Opaleshoni, Chemotherapy, Radiation, ndi Clinical Trials
Njira zomwe mungapangire khansa ya ovari zimadalira pazigawo za matendawa komanso zina zomwe zingaphatikizepo opaleshoni, chemotherapy, mankhwala ochiritsira, kapena mayesero. Pokhapokha pachimbukero choyambirira, zoterezi zimagwiritsidwa ntchito. Mankhwala amatha kusintha ngati khansara yanu ikubwereranso ndi khansara kapena ngati muli ndi mimba.
Gulu Lanu la Kusamalira Khansa
Gawo lanu loyamba posankha njira zabwino kwambiri zothandizira ndikumvetsa gulu lanu la chisamaliro cha khansa. Ndikofunika kudziwa yemwe angapange udindo woyang'anira chisamaliro chanu ndi omwe muyenera kuitanitsa ndi mafunso.
Kawirikawiri, khansara ya ovariya imapezeka koyamba, kapena osakayikira, ndi katswiri wamagetsi (OB / GYN) kapena dokotala wina woyang'anira chisamaliro. Posankha zosankha zamankhwala, zimalimbikitsa kuti mufunsane ndi amayi odwala matendawa payekha musanayambe regimen.
Anthu ena a gulu lanu la chithandizo cha zaumoyo angaphatikizepo dokotala wanu wamkulu, wogwira ntchito zachipatala kapena wothandizira, wodwala (yemwe amayang'ana minofu iliyonse itachotsedwa pamene akuchitidwa opaleshoni), mwinamwake wodwala wodwala wodwalayo (amene akuyang'ana kuthetsa zizindikiro za khansa) kapena katswiri wa chonde.
Njira Zothandizira
Pali mitundu iwiri yamachiritso ya khansa ya ovari:
- Zochitika Zam'deralo: Mankhwala monga opaleshoni ndi ma radiation ndi mankhwala am'deralo. Amayambitsa khansara kumene idayambira koma samayendetsa maselo ena a kansa omwe afalikira kupitirira malo oyambirira a khansa.
- Mankhwala Ochizira: Pamene khansa imafalikira kupitirira malo ake oyambirira, mankhwala ochizira monga chemotherapy, mankhwala othandizira, kapena mankhwala otchedwa hormonal therapy (omwe alibe zotupa za epithelial) nthawi zambiri amafunikira. Mankhwalawa amalankhula ndi maselo a khansa mosasamala kanthu kumene ali m'thupi lanu.
Anthu ambiri omwe ali ndi khansara yothamanga m'mimba adzaphatikiza mankhwalawa.
Nthaŵi zina, monga tizilombo toyambitsa matenda ndi stromal cell, kapena msinkhu (monga siteji IA) zotupa zapakati, opaleshoni yokha, popanda mankhwala a chemotherapy, akhoza kukhala othandiza.
Opaleshoni
Opaleshoni ndizofunika kwambiri kwa anthu ambiri omwe ali ndi khansara ya ovari. Zitha kusintha mosiyana ndi mtundu wa khansa ya ovari ndi siteji. Kafukufuku apeza kuti pamene opaleshoni ya khansa ya ovariya imayendetsedwa ndi azimayi opatsirana pogonana, zotsatira zake zimakhala zabwino kwambiri kuposa pamene opaleshoni imachitidwa ndi madokotala ena apadera, chifukwa izi ndizovuta kwambiri.
Komabe, ngakhale pakuwona katswiri wamagetsi odwala, ambiri amapeza kuti ndiwothandiza (ndipo nthawi zambiri amatitsimikizira) kuti apeze lingaliro lachiwiri. Ngati mukuganiza kuti mutero, mungakonde kulingalira chimodzi mwa zikuluzikulu za National Cancer Institute-malo opatsirana ndi khansa, omwe nthawi zambiri ali ndi opaleshoni opaleshoni omwe amapanga opaleshoni ina.
