I-follicular thyroid carcinoma ehlasela kakhulu

nguJason Wasserman MD PhD FRCPC
Mashi 22, 2023

Iyini invasive follicular thyroid carcinoma?

I-follicular thyroid carcinoma ehlasela kakhulu uhlobo lomdlavuza wegilo. I-tumor ibizwa ngokuthi "i-invasive kabanzi" ngoba amaqembu amangqamuzana omdlavuza atholakala kuyo yonke indlala yegilo evamile.

Itholakala kanjani i-follicular thyroid carcinoma ehlasela kakhulu?

Ukuxilongwa kwe-follicular thyroid carcinoma ehlasela kakhulu kungenziwa kuphela ngemva kokuba isimila sisusiwe futhi sithunyelwe kudokotela wezifo ukuze ahlolwe. Lokhu ngokuvamile kuhilela ukukhipha ngokuhlinzwa ingxenye yegilo yegilo nakuba ngezinye izikhathi yonke indlala yegilo ikhishwa. Ukuxilongwa akukwazi ukwenziwa ngemuva kwenqubo encane ehlaselayo ebizwa ngokuthi a i-fine needle aspiration biopsy (FNAB).

Yini eyenza i-follicular thyroid carcinoma ihlasele kakhulu?

I-Follicular thyroid carcinoma ibizwa ngokuthi "i-invasive kabanzi" lapho amangqamuzana omdlavuza esabalele kuyo yonke indlala yegilo evamile. Ngokuphambene, amangqamuzana omdlavuza ohlotsheni oluhlobene lomdlavuza abizwa ngokuthi i-follicular yegilo ehlasela kancane ngokuvamile ahlukaniswa nendlala evamile yegilo ngongqimba oluncane lwezicubu okuthiwa a isimila capsule.

Kungani usayizi wesimila ubalulekile?

Ngemuva kokuthi isimila sikhishiwe sonke, sizokalwa futhi nosayizi wesimila uzofakwa embikweni wakho we-pathology. Ubukhulu besimila bubalulekile ngoba sisetshenziselwa ukunquma isigaba se-pathologic tumor (pT) futhi ngenxa yokuthi izimila ezinkulu kungenzeka zisabalele kwezinye izingxenye zomzimba.

Kuyini i-angioinvasion (ukuhlasela kwemithambo) futhi kungani kubalulekile?

I-Angioinvasion (i-vascular invasion) isho ukuthi amangqamuzana omdlavuza abonakale ngaphakathi komthambo wegazi okungenani owodwa. Kuvame kakhulu ukuthola i-angioinvasion ku-follicular thyroid carcinoma ehlasela kakhulu. I-Angioinvasion ibalulekile ngoba amangqamuzana omdlavuza angena emithanjeni yegazi akwazi ukusabalala kwezinye izingxenye zomzimba njengamaphaphu noma amathambo.

Kuyini ukuhlasela kwe-lymphatic futhi kungani kubalulekile?

Ukuhlasela kwe-lymphatic kusho ukuthi amangqamuzana omdlavuza abonwa ngaphakathi komkhumbi we-lymphatic. Imikhumbi ye-lymphatic imigudu emincane emincane evumela udoti, uketshezi oluthe xaxa, namaseli ukuba kushiye izicubu. I-Lymphatics itholakala kuwo wonke umzimba. Ukuhlasela kwe-lymphatic kubalulekile ngoba kwandisa ingozi yokuthi amangqamuzana omdlavuza azotholakala endaweni i-lymph node. Ukuhlasela kwe-lymphatic akubonakali ngokuvamile ku-follicular thyroid carcinoma ehlaselayo.

Kuyini ukunwetshwa kwe-extrathyroidal futhi kungani kubalulekile?

Ukunwetshwa kwe-Extrathyroidal kusho ukuthi amangqamuzana omdlavuza asakazeke ngale kwegland yegilo kanye nasezicutshini ezizungezile. Amangqamuzana omdlavuza ahamba ngokwanele ngaphandle kwendlala yegilo angase ahlangane nezinye izitho ezinjengemisipha, umminzo, noma uqhoqhoqho.

Kunezinhlobo ezimbili ze-extrathyroidal extension:

• I-Microscopic – Amangqamuzana omdlavuza angaphandle kwendlala yegilo atholakala kuphela ngemva kokuba isimila sihlolwe ngesibonakhulu.
• I-Macroscopic (gross) – Isimila sibonakala sikhula sibe yizicubu ezisizungezile ngaphandle kokusebenzisa isibonakhulu. Lolu hlobo lwesandiso se-extrathyroidal lungabonwa udokotela wakho ohlinzayo ngesikhathi sokuhlinzwa noma umsizi we-pathologist owenza ukuhlola okujulile kwezicubu ezithunyelwe ku-pathology.

I-Macroscopic (gross) extrathyroidal extension ibalulekile ngoba yandisa i-pathologic tumor stage (pT) futhi ihlotshaniswa nokubi kakhulu. isibikezelo. Ngokuphambene, isandiso se-microscopic extrathyroidal asishintshi isigaba sesimila futhi asihlotshaniswa nokubikezelwa okubi kakhulu.

Iyini imajini futhi kungani imingcele ibalulekile?

