Zizindikiro ndi Chithandizo cha Matenda a Chiwindi kuchokera ku Breast Cancer
Ngati mwapezeka kuti muli ndi metastases ya chiwindi kuchokera ku khansa ya m'mawere mumakhala mukudzifunsa chomwe chimabwera kenako. Kapena, mmalo mwake, mwinamwake mwakhala mukudwala khansa ya m'mawere m'mbuyomo ndikudzifunsa ngati zizindikiro zomwe muli nazo zingakhale chizindikiro cha metastasis. Kodi muyenera kudziwa chiyani za zizindikiro, njira zomwe mungapeze mankhwala, komanso momwe matenda a khansa ya m'mawere imayambira pachiwindi?
Khansa ya m'mawere ipitirire ku chiwindi - Tanthauzo ndi Zowona
Matenda a chiwindi (kufalikira kwa khansara ku chiwindi) amapezeka pafupifupi theka la anthu omwe ali ndi kansa ya m'mawere. Chiwindi ndi malo achiwiri omwe amapezeka kutali ndi khansa ya m'mawere (yomwe imapezeka ndi mafupa).
Khansara ya m'mimba yomwe imafalikira pachiwindi ikadali khansara ya m'mawere, ndipo izi zingakhale zopezera chisokonezo chachikulu. Ngati mutatenga chitsanzo cha maselo a khansa pachiwindi ndikuyang'ana pansi pa microscope, muwona maselo oyamwa khansa. Matenda a khansa ya m'mawere ku chiwindi saganiziridwa ngati khansa ya chiwindi. Khansa ya chiwindi ndi khansara yomwe imayambira pachiwindi, ndipo pansi pa microscope mumatha kuona m'magulu a khansa ya chiwindi.) Khansara ya m'mimba imafalikira pachiwindi imatchedwa "khansa ya m'mawere ya m'mawere".
Mauthenga azinthu angasokoneze komanso, komanso khansa ya m'mawere ku chiwindi ingathenso kutchedwa khansa ya m'mawere , kapena khansa ya m'mawere, kapena khansa yachiwiri ya chiwindi.
Anatomy ndi Ntchito za Chiwindi
Zingakhale zothandiza pofotokozera zizindikiro za metastase ya chiwindi kuti muwone mwachidule momwe thupi limayambira komanso chiwindi.
Chiwindi chili pa chapamwamba chokwanira cha mimba, pansi pa chifuwa chachikulu ndipo chiri pafupi ndi ziwalo zazikulu za m'mimba (zomwe zingamenyane ngati zikukula kuchokera ku metastases).
Nthawi zambiri zimakhala pansi pa nthiti zomwe simungathe kuziwona, koma zikakula zimakhala zovuta kwambiri (nthawi zambiri zovuta) pansi pa nthiti yako kumbali yoyenera. Chiwindi chimapangidwa ndi lobes yomwe ili mkati mwa chimake. Chiwindi chikakula, chikhoza kuyambitsa kutsetsereka kumeneku, komwe kumakhala kowawa kwambiri.
Chiwindi chimagwira ntchito zingapo zofunika m'thupi . Ena mwa awa ndi awa:
- Kuchotsa poizoni kuchokera m'thupi
- Kusungira shuga ndi mavitamini ena
- Kupanga bile yomwe imagwiritsidwa ntchito pomwa mafuta kukhala mafuta monga gawo la chimbudzi
- Kupanga mapuloteni omwe amathandiza magazi kutsekemera
- Kupanga mapuloteni oyenerera kuti maselo akule ndi kukonzanso komanso ntchito zingapo zamagetsi m'thupi
Zizindikiro ndi Zizindikiro za Matenda a Chiwindi Kuchokera ku Khansa ya Amuna
Mukhoza kapena simungakhale ndi zizindikiro zokhudzana ndi chiwindi cha chiwindi, ndipo izi zimasiyana malinga ndi chiwerengero cha metastases, kukula kwake, ndi kumene kuli. Zizindikiro zina zotheka ndizo:
- Mimba ya m'mimba: Ululu umamveka pansi pa nthiti za kumtunda kwa mimba.
- Kumva ululu: Kupanikizika kwa mitsempha yomwe imayandikira pafupi ndi chifuwa cha chiwindi chimapangitsa kuti muzimva ululu m'manja mwanu.
- Nausea: Mphuno ikhoza kuchitika chifukwa cha kukhalapo kwa chiwindi chofutukuka chikugwedeza pazipinda zina zamimba ndi kuchokera kumangidwe kwa poizoni m'magazi pamene chiwindi sichigwira ntchito mwachizolowezi.