Oophorectomy (kwa Germ ndi Stomal Cell Tumors)
Zilonda zajeremusi zajeremusi ndi stromal zimapezeka pamayambiriro oyambirira. Anthu ambiri omwe ali ndi zotupa zimenezi ali aang'ono, ndipo opaleshoni kuchotsa ovary (oophorectomy) yokhayokha nthawi zina amatha kusunga mazira ena ndi chiberekero. Kuchita opaleshoni yokha kungakhalenso kothandiza m'matumbo oyambirira kwambiri.
Ngati mazira onsewa ayenera kuchotsedwa, palinso njira zina zomwe zingatetezere kubereka , monga mazira oyamwa. Ngati mukufuna kuchita izi ngati n'kotheka, lankhulani ndi dokotala yemwe amadziwa makamaka kusunga chithandizo musanayambe mankhwala.
Kuchulukitsa / Kuchulukitsa Opaleshoni (kwa Epithelial Cancer Cancer)
Pafupifupi 80 peresenti ya khansa yapachilendo yowopsa kwambiri imapezeka m'kupita kwa nthawi kwa matenda (siteji III ndi siteji IV). Mosiyana ndi khansara ya m'mawere ndi m'mapapo, kumene opaleshoni ya matenda a sewero la IV imapangitsa kuti moyo usakhale wathanzi, opaleshoni ikhoza kuwonjezera moyo kwa omwe ali ndi khansa ya masewera IV.
Zimathandizanso kuti phindu lidzapindule ndi chemotherapy.
Kuchita opaleshoni ya khansa yapamwamba ya ovariya imatchulidwa ngati opaleshoni yowonongeka (kuchitidwa opaleshoni yoipa). "Cyto" ndilo liwu loti maselo ndi "kuchepetsa" amatanthauza kuchepetsa, kotero cholinga cha opaleshoniyi ndi kuchepetsa chiwerengero cha maselo a kansa, osati kuthetsa khansa yonse.
Pali zotsatira zitatu zotheka za opaleshoniyi:
- Zomaliza: Khansara yonse yooneka imachotsedwa.
- Zokwanira: Khansa imakhalabe, koma malo onse ndi osachepera 1 masentimita awiri (nthawi zambiri amatchedwa matenda a miliary).
- Zomwe zimakhala zokwanira: Mankhwala omwe ali aakulu kuposa 1 masentimita awiri amakhalabe.
Kuchita opaleshoni yopanga chithandizo ndi opaleshoni yaitali komanso yovuta, ndipo kuopsa kwa njira yayitali kumaposa phindu. Choncho, "mulingo woyenera" cytoreduction nthawi zambiri cholinga cha opaleshoni.
Kuphatikizapo kuchotsa mazira ndi mazira omwe amachititsa kuti chiberekero chisamangidwe komanso chiberekero (hysterectomy), minofu imachotsedwa nthawi zambiri. Mwachitsanzo, mafuta otukumula omwe amadzaza mazira ndi matumbo, amachotsedwa kawirikawiri (omentectomy).
Kuchapa, njira yomwe saline imayikidwa mu mimba ndi m'mimba ndipo kenako imachotsedwa pofuna kuyang'ana kukhalapo kwa maselo a khansa omwe "ali otayika" m'mimba ndi m'mimba, amachitiranso.
Mankhwala am'mimba m'mimba ndi m'mimba nthawi zambiri amawombedwa kapena kuchotsedwa (kupyolera m'mimba). Kuwonjezera apo, zitsanzo zingatengedwe kuchokera pamwamba pa ziwalo zambiri za m'mimba ndi m'mimba, monga chikhodzodzo, m'matumbo, chiwindi, nthenda, m'mimba, ndulu, kapena pancreas. Ndi zotupa zovuta kwambiri, zowonjezereka zimachotsedwa.
Pamene zitsanzo zimachotsedwa m'matumbo, mapeto awiri kumbali zonse za deralo amachotsedwa ngati atatha. Ngati sichoncho, mapeto a matumbo asanafike pamalo opangira opaleshoni amatsekedwa pakhungu kotero kuti matumbowo akhoza kuthiridwa kunja (kulengedwa kwa stoma).
