Mankhwala ochizira amthera nthawi zambiri amachititsa kadoyo ya m'mawere, makamaka kwa omwe ali ndi zotupa zomwe zimapezeka ndi estrogen . Kusankha mankhwala kumadalira ngati inu muli mtsogoleri wamwamuna kapena wamwamuna, komanso ngati khansa yanu inabwerera pamene mukugwiritsa ntchito imodzi mwa mankhwalawa. (Ngati khansara yanu inabwerezedwa pamene mutenga imodzi mwa mankhwalawa amaganiza kuti khansa yanu imakhala yosagonjetsedwa ndi mankhwala.)
Udindo wa Estrogen
Kwa ma cancer oyamwitsa a estrogen, estrogen imakhala ngati mafuta, kumangiriza ndi maselo a estrogen pamwamba pa maselo a khansa ndikupangitsa kukula ndi kufalikira kwa khansa. Kuchita kwa estrogen pa maselo a khansa kungakhale kochepa m'njira zingapo; mwa kuchepetsa kuchuluka kwa estrogen m'thupi, kapena poletsa mavitamini a estrogen kotero estrogen silingathe kukula kwa maselo. Mosiyana ndi mankhwala a chemotherapy omwe amapha mwachindunji maselo a khansa mwachindunji (mophweka), mankhwala achimake amagwira ntchito "makamaka ndi njala" maselo a khansa ya estrogen.
Musanayambe kusamba, mazira anu ndi omwe amapanga kwambiri estrogen. Pambuyo pa kutha kwa thupi, chitsimikizo chachikulu cha estrogen m'thupi chimachokera ku kutembenuka kwa androgens kwa estrogen. Kutembenuka kumeneku kumatetezedwa ndi mankhwala a enzyme aromatase omwe amapezeka mu mafuta ndi minofu. Aromatase inhibitors ndi mankhwala omwe amachititsa kuti aromatase awonongeke kotero kuti kutembenuka kwa androgens kwa estrogens sikungatheke, kuchepetsa kuchepa kwa mayendedwe a estrogen.
Mankhwala osokoneza bongo sagwira ntchito kwa omwe ali ndi recerogor ndi progesterone receptor zoipa zotupa.
Ndifunikanso kuzindikira kuti zotupa zina zotchedwa estrogen zimakhala ndi HER 2 zabwino . Mu zotupa zomwe zimakhala zabwino kwa zonsezi, mankhwala oletsa anti-estrogen angagwiritsidwe ntchito kapena popanda mankhwala omwe amachita pa HER 2.
Themenopausal Therapy
Ngati muli odwala, mazira anu apitirize kukhala a estrogen, ndipo motero mafuta, chifukwa cha khansa ya m'mawere. Cholinga cha chithandizo cha amayi otsogolera ndi kuchepetsa mphamvu ya estrogen kukonzekera kukula kwa khansa yanu kapena kuchepetsa kuchuluka kwa estrogen (kupatsirana kwa ovarian mankhwala) komanso kusokoneza luso la estrogen kuti likhale ndi othandizira a estrogen pa khansa ya m'mawere maselo.
Mankhwala monga tamoxifen amatchulidwa kuti SERMS-kusankha selerogen receptor, ndipo amagwira ntchito pogwiritsa ntchito maselo a khansa kuti estrogen ilipo mu thupi silingathe kuyika selo ndikuwonetsa selo kukula.
Zimaganiziridwa kuti aromatase inhibitors angakhale opambana kuposa tamoxifen, koma izi sizingagwiritsidwe ntchito kwa amayi omwe ali ndi HIV chifukwa cha ntchito ya mazira. Kuti muchepetse estrogen yopangidwa ndi mazira ochuluka, ndikulolani kugwiritsa ntchito aromatase inhibitor, wanu oncologist angalimbikitse ovarian chithandizo mankhwala.
