I-squamous cell carcinoma ye-anal canal

nguCatherine Forse MD FRCPC
September 28, 2023

Iyini i-squamous cell carcinoma ye-anal canal?

I-squamous cell carcinoma (SCC) uhlobo lomdlavuza wangemuva. I-anal canal itholakala ekugcineni kwendlela yokugaya phakathi kwe-rectum ne-anus. I-squamous cell carcinoma iwuhlobo oluvame kakhulu lomdlavuza emseleni wangemuva.

Mayelana nalesi sihloko

Lesi sihloko sabhalwa odokotela bekanye nabeluleki beziguli. Yakhelwe ukusiza iziguli zifunde futhi ziqonde umbiko wazo we-pathology we-squamous cell carcinoma yomsele wangemuva. Izigaba ezingezansi zichaza izici eziningi ezivame kakhulu ezitholakala emibikweni ye-pathology yalesi simo. Uma unemibuzo mayelana nalesi sihloko, sicela Xhumana nathi.

Yini ebangela i-squamous cell carcinoma ye-anal canal?

Isizathu esivame kakhulu se-squamous cell carcinoma ku-anal canal ukutheleleka nge- i-human papillomavirus (HPV).

Yiziphi izimpawu ze-squamous cell carcinoma ku-anal canal?

Izimpawu ze-squamous cell carcinoma emseleni wangemuva zingase zihlanganise ukopha endunu, ukulunywa indunu, ubuhlungu bendunu noma ukukwazi ukuzwa isigaxa endunu yakho.

Kwenziwa kanjani ukuhlonzwa kwe-squamous cell carcinoma ku-anal canal?

Ukuxilongwa kuvame ukwenziwa ngemva kokukhishwa kwesiqephu esincane sesimila ngenqubo ebizwa ngokuthi a i-biopsy. Izicubu zithunyelwa kudokotela wezifo ukuze zihlolwe ngesibonakhulu. Ukuhlolwa okukhethekile okubizwa i-immunohistochemistry kungenziwa ukuze kuqinisekiswe ukuxilongwa.

Yini okufanele uyibheke embikweni wakho we-pathology we-squamous cell carcinoma ye-anal canal?

Ulwazi olutholakala embikweni wakho we-pathology we-squamous cell carcinoma ye-anal canal izoncika ohlotsheni lwenqubo eyenziwe. Isibonelo, ulwazi olutholakala embikweni ngemva kokwenziwa kwe-biopsy ngokuvamile lukhawulelwe ekuxilongweni nakuba eminye imibiko ingase ichaze imiphumela yokuhlolwa okwengeziwe okufana nokuhlola okungeziwe. i-immunohistochemistry ngoba p16 (bheka isigaba ngezansi). Ngemuva kokuthi sonke isimila sesisusiwe, umbiko wakho we-pathology uzofaka imininingwane eyengeziwe njengosayizi wesimila, ukunwetshwa kwesimila, ukuba khona noma ukungabikho kwe-tumor. i-lymphovascular futhi i-perineural ukuhlasela, kanye nokuhlolwa kwe imishado. Imiphumela yanoma iyiphi ama-lymph node okuhloliwe kufanele kufakwe kulo mbiko wokugcina. Lolu lwazi lusetshenziselwa ukunquma isigaba somdlavuza kanye nokunquma ukuthi kuyadingeka yini ukwelashwa okwengeziwe. Lezi zihloko zichazwe kabanzi ezigabeni ezingezansi.

Ibukeka kanjani i-squamous cell carcinoma yomsele wangemuva ngaphansi kwesibonakhulu?

Uma ihlolwa ngaphansi kwesibonakhulu, i-squamous cell carcinoma yomsele wangemuva yenziwa amangqamuzana e-squamous amakhulu, abukeka ngendlela engavamile. Isimila ngokuvamile sivela pink ngoba icyoplasm (umzimba) weseli ugcwele iphrotheni ebizwa ngokuthi i-keratin. Ngenxa yalokho, isimila ngokuvamile sichazwa ngokuthi i-keratinizing. Amaseli wesimila ahlasela (asakazeka) asuka ku- i-epithelium ebusweni bomsele wendunu ungene ngaphansi i-stroma (izicubu ezixhumene). Izazi ze-pathologists zivame ukuchaza lokhu njenge-stromal sokuhlasela.

