Zovuta Zomwe Zimayambira M'nyengo Yoyamba Khansa ya m'mawere

by Lynne Eldridge, MD

Zovuta zachipatala, Chemotherapy, Radiation Therapy, ndi zina

Ngati mumalankhula ndi anthu ambiri khansa ya m'mawere , mudzaphunzira kuti kuthana ndi matendawa kumaphatikizapo zambiri kuposa kumenyana ndi khansa yokha. Ndipotu, zotsatira zake ndi mavuto a khansa ndi mankhwala a khansa nthawi zambiri zimakhala zovuta ngati khansa yokha. Kodi ndi zotsatirapo zotani ndi mavuto omwe angachitike mukamapatsidwa khansa ya m'mawere oyambirira?

Tiyeni tiwone mavuto omwe angakhalepo okhudzana ndi opaleshoni, chemotherapy, ndi ma radiation, komanso "maganizo" komanso mavuto omwe mumakumana nawo.

Zotsatira zoyipa ndi zovuta

Ndikofunika kusiyanitsa zotsatirapo ndi mavuto, ngakhale tidzakambirana zonsezi. Zotsatira zake ndi zizindikiro zomwe zimakhala zachilendo ndipo nthawi zambiri zimayembekezeredwa. Chitsanzo cha zotsatira zoyipa ndi tsitsi lopweteka pa mankhwala a chemotherapy. Zovuta, mosiyana, sizodziwika ndipo sizikuyembekezeredwa, ngakhale zimadziwika kuti zimachitika nthawi zina. Chitsanzo chingakhale kukula kwa mtima kulephera kapena khansa ya m'magazi chifukwa cha chemotherapy.

Ngakhale kuti mutha kukhala ndi zotsatira zokhudzana ndi chithandizo, kumbukirani kuti anthu ambiri samakumana ndi mavuto omwe ali pansipa. Sitikufuna kuti mndandandawu ukuwopsyezeni, koma ndikuyembekeza kuti kukhala ndi chidziwitso ichi kukuchenjezani kuti chinachake chikhoza kukhala cholakwika, kuti mupeze thandizo lachipatala mwamsanga ngati kuli kotheka.

Tiyeni tiyambe kuyang'ana pa mankhwala omwe mungalandire.

Zotsatira Zotsatira ndi Ngozi Zowopsa za Opaleshoni

Kaya muli ndi vuto lotayirira kapena lumpectomy, mukhoza kuyembekezera zotsatira zina. Pambuyo pa opaleshoniyo, udzakhala wowawa kwa masiku angapo. Ngati mwakhala ndi matenda osokoneza bongo, mungathe kukhala osagwiritsidwa ntchito pazomwe mukupita.

Inde, opaleshoni imatanthauza kuti mudzakhala ndi chilonda.

Zingatheke zovuta, mosiyana, zingakhalepo:

Kutenga: Nthawi iliyonse imene munthu akuchitidwa opaleshoni, ali ndi chiopsezo cha mabakiteriya omwe amayamba kulowera mu mankhwala omwe angayambitse matenda. Dokotala wanu adzakufunsani kuti muyang'ane zizindikiro zirizonse, monga malungo, redness, kapena tenderness. Ngati mwayamba kuchotsa mastectomy kapena lymph nodes, mukhoza kukhala ndi mitsempha imodzi kapena angapo opaleshoni. Ngakhale kuti madziwa amatha kuchepetsa mavuto ena, angakhalenso njira ya mabakiteriya kuti alowe m'thupi lanu.
Zomwe zimachitikanso ndi anesthesia: Opaleshoni yambiri ya khansa ya m'mawere imayendetsedwa ndi anesthesia, ndipo imakhala ndi vuto lochepa la mavuto.
Seroma: Seroma ndi mchere wambiri m'madera omwe matenda anu amachotsedwa. Cholinga cha zitsamba ndicho kuchotsa madziwa, koma, ngakhale ndi zotupa, seroma nthawi zina zimachitika.
Hematoma: Ngati pali malo omwe mumapanga kupuma, magazi a hematoma angapangidwe.
Magazi amagazi: Kuchita opaleshoni ndi chinthu chowopsya kuti chitukuko cha magazi chikhalepo m'miyendo yanu. Ngati simukutsatiridwa, ma clotiwa amatha kuchoka ndikupita kumapapu anu (pulmonary emboli). Ngakhale kuti siwodziwika pambuyo pa opaleshoni ya khansa ya m'mawere, kukwera ndi kuyenda ndi kupewa kupuma kwa nthawi yayitali kungachepetse chiopsezo chanu. (Chemotherapy amachititsanso kuti pakhale ngozi ya magazi.)

