Kodi Khansa ya M'mimba Imafalikira Kuti?

Malo Ambiri Omwe Amagwiritsidwa Ntchito Kwambiri pa Matenda a Matenda a Kachiwerewere Ochepa

Ngati mwapezeka kuti muli ndi khansara ya m'mawere, kapena ngati muli ndi kansa ya m'mawere oyambirira ndipo muli ndi zizindikiro zatsopano, mwachibadwa muli ndi mafunso. Zina mwa zinthu zomwe mukudabwa nazo ndizo:

• Kodi khansa ya m'mawere imafalikira kuti?
• Kodi malo otchuka kwambiri a masewera a khansa ya m'mawere ndi ati?
• Kodi khansa ya m'mawere imayenda kangati kumadera awa a thupi?

• Ndi zizindikiro ziti zomwe muyenera kuzidziwa?
• Kodi khansa yapachifuwa imafalitsidwa motani?

Kufunika kwa Matenda a Kanseri Amtundu Wapakati

Pafupifupi 85 peresenti ya amayi, kufalikira kwa khansa ku madera akutali a thupi (kutalika kwa metastases ) kumachitika zaka ndi mwina ngakhale zaka makumi asanu ndi limodzi pambuyo poyambira matenda. Kwa azimayi 10 mpaka 15 peresenti ya amayi, masastases akutali amapezeka kale panthawi yomwe amadziwa.

Khansara ya m'mimba ikhoza kubwereranso m'mimba (m'mimba), m'madera ena (m'magulu am'mimba, pamwamba pa collarbone, kapena pakatikati pa chifuwa) kapena patali. Pa zokambiranazi, tikambirana makamaka za khansa zomwe zafalikira kumalo akutali.

Matenda otsika kwambiri ochokera ku khansa ya m'mawere ndi ofunika kwambiri chifukwa ali ndi udindo wa pafupifupi 90 peresenti ya anthu amene amamwalira. Izi zikuti, ngakhale mutakhala ndi metastases ku imodzi mwa malowa, mankhwala amapezeka; mankhwala omwe nthawi zambiri amatha kuwonjezera moyo.

Khansara ya pachifuwa yomwe ili kutali kwambiri ndi khansa imatchedwa khansa ya m'mawere (MBC) kapena kansa ya khansa ya m'ma 4 . Ngati mukudziŵa za matenda a TNM kwa khansara ya m'mawere , izi zikanatanthawuza khansa yomwe ili M1 (mmalo mwa M0 zomwe zikutanthawuza kuti palibe metastases.) Chotupa chomwe chiri ndi mphamvu zingakhale ndi nambala iliyonse ya T (kukula kwa chotupa) ndi N (chiwerengero cha minofu yomwe ili yabwino komanso komwe ili).

Kodi Khansa ya M'mimba Imafalikira Kuti?

Khansara ya m'mimba ingafalikire kumadera onse a thupi koma nthawi zambiri imafalikira kumadera ena kuposa ena. Khansa ikhoza kufalikira kupyolera mu magazi kapena kudzera mu mitsempha ya mitsempha yambiri, choncho imapezeka kufalikira ku madera omwe ali ndi magazi ambiri kapena amagazi ambiri. (Mungathe kudziwa zambiri zokhudza momwe kansa imafalikira .)

Mbali za thupi lomwe khansa ya m'mawere imafalikiranso imasiyanasiyana malinga ndi mtundu wa khansa ya m'mawere ndi mahomoni / HER2. Malo otchuka kwambiri ndi awa:

• Lymph nodes
• Miyala
• Maungulo (kuphatikizapo pleural effusions)
• Chiwindi
• Ubongo
• Peritoneal metastases (ndi lobular carcinoma)

Malo otchuka kwambiri a metastase amayang'aniridwa mu phunziro la 2013. Azimayi omwe ali ndi khansa ya m'mawere oyambirira anayesedwa kuti awone malo omwe amapezeka malo oyamba omwe ali ndi khansa. Kuwonongeka kunali:

• Mphungu - 41 peresenti
• Mabomba - 22 peresenti
• Chiwindi - 7.3 peresenti
• Ubongo - 7.3 peresenti
• Malo ena anali malo oyamba a masastasiti kwa anthu otsala

Kachilombo kotchedwa lobular carcinoma imakhala ndi mtundu wosiyana kwambiri wa masastases kuposa khansa ya m'mawere. Phunziro limodzi, pafupifupi anthu 70 peresenti ya metastases kuchokera ku lobular carcinoma anali ndi peritoneal metastases.