A wekhasi yinoma yisiphi isicubu okufanele sisikwe udokotela ohlinzayo ukuze akhiphe indlala yegilo emzimbeni wakho. Imajini ibhekwa njengenhle lapho kunamaseli omdlavuza emaphethelweni ezicubu ezisikiwe. Umkhawulo ongemuhle usho ukuthi awekho amangqamuzana omdlavuza abonwe emaphethelweni asikiwe ezicubu.

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

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.

Ngezinye izikhathi ama-lymph nodes entanyeni akhishwa ngesikhathi esifanayo ne-thyroid ngendlela ebizwa ngokuthi i-neck dissection. Ama-lymph nodes asusiwe ngokuvamile avela ezindaweni ezahlukene zentamo futhi indawo ngayinye ibizwa ngokuthi izinga. Amazinga entanyeni anenombolo 1 kuya ku-7. Umbiko wakho we-pathology uzovame ukuchaza ukuthi mangaki ama-lymph node abonwe ezingeni ngalinye elithunyelwe ukuze lihlolwe. Ama-lymph nodes ohlangothini olufanayo nesimila abizwa ngokuthi i-ipsilateral kanti lawo aphesheya kwesimila abizwa ngokuthi i-contralateral.

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. Uma amangqamuzana omdlavuza abonwa ku-lymph node, usayizi weqembu elikhulu kunawo wonke lamaseli omdlavuza (okuvame ukuchazwa ngokuthi “ukugxila” noma “idiphozithi”) nawo uzofakwa.

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.

Kusho ukuthini uma i-lymph node ichazwa njenge-positive?

Izazi zezifo zivame ukusebenzisa igama elithi “positive” ukuchaza i-lymph node equkethe amangqamuzana omdlavuza. Isibonelo, i-lymph node equkethe amangqamuzana omdlavuza ingase ibizwe ngokuthi “positive for malignancy” noma “positive for metastatic carcinoma”.

Kusho ukuthini uma i-lymph node ichazwa njengenegethivu?

Izazi zezifo zivame ukusebenzisa igama elithi “negative” ukuchaza i-lymph node engenawo amangqamuzana omdlavuza. Isibonelo, i-lymph node enganawo amaseli omdlavuza ingase ibizwe ngokuthi “negative for malignancy” noma “negative for metastatic carcinoma”.

Sinqunywa kanjani isigaba se-pathologic (pTNM) se-follicular thyroid carcinoma ehlaselayo?

Isigaba se-pathologic se-widely invasive follicular thyroid carcinoma sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwakhiwe ekuqaleni I-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 futhi esibi kakhulu isibikezelo.

Isiteji sesimila (pT) se-follicular thyroid carcinoma ehlasela kakhulu

I-follicular thyroid carcinoma ehlasela kakhulu inikezwa isigaba sesimila phakathi kuka-1 no-4 ngokusekelwe kubukhulu besimila kanye nokuba khona kwamangqamuzana omdlavuza ngaphandle kwegilo.

• T1 – Isimila singaphansi noma silingana no-2 cm futhi amangqamuzana omdlavuza awadluleli ngale kwendlala yegilo.
• T2 – Isimila sikhulu kuno-2 cm kodwa singaphansi noma silingana no-4 cm futhi amangqamuzana omdlavuza awadluleli ngale kwendlala yegilo.
• T3 - Isimila sikhulu kuno-4 cm OR amangqamuzana omdlavuza adlulela emisipha engaphandle kwegland yegilo.
• T4 - Amangqamuzana omdlavuza adlulela ezakhiweni noma ezithweni ezingaphandle kwegland yegilo okuhlanganisa uqhoqhoqho, umphimbo, noma umminzo.

I-Nodal stage (pN) ye-follicular thyroid carcinoma ehlasela kakhulu

I-follicular thyroid carcinoma ehlasela kakhulu inikezwa isigaba se-nodal sika-0 noma 1 ngokusekelwe ebukhoneni noma ekungabi bikho kwamangqamuzana omdlavuza endaweni. i-lymph node kanye nendawo yama-lymph nodes ahilelekile.

• N0 – Awekho amaseli omdlavuza atholakele kunoma yimaphi ama-lymph nodes ahloliwe.
• N1a - Amangqamuzana omdlavuza atholakala ku-lymph nodes eyodwa noma ngaphezulu kusukela kumazinga 6 noma 7.
• N1b - Amangqamuzana omdlavuza atholakala ku-lymph nodes eyodwa noma ngaphezulu ukusuka ku-level 1 kuya ku-5.
• NX - Awekho ama-lymph node athunyelwe ku-pathology ukuze ahlolwe.

Isiteji se-Metastatic (pM) se-follicular thyroid carcinoma ehlasela kakhulu

I-follicular thyroid carcinoma ehlasela kakhulu inikezwa isigaba se-metastatic esingu-0 noma esingu-1 ngokusekelwe ekubeni khona kwamaseli wesimila endaweni ekude emzimbeni (ngokwesibonelo amaphaphu). Isigaba se-metastatic singanqunywa kuphela uma izicubu ezivela endaweni ekude zithunyelwa ukuze zihlolwe i-pathological. Ngenxa yokuthi lesi sicubu asivamile ukuthunyelwa, isigaba se-metastatic asikwazi ukunqunywa futhi sifakwe kuhlu njenge-MX.