Mavuto a nthawi yaitali angaphatikizepo:

Mphepete mwachangu : Azimayi ena amayamba kusunthira pamapewa awo akutsata opaleshoni ya khansa ya m'mawere. Ngati kusuntha kuli koletsedwa, mukhoza kutha ndi mapewa. Mankhwalawa ndi othandiza kwambiri pochiza vutoli, koma kupewa nthawi zonse kumakhala bwino. Madokotala ena amalimbikitsa kuti amayi aziwona kansalu ya khansa ya m'mawere (makamaka amene amatsimikiziridwa kupyolera mu pulogalamu ya Star ya kukonzanso khansa) atachiritsidwa kuchokera kuchipatala, kuonetsetsa kuti alibe mavuto.
Lymphedema : Lymphedema ndi mkhalidwe umene ziwiya zam'mimba zam'mimba zimapweteka pakapita opaleshoni. Zimapezeka kawirikawiri pamene matenda opatsirana pogonana amatha. Zizindikiro zimaphatikizapo mkono umodzi womwe umakhala wotupa kuposa wina. Kusankha dokotala wa opaleshoni amene amachita opaleshoni yaikulu ya khansa ya m'mawere akhoza kuchepetsa chiopsezo chanu, komanso kusamala kuti musapewe kuvulala kumbali ya khansa yanu ya m'mawere. Mphamvu ya lymphedema ndi chifukwa chake dokotala wanu akukuuzani kuti musapezeke kuti magazi akukoka kapena kuti kuthamanga kwa magazi kukuyang'ane pambali pa khansa yanu ya m'mawere.

Zotsatira zowonongeka zosavuta: Ngakhale kuti sikuti ndizovuta kuwonongeka kwa thupi, zotsatira zosavuta zodzoladzola zingakhale zovuta kwambiri. Ngati izi zikuchitika, nthawi zambiri pali njira zambiri zomwe anthu angasinthire ma opaleshoni awo, komanso njira zowonetsera.

Mavuto chifukwa cha kukonzanso mawere:

Ntchito yomangidwanso imayambitsa mavuto omwe amachititsa opaleshoni ya khansa yoyamba monga matenda, magazi, ndi magazi.
Mgwirizano wambiri: Thupi lathu limazindikira kuti pali chinthu china chosazolowereka m'thupi mwathu, ndipo nthawi zambiri timayesetsa kuti tipeze khoma. Ochita opaleshoni yapulasitiki akhala akuyang'ana njira zochepetsera chiopsezo chotenga mgwirizano pambuyo pa kumangidwanso. Izi zikachitika, kuyamwa kwa m'mawere kungakhale kovuta, kuthawa kwawo, ndi kuchitira chifundo. Ngati mukukulitsa chikhalidwe ichi, komabe pali opaleshoni zomwe zingatheke.

Zotsatira za Chemotherapy

Zotsatira zake za chemotherapy zimadziwika bwino. Zomwe zimafala kwambiri zimaphatikizapo kutaya tsitsi, kupweteka kwa mafupa a mafupa (kumayambitsa maselo ofiira a m'magazi, maselo oyera a magazi, ndi mapiritsi), ndi mseru. Chemotherapy imapha anthu mofulumira kwambiri maselo monga khansa, koma maselo a tsitsi lanu, fupa la mafupa, ndi gawo lakumagawa akugawanika mofulumira.