Pafupifupi theka la amayi (ndi amuna, monga amuna amatenga khansa ya m'mawere ), khansa imafalikira ku ziwalo zambiri panthawi imodzimodzi. Tiyeni tiwone malo awa enieni, komanso malo ena omwe sangafanane ndi khansa ya m'mawere. Ngakhale njira zamankhwala zothandizira khansa ya m'mawere zimakhala zofanana ngakhale kuti khansa yayamba kufalikira, pali mankhwala omwe amagwiritsidwa ntchito pa malo enieni a metastasis.

Khansa ya m'mawere ifalikire ku ma Lymph Nodes

Kufalikira kwa khansa ya m'mawere kumalo amaliseche sikukutanthauza kuti khansara ya m'mawere ndi yovuta. Ngakhale khansara ikhoza kutuluka m'magulu a mitsempha (pafupi ndi mafupa a m'mimba) pafupi ndi m'mawere) imatengedwa ngati kubwerera m'midzi komanso osati kubwerera kutali .

Ife timabweretsa kufalikira kwa maselo a mitsempha chifukwa anthu ambiri amasokonezeka ngati amva kuti ali ndi kansa ya m'mawere yakhungu . Pachifukwa ichi, lipoti la matenda likhoza kunena kuti: "Matenda a khansa ya m'mawere ndi maselo a mitsempha" koma monga momwe taonera, izi zikutanthauza kuti khansara ya m'mawere ndi yovuta. Khansara ya m'mimba yomwe imafalikira ku maselo ammimba akhoza kukhala gawo 2, gawo lachitatu, kapena siteji IV.

Khansa ya m'mimba ifalikire ku mitsempha (Bone Metastases kuchokera ku ubongo wa khansa)

Malo otchuka kwambiri a khansa ya m'mawere ya m'mawere, yomwe imachitika pafupifupi 70 peresenti ya anthu omwe ali ndi kansa ya m'mawere, ndiyo mafupa. Pa mafupa omwe khansa ya m'mawere imafalikira, malo ambiri omwe amapezeka ndi monga msana, nthiti, pelvis, ndi mafupa aatali a mikono ndi miyendo. Matenda a metastases amakhala ndi malingaliro abwino okhudza metastases ku madera ena a thupi.

Matenda a metastases angapezedwe pansalu yopangidwa kuti ayang'ane metastases (pamene palibe zizindikiro zomwe zilipo) kapena zowoneka pazomwe zimachitika pofuna kuyesa zizindikiro monga ululu. Anthu ena sakudziwa kuti ali ndi mafupa a mitsempha mpaka amathyoledwa ndi vuto lochepa chabe. Mphuno yamagazi yomwe imafooka ndi khansa ya metastases imatchedwa fractures ya pathologic .

Pali mitundu yambiri ya mankhwala omwe amapezeka pamatenda a khungu kuchokera ku khansa ya m'mawere, ndipo zina mwazi zimatha kuyambitsa matendawa kwa nthawi ndithu. Mankhwalawa amawathandiza pakakhala mpumulo wofulumira, ndipo ukhoza kukhala wothandiza kwambiri pamtundu wa mafupa. Mankhwala monga Strontium 89 akuphatikizapo timadzi ta tizilombo ta tizilombo ta tizilombo toyambitsa matenda omwe timagwiritsidwa ntchito ndi mankhwala ena omwe amalowa mu magazi. Mankhwalawa, mosiyana ndi mankhwala opatsirana ndi dzuwa, nthawi zambiri amakhala othandiza pamene munthu ali ndi mitsempha yambiri yamagazi kapena yochuluka. Nthawi zina opaleshoni amafunika kuti pakhale mafupa omwe asweka kapena omwe ali pangozi yotsekemera chifukwa cha metastases.

