Ngati mukukhala ndi khansara ya mapapo 4, wanu wa oncologist wakhala akufotokozera cholinga cha mankhwala omwe mwalandira. Komabe ife tikuphunzira kuti zomwe anthu angayembekezere kuchokera ku mitundu ina ya mankhwala zimasiyana ndi zomwe oncologists akuyembekeza. Kodi ndi zoona zenizeni za mankhwala a chemotherapy ndi mankhwala omwe amapanga khansa ya khansa ya m'mapapo 4 ndipo ndi malingaliro olakwika ati?
Chiyembekezo ndi Chiyembekezo Chobodza ndi Kugonjetsa
Pali chiyembekezo chochuluka kwa omwe ali ndi kansa ya m'mapapo 4. Ndikofunika kuzindikira kutsogolo komwe kuti chiwonetsero cha anthu omwe ali ndi khansa ya mapapu 4 ikukula; Mankhwala atsopano ayamba kupezeka, ndipo chiwerengero cha moyo chikukula. Pali anthu ambiri omwe amaonedwa kuti ndi "a nthawi yayitali" opulumuka khansara ya mapapo 4, ndipo nambala imeneyo ikuwonjezeka chaka chilichonse.
Izi zinati, zizindikiro za khansa ya m'mapapo 4 ya mapapo sizinali zomwe tifuna, ndipo mankhwala ena samagwira ntchito monga momwe tingafunire. Pokukambirana za mankhwalawa, pali kusiyana pakati pa kulimbikitsa chiyembekezo ndikupereka chiyembekezo chonyenga.
Chiyembekezo chonyenga chokhudza chithandizo chingachititse anthu kupita kuchipatala chomwe chili ndi mtengo wolemetsa pokhudzana ndi khalidwe labwino. Chiyembekezo chonyenga chingapangitsenso anthu kupewa njira zochizira zomwe zingagwire ntchito bwino. Chiyembekezo chenicheni, mosiyana, chimaphatikizapo kuona moona ngati chithandizo chili choyenera, koma njira yomwe mungamvere kuti muli ndi mphamvu pakupanga zosankha pamoyo wanu.
Zolinga za Madokotala ndi Zoyembekezera za Odwala
Mpaka pano posachedwa tinaganiza kuti madokotala ndi odwala anali ndi lingaliro lomwelo panthawi ya kuyembekezera za mankhwala a khansa ya pakhungu 4. Kafukufuku wowerengeka, komabe, athyola chipolopolo chimenecho, mwa kulemekeza zoyembekeza zokhudzana ndi mankhwala a chemotherapy ndi mankhwala opatsirana pogwiritsa ntchito mankhwala.
(Njira zochiritsira, immunotherapy, ndi mtundu wina wa mankhwala opangidwa ndi ma ARV ndi nkhani ina ndipo tidzakambirananso pansipa) Tiyeni tiwone zomwe taphunzira.
Chemotherapy Zotsatira ndi Zoyembekeza
Mufukufuku wa 2012, ochita kafukufuku adawona ngati kuyembekezera kwa odwala ndi oncologists kunali kosagwirizana ndi ziyembekezo zokhudzana ndi chemotherapy pa khansa ya m'magazi 4 . Zotsatira za phunziroli zinali zovuta.
Onse, 69 peresenti ya odwala khansa ya m'mapapo 4 (ndi 81 peresenti ya malo odwala 4 odwala khansa) sakudziwa kuti chemotherapy sichikanatha kuchiritsa khansa yawo. Mwa kuyankhula kwina, ambiri mwa anthuwa ali ndi khansara yamapapo ali ndi chiyembekezo chonyenga chakuti chemotherapy ikhoza kuchiza matenda awo.
Phunziro lina lomwe linapangidwa mu 2015 linatsimikizira kuti kusiyana kumeneku kunachitikabe, kuti pafupifupi awiri mwa atatu mwa odwala omwe ali ndi khansa ya pakhungu kapena khansa sanamvetsetse kuti mankhwala a chemotherapy sakanatha kuchiritsa khansa yawo.
Chemotherapy, ikagwiritsidwa ntchito kwa anthu omwe ali ndi khansa ya m'mapapo 4, imatha kupulumuka. Anthu omwe amachizidwa ndi mankhwalawa amakhala, pafupifupi, masabata angapo kapena miyezi ingapo yaitali. Chemotherapy ingagwiritsidwenso ntchito ngati mankhwala opatsirana, kuchepetsa zizindikiro monga kupuma pang'ono.
