Njira Zothandizira ndi Matenda Opatsirana
Kachilombo ka chifuwa cha chifuwa ndi khansa ya m'mawere yomwe imabwerera pambuyo poyambitsa matenda . Khoma la chifuwa chimaphatikizapo khungu, minofu, ndi fascia pansi pa tsamba la chifuwa choyambirira, komanso maselo amphongo . Pamene khansara imayambiranso mu khoma la chifuwa, ikhoza kuwerengedwanso ngati kubwerera m'midzi, kapena kugwirizanitsidwa ndi mitsempha yayitali. Ngati khoma lachifuwa likubweranso, limatchulidwa ngati kusamalidwa kwa khansa ya m'mawere.
Pafupifupi 5 peresenti ya amayi omwe ali ndi vutoli adzabwezeretsedwa m'deralo zaka khumi zotsatira.
Zingakhale zosokoneza kwambiri ndikufufuza kafukufuku wamkati. Ndiziwerengero ziti zomwe ziri zolondola? Nchifukwa chiyani mankhwala akuwoneka kuti akutsutsana? Kwa cholinga cha nkhaniyi, tikukamba za anthu omwe ali ndi vutoli. Ngati khansara imatuluka m'mimba pambuyo pa lumpectomy , izi ndi zosiyana kwambiri.
Zizindikiro
Khoma la chifuwa cha chifuwa lingayambe kuwonedwa ngati chilonda chimene chimachiza, ndipo mwina chimatulutsa. Pangakhale kusokonezeka kapena kukopa.
Kudziwa
Ngati kubwereza kwanu kukuwoneka, chiwopsezo chingachitike kuti mudziwe ngati mukubwezeretsa bere kapena ayi. Ngati ndizowonjezera, ovomereza amalangizi amalimbikitsanso kubwereza mayesero kuti awone ngati ndiestrogen receptor positive, progesterone receptor positive, kapena HER2 zabwino . Izi zingawoneke zodabwitsa pambuyo poti ayesedwa kale, koma mobwerezabwereza, chikhalidwe cha maselo a kansa chingasinthe, makamaka ngati zakhala zoposa chaka chimodzi kapena ziwiri kuyambira mastectomy.
Mwa kuyankhula kwina, ngati poyamba munali ndi chifuwa cha khansa ya m'mawere chomwe chinali estrogen receptor zabwino, maselo anu amtundu angasinthe ndi kukhala estrogen receptor zoipa. Mwachikhalidwe, izi zimatchedwa "kusagwirizana kwa chotupa."
Anthu ena akhoza kudabwa kuti biopsy ikulimbikitsidwa ngati dokotala wanu ali otsimikiza kuti ndiwowonjezera khansa yanu yapachiyambi.
Ndi chifukwa cha kusagwirizana kumeneku, ndipo zingakhudze kwambiri posankha njira zabwino zothandizira.
Popeza kuti kubwereza kwapachilumbako monga chikhomodzinso cha mchifuwa kungagwirizanitsidwe ndi metastases kutalika, ntchito yothandizira kawirikawiri imayambanso kuchitidwa ndipo ingaphatikizepo PET kuyang'ana malo ena kufalikira m'thupi.
Kuchiza
Mofanana ndi matenda anu oyambirira a khansa ya m'mawere, kupatsirana kubwereza kumaphatikizapo mankhwala ochepa. Chithandizo chingathyoledwe:
- Mankhwala othandiza: Awa ndi mankhwala omwe amakhudza maselo a khansa kulikonse m'thupi lanu, ndipo amaphatikizapo mankhwala a chemotherapy, mankhwala ochiritsira, mankhwala achimuna, ndi zina mwa mankhwala atsopano omwe akupezeka m'mayesero a chipatala monga PARP inhibitors ndi zina.
- Zochitika zapanyumba: Mankhwalawa amakhudza khansa kumene imayambira (kapena imafalitsa) koma sichithetsa maselo a khansa kwinakwake m'thupi. Zitsanzo zimaphatikizapo chithandizo cha ma radiation, opaleshoni, ndi mankhwala a proton.
Gawo loyamba ndikutanthawuza ngati kubwereza kwa chifuwa ndikutembenuka kwina, kapena ngati malo ena obwereza, makamaka omwe ali kutali kwambiri.