Iyini i-p16 futhi kungani izazi zezifo ziyibheka ku-squamous cell carcinoma yomsele wangemuva?

Amaseli angenwe izinhlobo ezinobungozi obukhulu i-human papillomavirus (HPV) khiqiza inani elikhulu leprotheyini ebizwa ngokuthi p16. I-pathologist yakho ingenza ukuhlolwa okubizwa i-immunohistochemistry ukubheka i-p16 ngaphakathi kwamaseli omdlavuza. Cishe zonke izimo ze-squamous cell carcinoma ze-anal canal zilungile noma ziyasebenza ku-p16 okusho ukuthi udokotela wakho wezifo ubone iphrotheni ye-p16 kumaseli omdlavuza.

Kusho ukuthini uma isimila sichazwa ngokuthi siphilile, siphakathi, noma asihlukaniswanga kahle?

Izazi zezifo zisebenzisa igama elihlukanisiwe ukuhlukanisa i-squamous cell carcinoma yomsele wangemuva abe amabanga amathathu - ihluke kahle, ihlukene ngokumaphakathi, futhi ayihlukene kahle. Ibanga lisuselwa ekutheni amaseli wesimila abukeka ajwayelekile kangakanani ama-squamous cell. Isimila esihluke kahle (ibanga loku-1) sakhiwe amaseli e-tumor abukeka acishe afane namaseli e-squamous avamile. Isimila esihlukanisiwe ngokusesilinganisweni (ibanga lesi-2) sakhiwe amaseli wesimila abukeka ehluke ngokusobala kumaseli avamile we-squamous, nokho, asengabonwa njengamaseli e-squamous. Isimila esingahlukanisiwe kahle (ibanga lesi-3) sakhiwe amaseli wesimila abukeka mancane kakhulu njengamaseli e-squamous avamile. Lawa maseli angabukeka engavamile kangangokuthi udokotela wakho wezifo angase adinge uku-oda ukuhlolwa okwengeziwe okufana nalokhu i-immunohistochemistry ukuqinisekisa ukuxilongwa. Ibanga libalulekile ngoba izimila ezingahlukani kakhulu (izimila ezingahlukaniswanga kahle) ziziphatha ngendlela enolaka futhi kungenzeka zisabalele kwezinye izingxenye zomzimba.

Kungani usayizi wesimila ubalulekile?

Ngemuva kokuthi isimila sesisusiwe, udokotela wakho uzosikala ngezinhlangothi ezintathu futhi ubukhulu obukhulu buzochazwa embikweni wakho we-pathology. Ubukhulu besimila bubalulekile ngoba sisetshenziselwa ukunquma isigaba se-pathologic tumor (pT).

Kusho ukuthini ukunwetshwa kwesimila futhi kungani kubalulekile?

Izazi zezifo zisebenzisa igama elithi “isandiso sesimila” ukuchaza ukukhula kwesimila odongeni lomsele wendunu kanye nezicubu ezizungezile. I-squamous cell carcinoma iqala kusukela ama-squamous cell ngokuvamile kutholakala endaweni engaphakathi yomsele wangemuva. Amaseli e-squamous ayingxenye yongqimba oluncane lwezicubu ezibizwa ngokuthi mucous. Izingqimba zezicubu ezingaphansi kwe-mucosa zihlanganisa i-submucosa, imisipha, nezicubu ezithambile ze-perianal. Njengoba isimila sikhula amaseli angasakazekela kulezi zingqimba. Ekugcineni, amangqamuzana e-tumor angadabula ngaphandle komsele wangemuva futhi asabalale ezithweni eziseduze nezicubu.

Ukunwetshwa kwesimila kungakalwa kuphela ngemuva kokuba isimila sihlolwe ngaphansi kwesibonakhulu ngudokotela wezifo. Izimila ezibonisa izinga elijulile lokunwetshwa kwesimila zihlotshaniswa nengozi enkulu yokuphinda (iphinde ikhule) ngemva kokwelashwa futhi isakazekele endaweni ekude njengamaphaphu.

Kuyini ukuhlasela kwe-perineural futhi kungani kubalulekile?