Pakhala zothandiza kwambiri pakuyendetsa zotsatira za mankhwala a chemotherapy m'zaka zaposachedwapa. Mankhwala omwe amaperekedwa akhoza kuteteza kusokonezeka ndi kusanza, ndipo mukhoza kulandira majekeseni a Neulasta kapena Neupogen kuti musapitirize kuwerengera neutrophil (mtundu wa magazi oyera) kuti muthetse kachilombo ka HIV.

Mavuto, komanso zotsatira zomwe zingapitirire pambuyo pa mankhwala ndi izi:

Matenda (febrile neutropenia): Matenda aakulu akhoza kuchitika ngati kuchuluka kwa maselo oyera a magazi kumakhala kochepa kwambiri ndipo kumafuna chithandizo chamwano. Matenda chifukwa cha neutropenia yotchedwa chemotherapy-yomwe imachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda.
Mphuno ya m'mitsempha: Mphuno yokhudzana ndi matenda a ubongo ndi zovuta zokhudzana ndi nsapato zokhudzidwa, komanso zofooka, zomwe amayi angazizindikire mmanja mwawo. Mwamwayi, izi zikhoza kupitirira patapita nthawi yaitali, ngakhale akatswiri akuyang'ana njira zothetsera chiopsezo. Nthawi zambiri zimayambitsidwa ndi mankhwala osokoneza bongo monga Taxol (paclitaxel).
Chemobrain: Kuvuta ndi chidziwitso, kuchepetsa kukumbukira kwa nthawi yochepa (kutaya makiyi anu) ndi mavuto omwe mukukumana nawo ndikumangirira amayi ena (ndi amuna) pambuyo chemotherapy, ndipo wapangidwa " chemobrain ." Dera limeneli lapatsidwa chidwi kwambiri, ndipo ena okhulupirira zachipatala amakhulupirira kuti zochitika zamaganizo, ngakhale zitangochitika puzzles, zingathandize.
Kusadziletsa. Kupanda chithandizo pambuyo pa chithandizo cha khansa ndi chofala, ndipo amayi ambiri amasiya kukhala ndi mankhwala ochepa pambuyo pake. Kwa atsikana, nthawi zingabwererenso pakapita nthawi, koma izi sizitsimikizo zowonjezera. Ngati mukuganiza kuti mukufuna kutenga mimba mutatha kuchiza, lankhulani ndi oncologist musanayambe. Pali njira zomwe zilipo, monga mazira ozizira kwambiri, omwe amalola amayi ena kubala ngakhale atatha kumwa khansa ya m'mawere.

Mavuto aakulu ndi awa:

Matenda a mtima: Matenda a mtima angayambe ngakhale atatha zaka zambiri atalandira mankhwala a chemotherapy. Mankhwala a Adriamycin (doxorubicin) amachititsa mtima kulephera kwa amayi 1 mpaka 2 pa 100 omwe amalandira mankhwalawa. Mankhwala ena omwe angayambitse vuto la mtima ndi Herceptin (trastuzumab) ndipo mtima wanu ukuyenera kuyang'anitsitsa mosamala pamene mukuutenga. Mwinamwake mudzayesedwa ndi mtima musanayambe mankhwala a chemotherapy kuti mupeze mayendedwe oyerekeza. Zizindikiro za kufooka kwa mtima zimaphatikizapo kupuma pang'ono, kuchepetsa kupirira, kutupa kwa miyendo, ndipo nthawi zina zimakokera pinki, madzi ozizira.
Khansa yachiwiri monga khansa ya m'magazi: Mankhwala a chemotherapy omwe amagwiritsidwa ntchito pa khansa ya m'mawere amadziwika kuti khansa (opanga khansa). Ngakhale pali chiopsezo chochepa (1 mwa 100) ya kupanga khansara yachiwiri (nthawi zambiri minofu yofewa ya sarcoma kapena yovuta myelogenous leukemia kapena AML), phindu la chemotherapy nthawi zambiri limaposa zoopsa izi.

