Ugqirha, i-Chemotherapy, i-Radiation, kunye novavanyo lwezonyango
Izinyathelo zokonyango zomhlaza we-ovari zixhomekeke kwisigaba sesifo kunye nezinye izinto kwaye zingabandakanya ukuhlinzwa, i-chemotherapy, iipilisi ezijoliswe kuyo, okanye izilingo zamachiza. Ngaphandle kwexesha elidala kakhulu, idibansi yezo zonyango zisetyenziswa. Unyango lunokutshintsha xa umdlavuza wakho uphinda umhlaza okanye umva.
Iqela lakho lokuncedisa umdlavuza
Isinyathelo sakho sokuqala ekukhetheni ukhetho olungcono kunyango kukuba uqonde iqela lakho lokukhathalela umdlavuza. Kubalulekile ukwazi ukuba ngubani umniki-nxaxheba oza kudlala indima yokulawula ukunakekelwa kwakho kwaye ngubani ofuna ukubiza ngeembuzo.
Ngokuqhelekileyo, umdlavuza we-ovari unokuqala ukufunyaniswa, okanye ubuncinci ukukhankanywa, ngu-obstetrician-gynecologist (OB / GYN) okanye omnye ugqirha. Xa ukhetha ukhetho lwezonyango, ke kunjalo, kucetyiswa ukuba udibane nomzimba we-oncologist ngaphambi kokuba uqalise i-regimen.
Amanye amalungu eqela lakho lononophelo lwempilo angabandakanyeka ugqirha wakho wokunakekelwa kwezempilo, unontlalontle unontlalontle okanye umcebisi, ugqirha wezilwanyana (ojonge naziphi na izicubu ezisuswe ngexesha lotyando), kwaye mhlawumbi ugqirha wokunyamekela (ojolise ekunciphiseni iimpawu ezinxulumene nomhlaza) okanye ingcali yokuzala.
Izinyango Zonyango
Kukho iintlobo ezibini zokwenza unyango lomhlaza we-ovari:
- Utyando lweNgingqi: Ionyango ezifana nokuhlinzwa kunye neyeza zonyango zilapha. Baphatha umdlavuza apho ivela khona kodwa ayijongisi nayiphi na iseli yomhlaza esasazeka ngaphaya kwesayithi lokuqala lomhlaza.
- Unyango lweNkqubo: Xa umhlaza usasazeka ngaphaya kwendawo yawo yangaphambili, unyango lwe-systemic ezifana ne-chemotherapy, unyango olujoliswe kuyo, okanye unyango lwe-hormonal (kunye nezidumbu ezingezona i-epithelial) zivamekile. Ezi zonyango zijongana neeseli zomhlaza kungakhathaliseki ukuba ziphi emzimbeni wakho.
Uninzi lwabantu abane-cancer ye-ovarian epithelial iya kuba nelidibanisa le zonyango.
Ngezinye iinkhathi, ezinjenge-germ cell kunye ne-stromal cell tumors, okanye kwisigaba sokuqala (njengesigaba se-IA) izidumbu ze-epithelial, ukuhlinzwa kuphela, ngaphandle kwe-chemotherapy, inokusebenza.
Ukuhlinzwa
Uphando luyintloko yokunyanga kubantu abaninzi abanomdlavuza we-ovari. Iyakwazi ukutshintsha zombini ngohlobo lomhlaza wesibeleko kunye nesigaba. Izifundo ziye zafumanisa ukuba xa utyando lomhlaza we-ovaries luqhutywa yintsholongwane ye-oncologist, iziphumo ziba ngcono kakhulu kunokuba xa uphando lwenziwa ngabagqirha bezinye iindawo ezizodwa, njengoko ezi ziinkqubo ezinzima.
Sekunjalo, nangona xa bebona i-oncologist yezilwanyana, abaninzi abantu bayifumana iluncedo (kwaye bahlala beqinisekisa) ukuba bafumane umbono wesibini. Ukuba ucinga ukwenza njalo, unokuba unqwenela ukuqwalasela enye yeziko elikhulu leNational Cancer Institute-amaziko omhlaza okhethiweyo, odla rhoqo oogqirha abasebenza ngokukhethekileyo kwindlela ethile yokuhlinzwa.