- Kutaya njala
- Mafupa: Pamene chiwindi chikulitsidwa ndi kukwera motsutsana ndi chingwe, chikhoza kuyambitsa hiccups.
- Kuyamwa (pruritis): Kuyabwa komwe kumayendera ndi chiwindi metastases kungakhale koopsa. Chifukwa cha kuyabwa ndi bile acid zomwe zingamangirire pakhungu lanu. Anthu ena omwe ali ndi khansara ya m'mawere amapeza izi kuti zikhale zovuta kwambiri (ndipo ngati wokondedwa wanu akulimbana ndi izi (iye) angapemphe mobwezera mobwerezabwereza).
- Ascites : Kutulutsa madzi m'kati chifukwa cha kusagwira ntchito kwa chiwindi kumatchedwa ascites.
- Jaundice: Kutuluka kwa chikasu kwa khungu ndi azungu a maso, jaundice , amatha kukhala yachiwiri mpaka kumangidwe kwa bile acid pakhungu. Kaŵirikaŵiri zimachitika ngati pali chiwopsezo chachikulu cha chiwindi kapena kutsekemera kwa mankhwala a bile ndi chotupa.
- Kukulitsa kwa chiwindi nthawi zina kumawonekera ngati misa m'mimba mwako.
- Kudumpha: Kusasowa kwazifukwa chifukwa cholephera kugwira chiwindi kungayambitse magazi. Kutsekemera, kotero, kungayambitse kuperewera kwa magazi m'thupi.
- Kutuluka kwa usiku
- Kusokonezeka ndi kulephera
Chiwindi nthawi zambiri chimachotsedwa ndi chifuwa chachikulu chisanachitike kuti zizindikiro zichitike (malingana ndi malo a metastases). Chiwindi chimatha kukhalanso chodabwitsa pambuyo pochiza chiwindi cha metastases (mosiyana ndi zigawo zina monga ubongo).
Kuzindikira Mitastases ya Chiwindi
Matenda a chiwindi amatha kupezeka mu njira zosiyanasiyana. Nthawi zina mavitamini angapezeke asanakhalepo zizindikiro zilizonse pakakhala zojambulazo. Angakhalenso akukayikira ngati ntchito ya magazi imawunikira mayesero osayenerera a chiwindi .
Ngati zizindikiro zilipo, pali njira zingapo zomwe zingapezeke, kuphatikizapo mimba ya CT, MRI, ultrasound, kapena PET. Nthawi zina chigawo chapamwamba cha chiwindi chimapezeka kuti chimakhala ndi metastases pachifuwa cha CT.
Kodi khansa ya m'mawere imafalikira bwanji ku chiwindi?
Njira yomwe khansa ya m'mawere imafalikira pachiwindi sikumveka bwino komanso imene imakhala ndi mafupa a mafupa ndi mafupa, koma kufufuza kumapitirira. Tikuyembekeza kuti kumvetsetsa bwino njira zomwe zimachokera ku metastases ya chiwindi zidzathandiza ochita kafukufuku kupanga njira zabwino zothandizira, komanso njira zothandizira kuteteza chiwindi cha chiwindi. Zimene tikuphunzira ndikuti " microenvironment " ya chiwindi imathandiza kwambiri kuti chiwindi cha metastases chichitike.
Kuchiza kwa Metastases ya Chiwindi
Chithandizo cha chiwindi cha metastases chikuphatikizapo njira zofanana. Khansara ya m'mimba yomwe imafalikira ku chiwindi singathe kuchiritsidwa, choncho cholinga cha mankhwala ndikulitsa moyo komanso kuchepetsa zizindikiro. Mankhwala angaphatikizepo:
- Mankhwala othandiza anthu kuthana ndi zizindikiro za metastase ya chiwindi monga ascites, ululu, ndi kuyabwa.
- Mankhwala ambiri omwe amagwiritsidwa ntchito poyambitsa maselo a kansa ya m'mawere kulikonse mu thupi (mankhwala ochizira). Cholowa cha mchere chiyenera kuyambiranso ngati seti yotchedwa estrogen, progesterone receptor, ndipo HER2 / neu ndikhoza kusintha (mwa kuyankhula kwina, ngakhale kuti chotupa chinali poyamba estrogen receptor positive, chikhoza kukhala estrogen receptor negative).
- Mankhwala ochiritsira a Metastasis, omwe amatha kuika matenda a khansa pachiwindi mwachindunji. Izi zingagwiritsidwe ntchito kuchepetsa mphamvu ya metastases kuti athe kuchepetsa zizindikiro, kapena nthawi zina, ngati zilonda zamodzi kapena zochepa zilipo, mankhwala angayesere kuthetseratu chiwindi cha chiwindi.
