Kusamalira Matenda a Matenda a M'thupi mwa Breast Cancer
Khansara ya m'mawere imafalikira mafupa nthawi zambiri. Matenda a metastases amapezeka pafupifupi 70 peresenti ya amayi omwe ali ndi kansa ya m'mawere ( stage 4 ya kansa ya m'mawere ) ndipo nthawi zambiri amasonyeza kuti khansara yatha. Mwamwayi, mitsempha ya mafupa ikhoza kukhala ndi chithunzithunzi chabwino kuposa cha khansara ya m'mawere yomwe yafalikira kumadera ena, ndipo mankhwala ena alipo omwe amachepetsa kupweteka koma amatha kupulumuka.
Tiyeni tiwone komwe mafupa a m'mawere a m'mawere amatha kufalikirako, zizindikiro za mafupa a mitsempha, njira zosiyana zothandizira, komanso zovuta zomwe muyenera kuzidziwa.
Khansa ya m'mawere ndi Bone Metastases
Khansara ya m'mimba yomwe imafalikira ku fupa imayambitsa chisokonezo, kotero tiyambe kufotokoza ndendende kuti izi zikutanthauza chiyani. Khansara ya m'mimba yomwe imafalitsa ( metastasizes ) mafupa imakali khansa ya m'mawere. Ngati mutatenga chitsanzo cha chotupa mumphongo ndikuchiyang'ana pansi pa microscope, mungayang'ane maselo a m'mawere.
Khansara ya pachifuwa yomwe yafalikira mafupa si khansara ya mafupa (pansi pa kansa ya mafupa ya mafupa angapangitse maselo a mafupa a khansa). Pamene khansa ya m'mawere imapita ku mafupa, mawu omveka bwino ndi "khansa ya m'mawere ya m'mawere ndi mafupa." Pamene khansayo imapezeka m'mapfupa, zimakhala zovuta kwambiri kukhala khansa ya mthupi kuchokera kumalo ena a thupi kusiyana ndi khansa yapakhungu yapafupa.
Kufunika kwa Metastases
Kulimbana ndi matenda a mafupa ndi metastases ndizofunikira ngakhale ziribe msinkhu wa khansa ya m'mawere yomwe munthu ali nayo. Khansara ya m'mawere ikhoza kufalikira ku mafupa, koma mankhwala opatsirana khansa ya m'mawere monga mankhwala a mahomoni angayambitse mafupa. Ndipotu, mankhwala omwe amagwiritsidwa ntchito pa mafupa a metastases bisphosphonates) tsopano akuganiziridwa ngakhale kwa iwo omwe ali ndi kansa ya m'mawere oyambirira monga njira yolimbitsira mafupa ndipo mwinamwake kuteteza mafupa a mitsempha kuti asachitike poyamba.
Ululu umene umakhala nawo nthawi zambiri pamthambo, kuphatikizapo kuchepa kwa kuyenda chifukwa cha kuphulika kwa thupi kapena kugwiritsidwa ntchito kwa fractures, kumakhudza kwambiri moyo wa amayi omwe ali ndi khansa ya m'mawere. Komabe, mosiyana ndi lingaliro lodziwika kuti mulibe zochepa zomwe mungachite ngati muli ndi kansa ya m'mawere, pali zambiri zomwe zingatheke kuti musachepetse ululu ndi mavuto a mafupa, koma kuti mukulitse moyo.
Khansa ya m'mawere ipitirire ku fupa - mwachidule
Monga taonera kale, mafupa a mitsempha ya khansa ya m'mawere ndi malo ambiri omwe ali kutali kwambiri ndi khansa ya m'mawere. Matenda a metastases ndi ochepa kwambiri mwa amayi omwe ali ndi khansa ya m'mawere yotchedwa estrogen receptor (chiwindi ndi metastases ya ubongo ndizofala kwambiri kwa amayi omwe ali ndi khansa ya HER2 / neu yabwino komanso itatu yosamalitsa).
Matenda a metastases amakhalanso ofala kwambiri kwa amayi omwe ali ndi kansa ya m'mawere yoopsa kwambiri kuposa khansa ya m'mawere yotchedwa lobular (mu lobular carcinoma, metastases mpaka m'mimba (peritoneal metastases) ndi yowonjezereka). Pa subtypes zosiyana za khansa ya m'mawere, mitsempha ya mafupa imakhala yowonjezereka mu khansa yaumunthu.
Kodi Mitsempha Yotani Yabwino Yamatenda Ikufalikira?
