Chemotherapy amagwiritsidwa ntchito ngati chithandizo kwa anthu ambiri omwe ali ndi kansa ya m'mawere nthawi zina. Kaya amagwiritsidwa ntchito mzere woyamba kapena ayi, zimadalira mtundu wanu wa mankhwala, mankhwala oyamba, ndi zina.
Chemotherapy ndi mankhwala opatsirana omwe amachititsa maselo a khansa kulikonse komwe iwo ali m'thupi. Chinthu chimodzi chosiyana ndi ichi, ndiye ubongo, ndipo njira zambiri mwa mankhwalawa zimangokhalapo chifukwa cha kupezeka kwa magazi-ubongo.
Momwe Ikugwirira Ntchito
Chemotherapy amagwira ntchito polimbana ndi maselo okula mofulumira monga maselo a khansa . Mankhwala ambiri a mankhwala a chemotherapy amachititsa kuti maselo a kansa asokonezeke panthawi inayake, koma magawo osiyanasiyana a seloyo amasokonezedwa ndi mankhwala osiyanasiyana.
Popeza mankhwalawa amakhudza maselo aliwonse omwe akukula mofulumira, amathanso kusokoneza maselo omwe amakhalapo m'thupi monga a m'mimba ( nkhono ), tsitsi la tsitsi, ndi mafupa (kuchepa kwa magazi ndi kuchepa kwa magazi).
Pamene Zimagwiritsidwa Ntchito
Kachilombo ka mankhwala kake kamene kamapatsidwa mankhwala akudalira makamaka mtundu wa khansa ya m'mawere yomwe muli nayo, kaya kapena chotupa chanu ndi receroor ya estrogen kapena HER 2 receptor zabwino , ndipo ngati mankhwala osokoneza bongo amatha kukhala osapindulitsa.
Chemotherapy kawirikawiri imalangizidwa mzere woyamba (monga chithandizo choyamba cha khansara yamatenda):
- Kwa amayi omwe ali ndi zotupa zotenga estrogen zomwe zakhala zosagwirizana ndi mankhwala a mahomoni monga tamoxifen kapena aromatase inhibitors.
- Kwa amayi omwe ali ndi zotupa zabwino za HER (kuphatikizapo mankhwala othandizidwa monga Herceptin) omwe ali oterewa osalandira.
- Kwa amayi omwe ali ndi zotupa zomwe zimapezeka ndi estrogen receptor ndi HER2 zoipa (katatu yosamalitsa khansa).
- Zingagwiritsidwe ntchito limodzi ndi mankhwala a mahomoni kwa omwe ali ndi zotupa zotchedwa estrogen zokhudzana ndi mankhwala a mahomoni ngati kuchepetsa mofulumira kwa chotupachi n'kofunika.
Kusinthasintha
Chemotherapy nthawi zambiri imaperekedwa mozungulira zomwe zili patali masiku 21 kapena 28. Chiwerengero cha zochitika zomwe mumalandira chidzadalira zinthu zambiri, kuphatikizapo yankho lanu ku mankhwala kapena mankhwala.
Chemotherapy ikhoza kugwira bwino ntchito ya khansa ya m'mawere, ngakhale kuti zotupa nthawi zambiri zimakhala zosagwirizana ndi mankhwala ena kapena mankhwala osokoneza bongo m'kupita kwanthawi. Si zachilendo kuti anthu azikhala ndi mankhwala osachepera atatu omwe amachititsa mankhwalawa.
Chemotherapy ya kansa ya m'mawere imatha kuperekedwa mosalekeza (kuphatikiza kwa mankhwala pambuyo pake popanda kupumula) kapena intermittently ndipo pali ubwino ndi zoyipa kwa njira iliyonse. Zapezeka kuti mankhwala opatsirana amatha kuchepetsa kukula kwa khansara mofulumira kwambiri kusiyana ndi mankhwala opatsirana, ngakhale kuti sizimawoneka kuti ndi kusiyana kwakukulu pa moyo wonse.
