I-Chemotherapy isetyenziswe njengonyango kubantu abaninzi abanomdlavuza webele weemetastatic ngexesha elithile. Enoba isetyenziswe umgca wokuqala okanye ayikho kuxhomekeke kwisimo sakho se-receptor, unyango lwangaphambili kunye nezinye izinto.
I-Chemotherapy yonyango lwenkqubo ehlasela amaseli omhlaza naphi na apho kwenzeka khona emzimbeni. Ngaphandle kwelo, nangona kunjalo, ingqondo, kunye nokudlula amaninzi ala machiza aphelelwe yintsipheko yegazi-ingqondo yomqobo.
Ingaba isebenza kanjani
I-Chemotherapy isebenza ngokuhlasela iiseli ezikhula ngokukhawuleza ezifana neeseli zomhlaza . Uninzi lwamachiza e-chemotherapy luphazamisa amangqamuzana omhlaza ngexesha elithile kwinkqubo yokwahlukana, kodwa iingxenye ezahlukeneyo zomjikelo weseli ziyaphazamiseka ngezilwanyana ezahlukeneyo.
Ekubeni ezi zonyango zichaphazela nayiphi na iiseli ezikhula ngokukhawuleza, zihlala zonakalisa iiseli eziqhelekileyo emzimbeni ezinjengezo zendlela yokugaya ( isicupunu ), iinwele zentlungu (ukulahleka kweenwele), kunye nomnatha wethambo (i-anemia kunye ne-low white cells cell counts).
Xa Kusetyenziswa
Kamsinya nje i-chemotherapy iyanconywa unyango luxhomekeka ngokukodwa ngohlobo oluthile lomhlaza wesifuba onayo, nokuba ingaba isifo sakho sisifo se- estrogen okanye i- receptor ye- HER 2 , kwaye nokuba ingekho imithi yokwelapha i-hormonal isebenzayo kwi-tumor yakho.
I-Chemotherapy ivame ukucetyiswa umgca wokuqala (njengonyango lokuqala lomdlavuza we-metastatic):
- Kwababhinqa abane-tumor e-receptor-positive tumors eziye zaxhatshazwa kumachiza e-hormonal ezifana ne- tamoxifen okanye i-aromatase inhibitors.
- Kwabesetyhini abane-HER2 positive tumors (kunye neyeza elijoliswe kuyo njenge-Herceptin) ezingenayo i-estrogen receptor.
- Kubafazi abaneemvumi ezithatha i-estrogen receptor kunye ne-HER2 engalunganga
- Ingasetyenziselwa kunye nemithi yonyango kulabo abanesifo se-estrogen esiphumelelayo esiphendula kwimithi ye-hormonal ukuba ukunciphisa ngokukhawuleza kwidumbu kuyadingeka.
Ukuphindaphinda
I-Chemotherapy idla ngokunikezelwa ngemijikelezo ephakathi kweentsuku ezingama-21 ukuya kwezingama-28. Inani lemijikelezo oyifumanayo liya kuxhomekeka kwizinto ezininzi, kuquka ukuphendula kwakho kwiziyobisi okanye iziyobisi.
I-Chemotherapy inokusebenza kakuhle kumdlavuza webele we-metastatic, nangona iimvumi ziphantse zibe zichasene nanoma yisiphi isilwanyana okanye ukudibanisa kweziyobisi ngokuhamba kwexesha. Akuqhelekanga ukuba abantu bafumane ubuncinane abathathu abahlukeneyo be-chemotherapy regimens ngethuba.
I-Chemotherapy kwisifo somhlaza wesifo se- metastatic sinokunikezwa ngokuqhubekayo (ukudibanisa kwezilwanyana emva komnye ngaphandle kokuphuka) okanye ngokukhawuleza kwaye kukho i-pros and cons to each method. Kufunyenwe ukuba i-chemotherapy eqhubekayo inganciphisa ukukhula komhlaza ngokubhekiselele kunokuba unyango oluqhelekileyo, nangona kungabonakali luhlu olukhulu kumsebenzi wokuphila.