M'zaka zaposachedwapa, mankhwala opangidwa ndi mafupa awonjezeredwa ku mankhwala omwe alipo a metastases a mafupa ndipo akhoza kukhala othandiza kwambiri.

Bisphosphonates monga Zometa (zoledronic acid) sizothandiza kokha kuchepetsa kupweteka kwa metastases koma zimawoneka kukhala ndi zotsatira zowonongeka. Mankhwalawa amachepetsanso mwayi wopititsa patsogolo mitsempha ya mafupa ndikupulumuka. Xgeva mankhwala (denosumab) angathandizenso kuthana ndi mitsempha ya mafupa pamene akupulumuka.

Khansa ya m'mawere ipitirire ku chiwindi (Liver Metastases kuchokera ku ubongo wa khansa)

Matenda a khansa ya m'mawere a chiwindi amakhalanso ofanana kwambiri.

Matenda a chiwindi angakhale alipo popanda zizindikiro ndipo nthawi zambiri amawoneka ngati scet scan. Nthawi zina izi zimaganiziridwa kuti zimayambira pamayesero osadziwika a chiwindi . Zizindikiro za matenda a chiwindi zingaphatikizepo ululu wamimba, mseru, kuyabwa (zomwe zingakhale zovuta) ndi jaundice , kutuluka kwa chikasu khungu ndi oyera a maso.

Mankhwala ambiri a khansa ya metastatic (monga chemotherapy , mankhwala ochizira, komanso mankhwala othandizira) angachepetse matendawa, koma popeza chiwindi chimakhala "pakati" pa thupi, pangakhale bwino, ndipo nthawi zina chiwindi chimachepetsa kukwanitsa kulekerera chemotherapy.

Kuchiza mazira kwa chiwindi kungachepetse ululu ndipo kungapangitse kukhala ndi moyo. Nthaŵi zina mankhwala ena am'deralo angagwiritsidwe ntchito pofuna kuchiza matenda a chiwindi monga opaleshoni, radioembolization, chemoembolization, pulogalamu ya radiofrequency, kapena radiotherapy.

Khansa ya m'mawere ipitirire ku mapungulo (Lung Metastases kuchokera ku khansa ya m'mawere)

Monga momwe mwazi umasungidwira ndi chiwindi, magazi amadutsa m'mapapu, kupanga izi kukhala malo wamba a metastasis.

Mankhwalawa amatha kukayikira pogwiritsa ntchito sewero, yomwe nthawi zambiri imasonyeza madera angapo a metastases (mosiyana ndi khansa ya m'mapapo, yomwe imakhala ngati yaikulu yaikulu). Chizindikiro chofala kwambiri ndi mpweya wochepa, womwe ukhoza kukhala wofewa ndipo umangokhalapo pochita masewera olimbitsa thupi poyamba. Zizindikiro zina zingaphatikizepo chifuwa chosatha kapena kupweteka ndi kupuma .

Kuwonjezera pa kufalikira m'mapapu, kansa ya m'mawere imapangitsa kuti phokoso likhale lopweteka-kumangirira madzi pakati pa membranes ( pleura ) yomwe imayendera mapapu. Zokwanira sizimangokhalapo pamene khansa ya m'mawere imafalikira m'mapapu, koma imafalikira ku maselo am'mimba pakati pa mapapo ( mediastinum ). Madzi amadzimadzi amatha kukhala opanda mphamvu (popanda khansa) komanso zokhudzana ndi kusintha kwaukali, kapena m'malo mwake, ali ndi maselo a khansa (tsamba lopweteka kwambiri ).

Mavitamini ammimba amachiritsidwa kawiri ndi khansa ya m'mawere, koma mankhwalawa amathandiza kwambiri, makamaka ngati metastases imapangitsa kuti tizilombo toyambitsa matenda tiwonongeke.

Ziphuphu zitha kukhala zazikulu ndipo zimapangitsa mpweya wochepa. Madzi amachotsedwa nthawi zambiri mwa kuyika singano kudzera mu khoma la chifuwa komanso kumalo osungira madzi. Mwamwayi, kupempherera kwachangu nthawi zambiri kumabwereranso. Izi zikachitika, shunt ikhoza kuyikidwa, kapena pleurodesis analimbikitsa (njira yomwe zigawo za pleura zimawombera palimodzi kotero kuti madzi sangathe kubwereza).

