I-squamous cell carcinoma ehlaselayo yesikhumba

nguJason Wasserman MD PhD FRCPC kanye noZuzanna Gorski MD
December 20, 2023

I-Invasive squamous cell carcinoma (SCC) uhlobo oluvame kakhulu lomdlavuza wesikhumba. Isimila siqala kusuka ama-squamous cell ezivame ukutholakala ongqimbeni lwesikhumba olubizwa ngokuthi i-epidermis. Ngokuvamile, i-squamous cell carcinoma ehlaselayo yesikhumba isuka esimweni esiyingozi njenge i-actinic keratosis noma okungenasidingo uhlobo lomdlavuza wesikhumba okuthiwa squamous cell carcinoma in situ.

Yini ebangela i-squamous cell carcinoma yesikhumba?

Iningi le-squamous cell carcinomas elihlaselayo elenzeka kubantu abadala asebekhulile likhula ngenxa yamangqamuzana aku-epidermis awonakaliswa ukukhanya kwe-UV okuvela elangeni. Ukuchayeka isikhathi eside emisebeni ye-UV evela emibhedeni yokushuka kungabangela umonakalo ofanayo. Abantu abangenawo amandla okuzivikela omzimba ngenxa yokufakelwa izitho zomzimba noma ukutheleleka nge-HIV nabo basengcupheni enkulu yokuba ne-squamous cell carcinoma.

Umbiko wakho we-pathology we-invasive squamous cell carcinoma

Ulwazi olutholakala embikweni wakho we-pathology we-squamous cell carcinoma ehlaselayo ludlala indima ebalulekile ekunakekelweni kwakho kwezokwelapha. Ngaphezu kokuxilongwa, imibiko eminingi izobandakanya ibanga lesimila (kahle, elihlukanisiwe, elihlukanisiwe ngokusesilinganisweni, noma elingahlukaniswanga kahle) kanye nolwazi mayelana nogqinsi lwesimila, ukuba khona noma ukungabikho kokuhlasela kwe-perineural kanye nokuhlasela kwe-lymphovascular, kanye nokuhlolwa kwamamajini. Lezi zakhi zichazwe kabanzi ezigabeni ezingezansi.

Ibanga lesimila

I-squamous cell carcinoma ehlaselayo yesikhumba ihlukaniswe yaba amamaki amathathu - ahlukaniswe kahle, ahlukanisiwe ngokulingene, futhi ahlukaniswa kabi. Ibanga lisuselwa ekutheni amaseli wesimila abukeka angakanani ama-squamous cell ngokuvamile kutholakala esikhumbeni futhi kunganqunywa kuphela ngemva kokuba isimila sihlolwe ngesibonakhulu. Ibanga libalulekile ngoba izimila ezisezingeni eliphezulu (ikakhulukazi, izimila ezingahlukene kahle) ziziphatha ngendlela enolaka futhi maningi amathuba okuthi zikhule kabusha ngemva kokwelashwa futhi metastase (sakaza) ku ama-lymph node noma ezinye izitho zomzimba.

I-squamous cell carcinoma yesikhumba ihlelwa ngale ndlela elandelayo:

1. Ihlukaniswe kahle – I-squamous cell carcinoma ehlukaniseke kahle (eyaziwa nangokuthi ibanga loku-1) yenziwe ngamaseli wesimila abukeka acishe afane namaseli e-squamous avamile.
2. Ihlukaniswe ngokumaphakathi – I-squamous cell carcinoma ehlaselayo ehlukaniswa ngokumaphakathi (eyaziwa nangokuthi ibanga lesi-2) yenziwe ngamaseli wesimila abukeka ehlukile kumaseli e-squamous ajwayelekile, nokho, asengabonwa njengamaseli e-squamous.
3. Uhlukaniswe kabi – I-squamous cell carcinoma engahlukaniswa kabi (eyaziwa nangokuthi ibanga lesi-3) yenziwe ngamaseli wesimila abukeka kancane njengamaseli e-squamous avamile. Lawa maseli angabukeka engavamile kangangokuthi udokotela wakho wezifo angase adinge uku-oda ukuhlolwa okwengeziwe okufana nalokhu i-immunohistochemistry ukuqinisekisa ukuxilongwa.