Ukuhlasela kwe-Perineural kusho ukuthi amangqamuzana e-tumor abonwe exhunywe ku-nerve. Imizwa itholakala kuwo wonke umzimba futhi inesibopho sokuthumela ulwazi (njengokushisa, ukucindezela, nobuhlungu) phakathi komzimba wakho nobuchopho bakho. Ukuhlasela kwe-Perineural kubalulekile ngoba amangqamuzana e-tumor anamathele enzwa angasakazeka ezicutshini ezizungezile ngokukhula eduze kwenzwa. Lokhu kwandisa ingozi yokuthi isimila sizokhula kabusha ngemva kokwelashwa.

Kuyini ukuhlasela kwe-lymphovascular futhi kungani kubalulekile?

Ukuhlasela kwe-lymphovascular kusho ukuthi amaseli e-tumor abonwe ngaphakathi kwesitsha segazi noma isitsha se-lymphatic. Imithambo yegazi amashubhu amade azacile athwala igazi emzimbeni wonke. Imithambo ye-lymphatic ifana nemithambo yegazi emincane ngaphandle kokuthi ithwala uketshezi olubizwa ngokuthi i-lymph esikhundleni segazi. Ukuhlasela kwe-lymphovascular kubalulekile ngoba amangqamuzana e-tumor angasebenzisa imithambo yegazi noma imithambo ye-lymphatic ukuze asakaze kwezinye izingxenye zomzimba ezifana ama-lymph node noma amaphaphu.

Ingabe ama-lymph nodes ahloliwe futhi ingabe akhona amaseli omdlavuza?

Izindawo ezinama-lymph amasosha omzimba amancane atholakala kuwo wonke umzimba. Amaseli omdlavuza angasakazeka esuka esimila aye kuyi-lymph node ngokusebenzisa imithambo ye-lymphatic etholakala ngaphakathi naseduze kwesimila (bheka i-Lymphovascular invasion ngenhla). Ukunyakaza kwamangqamuzana omdlavuza kusuka esimila kuya ku-lymph node kubizwa i-metastasis. Ama-lymph nodes endaweni yesimila angase akhishwe ukuze kubhekwe amangqamuzana omdlavuza. Lolu lwazi bese lusetshenziselwa ukunquma isigaba se-pathologic nodal (pN).

Uma ama-lymph nodes esusiwe, udokotela wakho wezifo uzohlola i-lymph node ngayinye yamangqamuzana omdlavuza. Ama-lymph nodes anamaseli omdlavuza abizwa ngokuthi ama-positive kanti lawo angenawo amangqamuzana omdlavuza abizwa ngokuthi ama-negative. Imibiko eminingi ihlanganisa inani eliphelele lama-lymph nodes ahloliwe kanye nenombolo, uma ikhona, equkethe amaseli omdlavuza.

Iyini imajini futhi kungani imingcele ibalulekile?

Emgudwini wendunu, a wekhasi yinoma yisiphi isicubu esisikwe udokotela ohlinzayo ukuze akhiphe isimila emzimbeni wakho. Ama-margins abalulekile ngoba asiza udokotela wakho ukuthi abone ukuthi isimila sisusiwe noma esinye isimila sishiywe ngemuva.

Izinhlobo zamamajini akhona zizoncika ohlotsheni lwenqubo eyenziwe. Ezibonelweni ze-abdominoperineal resection (APR) lapho i-anal yonke isusiwe, amamajini azobandakanya:

• Imajini eseduze - Le majini itholakala ngaphakathi kwekholoni ye-sigmoid noma i-rectum ngaphambi komsele wangemuva.
• Imajini ehlukene – Lo mkhawulo uvamise ukuba sesifundeni futhi ngokuvamile uhlanganisa indunu.
• Imajini yeradial – Lesi isicubu esizungeze ingaphandle lomsele wangemuva.

Ngokuhlinzwa kwe-endoscopic (ukukhishwa kwediski ye-transanal) lapho kukhishwe khona ingxenye encane yangaphakathi yomsele wangemuva, amamajini azobandakanya:

• I-mucosal margin – Lesi yisicubu esihlanganisa ingaphakathi lomsele wangemuva.
• Imajini ejulile – Lesi sicubu singaphakathi odongeni lomsele wendunu. Itholakala ngaphansi kwesimila.