Khansa ya m'mawere ipitirire ku ubongo (Brain Metastase Kuchokera ku khansa ya m'mawere)

Khansara ya m'mimba imafalikira ku ubongo pafupifupi 10 mpaka 15 peresenti ya anthu omwe ali ndi kansa ya m'mawere. Mitsempha ya ubongo imakhala yowonongeka kwambiri kwa amayi omwe ali ndi ziwalo zotere za HER2 komanso khansa ya m'mawere itatu , zomwe zimakhala ndi ubongo wa ubongo womwe umapezeka pafupifupi pafupifupi atatu mwa anthu omwe ali ndi khansa ya m'mawere yomwe ili ndi HIV.

Zizindikiro za metastases ya ubongo nthawi zambiri zimaphatikizapo kupweteka mutu, kusintha kwa maso, chizungulire kapena kupweteka (nthawi zina kugwidwa ndi chizindikiro choyamba). Zizindikiro zina zingakhale zofooka pambali imodzi ya thupi, mavuto ndi kugwirizana, kapena kusintha kwa umunthu.

Mosiyana ndi metastases ku madera ena, mankhwala monga chemotherapy ndi mankhwala ochiritsira nthawi zambiri sagwira ntchito motsutsana ndi metastases ya ubongo chifukwa cha vuto la ubongo wa magazi. Mitsempha ya ubongo ndi ubongo wa capillaries wokonzedwera kuteteza ubongo ku poizoni (monga chemotherapy).

Chithandizo cha metastases kawirikawiri chimaphatikizapo steroids kuti achepetse kutupa mu ubongo. Ubongo wonse wautali ungagwiritsidwe ntchito kuthetsera metastases, kapena ngati "mawanga" amodzi a masastasis alipo, thupi la stereotactic radiotherapy ( SBRT ) lingagwiritsidwe ntchito poyesa kuwononga metastasis kwathunthu. SBRT, yomwe imadziwika kuti Cyber ​​knife kapena gamma mpeni ndiyo njira yomwe mazira akuluakulu amatha kuperekedwa kumalo ochepa kwambiri a minofu.

Zomwe Zing'onozing'ono Zomwe Zimagwiritsidwa Ntchito pa Ma Metastases Osiyana

Monga taonera kale, khansa ya m'mawere imatha kufalikira pafupifupi dera lililonse la thupi. Ena mwa malo osadziwika kwambiri (kupatulapo lobular carcinoma) a metastasis ndi awa:

• Khansa ya m'mafupa - Khansa ya pachifuwa yomwe yafalikira ku fupa imaphatikizapo mafupa (kuphatikizapo mafupa omwe amapezeka m'mafupa ambiri omwe amakhala ndi khansa ya m'mawere). Zizindikiro zingakhale ndi selo loyera la magazi kapena maselo ofiira a magazi omwe sali ogwirizana ndi chemotherapy.
• Mavitamini a Peritoneal - Pafupifupi theka la magawo atatu a anthu omwe ali ndi metastatic lobular carcinoma amapanga mavitamini otchedwa peritoneal metastases.
• Chifuwa chosiyana
• Ovary
• Matenda a adrenal
• Mphukira
• Khungu ndi minofu yofewa
• Malo osadziwika a metastases ndi malo omwe amachokera pachiberekero mpaka diso.

Masitepe a Mitastases ndi Mitundu ya khansa ya m'mimba

Monga tanenera pamwambapa, HER2 zabwino ndi katatu zowononga khansa za m'mawere zimatha kufalikira ku ubongo ndi chiwindi, pamene zotupa za estrogen zimakhala zofala kwambiri ku mafupa. Mankhwala otchedwa lobular carcinomas amakhala ndi chizoloŵezi chofalikira pamimba.

N'chifukwa Chiyani Khansa Imafalikira?

Sitikukayikira chifukwa chake khansara imayambiranso ndi kufalikira , komanso momwe ingawonekere kuti ikugona kwa zaka zambiri ngakhale zaka zambiri ndikubwereranso. Popeza kutalika kwa metastases ndiko chifukwa cha kufa kwa khansa zambiri, kafukufuku wambiri akuyang'anitsitsa kuyang'ana chifukwa chake metastases imachitika, komanso njira zomwe zingalepheretse kufala kwa khansa.

