Ubwino ndi Zovuta za Tamoxifen mu Premenopausal Cancer ya Breast
Tamoxifen, yemwenso amadziwika ndi dzina lakuti Nolvadex, ndi imodzi mwa mankhwala omwe amalembedwa kawirikawiri popewera kubwereza khansa ya m'mawere. Kodi phindu logwiritsa ntchito mankhwalawa pambuyo pa chithandizo chamankhwala kwa khansa ya m'mawere , ndi zotsatira zotani zomwe zimawopsa, ndipo ndizoopsa zotani?
Mwachidule
Tamoxifen ndi mankhwala omwe ali ndi anti-estrogen ndi-estrogen-monga zotsatira, malingana ndi mtundu wina wa minofu mu thupi kumene imachita.
Amagwiritsidwa ntchito ngati estrogen receptor modulator (SERM) komanso mankhwala a Evista (raloxifene).
Pali zitatu zofunikira kwambiri pa tamoxifen:
- Azimayi ndi abambo amapezeka kuti ali ndi kansa ya m'mawere oyambirira, omwe ali ndi kansa ya m'mawere oyambirira, atatha opaleshoni, chemotherapy kapena ma radiation kuti athe kuchepetsa ngozi.
- Amayi ndi abambo amapezeka kuti ali ndi kansa yapamwamba kapena khansa ya m'mawere yomwe imakhala ndi mchere wokhala ndi mahomoni
- Kupewa khansa yapachifuwa kwa anthu omwe ali pangozi yowonjezera matendawa.
Kawirikawiri Tamoxifen sichinthu chothandiza kwa omwe ali ndi estrogen kapena progesterone ya khansa ya m'mawere.
Tamoxifen amabwera mapiritsi 10 mg kapena 20 mg omwe ali ndi mlingo wochuluka kwambiri wokhala 20 mg kamodzi pa tsiku. Pali zofunikira zambiri zolimbana ndi mankhwala zomwe zingachepetse mphamvu ya mankhwala. Kawirikawiri amatengedwa tsiku lililonse kwa zaka 5 mpaka 10 kapena mpaka munthu atembenukira ku aromatase inhibitor.
Ubwino
Tamoxifen inavomerezedwa mu 1998 ndipo zakhala zikupezeka zothandiza pochiza khansa ya m'mawere kwa anthu mamiliyoni ambiri. Amagwiritsidwanso ngati njira yabwino kwambiri ngati inu muli mtsogoleri wam'malamulo kapena muli wam'mawopa ndipo simungathe kutenga aromatase inhibitor.
Mukagwiritsidwa ntchito pambuyo pa mankhwala oyamba mukhoza kuchepetsa chiwopsezo cha kubwereza khansa ya m'mawere ndi theka, ngati chotupa chanu chinali cholowa cha estrogen.
Ikhoza kuchepetsa chiopsezo chanu chokhala ndi khansa ina mumatumbo omwewo kapena khansara yatsopano m'mimba mwako mpaka 50 peresenti. Izi zowonjezera chiopsezo zimagwira zoona kwa onse omwe ali ndi chiopsezo chachikulu cha 70-gene.
Zingakhale zothandiza kuzindikira kuti tamoxifen imapindulabe pothandiza kuchepetsa chiopsezo cha kubwereranso ngakhale mutasiya kumwa mankhwala.
Kuphatikizapo zotsatira zake pochepetsa chiopsezo cha khansa ya m'mawere kapena kubwereza, tamoxifen imathandizanso. Mosiyana ndi zotsatira zake zotsutsa-estrogen pamatenda a m'mawere, tamoxifen ali ndi zotsatira za estrogen pa fupa. Choncho tamoxifen (komanso Evista) amathandizira kuchepetsa kapena kusiya mafupa. (Mosiyana ndi zimenezi, aromatase inhibitors nthawi zambiri amachititsa mafupa). Tamoxifen amathandizanso kuchepetsa mafuta a kolesterolini, makamaka LDL cholesterol.
Momwe Ikugwirira Ntchito
Maselo a khansa ya pachifuwa omwe amapezeka ndi estrogen receptor positive amadyetsedwa ndi estrogen. Estrogen mu thupi imamangiriza kwa mapuloteni pamwamba pa maselo (estrogen receptors) kuti awonetse selo kuti ligawane ndi kukula. Tamoxifen imamangiriza kulandirira ichi kotero estrogen sangathe, makamaka njala ya maselo a khansa.
Zotsatira Zotsatira ndi Ngozi
Zotsatira zambiri zowopsa za tamoxifen ndizo zotsatira zake za kuchepa kwa estrogen mu thupi (kusamba kwa mimba).
Choncho kutentha kumatentha, kutuluka kwa usiku, kumaliseche kwa madzi ndi madzi, komanso kuchepetsa libido ndizofala. Monga mawu ofulumira, ngati izi zikukuvutitsani, kutentha kwakukulu kumagwirizana ndi kupulumuka bwino kwa khansa ya m'mawere). Matenda amatha kuchitika.
Zochita za Tamoxifen pa ziwalo za uterine (endometrial) zingapangitse chiopsezo cha khansa ya uterine . Kuopsa kumeneku kumadalira kutalika kwa nthawi yomwe muli pa mankhwala. Mavutowa ndi apamwamba kwambiri kwa amayi oposa zaka 50 koma osachepera 1 peresenti.
