Kuchiza ndi Kutupa kwa Khansa Yam'mimba Imafalikira
Matenda a metastases ochokera ku khansa ya m'mapapo (kufalikira kwa khansara yamapapo mafupa) ndi ofala kwambiri ndi khansa ya m'mapapo, yomwe imakhuza anthu 30 mpaka 40 peresenti ya anthu omwe ali ndi khansara ya m'mapapo . Ndipotu, ngati chiwopsezo cha khansa ya m'mapapo chikukula, chiŵerengero cha anthu omwe amakhala ndi mafupa a mitsempha akuwonjezereka.
Kuphatikiza pa kukhumudwitsa kwambiri ndi kupweteketsa, mafupa a metastases angayambitse kupweteka komwe kumalepheretsa ntchito za tsiku ndi tsiku ndikuchepetsa moyo wanu.
Kodi zizindikiro, machiritso, ndi zizindikiro za khansa ya m'mapapo ndi mitsempha ya mafupa?
Mwachidule
Khansara ya m'magazi ndi mafupa a metastases amatanthauza maselo a khansa yamapapu omwe amafalikira ku fupa kudzera m'magazi kapena kudzera m'matumbo (zombo zomwe zimanyamula maselo opatsirana pogonana kudzera mu thupi). Khansara ya mthendayi imasiyanasiyana ndi khansara ya mafupa yomwe imachokera m'mafupa ndipo imakhala ndi maselo osadziwika a mafupa. Khansara ya metastatic kuti fupa imapangidwa ndi maselo omwe amachokera ku khansa yapachiyambi -mu nkhani iyi, mapapo. Ngati izi zikusokoneza, mukhoza kudziwa zambiri za momwe kansa imafalikira kudzera mu thupi .
Kodi Mitsempha Yoyamba Yolalikira Imafalitsa Kuti?
Khansa ya m'mimba ndi Njira yachitatu ya khansa yofalitsidwa ndi mafupa (pambuyo pa khansa ya m'mawere ndi khansa ya prostate), ndipo pamene metastases mafupa amapezeka popanda chitsimikizo chodziwika, theka la nthawi likugwirizana ndi khansa ya m'mapapo yapansi. Matenda ambiri omwe khansa ya m'mapapo imafalikira ndi monga:
- Mphepete (makamaka vertebrae m'chifuwa ndi m'mimba m'mimba)
- Nkhumba
- Mafupa apamwamba a mikono ndi mwendo (humer ndi femur)
Khansa ya m'magazi imakhala yapadera kwambiri chifukwa imatha kufalitsa mafupa m'manja ndi mapazi.
Zizindikiro
Ululu kawirikawiri ndi chizindikiro choyamba cha khansara yamapapo ndi mafupa a metastases.
Ululu ukhoza kuyamba kumverera ngati kuthamanga kwa minofu kapena kupsyinjika, koma pang'onopang'ono zimafalikira ndipo zingakhale zovuta. Pamene metastases ya fupa imakhudza mikono ndi miyendo, ululu umakhala woipa kwambiri ndi kuyenda. Ululu chifukwa cha kufalikira kwa khansa ya m'mapapo kwa msana Nthawi zambiri zimakhala zovuta usiku komanso atagona pabedi.
Ngati mitsempha ya minofu ikuphatikizapo msana, kupanikizika kwa msana wamtsempha chifukwa cha chotupacho kungayambitse kupweteka ndi kuyenda ndi kufooka kapena kumangirira m'milingo. Ngati vuto la msana ndilopweteka kwambiri (cauda equina syndrome), kupweteka ndi kufooketsa miyendo zingathe kuchitika pamodzi ndi kutaya thupi kapena chikhodzodzo. Izi ndizodzidzidzi zamankhwala, ndipo zizindikiro zikhoza kukhala zamuyaya popanda mankhwala ofulumira.