Opaleshoni yonseyi ikhoza kuchitidwa nthawi yomweyo, kapena mmalo mwake pambuyo poti mankhwala a chemotherapy aperekedwa kapena pambuyo pa kubwerera kwa khansa.
Zotsatira zofala kwambiri za opaleshoni zimachotsa magazi, matenda, ndi zomwe zimachitika ku anesthesia. Popeza kuti opaleshoni ya cytoreduction imakhala yotalika nthawi yaitali, zimalimbikitsidwa kuti omwe ali pachiopsezo ayambe kufufuza bwino mtima ndi mapapu asanayambe opaleshoni.
Chemotherapy
Ndi khansa ya ovari, ndizosatheka kuchotsa khansa yonse. Ngakhale pamene opaleshoni imachotsa maselo onse a kansa (monga kale ndi magawo oyambirira), chiwerengerochi chimakhala chokwanira kwambiri pa 80 peresenti. Izi zikutanthauza kuti ngakhale khansayo yowonekayo sichiwoneka, malo ochepa a khansara amasiyidwa mmbuyo. Choncho, chemotherapy imaperekedwa kwa onse koma magawo oyambirira kwambiri a khansa ya m'mimba. Chemotherapy imagwiritsidwanso ntchito popititsa mitsempha ya majeremusi.
Mankhwala Ogwiritsidwa Ntchito
Mankhwala omwe amagwiritsidwa ntchito nthawi zambiri amawaphatikizapo:
- Mankhwala a Platinum: Paraplatin (carboplatin) kapena Platinol (cisplatin).
- Mitundu: Taxol (paclitaxel) kapena Taxotere (docetaxel).
Palinso mankhwala ambiri omwe angagwiritsidwe ntchito, monga Doxil (liposomal doxorubicin) ndi Gemzar (gemcitabine).
Ndi zotupa za majeremusi, mankhwala amadzimadzi amatha kukhala ndi Platinol (cisplatin), VP-16 (etoposide), ndi bleomycin.
Njira Zothandizira
Chemotherapy angaperekedwe mwa njira imodzi:
- Momwemo (IV): IV chemotherapy nthawi zambiri amapatsidwa milungu itatu kapena inayi iliyonse ndipo imabwerezedwa kwa zaka zitatu kapena zisanu ndi chimodzi. Izi zikhoza kuperekedwa kupyolera mu kathete yomwe imayikidwa mdzanja lanu, kapena kudzera mu doko la chemotherapy kapena mzere wa PICC.
- Mankhwala opatsirana pogonana: Mwa njirayi, chemotherapy imaperekedwa kupyolera mu singano yomwe imayikidwa mwachindunji m'mimba.
Ulamuliro wa IV ndi wochuluka, koma ofufuza tsopano akukhulupirira kuti mankhwala opatsirana pogwiritsa ntchito mankhwala otchedwa intraperitoneal chemotherapy amagwiritsidwa ntchito mopitirira muyeso kwa khansa ya ovari. Mutha kufunsa za izo.
Mu kafukufuku wa 2016, ofufuza apeza kuti mankhwala ophera tizilombo toyambitsa matenda amatha kupulumuka ndi khansa ya ovariya kuposa IV chemotherapy. Phunziro ili, adatchulidwa kuti mankhwala ophera tizilombo toyambitsa matenda omwe amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda, tizilombo toyambitsa matenda, kupweteka, ndi matenda.
Izi zimati, mankhwala ophera tizilombo toyambitsa matenda omwe amachititsa kuti tizilombo tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda sizingaloledwe komanso tizilombo toyambitsa matenda tizilombo toyambitsa matenda ndipo sitingagwiritsidwe ntchito ngati pali vuto la impso kapena m'mimba. .
Zotsatira Zotsatira
Mankhwala a chemotherapy amachititsa kuti magulu olekanitsa aphatikize pazigawo zosiyana siyana ndipo amatha kupha maselo omwe akukula mofulumira, monga maselo a kansa. Mwatsoka, chithandizochi chimakhudza zachilendo, ndikugawanitsa maselo mofulumira, ndikupangitsa zotsatira zosayenera.