Palinso zochepa, koma nthawi zina zotsatira zoyipa za chemotherapy .

Zovuta Zokhudza Kuchiza kwa Hormonal

Tamoxifen onse (a amayi omwe amayamba kumwa mankhwalawa) ndi aromatase inhibitors (kwa amayi omwe amatha kupha amayi kapena amayi omwe ali ndi vuto loyambitsa matenda osokoneza bongo) angayambitse kutentha. Pali kusiyana pakati pa ziwiri, komabe, monga tamoxifen ali ndi zotsatira za estrogen pa zina zotupa ndi zotsatira zotsutsa-estrogen kwa ena.

Aromatase inhibitors , mosiyana, amachepetsa mapangidwe a estrogen m'thupi ndipo zizindikiro zambiri ndizo za kusowa kwa estrogen. Mankhwala omwe amadziwika kuti aromatase inhibitors akuphatikizapo Arimidex (anastrozole), Femara (letrozole), ndi Aromasin (exemestane).

Mitundu yonse ya mankhwala ikhoza kuyambitsa kutentha, kutentha kwa amayi, ndi kusokonezeka. Tamoxifen imatha kupweteka kwa minofu, koma aromatase inhibitors amadziwika bwino chifukwa cha kupweteka kwa minofu ndi mgwirizano pafupifupi theka la anthu ogwiritsira ntchito mankhwalawa. Pazifukwa zabwino, mitundu yonse ya mankhwala imachepetsa chiopsezo cha kubwereza khansa ya m'mawere ndi theka. Ndipo, ngati kuwala kotentha kukukuyendetsani pang'ono chabe, mungathe kumasulidwa podziwa kuti pali ndalama zowonjezera siliva, ndipo kutentha kwakukulu kumakhala ndi chiwerengero chachikulu cha anthu omwe amagwiritsira ntchito mankhwala opanga mankhwala.

Mavuto ochokera ku tamoxifen angaphatikizepo:

Khansa ya uterine : Mosiyana ndi minofu ya m'mawere, tamoxifen ikhoza kuyambitsa uterine (minofu ya endometrial). Malingana ndi American Cancer Society, chiopsezo cha khansa ya uterine ndi yochepa, pafupifupi 1 pa 500 ali ndi zaka 50, ndipo kawirikawiri amadziwika kumayambiriro akale ngati izo zikuchitika. Chizindikiro chofala kwambiri ndi magazi a m'mimba.
Magazi amagazi: Magazi onse m'magazi (deep vein thrombosis) ndi pulmonary emboli (magazi omwe amapita kumapapo) amapezeka mosavuta.
Zoopsa: Mwamwayi, nthendayi ndi yosavuta kuchiritsa ndi opaleshoni.

Mavuto ochokera kwa aromatase inhibitors angaphatikizepo:

Osteopenia ndi matenda otupa mafupa. Aromatase inhibitors amachititsa kuti mafupa awonongeke, ndipo nthawi zambiri amaphulika chifukwa cha fupa la msana, chiuno, ndi madera ena. Kuwonjezeka kwaposachedwapa kwa bisphosphonates (monga Zometa) kuchipatala kwa amayi ena kungachepetse ngoziyi mtsogolomu.
Matenda a mtima. Matenda a mtima monga matenda a mtima, mavuto a mtima wa valve, ndi pericarditis amadziwika kwambiri mwa amayi pa aromatase inhibitors, koma palibe chiopsezo chowonjezereka cha mavuto aakulu omwe amawopsa monga mtima ndi zilonda.

