Kugwiritsira Ntchito Mankhwala Otsitsirako Matenda a Kanseri ya Breast Cancer Metastasis

by Lynne Eldridge, MD

Chifukwa Chake Matenda a Pakhomo Ali Ochepa Amagwiritsidwa Ntchito mu Matenda a M'thupi Achimake

Mafunde ndi opaleshoni ndizochipatala, ndipo ali ndi ntchito yochepa kwa anthu omwe ali ndi khansa ya m'mawere. M'malo mwake, mankhwala ochizira-mankhwala monga mankhwala ochizira , mankhwala a mankhwala , mankhwala ochiritsira , ndi immunotherapy, omwe amauza khansa kulikonse kumene kuli m'thupi-ndiwo mankhwala opambana.

Ngati metastases ku mafupa anu, chiwindi, mapapo, kapena ubongo sizimayambitsa matenda, kapena ngati sakuika pangozi ya mavuto monga kupweteka, nthawi zambiri amachiritsidwa ngati gawo lanu lachidziwitso cha khansa ya m'mawere ndi mankhwala ochizira .

Kodi Mankhwala Am'mudzi Amagwiritsidwa Ntchito Pati?

Pali nthawi zina, pamene chithandizo chotsatira cha metastases ndi opaleshoni, mankhwala othandizira mazira, kapena mankhwala ena ndi othandiza. Zifukwa zomwe mankhwalawa angagwiritsidwe ntchito ndi awa:

Kulimbana ndi ululu (makamaka ndi metastases ya fupa)
Kupuma kapena kusokoneza mumlengalenga kumayambitsa matenda a m'mapapo
Matenda a metastases omwe amachititsa kuti phokoso liwonongeke kapena likhoza kupangitsa kupweteka kwa msana
Matenda a ubongo omwe ali ndi zizindikiro zowononga, monga kusintha kwa mutu, kusintha kwa umunthu, kusokonezeka kwa maso, kapena kupweteka kwa magazi (mwazi wa ubongo umaletsa mankhwala ambiri monga chemotherapy mankhwala kulowa mu ubongo kapena msana)
Kuchotsa metastases zopweteka kumalo a khungu kapena chifuwa
Kuchiza kwa Oligometastase - Oligometastases ndi mawu omwe amagwiritsidwa ntchito pofotokoza malo amodzi okha kapena ochepa chabe a matenda oopsa. Kawirikawiri khansa ya m'mawere imabweretsa mitsempha yambiri m'madera ambiri a thupi. Nthawi zambiri, chithandizo ndi opaleshoni, chithandizo cha ma radiation, radiofrequency ablasion (RFA), kapena microembolization angaganizidwe kwa iwo omwe ali ndi mitsempha imodzi (kapena mwinamwake) imodzi yokha.

Ngakhale izi sizinawonetsedwe kuti zipangitse kuti amayi ndi abambo azikhala ndi kansa ya m'mawere, yasonyezedwa, nthawi zambiri, kuti apulumuke kwa anthu omwe ali ndi metastases okhudzana ndi zotupa zina.

Bone Metastases

Chithandizo cha mitsempha ya m'mawere kuchokera ku khansa ya m'mawere chimadalira kuchuluka kwa metastases, zizindikiro zomwe zimayambitsa, ndi zina zomwe mukuzilandira. Mankhwala am'thupi, mankhwala ochiritsira, ndi chemotherapy amatha kuchepetsa zizindikiro za khansa ya m'mawere yomwe yafalikira mafupa.