I-Oophorectomy (yeJerman kunye neSomomal Cell Tumors)
Izilwanyana zesigxina kunye neeseli zesigxina zivame ukufumaneka kwiindawo zokuqala. Abantu abaninzi abanezikhumba bancinci, kwaye utyando ukususa kuphela i-ovary echaphazelekayo (i-oophorectomy) ngamanye amaxesha kungabangela ukugcinwa kwesinye i-ovary kunye nesisu. Ugqirha yodwa ingasebenza nakwiimvumba zangaphambili.
Ukuba zombini ii-ovari zimele zisuswe, kusekho ezinye iindlela zokulondoloza ukuzala , njengama-embrosifri. Ukuba unomdla wokwenza oku xa kunokwenzeka, ncokola nodokotela ogqwesileyo ukulondolozwa kokuzala ngaphambi kokuba unyango lwakho luqale.
Ukutshitshiswa kwe-Cytoreduction / Debulking Surgery (kwi-Epithélial Ovarian Cancer)
Phantse iipesenti ezingama-80 zeengcambu ze-ovarian epithelial zifunyenwe kwizigaba ezilandelayo zesifo (isigaba III nesigaba IV). Ngokungafani nomhlaza wombele nomphunga, apho utyando lwegciwane lesigaba se-IV alinakuphucula ukulinda ubomi, utyando lunokwandisa ubomi kubantu abanomdlavuza wesigaba se-IV.
Ikwaphucula kwakhona ukuzuza ngokuzayo kwi-chemotherapy.
Ugqirha lwe-epithelial cancer ovarian ubizwa ngokuba ngu-optoticuctive operesheni (utyando lwe-debulking). "I-Cyto" ligama leengcambu kunye "nokunciphisa" kuthetha ukunciphisa, ngoko injongo yaloo misebenzi ukunciphisa inani lomhlaza wamaseli ekhoyo, kunokuphelisa yonke umdlavuza.
Kukho iziphumo ezintathu zendlela yokuhlinzwa:
- Gcwalisa: Wonke umhlaza obonakalayo ususwe.
- Efanelekileyo: I- Cancer ihlala, kodwa yonke indawo ingaphantsi kwe-1 cm ububanzi (edlalwa ngokuba yi-miliary disease).
- I-sub-optimal: Iimodyuli ezinkulu kune-1 cm ububanzi zihleli.
Utyando olwenziwa nge-Cytoreductive luyilo olude kwaye luyingozi, kwaye ingozi yenkqubo eninzi ihlala iphezulu kuneenzuzo. Ngako oko, i-cytoreduction "i-optimal" yinto ekuqhelekileyo yinjongo yokuhlinzwa.
Ukongeza kokususa ama-ovari kunye nama-tublopian tubes (i-salpingo-oophorectomy) kunye ne-uterus (hysterectomy), ezinye izicubu zisuswe okanye zikhutshwe. Ngokomzekelo, i- omentum , okanye uluhlu lweethambo ezinamafutha ezigqithisa ama-ovari kunye ne-pelvis, isuswa rhoqo (i-omentectomy).
Ukuhlamba, inqubo apho i-saline ifakwe kwisisu nangentsimbi kwaye ihoxiswe ukwenzela ukuba ikhangele ubukho bomzimba wamaseli "avumbileyo" esiswini nasemagqabini, kwakhona kwenziwa.
I-lymph nodes kwisisu kunye neentloko zidla ngokuphindaphindiweyo okanye zisuswe (i-lymph node dissection). Ukongeza, iisampuli zinokuthi zithathwe ebusweni beenxalenye ezininzi zeplavic nezisu, ezifana nesisu, amathumbu, isibindi, isantya, isisu, i-gallbladder, okanye i-pancreas. Ngezifo eziphambili ze-epithelial, isihlomelo sivame ukususwa.
Xa iisampuli zithathwa emathunjini, ezo ziphelo ziphela kwicala lommandla zisuswe xa zikhona. Ukuba akunjalo, ukuphela kwesibonda ngaphambi kokuba indawo yokuqhawula isetyenziswe elukhumbeni ukwenzela ukuba isilwane singashenxiswa ngaphandle (ukudala i-stoma).