Zotsatira zowopsa za mankhwala a chemotherapy omwe amagwiritsidwa ntchito pa khansa ya ovari ndi monga:
- Mphuno ndi kusanza: Mankhwala osokoneza bongo ndi mankhwala osokoneza bongo amayamba bwino kwambiri m'zaka zaposachedwa, ndipo mankhwala opatsirana tsopano amalola anthu kuti adutse mankhwala a chemotherapy popanda kusanza pang'ono kapena osasanza.
- Kuthamanga kwa mitsempha ya mafupa kumalo otsika a maselo oyera a magazi, maselo ofiira a magazi, ndi mapuloletsiti. Ndilo mlingo wotsika wa mtundu wina wa maselo oyera omwe amatchedwa neutrophils omwe amachititsa anthu kukhala ndi matenda pa mankhwala a chemotherapy .
- Kutopa
- Kutaya tsitsi
Zotsatira za nthawi yaitali za chemotherapy zingakhale ndi phokoso la ubongo (kupweteka, kupweteka, ndi kupweteka m'manja ndi mapazi) ndi kutaya kwa kumva (ototoxicity). Palinso kachiopsezo kakang'ono ka khansa yachiwiri pamsewu.
Zotsatirapo ndi zovuta za mankhwala a chemotherapy, komabe, nthawi zambiri zimakhala zocheperapo ndi kupindula kwa mankhwalawa.
Zotsatira Zothandizira
Mankhwala othandizidwa ndi mankhwala omwe amalepheretsa njira zowonjezera kukula kwa khansa. Popeza iwo amatsogozedwa makamaka pa maselo a khansa, nthawi zina (koma nthawizonse) amakhala ndi zotsatira zochepa kuposa mankhwala a chemotherapy. Mankhwala omwe angagwiritsidwe ntchito ndi khansara ya ovari ndi awa:
- Angiogenesis inhibitors: Khansa imafunika kupanga mitsempha yatsopano ya magazi kuti ikule ndi kufalikira. Angiogenesis inhibitors amachititsa zimenezi, makamaka njala ya magazi atsopano. Avastin (bevacizumab) nthawi zina akhoza kuchepetsa kukula kwa khansa ya ovari koma ingakhale ndi zotsatira zoyipa monga magazi, magazi, ndi matumbo a perforated.
- PARP Inhibitors: Yoyamba ya PARP inhibitor inavomerezedwa ku khansa ya ovari mu 2015. Mosiyana ndi chemotherapy, mankhwalawa angaperekedwe mu mapiritsi m'malo mwa IV. PARP inhibitors amagwira ntchito mwa kulepheretsa njira yotsitsimutsa yomwe imayambitsa maselo okhala ndi BRCA gene mutation kuti afe. Mankhwala osokoneza bongo alipo monga Lynparza (olaparib), Rubraca (rucapraib), ndi Zejula (niraparib).
Mankhwalawa amagwiritsidwa ntchito kwambiri kwa amayi omwe ali ndi kusintha kwa BRCA, koma Lynparza ndi Zejula angagwiritsidwe ntchito kwa amayi opanda kusintha kwa BRCA kuti athetse khansa ya ovarian recurrences pambuyo chemotherapy. Zotsatirapo zingakhale kuphatikizapo kupweteka kwa thupi, kupwetekedwa mtima, ndi kuchepa kwa magazi pakati pa ena, koma zimakhala zolekerera kusiyana ndi chemotherapy. Palinso kachilombo kochepa (monga mankhwala a chemotherapy) a khansa yachiwiri monga khansa ya m'magazi.
Mankhwala Ena
Mitundu ina ya mankhwala ingagwiritsidwe ntchito ndi mitundu yosiyana ya khansa ya ovari kapena matenda ofala. Mankhwala osokoneza bongo amagwiritsidwa ntchito kwambiri pa khansa ya m'mawere. Koma mankhwala monga mankhwala osokoneza bongo, tamoxifen, ndi aromatase inhibitors angagwiritsidwe ntchito pa zotupa zam'mimba, komanso zosaoneka bwino, zopweteka zapakati. Mankhwalawa sagwiritsidwa ntchito kawirikawiri kwa khansa ya ovari koma ingagwiritsidwe ntchito pamene pali metastases yambiri m'mimba.