Kuponderezedwa kwa ovariya kungakwaniritsidwe ndi:
- Kugwiritsa ntchito mankhwala otchedwa Zoladex (goserelin) - Awa ndi mankhwala operekedwa mochepa ndipo amalepheretsa kuti estrogen ndi thupi, ndipo amadziwika ngati gonadotropic yomwe imatulutsa wotsutsa mahomoni. Mazirawa amabweretsa estrogen chifukwa cha hormone yotchedwa gonadotropin yotulutsa hormone yomwe imadziwika ndi chithokomiro. Zoladex imalepheretsa mphamvu ya gonadotropin yotulutsa hormone kuti ikhale ndi mazira ambiri.
- Mavuto Osavuta - Amayi ambiri amasankha kuchotsa mazira awo (kudzera mu njira yotchedwa oophorectomy) m'malo mogwiritsa ntchito Zoladex. Kuchita opaleshoniyi sikuchitika kawirikawiri chifukwa cha zoopsa zowonjezereka ndi opaleshoni, koma amayi ena angasankhe njira iyi, makamaka omwe ali ndi chiopsezo cha khansa ya ovari komanso khansa ya m'mawere.
Mankhwala osokoneza bongo amatha kuchitidwa ngati njira ya laparoscopic ndipo nthawi zambiri amachitidwa opaleshoni yomweyo. M'malo otchedwa laparoscopic oophorectomy, zochepa zazing'ono zimapangidwa m'mimba ndipo mazira amachotsedwa mothandizidwa ndi zida zapadera.
Pambuyo pa mankhwala osokoneza bongo, amayi omwe amayamba kumwa mankhwala amatha kupatsidwa mankhwala monga amayi omwe amachititsa m "mene amachitira m'munsimu kapena ndi tamoxifen.
Therapyopaopausal Therapy
Pambuyo pa kutha kwa thupi, chitsimikizo chachikulu cha estrogen m'thupi chimachokera ku kutembenuka kwina kwa androgen kwa estrogen. Khansara ya m'mimba ya menopausal imatha kuchitidwa ndi tamoxifen (kuteteza estrogen imeneyi kuti isamangidwe ndi maselo a khansa) koma gulu la mankhwala otchedwa aromatase inhibitors likuwoneka bwino kwambiri ndi zotsatira zochepa.
Opezeka aromatase inhibitors ndi awa:
- Arimidex (anastrozole)
- Femara (letrozole)
- Aromasin (chiwombankhanga)
Aromatase inhibitors angagwiritsidwe ntchito payekha, kapena kuphatikizapo mankhwala a chemotherapy . Mwachitsanzo, kuphatikizapo Femara (letrozole) ndi Ibrance (palbociclib) ndi Aromasin (mphepo yamkuntho) ndi Afinitor (everolimus). Pali nthawi zonse zowonjezereka pamene mukuwonjezera mankhwala ena. Ngakhale kugwirizanitsa kungakhale kothandiza, palinso kuwonjezeka kwa zotsatirapo pamene mukuphatikiza mankhwala oposa limodzi.
Ndi zothandiza kukumbukiranso kuti cholinga cha chithandizo nthawi zambiri chimakhala chosiyana ndi khansa ya m'mawere ya m'mawere kusiyana ndi khansa ya m'mawere oyambirira. Kuyambira kale, khansa ya m'mawere, cholinga chake ndi kuchizira, ndipo filosofi ndiyo "kutulutsa mfuti zazikulu" kuti athe kuchiza matendawa. Filosofi yomwe imakhala ndi kansa ya m'mawere, makamaka, imathandiza kuchepetsa kukula kwa khansa ndi mankhwala osakwanira, kupulumutsa mankhwala ena nthawi yomwe mankhwala oyambirira sakugwiranso ntchito.
