Kusintha Njira Zothandizira Khansa ya M'thupi Yamatenda

Zachidule za Njira Yoyamba Yopangira Njira Zopangira Khansara Yamatenda Achimake

Musanalankhule za mankhwala onse omwe mungasankhe pa khansa ya m'mawere , imathandizira kukambirana za mtundu wa mankhwala, zolinga zamankhwala, komanso mankhwala omwe amayamba kugwiritsidwa ntchito kuti athetse khansa ya mthupi.

Mwinamwake mukudabwa momwe mungamvetsetsere mankhwala omwe ali abwino ngati mulibe mbiri ya mankhwala, koma n'zotheka kuti muphunzire mokwanira kuti musankhe bwino.

Zolinga za Chithandizo

Mosiyana ndi khansa ya m'mawere, sikutheka kuchiza khansa ya m'mawere, koma ndibwino kuti muganizire zolinga zanu.

Mwachitsanzo, anthu ena akufuna kuyesa kukhala ndi moyo wawo wonse ngati ali ndi khansara ngakhale zitakhala zovuta. Ena amatha kumva kuti moyo wawo ndi wofunika kwambiri kuposa kuchulukirapo, ndipo amasankha mankhwala omwe alibe zotsatira zochepa.

Tikukhumba kuti aliyense akhale ndi cholinga chokhala ndi nthawi yaitali ndi khansa ya m'mawere, koma pakadali pano, izi sizomwe angapange kwa anthu ambiri. Ndi khansa ya metastatic, umoyo wanu umakhala wofunikira kwambiri, koma zomwe zikutanthawuza zikhoza kukhala zosiyana kwambiri ndi munthu aliyense.

Pamene mukuganizira zomwe mungachite, ganizirani zolinga izi:

• Kodi chithandizochi chingawonjezere moyo wanga?
• Kodi mankhwalawa amachedwa kuchepetsa khansa yanga?
• Kodi mankhwalawa angakhudze bwanji moyo wanga? Kodi ndikuyembekeza kusintha zizindikiro zomwe ndikukumana nazo?

• Ngati pali zotsatirapo, kodi ndi zotsatira zotani zomwe mungapezeke nazo zosavuta komanso zosavomerezeka?

Mitundu ya Chithandizo

Ngakhale kuti tsopano tili ndi mitundu yosiyanasiyana ya chithandizo cha khansa, izi zikhoza kusweka m'magulu akulu awiri.

Zochitika Zachigawo

Mankhwala am'deralo amakhudza khansa m'malo omwe amayamba (kapena mthupi limodzi kumagulu.) Mankhwalawa ndi awa:

• Opaleshoni
• Kuchiza ma ARV

Mankhwala Ochiritsira

Mosiyana ndi zimenezi, mankhwalawa amatha kulumikiza maselo a khansa kulikonse kumene angakhale m'thupi. Izi zikuphatikizapo:

• Thandizo la mahomoni
• Chemotherapy
• Zovuta zothandizira
• Immunotherapy

Kansera yamatenda a m'matumbo, mankhwala ochizira amachititsa chithandizo chachikulu kwambiri. Mankhwala am'deralo monga opaleshoni kapena ma radiation amagwiritsidwa ntchito makamaka pofuna kuchiza mavitamini pamene izi zimayambitsa zizindikiro, monga mitsempha ya mafupa omwe imayambitsa chiopsezo cha fractures kapena metastases ku khungu kapena khoma lachifuwa lomwe limatuluka ndi lopweteka.

Anthu ambiri amadzifunsa kuti n'chifukwa chiyani opaleshoni ya m'mawere monga kondectomy kapena mastectomy sizimachitika kawirikawiri kwa anthu omwe ali ndi kansa ya m'mawere, pafupifupi asanu mpaka khumi mwa anthu omwe ali ndi kansa yapamtunda pa nthawi ya matenda. Kuganiza kwa izi ndikuti ndi metastases, khansara yayamba kufalikira bwino kuposa chifuwa.

Mankhwalawa sangathe kuchiza khansara yomwe yafalikira. M'malo mwake, opaleshoni-chifukwa cha nthawi yopuma komanso chitetezo cha chitetezo cha mthupi-chingatanthauze kuchepetsa njira zamankhwala zowonongeka, zomwe pamapeto pake zimasewera kwambiri pakuchiza khansa yanu.