Ngokwahlukileyo, abo bafumana unyango oluphakathi kwamathuba athile banomgangatho wobomi obulunga ngakumbi. Kungenxa yezizathu ezininzi ezifana nale nto ukuba i- oncologist yakho iya kufuna ukuqonda izinto ozikhethayo malunga nokulawula umhlaza wakho.
Iinjongo
Iinjongo zonyango lwe-chemotherapy kwisifo somhlaza wesifo se-metastatic zihlala zihluke kuneenjongo zokunyanga kwe-chemotherapy kwizifo zakuqala, kwaye oku kunokudideka kakhulu.
Ngomdlavuza webele wamandulo, i-chemotherapy idlalwa rhoqo ngenjongo yokuphilisa eso sifo. Ngokomzekelo, xa i-chemotherapy inikezwa emva kokuhlinzwa komhlaza webele, kunethemba lokuba iziyobisi ziya kuhlasela naliphi na amangqamuzana omhlaza emzimbeni (ongenakubonwa kwizifundo zokucinga,) enethemba lokuba umhlaza uya kuphiliswa. Isetyenziswe ngale ndlela, i-chemotherapy ibizwa ngokuba yi-adjuvant therapy.
I-Chemotherapy ingasetyenziselwa isifo somhlaza wesifuba sokuqala ukunciphisa ubungakanani besisu ukuze utyando lube lunokwenzeka. Isetyenziswe ngale ndlela, i-chemotherapy ibizwa ngokuba yi-neoadjuvant yonyango, kunye nenjongo yonyango.
I-Chemotherapy kumdlavuza webele we-metastatic, nangona kunjalo, isetyenziswe ngeenjongo ezahlukeneyo. Ezi njongo zi:
- Ukwandisa ubomi bakho
- Ukuphucula umgangatho wobomi
- Ukuphucula iimpawu zakho
Ngamanye amagama, ngokuchasene nekhemotherapy kwintsholongwane yokuqala yesifo somhlaza, i-chemotherapy kwisifo somhlaza wesifo se-metastatic asikhange ngenjongo yokuphilisa eso sifo, kodwa kunoko ukulawula eso sifo kangangoko kunokwenzeka.
Kutheni Ingeyonyango Injongo?
Kunokuba buhlungu kakhulu kwaye kuyantyantya xa uqonda ukungafani phakathi kweyiphi i-chemotherapy enokunika isifo somhlaza wesifuba sokuqala kunye nento enokuyenza ngayo ngomhlaza wesisu se-metastatic.
Akunjalo ukuba oogqirha abafuni ukuzama ukuphilisa umdlavuza webele we-breast and chemotherapy. Benza. Oku kunjalo kunye nezidakamizwa esinawo ngoku, kunye nokuxhatshazwa okuqhubeka ngokuhamba kwexesha, iingxaki zekhemotherapy ephilisa umdlavuza ophezulu ziphantsi kakhulu. Oku kuyinyaniso nokuba ngaba ufanele uphathwe ngamanyathelo aphezulu kakhulu kunye nobudlova obuninzi bala machiza.
Ngelishwa, ngokutsho kweengcaphephe, abafazi abaninzi (kunye namadoda) balindele impendulo eyahlukileyo kunabantwana be-oncologists, kwaye banethemba lokuba i-chemotherapy iya kunyanga umdlavuza wabo we-metastatic. Siyabelana ngalokhu ukuba singathathi ithemba lakho. Kukho abantu abaphendulayo kwaye baqhubeke bephendula kwi-chemotherapy ixesha elide. Nangona kunjalo, kubalulekile ukuqonda ukuba yiyiphi ikhemotherapy kwaye ayikwazi ukuyenza ngamachiza esinawo ngoku.
