I-squamous cell carcinoma yamaphaphu

nguJason Wasserman MD PhD FRCPC
December 14, 2023

I-squamous cell carcinoma (SCC) wuhlobo lomdlavuza wamaphaphu ongewona omncane. I-tumor iqala ku-specialized ama-squamous cell ezivame ukutholakala ngaphakathi kwemigudu yomoya yamaphaphu. Lawa maseli akha umgoqo obizwa ngokuthi i i-epithelium esiza ukuvikela imigudu yomoya ekulimaleni.

I-SCC yamaphaphu ingaba yi-keratinizing (KSCC), i-non-keratinizing (NKSCC), noma i-basaloid. I-Keratinizing isho ukuthi amaseli wesimila enza iphrotheni ebizwa ngokuthi i-keratin. I-Non-keratinizing kusho ukuthi amaseli wesimila awenzi i-keratin. I-Basaloid isho ukuthi amaseli e-tumor afana ne- amaseli e-basal ngokuvamile itholakala ngaphansi kwe-epithelium. Ngaphandle kwalo mehluko, womathathu ama-subtypes akhombisa ukuziphatha okufanayo kanye isibikezelo.

Yini ebangela i-squamous cell carcinoma yamaphaphu?

Isizathu esivame kakhulu se-SCC emaphashini ukuchayeka entuthuni kagwayi isikhathi eside.

Yiziphi izimpawu ze-squamous cell carcinoma yamaphaphu?

Izimpawu ze-SCC zamaphaphu zihlanganisa ukukhwehlela okuqhubekayo noma okubi kakhulu, ukukhwehlela igazi, ubuhlungu besifuba, nokuphelelwa umoya. Amathumba asabalele kwezinye izingxenye zomzimba angase abangele izimpawu ezengeziwe kuye ngendawo emzimbeni. Ngokwesibonelo, izimila ezisakazekela emathanjeni zingabangela ubuhlungu bamathambo futhi zibangele ukuba ithambo liphuke. Odokotela bachaza lokhu njenge-pathologic ukwa.

Kwenziwa kanjani ukuxilongwa kwe-squamous cell carcinoma?

I-SCC yamaphaphu ivamise ukuxilongwa ngemva kokukhishwa kwesampula encane yesicubu ngenqubo ebizwa ngokuthi a i-biopsy noma i-fine needle aspiration (FNA). Kwezinye izimo, ukuxilongwa kwenziwa kuphela ngemva kokuba isimila sisusiwe.

Ibukeka kanjani i-squamous cell carcinoma yamaphaphu ngaphansi kwesibonakhulu?

Uma ihlolwa ngaphansi kwesibonakhulu, i-SCC ivamise ukwakhiwa ngamaseli amakhulu aphinki akhula ngamaqembu abizwa ngokuthi amashidi noma izidleke. Kodwa-ke, amaseli wesimila ku-squamous cell carcinoma abukeka ehlukile kwenempilo ama-squamous cell evame ukukala ingaphakathi lemigudu yomoya. Amaseli wesimila avamise ukuba makhudlwana kunamaseli avamile we-squamous kanye namaseli nucleus yeseli eliphethe izakhi zofuzo kuba mnyama. Izazi zezifo zichaza la maseli ngokuthi hyperchromatic. Amaseli e-Tumor avame ukukhombisa izinhlobonhlobo zomumo nosayizi abachazwa yizazi ze-pathology i-pleomorphic. Ziningi izibalo ze-mitotic (amaseli esimila ahlukanisayo ukuze akhe amaseli amasha wesimila) nawo avame ukubonakala.

Yiziphi ezinye izivivinyo ezingenziwa ukuze kuqinisekiswe ukuxilongwa?

I-pathologist yakho ingenza ukuhlolwa okubizwa i-immunohistochemistry ukuqinisekisa ukuxilongwa. Lokhu kuhlola kusiza ukuhlukanisa i-SCC kwezinye izinhlobo zezimila zamaphaphu njenge i-adenocarcinoma lokho kungabukeka ngendlela efanayo ngaphansi kwe-microscope. Imiphumela izochazwa njengephozithivu (esebenzayo) noma inegethivu (engasebenzi).

I-squamous cell carcinoma yamaphaphu ngokuvamile ibonisa imiphumela elandelayo:

• p40 – Okuhle.
• CK5 – Okuhle.
• I-TTF-1 – Negative.
• I-Chromogranin – Negative.
• I-Synaptophysin – Negative.

Kwenzekani uma kutholakala isimila esingaphezu kwesisodwa?

Kwezinye izimo, kutholakala isimila esingaphezu kwesisodwa lapho izicubu zamaphaphu zihlolwa ngesibonakhulu. Uma lokhu kwenzeka, isimila ngasinye sizochazwa ngokwehlukana embikweni wakho.