Komabe chemotherapy amangowononga mankhwala a kansa yamapapo.
Mankhwala Opanga Mafuta
Mofanana ndi mankhwala a chemotherapy, zikuwoneka kuti anthu ambiri ali ndi maganizo olakwika ponena za kupindula kwa mankhwala opatsirana pogwiritsa ntchito khansa ya m'mapapo 4 . Mufukufuku wa 2012, adapezeka kuti 64 peresenti ya anthu sanazindikire kuti kutentha kwa dzuwa sikukanatha kuchiritsa khansa yawo.
Thandizo la mankhwala, monga mankhwala a chemotherapy, akhoza kupatsa moyo, kapena kuthandizira zizindikiro za khansara, koma kawirikawiri zimakhala ndi moyo wanthaŵi yaitali. Koma mosiyana ndi chemotherapy, ma radiation angakhale othandiza kwambiri poletsa kutaya mwazi kapena kusokoneza kayendedwe ka kansa ya m'mapapo, kapena kupangitsa mafupa a mitsempha omwe amatha kupweteka kapena kupweteka.
Pali mtundu umodzi wa mankhwala omwe amawotchedwa ma radiation omwe nthawi zina amagwiritsidwa ntchito ndi ziyembekezo za kukhalapo kwa nthawi yaitali pakati pa omwe ali ndi khansa ya m'mapapo 4. Ngati munthu ali ndi mitsempha yochepa kapena yochepa yokha ku ubongo , mwachitsanzo, thupi lotchedwa radiotherapy (SBRT) lomwe limadziwika kuti CyberKnife, nthawi zina limapangitsa kuti matendawa athetseretu.
Zotsatira za Chiyembekezo Chabodza
Zakhala zikukangana nthawi zina kuti kukhala ndi chiyembekezo chonyenga ndi khansa kuli bwino kusiyana ndi chiyembekezo. Komatu pofunsidwa, zikuwoneka kuti anthu ambiri samafuna kupatsidwa chiyembekezo chenicheni. Chiyembekezo chonyenga chimawakana anthu mwayi wodzipangira okha zisankho kapena kukhala ovomerezeka awo pa chisamaliro chawo. Pali zifukwa ziwiri zotsutsana chifukwa chiyembekezo chonyenga chimenechi chikhoza kuvulaza anthu omwe ali ndi khansara yamapapu .
Chifukwa chimodzi ndi chakuti chiyembekezo chonyenga chimapereka anthu omwe akufuna kuchita zonse zomwe zingatheke kuti athe kuchiza matenda awo chinyengo chakuti izi zachitika kale. Tili ndi mankhwala panopa kuphatikizapo chemotherapy, opaleshoni, ndi mankhwala omwe amawathandiza kuti akhale ndi chiyembekezo kapena mwayi waukulu wopulumuka kwa anthu ena. Popeza zina mwa mankhwalawa atsopano zangobvomerezedwa posachedwapa kapena zimangowoneka m'mayesero a kliniki. Popeza zina mwa mankhwalawa atsopano zakhala zikuvomerezeka kapena zikupezeka m'mayesero a kachipatala, atakhala ndi chiyembekezo chonyenga chakuti chemotherapy angakhale chithandizo chomwe chingalepheretse anthu kuti asatenge njira zomwe angathe kuchita kuti athe kukwaniritsa zomwe akuyembekezera.
Chifukwa chosiyana ndi chakuti munthu angapange kuchipatala chomwe chimachepetsa moyo wawo ndikuganiza kuti chidzachulukitsa kuchulukitsa pamene sizikutheka. Mwanjira iyi, chiyembekezo chonyenga chikana anthu kusankha kusankha moona momwe angafunire kugwiritsira ntchito masiku awo otsiriza.
Wodwala / Wodziwitsa Wogwira
Kuyang'ana kusiyana pakati pa ziyembekezo pakati pa odwala ndi madokotala mukhoza kuganiza kuti kuyankhulana kunali vuto. M'malo mwake, anapeza kuti odwala omwe amati adalankhulana bwino ndi madokotala awo amatha kunyamula chiyembekezo chonyenga chakuti chemotherapy ikhoza kukhala yowononga. Ngakhale zifukwa izi sizikudziwikiratu, zikhoza kukhala kuti oncologists akuwopa kuti kugawana choonadi ponena za chemotherapy kungachotse chiyembekezo.