Khansara ya m'mimba imakonda kufalitsa mafupa ena mthupi mochulukirapo kuposa ena, koma izi zimatha kukhala ndi mafupa osiyanasiyana m'thupi.
Metastases zimachitika kawirikawiri kwa:
- Mphepete
- Mizere
- Pelvis
- Mafupa aakulu a mikono ndi miyendo (humer ndi femur)
Si zachilendo kuti mitsempha ya mafupa ichitike m'mafupa ochepa panthawi imodzimodzi, monga msana ndi pakhosi. Mavitamini angathenso kupezeka m'madera ena a thupi (monga chiwindi, mapapo, kapena ubongo) panthawi yomweyo omwe amadziwika m'mapfupa.
N'chifukwa chiyani khansa ya m'mawere imafalikira ku mitsinje?
Sitikudziwa chifukwa chake khansa ya m'mawere ikufalitsa mafupa. Mafupa ali olemera ndi mitsempha yamagazi, komanso chiwindi ndi mapapo, malo omwe khansa ya m'mawere imafalikira koma ndifupipafupi kuposa mafupa.
Popeza kuti metastases ndi ofunika kwambiri (metastases ndi omwe amachititsa kuti amayi 90 pa 100 alionse amafa ndi khansa ya m'mawere), dera limeneli likufufuzidwa mwakhama.
Pali lingaliro lakuti khansara ya m'mawere ikhoza kugona mu fupa la mafupa , ndipo mafupa omwe khansa ya m'mawere imafalikira kwa iwo omwe ali olemera mu fupa. Ngati muli ndi chidwi, mukhoza kuphunzira zambiri za chiphunzitso cha khansa zam'mimba ndi dormancy monga momwe zingatanthauzire chifukwa chake khansara ya m'mawere ikhoza kubisala kwa zaka kapena zaka zambiri ndikubwereranso.
Kodi Matenda Opangidwa ndi Matenda a Khungu Amayamba Bwanji?
Matenda a metastases ochokera ku khansa ya m'mawere angapezeke m'njira zosiyanasiyana. Nthaŵi zina metastases imawonekera pamene x-ray yachitidwa chifukwa cha kupweteka kumene kunachitika ndi vuto lalikulu (chifukwa cha kufooka kwa fupa chifukwa cha kupweteka kwa thupi, kupweteka kwa matenda ). Nthaŵi zina, mafupa a metastases amapezeka ngati mwadzidzidzi pamene mayesero onga PET amawonekera chifukwa china. Mayesero amachititsa kuti apeze mafupa a mitsempha kuphatikizapo fupa la fupa ndi PET akuyesa, kuphatikizapo PET / CT, SPECT / CT, thupi lonse la MRI, ndi PET / MRI zomwe zimapereka mphamvu zowonjezera. Pali kutsutsanako pa mayesero abwino, koma oncologist wanu atenga zowerengera zambiri pakupanga ndemanga.
Mankhwala a Metastases a Matenda
Mankhwala osiyanasiyana amapezeka pamatenda a mafupa. Njira yomwe ili yabwino kwa inu imadalira pa zifukwa zingapo monga nambala ndi malo omwe mafupa amakhudzidwa, kupezeka kwa mavitamini ena, ndi thanzi lanu lonse.
Njira zambiri zothandizira matenda a khansa ya m'mawere monga chemotherapy , mankhwala opatsirana amadzimadzi, komanso mankhwala omwe amagwiritsidwa ntchito nthawi zambiri amagwiritsidwa ntchito, koma njira zina zomwe zimagwiritsidwa ntchito pofuna kuthandizira kufala kwa khansa ndi mafupa zimagwiritsidwa ntchito, ndipo nthawi zambiri zimatha kuwongolera khansa nthawi yina. Izi ziphatikizapo:
Kupweteka kwa mitsempha - Metastases mafupa angakhale opweteka kwambiri, komabe pali njira zambiri zochepetsera ululu. Kupeza mankhwala abwino komanso kuyanjanitsa zotsatira za mankhwalawa ndi kupuma koyenera kungakhale kovuta. Ngati izi zimakhala zovuta, anthu ena amagwira ntchito ndi dokotala wodwala wodwalayo kapena katswiri wa ululu kuti athetse kasamalidwe ka bwino kwa ululu wawo.
Thandizo la ma ARV - Mankhwalawa amawathandiza ndipo amathandiza kuchepetsa ululu ndi kuchepetsa chiopsezo cha zophulika. Mankhwalawa ndi "mankhwala am'deralo" omwe amatanthauza kuti zimakhala bwino kumadera akutali a metastases kusiyana ndi mavitamini ambiri.