I-Keratoacanthoma-like squamous cell carcinoma

I-squamous cell carcinoma ehlaselayo ichazwa njenge-'keratoacanthoma-like' lapho isimila sifana. i-keratoacanthoma, enolaka futhi benign (noncancerous) isikhumba isimila. Kubalulekile ukuqaphela ukuthi nakuba zingase zibonakale zifana, i-keratoacanthoma kanye ne-squamous cell carcinoma ehlaselayo ziyizinhlaka ezihlukene. I-squamous cell carcinoma, kuhlanganise nalawo mathumba afana ne-keratoacanthoma, iwuhlobo lomdlavuza wesikhumba futhi ingadinga ukwelashwa okufana nokuhlinzwa. ukuziqhenya, kuyilapho i-keratoacanthomas ngezinye izikhathi ingase ihlehle ngokuzenzakalelayo.

Ukushuba kwesimila

I-squamous cell carcinoma ehlaselayo yesikhumba iqala ongqimbeni oluncane lwethishu ebusweni besikhumba olubizwa ngokuthi i-epidermis. Ukushuba kwesimila kuyisilinganiso sokuthi amaseli wesimila asabalele kude kangakanani ukusuka phezulu kwe-epidermis kuya ezingqimbeni zezicubu ezingezansi (isikhumba nezicubu ezingaphansi kwesikhumba). Ugqinsi lwesimila luyefana kodwa luhlukile ekujuleni kokuhlasela okuyisilinganiso sokuthi amangqamuzana esimila asakazeke kangakanani ukusuka phansi kwe-epidermis kuya ezingeni elijulile le-tumor. sokuhlasela. Ukushuba kwesimila okungaphezu kuka-2 mm kuhlotshaniswa nokubi kakhulu isibikezelo. Ikakhulukazi, lezi zimila kungenzeka zisabalale ama-lymph node noma ukukhula futhi ngemva kokwelashwa.

Izinga likaClark

Izinga likaClark wuhlelo olusetshenziswa emibikweni ye-pathology ukuchaza ukuthi umdlavuza wesikhumba njenge-invasive squamous cell carcinoma usabalale kangakanani esikhumbeni. Kuyisici esibalulekile ekunqumeni ukuqina kanye nokuziphatha okungenzeka kwesimila. Uhlelo lunamazinga amahlanu, ngalinye libonisa ukuthi isimila singene ngokujula kangakanani ezingxenyeni zesikhumba:

1. Izinga I: Isimila sivalelwe ku-epidermis, ungqimba olungaphandle lwesikhumba. Lokhu kwaziwa nangokuthi squamous cell carcinoma in situ.
2. Izinga II: Isimila singene ku-papillary dermis, ingxenye engaphezulu yongqimba lwesibili lwesikhumba.
3. Izinga III: Isimila sigcwalise yonke i-papillary dermis kodwa asikafinyeleli ku-reticular dermis, ingxenye engezansi yongqimba lwesibili lwesikhumba.
4. Izinga IV: Isimila sihlasele i-reticular dermis.
5. Izinga V: Isimila singene emafutheni angaphansi kwesikhumba, ungqimba olungaphansi kwesikhumba.

Ukwanda ngakunye kwezinga likaClark kukhombisa ukungena okujulile kwesimila futhi okungenzeka kube kubi kakhulu isibikezelo, njengoba izimila ezijulile zinengozi enkulu yoku i-metastasizing (esakaza) ku ama-lymph node. Kodwa-ke, kubalulekile ukuqaphela ukuthi nakuba izinga likaClark linikeza ulwazi olubalulekile mayelana nokujula kwesimila, ezinye izici ezifana nokuqina kwesimila (okukala ukujula kwangempela kwesimila. sokuhlasela ngamamilimitha) nazo zibalulekile esiteji nasekubikezelweni. Ukuhlolwa okuhlanganisiwe kwalezi zici kusiza ukuqondisa izinqumo zokwelashwa.