Nthawi zina chizindikiro choyamba chimene kansa ya m'mapapo yafalikira pamphupa ndi kupasuka ( kupweteka kwa thupi ) Pachifukwa ichi, maselo a khansa amatenga minofu yowonongeka, ndipo imafooka kwambiri. Mphunoyi imatha kuchitika popanda kupwetekedwa mtima kwakukulu (ngakhale kuyendayenda pabedi) komanso pazochitika za tsiku ndi tsiku.
Chifukwa cha kuwonongeka kwa fupa, lomwe limatulutsa calcium, kashiamu yowonjezereka m'magazi (hypercalcemia) ingayambitse chisokonezo, kunyoza ndi kusanza, ludzu, ndi kufooka kwa minofu.
Mavuto
Monga taonera kale, mitsempha ya mafupa ingayambitse mitundu yambiri ya zizindikiro, zambiri zomwe zimachepetsa moyo wa anthu omwe ali ndi khansa ya m'mapapo.
- Ululu - Ubwino wogwirizana ndi mafupa a metastases ukhoza kukhala wovuta kwambiri, wosokoneza khalidwe la moyo. Kuphatikizanso apo, mankhwala ochizira kupweteka angapangitse kutopa, komanso kudzimbidwa.
- Mphuno - Mapuloteni ndi ofunika, koma amachepetsanso khalidwe labwino. Kuphatikizidwa ndi khansara, kuchepa kwa kuyenda chifukwa cha fracture kumawonjezera pangozi yotenga magazi ndi pulmonary emboli .
- Mphepete mwachitsulo - Kuphatikizapo kuchititsa zizindikiro, kupweteka kwa msana ndi matenda oopsa omwe angayambitse kudwala ndi kutaya kwa thupi ndi chikhodzodzo.
- Hypercalcemia - Kuphatikizapo kuchititsa zizindikiro pamwamba, hypercalcemia mu khansa odwala ndidzidzidzi, ndipo zingabweretse chizoloŵezi cha mtima, zosokonezeka, ngakhale imfa. Zizindikiro za hypercalcemia zingaphatikizepo kunyoza ndi kusanza, ludzu lowonjezeka, kuchepa kwa kuyamwa, minofu ndi mgwirizano, kufooka, ndi chisokonezo.
- Mauthenga Owonjezereka, Opaleshoni, ndi Mankhwala - Ngati mankhwala opatsirana ndi ma radiation, opaleshoni kapena mankhwala akugwiritsidwa ntchito pofuna kuthana ndi mavuto a mafupa a metastases, zotsatira za mankhwalawa zimaphatikizidwa ku zotsatira za mankhwala ochiritsira khansa poyamba.
- Kuperewera kwa Machiritso - Njira imodzi yomwe nthawi zambiri imayamikiridwa, ndi momwe mafupa a mitsempha angapangire mankhwala ena a khansa. Mwa njira iyi, zochitika zofanana ndi zigoba (monga fractures) zingakhale mbali ya nkhanza yomwe khansara imayambitsa vuto (mwachitsanzo kupweteka) komwe kumachepetsa kugwiritsa ntchito mankhwala ndi opaleshoni kuchiza khansara.
Kudziwa
Mayesero omwe amagwiritsidwa ntchito kufufuza mafupa amtundu angaphatikizepo:
- Matenda a mafupa : Mafupa a mafupa amagwiritsidwa ntchito mobwerezabwereza kuti ayang'ane mitsempha ya mafupa kusiyana ndi kale lomwe, ndipo nthawi zina zimakhala zovuta kusiyanitsa khansara ya mafupa ena.
- PET imawunika : PET yowunika ndi yowopsya kwambiri pozindikira mitsempha ya mafupa , pamene ikuyang'ana malo okhudzira kukula mu fupa.