Chifuwa cha Wall Recurrence Plus Distant Metastases
Ngati palinso umboni wa kutalika kwa mankhwala , kansa ya kansa ya m'mawere idzakhala njira yoyamba.
Izi zingaphatikizepo. Mankhwala am'deralo angagwiritsidwe ntchito kuti athetse khansa mu khoma la chifuwa monga momwe tafotokozera m'munsimu. Malinga ndi kafukufuku wa 2018 pafupi ndi 27 peresenti ya amayi omwe ali ndi kubwerera kwawo, monga chikhomodzinso chikhomodzinso, chidzakhala ndi ma synastronous distant metastasis.
Mphepete mwa Chigwa cha Wall Metastases (Kupanda Mavitamini Osasintha)
Ngati palibe umboni wa matenda omwe ali kutali kwambiri pa kuyesedwa (palibe umboni wa khansara umene wafalikira mafupa, mapapo, chiwindi, ubongo, kapena madera ena), mankhwala am'deralo kuthetsa kubwereza ndi cholinga cha chithandizo. Popeza kuti chotupa chimene chafalikira ku khoma la chifuwa chakhala "chinenedwa cholinga chake" kufalitsa ku madera ena a thupi, njira zochiritsira zofunikira ndizofunikira.
Musanayambe kulandira chotupacho, nkofunika kuti "re-biopsy" ichitike kuti muzindikire momwe chikumbumtima chimayambira. Zosankha zikuphatikizapo:
Chemotherapy
Ngati malo obwerezabwereza ndi ochuluka kwambiri kuti athetsedwe kwathunthu ndi opaleshoni, chemotherapy ikhoza kugwiritsidwa ntchito poyamba kuchepetsa kukula kwa chotupa kotero kuti chithandizo chapafupi chichitike.
Mankhwala Opanga Mafuta
Ngati mankhwalawa sakagwiritsidwa ntchito panthawi yomwe khansa yapachiyambi inkagwiritsidwa ntchito, izi zimagwiritsidwa ntchito (kuphatikizapo opaleshoni kapena njira zina zochotsera chotupa) kuti zithetse kuti maselo a khansa amachiritsidwa (maselo omwe sangawoneke pa mafano koma amaganiziridwa Ngati mankhwalawa akugwiritsidwa ntchito kale, mawotchi anu amachititsa kuti phindu likhale lopindulitsa poyang'ana kuti mwakhala ndi mankhwala otani kwa nthawi yaitali, ndipo ngati mungafunikire kuchepetsa mlingo wa mankhwalawa.
Opaleshoni
Kuchita opaleshoni ndiyo njira yowonjezereka yothandizira kuchotsa malo obwereza. Monga tanenera kale, mankhwala a chemotherapy angafunikike kuti achepetse kukula kwa chotupacho asanayambe opaleshoni, ndipo mankhwala opatsirana pogwiritsa ntchito mankhwalawa amatchulidwa kawirikawiri atatha opaleshoni.
Zowonjezera zowonjezera resection zimalimbikitsidwa ngati zingatheke, ndipo zikachitika kwa anthu omwe ali oyenerera, zinachititsa 41 peresenti ya kupulumuka pambuyo pa zaka 15 malinga ndi phunziro la 2018.
Thandizo la Hormonal
Ngati kubwereza ndikutenga kachilombo ka estrogen ndipo kunali kosalephereka, mankhwala opangira mahomoni adzalimbikitsidwa. Izi zikhoza kukhala tamoxifen, chifukwa cha anthu omwe amachititsa mchitidwe wamagazi wamagazi kapena odwala matendawa, ndipo amatha kupatsirana pogwiritsa ntchito mankhwala a antibiotic, aromatase inhibitor monga Aromasin (exemestane), Arimidex (anastrozole), kapena Femara (letrozole). Ngati chotupacho ndi cholandira cha estrogen chabwino ndipo chotupa chanu choyamba chinali receptor chitsimikizo, wanu oncologist adzasamala mosamala zomwe mungasankhe. Pamene kubwereza kumachitika mukakhala ndi mankhwala a mahomoni, chotupacho chikhoza kukhala chosagonjetsedwa. Mankhwala osiyana angakonzedwe, kapena
Thandizo Lolinga
Ngati chotupa chanu chiri HER2 zabwino ndipo chotupa chanu choyambirira chinali HER2 chosasangalatsa, HER2 zomwe zakhudzana ndi chithandizo monga Herceptin (trastuzumab) zingakonzedwe. Ngati chotupa chanu chiri HER2 zabwino komanso chinali HER2 chitsimikizo, chithalo chosiyana cha HER2 chingagwiritsidwe ntchito.