Komabe, nthawi zina, mankhwala awa onse sali okwanira. Mankhwala am'derali monga mankhwala opatsirana pogwiritsa ntchito mankhwalawa angagwiritsidwe ntchito pa ululu wosasamalidwa bwino ndi mankhwala ochizira, kapena kuteteza fractures kapena kupweteka kwa msana chifukwa cha metastases. Dokotala wanu angakulimbikitseni mawonekedwe a ma radiation kapena mankhwala osokoneza bongo omwe amatchedwa "osokoneza mafupa." Zosankha ndizo:

Thandizo la ma ARV - Mankhwalawa amagwiritsidwa ntchito pochizira matenda a kansa ya m'mawere ku mafupa omwe amachititsa kuti fupa lifooke komanso liwonongeke.
Radiopharmaceutics - Radiopharmaceutics ndi mankhwala omwe amanyamula radioactive particles mwachindunji mafupa. Chitsanzo ndi strontium 89.
Aganyu-Omasintha Zinthu - Pali magulu awiri a mawonekedwe osinthika mafupa omwe angagwiritsidwe ntchito pa mitsempha ya mafupa. Zina mwa izi zimagwiritsidwa ntchito kwa anthu omwe ali ndi matenda ofooka matenda. Mofanana ndi mankhwala othandizira mazira, angagwiritsidwe ntchito popewera fractures, kuteteza kupweteka kwa msana, ndi kupatsirana kwambiri m'magazi chifukwa cha kupasuka kwa fupa ndi mitsempha ya mafupa (hypocalcemia of malignancy).

Zitsanzo za bisphosphonates zikuphatikizapo:

Aredia (pamidronate)
Zometa (zolendronic acid)
Boniva (ibandronate)

RANK (receptor activator ya nyukiliya factor kappa B) ligand inhibitors ndi:

Xgeva (denosumab)

Matenda a Chiwindi

Matenda a chiwindi sangayambitse zizindikiro zirizonse, ndipo mukhoza kungodziwa izi chifukwa cha kuwonjezereka kwa chiwindi pamayeso anu kapena pakupeza mayeso pamayesero.

Pamene ali ndi zizindikiro, mankhwala am'deralo monga opaleshoni kapena mankhwala opatsirana pogonana angaganizidwe kupatulapo mankhwala ambiri a khansa ya m'mawere.

Mafuta a Metungase / Pleural Effusions

Monga momwe zilili ndi malo ena a masiteji, chithandizo cha mankhwala a mapapu chimaphatikizapo mankhwala opatsirana khansa ya m'mawere ambiri. Nthaŵi zina, mavitamini ammapapo amatha kuyambitsa kuthamanga kwapansi kapena kutuluka magazi m'mlengalenga.

Izi zikachitika, mankhwala opatsirana pogwiritsa ntchito mankhwala a radiation angakhale othandiza kuchepetsa zizindikiro.

Pleural effusions (kumangirira kwa madzi pakati pa nembanemba kumapapu) amakhalanso ndi khansa ya m'mawere. Kuchotsa madziwa ndi singano (thoracentesis) kumachepetsa kwambiri zizindikiro, koma kuwonongeka kwafupipafupi kumabwereranso. Izi zikachitika, zimatha kuika chimbudzi pamtambo wodula womwe umagwirizanitsidwa ndi chubu kupita kunja kwa thupi lanu (kudzera mu khoma la chifuwa) lomwe limalola kuti madziwo asungidwe.

Anthu ambiri omwe ali ndi stent amaloledwa kukhetsa madziwo pakhomo pawokha (mothandizidwa ndi wokondedwa) pamene madzimadzi amachititsa zizindikiro zawo tsiku ndi tsiku.

Matenda a ubongo

Matenda a mitsempha amatha kukhala ovuta kuchiza khansa ya m'mawere ambiri chifukwa mankhwala osokoneza bongo amatha kulowa mu ubongo ndi msana. Maselo amadzimadzi otetezeka omwe ali pamtunda wa ubongo wotchedwa magazi olepheretsa magazi amachititsa kuti poizoni zisalowe m'katikati mwa manjenje. Mwamwayi, chotchinga ichi chimapewanso mankhwala osokoneza bongo kuti asamfike kudera lino.

Pali malo awiri omwe opaleshoni kapena ma opaleshoni angapangidwe kuti amachititse ubongo metastases.

