macrometastases (metastases yakakura kupfuura 2.0 mm) inowedzera kufungidzira kwechirwere. Izvo zvakawanikwa zvakare kuti kufungidzira kwevakadzi vane micrometastases kumusana weininel vane chirevo chinotambudza kupfuura vakadzi vasina humwe uchapupu hwechirwere mumakirini aya. Kusiyana neizvi, vakadzi avo vakavhara masero emumakumbo mumutsetse weusinel (netsanangudzo nzvimbo yezviremera masero vasingapfuuri 0.2 mm muupamhi) havane chirevo chinonyanya kukunda kupfuura mukadzi asina uchapupu hwemasimisita kune imwe node.
Kuva neruzivo urwu kunogona kubatsira vatsvakurudzi kudzidza zvakare kuti ndevei vakadzi vachada ruzivo rwakakwana rwe-axillary lymph node dissection, uye izvo vakadzi vanofanira kufunga nezvekurapa adjuvant kwekenza yavo yepabonde.
Pasi Pasi
Mukati mekugadzirisa kenza yebonde, kuwanikwa kwe micrometastases kunokosha mukusarudza kurapa kwakanaka. Mishonga yemukondombera yakatanga kufamba kuitira kuti kenza yemasumbu emisasa inowanikwa mumakirini ane nhengo dzinowanzopararira kune dzimwe nzvimbo dzomuviri. Saka zvinowanzokosha kuti uve nehasha uye kushandisa adjuvant chemotherapy uye / kana remishonga inonzi radiation (kuti ibvise masango emasero ekenza kwete mumakirini esirivha ari pedyo, asi avo avo vangangodaro vakaenda kumapfupa, chiropa, kana dzimwe nzvimbo).
Asi micrometastases inonyanya kukosha uye inenge chero chero kenza. Ndiyo masango aya okutanga emasero ekenza anotenderera kubva kumucheka wepakutanga, kazhinji kuine lymph nodes, uyezve kune dzimwe nhengo dzomuviri dzakadai semapapu, mapfupa, chiropa, uropi, kana dzimwe nzvimbo. Kana tikakwanisa kuwana ndokubva tadzikisa micrometastase tinogona kunyanya kubvisa chikonzero che 90 muzana yekufa kwekenza.
> Sources:
> Mayer, E., uye L. Dominici. Chirwere chepabonde Axillary Staging: Zvakawanda Ado NezveMagrometastatic Disease. Nyaya yeCliniki Oncology . 2015. 33 (10): 1095-7.
> National Cancer Institute. Breast Cancer Treatment (PDQ) -Health Professional Version. Updated 10/13/17.
> Tvedskov, T., Meretoia, T., Jensen, B., Leidenius, M., naN. Kroman. Muchinjikwa-Kubvumirwa kweTatu Predictive Tools dzeMutambo weNot-Sentinel Node Metastases muBermin Cancer Patients. European Journal of Oncology Surgery . 2014. 40 (4): 435-41.