Mosiyana ndi zimenezi, omwe amalandira mankhwala othandizira ena amakhala ndi moyo wabwino kwambiri. Ndi zifukwa zambiri monga izi kuti wanu oncologist adzafuna kumvetsa zokonda zanu pankhani yosamalira kansa yanu.
Zolinga
Zolinga za mankhwala a chemotherapy kwa kansa ya m'mawere ndizosiyana kwambiri ndi mankhwala a chemotherapy pa matenda oyambirira, ndipo izi zingakhale zosokoneza kwambiri.
Kwa khansa ya m'mawere oyambirira, mankhwala a chemotherapy amatchulidwa kawirikawiri ndi cholinga chochiza matendawa. Mwachitsanzo, pamene chemotherapy imaperekedwa pambuyo pa opaleshoni ya khansa ya m'mawere, akuyembekezeredwa kuti mankhwalawa adzaukira maselo ena onse a khansa (omwe sungakhoze kuwonedwa pa maphunziro a kujambula,) mu chiyembekezo kuti khansara idzachiritsidwa. Amagwiritsidwa ntchito motero, chemotherapy imatchedwa mankhwala a adjuvant.
Chemotherapy ingagwiritsiridwenso ntchito khansa ya m'mawere oyambirira kuti ichepetse kukula kwa chotupa kotero kuti opaleshoni n'zotheka. Amagwiritsidwa ntchito motero, chemotherapy imatchedwa neoadjuvantrapy, ndipo cholinga ndi chithandizo.
Chemotherapy chifukwa cha khansa ya m'mawere, komabe imagwiritsidwa ntchito ndi zolinga zosiyana. Zolinga izi ndi:
- Kuwonjezera moyo wanu
- Kupititsa patsogolo umoyo wanu
- Kuchepetsa zizindikiro zanu
Mwa kuyankhula kwina, mosiyana ndi mankhwala a chemotherapy pa khansa ya m'mawere oyambirira, mankhwala a khungu la khansa ya m'matumbo sakuperekedwa ndi cholinga chochiza matenda, koma m'malo moletsa matendawa mwamsanga.
Nchifukwa Chiyani Sichichiza Cholinga?
Zingakhale zopweteka komanso zochititsa mantha mukamvetsa kusiyana pakati pa mankhwala omwe amachititsa khansa ya m'mawere oyambirira komanso zomwe zingakwaniritse khansa ya m'mawere.
Sikuti madokotala sakufuna kuyesa kuchiritsa khansa ya m'mawere ndi chemotherapy. Iwo amachita. Zili choncho ndi mankhwala omwe tili nawo pakalipano, komanso kukana kumeneku kumachitika m'kupita kwa nthawi, zomwe zimapangitsa kuti mankhwala a kanseri apite patsogolo ndi ochepa kwambiri. Ichi ndi chowonadi ngakhale mutakhala kuti mukuchitiridwa mankhwala oopsa kwambiri komanso oopsa a mankhwala osiyanasiyanawa.
Mwamwayi, malinga ndi kafukufuku, amayi ambiri (ndi amuna) akuyembekeza kuti ayankhe mosiyana ndi a oncologists, ndipo akuyembekeza kuti chemotherapy idzachiritsa khansara yawo ya mthupi. Timagawana izi kuti tisachotse chiyembekezo chanu. Pali anthu ena omwe amamva ndi kupitirizabe kuyankha kwa mankhwala a chemotherapy kwa nthawi yaitali. Komabe, ndizofunika kumvetsa zomwe mankhwala a chemotherapy angathe komanso sangathe kuchita ndi mankhwala omwe tili nawo panopa.
Ngati mukuyembekeza kuchiza, lankhulani ndi dokotala wanu. Pa nthawiyi palibe mankhwala ovomerezeka omwe angachiritse khansa ya m'mawere, ngakhale kuti mankhwala atsopano nthawi zonse amayesedwa m'mayesero a zachipatala. Kwa anthu ochepa, ena mwa mankhwalawa atsopano, monga mankhwala osokoneza bongo, akhoza (koma sitikudziwa ndipo chifukwa chake akuphunziridwa) amapereka mwayi waukulu wa kupulumuka kwa nthawi yaitali.