Zochiritsira Zina za Hormonal
Kuwonjezera pa tamoxifen ndi aromatase inhibitors, palinso mankhwala ena okhudzana ndi mahomoni omwe angagwiritsidwe ntchito pa khansa ya m'mawere. Ngati khansara ya m'mawere ikukula kapena kufalikira pa mankhwala operekedwa pamwambapa nthawi zambiri imakhala yosagonjetsedwa ndi mankhwalawa. Kansera yamatenda a m'matumbo nthawi zambiri imakhala yogonjetsedwa ndi mankhwalawa nthawi. Izi zikachitika, zosankha ndizo:
- Faslodex (fulvestrant) -Akazi omwe amatha kutsata khansa pa tamoxifen kapena aromatase inhibitor, amatha kugwiritsa ntchito mankhwala a Faslodex. Faslodex panopa ndi mankhwala okhawo amene amavomereza khansa ya m'mawere mu gulu lotchedwa SERD-kusankha selerogen receptor regul regulators.
Mankhwalawa amatchulidwa kuti "anti antirorogen" ndipo amachititsa kuti isrogen ikhale ndi maselo a khansa ya m'mawere, koma mosiyana ndi tamoxifen (ndi wotsutsa wa estrogen.) Faslodex ingagwiritsidwe ntchito yokha kapena yogwirizana ndi Mankhwalawa (palbociclib), mankhwala a chemotherapy, ndipo amaperekedwa ngati jekeseni.
Mankhwala Amagwiritsidwa Ntchito Nthawi Zambiri
Palinso mankhwala ena ochizira omwe amagwiritsidwa ntchito mobwerezabwereza koma nthawi zina amatengedwa ngati mzere wachitatu kapena mankhwala a 4th line. Izi zikuphatikizapo:
- Fareston (toremifene) - Fareston ndi mankhwala ofanana ndi tamoxifen komanso amaonedwa kuti ostrogen receptor modulating wothandizira nthawi zina amalingaliridwa ndi amayi omwe ali ndi matenda opatsirana pogonana omwe ali ndi khansa ya m'mawere yotchedwa estrogen, makamaka kwa amayi omwe alibe mavitamini omwe amatembenuza tamoxifen ku mawonekedwe ake thupi.
- Progestins - Megace (megestrol) ndi mawonekedwe a progesterone omwe nthawi zina amagwiritsidwa ntchito kwa anthu okhala ndi khansa ya m'mawere ya estrogen yomwe imakhala yosagwirizana ndi tamoxifen. Ankagwiritsidwa ntchito mobwerezabwereza m'mbuyomo, mankhwala asanakhale atsopano.
- Mahomoni a steroid - Mahomoni monga estrogen ndi androgens sagwiritsidwa ntchito ndi khansa ya m'mawere, koma nthawi zina amagwiritsidwa ntchito pamene mankhwala ena amatha.
Kuchiza kwa Amuna
Amuna omwe ali ndi khansa ya m'mawere yomwe imakhala ndi mchere wokhala ndi mahomoni amachitiridwa ndi tamoxifen.
Zotsatira Zotsatira
Tamoxifen
Tamoxifen ali ndi ntchito zosiyana, zonse zimatsanzira zotsatira za estrogen m'madera ena a thupi ndi kulimbana ndi ena. Zizindikiro zambiri zimaphatikizapo kutentha ndi maonekedwe a thupi omwe apangidwa "matenda akale a mayi" ngakhale kuti matupiwa amawopsa kwambiri kuposa aromatase inhibitors.
Zotsatira zoyipa zimaphatikizapo chiopsezo chowonjezereka cha mitsempha ya magazi m'milingo (onani tsamba 5) ya mitsempha (veous thromboembolism) yomwe, ngati yosatulutsidwa, ikhoza kumasuka ndikupita kumapapo (pulmonary emboli.) Kwa nthawi, tamoxifen ingayambitsenso magazi m'mimba ndipo imayanjanitsidwa ndi kuwonjezeka kwakung'ono pa chitukuko cha khansa ya uterine.
Azimayi ena (ndi amuna) kutenga tamoxifen angayambe kuwonjezereka kwa zizindikiro zawo (mwachitsanzo, kuwonjezeka kwa ubweya wa mitsempha ya khungu kapena kuwonjezereka kupweteka kwa mafupa kuchokera ku mitsempha ya mafupa) mkati mwa masiku angapo kuti ayambe kumwa mankhwala.