Radiopharmaceuticals - Radiopharmaceuticals ndi mankhwala omwe amaphatikizapo tinthu ta tizilombo ta tizilombo ta tizilombo toyambitsa matenda, omwe amatha kuikidwa mu magazi. Dzuwa limaperekedwa molunjika ku mitsempha ya mafupa. Zitsanzo ndi Strontium-89 ndi Radium-223. Ma Radiopharmaceuticals angakhale othandiza kwambiri kwa anthu omwe ali ndi mitsempha yambiri kapena yochuluka ya mafupa omwe angakhale ovuta kuchiza ndi mankhwala am'deralo monga mankhwala ochizira. Zili ndi zotsatira zochepa zokha ndipo zingathe kulamulira kupweteka kwa mafupa.
Agulu-osinthira mafupa - Agent -modifying agents ndi mankhwala omwe angagwiritsidwe ntchito pamlomo kapena mwa jekeseni kuti achepetse mitsempha ya mafupa. Izi zikuphatikizapo:
- Bisphosphonates - Bisphosphonates ndizo mankhwala omwe poyamba anavomerezedwa ku matenda a mitsempha ya m'mimba ndipo amawoneka kuti ndi othandiza kwambiri pochiza mafupa. Chitsanzo ndi Zometa (zoledronic acid). Kuwonjezera pa kuchepetsa mavuto omwe amabwera chifukwa cha mitsempha ya mitsempha, mankhwalawa amawoneka kuti ali ndi mphamvu zolimbana ndi zotupa. Pachifukwachi, iwo akuganiziridwa ngakhale kwa amayi omwe ali ndi khansa ya m'mawere oyambirira (omwe ali am'mawopa wamagazi kapena amodzi omwe amachititsa kuti asapitirire mankhwala ochotsera ovarian), chifukwa onse awiri angathe kuthandizidwa ndi mafupa am'thupi (monga aromatase inhibitors) ndi kupewa metastases ku fupa. Mabisphosphonates amanyamula zotsatira zosavuta za osteonecrosis za nsagwada.
- Xgeva (denosumab) - Denosumab ndi anti-antibody yomwe yapezeka kuti ikuthandiza kuchepetsa mavuto (monga zophulika) kwa anthu omwe ali ndi mitsempha ya mafupa kuchokera ku khansa ya m'mawere. Zikuwoneka kuti zili ndi zotsutsana ndi khansa. Amapatsidwa ngati jekeseni ya subcuticular kamodzi pa masabata anayi.
Opaleshoni - Opaleshoni imagwiritsidwa ntchito nthawi zambiri kuti ikhale yolimbitsa fractures kapena malo a fupa omwe ali pangozi yophulika (onani m'munsimu).
Zovuta Zingatheke Kuchokera ku Matenda a Metastases
Matenda a metastases akhoza kutsogolera zizindikiro zosiyanasiyana komanso zovuta. Izi zikuphatikizapo:
Zowawa-ku-kuyendetsa ululu - Ululu umene umayenda ndi mitsempha ya mitsempha imakhala yovuta. Kupweteka kumaphatikizidwa kawiri ndi mankhwala opweteka ndi mankhwala omwe cholinga chake chimachepetsa metastases. Kuwonjezera pa mankhwala opweteka, akatswiri opweteka amakhala ndi njira zina zothandizira, kuphatikizapo mitsempha yomwe nthawi zina imafunika.
Mphuno / chiopsezo cha zophulika - Si zachilendo kuti munthu ayambe kuphunzirira kuti ali ndi mafupa amthambo atatha kuphulika. (Pano pali chitsanzo cha mkazi yemwe ali ndi khansa ya m'mawere ndi matenda opatsirana mthupi chifukwa cha metastases.) Opaleshoni nthawi zambiri amatha kukonzanso ziphuphu. Ndi mafupa akuluakulu a mikono kapena miyendo, kawirikawiri amangoikidwa ndodo. Izi sizikuthandizira kokha kuthandizira fupa lofooka, koma lingalole kuti muthamangire mwamsanga. Vertebroplasty kapena "simenti" ingagwiritsidwe ntchito pa mitsempha ya msana kapena mitsempha yowonongeka.
Kupsinjika kwa msana wam'mimba - Kupsinjika kwa msana ndi matenda oopsa omwe angayambidwe ndi mitsempha ya mafupa. Kulowa kwa khansa m'munsi mwa msana kungayambitse kugwa kwa mavitenda, ndipo pamapeto pake, kupweteka kwa mitsempha yomwe imachoka msana kupita kufupi ndi theka la thupi. Zizindikiro zingaphatikizepo kuwonjezera kupweteka kwapweteka komwe kumachepetsa miyendo, kufooka kapena kupweteka m'modzi kapena miyendo yonse, ndi kutaya chikhodzodzo ndi / kapena kuchepetsa thupi pamene matenda a khansa ya m'mawere amatha kupweteka msana. Njira zopangira opaleshoni zimagwiritsidwa ntchito kuti zikhazikitse msana.