Ukuba usenethemba lokunyanga, xela ugqirha wakho. Ngeli xesha alikho nayiphi na imithi evunyiweyo engayiphilisa umdlavuza webele we-metastatic, nangona amayeza amasha ahlala ehlolwa kwizilingo zekliniki. Kubantu abambalwa, amanye ala machiza amasha, njengamayeza e-immunotherapy, anokuthi (kodwa asiyazi kwaye yintoni eyenza bafundwe) banike ithuba elikhulu lokuphila ixesha elide.
Ngelo xesha, nangona kunjalo, akukho nto engaziwayo, kwaye kude kubekho izidakamizwa ezivunyiweyo asiqinisekanga ukuba abayi kuyenza izinto zibi nakakhulu.
Izidakamizwa zeKhemotherapy
Ukuba umhlaza wakho uphinda uphinde ube ne-chemotherapy okokuqala, izidakamizwa ezahlukeneyo zisetyenziswa rhoqo. Kucingelwa ukuba amangqamuzana omhlaza asele ngaphaya kwonyango lokuqala ayenakuxhatshazelwa kumachiza. Ngamanye amazwi, i-chemotherapy ingaba yayibulale amaninzi eeseli zomhlaza kodwa iiseli eziseleyo ezichasene neziyobisi zashiywa emva.
Akuqhelekanga ukuba umntu abe neerimotherapy ezintathu ezihlukeneyo zonyango ezisetyenziselwa ukunyanga umhlaza wazo. Ukwahlula oku kunyango, i-oncologists ngokuqhelekileyo ibhekisela kwi-regimen ye-chemotherapy njengowokuqala, umgca wesibini, umgca wesithathu, njalo njalo. I-Chemotherapy ithambekele ekusebenziseni ngaphantsi kwexesha njengoko kufuneka iirmimen ezininzi.
Udidi lweMithi
Kukho iintlobo ezahlukeneyo zamachiza ezinokusetyenziswa. Ambalwa amachiza e-chemotherapy asetyenziselwa isifo somhlaza wesifo se-metastatic esahlukileyo esiya kumaqela achaphazelekayo afaka:
- I-Anthracyclines - i-Adriamycin (doxorubicine), i-Ellence (i-epirubicine)
- Ama-alkylating agents - iCytoxan (cyclophosphamide)
- I-Taxanes - I-Taxol (paclitaxel), i-Taxotere (docetaxel)
- Mitotic inhibitors - i-Halaven (eribulin)
- Izidakamizwa ze-Nucleoside analog - iGemzar (gemcitabine) kunye ne-DNA synthesis inhibitors Xeloda (capecitabine)
- Antimetabolites - methotrexate
- Microtubule inhibitors - Ixempra (ixabepilone), i-Navelbine (vinorelbine)
- Iiplatinum (Platinol (cisplatin), iParaplatin (carboplatin)
- Iziyobisi ze-Topoisomerase - etoposide
Ulwalamano olulodwa kunye noNyango
Ngokungafani nonyango lwe-adjuvant ekuqaleni komhlaza wesifuba esesiswini esicinga ukuba kusetyenziswe ukudibanisa iziyobisi, unyango olulodwa lonyango lusetyenziswa rhoqo kumdlavuza webele we-metastatic. Ukusetyenziswa kohlobo lwe-chemotherapy ngokuqhelekileyo lukhawuleza kumaxesha apho umhlaza uphuthuka ngokukhawuleza ukuze ufumane ukulawula kwesi sifo.
Ukuhlanganiswa okumbalwa okuqhelekileyo kusetyenziswa i-Xeloda (capecitabine) kunye ne-Taxotere (docetaxel) kunye ne-Gemzar (gemcitabine) kunye ne-Taxol (paclitaxel).
Brain Metastases
Nangona i-chemotherapy iyakwazi ukunyanga iiseli zeengculaza phantse yonke indawo emzimbeni, amaninzi amachiza e-chemotherapy akakwazi ukufikelela kwingqondo. Oku kungenxa yembumba ekhethekileyo yamaplasilla eyaziwa ngokuba ngumqobo wegazi.