Yonke into yokuhlinzwa ingenziwa ngokukhawuleza, okanye endaweni yoko emva kokuba i-chemotherapy inikwe okanye emva kokuphindaphinda komhlaza.
Iziphumo eziqhelekileyo eziqhelekileyo zokuhlinzwa ziphuma, izifo, kunye nokuphendula kwi-anesthesia. Ekubeni utyando lwe-cytoreduction luba lusebenze ixesha elide, kuyanconywa ukuba abo basemngciphekweni babe nokuvavanya kwenhliziyo kunye nomphunga phambi kokuhlinzwa.
Chemotherapy
Ngomhlaza we-ovari, akunakwenzeka ukususa yonke umdlavuza. Nangona utyando lususa zonke iiseli zomhlaza ezibonakalayo (njengezigaba zangaphambili), izinga lokuphindaphinda liphezulu kakhulu malunga nama-80 ekhulwini. Oku kuthetha ukuba nangona umhlaza obonakalayo ungabonakali, indawo ezincinci zomhlaza zishiywa emva. Ngoko ke, i-chemotherapy idlalwa ngokubanzi kuzo zonke kodwa izigaba zokuqala zesifo se-ovarian epithelial. I-Chemotherapy isoloko isetyenziselwa izigaba eziphezulu zezilwanyana zesifo segciwane.
Iziyobisi ezisetyenzisiweyo
Iziyobisi ezisetyenziswa ngokuqhelekileyo ziquka ukudibanisa:
- Iziyobisi zePlatinum: i-Paraplatin (carboplatin) okanye iplatinol (cisplatin).
- Iirhafu: I-Taxol (paclitaxel) okanye i-Taxotere (docetaxel).
Zininzi ezinye iziyobisi ezingasetyenziswa ngokunjalo, kuquka iDoxil (liposomal doxorubicin) kunye neGemzar (gemcitabine).
Ngama-tumor cells, i-chemotherapy iquka ukudibana kwePlatinol (cisplatin), i-VP-16 (etoposide) kunye ne-bleomycin.
Iindlela zoLawulo
I-Chemotherapy inokunikezwa ngeendlela ezimbini:
- I-intravenously (IV): IV i-chemotherapy i-IV idlalwa rhoqo emva kweeveki ezintathu ukuya kwezine kwaye iphinda iphindwe kwiimjikelezo ezintathu ukuya ezintandathu. Oku kunokunikezwa ngecathter egcinwe engalo yakho, okanye ngechwephethi ye- chemotherapy okanye umgca we-PICC.
- I-intraperitoneal chemotherapy: Kule nkqubo, i-chemotherapy inikezwa ngenaliti efakwe ngqo kwisigxina esiswini.
Ulawulo lwe-IV luqhelekileyo, kodwa abaphandi ngoku bakholelwa ukuba i-intraperitoneal chemotherapy isetyenziswa kakhulu kumdlavuza we-ovari. Unokufuna ukubuza malunga nayo.
Ngohlolo lwe-2016 lophando, abaphandi bafumene ukuba i-intraperitoneal chemotherapy yandisa ukwanda komhlaza wesi-ovariya ngaphezu kwe-IV chemotherapy. Kulo cwaningo, kwaphawulwa ukuba i-intraperitoneal chemotherapy yabangela ukwanda kwemiphumo yecala lokutya, umkhuhlane, intlungu, kunye nokusuleleka, kodwa kwakungekho ngaphantsi kwe-IV ikhemotherapy eyenza ukulahlekelwa kwindlebe (ukutshatyalaliswa kwezilwanyana).
Okokuthi, i-intraperitoneal chemotherapy ayinyanzelwanga kunye ne-IV chemotherapy kwaye ayinakusetyenziswa xa kukho iimpilisi ezingasebenzi okanye izicathulo ezinobunzima esiswini, ngoko ke ngokuqhelekileyo kubanjelwe kubafazi abanegciwane lesigaba se-IV kunye nalabo babephethe i-cytoreduction .
Imiphumela
Iyezabisi ze-Chemotherapy ziphazamisa ukwahlukana kweseli kumaphulo ahlukeneyo kumjikelezo kwaye ziphumelela ekubulaleni amaseli akhula ngokukhawuleza, njengengqamuzana yomhlaza. Ngelishwa, unyango luchaphazela ukuqhelekileyo, ukwahlukana kweeseli kwakhona, kubangele imiphumo engathandekiyo.