- MRI ikuyang'ana
- CT ikuyang'ana
Chithandizo
Chithandizo cha khansa ya m'mapapo ndi mafupa a metastases ndi operewera kwambiri -ndiko kuti, amatanthawuzira kuthetsa zizindikiro, koma osati kuchiza khansa. Cholinga chachikulu cha chithandizo ndi kuchepetsa kupweteka kumene kumayambitsa metastases ndi kuchiza kapena kuteteza fractures ndi mavuto ena. Izi zati, kwa anthu okhala ndi metastases ochepa chabe (omwe amatchedwa oligometastatic), madokotala angalingalire kuchiza metastases mwachiwawa ndi chiyembekezo cha moyo wamuyaya (onani m'munsimu).
Njira zothandizira mafupa a mfupa zalembedwa m'munsimu. Chofunika kwambiri kukumbukira, komabe, cholinga cha chithandizo chiyenera kukhala kuthetsa ululu uliwonse kapena zovuta zomwe mukukumana nazo. Kafukufuku amatiuza kuti mpumulo wabwino umatheka. Izi zati, zinthu zingapo zingathe kutsimikizira kuti izi zimachitika. Ndikofunika kuti anthu omwe ali ndi khansa azindikire kuti mankhwala opweteka, akamagwiritsidwa ntchito monga momwe amachitira, sagwiritsa ntchito mankhwala osokoneza bongo, ndipo simungachepetse mwayi wokhala ndi ululu m'tsogolo mukamagwiritsa ntchito mankhwala opweteka tsopano. N'kofunikanso kukhala wothandizira nokha pa chisamaliro chanu cha khansa ndi kuwalola dokotala wanu kudziwa ngati muli ndi ululu uliwonse womwe umasokoneza umoyo wanu.
Zosankha zamankhwala zimaphatikizapo zonse systemic (m'thupi lonse) ndi kumalo (kulumikiza mafupa metastases okha) mankhwala. Tiyeni tiyang'ane pa izi zilizonse.
Njira Zothandizira Zokwanira
Mankhwala ambiri a khansa ya m'mapapo ya m'mapapo, monga chemotherapy, mankhwala ochiritsira, ndi immunotherapy, amachepetsa mitsempha ya mafupa. Mankhwala oyamba a khansa ya m'mapapo ya khansa ya m'mapapo adavomerezedwa mu 2015, ndipo tsopano mankhwala anayi aliwonse amapezeka ku khansara yamapapo. Pofuna kupeza bwino, kafukufuku wa 2018 anapeza kuti kukhalapo kwa mafupa a metastases kunali kudziimira payekha kuti Opdivo (nivolumab) ingakhale yothandiza kansalu.
Local Treatment Options
Pali njira zingapo zomwe mungapeze kuchipatala chophatikiza mafupa kuphatikizapo chithandizo chilichonse chomwe mukuchiza khansayo. Mankhwalawa angagwiritsidwe ntchito payekha kapena osakaniza malingana ndi kukula kwa ululu wanu komanso mavuto omwe angachitike. Zosankha zikuphatikizapo:
Mankhwala opweteka - Mankhwala otsutsana ndi kutupa komanso mankhwala osokoneza bongo, monga morphine, angagwiritsidwe ntchito kuchepetsa kupweteka kwa mitsempha ya mafupa. Apa pali zambiri zokhudzana ndi kuyang'anira ululu chifukwa cha khansa.
Thandizo la ma Radiation - Mankhwalawa ndi omwe amachititsa kuchepetsa kupweteka, kuteteza kuphulika, komanso kuchepetsa kupweteka kwa msana kumatenda. Anthu ambiri amapeza kupweteka kwakukulu kuchokera kuchipatala, ndipo kwa anthu ambiri, ma radiation amatha kuthetsa ululu wawo wonse.
Opaleshoni - Opaleshoni imagwiritsidwa ntchito makamaka kuti ikhale yolimba mafupa ngati iphwanyidwa, kapena kuteteza kupunthwa m'phfu lomwe lafooka kwambiri ndi khansara (kutayika koyandikira). Nthaŵi zina opaleshoni ingagwiritsidwe ntchito ngati chotupa chikuyambitsa kupweteka kwa msana, monga cauda equina syndrome.