Mipata ya Chithandizo

Mwinamwake mudzamva dokotala wanu akuyankhula za "mankhwala oyamba," "mankhwala achiwiri," ndi zina zotero.

Liwu limeneli limangotanthauza mankhwala oyamba kapena mankhwala, mankhwala achiwiri, ndi zina zotero zomwe zingagwiritsidwe ntchito sequentially pochiza khansa yanu.

Ndizofala kwambiri ndi khansara ya m'mawere ya mthupi kuti ikhale ndi "mizera" yosiyanasiyana ya mankhwala. Kawirikawiri mankhwalawa amasankhidwa pogwiritsa ntchito mankhwala omwe angapambane ndi zotsatira zochepa, koma pali zambiri zomwe mungachite.

Njira Zochiritsira Zoyamba

Aliyense yemwe ali ndi khansa ya metastatic ndi yosiyana, ndipo khansara iliyonse ndi yosiyana kotero ndi kovuta kulankhula za "kachitidwe" ka khansa. Izi zinati, njira zoyamba zothandizira khansara yamtunduwu zimakhala zofanana ndi matenda a kansa ya kansa yanu.

Njira zothandizira mankhwalazi zidzadalira malo anu okhudzidwa pambuyo pa " rebiopsy " ya chotupa chanu kapena metastasis, osati momwe malo anu okhudzira analiri pamene munayamba mwapeza ngati chotupa chanu chikubwereranso. Ngati khansara yanu yapachiyambi inali yamtundu wa estrogen, ikhoza kukhala yoipa, ndipo mosiyana.

Apanso ndizofunika kuzindikira kuti cholinga cha chithandizo cha khansa ya m'magazi nthawi zambiri amagwiritsira ntchito mankhwala ocheperako kuti athe kukhazikika ndi kuchepetsa matendawa. Izi ndi zosiyana ndi njira "yothetsera" yomwe imakhala ndi khansa ya m'mawere kwambiri.

Zitsanzo za mankhwala oyamba omwe angakhalepo okhudzana ndi malo ovomerezeka ndi awa:

Estrogen Receptor (ER) Mmodzi Wachikondi wa Metastatic Breast Cancer

Chithandizo choyamba cha kansa ya m'mawere yotchedwa estrogen ndi kanthana kawirikawiri, ndipo izi zimagwiritsidwa ntchito payekha. Kusankha mankhwala osokoneza bongo kudzadalira ngati mutakhala ndi mankhwala ophera mahomoni pamene khansa yanu inabwerera.

Kwa amayi omwe ali ndi HIV, tamoxifen imafunika chifukwa maantirogen ambiri opangidwa ndi thupi amachokera ku mazira. Mwinanso, kuponderezedwa kwa mazira ndi Zoladex (goserelin) kapena kawirikawiri, kuchotsedwa kwa mazira ochuluka, kungatengedwe ndi mankhwala ndi tamoxifen kapena imodzi mwa aromatase inhibitors.

Kwa amayi am'mayi amodzi, amodzi mwa aromatase inhibitors amagwiritsidwa ntchito payekha, kupatulapo kubwereza kachiwiri pogwiritsa ntchito mankhwalawa. Ngati chotupa chanu chinabwereranso pa aromatase inhibitor , njira ina ingakhale ikugwiritsa ntchito mankhwala osokoneza bongo a Faslodex (fulvesrant).

Ngati chotupa chanu chiri cholowa cha estrogen koma chikukulirakulira mofulumira, pali njira zingapo. Ngati chotupa chanu chiri kachilombo ka HIV, kachilombo ka HIV kowonjezera kawiri kakhoza kuwonjezeredwa kuchipatala cha hormonal. Chemotherapy ikhoza kugwiritsidwanso ntchito pokhapokha mankhwala opatsirana kwa mahomoni kwa omwe ali ndi zotupa zomwe zikukula mofulumira.

Ngati muli ndi zizindikiro zazikulu zokhudzana ndi metastases, mankhwala ena akhoza kuwonjezedwanso. Mankhwala otchedwa bone metastases, mankhwala opatsirana pogwiritsa ntchito mankhwala kapena mankhwala osokoneza mafupa angagwiritsidwe ntchito kuchepetsa vuto la kupasuka, kupanikizika kwa msana, kapena kupweteka kwambiri.