Hypercalcemia - Monga mafupa akusweka ndi khansa, calcium imamasulidwa m'magazi. Izi, zowonjezera, zingayambitse kudzimbidwa, kutopa, ludzu lalikulu, ndi kufooka kwa minofu. Pamene matenda oopsa omwe amayamba chifukwa cha khansa amatha kusokonezeka, amatha kufa, amwalira. Njira yoyamba yothandizira imaphatikizapo kutulutsa madzi ndi ma bisphosphonates. Nthawi zina mankhwala ena monga calcitonin, gallium nitrate, kapena mithramycin angagwiritsidwe ntchito. Ngati hypercalcemia ndi yovuta, dialysis ndi njira ina.
Kutaya kwa kuyenda - Zotsatira za kuchepa kwa ntchito zomwe zimagwirizanitsa ndi kupumula kuchokera pa kupasuka sikungatheke kuponderezedwa. Ndi maphunziro omwe akutiuza kuti kuchita masewero olimbitsa thupi kungathandize kuti mukhale ndi moyo, ngakhale ndi khansa ya m'mawere, chirichonse chomwe chimachepetsa kuthekera kwanu kuti mukhale wogwira ntchito kumafunika kuthandizidwa mosamala.
Mkhalidwe wosauka wa moyo - Pakati pa ululu wokhudzana ndi mitsempha ya mitsempha, komanso kusasuntha komwe kumagwirizana ndi fractures kapena ngozi ya fractures, metastases ya mafupa ikhoza kuchepetsa kwambiri umoyo wanu. Mwamwayi, monga taonera kale, pali njira zambiri zothandizira.
Kugonjetsa Pamene Khansa ya M'thupi Imafalikira ku Fupa
Kuwonetsa kwa khansa ya m'mawere yomwe imafalikira kokha kwa mafupa kuli bwinoko kusiyana ndi khansa yomwe yafalikira kumadera ena a thupi. Chithandizo cha mitsempha ya mafupa nthawi zina chimatha kuchepetsa matendawa kwa nthawi yaitali. Kawirikawiri kupulumuka kwa khansa ya m'mawere ndi miyezi 18 mpaka 24, ndipo ndi anthu oposa 20 peresenti ya anthu amene apulumuka kupitirira zaka zisanu. Ndikofunika kuti muzindikire, komabe, kuti chithunzithunzi chili bwino kwa anthu omwe ali ndi mafupa okhaokha ndipo pali opulumuka nthawi yaitali a khansa ya m'mawere yomwe yafalikira ku mafupa.
Pansi pa Matenda a Matenda Chifukwa cha Khansa ya M'bwere
Pamene khansa ya m'mawere imayambira mafupa imakhala yochititsa mantha, makamaka ngati ndi njira yomwe mumadziwira kuti kansa yanu yayambiranso ndipo tsopano muli ndi kansa ya m'mawere.
Ngakhale mitsempha ya mafupa imatsimikizira kuti khansa yanu yafalikira ndipo ikhoza kukhala yopweteka, pali njira zina zabwino zothetsera mankhwala zomwe zilipo, ndi mankhwala ambiri omwe akuyang'aniridwa panopa.
Zotsatira:
Coleman, R. Impact ya Matenda-Matenda Otsatiridwa pa Matenda Otsalira ndi Kupulumuka mu Khansara Yamatumbo. Oncology (Williston Park) . 2016. 30 (8): pii: 218394.
Das, T., ndi S. Banerjee. Ma Radiopharmaceuticals kwa Metastatic Bone Pain Palliation: Njira Zowonjezera mu Clinical Domain ndi Zofananako. Metastasis yachipatala ndi yowunika . 2017. 34 (1): 1-10.
National Cancer Institute. Meta-Analysis Amapeza Zopindulitsa za Adjuvant Bisphosphonates kwa Khansa ya Amuna Yomwe Imayambitsa Mayi. 09/09/15. https://www.cancer.gov/types/breast/research/adjuvant-bisphosphonates-meta-analysis
O'sullivan, G., Carty, F., ndi C. Cronin. Kujambula kwa Matenda a Metastasis: Chotsitsimutsa. World Journal of Radiology . 2015. 7 (8): 202-211.