Kunezincazelo ezimbili ezingaba khona zokuthola isimila esingaphezu kwesisodwa:

1. Amaseli wesimila asuka kwesinye isimila asesabalele kwenye ingxenye yephaphu. Le ncazelo ingenzeka kakhulu uma zonke izimila ziwuhlobo olufanayo. Isibonelo, zonke izimila ziyi-SCC. Uma izimila zisohlangothini olulodwa nomzimba, izimila ezincane zibizwa ngokuthi amaqhuqhuva. Uma izimila zisemaceleni ahlukene omzimba (iphaphu lesokudla nesobunxele), isimila esincane sibizwa i-metastasis. Amaqhuqhuva esimila akhuphula isigaba sesimila kuyilapho isifo se-metastatic sandisa isigaba se-metastatic (bona isigaba se-Pathologic ngezansi). Zombili zihlotshaniswa nokubi kakhulu isibikezelo.
2. Amathumba athuthukile ngokwehlukana. Lena incazelo engenzeka kakhulu lapho izimila ziyizinhlobo ezahlukene. Isibonelo, isimila esisodwa siyi-SCC kanti esinye siyi- i-adenocarcinoma. Kulesi simo, izimila zibhekwa njengezifo ezihlukene hhayi isifo se-metastatic

Kusho ukuthini ukuhlasela kwe-pleural futhi kungani kubalulekile?

Amaphaphu azungezwe izicubu ezincane ezibizwa ngokuthi i-pleura. I-pleura inokubili ulwelwesi lwangaphakathi nolwangaphandle. Ulwelwesi lwangaphakathi luthinta iphaphu kanti ulwelwesi lwangaphandle lubheke endaweni evulekile ebizwa ngokuthi i-pleural space. Izimila ezidabula ulwelwesi lwangaphakathi lwe-pleura zingasakazeka endaweni ye-pleural futhi ukusuka lapho ziye kwezinye izingxenye zomzimba.

Udokotela wakho wezifo uzohlolisisa zonke izingxenye ze-pleura ngaphansi kwe-microscope ukuze abone ukuthi akhona yini amangqamuzana e-tumor adlulile ulwelwesi lwangaphakathi lwe-pleural. Ukunyakaza kwamangqamuzana e-tumor ngokusebenzisa ulwelwesi lwangaphakathi lwe-pleural kubizwa ngokuthi i-pleural invasion. Ukuhlasela kwe-Pleural kubalulekile ngoba kwandisa isigaba sesimila (bona isigaba se-Pathologic ngezansi) futhi sihlotshaniswa nokubi kakhulu. isibikezelo.

Ingabe isimila sesikhulile saba izitho ezingaphandle kwephaphu?

Iphaphu lizungezwe izitho eziningana ezihlanganisa amathambo, imisipha, i-diaphragm, inhliziyo, umminzo, kanye ne-trachea. Izimila ezinkulu zingakhula ngale kwephaphu futhi zibe kunoma iyiphi yalezi zitho ezizungezile. Ukungena kwesinye isitho kubalulekile ngoba kwandisa i-pathologic tumor stage (pT) futhi kuhlotshaniswa nokubi kakhulu. isibikezelo.

Usho ukuthini umphumela wokwelapha?

Umphumela wokwelashwa uchazwa embikweni wakho kuphela uma uthole ukwelashwa ngamakhemikhali noma ngemisebe ngaphambi kokuhlinzwa ukuze kukhishwe isimila. Ukuze unqume umphumela wokwelapha, udokotela wakho wezifo uzokala inani lethumba eliphilayo (eliphilayo) futhi aveze leyo nombolo njengephesenti lesimila sokuqala. Isibonelo, uma udokotela wakho wezifo ethola u-1 cm wesimila esisebenzayo futhi isimila sokuqala sasingu-10 cm, iphesenti lesimila esiphilayo singu-10%.

Kusho ukuthini ukuhlasela kwe-lymphovascular futhi kungani kubalulekile?A

Ukuhlasela kwe-lymphovascular kusho ukuthi amangqamuzana omdlavuza abonwa 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. Imikhumbi ye-lymphatic ixhuma nezitho ezincane zokuzivikela ezibizwa ngokuthi ama-lymph node ezitholakala kuwo wonke umzimba. Ukuhlasela kwe-lymphovascular kubalulekile ngoba amangqamuzana omdlavuza angasebenzisa imithambo yegazi noma imithambo ye-lymphatic ukuze asakazekele kwezinye izingxenye zomzimba njengama-lymph nodes noma isibindi.

Iyini imajini futhi kungani imingcele ibalulekile?