Mofananamo, metastases kumapapu omwe amachititsa magazi kapena kusokoneza, kapena metastases ya ubongo yomwe imayambitsa zizindikiro zazikulu ingathenso kuthandizidwa ndi mankhwala am'deralo monga ma radiation kapena opaleshoni.

HER2 Posakaniza Metastatic Breast Cancer

Ngati muli ndi chotupa chomwe chiri cholowa cha estrogen ndi HER 2 zabwino, chithandizo choyamba choyamba chingayambe ndi mankhwala a hormonal okha kapena kuphatikiza mankhwala osokoneza bongo komanso mankhwala osokoneza bongo.

Njira yoyamba yothandizira kadoyo ya m'mawere yokhala ndi kachilombo ka HIV iwiri imadalira ngati simunapangidwe ndi imodzi mwa mankhwalawa pamene munayambiranso. Ngati khansara yanu inabwerera ku Herceptin, imodzi mwa mankhwala ena a HER 2 ingagwiritsidwe ntchito. Ngati chifuwa chanu chikukula mofulumira, mankhwala a chemotherapy angaganizidwe.

Mofanana ndi zotupa zotchedwa estrogen, zimakhala zofunikiranso mankhwala am'deralo. Mwachitsanzo, kupweteka kwa mafupa a metastases kapena metastases omwe amachititsa ngozi kuti mutha kupasula fupa akhoza kuchiritsidwa ndi mankhwala opatsirana pogwiritsa ntchito mankhwala kapena mpweya wothandizira.

Khansa Yachiwerewere Yosavuta Yambiri

Khansara ya katatu ya mthenda ya m'mawere imakhala yovuta kwambiri kuchiritsa, makamaka kuposa khansa ya m'mawere yomwe ili mchere wa estrogen kapena HER 2 zabwino, komabe palinso zosankha.

Chemotherapy kawirikawiri amagwiritsidwa ntchito mzere woyamba wa khansa izi, ndipo kusankha kwa mankhwala nthawi zambiri kumadalira kuti chemotherapy imagwiritsidwa ntchito kale.

Kwa Amuna

Kansera yamatenda a m'matumbo mwa amuna ali ndi kusiyana kwakukulu kosiyanasiyana, koma kawirikawiri, njira yomweyo imatengedwa. Chithandizo chingayambe ndi tamoxifen kwa omwe ali ndi zotupa zotchedwa estrogen, kapena ndi chemotherapy.

Njira Yabwino Yothandizira

Kodi mukufunikira kudziwa chiyani kuti mupange chisankho chabwino chokhudza chithandizo chanu?

Gawo loyamba ndikudziphunzitsa nokha za matenda anu. Werengani kudzera pa zomwe zafotokozedwa apa, ndi zina zomwe mwalandira kuchokera kuchipatala chanu.

Sungani mndandanda wa mafunso kuti mufunse anu oncologist, ndipo muwabweretsereni kuti mukonzekere. Ngati mukuwona kuti ndi kovuta kumvetsa kanthu, funsani.

Pali zambiri zomwe mungaphunzire mu nthawi yochepa, komanso zovuta zomwe zimakhala ndi matenda a khansa yothandizidwa ndi matenda a khansa, wanu wa oncologist sadzakwiya ngati mukufunsanso mafunso omwewo mobwerezabwereza. Izi ndi zachilendo.

Anthu ambiri amaona kuti zimathandiza kulankhula ndi anthu omwe "akhalapo." Kuphatikiza pa magulu othandizira ammudzi , tsopano tili ndi mwayi wothandizira 24/7 woperekedwa ndi anthu omwe amathandizidwa ndi khansa ya pa Intaneti. Pali midzi yopangidwa ndi anthu okha omwe ali ndi khansa ya m'mawere, yomwe ingakhale yothandiza kwambiri pamene mukukumana ndi zisankho izi.

Lankhulani ndi anzanu ndi abambo anu, ndipo funsani zofuna zawo, koma zosankha zogwirizana ndi zanu. Izi zingakhale zovuta, makamaka ngati achibale anu sakuvomerezana ndi zosankha zanu.

Mvetserani kwa okondedwa anu ndipo muwayamike chifukwa cha zomwe akuwathandiza, koma muwakumbutseni, ngati pakufunikira, kuti muzisankha njira yomwe imalemekeza kwambiri zosowa zanu ndi zofuna zanu.