Emgudwini wangemuva, i-margin ibhekwa njengenhle uma kunamaseli omdlavuza emaphethelweni ezicubu ezisikiwe. Imajini eqondile ihlotshaniswa nengozi enkulu yokuthi isimila sizophinde sikhule endaweni efanayo ngemva kokwelashwa.

Usho ukuthini umphumela wokwelapha?

Uma uthole ukwelashwa (okungaba i-chemotherapy noma i-radiation therapy) yomdlavuza wakho ngaphambi kokuba isimila sikhishwe, udokotela wakho wezifo uzohlola zonke izicubu ezithunyelwe ukuze abone ukuthi singakanani isimila esisaphila (siyasebenza). Izindawo ezinama-lymph namangqamuzana omdlavuza nawo azohlolwa ngemiphumela yokwelapha. Umphumela wokwelapha uvame ukubikwa esikalini sika-0 kuye ku-3 kanti u-0 ungewona amangqamuzana omdlavuza asebenzayo (wonke amangqamuzana omdlavuza afile) futhi u-3 uwumdlavuza osabalele ngaphandle kokuhlehla okusobala kwesimila (wonke noma iningi lamaseli omdlavuza uyaphila).

Sinqunywa kanjani isigaba se-pathologic (pTNM) se-squamous cell carcinoma yomsele wangemuva?

Isigaba se-pathologic se-squamous cell carcinoma ye-anal canal sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwasungulwa yi-American Joint Committee on Cancer. Lolu hlelo lusebenzisa ulwazi mayelana nesimila esiyinhloko (T), ama-lymph node (N), futhi kude i-metastatic isifo (M) ukucacisa isigaba esiphelele se-pathologic (pTNM). I-pathologist yakho izohlola izicubu ezithunyelwe bese inika ingxenye ngayinye inombolo. Ngokuvamile, inani eliphakeme lisho isifo esithuthuke kakhulu kanye nokubikezelwa okubi kakhulu.

Isiteji sesimila (pT) se-squamous cell carcinoma yomsele wangemuva

I-squamous cell carcinoma inikezwa isigaba sesimila phakathi koku-1 no-4 ngokusekelwe kusayizi wesimila.

• T1 - I-Tumor ≤ 2 cm ngosayizi omkhulu kakhulu.
• T2 Isimila > 2 cm kodwa ≤ 5 cm ngobukhulu obukhulu.
• T3 Isimila > 5 cm ngosayizi.
• T4 - Isimila sanoma yimuphi usayizi nge sokuhlasela izitho eziseduze (i-vagin, isinye, i-urethra).

Isiteji se-Nodal (pN) se-squamous cell carcinoma ye-anal canal

I-squamous cell carcinoma ye-anal canal inikezwa isigaba se-nodal sika-0 noma 1. Isiteji se-Nodal 1 sihlukaniswe ngo-1a, 1b no-1c ngokusekelwe lapho ama-lymph node ahlaselwe amangqamuzana omdlavuza atholakala emzimbeni.

• N0 – Awekho amaseli omdlavuza abonwa kunoma iyiphi i-lymph nodes ehloliwe.
• N1a - Amangqamuzana omdlavuza atholakala kuma-lymph nodes angu-inguinal, e-mesorectal noma angaphakathi.
• N1b - Amangqamuzana omdlavuza atholakala kuma-lymph nodes angaphandle.
• I-N1c - Amangqamuzana omdlavuza kuma-lymph nodes angu-inguinal, mesorectal, noma angaphakathi iliac kanye nama-lymph nodes angaphandle.
• NX - Awekho ama-lymph nodes athunyelwe ukuhlolwa kwe-pathologic.

Isiteji se-Metastatic (pM) se-squamous cell carcinoma ye-anal canal

I-squamous cell carcinoma inikezwa isigaba se-metastatic sika-0 noma 1 ngokusekelwe ekubeni khona kwamangqamuzana omdlavuza endaweni ekude emzimbeni (ngokwesibonelo amaphaphu). Isigaba se-metastatic singanqunywa kuphela uma izicubu ezivela endaweni ekude zihanjiswa ukuze zihlolwe ukugula. Ngenxa yokuthi lesi sicubu asivamile ukuba khona, isigaba se-metastatic asikwazi ukunqunywa futhi sibhalwe njengo-X.