Tiyeni tiwone mbali iliyonse ya mankhwalawa.
Kuchiza kwa Zizindikiro Chifukwa cha Matenda a Chiwindi
Kuwonjezera pa mankhwala opangidwa kuti athetse khansa, chithandizo choletsa zizindikiro ndi chofunikira kwambiri. Izi zingaphatikizepo chithandizo cha kuyabwa . mankhwala (monga m'mimba pamimba , pogwiritsa ntchito singano kuchotsa madzimadzi) kuchepetsa mavuto chifukwa cha ascites, komanso kuchepetsa kupweteka ndi mseru. Ndikofunikira kudziwa zinthu (monga mankhwala) zomwe zingawononge kwambiri chiwindi pamene mavitamini alipo, ndipo izi zikufotokozedwa pansipa.
Mankhwala Ochiritsira a Khansa ya Metastatic
Chinthu chofunikira choyamba kwa anthu okhala ndi metastases, kaya chiwindi okha kapena kwinakwake, ndikutenganso udindo wa receptor. Anthu ambiri amadabwa kuona kuti malo omwe ali ndi khansa ya m'mawere yomwe imachokera kutali imakhala ndi makhalidwe osiyana ndi khansa yoyambirira ya m'mawere. Mwachitsanzo, chotupa chimene chiri pachilumba cha estrogen chokhazikika tsopano chikhoza kukhala estrogen receptor, ndipo chotupa chimene chiri poyamba HER2 / neu positive chikanakhoza kukhala HER2 / neu cholakwika komanso mosiyana.
Njira zoyamba zothandizira khansa ya m'mawere zimadalira matendawa ndipo zimaphatikizapo mankhwala a chemotherapy , mankhwala a endocrine, mankhwala othandizidwa ndi khansa ya m'mawere ya HER2 / neu , komanso mankhwala ena.
Mosiyana ndi msinkhu wa khansa ya m'mawere, yomwe cholinga chake nthawi zambiri amachiza nkhanza kuti zisawonongeke, cholinga chake ndi khansa ya m'mawere nthawi zambiri amagwiritsa ntchito mankhwala ochepa kuti athetse matendawa. (Pakhoza kukhala zosiyana kwa iwo omwe ali okhaokha kapena ochepa metastases kudera limodzi.)
Kuchiza Mwapadera kwa Metastases a Chiwindi
Kuphatikiza pa mankhwala opangidwa ndi khansa yamtunduwu, pali njira zingapo zowonetsera chiwindi cha metastases makamaka. Kugwiritsa ntchito mankhwalawa kumasiyana malinga ndi zinthu zambiri kuphatikizapo mtundu wa khansa, kupezeka kwa malo ena a metastases, chiwerengero ndi kukula kwa metastase, ndi malo a zilonda izi. Mankhwalawa angagwiritsidwe ntchito mofananamo (makamaka chifukwa chemotherapy sichigwira ntchito molimbika ndi chiwindi cha metastases) kapena pofuna kuyesa kupulumuka kwa nthawi yaitali.
Chithandizo chamankhwala: Kuwopsa kwa mankhwala kwa chiwindi kumagwiritsidwa ntchito monga mankhwala opatsirana, chifukwa nthawi zambiri amachepetsa kukula kwa chiwindi cha chiwindi, ndipo chifukwa chake zizindikiro.
Kuchiza kwa oligometastase ku chiwindi: Pamene chiwindi ndi malo okhawo omwe ali ndi matenda a khansa, ndi khansa ya m'mawere yokha, kapena mankhwala ochepa okha, mankhwala opatsirana angayesedwe ndi chiyembekezo cha kupulumuka kwa nthawi yaitali. Mawu akuti "oligometastases" amagwiritsidwa ntchito polongosola chochitika ichi ndi mawu akuti "oligo" amatanthawuza ochepa. Izi zikhoza kutchulidwenso ndi "mankhwala am'deralo." Njira yoyenera yothandizira imadalira kukula, mawonekedwe, ndi malo a metastase Mankhwalawa amagwira ntchito bwino kwambiri pa zotupa zokwana masentimita asanu (pafupifupi masentimita 2½) kukula kapena zochepa, ndipo ngati chiwindichi chibwererenso chaka chimodzi kapena ziwiri pambuyo pa khansa yoyambirira ya m'mawere.
- Opaleshoni: Zikodzo zina zimatha kuchotsedwa opaleshoni kudzera mu njira yotchedwa " metastasectomy ." Mankhwalawa athandiza anthu kukhala osankhidwa nthawi yaitali.