Mayesero Amakono
Pali zambiri zomwe zikuyendera mchipatala ndikuyang'ana njira zochiritsira zomwe zili pamwambapa, komanso njira zatsopano zothandizira matenda a khansa ya ovari ndi ma recurrences. Nyuzipepala ya National Cancer Institute ikuyamikira kulankhula ndi adokotala za zomwe zingakhale zoyenera kwa inu.
Nthawi zina njira yokha yogwiritsira ntchito mankhwala atsopano ndikukhala mbali ya maphunzirowa. Pali nthano zambiri zokhudzana ndi mayesero a kachipatala , koma zoona ndizokuti mankhwala omwe tili nawo tsopano kwa khansa adayamba kuphunzira motere.
Mankhwala Osakaniza Owonjezera (CAM)
Pakadali pano, palibe maphunziro omwe amasonyeza kuti mankhwala a CAM akhoza kuthana ndi khansa ya ovari. Kupititsa patsogolo mankhwala ochiritsira pakadalirika pazochita zoterezi kungakhale kovulaza.
Izi zati, ena angathandize ndi zizindikiro za khansa ndi mankhwala ake, kupititsa patsogolo moyo wabwino. Pa chifukwa chimenechi, malo ambiri a khansa amapereka njira zosiyanasiyana zochiritsira . Zosankha zomwe zasonyeza ubwino pa zochepa zofukufuku zofukufuku zimaphatikizapo kuchitapo kanthu , kusinkhasinkha , yoga , mankhwala othandizira , ndi mankhwala a pet .
Zowonjezera ndi Zakudya
Lankhulani ndi oncologist wanu musayese vitamini kapena mineral supplements . Zonsezi zimagwiritsidwa ntchito ndi chiwindi kapena impso ndipo zimatha kupititsa patsogolo kapena kuthamanga mankhwala a chemotherapy, omwe amakhudza mankhwala. Ena, makamaka, amavomereza chenicheni: Vitamini E (komanso chitsamba Ginkgo biloba) amatha kuwonjezereka magazi nthawi ndi nthawi atatha opaleshoni, ndipo zina zowonjezereka zingapangitse chiopsezo cha mtima wosayenerera kapena kugwidwa ndi matenda okhudzana ndi anesthesia.
Kuwonjezera apo, mankhwala okhudzana ndi antioxidant angathe kutha kuteteza maselo omwe amachititsa kuti mankhwalawa asokonezeke; Mankhwalawa amagwira ntchito pochititsa kuwonongeka kwa okosijeni ku maselo a khansa. Akatswiri ambiri amakhulupirira kuti kudya zakudya zopatsa thanzi si vuto panthawi ya mankhwala.
Omega-3 fatty acids, komabe, zingakhale zothandiza kwa ena. Izi zimathandiza kuti thupi likhale ndi minofu kwambiri, omwe amakhala ndi vuto la kulemera kwa thupi, kutayika kwa minofu, ndi kusowa kwa kudya kumene kumakhudza pafupifupi 80 peresenti ya anthu omwe ali ndi khansa yakula.
Pali chidwi china pa turmeric (ndi phokoso lake, curcumin), zomwe zimagwiritsidwa ntchito podzikongoletsera ndi mpiru zomwe zimapatsa zakudya zimenezi chikasu. Kafukufuku wina amavomereza kuti timmeric ikhoza kuyambitsa imfa ya maseŵera a khansa ya ovary, koma osati yachibadwa, ndipo maselo a khansa ya ovary "odyetsa" turmeric sangakhale osagwirizana ndi chemotherapy. Kafukufukuyu sagwirizana ndi momwe akugwiritsira ntchito mwa anthu, koma palibe vuto pogwiritsa ntchito zonunkhira.