Iziphumo eziqhelekileyo ezichaphazelekayo zamachiza e-chemotherapy ezisetyenziselwa umdlavuza we-ovari ziquka:
- Ukukhathazeka nokuhlanza: Ukunyanga kwe- chemotherapy-induced leusea kunye nokuhlanza kuye kwaphucula kakhulu kwiminyaka yakutshanje, kwaye imithi yokukhusela ngoku ivumela abantu ukuba baphumelele kwi-chemotherapy ngokuncinci okanye kungekhohlanza.
- Ukunciphisa umongo we-Bone ukukhokelela kumgangatho ophantsi weeseli ezimhlophe zegazi, iiseli ezibomvu zegazi kunye neeplatelets. Yilona nqanaba eliphantsi lohlobo lwegazi elimhlophe elibizwa ngokuba yi-neutrophils ebeka phambili abantu kwiintsholongwane ngexesha le-chemotherapy .
- Ukukhathala
- Ukulahleka kweenwele
Imiphumo emide yexesha elide ye-chemotherapy inokubandakanya i- peripheral neuropathy (ukulinganisa, intlungu, kunye nokuphefumula kwezandla kunye neenyawo) kunye nokulahlekelwa kwindlebe (i-ototoxicity). Kukho umngcipheko omncinci wokuphucula i- cancer yesibini phantsi komgca.
Iziphumo ezibi kunye noxinzelelo lwe-chemotherapy, nangona kunjalo, ngokuqhelekileyo zigqithise kakhulu ukuxhamla kwezi zonyango.
Iipilithi ezijoliswe
Ulwaphulo olulindelekileyo luyonyango oluphazamisa amanyathelo athile ekukhuleni komhlaza. Ekubeni zijoliswe ngqo kumaseli omhlaza, ngamanye amaxesha (kodwa kungekho njalo) zinemiphumo embalwa yecandelo kune-chemotherapy. Iipilisi ezingasetyenziselwa umhlaza we-ovari ziquka:
- I-Angiogenesis inhibitors: I-Cancer kufuneka idale imithambo yegazi entsha ukuze ikhule kwaye isasaze. I-Angiogenesis inhibitors inqanda le nkqubo, ngokukodwa ilambile i-tumor ye-blood supply entsha. I-Avastin (bevacizumab) ngamanye amaxesha inganciphisa ukukhula komhlaza wesi-ovari kodwa ingaba nemiphumo emibi efana nokuphuma kwamanzi, i-blood clots, kunye nesilonda esiswini.
- I-PARP Inhibitors: I-PARP inhibitor yokuqala ivunyiwe kumdlavuza we-ovarian ngo-2015. Ngokungafani ne-chemotherapy, le miyeza inokunikezwa kwifomu yepilisi kunokuba i-IV. I-PARP inhibitors isebenza ngokuthintela umzila owenzela umonakalo obangela ukuba iiseli ezinezakhi zofuzo ze-BRCA zife. Izidakamizwa ezikhoyo ziquka uLynparza (olaparib), uRubraca (rucapraib), noZejula (niraparib).
La mayeza aqhelekileyo asetyenziswa kubasetyhini abaneenguquko ze-BRCA, kodwa zombini uLynparza noZejula bangasetyenziselwa abafazi ngaphandle kweenguqu ze-BRCA ukunyanga umdlavuza we-ovariya emva kwe-chemotherapy. Imiphumo emibi ingabandakanya ubuhlungu obudibeneyo kunye nobuhlungu be-muscle, i-nausea, kunye ne-anemia phakathi kwabanye, kodwa kunzima ukunyamezela ngakumbi kunokhemotherapy. Kukho umngcipheko omncinci (njengokhemotherapy) yeekliniki zesibini ezinjenge-leukemia.