Matenda a zizindikiro - Ngati ubongo wanu metastases akuyambitsa zizindikiro zazikulu, chithandizo chamankhwala chikhoza kusintha umoyo wanu. Izi zingaphatikizepo mankhwala onse okhudza ubongo wa mitsempha yowonjezereka ndi yambiri, kapena miyendo yowonjezera ndi yowonjezereka yomwe imapangidwa ndi metastases yamodzi koma yaikulu.
Matenda a m'misitomala - Kuchuluka kwa metastases yaikulu yomwe imayambitsa zizindikiro, kapena ngati muli ndi metastases imodzi (kapena yochepa) ya ubongo koma mulibe umboni wa mavitamini kumalo ena m'thupi lanu, mitundu ina ya ma radiation yotchedwa stereotactic body radiotherapy (SBRT kapena Cyberknife) kapena Pulogalamu yamagetsi yowonjezereka (RFA) ingagwiritsidwe ntchito. Mankhwalawa amatsogolera kutalika kwa mazira ndi malo omwe ali mu ubongo. Mmalo mwake, opaleshoni ikhoza kuonedwa kuti imachiza matendawa.

Mankhwala Ena

Palinso mankhwala ena omwe akuyesedwa kuti azitha kuchipatala chifukwa cha khansa ya m'mawere. Njira monga machiritso ndi zina zingapereke mankhwala abwino m'tsogolomu. Pali mayesero angapo a zachipatala omwe akupitirizabe kuphunzira chithandizo cha metastases.

Kusamalira Zotsatira Zachimake

Thandizo la ma ARV, monga mankhwala ena a khansa, lingabweretse mavuto. Zotsatira zake zenizeni ndi momwe zidzasinthire zidzasiyana malinga ndi zinthu zambiri kuphatikizapo dera lanu lomwe limalandira ma radiation. Zina mwa zotsatira zofala kwambiri ndi izi:

Kukhumudwa kwa khungu - Malo omwe mumalandira mankhwala a radiation angapangitse kukhala wofiira ndipo nthawi zina amathamanga, mofanana ndi kutentha kwa dzuwa. Katswiri wanu wamagetsi a zamagetsi amakuuzani za zizindikiro zomwe muyenera kuziyang'anira ndipo angakupatseni mankhwala odzola.
Kutopa - Kutopa ndi njira yowopsa kwambiri ya mankhwala opatsirana, omwe amakhudza anthu ambiri amene ali ndi mankhwalawa pamlingo winawake. Kutopa kumeneku kumakhala kuwonjezereka ndipo kumapitirira nthawi.

Monga kutopa kokhudzana ndi chemotherapy, zizindikirozi zingayambitsenso ndi mavuto omwe amatha kusintha (monga kuperewera kwa magazi m'thupi) ndipo ndikofunikira kulankhula ndi a oncologist wanu za msinkhu wanu.

Chithandizo chabwino kwambiri cha kutopa ndicho makamaka kupeza njira zothetsera kutopa. Funsani thandizo ndikulola ena kuti akuthandizeni. Pumula pamene mukufunikira. Ndipo kambiranani ndi dokotala wanu za mavuto alionse ogona omwe akuthandizani kutopa.
Kutaya tsitsi - Kutaya tsitsi kumapiri ndi mankhwala opatsirana ndi dzuwa kumasiyana ndi tsitsi lomwe limakhudzana ndi mankhwala a chemotherapy, chifukwa akhoza kukhala osatha. Kutaya tsitsi kumadalira malo a thupi limene mumalandira mankhwala opatsirana pogwiritsa ntchito mankhwala.

Mwachitsanzo, mazira onse a ubongo pamutu mwanu amachititsa kuti tsitsi lanu likhale lopweteka, pamene mazira ndi chifuwa cha chifuwa chanu, pamapapo, amachititsa kuti tsitsi lanu liwonongeke m'chifuwa chanu.
Kusamvetsetsana kwabwino - Kupatsirana kwa ubongo ku ubongo, makamaka ubongo wa radiotherapy, kungayambitse zizindikiro monga kukumbukira kukumbukira komanso kusamvetsetsa (kusamvetsetsana bwino). .

Kuchiza mazira kwa ubongo kumayambitsa kuwonongeka kwa ziwalo za ubongo m'mayendedwe a ubongo.

> 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.