- Kuwombera: Matenda opatsirana m'magazi angagwiritsidwe ntchito. Izi zimaphatikizapo kupanga thupi (TAE), chemoembolization , ndi radioembolization . Njirazi zingakhale zothandiza pa zotupa zomwe sizingatheke mosavuta ndi opaleshoni.
- Kuperekera kwa pulogalamu yamtundu wambiri (radiofrequency ablation, microwave mphamvu ablation kapena cryoablation (yozizira) ingagwiritsidwe ntchito nthawi zina.
- Thupi la radiotherapy (stereotactic body radiotherapy) (SBRT): SBRT imagwiritsa ntchito mphamvu zamtundu wa mphamvu zamtundu wa dzuwa zomwe zimaperekedwa ku malo enieni a minofu pofuna kuyesa kuwononga kachigawo kakang'ono ka minofu (monga chiwindi kapena metastases).
Zisamalidwe ndi Zamoyo Zomwe Mungachite Ngati Muli Ndi Matenda a Chiwindi
Zitetezo zomwe mungafunikire kutengera zimadalira mlingo wa metastases omwe muli ndi chiwindi chanu. Kwa anthu ena, metastases amadziwika pajambuzi koma mayesero a chiwindi amakhalabe abwino ndipo palibe zizindikiro. Komabe, anthu ena ali ndi mayesero a chiwindi omwe ndi osalimba kapena zizindikiro zokhudzana ndi chifuwa chachikulu m'chiwindi.
Ngakhale mutakhala ndi miyeso ingapo, komabe kuwona zina mwazimenezi ndikofunikira:
- Mowa umadya: Anthu omwe ali ndi metastases yaikulu ya chiwindi nthawi zambiri amalangizidwa kuti asamwe mowa. Chifukwa cha izi ndi ziwiri. Ngati chiwindi chanu sichigwira ntchito mokwanira, simungathe kumwa mowa wambiri monga momwe mungakhalire. Izi zingayambitse kumanga mowa ndikupitirizabe kuntchito yanu. Kuchokera mosiyana, tikudziwa kuti mowa ukhoza kukhala poizoni kwa maselo a chiwindi, ndipo kuwonjezera izi ku maselo omwe atha kale kusokonekera akhoza kuwonongera kuwonongeka kwa chiwindi chimene muli nacho.
- Mankhwala amatsitsimutsa ndi chiwindi: Mankhwala ambiri amatha kusokonezeka (chiwindi) ndi chiwindi kapena impso. Nthawi zambiri pamakhala njira zothandizira kuchipatala, kuphatikizapo mankhwala omwe amachiza chiwindi ndi ena omwe amatsitsimutsa ndi impso. Ngati njirayi ikupezeka, dokotala wanu angakulimbikitseni chithandizo chimene chimagwiritsidwa ntchito ndi impso (malinga ngati mulibe zolakwika m'maganizo anu). Ngati mankhwala omwe amawoneka ndi chiwindi ayenera kugwiritsidwa ntchito (monga mankhwala ambiri a chemotherapy), mlingowo ukhoza kusinthidwa malinga ndi kuchuluka kwa chiwindi chosagwirizana.
- Pazitsamba zowonongeka ndi zitsamba: Ndikofunika kuzindikira kuti pali zambiri zowonongeka ndi zitsamba zomwe zimayambitsidwa ndi chiwindi. Chitsanzo chimaphatikizapo kupitilira kupweteka kwapakompyuta. Tylenol (acetaminophen) imagwiritsidwa ntchito m'magazi (ndipo imayenera kupeŵedwa kwa anthu omwe ali ndi chiwindi chosagwira ntchito) koma ambiri omwe saliidal anti-inflammatory monga Advil (ibuprofen) amalowetsedwa ndi impso. Ndikofunika kuzindikira kuti kukonzekera kwina kungakhale kovuta ngati muli ndi chiwindi cha chiwindi chifukwa cha kuchepa kwake kwa thupi, koma vitamini ndi mineral zina zowonjezereka zingasokoneze chemotherapy .
Kugonjetsa / Moyo Wopangika wa Khansa Yachifuwa yomwe Yafalikira ku Chiwindi
Mavitamini ku chiwindi ndi ofanana kwambiri, ndipo kukhala ndi moyo kumasiyana kwambiri pakati pa anthu osiyanasiyana. Chiyembekezo cha moyo wa khansa ya m'mawere ndi metastases ya chiwindi popanda chithandizo ndi miyezi inayi kapena eyiti okha, koma anthu ambiri amafuna chithandizo. Ndi mankhwala, zaka 5 zomwe zimakhala ndi moyo kwa anthu omwe ali ndi metastases kutali kwambiri ndi khansa ya m'mawere ndi 23 peresenti.