Ezinye iiNyango
Ezinye iintlobo zonyango zingasetyenziselwa iintlobo ezahlukeneyo zomhlaza we-ovari okanye izifo ezazisasazekayo. Iziyobisi zonyango zeHormon ziqhelekileyo zisetyenziselwa umdlavuza webele. Kodwa iziyobisi ezifana nezidakamizwa zokunciphisa i-ovari, i-tamoxifen, kunye ne-aromatase inhibitors zingasetyenziselwa izicubu zeeselum, kwaye ngokungaqhelekanga, izicubu ze-epithelial cell. Ulwaphulo lwe-radiation aluqhelekanga kumdlavuza we-ovari kodwa lungasetyenziswa xa kukho izidumbu ezininzi kwisisu.
Uvavanyo lweZliniki
Kukho izilingo ezininzi zenkqubela yeklinikhi ezijonge ukudibanisa kwezi zonyango ezilapha ngasentla, kunye nokunyango olutsha, kokubili ukuxilongwa kwesifo somhlaza we-ovari kunye nokuphindaphinda. I-National Cancer Institute incoma ukuba uthethe noogqirha ngezo zinto ezifanelekileyo.
Ngamanye amaxesha indlela yokuphela kwendlela yokwenza unyango olutsha kukuba yinxalenye yalezi zifundo. Kukho iinkolelo ezininzi malunga neemvavanyo zonyango , kodwa inyaniso kukuba yonke imithi esinazo ngoku umdlavuza yaqala ukufundiswa ngale ndlela.
I-Alternative Medicine (CAM)
Ukwangoku, akukho zifundo ezibonisa ukuba ii-CAM zonyango ziyakwazi ukunyanga umdlavuza we-ovari. Ukunyango okuqhelekileyo okuqhelekileyo ngenxa yokukhetha okunjalo kunokuba yingozi.
Oko kwathiwa, abanye banokukunceda ngeempawu zomhlaza kunye nezo unyango, ukuphucula umgangatho wobomi. Ngenxa yeso sizathu, amanqanaba amanomhlaza amaninzi anikezela ngeendlela ezahlukeneyo zokwelapha . Izinketho eziye zabonisa inzuzo ethile ubuncinane kwizifundo ezimbalwa zophando ziquka ukucima , ukucamngca , i- yoga , unyango lomculo , kunye neyeza zonyango .
Izibonelelo kunye nokutya
Thetha nge-oncologist yakho ngaphambi kokuba uzame nayiphi na i- vitamin okanye i-mineral supplements . Zonke zihambelana nesibindi okanye iintso kwaye zikwazi ukunciphisa okanye zikhawulezise imetabolism yezilwanyana zamachiza, ezichaphazela unyango. Abanye, ngokukodwa, ukugunyazwa ngokukhethekileyo: I-Vitamin E (kwakunye ne-Herb Ginkgo biloba) inokunyuka ukuphuma kwegazi ngexesha nangemva kokuhlinzwa, kunye nezinye izongezelelo zinganomngcipheko weengcamango zentliziyo ezingavamile okanye ukuxhatshazwa okunxulumene ne-anesthesia.
Ukongezelela, amalungiselelo okulwa ne-antioxidant angapheli ekukhuseleni iiseli ze-chemotherapy kunye neyeza zonyango ekujoliswe kuzo ukutshabalalisa; ezi zonyango zisebenza ngokubangela umonakalo ochaphazelekayo kwimveliso yezofuzo kumaseli omhlaza. Uninzi lwama-oncologists bakholelwa ukuba ukutya ukutya okunomsoco-nkunkuma akuyona ingxaki ngexesha lokonyango, nangona kunjalo.
I-Omega-3 fatty acids, nangona kunjalo, inokuba luncedo kwabanye. Ezi zongezelelo zinganceda ukugcina ubuninzi bemisipha kulabo abane- cachexia yomhlaza , imeko equka ukulahleka kwesisindo, ukulahleka kwesisundu somzimba kunye nokulahlekelwa kwesidlo esichaphazela malunga nama-80 ekhulwini abantu abanomdlavuza ophezulu.
Kunomdla kwi- turmeric (kunye ne-compound yayo, i-curcumin), isithako esifanayo kwi-curry kunye namaswatchdi anika oku kudla umbala wabo ophuzi. Ezinye izifundo zesebhu zibonisa ukuba i-turmeric ingakhuthaza ukufa kweeseli ze-ovarian cells, kodwa kungekhona eziqhelekileyo, kwaye iiseli ze-ovarian "ezondla" i-turmeric zingenakukwazi ukumelana ne-chemotherapy. Olu phando aluhambelani ngokubhekiselele kwisicelo salo kubantu, kodwa akukho nzakalo ekusebenziseni isiqholo.
