Kusanthula, Kuchiza, Kupulumuka
Khwerero 3 ya khansa ya m'mawere yakwera kwambiri kuposa siteji yachiwiri , koma sichiwerengedwe ngati mchere. Kuti matendawa asapitirire, khansa sinafalikire kuchokera pachifuwa kupita ku ziwalo kapena malo ena akutali m'thupi, koma maselo a khansa apita kumalo osungirako zida zapafupi (orilla), kapena amakhala m'magulu a pansi pa bere lanu (sternum) kapena pansi collarbone wanu.
Mwachidule
Chotupa chachitatu cha m'mawere chikhoza kukula kuchokera pa masentimita 2 mpaka 5 masentimita, koma nthawi zina palibe chotupa chomwe chimapezeka m'mimba. Gawo ili la khansa ya m'mawere imatha kukhala ndi mitsempha ya m'chifuwa pansi pa bere, kapena ikhoza kumakhudza khungu. Ngati khungu la m'mawere limatupa kapena limadwalitsidwa ndi khansa, ikhoza kukhala yotupa khansa ya m'mawere (IBC).
Gawo lachitatu ndi khansara ya m'mawere yomwe imatha kufotokozedwa ndi zochitika zitatu: 3A, B, ndi C. Izi ndi zina zowonongeka ndi chifuwa chachikulu ndi chikhalidwe, monga momwe tafotokozera ndi TNM . Ngakhale ma lymph nodes akhoza kutenga mbali, siteji 3 sichiyamikiridwa ndi metastatic.
TNM Kukhazikitsa Gawo 3 Khansa ya m'mawere
Khwerero 3 ya khansa ya m'mawere yathyoledwa kulowa mu siteji 3A, 3B, ndi 3C. Popeza malangizidwe opatsirana komanso majekesi angakhale osiyana kwambiri pakati pa zigawozi, kuyang'ana mosamala n'kofunika. Poyamba, dongosolo la TNM lingasokoneze. Komabe kufotokoza za T, N, ndi M, kumapereka madokotala kuti adziwe bwinobwino malowo.
TNM imatanthawuza:
- T: kukula kwa chotupa. T0 imatanthawuza khansa ya m'mawere yomwe simunapezepo m'matumbo anu koma yapezeka kwina kulikonse. T1 imaphatikizapo zotupa zomwe zili 2 cm (pafupifupi 1 inchi) kapena yaying'ono. T2 imaphatikizapo zotupa zomwe ziri pakati pa 2 cm ndi 5 masentimita awiri. Matenda a T3 ndi aakulu kuposa masentimita 5. Matenda a T4 akhoza kukhala kukula kwake koma adalowa khoma kapena chikopa. T4 imaphatikizapo khansa yotupa ya m'mawere.
- N: nodes. N0 amatanthauza kuti chotupacho sichinafalikire ku minofu. N1 imatanthawuza zotupa zomwe zafalikira ku maselo amkati a pafupi (mpaka 3). N1mi amatanthauza kuti pali micrometastases, kapena maselo otupa omwe angakhoze kuwonedwa pansi pa microscope. N2 imatanthawuza kuti chotupa chafalikira ku maselo a 4 mpaka 9 pansi pa mkono kapena pali kufalikira kwakukulu kwa maselo amkati a mammary. N3 ikhoza kutchula zochitika zosiyanasiyana, monga kukhala ndi maselo 10 kapena ambiri omwe ali othandiza kapena ngati khansara yayamba kufalikira pansi pa nkhono (pansi pa collarbone).
- M: metastases. M0 amatanthawuza kuti kulibe metastases kutali. M1 imatanthauzira zotupa zomwe zasintha (ndi siteji 4) ndipo zafalikira. Pamene khansa ya m'mawere imafalitsa malo ambiri a metastases ndi mafupa, chiwindi, ubongo, kapena mapapo.
Gawo 3A Khansa ya m'mawere
- Gawo 3A: T0, N2, M0: Palibe zotupa zapezeka m'matumbo a m'mawere, koma maselo a khansa apezeka m'magulu a nyerere m'thupi lanu.
- Gawo 3A: T1, N2, M0: Chotupacho ndi 2 cm kapena chaching'ono, KAPENA chabaya mnofu. Kuwonjezera apo, khansara yafalikira ku maseĊµera a nyerere m'thupi lanu kapena m'mimba mwanu.
- Gawo 3A: T2, N2, M0: Chotupacho chiposa 2 cm, koma pansi pa masentimita asanu. Khansara yapita ku ziwalo zam'mimba m'thupi lanu kapena m'mimba mwanu.