Proton Therapy
Thandizo la Proton ndi mankhwala atsopano, ndipo tilibe maphunziro ambiri. Kafukufuku wina wa 2017 anapeza kuti mankhwala a proton a chifuwachi amatha kubwerera, pamene mankhwala opatsirana pogwiritsa ntchito mankhwalawa anachitidwa kwa khansa yoyamba, anali ndi poizoni ovomerezeka. Opaleshoni ku khoma la chifuwa, komabe, pambuyo pa mankhwala a proton, angabweretse mavuto aakulu pa machiritso a machiritso.
Kuthamangitsani
Chiwerengero cha zaka 10 zomwe zimakhalapo pa khansa ya m'mawere ndi chikhomodzinso chifuwachi ndi pafupifupi 50 peresenti, koma izi zingasinthe tsopano ndi njira zabwino zothandizira. Nthawi yayitali pakati pa kansa ya m'mawere oyambirira ndi kubwereza kwawo kumakhala ndi ntchito yofunika kwambiri kuti apulumuke, pamodzi ndi omwe ali ndi chifuwa chachifuwa m'kati mwa zaka zitatu za matendawa (pafupifupi 30 peresenti), pamene iwo akubwereranso pambuyo pa zaka zitatu , kupulumuka kwake kungakhale 70% kapena kuposa.
Kulimbana
Ngati khansa yako ya m'mawere imabwereranso, zingakhale zoopsa kwambiri kuti pamene mutenga kale matendawa. Chimodzi mwa izi ndi chakuti 27 peresenti ya mchimake khoma recurrences imayanjanitsidwa ndi kutali (metastatic khansa ya m'mawere) yomwe imatanthauza kuti khansa sichirachiritsidwa. Komabe, ngakhale khansara sichizachiritsidwa, ikadali yotheka kwambiri, ndipo pali njira zingapo zomwe zingatheke.
Kwa iwo omwe ali ndi kutalikiranso kwina kumeneku, kuchotsa makulidwe amtunduwu kungapangitse kukhala ndi moyo kwa nthawi yaitali kwa anthu ambiri omwe akufuna thandizoli.
> Zotsatira:
> Cardoso, F., Fallowfield, L., Costa, A., Catiglione, M., ndi E. Senkus. Khansa ya m'mimba yowonongeka kapena yowonjezera m'mimba: Njira zogwiritsira ntchito zachipatala za ESMO za Kufufuza, Chithandizo ndi Kutsata. Annals of Oncology . 2011. 22 (Suppl 6): vi25-vi30.
> D'Aiuto, M., Cicalese, M., D'Aiuto, G., ndi G. Rocco. Opaleshoni ya Khoma la Chifuwa Chothandizidwa ndi Khansa ya M'bwere. Zipatala Zopha Opaleshoni . 2010. 20 (4): 509-17.
> McGee, L., Iftekaruddin, Z., Chang, J. et al. Wall Reirradiation ndi Proton Therapy kwa khansa ya m'mawere. Mafilimu a Oncology, Biology, ndi Fiziki . 2017. 99 (2): E34-E35.
> Neuman, H., Schumacher, J., Francescatti, A. et al. Kuopsa kwa Kusakanikirana Kwambiri pa Nthawi Yowonongeka kwa Odwala Amene Ali ndi Gawo Lachiŵiri ndi Stage III Khansa Yamtundu (AFT-01). Journal of Clinical Oncology . 2018. 2017.75.538.
> Shen, M. et al. Odwala Amayi Odwala Matenda a Kanseri Omwe Ali ndi Kutalika Kwambiri Ndiponso Odziwika Kwambiri Pamwamba Mabokosi Achikumbutso Akugwirizanitsa Ndi Kupanda Opaleshoni Yaikulu. Zolemba za Oncology Opaleshoni . 2013. 20 (13): 4153-60.
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