Zovuta Kuchokera ku Mankhwala Opatsirana

Mankhwalawa amagwiritsidwa ntchito poyambitsa lumpectomy, kapena kwa amayi amene ali ndi vuto lopweteka kwambiri. Zotsatira zoyipa zimaphatikizansopo khungu lofiira ndi zotupa, komanso kutopa.

Zovuta za mankhwalawa zimaphatikizapo:

Matenda: Kufiira komanso ngakhale mabulter akhoza kukhala ndi zotsatira zoyenera, koma zilonda zotseguka zimatha kuonjezera chiopsezo chokhala ndi matenda aakulu. Anthu omwe ali ndi ma radiation pambuyo pochita opaleshoni yomweyo amakhala pachiopsezo chachikulu chotenga matenda.
Fibrosis: Mankhwalawa amachititsa kuti thupi likhale losavuta kusintha. Izi zingachititse kusintha kwa minofu yanu (fibrosis), ndi mgwirizano waukulu ngati mwakhazikitsanso kumayambiriro. Maizoni angayambitsenso kutupa m'mapapo (radiation pneumonitis) omwe angapangitse pulmonary fibrosis .
Matenda a mtima: Mankhwalawa amatha kuwononga mtima, ngakhale odwala atulukira ma radiation omwe amawalandira kuti asachepetse mtima wanu. Njira yatsopano yomwe imatchedwa kupuma poyambira ingachepetse mtima kuwonetsetsa kwambiri mphamvu ya dzuwa, pogwiritsira ntchito kupuma. Kuphatikizidwa kwa zotsatira zokhudzana ndi mtima wa ma radiation ndipo chifukwa cha chemotherapy tiyenera kuziganizira. Ofufuza ena amakhulupirira kuti amayi omwe adalandira mankhwalawa (makamaka kuphatikiza mankhwala a Adriamycin ndi ma radiation pambuyo pa matenda oopsa) ayenera kufunsa katswiri wa cardiologist, makamaka ngati akukula zizindikiro zomwe zingayambitse matenda a mtima.

Palinso zochepa zochepa koma za zotsatira za nthawi yayitali za mankhwala omwe amatulutsa mazira , monga kuchulukira kwa khansa ya m'mapapo ndi yowopsa. Ngakhale kuti kawirikawiri ubwino wothandizidwa ndi ma radiation umapangitsa kuti pakhale mavutowa, phunziro la 2017 linapereka kuti akazi omwe amasuta, kuopsa kwa ma radiation pamodzi ndi kusuta kungapitirire phindu. Amene amasuta ayenera kusiya mankhwala asanatuluke, ndipo ngati n'zosatheka, ayenera kulankhula momveka bwino ndi mafilimu awo onena za nzeru zapamwamba za nzeru pochita ma radiation.

Maganizo / Zochitika Zachikhalidwe Zovuta ndi Zovuta

Kupezeka ndi khansa ya m'mawere ndiko kusintha kwakukulu kwa maganizo. Kafukufuku amasonyeza kuti ziribe kanthu ngati muli ndi chotupa chachikulu chochiritsika, kapena chotupa chachikulu, chopita patsogolo; kulandira chithandizo cha "C" mawu kusintha moyo wanu mphindi.

Ubale nthawi zambiri umasintha, ndipo abwenzi akutali akhoza kukhala pafupi, pamene mabwenzi anu apamtima angathe kutha. Aliyense amapereka khansa kwa wokondedwa m'njira yina.

Nthawi zina khansara imayambitsa kuvutika maganizo, ndipo chiwerengero cha kudzipha ndichokwera kwambiri kwa anthu omwe ali ndi khansa kuposa anthu ambiri. Kuwonjezera malingaliro amenewa ndi kutopa kwa khansa , komanso kulimbana ndi khansa n'kovuta.