Zinthu Zomwe Zimakhudza Kusankha

Pali zifukwa zambiri zomwe zingaganizidwe posankha chithandizo chabwino cha khansara yanu, poyamba, ndipo nthawi ikupitirira. Ena mwa awa ndi awa:

• Chilolezo cha chotupacho
• Zochizira zam'mbuyomu (khansa ya m'mawere nthawi zambiri imakhala yosagwirizana ndi chithandizo pa nthawi)
• Matenda amtundu (mimba yanu ndi yaikulu bwanji)
• Zizindikiro zenizeni zomwe mwalankhula ndi khansa yanu komanso momwe zimakuvutitsani
• Khansara ikukula mofulumira kwambiri
• Zomwe mumakonda zokhala ndi chithandizo chamankhwala (oral vs IV chitsanzo), ndi kulekerera zotsatira zake (ena amapeza zotsatira zina zovuta kuposa zina)
• Kaya mukuchita nawo chiyeso cha mankhwala

Mafunso Odzifunsayo

Padzakhala mafunso ambiri oti muwafunse pankhani ya chithandizo chamankhwala, koma pali mafunso omwe mungayambe kulingalira ngakhale musanayambe kuchita zosankha zosiyanasiyana.

• Kodi mukufuna kuti muzisamalire kuti?
• Kodi ndinu okonzeka kupita ku mayeso a zachipatala ngati mukufunikira, kapena mukufuna kukhala pafupi ndi kwanu?
• Ngati mutasankha kuyenda, kodi pali malo odwala khansara omwe ali pafupi ndi abwenzi kapena achibale omwe mungakhale nawo?
• Kodi mungapite kuti ndi inshuwalansi yanu?
• Ngati mukuganiza kuchokera kwa opereka chithandizo, kodi izi zikutanthauza chiyani kwa inu?
• Kodi mungalingalire kutenga nawo mbali mu mayesero a zachipatala (mayesero okhudzana ndi khansara ya m'mawere amatha kukufotokozedwa pambuyo pake.)
• Ndi mabwenzi ati omwe angakuthandizeni pazinthu monga kusamalira ana ndi zina?

Kugonjetsa ndi / Popanda Chithandizo

Anthu ena amafuna kudziwa momwe amachitira; zomwe "zowonjezera" zotsatira ndi za munthu yemwe ali ndi matenda ake. Anthu ena samafuna kudziwa, ndipo izi ndi zabwino. Chowonadi n'chakuti sitingathe kunena momwe munthu mmodzi aliyense angachitire atapezeka kuti ali ndi khansara ya m'mawere.

Tili ndi ziwerengero zomwe zingatipangitse kulingalira za momwe munthu angachitire ndi mankhwala enaake, koma pali mavuto ambiri ndi ziwerengero. Chimodzi ndi chakuti chiŵerengero ndi manambala, osati anthu. Titha kuyankhula za chiŵerengero cha anthu, pafupipafupi, omwe amakhala chaka chimodzi kapena khumi ndi khansa ya m'mawere, koma tilibe njira yodziwiratu kuti anthu amenewo adzakhala ndani.

Zina mwazifukwa zowerengera zimatilepheretsa ife ndikuti ndizoyeso momwe anthu adachitira kale. Kuchiza kwa khansa ya m'mawere kumasintha, ndipo sitikudziwa momwe munthu angathandizire ndi mankhwala atsopano. Ziwerengero zambiri zomwe timagwiritsa ntchito kuti tiweruzire zizindikiro zili ndi zaka zisanu. Komabe mankhwala ambiri omwe amakhalapo pa khansa ya m'mawere sakadalipo zaka zisanu zapitazo.

Pa nthawi yomweyi (yochokera paziwerengero, kupulumuka kwapakati pa khansa ya m'mawere (kuphatikizapo mitundu yonse) ndi chithandizo amalingaliridwa kuti ndi miyezi 18 mpaka 24. Izi zikutanthauza kuti patatha miyezi 24 atagwiritsidwa ntchito, theka la anthu anafa ndi theka adzakhalabe ndi moyo.Zomwe zimakhalapo zaka 5 za khansa ya m'mawere ndi makumi awiri ndi awiri (22). Palinso anthu ambiri amene akhala akudwala kansa ya m'mawere kwa zaka 10 kapena kuposerapo.