Kuchiza kwa Kubwereza
Mwamwayi, pafupifupi 80 peresenti ya khansa ya ovary yomwe imachiritsidwa ndi mankhwala ochiritsira pamwambapa idzabwereranso. Njira yothetsera kubwereza ikudalira nthawi yake:
- Kubwereza mwamsanga pambuyo pa chithandizo: Zikalata zoterozo zimatengedwa kuti zimatsutsana ndi platinum, kapena zimagonjetsedwa ndi platinum chemotherapy. Zosankha zikuphatikizapo kubwereza chemotherapy ndi mankhwala omwewo (ngakhale kuti izi zimachititsa kuti anthu asamvetse bwino), pogwiritsa ntchito mankhwala enaake osiyana siyana (pali njira zingapo zosiyana), kapena kuyembekezera mayesero a zachipatala.
- Kuchuluka kwa miyezi isanu ndi umodzi yothandizira: milandu yotereyi imatengedwa ngati platinum yogonjetsedwa. Zosankha panthawiyi zingakhale zosiyana ndi mankhwala a chemotherapy kapena regimen, kapena mayesero a zachipatala. Nthawi zambiri opaleshoni imalimbikitsidwa.
- Patapita miyezi isanu ndi umodzi kapena kuposerapo chithandizo chitatha: Ngati chemotherapy yapachiyambi imaphatikizapo kugwiritsa ntchito mankhwala a platinum mankhwala (Platinol kapena Paraplatin), chotupacho chimatengedwa ngati chovomerezeka cha platinum. Mankhwalawa amalimbikitsa zosiyanasiyana koma angaphatikizepo opaleshoni ya cytoreduction kuphatikizapo mankhwala ndi mankhwala oyambirira a chemotherapy.
Kuchiza mukutenga
Makondomu ambiri omwe amapezeka pamimba ali ndi mitsempha ya jeremusi kapena maselo osokoneza bongo. Ziphuphuzi nthawi zambiri zimakhudza ovary mmodzi, ndipo opaleshoni kuchotsa ovary n'kotheka pa nthawi ya mimba, ngakhale kuyembekezera mpaka theka la trimester likufunidwa.
Kwa amayi apakati omwe ali ndi khansa ya epithelial ovarian ndi selo yambiri yapamwamba ya stromal kapena maselo a magulu a majeremusi, opaleshoni ya cytoreduction ndi yotheka. Kudikira mpaka pambuyo pa trimester yoyamba ndi koyenera, koma opaleshoni ikhoza kulingaliridwa kale. Chemotherapy imakhala yotetezeka pambuyo pa trimester yoyamba ndipo kawirikawiri imayambika kuzungulira masabata 16. Matenda a khansa ya m'mimba, kuphatikizapo Paraplatin (carboplatin) ndi Taxol (paclitaxel) amagwiritsidwa ntchito, kuphatikizapo Platinol (cisplatin), Velban (vinblastine), ndi bleomycin yomwe imagwiritsidwa ntchito m'malo otupa.
> Zotsatira:
> Fruscio, R., de Haan, J., Van Calsteren, K. et al. Zotsatira Zabwino ndi Kafukufuku. Mankhwala Osokoneza Bongo ndi Gynecology. 2017. 41: 108-117.
> Jaaback, K., Johnson, N., ndi T. Lawrie. Intraperitoneal Chemotherapy Yoyamba Kusamalira Mphungu Yoyamba ya Khansa ya Ovarian. Dongosolo la Cochrane la Zosintha Zogwirizana . 2016. (1): CD005340.
> National Cancer Institute. Ovarian epithelial, Tube Fallopian, ndi Primary Primary Peritoneal Treatment Treatment (PDQ) -Achilengedwe Professional Version. Kusinthidwa 01/19/18. https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq
> van Driel, W., Koole, S., Sikorska, K. et al. Hyperthermic Intraperitoneal Chemotherapy mu Khansa ya Ovarian. The New England Journal of Medicine . 2018. 378 (3): 230-240.