Tikuphunziranso kuti thandizo lothandizira anthu ndi lofunika kwambiri moti linagwirizananso ndi kupulumutsidwa kwa khansa ya m'mawere, ndipo muyenera kuthana ndi mavuto omwe mungakhale nawo. Anthu ambiri amapeza kuti kukambirana ndi wothandiza kumathandiza panthawi ya kusintha. Onetsetsani kuti mukulankhulana ndi dokotala ngati muli ndi vuto lolimbana.

Kuchepetsa Vuto Lanu la Mavuto

Ndikofunika kuzindikira kuti pali zinthu zingapo zomwe mungachite kuti muchepetse chiopsezo chanu chokhala ndi mavuto pamatenda oyambirira a khansa ya m'mawere.

Ngati mumasuta, musiye. Kusuta kumasokoneza machiritso a chilonda ndipo kumawonjezera chiopsezo chanu cha matenda (ndi chirichonse chomwe chikuyenda ndi matenda). Amathandizanso kuti matenda aliwonse amtima apweteke chifukwa cha chithandizo.

Yesetsani kupewa matenda a chemotherapy . Ngakhale mutalandira mankhwala kuti musunge magazi anu oyera, samalani kuti musambe manja, pewani malo otukuka, ndipo mukhale kutali ndi anthu omwe akudwala.

Musamvetsetse kafukufuku waposachedwapa pa khansa ya m'mawere. Ndili ndi anthu ambiri omwe akupulumuka, tikuphunzira zambiri zokhudza nkhani za nthawi yaitali zokhudzana ndi chithandizo, komanso momwe tingachepetsere ngozi.

Dziwani thupi lanu ndi zizindikiro zilizonse zomwe muli nazo. Zambiri mwazovuta za matenda a khansa ya m'mawere ndizochiritsidwa, ndipo nthawi zambiri mankhwala amayamba bwino kwambiri pomwe ayamba mofulumira.

Khansa Yokonzanso Khansara

Ndili ndi anthu ambiri omwe ali ndi khansa, tikuphunzira kuti ambiri opulumutsidwa ndi khansa akulimbana ndi zotsatira za mankhwala. Zaka zaposachedwapa, pulojekiti yakhazikitsidwa kuti "Ndondomeko ya Nyenyezi Yokonzanso Khansa." Pulogalamuyi tsopano ikupezeka pa malo ambiri a khansa. Zapangidwa kuti zichepetse zotsatira za nthawi yaitali za khansa, ndikuthandizeni kuthana ndi zizindikiro zilizonse zakuthupi kapena zamaganizo zimene zikukulepheretsani kumoyo wanu watsopano.

Mawu Ochokera

Poyang'ana mndandanda wa zovuta za matenda opatsirana khansa, kuwonjezera pa zotsatira zomwe mungayembekezere, zingakhale zoopsa. Kumbukirani kuti mavutowa ndi osazolowereka, ndipo nthawi zambiri mumatha kuchipatala popanda kupeza zambiri kapena zina. Chofunika kwambiri, ngakhale pamene pali zoopsa, ndiko kuti kafukufuku apeza kuti phindu la mankhwalawa poletsa khansara yanu kutali kwambiri ndi zoopsa zomwe zingakhalepo.

> Zotsatira:

> American Society of Clinical Oncology. Cancer.Net. Matenda a khansa ya m'mawere. Kusinthidwa 04/07. https://www.cancer.net/cancer-types/breast-cancer/treatment-options

> Hurria, A., Come, S., ndi L. Pierce. Zitsanzo za Kubwerezabwereza ndi Zovuta Zakale Zamagulu Opulumutsidwa M'thupi la Khansa. Kupititsa patsogolo . Kusinthidwa 08/15/17.

> Rakhra, S., Bethke, K., Strauss, J. et al. Zinthu Zowopsa Zomwe Zimayambitsa Mavuto Mu Khansara Yoyambirira Yamatenda Achiwerewere Kuchita Opaleshoni Yoteteza Ubere ndi Njira Yothandizira Odwala. Zolemba za Oncology Opaleshoni . 2017. 24 (5): 1258-1261.