I-Squamous Cell Carcinoma: Umkhuhlane Wesikhumba Ofuna Ukwaziswa

I-squamous cell carcinoma (SCC) iyifomu yesibili evamile yomkhuhlane wesikhumba, ivela kumaseli e-squamous akha izingqimba eziphakathi nezangaphandle ze-epidermis. 8 million cases ziqashelwa e-United States minyaka yonke, futhi ukuvela kwe-SCC kuye kwanda kakhulu — ngokwezinye izilinganiso kukhuphuka ngo-200% eminyakeni engama-30 edlule ngenxa yokukhula kwabantu, ukuvuvukala kwe-UV, nokwanda kokutholwa. I-SCC ibamba indawo ebalulekile phakathi kobunzima bomkhuhlane wesikhumba: ivame kakhulu futhi ngokujwayelekile ayinabungozi obukhulu kune-melanoma, kodwa ibaluleke kakhulu kunobungozi be-basal cell carcinoma ngenxa yokwenzeka kwayo kokuhamba.

Uma i-SCC isakazeka ezindaweni ze-lymph ezikude noma emathunjini, ukuhlela kwezimali kuyanda kakhulu — i-SCC ehambayo iletha izinga lokuphila elingama-30-50% eminyakeni emihlanu, kuye ngendawo yokuhamba. Lesi sifo ngokuvamile sithuthukiswa esikhumbeni esithole ilanga — ubuso, izindlebe, isikhumba, ikhanda, izandla, nezandla — kodwa singavela nasemlonyeni, ngaphakathi emlonyeni, ezindaweni zokuzala, nasezindaweni zokuhlala ezibuhlungu noma ezivuvukalayo. I-SCC ivame ukuvela ezimeni eziphambili, ikakhulukazi ama-actinic keratoses, okwenza kube omunye wemikhuhlane eminingi enezigaba ezitholakalayo ezivumela ukuhlinzwa kokuvimbela. Umgwaqo ovela esikhumbeni esijwayelekile uya ekonakaleni kwelanga, uya ku-actinic keratosis, uya ku-SCC ehlaselayo ubonisa ukuthi ukuvikelwa kwelanga okwandile kubalulekile kuzo zonke izigaba zokuphila nokuthi ukwelashwa kwezigameko eziphambili kuvimbela ukuthuthukiswa komkhuhlane.

Ukuvuvukala kwe-ultraviolet okwandile kuyisici esikhulu sokubanga se-SCC — ngokungafani ne-melanoma, ehlobene nokuvuvukala okukhulu okujwayelekile nokushisa kwelanga, i-SCC ihlobene kakhulu nenani eliphelele le-UV empilweni. Lokhu kwenza i-SCC ikhethekile kakhulu kubasebenzi basemaphandleni, abantu abahlala ezindaweni eziphansi, kanye nalabo abaneziminyaka eziningi zokuvuvukala kwelanga. Isikhumba esihle, izinwele ezilula, kanye namehlo aluhlaza noma aluhlaza okwesibhakabhaka kunikeza ubungozi obukhulu, kodwa i-SCC ivela kuzo zonke izinhlobo zesikhumba.

Kubantu abanesikhumba esinsundu, i-SCC ivame ukuvela ezindaweni zokuhlala ezibuhlungu, ukuvuvukala, noma ezindaweni ezingatholi ilanga, futhi lezi i-SCC ziba nobungozi obukhulu. Ukuvinjelwa kokuvuvukala kuyisici esinamandla sokwandisa ubungozi: abatholi bezitho zomzimba abathola imishanguzo yokuvimbela ubungozi be-SCC bahlala benobungozi obuphindwe kabili kuya kwe-250 uma kuqhathaniswa nezwe elijwayelekile, futhi i-SCC yabo ibaluleke kakhulu futhi ibonakala kakhulu. I-HIV/AIDS, i-chronic lymphocytic leukemia, nezinye izimo ezivimbela ukuvuvukala zikhuphula ubungozi ngendlela efanayo.

Ukuhlukunyezwa kwe-human papillomavirus (HPV) kudlala indima ekuthuthukiseni i-SCC, ikakhulukazi ezindaweni zokuzala, endaweni ye-perianal, nasezindaweni ezivimbela ukuvuvukala. Izinhlobo ezithile ze-HPV (16, 18) zikhona ezithinta ngqo amaseli e-squamous. Izilonda eziphindaphindiwe, izibazi, nezindawo zokuvuvukala eziphindaphindiwe zingaholela ku-SCC — i-Marjolin's ulcer ichaza i-SCC evela ezilondweni eziphindaphindiwe noma ezibazi zokushisa, imvamisa eminyakeni engama-30 ngemva kokulimala kokuqala.