Pamapeto ena a masewerawa, anthu osankhidwa ndi chiwindi (oligometastatic disease) omwe amachiritsidwa ndi mankhwala a chemotherapy komanso resection (kapena ablation) a chiwindi cha metastases, zaka zisanu zapakati pa moyo wawo zimatha kukhala 40 peresenti.
Kugonjera kumaipa kwambiri kwa iwo omwe ali ndi vuto loipa kwa mankhwala a chemotherapy komanso kwa iwo omwe ali ndi matenda oterewa a estrogen.
Mfundo Yofunika Kwambiri pa Khansa ya M'bwere ndi Metastases ya Chiwindi
Ngakhale khansara ya m'mawere yomwe yafalikira pachiwindi siichichiritsidwa, njira zamankhwala zilipo zomwe zimachepetsa zizindikiro koma zingathe kuwonjezera chiyembekezo cha moyo ndi matendawa. Ife panopa tikudziwa pang'ono za njira zomwe zimayambitsa matenda a chiwindi kuposa malo ena a masastases, komabe izi zimapereka chiyembekezo kuti mankhwala atsopano ndi abwino angapezeke onse kuti azitha kuchiza ndikuyembekeza kupewa chiwindi cha chiwindi m'tsogolomu.
Kulimbana ndi Canast Metastatic ku Chiwindi
Kudziwa kuti muli ndi khansa ya metastatic ikhoza kudabwitsa kwambiri. Ngati mudakhala ndi khansa ya m'mawere oyambirira, tsopano mukudwala matenda osachiritsika, ndipo nthawi zambiri amafunika mtundu wina wa mankhwala kwa moyo wanu wonse.
Kumbukirani kuti ngakhale ndi metastases, mankhwala akukula. Monga momwe tawonera pazifukwa zamankhwala za chiwindi cha chiwindi pamwambapa, pali mankhwala osiyanasiyana omwe akugwiritsidwa ntchito komanso ambiri mu mayesero a zamatenda. Palinso chiyembekezo kuti kufufuza kuyang'ana pa ntchito ya microenvironment ya khansa pachiwindi kudzapereka njira zowonjezereka mankhwala.
Ndikofunika kuphunzira za khansara yanu komanso kukhala wothandizira pa chisamaliro chanu cha khansa . Yesetsani kwa abwenzi ndi abwenzi ndikuwalola kuti awathandize. Kukhala nawo pagulu lothandizira kapena gulu lothandizira makamaka kwa anthu omwe ali ndi kansa ya m'mawere angathandizenso kwambiri, osati pokhapokha powapatsa chithandizo chamumtima (kumatha kulankhula ndi munthu yemwe "wakhalapo") koma pokhala ndi mgwirizano kudzera Phunzirani za kafukufuku watsopano. Tengani kamphindi kuti mudziwe za kanema ndi kansa ya m'mawere , komanso Project Metastatic Breast Cancer . Studies amatiuza kuti kukhala gawo lolimbika la gulu lanu lachipatala kumabweretsa mavuto ochepa ndipo angapangitse kusiyana Zotsatira zake ndizoopsa komanso zochititsa mantha kuti mudziwe kuti muli ndi khansa yamtunduwu, koma pali chiyembekezo chambiri, ndipo zonsezi zikupitirira chaka chilichonse.
> Zotsatira:
> Criscitiello, C., Andre, F., Thompson, A. et al. Kutsimikizira kwa Biopsy Maseti a Metastatic M'chifuwa cha Khansa ya M'bwere: Odwala Pachipatala ndi Zochitika Zotsatira. Kafukufuku wa khansa ya m'mawere . 2014. 16 (2): 205.
> Gulu, N. Liast Metastase Kuchokera ku Khansa ya m'mimba: Kodi Ntchito Yopaleshoni Ndi Yotani? Zizindikiro ndi Zotsatira. Khansa ya m'mimba ya khansa . 2017. DOI: kapenag / 10.1016 / j.clbc.2016.12.012.
> Ma, R., Feng, Y., Shuang, L. et al. Njira zothandizira pa khansa ya m'mawere Chiwindi Metastasis. Journal of Translational Medicine . 2015. 13:64.
> Weinrich, <., Wieb, C., Schuld, J., ndi B. Rau. Kugonana kwa Chiwindi cha Matenda Achilendo Omwe Ali M'kati mwa Khansa ya M'thupi: Zotsatira ndi Zochitika Zowonongeka Zotheka. Opaleshoni ya HPB . 2014. ID 893829.