Tanthauzo, Kuzindikira, Kuchiza, ndi Kugonjetsa
Kuzindikira kwa gawo lililonse la khansa ya m'mawere kungachititse mantha ndi mantha. Ngakhale mutatsimikiziridwa kuti muli ndi sitepe yoyambirira ya kansa ya m'mawere mungathe kuchita mantha komanso kukhumudwa. Taphunzira kuti zomwe timachita pa matendawa zimakhala zofanana ngakhale zili zotani. Kodi kutanthauzira kwa chotupa 1, ndi njira ziti zamankhwala zomwe zingapezeke, ndipo mukuganiza chiyani?
Pamene sitingathe kulonjeza kuti kudziphunzitsa nokha kudzathetsa mantha anu onse, kungakuthandizeni kuti mulowe mu mpando wa dalaivala ndikudzimva kuti muli ndi mphamvu muchisamaliro chanu.
Tanthauzo
Gawo 1 khansa ya m'mawere ndi gawo loyambirira la khansara ya m'mawere. Kuwona mau osokonezeka akuwopsya, koma mawu osokoneza ponena za siteji sakutanthauza kuti khansara imayambuka mbali zina za thupi. Chophweka chimangotanthauza kuti maselo a chifuwa chanu awononga chinthu chapitalo chomwe chimatchedwa chipinda chapansi. Ndikumenyana kumene kudutsa kamphanga kakang'ono kamene kamatanthawuza chinthu monga khansara.
Khansara ya m'mawere ikamayamba, sichikulirepo pamtundu uwu. Ziphuphu pamasitepe awa sizingatengedwe ngati khansara, koma m'malo mwa carcinoma-in-situ . Amatchulidwanso ngati matenda a stage 0. Carcinoma-in-situ ndi 100 peresenti yochiritsidwa ndi opaleshoni chifukwa maselo ali nawo. Palibe mwayi umene ungafalikire.
Mitsempha yachitetezo 1 ndiyo gawo loyamba la khansa yeniyeni ya m'mawere. Ziphuphuzi ndizochepa, ndipo ngati zimafalikira mpaka maselo amphongo amwazika kwambiri.
Makhalidwe a Stage ndi TNM
Kuti mumvetsetse momwe dokotala wanu amakhalira siteji ya khansa yanu, ndipo ngati muli ndi sitepe ya 1A kapena stage 1B, ndizothandiza kudziwa pang'ono za dongosolo la TNM.
Pachifukwa ichi:
- T imaimira kukula kwa chotupa: Machesi a T1 amatanthauza kuti chotupa chanu chili 2 cm (pafupifupi masentimita) kapena osachepera. Kawirikawiri, zivomezi za T2 ndi zazikulu kuposa 2 cm ndipo zing'onozing'ono kuposa masentimita asanu, ndi matumbo a T3 akuluakulu kuposa masentimita asanu.
- N imayimira node: N0 zikutanthauza kuti khansayo sinafalikire ku mitsempha iliyonse. N1 imatanthauza kuti khansara yayamba kufalikira ku minofu pafupi, ndipo N2 imatanthauza kuti yafalikira ku minofu pang'ono kwambiri. Ndili ndi mapiritsi oyamba, gawo lina limakhala lofunika. Mawu akuti micrometastases amatanthauza kuti khansara yayamba kufalikira ku minofu koma ikhoza kuwonedwa pansi pa microscope. Micrometastases alipo pamene maselo a khansa amapezeka mu minofu ndipo ali oposa 0.2 mm m'mimba mwake koma osachepera 2 mm (0.2 cm) mwake. Khansa yomwe imakhala ndi micrometastases mu mimba yapafupi yomwe imayandikira idzafotokozedwa ngati T1mi. Macrometastases, mosiyana, imatchula khansara m'matumbo omwe ali aakulu kuposa 2 mm m'mimba mwake (ndipo amatha kuwonetsa ndi diso lakuda).
- M imayimira metastases: M0 imatanthauza kuti khansayo siidasokonezedwe (mwachitsanzo, mafupa, ubongo, kapena chiwindi). M1 imatanthauza kuti ilipo.