Umqobo we-blood-brain is designed to prevent the toxins from entering the tissue of the brain and spinal cord, kodwa ngelanga, kunokuthintela iziyobisi ze-chemotherapy ukuba ungene. Olunye ukhetho lwezokwelapha, olunjengeengqondo zonke i-radiotherapy, lingafuneka ukuba uphathe umdlavuza webele oye wasasazeka kwingqondo.
Iziphumo eziPhakathi
Uninzi lwabantu luyazi ukuba iziyobisi zamakhemikhali zineempembelelo. Nangona oku kuyinyani, kuye kwabakho intuthuko ebalulekileyo ekulawuleni imiphumo emibi yechemotherapy kwiminyaka yakutshanje, ingakumbi iimpawu ezinjengezonyameko kunye nokuhlanza.
Imiphumo echaphazelekayo yezidakamizwa ezahlukeneyo iyahluka, kwaye kubalulekile ukuthetha nodokotela wakho malunga nokusabela okungalunganga ongayilindela.
Ukukhathala - Ukukhathala ngenye yezinto eziqhelekileyo ezichaphazelekayo kwi-chemotherapy, kunye nenye yezinto eziphazamisayo. Nangona asinakho unyango oluthile lokukhathala, njengokuba sisenza isicathulo, kukho ezininzi izinto onokuzenza ukuze zenzeke ngakumbi.
Amanyathelo alula, njengokuzenzekela ngemini, ukubeka phambili imisebenzi, nokufunda ukunikezela, kunokubanceda kakhulu. Gcina ukhumbule ukuba ngexesha elifanayo njengoko ufumana ukukhathala, abathandekayo bakho mhlawumbi banokuziva beziva bengenakunceda. Ukufunda ukunikezela, nokucela nokufumana uncedo akunakukunceda nje ngokukhathala kwakho kodwa kuya kuvumela abo bathandekayo indlela yokuhlangabezana neemvakalelo zabo zokungancedi.
Ukulahleka kweenwele - Ukulahleka kweenwele kufana neziyobisi ezininzi ze-chemotherapy. Kwabo babenokhemotherapy "okokuqala ngqa" oku kunokuba nzima nakakhulu ngeli xesha. Ngokungafani ne-chemotherapy e-adjuvant, akukho siqhelo ekugqibeleni.
Ukuba awuzange ufake imali kwi-wig ngaphambili, le nto inokuba yinto enhle yokwenza njalo. I-inshurensi ihlala ihlanganisa inxalenye yale nto, kwaye imibutho emininzi inika ama-wigs kumahhala avela kwiinwele ezizinikeleyo. Imiqhekeza kunye neengubo zikunokukhetha, kwaye zihlala zikhululekile.
Kuphandwe uphando kwiminyaka yamuva nje ibheka iindlela zokuthintela ukulahleka kweenwele. Nangona ezi ndlela, ezifana nokugqoka i-ice cap ngexesha lokungena kwakho, zinganciphisa ukulahleka kweenwele zakho, zingenakunqweneleka kakhulu.
Ukuxubusha nokuhlanza - Nangona ezininzi iziyobisi ezisetyenziselwa umdlavuza webele we-metastatic zingenza i-nausea kunye nokuhlanza, kukho iindlela ezininzi zokulungisa le nto. Enyanisweni, kukho abantu abaninzi abanamava amaninzi okanye awanaso nasusongweni.
Kukho iintlobo ezahlukahlukeneyo zonyango ezisetyenzisiweyo, ezinye ezenzelwe ukukhusela isicupuchelelo kwindawo yokuqala, kunye nezinye ezingasetyenziselwa ukunyanga isicupunu. Qinisekisa ukuba uthethe ugqirha wakho ukuba ufumana nantoni na .
Nangona kukho iindlela ezininzi zonyango, ezinye zisebenza ngcono kwabanye abantu, kwaye kunokuba nzima ukwazi ukuba iziphi iziyobisi ezichasayo ziza kusebenza kangcono kunoma yimuphi umntu. Unokuva abantu bethetha ngama-acupressure bands, i-ginger, kunye nezinye izinto ezibizwa ngokuthi "ezinye iindlela" zonyango zokukhangela isicupucu se-chemotherapy.