- Gawo 3A: T3, N1, M0: Chotupa ichi ndi chachikulu kuposa 5cm kudutsa ndipo sichidafika pakhungu la m'mawere kapena mitsempha ya mchifuwa. Khansara yapezeka m'magazi amphamvu kwambiri.
- Gawo 3A: T3, N2, M0: Chotupa ichi chachikulu kuposa 5cm kudutsa ndipo sichinakhudze mnofu wa m'mawere kapena mitsempha ya pachifuwa. Khansara yapezeka m'magazi amphamvu a m'magazi kapena m'mimba mwanu.
Gawo 3B Khansa ya m'mawere
- Gawo 3B: T4, N0, M0: Chotupacho chingakhale kukula kwake ndipo kakhudza khungu la chifuwa, kapena chakula mu khoma lanu la chifuwa, popanda kuphatikizapo minofu ya pectoralis. Nthawi zina khansara imatha kufika pakhungu lanu komanso khoma la chifuwa. Chotupachi chingakhalenso khansa ya m'mimba yotupa.
- Gawo 3B: T4, N1, M0: Chotupachichi chingakhale kukula kwake ndipo chingagwirizane ndi khungu kapena khoma la chifuwa, kapena mwina kansalu yotupa ya m'mawere. Khansara imapezekanso m'magazi amphamvu kwambiri pafupi ndi mawere okhudzidwa.
- Gawo 3B: T4, N2, M0: Chotupachi chingakhale kukula kwake, kamene kamakhudza khungu la mbuzi kapena khoma la chifuwa, kapena ikhoza kukhala ndi khansa ya kutupa pachifuwa. Khansara imapezekanso m'magulu a magazi kapena nodes mkati mwa bere.
Gawo 3C Khansa ya Chamoyo
- Gawo 3C: T (aliyense), N3, M0: Chotupa ichi ndi kukula kwake, koma chiri mkati mwa minofu yokha. Khoma lanu pachifuwa ndi khungu la m'mawere lisamakhudzidwe. Mkhalidwe wamatenda amtunduwu umasiyanasiyana motere: khansara ikhoza kupezeka mu nodes pansi pa dzanja lanu, mkati mwa bere lanu, pamwamba pa collarbone yanu, kapena pansi pa collarbone yanu. Chimodzimodzinso, khansara ikhoza kuwonetsa malo angapo.
Chiwerengero cha Survival
Chiwerengero cha zaka 5 zomwe zimakhalapo pa khansa ya m'mawere ndi gawo limodzi la magawo makumi asanu ndi atatu (73 peresenti), koma izi zingathe kusintha mosiyana ndi zigawo zina ndi zina zambiri.
Akatswiri a zachipatala amakamba za chiwopsezo cha khansa ya m'mawere pa zaka zisanu zapakati pa moyo. Izi sizikutanthauza kuti wodwala wodwalayo adzakhala ndi zaka zoposa zisanu kuti akhalenso atakhala ndi matendawa. Izi zikutanthauza kuti odwalawo anapulumuka zaka zisanu zoposa zomwe anazipeza, ndipo ambiri a iwo anakhala moyo wotalika kwambiri. Osati odwala onse adzagonjetsedwa ndi khansa ya m'mawere, koma akhoza kufa ndi zinthu zina.
Dokotala wanu adzakambirana nanu za momwe mumaonera moyo wanu, malinga ndi thanzi lanu, msinkhu, zinthu zina, ndi ma hormone a khansa yanu. Nambala zomwe madokotala amagwira nazo zimachokera ku ziwerengero zochokera ku gulu lalikulu la anthu, koma sizingagwirizane ndi vuto lanu. Kuonjezera apo, ziwerengero izi zikuwonetsa ntchito yapitayi ya mankhwalawa; Miyezo yakhala ikukwera zaka zingapo zapitazo.
Kuchiza
Mapulani anu azachipatala angaphatikizepo opaleshoni, chemotherapy, ndipo nthawi zambiri, ma radiation. Ngati chifuwa chanu chinali HER2-chonde , mudzalandira Herceptin, ndipo ngati mankhwalawa ndi odwala (estrogen ndi / kapena progesterone-positive), mutha kuyembekezera kutenga mankhwala a mahomoni kwa zaka zosachepera zisanu mutatha mankhwala oyamba.