Ukuhlola imithi yokwelapha kwezinye izimo kukhuphula ubungozi be-SCC endaweni ethintwayo. Ukuvuvukala kwe-arsenic, ezinye izinto zokwakha, kanye ne-coal tar derivatives kukhuphula ubungozi. Umlando wakho siqu wemikhuhlane yesikhumba ungenza kube phezulu kakhulu ubungozi be-SCC, njengoba umlando we-actinic keratoses.

Izimo zezakhi zofuzo ezifana ne-xeroderma pigmentosum (ukuphazamiseka kokulungisa i-DNA) zenza kube nokwenzeka kakhulu. Ukubhema kuhlobene ngqo ne-SCC yomlomo.

I-squamous cell carcinoma ibonakala ngezindlela eziningi, futhi ukuqaphela ukubonakala kwayo okuhlukahlukene kubalulekile ukuze kutholakale kusenesikhathi. Ukubonakala okuvamile kakhulu kuyinodulo eliqinile, elibomvu, ngokuvamile elinendawo eqinile, enesikhumba, noma enezinhlamvu. Ngokungafani nekhwalithi ye-pearly, ebonakalayo ye-basal cell carcinoma, i-SCC ivame ukubukeka ikhululekile, inobungozi, futhi ibonakala kakhulu.

I-lesion eqinile enendawo eqinile, enezinhlamvu ezikhula kancane kancane iyona enye indlela evamile yokubonakala, ikakhulukazi emzimbeni nasemathunjini. I-SCC yomlomo ivame ukuvela njengendawo eqinile, enezinhlamvu, noma enezilonda emlonyeni ophansi. Isixwayiso esiyinhloko esabelana phakathi kokubonakala kwe-SCC yisilonda esingapholi — i-lesion ehlanzekile, enezinhlamvu, ebonakala ithuthuka, bese iphuka futhi iphinde iphuke izikhathi eziningi phakathi kwezinsuku kuya ezinyangeni.

Noma iyiphi ilonda engapholi esikhumbeni esithole ilanga kufanele ihlolwe. I-SCC ingavela futhi njengokukhula okufana ne-wart, ukuphakama okufana ne-horn ye-keratin (i-cutaneous horn), noma indawo yesikhumba esiqinile, esinobungozi esiphuma uma izinhlamvu zikhishwa. Ezinhliziyweni, i-SCC ivame ukuvela njengodulo oluthambile, olunezinhlamvu ezithambile.

Ekhanda, ingase ibonakale njengosilonda olungapholi noma indawo yokukhula endaweni engatholi ilanga. Izici ezikhombisa ubungozi obukhulu zifaka ukukhula okusheshayo, usayizi omkhulu (ongaphezu kwe-2cm), indawo ezindlebeni, emlonyeni, noma emathanjeni, ukuhamba ezakhiweni ezijulile (ukubamba okubonakalayo kumathambo aphansi), ubuhlungu noma ubuhlungu, nezimpawu zokuhamba kwe-perineural ezifana nokungabi namandla, ukuvuvukala, noma ubuthakathaka bemisipha endaweni. Ukushintsha kusuka ku-actinic keratosis kuya ku-SCC kungaba kuncane — i-AK ethuthuka ibe nkulu, ithambile, noma ithuthukisa isisekelo esiphakeme ingase ibonakale ithuthuka ku-SCC ehlaselayo futhi idinga i-biopsy.

Ukuhlola i-SCC kuqinisekisa indlela yokwelashwa futhi kuhlola umphumela. Uhlelo lokuhlola lwe-American Joint Committee on Cancer (AJCC) luthatha usayizi we-tumor, ubukhulu bokuhlasela, indawo, nezici zokuhlola. I-SCC yeziqongo I iyizifo ezincane ezingaphansi kwe-2cm ngaphandle kwezici eziphakeme, nezinga lokwelashwa lidlula u-95% uma kuhlolwa kahle.

I-SCC yeziqongo II iyizifo ezinkulu ezingaphezu kwe-2cm noma zinezakhiwo eziphakeme zokuhlola (ukuhlukaniswa okuphansi, ukuhamba kwe-perineural, ubukhulu obungaphezu kwe-6mm noma ngaphakathi kwefat ye-subcutaneous) kodwa zihlala zikhona, nezinga lokwelashwa le-70-90%. I-SCC yeziqongo III ibonisa ukuhlanganiswa kwe-lymph regional, nezinga lokuphila leminyaka emihlanu lehla lize kube ngu-40-60%. I-SCC yeziqongo IV ibonisa ukuhamba okude, inezinga lokuphila leminyaka emihlanu elingama-20-30%.