Zingakhale zosokoneza (ndi zoopsa kwambiri) ngati muwerenga kafukufuku wanu ndipo onani kuti khansayo "yaying'ono kwambiri." Izi sizikutanthauza kuti muli ndi khansa ya m'mawere (siteji ya khansa ya m'mawere 4).
Mukhoza kukhala ndi lymph node metastases ngakhale matenda oyambirira.
Pogwiritsira ntchito TNM dongosolo, khansa 1 ya khansa imagawanika kupitirira:
- Gawo 1A: T1N0M0. Chotupacho n'chosakwana 20mm (2 cm) kukula kwake ndipo palibe kufalikira kwa maselo am'mimba
- Gawo 1B: T1N1miM0 kapena T0N1miM0. Ndi choyamba chophatikiza, chotupacho n'chosakwana 20 mm (2 cm) kukula kwake ndipo pali micrometastases mu nthendayi yapafupi yomwe ili pafupi. Chitsanzo china sichimadziwika kwambiri ndipo chiripo ngati palibe umboni wa chotupa chachikulu m'kati mwa bere koma pali micrometastases mu mitsempha yam'mimba (kawirikawiri pamtambo).
Zonsezi zimakhala zochepa kwambiri kuposa masentimita awiri ndipo sizimakhala ndi mitsempha yofiira kapena imafalitsidwa ku maselo am'mbali koma pafupi kwambiri.
Mukadziwa siteji ya khansa yanu ya m'mawere muli zinthu zambiri zomwe muyenera kuzidziwa musanasankhe njira zabwino zothandizira.
Mitundu
Pali mitundu yosiyanasiyana ya khansa ya m'mawere. Kawirikawiri khansa yapamtunda imakhala yowonongeka ndi katemera wa lobular. Mitundu ina yosawerengeka ya khansara ya m'mawere ndi khansa ya m'mimba yotentha, medullary carcinoma, tubular carcinoma, ndi zina zambiri.
Ziphuphu
Chiwerewere kalasi ndi nambala yomwe ikufotokoza kukhumudwa kwa chotupa. Akatswiri a zachipatala amawona maselo a khansa kuchokera ku chidziwitso ndi / kapena opaleshoni pogwiritsa ntchito microscope pofuna kudziwa zinthu monga momwe maselo akugawira. Ziphuphu zimapatsidwa kalasi ya 1, 2, kapena 3, ndi 1 kukhala yosautsa kwambiri ndipo 3 kukhala ziwalo zoopsa kwambiri. Vuto lanu lachiberekero sikuti limakuuzani zomwe mukuchita, koma zimakuthandizani inu ndi dokotala wanu kusankha zosamalidwa bwino.
MultigeneTesting
Zaka khumi zapitazi taphunzira momwe chotupa chilichonse chiri chosiyana pa mlingo wa maselo. Mwa kuyankhula kwina, zotupa ziwiri zomwe ziri sitepe yoyamba ya carcinomas ndipo zimakhala ndi chifuwa cha 2 zingathe kuchita mosiyana. Ngati mulibe ma lymph node ndi chotupa chaching'ono, wanu oncologist angalimbikitse kuyang'ana pa kuyesedwa kuti awone ngati mankhwala adjuvant monga chemotherapy ndi ofunika. Mayeso a Multigene monga Oncotype DX ndi MammaPrint angagwiritsidwe ntchito kudziwa ngati chemotherapy ndi yofunikira pa khansa ya m'mawere yosawerengeka.
Chikhalidwe Cholandira
Posankha njira zabwino zothandizira khansa yanu ya m'mawere, dokotala wanu adzafuna kuyesa kulandira chithandizo cha khansa yanu. Ovomerezeka ndi mapuloteni opezeka pamwamba pa maselo a khansa ndipo ndi ofunikira kukula kwa maselo.
Estrogen Receptors
Acrogen receptors ndi mapuloteni (receptors) omwe amapezeka pamwamba pa maselo a khansa. Khansa ya m'mawere yomwe ili estrogen-receptor zabwino imalimbikitsidwa kukula pamene estrogen ikuphatikiza ndi mapulogalamu awa.