Pa nthawi imodzimodziyo, pali zosadziwika, ndipo mpaka mankhwalawa atavomerezedwa sitingakhale otsimikiza kuti sangapangitse zinthu kuipiraipira.
Chemotherapy Mankhwala Osokoneza Bongo
Ngati khansara yanu ikubwereranso ndipo mumakhala ndi mankhwala a chemotherapy nthawi yoyamba, mankhwala osiyanasiyana amagwiritsidwa ntchito. Zimaganizidwa kuti maselo a khansa omwe adapitiliza kupitirira chithandizo chanu choyambirira anali osagonjetsedwa ndi mankhwala. M'mawu ena, mankhwala a chemotherapy ayenera kuti anapha khansa zambiri koma maselo otsala omwe anali otsutsana ndi mankhwalawa anatsalira.
Si zachilendo kuti munthu akhale ndi mankhwala osachepera atatu omwe amagwiritsidwa ntchito pochiza khansa yawo. Posiyanitsa mankhwalawa, ovomerezeka amagwiritsa ntchito mankhwala a chemotherapy regimen monga mzere woyamba, wachiwiri, mzere wachitatu, ndi zina zotero. Chemotherapy amatha kukhala osagwira ntchito mofulumira pakapita nthawi pamene maulamuliro ambiri akufunika.
Maphunziro a mankhwala
Pali mitundu yosiyanasiyana ya mankhwala omwe angagwiritsidwe ntchito. Mankhwala enaake omwe amagwiritsidwa ntchito pa khansa ya m'mawere yakhudzidwa m'magulu ena ndi awa:
- Anthracyclines - Adriamycin (doxorubicine), Ellence (epirubicine)
- Alkylating agents - Cytoxan (cyclophosphamide)
- Taxanes - Taxol (paclitaxel), Taxotere (docetaxel)
- Mitotic inhibitors - Halaven (eribulin)
- Mankhwala a nucleoside analog - Gemzar (gemcitabine) ndi DNA synthesis inhibitors Xeloda (capecitabine)
- Antimetabolites - methotrexate
- Microtubule inhibitors - Ixempra (ixabepilone), Navelbine (vinorelbine)
- Mankhwala a Platinum - Platinol (cisplatin), Paraplatin (carboplatin)
- Matenda a Topoisomerase - etoposide
Kusakanikirana ndi Mnyamata Osakwatira
Mosiyana ndi mankhwala a adjuvant pa khansa ya m'mawere oyambirira yomwe nthawi zonse imaphatikizapo kugwiritsira ntchito mankhwala osakaniza, mankhwala omwe amagwiritsidwa ntchito limodzi amagwiritsidwa ntchito pa khansa ya m'mawere. Kugwiritsiridwa ntchito kwa mankhwala a chemotherapy nthawi zambiri kumangokhala nthawi imene khansara ikuyenda mofulumira kuti athetse matendawa.
Kuphatikiza pang'ono komwe kumagwiritsidwa ntchito kwambiri ndi Xeloda (capecitabine) ndi Taxotere (docetaxel) ndi Gemzar (gemcitabine) ndi Taxol (paclitaxel).
Matenda a ubongo
Ngakhale chemotherapy ikhoza kuchiza maselo a khansa pafupifupi kulikonse m'thupi, mankhwala ambiri a chemotherapy sangathe kufika mu ubongo. Izi zimakhala chifukwa cha kapangidwe kamene kamene kamatchedwa capillaries kamene kamatchedwa khungu la ubongo.
Mitsempha ya ubongo ya ubongo imapangidwa kuti iteteze poizoni kuti zisalowe m'zigawo zovuta za ubongo ndi msana, koma mwatsoka, zitha kupewa mankhwala a chemotherapy kuti asathenso kupeza. Njira zina zothetsera matenda, monga ubongo wonse wa radiotherapy, zingafunikire kuchiza khansa ya m'mawere yomwe yafalikira ku ubongo.