Ku-pathology, umkhawulo uwunqenqema lwesicubu esisikwa lapho kususwa isimila emzimbeni. Amamajini achazwe embikweni we-pathology abaluleke kakhulu ngoba akutshela ukuthi isimila sisusiwe sonke noma ukuthi esinye isimila sishiywe ngemuva. Isimo semajini sizonquma ukuthi yikuphi (uma kukhona) ukwelashwa okwengeziwe ongakudinga.

Imibiko eminingi ye-pathology ichaza kuphela amamajini ngemva kokuhlinzwa okubizwa ngokuthi ukuhlinza noma ukuhlinza ukuze kukhishwe lonke isimila. Ngalesi sizathu, amamajini awavamile ukuchazwa ngemva kwenqubo ebizwa ngokuthi a i-biopsy kwenziwa ukuze kukhishwe ingxenye kuphela yesimila. Inani lamamajini achazwe embikweni we-pathology lincike ezinhlotsheni zezicubu ezisusiwe kanye nendawo yesimila. Ubukhulu bomkhawulo (inani lezicubu ezivamile phakathi kwesimila kanye nonqenqema olusikiwe) lincike ohlotsheni lwesimila esikhishwayo kanye nendawo yesimila.

Izazi ze-pathologists zihlola ngokucophelela ama-margin ukuze zibheke amaseli wesimila emaphethelweni asikiwe ezicubu. Uma amaseli wesimila ebonakala emaphethelweni asikiwe ezicubu, umkhawulo uzochazwa njengephozithivu. Uma engekho amaseli wesimila abonwa emaphethelweni asikiwe ezicubu, umkhawulo uzochazwa njengenegethivu. Ngisho noma wonke amamajini engemihle, eminye imibiko ye-pathology izohlinzeka ngesilinganiso samaseli wesimila aseduze onqenqemeni lwethishu.

Imajini ephozithivu (noma esondele kakhulu) ibalulekile ngoba kusho ukuthi amaseli e-tumor kungenzeka ukuthi ayeshiywe ngemuva emzimbeni wakho lapho isimila sikhishwa ngokuhlinzwa. Ngenxa yalesi sizathu, iziguli ezinomkhawulo omuhle zingase zinikezwe okunye ukuhlinzwa ukuze kususwe sonke isimila noma ukwelashwa ngemisebe endaweni yomzimba enemajini eqondile.

Ayini ama-lymph nodes futhi kungani abalulekile?

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 i-metastasis.

Ama-lymph nodes entanyeni, esifubeni, nasemaphashini angase akhishwe ngesikhathi esifanayo nesimila. Lawa ma-lymph nodes ahlukaniswe abe izindawo ezibizwa ngokuthi iziteshi. Kuneziteshi eziyi-14 ezahlukene entanyeni, esifubeni, nasemaphashini (bheka isithombe ngezansi).

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.

Isigaba se-Pathologic (pTNM)

Isigaba se-pathologic se-SCC yamaphaphu sisekelwe ohlelweni lwesiteji lwe-TNM, uhlelo olwaziwayo emhlabeni wonke olwakhiwe 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.

Isigaba sesimila (pT) se-squamous cell carcinoma yamaphaphu

I-SCC inikezwa isiteji sesimila esiphakathi koku-1 no-4 ngokusekelwe kusayizi wesimila, inani lezimila ezitholwe kusicubu esihloliwe, kanye nokuthi ingabe isimila sibhodloze i-pleural noma sesisabalele ezithweni eziseduze kwamaphaphu.

Isiteji se-Nodal (pN) se-squamous cell carcinoma yamaphaphu

I-SCC inikezwa isigaba se-nodal phakathi kuka-0 no-3 ngokusekelwe ebukhoneni noma ukungabikho kwamangqamuzana omdlavuza ku-a i-lymph node kanye nendawo yama-lymph nodes aqukethe amaseli wesimila.

• NX - Awekho ama-lymph node athunyelwe ukuhlolwa kwe-pathologic.
• N0 - Awekho amaseli wesimila atholakele kunoma iyiphi i-lymph nodes ukuhlolwa
• N1 - Amangqamuzana e-tumor atholakala okungenani ku-lymph node eyodwa ngaphakathi kwephaphu noma eduze kwemigudu yomoya emikhulu eya emaphashini. Lesi sigaba sihlanganisa iziteshi 10 kuya ku-14.
• N2 - Amangqamuzana e-tumor atholakala okungenani ku-lymph node eyodwa kusuka esicutshini esimaphakathi nesifuba naseduze nemigudu yomoya emikhulu. Lesi sigaba sihlanganisa iziteshi 7 kuya ku-9.
• N3 - Amaseli e-Tumor atholakala entanyeni noma kunoma yimaphi ama-lymph nodes ohlangothini lomzimba obhekene (contralateral) ne-tumor. Lesi sigaba sihlanganisa iziteshi 1 kuya ku-6.

Mayelana nalesi sihloko

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

Ezinye izinsiza eziwusizo

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