Progesterone Receptors
Mavitoni a Progesterone nthawi zambiri amaphatikizana ndi ovomerezeka a estrogen.
HER2 Cancers Posachedwapa
Ma khansa ena a m'mawere amatchedwa HER2 zabwino. HER2 ndi mapuloteni pamwamba pa maselo a khansa. Zowonjezera zikumangiriza ndi chotengera ichi kuti chilimbikitse kukula. Selo lonse la m'mawere lili ndi maselo a H22, koma ali ndi khansa yabwino ya HER2, pamakhala maulendo angapo oposa awa (mukhoza kuona mawu monga HER2 kukulitsa kuwonetsera za majini owonjezera omwe akulembera mapuloteni kapena HER2 owonjezera, ponena za kuchulukitsa manambala za obvomerezedwa pa maselo a khansa).
Pali mankhwala enieni omwe angawathandize kulandira izi zomwe zingachepetse chiopsezo cha kubwereza. Ngati zovomerezeka zanu zonse ziri "zosayenera" poyezetsa, zotupa zanu zikanakhala ngati "khansa ya m'mawere" itatu.
Kuchiza
Mankhwala amayamba kusweka m'magulu akulu awiri:
- Zochitika zapanyumba: Zochiritsira zakumalopo zimapereka khansayo kumidzi, ndipo zimaphatikizapo opaleshoni komanso mankhwala opatsirana
- Mankhwala othandiza: Mankhwala ochizira amachititsa khansa kuthupi kapena thupi lonse. Izi zimaphatikizanso mankhwala a chemotherapy, mankhwala opatsirana pogwiritsa ntchito mankhwala, mankhwala othandizira, ndi ma immunotherapy.
Ngati chotupa chiri chochepa kwambiri, mankhwala am'deralo nthawi zambiri amafunikira. Ngati chotupacho chikulirapo, choopsa kwambiri (chiri ndi mapiritsi apamwamba kwambiri), chafalikira ku maselo amphongo, kapena chiri ndi mbiri ya maselo yomwe imasonyeza kuti khansara ikhoza kufalikira, mankhwala ochiritsira nthawi zambiri amalimbikitsidwa. Pochita masewera olimbitsa thupi amayamba kugwiritsa ntchito njira yothandizira (addictive therapy) ndipo cholinga chake ndicho kuthetsa maselo ena a khansa omwe afalikira kupyola pachifuwa koma ndi ochepetsetsa kuti asazindikiridwe ndi mayesero omwe tili nawo panopa.
Zosankha zamankhwala zingaphatikizepo:
Opaleshoni
Opaleshoni imalimbikitsidwa kwa ambiri khansa ya khansa 1. Zosankha zikuphatikizapo lumpectomy kapena mastectomy . Pali zifukwa zingapo zomwe anthu amasankhira wina ndi mzake, ndipo zingakhale zosankha zaumwini. Ngati lumpectomy imasankhidwa, mankhwala othandizidwa ndi ma radiation kwa minofu yotsalayo nthawi zambiri amalimbikitsidwa. Ngati muli ndi vutoli, dokotala wanu adzakuuzani za njira yokonzanso mawere. Kuchita opaleshoni ya khungu kumakhala kofala kwambiri, ndipo ndi njirayi, kuyika kapena kuthamangitsa kawirikawiri kumaikidwa nthawi imodzimodzimodzi ndi vuto lanu lotayirira.
Ndi opaleshoni, chidziwitso cha nthendayi chikhoza kuchitika. M'mbuyomu, ma lymph nodes ambiri amachotsedwa ndikuyesedwa pansi pa microscope, koma tsopano tikhoza kudziwa kuti ndi mankhwala ati omwe angayambe kufalitsa khansa. Ngati ma lymph nodes anu ali othandiza , zikutanthauza kuti khansa yanena kuti cholinga chake chifalikira.