Ukuhlasela kwe-Perineural

Izazi zezifo zisebenzisa igama elithi “perineural invasion” ukuchaza isimo lapho amangqamuzana omdlavuza enamathela noma ehlasela inzwa. "Ukuhlasela kwe-Intraneural" yigama elihlobene elisho ngokuqondile amangqamuzana omdlavuza atholakala ngaphakathi kwenzwa. Imizwa, efana nezintambo ezinde, iqukethe amaqembu amaseli aziwa ngokuthi ama-neurons. Lezi zinzwa, ezikhona kuwo wonke umzimba, zidlulisela ulwazi olufana nezinga lokushisa, ukucindezela, nobuhlungu phakathi komzimba nobuchopho. Ukuba khona kokuhlasela kwe-perineural kubalulekile ngoba kuvumela amangqamuzana omdlavuza ukuthi ahambe eduze kwenzwa aye ezithweni eziseduze nezicubu, okuphakamisa ingozi yokuphindaphinda kwesimila ngemva kokuhlinzwa.

Ukuhlasela kwe-lymphovascular

Ukuhlasela kwe-lymphovascular kwenzeka lapho amangqamuzana omdlavuza ehlasela isitsha segazi noma isiteshi se-lymphatic. Imithambo yegazi, amashubhu azacile athwala igazi kuwo wonke umzimba, ahluke emiseleni ye-lymphatic, ethwala uketshezi olubizwa ngokuthi i-lymph esikhundleni segazi. Lezi ziteshi ze-lymphatic zixhuma ezithweni zokuzivikela ezincane ezaziwa ngokuthi ama-lymph node, zihlakazeke umzimba wonke. Ukuhlasela kwe-lymphovascular kubalulekile ngoba kwenza amangqamuzana omdlavuza asakazekele kwezinye izingxenye zomzimba, kuhlanganise nama-lymph nodes noma amaphaphu, ngegazi noma imithambo ye-lymphatic.

Amanqamu

Ku-pathology, i-margin isho unqenqema lwezicubu ezikhishwe ngesikhathi sokuhlinzwa kwesimila. Isimo semajini embikweni we-pathology sibalulekile njengoba sibonisa ukuthi isimila sisusiwe sonke noma uma ezinye zishiywe ngemuva. Lolu lwazi lusiza ekunqumeni isidingo sokwelashwa okwengeziwe.

Ama-pathologists ngokuvamile ahlola ama-margins ngokulandela inqubo yokuhlinzwa njenge- ukuziqhenya or ukukhishwa kabusha, okuhloswe ngayo ukususa sonke isimila. Amajikijolo awavami ukucutshungulwa ngemva kwe-a i-biopsy, esusa ingxenye kuphela yesimila. Inani lamamajini abikiwe kanye nosayizi wawo—ukuthi singakanani izicubu ezivamile phakathi kwesimila nonqenqema olusikiwe—ziyahlukahluka ngokuya ngohlobo lwethishu nendawo yesimila.

Izazi ze-pathologists zihlola ama-margins ukuze zihlole ukuthi ama-tumor cells akhona yini emaphethelweni ezicubu. Umkhawulo omuhle, lapho kutholakala khona ama-tumor cells, uphakamisa ukuthi omunye umdlavuza ungase uhlale emzimbeni. Ngokuphambene, imajini engalungile, engenawo amaseli e-tumor emaphethelweni, iphakamisa ukuthi isimila sisuswe ngokuphelele. Eminye imibiko iphinda ilinganise ibanga phakathi kwamaseli wesimila aseduze kanye nemajini, noma ngabe wonke amamajini anegethivu.

Kukhishwe ngokuphelele

Ukukhishwa ngokuphelele kusho ukuthi sonke isimila sikhishwe ngempumelelo ngokuhlinzwa okwenziwa. Izazi ze-pathologists zinquma ukuthi isimila sikhishwe ngokuphelele ngokuhlola i-tumor imishado kwezicubu (bheka ngenhla ukuze uthole ulwazi olwengeziwe mayelana namamajini).