Mfupa inkapezeka ndi mankhwala kapena mankhwala othandizira mafupa - Mungawamve dokotala wanu akulankhula za mankhwala othandizira mafupa . Mankhwalawa amaphatikizapo kugwiritsa ntchito bisphosphates (yomwe ikufotokozedwa patsogolo) ndi kugwiritsa ntchito denosumab).
Bisphosphonates - Bisphosphonates ndi mankhwala omwe agwiritsidwa ntchito pochiza mafupa ochepa thupi, koma angathandizenso kuchepetsa kupasuka kwa fupa kwa anthu okhala ndi mafupa a metastases chifukwa cha khansa. Mankhwala ogwiritsidwa ntchito kwa anthu omwe ali ndi kansa ya m'mapapo ndi Zometa (zoledronic acid) ndi Prolia (denosumab).
Mankhwalawa ndi otetezeka, nthawi zambiri amatha kupanga vuto lotchedwa osteonecrosis la nsagwada (kugwa kwa fupa mumphono) ndi kuwonongeka kwa impso. Zikhoza kugwiritsidwa ntchito pambuyo pa zovuta za mitsempha ya mafupa, kapena kupeŵa mavuto m'malo oyamba. Zometa ndi Prolia akupindulanso kwambiri kukhala ndi ziwalo zamagetsi. Zometa ndi Prolia zimaperekedwa ngati mankhwala opatsirana (IV) masabata atatu kapena anai onse a Zometa, kapena masabata awiri kapena anayi ndi Prolia.
Denosumab - Denosumab ndi munthu wotsutsa munthu amene wakhala akugwiritsidwa ntchito bwino kwa anthu omwe ali ndi khansa ya m'mawere komanso ya prostate yomwe yafalikira mafupa. Pakali pano akuganiza kuti zingachepetse mavuto, monga zophulika, zokhudzana ndi khansa ya m'mapapo yomwe yafalikira ku mafupa. Zimaganiziranso kuti zingakhale ndi zotsatira za khansa yokhayo chifukwa imakhala ndi mankhwala okhudzana ndi zotupa. Denosumab amaperekedwa ngati jekeseni ya subcuticular (pansi pa khungu) masabata anai onse.
Radionuclide Treatment - Mankhwala othandizira ma Radionuclide ndi njira yochizira mafupa a metastases omwe agwiritsidwa ntchito makamaka kwa prostate ndi khansa ya m'mawere. Kuwunika kwa mayesero angapo omwe apangidwa mpaka lero kunapeza kuti mankhwalawa amachititsa kupweteka kwa anthu 75 peresenti ya anthu omwe ali ndi khansara yamapapo amayamba masabata asanu mpaka asanu atalandira chithandizo ndipo amakhala mpaka miyezi isanu ndi umodzi. Tikuyembekeza kuti maphunziro akuluakulu adzafufuza momwe ntchitoyi ikugwirira ntchito posachedwapa.
Zilonda zam'chipatala - Zovuta zachipatala zikuyang'anitsitsa njira zabwino zothandizira mitsempha ya mafupa chifukwa cha khansa.
Njira Zothandizira Mankhwala Osiyanasiyana - Akatswiri ofufuza akuyang'ananso njira zowonjezera zothandizira kupweteka kwa mafupa chifukwa cha khansa ya metastatic, ndipo kudulidwa magazi kungakhale ndi lonjezo pamene likugwiritsidwa ntchito kuwonjezera pa mankhwala enawa.
Kuchiza kwa Okhaokha ndi Oligometastases
Monga taonera kale, kawirikawiri anthu omwe ali ndi masewera amodzi kapena ochepa okha amatha kupumira ku khansa yamapapu, mankhwala opatsirana pogwiritsa ntchito mazira ( SBRT ) angaganizidwe. Pakalipano izi zachitidwa makamaka kwa anthu omwe ali ndi masewera amodzi kapena ochepa ku ubongo kapena chiwindi.