Ngoxa le miqathango inokuthi ifumaneke, kufuneka isetyenziswe kuphela njengongezwayo kwiyeza zokuchasana ne-nasusea, kungekhona njengenxalenye.
I-diarrhea ingabonakalisa njengempembelelo yecala. Sebenzisana nogqirha wakho ukuphonononga oko ungakwenza ukuhla kwempembelelo.
Ukunciphisa umongo we-Bone - Impembelelo yamachiza e-chemotherapy kwi-bone marrow ingakhokelela ekunciphiseni amanqanaba kuzo zonke iintlobo zeeseli zegazi eziveliswa kwintolongo yethambo. Oku kunokubandakanya amaseli egazi abomvu (i-anemia), amaseli egazi ezimhlophe (leukopenia okanye i-neutropenia), kunye neeplatelet thrombocytopenia.
Umngcipheko omkhulu ngenxa yokunciphisa umongo we-bone i-white cell cell count. Oku kunokubangela ukuba usulele kwiintsholongwane ezinobungozi ezingenangozi, kwaye wenze kube nzima ukulwa nesifo xa sele kwenzeka. Ukuba uhlakulela intsholongwane ngexesha lohlobo lwe-chemotherapy (nangona oluphantsi kwe-100.5) kubalulekile ukubiza ugqirha wakho ngokukhawuleza.
Uninzi lwezi zifo luyakhathazeka kakhulu, kodwa unyango olukhawulezayo lunokwenza ukubahluko omkhulu. Ugqirha wakho uya kuthetha nawe ngeendlela zokunciphisa ukusuleleka, kwaye kubalulekile ukuphonononga oku. Abantu abakwi-chemotherapy-nokuba ingaba i-white white cell count is-low-often they are told to avoid areas (in particular during the winter and season) kunye nokunciphisa ukudibanisa nabathandekayo abagulayo. Ngamanye amayeza e-chemotherapy, ugqirha wakho unokumisela imishanguzo yokwandisa i-white cell count count.
I-anemia inegalelo ekukhatheni kwakho. Thetha ugqirha wakho malunga ne-hemoglobin kwaye xa ecinga ukuba uphatha izinga eliphantsi. Inani elisezantsi leplatelet linokunyusa umngcipheko wokukhupha. Ukuba izinga lakho liphantsi, kuyilungileyo ukuphepha izinto ezinokubangela ukuphuma okanye ukuphazamiseka.
I-peripheral neuropathy - Ezinye zeziyobisi zamakhemikhali, zingabangela ukudibanisa okungenakukhathazeka kweempawu ezibizwa ngokuba yi-peripheral neuropathy. Iimpawu zingabandakanywa ukutshisa, ukubetha, kunye neengqungquthela ezenzeka kwi-"stocking and glove" ezandleni nasezinyaweni.
Ekubeni ukuphahla kweenyawo ezinyaweni zakho kunokuphazamisa ukuhamba kunye nokulinganisela, abantu basebenzisa ezi ziyobisi kufuneka bajonge kwiindawo zabo zasekhaya ukuze banciphise amathuba abo okuwa, gweba ukusebenzisa izithintelo ezifana nokuphosa umbhoxo kwaye uqaphele xa uhamba ngeqhwa nekhephu . Nangona i-peripheral neuropathy ingaphucula ngokuhamba kwexesha, ezinye zezi zimpawu zingasigxina emva kokuyeka unyango.
> Imithombo:
> DeVita, Vincent., Et al. I-Cancer: Imigaqo kunye nokuSebenza kwe-Oncology. Ngomhlaza we Breast. Wolters Kluwer, 2016.
> Liedtke, C., noH. Kolberg. Ulwaphulo lwe-Systemic lwe-Advanced / Metastatic Breast Cancer-Ubungqina Bokukhoyo kunye Neengcinga Zomso. Unakekelo lwebele . 2016. 11 (4): 275-281.