Zotsatira Zothandizira
Aliyense yemwe ali ndi siteji yachinayi yopanda khansa yapakhungu ayenera kukhala ndi majekesitomu (kuyesera kwa jini) imodzi mwa zotupa zawo. Kwa iwo amene ali ndi kusintha kwa EGFR , ALK rearrangements , ROS1 rearrangements , kapena kusintha kwasintha, njira zina zochiritsira zomwe zingawathandize zingachititse kuti asatengere kanseri kuposa momwe angayang'anire ndi chemotherapy.
Ngakhale khansa nthawi zambiri imakhala yogonjetsedwa ndi mankhwalawa nthawi (nthawi zambiri kuzungulira pachaka koma nthawi zina zaka zambiri), mankhwala ena (achiwiri kapena atatu) akhoza kukhala osankha. Mwachitsanzo, chifuwa chachikulu cha EGFR chomwe chimayendetsedwa kwa kanthawi pa Tarceva (erlotinib) koma chimawatsutsa, chingakhale chokhudzidwa ndi mankhwala a mbadwo wachitatu. Mwanjira iyi, khansara yamapapo, osachepera khansa ya m'mapapo ndi kusintha kwapadera, akuyandikira kwambiri kuti ayambe kuchitidwa ngati matenda aakulu: osachiritsika, koma olamulidwa kwa nthawi yochulukirapo.
Immunotherapy
Mu 2015, mankhwala atsopano a immunotherapy adavomerezedwa kuti adziwe khansa yamapapo. Immunotherapy amagwira ntchito pogwiritsa ntchito mfundo za chitetezo chathu cha mthupi kuti tipewe maselo a khansa. Ngakhale anthu ambiri samayankha mankhwalawa, anthu omwe amatha kuyankha nthawi zina amatha kupeza nthawi yambiri yoletsa khansa yawo. Mwa kuyankhula kwina, anthu omwe amamvera mankhwalawa, monga Keytruda (pembrolizumab) kapena Opdivo (nivolumab) akhoza kukhala ndi moyo kwautali kuposa momwe angayang'anire kukhala ndi mankhwala ngati mankhwala okhaokha.
Nkhani Za Kutha kwa Moyo Care
Kuwonjezera pa kuthekera kwa kugwiritsa ntchito mankhwala atsopano omwe angakhale othandiza kwambiri kuposa chemotherapy, taona kuti chemotherapy kapena mankhwala othandizira mankhwalawa ngati wina akugwiritsa ntchito mankhwalawa akuyembekeza kuti athe kuchiza khansa yawo yamapapu yapamwamba-angachepetse mwayi wokambirana moona mtima ndi awo oncologist pankhani za kutha kwa moyo.
Tikuphunziranso kuti kusamalidwa kwabwino (kugwiritsidwa ntchito mosamala kungagwiritsidwe ntchito ngakhale ngati wina akuyenera kuchiritsidwa) sikungowonjezera khalidwe la moyo kwa anthu omwe ali ndi khansara yamapapu, koma akhoza kuonjezera kupulumuka. Chisamaliro cha chipatala ndi mtundu umodzi wa chisamaliro chosamalidwa bwino, ndipo zomvetsa chisoni, anthu ambiri amasankha chisamaliro chimenechi kanthawi kochepa mu matenda awo ndipo akukhumba kuti atachita kale chifukwa cha chithandizo chomwe chimadza ndi chisankhochi.
Chitsime:
Chen, A., Cronin, A., milungu, J. et al. Zoyembekeza zokhudzana ndi Mphamvu ya mankhwala opatsirana pogwiritsa ntchito ma ARV pakati pa odwala ndi khansa yosachiritsika. Journal of Clinical Oncology . 2013. 31 (21): 2730-5.
Mack, J., Walling, A., Dy, S. ndi al. Zikhulupiriro zoleza mtima zomwe Chemotherapy ikhoza kukhala zowonongeka ndi chisamaliro chomwe chimalandira pa mapeto a moyo pakati pa odwala Matumbo a Metastatic ndi Caolorectal Cancer. Khansa . 2015. 121 (11): 1891-7.
Masabata, J., Catalano, P., Cronin, A. et al. Zoyembekeza za odwala za zotsatira za Chemotherapy kwa Khansa Yapamwamba. The New England Journal of Medicine . 2012. 367: 1616-1625.