Kuthamangitsani
Kupulumuka kwapakati -mwachitsanzo, kuchuluka kwa nthawi yomwe 50 peresenti ya anthu ndi amoyo ndipo 50 peresenti yafa-ndizosautsa miyezi yosachepera sikisitini kwa anthu okhala ndi mafupa a mitsempha ya khansa ya m'mapapo. Kupulumuka kumakhala kochepa kwambiri kwa amayi , omwe ali ndi adenocarcinoma , anthu omwe ali ndi mafupa amodzi okha, ndi omwe alibe operewera. Izi zati, anthu ena apulumuka ndipo akhala bwino kwa zaka zambiri pambuyo pozindikira kuti khansa ya m'mapapo ndi mitsempha ya mafupa.
Mawu Ochokera ku Mafupa Amtundu wa Khansa ya M'mimba
Kuphunzira kuti muli ndi mafupa a mafupa a khansa ya m'mapapo ndi okhumudwitsa. Izi zikutanthauza kuti khansara yanu ndi siteji ya 4 (metastatic) ndipo imachiritsiranso. Kuphatikizanso, mitsempha ya mafupa ikhoza kukhala yopweteka kwambiri ndipo imakhudza momwe mungathe kuyendera. Izi zinati, mankhwala akukula. Mankhwala opatsirana khansa ya m'magazi, monga chemotherapy, mankhwala ochiritsira, ndi immunotherapy angathandizenso mafupa a metastases. Kuphatikizanso apo, mitsempha ya mafupa imatha kuchiritsidwa kwanuko ndi njira zomwe mungagwiritse ntchito monga mankhwala osokoneza bongo (omwe angakhale ndi zotsatira zotsutsana ndi khansa) komanso mankhwala opatsirana. Ngakhale kuti mankhwalawa ndi osauka kwenikweni, anthu ena akhala zaka zambiri ndi matenda a mfupa a khansa ya m'mapapo.
> Zotsatira:
> De Castro, J., Garcia, R., Garrido, P. et al. Thandizo Labwino la Denosumab M'madokotala Odwala Khansa ya M'magazi: Kuposa Kupewa Matenda Osautsa. Khansara Yam'mimba Yamakono . 2015. 16 (6): 431-46.
> Hendriks, L., Hermans, B., van den Beuken-van Everdingen, M., Hochstenbag, M., ndi A A. Dingemans. Zotsatira za Bisphosphonates, Denosumab, ndi Radioisotopes pa Matenda a Mafupa ndi Umoyo wa Odwala kwa Odwala Osagwira Nkhuku Zambiri za M'magazi ndi Matenda a Mitsempha: Kugwiritsira Ntchito Mwatsatanetsatane. Journal of Thoracic Oncology . 2016. 11 (2): 155-73.
> Langer, C. ndi V. Hirsh. Matenda opatsirana m'matenda a khansa ya m'mapapo ndi mafupa a metastases: akuwonetsa kufunikira koyambitsa matenda ndi matenda a bisphosphonates. Khansa Yam'mimba . 2010. 67 (1): 4-11.
> Oyewumi, M. et al. Matenda a khansa ya m'mapapo yowonongeka pogwiritsa ntchito tizilombo toyambitsa matenda. International Journal of Cell Biology . Epub 2014 Aug 14.
> Tamiya, M., Tamiya, A., Inoue, T. et al. Ma site a Metastatic monga Nivolumab Ogwira Ntchito kwa Odwala Amene Ali ndi Matenda Ovuta Kwambiri Osakhala Amtundu wa Khansayo: Mlandu Wowonongeka Wowonongeka. PLoS One . 2018. 13 (2): e0192227.
> Zacho, H., Karthigaseu, N., Fonager, R., ndi L. Petersen. Kuchiza ndi mafupa a radionuclides a mafupa opweteka a metastases odwala odwala khansa ya m'mapapo: ndondomeko yowonongeka. Bungwe la BMJ Lochirikizira ndi Lothandizana . 2016 Jan 27. (Epub patsogolo pa kusindikiza).