Ikhishwe ngokungaphelele

Ukukhishwa ngokungaphelele kusho ukuthi ingxenye kuphela yesimila yasuswa ngokuhlinzwa okwenziwa. Izazi ze-pathologists zichaza isimila njengesikhishwe ngokungaphelele lapho amaseli e-tumor ebonakala wekhasi noma usike unqenqema lwethishu (bheka ngenhla ukuze uthole ulwazi olwengeziwe mayelana namamajini).

Kuvamile ukuthi isimila sikhishwe ngokungaphelele ngemva kwenqubo encane efana ne- i-biopsy ngoba lezi zinqubo ngokuvamile ayenziwa ukuze kususwe sonke isimila. Nokho, izinqubo ezinkulu ezifana izinqumo futhi ukuhlinzwa ngokuvamile kwenziwa ukuze kususwe sonke isimila. Uma isimila sikhishwe ngokungaphelele, udokotela wakho angase atuse enye inqubo ukuze kususwe sonke isimila.

Izindawo ezinama-lymph

Izindawo ezinama-lymph amasosha omzimba amancane atholakala kuwo wonke umzimba. Amangqamuzana omdlavuza angasakazeka esuka esimila kuye kuma-lymph nodes ngokusebenzisa imikhumbi emincane ebizwa ngokuthi i-lymphatics. Ngenxa yalesi sizathu, ama-lymph nodes avame ukususwa futhi ahlolwe ngesibonakhulu ukuze kubhekwe amangqamuzana omdlavuza. Ukuhamba kwamangqamuzana omdlavuza ukusuka esimila ukuya kwenye ingxenye yomzimba njenge-lymph node kubizwa ngokuthi a i-metastasis.

Amaseli omdlavuza ngokuvamile asakazeka kuqala kuma-lymph nodes eduze kwesimila nakuba ama-lymph nodes akude nesimila nawo angabandakanyeka. Ngenxa yalesi sizathu, ama-lymph nodes okuqala asusiwe ngokuvamile aseduze nesimila. Ama-lymph nodes aqhelelene nesimila avame ukususwa kuphela uma ekhulisiwe futhi kukhona izinsolo eziphakeme zomtholampilo zokuthi kungase kube namaseli omdlavuza ku-lymph node.

Uma noma imaphi ama-lymph node akhishiwe emzimbeni wakho, azohlolwa ngesibonakhulu udokotela wezifo futhi imiphumela yalokhu kuhlolwa izochazwa embikweni wakho. Imibiko eminingi izobandakanya inani eliphelele lama-lymph nodes ahloliwe, lapho emzimbeni kutholwe khona ama-lymph nodes, kanye nenombolo (uma ikhona) equkethe amaseli omdlavuza. "Positive" kusho ukuthi amaseli omdlavuza atholakala ku-lymph node. “Okubi” kusho ukuthi awekho amaseli omdlavuza atholakele. Uma amangqamuzana omdlavuza etholakala ku-lymph node, usayizi weqembu elikhulu kunawo wonke lamangqamuzana omdlavuza (okuvame ukuchazwa ngokuthi “ukugxila” noma “idiphozithi”) nawo angase afakwe embikweni wakho.

Ukuhlolwa kwama-lymph nodes kubalulekile ngenxa yezizathu ezimbili. Okokuqala, lolu lwazi lusetshenziselwa ukunquma isigaba se-pathologic nodal (pN). Okwesibili, ukuthola amangqamuzana omdlavuza ku-lymph node kwandisa ingozi yokuthi amangqamuzana omdlavuza azotholakala kwezinye izingxenye zomzimba esikhathini esizayo. Ngenxa yalokho, udokotela wakho uzosebenzisa lolu lwazi lapho enquma ukuthi kuyadingeka yini ukwelashwa okwengeziwe okufana ne-chemotherapy, i-radiation therapy, noma i-immunotherapy.

Mayelana nalesi sihloko

Lesi sihloko sabhalwa odokotela ukuze sikusize ufunde futhi uqonde umbiko wakho we-pathology we-squamous cell carcinoma ehlaselayo. Xhumana nathi uma unemibuzo mayelana nalesi sihloko noma umbiko wakho we-pathology. Funda lesi sihloko ukuze uthole isingeniso esijwayelekile ezingxenyeni zombiko we-pathology ojwayelekile.

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