Ngati mukulitsa zizindikirozi, nthawi zambiri amatha kuthetsa masabata anayi kapena asanu ndi limodzi, ngakhale nthawi zina mankhwala amafunika kuthetsedwa. Siliva yophimba ngati muli ndi vutoli ndikuona kuti mankhwalawa akusonyeza kuti mankhwala akugwira ntchito ndipo adzakhala othandiza. Zoladex zingayambitsenso zomwezo.
Dziwani kuti Tamoxifen ikhoza kuyambitsa matenda osayeritsa thupi, kuyamwa magazi, ndi mapuloteni otsika ndipo imakhala ndi chiopsezo chowonjezeka cha khansa ya m'mimba. Kambiranani ndi dokotala ngati njirayi ndi yabwino kwa inu.
Aromatase inhibitors (AI)
AI amachititsanso kuti thupi liziyenda, ndipo pafupifupi 40 peresenti ya anthu amawona minofu yambiri komanso kupweteka. Kuwonongeka kwa mafupa ndi zotsatira zochepa, ndipo oncologist wanu amachititsa kuti pang'onopang'ono mafupa awone ngati mukudwala matenda odwala matenda a m'mimba, panthawi yoyamba ya mankhwala komanso nthawi zina. Mphuno imatha chifukwa cha kupweteka kwa mafupa, ngakhale popanda mafupa a metastases. AI akhoza kuonjezeranso ngozi ya matenda a mtima.
Faslodex
Nthaŵi zambiri faslodex imalekerera bwino, ndipo zotsatira zake zimakhala zozizira kwambiri komanso zimayambitsa matenda a chiwindi.
Zoladex (goserelin)
Chimodzi mwa zotsatira zofala kwambiri za mankhwalawa ndizofunikira kwenikweni. Cholinga cha chithandizo ndikutetezera mazira, mwa kuyankhula kwina, asiye mazira ochuluka kuti asatulutse estrogen. Kuchita izi kumayambitsa kusamba kwabwino kwa mankhwala ndipo motero, zizindikiro zowononga kwa thupi monga kutentha ndi kutentha kwa amayi ndizofala.
Monga momwe tamoxifen amachitira, anthu ena akhoza kukhala ndi vuto loyamba pamene akuyamba kumwa mankhwala, mwachitsanzo, kuwonjezeka kwa kupweteka kwa fupa kwa anthu omwe ali ndi mafupa.
Kutha kwachisawawa
Zotsatira zoyamba zokhudzana ndi kuchotsa mazira ochuluka ndi monga mankhwala omwe amachititsa kuti magazi asapitirire, monga zizindikiro zowonongeka monga kutentha kwa magazi komanso kuuma kwa amayi. Palinso zotsatirapo ndi zoopsa za opaleshoni. Chombo cha oophorectomy chikhoza kuchitidwa ndi opaleshoni yochepa (laparcopysi) kupyolera mu mapangidwe ang'onoang'ono pakhungu ndipo kawirikawiri imachitidwa ngati njira yofanana yopangira opaleshoni.
Faslodex (fulvestrant)
Popeza izi ndi mankhwala oletsa anti-estrojeni, zizindikiro zambiri zimakhala zofanana ndi zomwe zimapezeka ndi kusintha kwa thupi, monga ndi tamoxifen ndi aromatase inhibitors. Pafupifupi munthu mmodzi pa atatu alionse amakhala ndi chifuwa chofewa, koma apo ayi, mankhwalawa amalekerera.
> Zotsatira:
> American Society of Clinical Oncology. Cancer.Net. Mankhwala Ochizira Omwe Amachiza Khansa Yamtundu wa Metastatic. Kusinthidwa 05/2016. Chichewa /
> Martin, M., Lopez-Tarruella, S., ndi Y. Gilarranz. Thandizo la Endocrine la Matenda a Hormone-Naïve Advanced Cancer Cancer. Mimba . 2016. (Epub patsogolo pa kusindikiza).