Lingaliro lomaliza limene tiyenera kukumbukira ndilokuti tikupita patsogolo pakuchiza khansa ya m'mawere. Mayesero a chipatala amaphunzira chirichonse kuchokera ku immunotherapy mpaka katemera wa khansa kwa khansa ya m'mawere ikuchitika pakalipano. Tikuyembekeza kuti magulu atsopanowa azachiritso posachedwapa adzasintha ziwerengero zakale za khansa ya m'mawere.

Kudzitengera Yekha

Malo abwino kwambiri oti muyambe kulankhula za mankhwala ndi udindo wanu monga membala wofunikira mu gulu lanu la chisamaliro. Mwinamwake mwakhala mwamvapo kale kuti ndikofunikira kukhala wothandizira anu pa chisamaliro chanu, koma kodi izi zikutanthauza chiyani?

Kukhala wothandizira wanu kumatanthawuza kutenga mbali pazochita zomwe zikugwirizana ndi chithandizo chanu. Zimatanthauza kufunsa mafunso pamene simumvetsa kanthu, ndikupemphabe mpaka mutamvetsa.

Pamene tikulankhula za kukhala mtsogoleri wanu yemwe ali ndi khansa sitikutanthauza kuti mudzakhala ndi chiyanjano ndi a oncologist anu ndi ena a gulu lanu la thanzi . Mosiyana, kukhala woimira wanu kumakuthandizani kuti muthandize wanu wa oncologist kumvetsa zomwe ziri zofunika kwambiri kwa inu monga munthu.

M'mbuyomu, kawirikawiri pamakhala zosankha zochepa zomwe anthu amapezeka kuti ali ndi khansa ya mthupi. Izi zasintha kwambiri m'zaka zaposachedwa, ndipo pakalipano pali njira zingapo zomwe zingagwirizane ndi zofuna zanu.

Simudzafunsidwa kusankha pakati pa chithandizo chimene chiyenera kuchitika bwino ndi zotsatira zochepa chabe ndi zomwe sizigwira ntchito kapena zowopsa. Chowonadi ndi chakuti zambiri mwa zosankha izi zidzatsika kusiyana ndi zosowa zanu zokha.

Mwachitsanzo, mungafunikire kusankha pakati pa kulandila pafupi ndi nyumba yanu kapena kuchipatala cha kunja kwa tawuni, kapena mungasankhe pakati pa zigawo ziwiri zosiyana.

Anthu ena amaziwona kukhala zovuta kwambiri kuposa ena kuti adzivomereze okha. Ngati nthawi zambiri mumalankhula momasuka komanso mwakachetechete-wopanga mtendere mwina-mungapeze zovuta kulola gulu lanu lachipatala kudziwa pamene zinthu sizikuyenda momwe inu mungafunire. Ngati izi zikugwirizana ndi umunthu wanu, nthawi zambiri zimathandiza kusankha bwenzi kapena achibale anu kuti akuthandizani ndipo angathe kufunsa mafunso ovuta omwe simukuwafunsa.

Mawu Ochokera

Zitsanzo za mankhwala oyamba omwe ali pamwambawa ndi zitsanzo chabe, ndipo ovomerezeka anu angakulimbikitseni njira yosiyana yosiyana ndi zovuta zanu. Mankhwala ambiri akuyang'aniridwa mu mayesero a zamankhwala, ndipo imodzi mwa njirazi ingapereke njira yosiyana.

Chofunika ndikulankhulana ndi dokotala wanu chifukwa chake mankhwala ena angakonzedwenso ndikumvetsetsa zosankhazo komanso njira zina zotheka. Anthu ambiri amapeza kuti ndibwino kufunsa za mankhwala omwe angakonzedwe ngati regimen imeneyi sichiteteza chifuwa chawo.

Kuchita chimodzimodzi m'malingaliro anu kungakuthandizeni kuthana ndi zosavuta mosavuta ndi nkhawa zokhudzana ndi zomwe simukuzidziwa.

_Zotsatira:

_{Hayes, D. Maphunziro a odwala: Kuchiza khansa ya m'mawere (Pambali pa Zowona). Kupititsa patsogolo .}

> 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.