Izici eziphakeme ezithuthukisa ukuhlela zifaka usayizi we-tumor obukhulu kune-2cm, ubukhulu obungaphezu kwe-6mm noma ukuhamba okungaphezu kwefat ye-subcutaneous, ukuhamba kwe-perineural (umkhuhlane ukhula ngaphezulu kwezitho zenu, okudala ubuhlungu, ukungabi namandla, noma ubuthakathaka), ukuhlukaniswa okuphansi, indawo ezindlebeni noma emlonyeni (ezithwala ubungozi obuphindwe kabili kuya kwezindawo ezihlukene), ukuvinjelwa kokuvuvukala, nokuphindaphinda ngemva kokwelashwa. Izinga lokuhamba kwe-SCC ye-cutaneous ngokujwayelekile lingama-2-5%, kodwa kumaphuzu aphezulu lokhu kukhuphuka kakhulu — i-SCC yomlomo ihamba kuze kube ngu-14% wezimo, futhi i-SCC kubantu abavimbela ukuvuvukala ihamba kakhulu. Ukuqonda iphrofayili yakho ethile yokubanga kuholela ekwelashweni okukhulu: i-SCC encane, ehlukanisiwe kahle esandleni ingase ihlolwe kahle ngokuhlinzwa okujwayelekile, kanti i-SCC engahlukanisiwe kahle ezindlebeni enokuhamba kwe-perineural idinga ukuhlinzwa kwe-Mohs, imishanguzo yokwelapha, nokuhlolwa okuqinile kokuhamba.

Izinketho zokwelashwa ze-SCC zixhomeke ezicini ze-tumor nasekucaciseni ubungozi. Ukuhlinzwa okujwayelekile kokukhishwa ngezikhala ezinqunyiwe (4-6mm ye-tumor eziphansi, ezinkulu kakhulu ezindaweni eziphakeme) kufanelekile kuma-SCC amaningi, kunikeza izinga lokwelashwa eliphezulu kakhulu le-92% lezi zifo eziyisisekelo. I-sampula ithunyelwa ukuze ihlolwe ukuze kuqinisekiswe izikhala ezicacile.

Ukuhlinzwa kwe-Mohs micrographic kunikeza izinga lokwelashwa eliphezulu kakhulu (97-99% ye-SCC eyisisekelo) kanye nokugcina izicubu eziningi kakhulu ngokuhlola u-100% wezikhala zokuhlinzwa ngesikhathi sokuhlinzwa. I-Mohs ikhethekile kakhulu kuma-SCC ebusweni, ezindlebeni, emlonyeni, ezandleni, nasezindaweni zokuzala; kumatshali amakhulu noma abukhali; kumatshali anemikhawulo engacacile; kumatshali aphindaphindiwe; nasezindaweni ezivimbela ukuvuvukala. Ikhono lokuhlola yonke imikhawulo yokuhlinzwa ngesikhathi sangempela, esikhundleni sokuhlola ingxenye njengokukhishwa okujwayelekile, kubalulekile ukuze kuqinisekiswe izinga eliphezulu lokwelashwa.

Kubantu abangabafundi bezokwelapha ngenxa yezimo zomzimba, ukuhlinzwa kwe-radiation kunikeza enye indlela ephumelelayo, kufinyelela izinga lokwelashwa le-90% kuma-SCC amancane, ayisisekelo. Ukuhlola imithi yokwelapha ngemva kokuhlinzwa kwezakhiwo eziphakeme ezifana nokuhamba kwe-perineural noma imikhawulo emihle lapho ukwakhiwa kabusha kungafaneleki. Ukuhlola nokuhlanza kungase kube kuhle kuma-SCC amancane, aphansi ezindaweni ezingathinteki.

Kubantu abane-SCC abavela, abavimbela ukuvuvukala, noma abane-SCC ehamba, i-immunotherapy yesistimu enezithiyo zokuhlola ithuthukise umkhakha wokwelashwa. I-Cemiplimab (Libtayo) kanye ne-pembrolizumab (Keytruda) ziqinisekisiwe kuma-SCC akhulu futhi zifeza izinga lokuphendula elingama-40-50%, zinikeza inzuzo ebalulekile kubantu abaye bahlala bengekho nezinye izinketho. I-chemotherapy (izinhlelo ezisekelwe ku-cisplatin) isaqhubeka njengenketho kodwa ayisebenzi kahle futhi ibuhlungu kakhulu kune-immunotherapy.

Ukuhlola okuqondile nge-EGFR inhibitors (cetuximab) kunikeza enye indlela yesistimu. Kubantu abane-SCC abavela, abangafaneleki ukuhlinzwa noma ukuhlinzwa, ukuhlola kwe-multidisciplinary tumor board kuqinisekisa ukuhlela kahle kokwelashwa.