Tamoxifen ikhoza kuwonjezera mwayi wanu wopanga magazi m'milingo yanu (deep vein thrombosis) kapena mapapo ( pulmonary embolism ). Sitikukayikira panthawi ino, koma tamoxifen ingakhalenso kuonjezera chiopsezo cha mtima kapena stroke.
Nthawi yoitanira Dokotala Wanu
Ndikofunika kutchula dokotala wanu ngati muli ndi zizindikiro zilizonse zomwe mukudandaula nazo, koma makamaka, muyenera kutchula ngati mukukonzekera zotsatirazi:
- Kuchepetsa magazi kumaliseche
- Ululu mu pelvis yanu
- Kutupa mwendo
- Kupweteka pachifuwa
- Kupuma pang'ono
- Kufooka, kupweteka kapena kung'ung'udza
- Masomphenya
Tamoxifen vs. Aromatase Inhibitors
Tamoxifen ndi aromatase inhibitors zimasiyana pokhudzana ndi ubwino ndi zoopsa. Kwa amayi omwe ali ndi postmenopausal kapena omwe ali a premenopausal ndipo adalandira mankhwala ochotsera ovarian, mankhwala a aromatase inhibitor angapindule kwambiri pochepetsa chiopsezo cha kubwereza. Aromatase inhibitors amachititsanso kuti matenda a mitsempha ayambe koma amatha kupweteka mafupa m'malo mochepetsa ngati tamoxifen. Kupweteka kwa mafupa ndi kuphatikiza kumachitika ndi gulu la mankhwala koma ndilofala kwambiri ndi aromatase inhibitors.
Machenjezo
Kuyanjana kwa Mankhwala
Chifukwa cha njira yomwe imagwiritsiridwa ntchito, tamoxifen angagwirizane ndi mankhwala ndi mankhwala owonjezera. Lankhulani ndi dokotala wanu za mankhwala ena omwe mumagwiritsa ntchito ndipo onetsetsani kuti mzimayi wanu akudziwanso. Makamaka, mankhwala ochepetsa kupatsirana, komanso mankhwala owonjezera, angachepetse mphamvu ya tamoxifen.
Mimba
Chifukwa cha kuchuluka kwa zilema zobereka, tamoxifen sayenera kugwiritsidwa ntchito pathupi , ndipo mankhwalawa ayenera kuyimitsidwa kwa miyezi iwiri asanayambe kutenga mimba.
Ndiyenera Kutenga Nthawi Yanji
Malinga ndi umboni wooneka bwino kuchokera ku maphunziro awiri akuluakulu omwe amachititsa kuti pakhale matenda a khansa ya m'mawere (ATLAS ndi aTTom), zaka 10 osati mankhwala asanu a adjuvant ndi Tamoxifen akugwirizanitsidwa ndi chiopsezo chochepa cha kubwereza komanso kuchepetsa kufa kwa khansa ya m'mawere.
Kuchepetsa kuchepa kwa khansa ya m'mawere kuyenera kuyesedwa ndi zotsatira zowopsa kwa munthu aliyense payekha. Ngati ndinu mtsogoleri, dokotala wanu angalimbikitse tamoxifen kwa zaka zitatu kapena zisanu musanayambe kusintha kwa aromatase inhibitor kwa zaka zina zisanu.
Ndikofunika kumamatira mankhwala anu. Tsoka ilo, anthu ambiri amaphonya mankhwala kapena amasiya mankhwalawa msanga, zomwe zimachititsa kuti pakhale ngozi yaikulu yobwereza.
Mfundo Yofunika Kwambiri
Tamoxifen ikhoza kuchepetsa kwambiri chiopsezo cha kubwereka kwa khansa ya m'mawere pambuyo pa mankhwala ochiritsira ndi opaleshoni, chemotherapy ndi / kapena mankhwala othandizira mazira. Monga mankhwala aliwonse, tamoxifen ali ndi zoopsa ndi zotsatirapo ndipo ubwino wa mankhwala uyenera kulemedwa ndi zoopsazi. Onetsetsani kukambirana ndi dokotala wanu za matenda ndi kuyankhula naye ngati mukukumana ndi zotsatirapo zina. Pitirizani kuyankhulana momasuka kuti tamoxifen ikugwiritseni ntchito popanda zovuta zazikulu.
> Zotsatira:
> National Cancer Institute. Matenda a khansa ya m'mawere (PDQ) -Health Professional Version.
> Sahebkar, A., Serban, M., Penson, P. et al. Zotsatira za Tamoxifen pa Plasma Lipoprotein (a) Maganizo: Kukonzekera Mwadongosolo ndi Meta-Analysis. Mankhwala . 2017. 77 (11): 1187-1197.
> Yu, Z., Guo, X., Jiang, Y. et al. Adjuvant Endocrine Monotherapy kwa Odwala Ammimba Oyamba Amuna Omwe Amayambitsa Matenda a Kachiwerewere Omwe Amakhala ndi Hormone-Receptor Positive: Kukonzekera Kwambiri ndi Meta-Analysis. Khansa ya m'mawere . 2017 Jul 28.