Zilonda zazing'ono zomwe sizinasweke pakhungu kapena minofu zingachotsedwe ndi lumpectomy , ndipo nthenda yamagulu yodzitetezera idzafunika kuti mudziwe ngati maselo a kansa ayenda kupyola pachifuwa chanu. Ziphuphu zazikuru, kuphatikizapo zomwe zasokoneza khoma la chifuwa, zidzafuna kuwonongeka kwa mimba komanso matenda a lymph node biopsy. Mungaperekedwe kwa abambo, koma nthawi zina muyenera kuchedwa chifukwa cha mankhwala opatsirana .
Chemotherapy amaperekedwa kuti athamangitse maselo aliwonse osowa khansa m'thupi lanu; izi zimathandiza kupewa kubwereza. Koma chemo ikhozanso kuperekedwa chisanachitike opaleshoni kuti iwononge chotupacho. Pamene chemotherapy imaperekedwa pambuyo pa opaleshoni pachiyambi cha khansa ya m'mawere imatchedwa "adjuvant chemotherapy." Mukapatsidwa opaleshoni imatchedwa "neoadjuvant chemotherapy."
Nthawi zina pamene khungu la m'mawere limakhudzidwa ndi khansa, amatchedwa khansa ya kutupa. Thandizo lachidziwitso monga chemotherapy ndilo njira yoyamba yothandizira khansa yapakhungu yotupa; Zonsezi zimachepetsa chotupa chachikulu, zomwe zimapangitsa kuti dokotala wa opaleshoni amuchotsere mosavuta, komanso amapha maselo otupa oyandama m'mphepete mwake komanso malo omwe sagwiritsidwa ntchito ndi maselo a khansa. Popanda kuchotsa mitsempha iyi ya maselo a khansa, m'mphepete mwa nyanja zimakhala zikuwoneka bwino, nthawi zambiri zimachititsa opaleshoni mobwerezabwereza ndi mawonekedwe oipa kwambiri. Khansara yotupa ya m'mawere nthawi zambiri imakhala ndi mastectomy ndi axillary lymph node dissection.
Kusamalira Kutsata
Zotsatira zamankhwala zidzadalira ma hormone ndi HER status. Mukalandira mankhwala otha msinkhu, mudzakhala ndi zaka zisanu zokha zomwe mungachite pofufuza ndi anu oncologist, pamene mukufunika kutenga mankhwala a hormone ngati chotupa chanu chinali chovuta kwambiri. Mudzakhalabe ndi mamemogram anu apachaka ndipo muyenera kukhala panopa ndi mawere anu omwe mukuyesedwa, pokhapokha mutakhala ndi minofu pambuyo pa opaleshoni. Malingana ndi kukhala ndi khansa ya m'mawere, dokotala wanu angakulangize nthawi zina ma ARVs omwe ali pachifuwa chanu. Pitirizani kukhazikitsa zakudya zabwino, ndipo kambiranani ndi dokotala za ntchito yabwino yochita masewera olimbitsa thupi yomwe idzakhazikitsenso mphamvu ndi ubwino wanu.
Mawu ochokera pa Gawo 3 Khansa ya m'mawere
Gawo lachitatu ndilo njira yoyambirira kwambiri ya khansa ya m'mawere koma akadali ochiritsira kwambiri. Ndipo mankhwala akukula. Mwachitsanzo, mu 2017 kuwonjezera kwa bisphosphonates kunaphatikizidwanso ku mitsempha ya m'mawere yotchedwa estrogen pofuna kuchepetsa chiopsezo kuti khansa idzafalikira ku mafupa. Kumbukirani kuti ziwerengero zomwe mumamva mukamawerenga za kupulumuka musaganizire mankhwala atsopanowa. Kufikira kwa ena kwawonetsedwanso kuti zipangitse kuti anthu apulumuke apulumuke. Gwiritsani gulu lothandizira kapena kupeza khansa ya pa Intaneti. Koposa zonse, khalani ovomerezeka anu mu chisamaliro chanu, osati kokha pa khansa ya m'mawere, koma kuti mupitirize kukhala ndi thanzi labwino pambuyo pa chithandizo.
> Zotsatira:
> AJCC Buku Lopangitsira Khansa 6 Kukonzekera. Springer Verlag, New York, NY. 2002, masamba 223-240.
> American Cancer Society. Matenda a khansa ya m'mawere Mapiri ndi Gawo.
> American Cancer Society. Kuchiza kwa Khansa Yamtundu Yowonongeka, Ndi Gawo.
> National Cancer Institute. Zotsatira za khansa ya m'mawere. Gawo IIIA-C.
> Chikondi, Susan M. Ndili ndi mtundu wanji wa khansa ya m'mimba: Kulemba. Pp. 303-321. Dr. Susan Love's Breast Book. Gulu lachisanu la MD, 2010.