Chemotherapy
Chemotherapy pa khansa ya m'mawere nthawi zina amagwiritsidwa ntchito ngati mankhwala a adjuvant ndi siteji yoyamba, ngakhale kuti nthawi zambiri zimakhala zovuta kudziwa omwe angapindule. Kwa anthu omwe ali ndi micrometastases kuti apange mankhwala am'mimba, mankhwala otchedwa chemotherapy amathandizidwa nthawi zambiri. Cholinga cha chemotherapy ndi kuchiza maselo aliwonse a khansa omwe angakhale atasochera kuchokera pachifuwa chanu asanamere kukula. Khansa yomwe yafalikira (ngakhale pangТonoting'ono) ku maselo a mitsempha imayambitsa cholinga chawo chofalitsa.
Ndi khansa ya m'mawere yomwe ili ndi 2 masentimita awiri kapena osachepera (siteji 1) imakhala yosavuta. Maseŵera a Oncotype Dx Recurrence Score kapena MammaPrint ndi mayesero osiyanasiyana a genomic omwe angakhale othandiza. Omwe amapambana pa mayeserowa adachulukanso kuchulukirapo pamene mankhwala a chemotherapy aperekedwa. Anthu omwe ali ndi zochepa zotere sangathe kupindula ndi chemotherapy. Popeza mankhwala a chemotherapy ali ndi zotsatira zoopsa (mtima wosalimba ndi khansa yachiwiri ya m'magazi sizinali zachilendo) ndikofunika kufufuza zoopsa ndi phindu lomwe munthu aliyense payekha angachite.
Mankhwala Opanga Mafuta
Ngati muli ndi lumpectomy, mankhwala opatsirana pogwiritsa ntchito mankhwalawa amagwiritsidwa ntchito pochizira matupi anu otsala. Pokhala ndi khansa ya m'mawere ya m'mawere, mankhwala ochizira mavitamini sagwiritsidwa ntchito pambuyo pa vutoli.
Matenda a Hormone
Ngati chotupa chanu chiri chovomerezeka ndi estrogen, mankhwala opangidwa ndi mahomoni nthawi zambiri amalangizidwa pakutsata mankhwala apadera ndi opaleshoni ndi mankhwala a chemotherapy / mankhwala opatsirana. Cholinga ndi kuchepetsa chiopsezo kuti khansa idzabweranso. Matenda a Estrogen amatha kukhala ndi nthawi yobwereza (pambuyo pa zaka zisanu ndi kupitirira). Kwa amayi oyambirira, tamoxifen amagwiritsidwa ntchito nthawi zambiri. Kwa amayi am'mawa, mankhwalawa amakhala aromatase inhibitor monga Aromasin (exemestane), Arimidex (anastrozole), kapena Femara (letrozole).
HER2 Mankhwala Operekedwa
Ngati chotupa chanu chiri HER2 chitsimikizo, mankhwala omwe amalangizidwa ndi HER2 monga Herceptin (trastuzumab) amayamba kawirikawiri pambuyo pa mankhwala oyamba.
Mayesero Amakono
Njira yokhayo yomwe chitukuko chimapangidwira pa chithandizo cha khansa ya m'mawere ndi kuphunzira mankhwala atsopano ndi njira zowonongeka. Pali nthano zambiri zokhudzana ndi mayesero a kachipatala , koma zoona ndizokuti mankhwala omwe timagwiritsa ntchito tsopano adayesedwa mu mayesero a zachipatala.
Kusankha Thandizo Labwino
Pokhala ndi siteji 1 kansa ya m'mawere chimodzi mwa zisankho zazikulu ndi mtundu wa opaleshoni. Pali ubwino ndi chisokonezo kwa opaleshoni iliyonse, ndipo zifukwa zambiri ziyenera kuwerengedwa ngati mbiri ya banja lanu (mwayi woti mukhala ndi khansa yambiri ya m'mawere), kumene mumatulutsa chifuwa chanu, ndi zomwe mungathe kuyembekezera kuti musamalidwe. Ndikofunika kusankha mankhwala omwe angakuthandizeni, ziribe kanthu zomwe wina angasankhe. Ndifunikanso kuti mukhale woyimilira nokha pa khansa yanu . Odwala ndi madokotala akugwirira ntchito limodzi mwatcheru kuti m'mbuyomu ndipo ndinu membala wofunikira pa gulu lanu la khansa.