Noma iyiphi ukukhula okusha noma okushintshayo esikhumbeni esithole ilanga kudinga ukuhlolwa kwe-professional, kodwa izici ezithile zidinga ukunakwa okuphuthumayo. Isilonda esingapholi ngemva kwezinsuku ezi-3-4 kufanele sihlolwe — ukungapholi okuqhubekayo kuyisixwayiso esivamile sokubonakala kwe-SCC. Ukukhula okusheshayo kwe-lesion yesikhumba phakathi kwezinsuku kuya ezinyangeni kukhombisa inqubo enobungozi edinga i-biopsy esheshayo.

' Uma unomlando we-actinic keratoses futhi enye iba nkulu, ibuhlungu kakhulu, noma ithuthukisa isisekelo esiphakeme, lokhu kungase kubonise ukuhamba ku-SCC. Noma iyiphi ukukhula emlonyeni, ezindlebeni, noma emathanjeni okuqhubeka ngaphezu kwezinsuku ezimbalwa kufanele kuhlolwe — lezi zindawo zinezingcuphe eziphezulu zokuhamba futhi zidinga ukuhlolwa okuphuthumayo. Ukungabi namandla, ukuvuvukala, noma ubuthakathaka bemisipha eduze kwe-lesion yesikhumba kukhombisa ukuhamba kwe-perineural futhi kudinga ukuhlolwa okuphuthumayo.

Izitho ze-lymph ezivuvukalayo eduze komkhuhlane wesikhumba noma endaweni yokuhlala yesikhumba edlule zidinga ukuhlolwa ngokuphuthumayo ukuze kuhlolwe ukuhamba. Kubantu abavimbela ukuvuvukala (abatholi bezitho zomzimba, abantu abane-HIV, abantu abathola imishanguzo yokuvimbela ukuvuvukala), noma iyiphi ukukhula kwesikhumba okusha kudinga umkhawulo ophansi we-biopsy ngenxa yokukhuphuka kakhulu kwe-SCC nokuziphatha okukhulu kule ndawo. Uma uke waba ne-SCC, qhubeka uqaphele — ubungozi bokuthuthukisa i-SCC eyengeziwe bukhulu, futhi ukutholwa kwangaphambili kwezinto ezintsha noma ukuphindaphinda kubalulekile.

I-squamous cell carcinoma iyalashwa kakhulu uma itholakala kusenesikhathi kodwa ingaba yingozi empilweni uma iqashelwa sekwedlule. I-Skinscanner inikeza ithuluzi lokuhlola elitholakalayo elingasiza ekuqapheliseni ama-lesions angathandeki phakathi kokuhlolwa kwesikhumba okwenziwa ochwepheshe. I-AI yethu ifundiswe ukuqaphela izici zokubona ezihlobene ne-SCC — ama-nodules aqinile anendawo eqinile noma enezinhlamvu, izilonda ezingapholi, nezinguquko ezincane ezihlukanisa umkhuhlane ophumayo endaweni engathandeki.

Ngokuthwebula izithombe zama-lesions akhathazayo, uthola ukuhlaziywa okusheshayo okukhombisa izici ezidinga ukuhlolwa kwe-dermatologic. Kubantu abanezingcuphe eziphezulu — abantu abanesikhumba esihle abane-UV enkulu, abantu abavimbela ukuvuvukala, noma ubani onomlando wemikhuhlane yesikhumba noma ama-actinic keratoses — ukuhlola njalo kwezindawo ezithole ilanga kudala uhlelo lokuhlola oluthola izinguquko kusenesikhathi. Ukubhaliswa kwenyanga kwesikhumba sakho kukuvumela ukuthi uqaphele ukukhula okuncane, izinguquko zendawo, noma ukuthuthukiswa kwe-lesion okwenziwa kancane kancane ukuze kudlule emqondweni kodwa kubonakale kalula ezithombeni ezithathwe ezinyangeni ezahlukene.

I-Skinscanner ibaluleke kakhulu ekuhloleni ama-actinic keratoses aziwayo, njengoba ukushintsha kusuka ku-pre-cancer kuya ku-SCC ehlaselayo kungaba kuncane — ukukhula, ukwanda kokuthambile, noma ukuthuthukiswa kwesisekelo esiphakeme kungabhalwa ezithombeni ngaphambi kokuthi uqaphele ushintsho empilweni yansuku zonke. Ezindaweni ezinzima ukufinyelela ezifana nekhanda, izindlebe, nempundu lapho i-SCC ivame ukuvela, ukuba nomngane ukuthwebula lezi zindawo ukuze kuhlolwe i-AI kugcwalisa igebe elibalulekile ekuhloleni. I-Skinscanner ayiqasheli umkhuhlane — kuphela i-biopsy ingaqinisekisa i-SCC — kodwa inikeza isixwayiso sokuqala esikukhuthaza ukuthi ufune ukuhlolwa kwe-professional okungasindisa impilo yakho.