Unyango lokuphindaphinda
Ngelishwa, malunga neepesenti ezingama-80 zeengqimba zomhlaza ze-ovari eziphathwa ngeendlela eziqhelekileyo eziphezulu ziya kuphinda zibuye. Indlela yokwelapha yokuphindaphinda ixhomekeke ngexesha layo:
- Ukuphindaphinda ngokukhawuleza emva kokuba unyango: Iimeko ezinje zibhekwa njenge-platinum refractory, okanye zichasene ne-platinum chemotherapy. Okukhethiweyo kubandakanya ukuphinda i-chemotherapy kunye neziyobisi ezifanayo (nangona oku kubakhokelela kwimpendulo engafanelekanga), usebenzisa i-regimen eyahlukeneyo (kukho iindlela ezininzi ezahlukeneyo), okanye ucinga ityala leklinikhi.
- Ukuphindaphinda phakathi kweenyanga ezintandathu zonyango: Iimeko ezinje zibhekwa njenge-platinum resistant. Izinketho kule ngxaki zingase zibe yilisi ekhethiweyo okanye i-regimen, okanye ityala lekliniki. Ukuvuthwa akuqhelekanga kucetyiswa.
- Ukuphindaphinda inyanga ezintandathu okanye ngaphezulu emva kokugqitywa kwonyango: Ukuba i-chemotherapy yasekuqaleni yayiquka ukusetyenziswa kweziyobisi zeplatinum chemotherapy (iPlatinol okanye iParaplatin), i-tumor ithathwa njenge-platinum. Iingcebiso zonyango ziyahluka kodwa zingabandakanya ukuhlinzwa okwenziwa nge-cytoreduction kunye neyonyango kunye neyeza zangaphambili zonyango.
Unyango lo ku khulelwa
Uninzi lwee-ovarian cancers ezenzeka ngexesha lokukhulelwa zi-tumors zegciwane okanye iintsholongwane ze-tumors. Ezi zicubu zihlala zibandakanya i-ovary eyodwa kuphela, kwaye utyando lokususa i-ovary luyakwenzeka ngexesha lokukhulelwa, nangona ulinde ukuya kutsho i-trimester yesibini.
Abafazi abakhulelweyo abaneengqungquthela ze-ovarian ze-epithelial kunye nesinye se-stromal cell cell okanye i-germ cells tumors, ukuhlinzwa ngokutsha kwe-cytoreduction kunokwenzeka. Ukulinda de emva kwe-trimester yokuqala kulungile, kodwa ukuhlinzwa kunokuqwalaselwa kwangaphambili. I-Chemotherapy ikhuselekile emva kokuqala kwe-trimester kwaye ingaqalwa ngokutsha malunga neeveki ezili-16. I-cancer ye-ovarian ye-epithelial, inhlanganisela yeParaplatin (carboplatin) kunye ne-Taxol (paclitaxel) isetyenziswa rhoqo, ngokudibanisa nePlatinol (cisplatin), i-Velban (vinblastine) kunye ne-bleomycin esetyenziselwa izicubu ezingezona i-epithelial.
> Imithombo:
> Fruscio, R., de Haan, J., Van Calsteren, K. et al. Izenzo eziPhambili kunye noPhando. I-Clinical Obstetrics kunye neGynecology. 2017. 41: 108-117.
> Jaaback, K., Johnson, N., noT. Lawrie. I-intraperitoneal Chemotherapy yoLawulo lokuQala lwe-Epithelial Primary Cancer. I-Cochrane Database yeeNkqubo eziPhezulu . 2016. (1): CD005340.
> INational Cancer Institute. I-Ovarian Epithelial, iTallopian Tube, kunye ne-Primary Peritoneal Cancer Treatment (PDQ). Ukuhlaziywa 01/19/18. https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq
> van Driel, W., Koole, S., Sikorska, K. et al. I-Hyperthermic Intraperitoneal Chemotherapy kwi-Ovarian Cancer. I-New England Journal of Medicine . 2018. 378 (3): 230-240.