Kulimbana ndi Kuthandizidwa
Chimodzi mwa zinthu zabwino kwambiri zomwe mungadzichitire nokha mutatha kupeza chithandizo ndicho kusonkhanitsa chithandizo. Mukhoza kulemba ngakhale mndandanda wa mabwenzi omwe angapereke chithandizo. Ngakhale mutakhala bwino pogwiritsa ntchito chithandizo chanu, zingakhale zovuta kuwonjezera mankhwalawa ku ndondomeko yathu yonse yokonzekera. Funsani thandizo ndikulola anthu kuthandizira.
Mungafune kukhazikitsa malo a CaringBridge kapena wina atakuchitireni izi. Imeneyi ndi njira yabwino kwambiri yosunga banja lanu ndi abwenzi anu mosiyana ndi zomwe mukuchita popanda kuwononga maola ambiri tsiku ndi tsiku pa foni. Anzanu adzalandira mwayi wakupatsani ndemanga ndikulemba zolemba zanu popanda kudandaula za kusokoneza mpumulo wanu. Palinso malo omwe amalola anthu kulemba kuti abweretse chakudya, kukutsogolerani ku maulendo a ma radiation, ndi thandizo lina monga Tenga Chakudya ndi Lotha Thandizo Labwino.
Mwamtima mumamva ngati mukugwedezeka nthawi zina. Kafukufuku amatiuza kuti anthu amachitanso chimodzimodzi atapezeka kuti ali ndi khansa ndipo ziribe kanthu kaya ndiyambirira kapena yopita patsogolo. Musalole kuti wina aliyense akuchititseni kudzimva mwachinyengo mwa kunena kuti "ndizokhazikika 1." Ndi khansa, ndi khansa yowopsya! Maganizo anu angayambe kuopa mantha ndikudandaula kuti asokonezeke ndikuwopsya-nthawi zina mumphindi. Sitiyenera nthawi zonse kuti mukhale otsimikiza ndipo ndikofunikira kufotokoza maganizo anu olakwika.
Kuphatikizidwa mu gulu lothandizira kapena gulu lothandizira pa intaneti lingakhale lopambana. Pali chinachake chapadera kwambiri ponena za ena omwe akukumana ndi mavuto omwe muli nawo. Midziyi imapatsanso mwayi wophunzira zaposachedwapa za khansa ya m'mawere, popeza palibe amene akulimbikitsidwa ngati omwe ali ndi matendawa.
Kuthamangitsani
Kuvomereza kwa gawo 1 khansa ya m'mawere ndi yabwino. Kwa iwo amene amalandira chithandizo ndi opaleshoni ndi chemotherapy kapena mankhwala a radiation, ngati akulimbikitsidwa, zaka 5 zomwe zimakhalapo ndi pafupifupi 100 peresenti. Izi zinati, kupyolera mu mankhwala opatsirana khansa ya m'mawere sikophweka. Zotsatira zake zimakhala zachilendo, makamaka ndi chemotherapy, ndipo kutopa kuli pafupifupi konsekonse.
Mawu Ochokera
Kuzindikira kuti gawo la 1 khansa ya m'mawere ndi loopsa. Ngakhale kuti chiwerengero cha moyo ndi chabwino kwambiri, zingakhale zovuta kulingalira za masitepe onse omwe mukufuna kuti mufikepo. Khulupirirani ena ndikuwalola kuti akuthandizeni. Malo ambiri a khansa ali ndi magulu othandizira kapena othandizira kwa omwe atulukira kumene. Kutenga nthawi yocheza ndi anthu omwe adutsa mankhwalawa ndikubwera osati kungopulumuka, koma kukhala okhwima, kungakhale kulimbikitsa masiku amenewo pamene kutopa kwa khansa kumagunda.
> Zosowa
> McVeigh, T., ndi M. Kerin. Kugwiritsa Ntchito Kachilombo ka Oncotype DX Genomic Test to Guide Guide Chithandizo cha Odwala Amene Ali Osavuta Khansa ya M'bwere. Khansa ya m'mawere (Dove Med Press) . 2017. 9: 393-400.
> National Cancer Institute. Matenda a khansa ya m'mawere (PDQ) -Health Professional Version.