Zotsatira Zogwirizana
Anthu ambiri amadziwa kuti mankhwala a chemotherapy amakhala ndi zotsatirapo. Ngakhale izi ziri zoona, pakhala zothandiza kwambiri pakuyendetsa zotsatira za mankhwala a chemotherapy m'zaka zaposachedwapa, makamaka zizindikiro monga kunyoza ndi kusanza.
Zotsatira zake za mankhwala osiyanasiyana zingakhale zosiyana, ndipo ndizofunika kuyankhula ndi dokotala wanu zokhudzana ndi zomwe mungayang'ane.
Kutopa - Kutopa ndi chimodzimodzi mwa mankhwala omwe amagwiritsidwa ntchito ndi mankhwala a chemotherapy, ndipo chimodzi mwa zokhumudwitsa kwambiri. Ngakhale kuti tilibe chithandizo chapadera cha kutopa, monga momwe timachitira ndi mseru, pali zinthu zambiri zomwe mungachite kuti mukhale olekerera.
Njira zosavuta, monga kuyendetsa tsiku, kuika patsogolo ntchito, ndikuphunzira kugawana, zingakhale zothandiza kwambiri. Kumbukirani kuti panthawi imodzimodziyo ngati mukutopa, okondedwa anu mwina akukumana ndi kumverera kopanda thandizo. Kuphunzira kupereka nthumwi, ndikupempha ndi kulandira chithandizo sikungakuthandizeni kokha ndi kutopa kwanu koma kumalola okondedwa anu njira yothetsera mavuto awo.
Kutaya tsitsi - Kutaya tsitsi kumakhala kofala ndi mankhwala ambiri a chemotherapy. Kwa iwo omwe anali ndi chemotherapy "nthawi yoyamba pozungulira" izi zingakhale zovuta kwambiri nthawi ino. Ndipo mosiyana ndi mankhwala a adjuvant chemotherapy, nthawi zambiri pamakhala mapeto omveka bwino.
Ngati simunayambe kugwiritsira ntchito ndalama zanu pompano, izi zingakhale nthawi yabwino kuti muchite zimenezo. Inshuwalansi kaŵirikaŵiri imaphatikiza gawo la izi, ndipo mabungwe angapo amapereka mafilimu aulere ku tsitsi lopatsidwa. Nkhono ndi zipewa ndizo zosankha, ndipo nthawi zambiri zimakhala bwino.
Pakhala palifukufuku m'zaka zaposachedwapa kuyang'ana njira zothandizira kutaya tsitsi. Ngakhale kuti njirazi, monga kuvala ayezi panthawi yopuma, zingachepetse tsitsi lanu, zikhoza kukhala zosasangalatsa kwambiri.
Nsowa ndi kusanza - Ngakhale mankhwala ambiri omwe amagwiritsidwa ntchito pa khansa ya m'mawere imatha kuyambitsa chifuwa ndi kusanza, pali njira zambiri zothetsera vutoli. Ndipotu, palinso anthu ambiri omwe amadwala pang'ono kapena osasamala.
Pali mitundu yosiyanasiyana ya mankhwala omwe amagwiritsidwa ntchito, zomwe zimapangidwa kuti zisawonongeke pomwepo, ndi zina zomwe zingagwiritsidwe ntchito pofuna kuchiza khungu. Onetsetsani kuti mukalankhule ndi dokotala ngati mukukumana ndi vuto lililonse .
Ngakhale pali mankhwala ambiri, ena amagwira ntchito bwino kwa anthu ena kuposa ena, ndipo zimakhala zovuta kudziŵa mankhwala omwe amatsutsa nkhanza omwe amagwira bwino ntchito kwa munthu aliyense. Mungamve anthu akuyankhula za magulu a acupressure, ginger, ndi zina zotchedwa "njira zina" zothandizira mankhwala a chemotherapy.