Kulimbana ndi Matenda a Matastastra Achimake

Ngati mwapezeka kuti muli ndi kansa ya m'mawere, mumakhala mwamantha ndipo mwinamwake mukudabwa ndi zonse zomwe mwapatsidwa. Kansera yamatenda a m'matumbo ndi yosiyana kwambiri ndi khansa ya m'mawere oyambirira. Lankhulani ndi anzanu ndi achibale anu. Anthu ambiri amaona kuti zimathandiza kukhala nawo pagulu lothandizira kapena gulu lothandizira lomwe limapangidwa makamaka kwa anthu omwe ali ndi kansa ya mthupi. Phunzirani zonse zomwe mungathe zokhudza matenda anu. Chithandizo, ngakhale cha khansara ya m'mawere, ikukula, ndipo kupulumuka kuli kutalika. Chinthu chimodzi chofunikira kwambiri chomwe mungatenge ndicho kukhala wothandizira wanu pa chisamaliro chanu cha khansa . Pali zifukwa zambiri zomwe mungasankhe zokhudzana ndi chithandizo, ndipo ndi okhawo amene mukudziwa zomwe mwasankha bwino.

Kwa Mabwenzi ndi Banja

Ngati wokondedwa wanu atapezeka kuti ali ndi metastases yayitali iye (kapena iye) mwina akuvutika kwambiri. Ngati iye ali ndi khansa ya m'mawere kale, ndi nkhani yosiyana kachiwiri. Wokondedwa wanu adzafuna thandizo lanu kuti akonzekere kuyang'ananso izi.

Ndikofunika kufotokozera mwamsanga njira zomwe mankhwala angapangire khansa ya m'mawere ndizosiyana, ndipo filosofi yokhudza chithandizo cha kansa ya m'mawere imakhala yosiyana kwambiri ndi yomwe ikuyambitsa khansa ya m'mawere. Poyamba khansa ya m'mawere, cholinga chake chimakhala chokwiya kwambiri kuti athe kuchepetsa khansara. Komabe, ndi khansa ya m'mawere, makamaka filosofi nthawi zambiri amagwiritsa ntchito kuchuluka kwa mankhwala oyenera kuti athetse matendawa. Kuchiza matendawa mopitirira muyeso sikusintha moyo, koma kumawonjezera zotsatirapo ndi kuchepetsa khalidwe la moyo.

Kupanda kumvetsetsa kwakukulu kwa kusiyana kumeneku kwachititsa kuti anthu ambiri omwe akulimbana ndi khansa ya m'mawere yakhudzidwe ndi zopweteka kwambiri. Tengani kamphindi kuti muphunzire zomwe simukuyenera kunena kwa munthu amene ali ndi kansa ya m'mawere .

> Zotsatira:

> Berman, A., Thukral, A., Hwang, W., Solin, L., ndi N. Vapiwala. Chikhalidwe ndi Zitsanzo za Metastases Zambiri kwa Odwala Amene Ali ndi Matenda Oyamba Kwambiri Khansara Yamatenda Pambuyo pa Chithandizo cha Kusamalidwa kwa M'thupi. Khansa ya m'mimba ya khansa . 2013. 13 (2): 88-94.

> Coleman, R. Impact ya Matenda-Matenda Otsatiridwa pa Matenda Otsalira ndi Kupulumuka mu Khansara Yamatumbo. Oncology (Williston Park) . 2016. 30 (8): pii: 218394.

> Inoue, M., Nakagomi, H., Nakada, H. et al. Malo Odziwika a Metastases mu Lobular Carcinoma Yopangika: A Retrospective Cohort Phunziro la Matenda a Maseti a Metastatic. Khansa ya m'mawere . 2017 Jan 20. (Epub patsogolo pa kusindikiza).

> Yeung, C., Hilton, J., Clemons, M. et al. Estrogen, Progesterone, ndi HER2 / neu Kugonana kwapakati pakati pa Matenda oyambirira ndi Ametastatic Breast - A Review. Khansa ya Metastasis . 2016. 35 (3): 427-37.