Ngakhale kuti izi zingakhale ndi zotsatira zina, ziyenera kugwiritsidwa ntchito ngati mankhwala owonjezera kutsutsa, osati monga choloweza mmalo.
Kutsekula m'mimba kungasonyezenso ngati zotsatira zake. Gwiritsani ntchito ndi dokotala kuti muone zomwe mungachite kuti muchepetse mbali iyi.
Matenda a mafupa a mitsempha - Zotsatira za chemotherapy mankhwala pa fupa la mafupa zingayambitse kuchepa kwa mitundu yonse ya maselo a magazi opangidwa m'mafupa. Izi zimaphatikizapo maselo ofiira a magazi (maselo a magazi), maselo oyera a magazi (leukopenia kapena neutropenia), ndi mapuloletsiti thrombocytopenia.
Chiopsezo chachikulu chochotsedwa chifukwa cha kuperewera kwa m'mawere ndi chiwerengero choyera cha maselo oyera. Izi zikhoza kukupangitsani kuti mukhale ndi matenda opatsirana ndi mabakiteriya omwe nthawi zambiri samakhala opweteka, ndipo zimakhala zovuta kuti mumenyane ndi matenda akatha. Ngati mumakhala ndi malungo pomwe muli mankhwala a chemotherapy (ngakhale osakwana 100.5) ndikofunika kutchula dokotala nthawi yomweyo.
Ambiri mwa matendawa ndi ochiritsidwa kwambiri, koma chithandizo chofulumira chingapangitse kusiyana kwakukulu. Dokotala wanu adzakuuzani za njira zochepetsera matenda, ndipo nkofunika kuti muwerenge izi. Anthu omwe amagwiritsa ntchito mankhwala a chemotherapy-omwe ali ndi kachilombo ka magazi kawirikawiri amadziwika kuti amapewa malo ambiri (makamaka m'nyengo yozizira ndi nyengo ya chimfine) komanso kuchepetsa kukhudzana ndi okondedwa awo omwe akudwala. Ndi mankhwala enaake a mankhwala, dokotala wanu angapereke mankhwala kuti muwonjezere kuchuluka kwa maselo oyera a magazi.
Kuchuluka kwa magazi m'thupi kungakuthandizeni kuti mudwale. Lankhulani ndi dokotala wanu za hemoglobin ndipo pamene angaganize kuti azisamalira bwino. Kuwerengera kochepa pamatope kungapangitse chiopsezo chanu chokhala ndi magazi. Ngati msinkhu wanu uli wotsika, ndibwino kupewa zinthu zomwe zingayambitse magazi kapena kuvulaza.
Matenda a m'mitsempha - Zina mwa mankhwala a chemotherapy, angayambitse kuphatikizapo zizindikiro zosokoneza ubongo. Zizindikiro zimaphatikizapo kutenthedwa, kuyimba, ndi kupweteka kumene kumachitika "kugawa ndi kugulitsa" m'manja ndi mapazi.
Popeza kuchepa kwa msampha kumapangitsa kuti musayende bwino, anthu ogwiritsa ntchito mankhwalawa ayenera kuyang'ana pozungulira malo awo a nyumba kuti achepetse mwayi wawo wogwa, pewani kugwiritsa ntchito zopinga monga kuponyera makoti ndi kusamala pamene mukuyenda mu ayezi ndi chipale chofewa . Ngakhale kuti matenda a ubongo amatha kusintha pakapita nthawi, zizindikiro zina zikhoza kukhala zotsalira pambuyo posiya chithandizo.
> Zotsatira:
> DeVita, Vincent., Et al. Khansara: Mfundo ndi Zochita za Oncology. Khansa ya pachifuwa. Wolters Kluwer, 2016.
> Liedtke, C., ndi H. Kolberg. Thandizo labwino la Khansa yapamwamba / Metastatic Breast Breast-Umboni Weniweni ndi Malingaliro Amtsogolo. Care Care . 2016. 11 (4): 275-281.