Uqwalaselo lweeNgcaciso zoLwazi lweNqanaba lokuqala kwiCetastatic Breast Cancer
Ngaphambi kokuba uthethe ngazo zonke iinkqubo ezithile zonyango onokuzikhethela umdlavuza webele we-metastatic , kunceda ukuthetha malunga neentlobo zonyango, iinjongo zonyango, kwaye yintoni na unyango oluthile olusetyenziselwa kuqala ukujongana nomdlavuza we-metastatic.
Unokuzibuza ukuba ungayiqonda njani ukuba unyango lungcono xa ungenayo imvelaphi yezokwelapha, kodwa kunokwenzeka ukuba ufunde ngokwaneleyo ukwenza ukhetho olulungele wena njengomntu.
Iinjongo Zonyango
Ngokungafani nexesha lokuqala kweengcambu zebele, akunakwenzeka ukuphilisa umdlavuza webele we-metastatic, kodwa kubalulekile ukuqwalasela iinjongo zakho kunyango.
Ngokomzekelo, abanye abantu banqwenela ukuzama ukuhlala ixesha elide ngangokunokwenzeka ngomhlaza wabo kungakhathaliseki ukuba iziphumo zempembelelo. Abanye banokuthi banomuvo wokubaluleka kobomi babo kubaluleke kunokuba baninzi, kwaye bakhethe unyango ngeempembelelo ezimbalwa.
Sinqwenela ukuba wonke umntu abe nenjongo yokuhlala ixesha elide nomhlaza wesisu se-metastatic, kodwa okwangoku ngoku, oko akukhethwa ngabantu abaninzi. Ngomdlavuza we-metastatic, umgangatho wobomi ubaluleke kakhulu, kodwa oko kuthetha ukuthini ukuhluka ngokubanzi kumntu kumntu.
Njengoko ucinga ngeendlela ozikhethayo, qwalasela ezi njongo:
- Ngaba lo unyango luyongamela ubomi bam?
- Ngaba le nyango iya kulibazisa ukunyuka komhlaza wam?
- Olu unyango luya kuthinta njani umgangatho wobomi? Ngaba kulindeleke ukuba kuphuculwe iimpawu endizifumanayo?
- Ukuba kukho imiphumo emibi, yiziphi iimpembelelo ezinokuthi ufumane ukunyamezela kunye nokunyamezeleka?
Iintlobo Zonyango
Nangona ngoku sineentlobo ezininzi ezahlukeneyo zonyango lomhlaza, ezi zinokuphulwa zibe ziindidi ezibalulekileyo.
ZoNyango lweZonyango
Iipilisi zengingqi zijongana nomdlavuza kwindawo apho iqala khona (okanye kwi-metastasis enye kwi-organ.) Ezi zonyango ziquka:
- Ukuhlinzwa
- Ukunyanga kwamayeza
Unyango lweZonyango
Ngokwahlukileyo, ezi zonyango zijongana neeseli zomhlaza apho zikhona khona emzimbeni. Ezi ziquka:
Ngomdlavuza webele we-metastatic, unyango lwenkqubo ludlala indima enkulu kunyango. Utyando lweendawo ezifana nokuhlinzwa okanye i-radiation isetyenziselwa ukuphatha ii-metastases xa ezi zibonakalisa iimpawu, ezifana ne-boneastastimas ezenza ingozi yefractures okanye i-metastase eludongeni loluswini okanye elukhunjini oluphuma kwaye luhlungu.
Abantu abaninzi bayazibuza ukuba kutheni ukuhlinzwa kwebele kunjenge- lumpectomy okanye i- mastectomy ayinakwenziwa rhoqo kubantu abanomdlavuza webele, ubuncinci kwi-five to ten percent of people who have a cancer metastatic ngexesha lokuxilongwa. Ukuqiqa oku kukuthi ukuba ngeemastastas, umhlaza sele usasazeke ngaphaya kwebele.
Ezi zonyango azikwazi ukuphilisa umhlaza osasazekayo. Kunoko, utyando-ngenxa yexesha lokuphucula kunye nokuxhatshazwa kwe-immune system-kunokuthetha ukulibazisa iindlela zokwelapha zenkqubo, ekugqibeleni idlala indima enkulu ekuphatheni umhlaza wakho.
Imida Yonyango
Mhlawumbi uya kuliva ugqirha uthetha ngo "unyango wokuqala," "unyango lwesibini," njalo njalo.
Eli gama lithetha nje unyango lokuqala okanye unyango, unyango lwesibini, kunye nokunye okunokusetyenziswa kusetyenjini ukuze uphathe umhlaza wakho.
Kuqhelekileyo umdlavuza webele weemetastatic ukuba ibe "imida" eyahlukeneyo yonyango. Uthotho lwamayeza lokuqala lukhethwe ngokusekelwe kwindlela unyango olunokuthi luphumelele ngayo nemiphumo embalwa, kodwa kukho iindlela ezininzi ezikhoyo.
Ukwelashwa kokuQala kokuQala
Wonke umntu onomdlavuza we-metastatic uhlukile, kwaye yonke umdlavuza uhlukile ngoko kunzima ukuthetha ngonyango "lomzimba". Oko kwathiwa, unyango lokuqala olukhethiweyo ngumhlaza wesifo se-metastatic luhlala lunxulumene nesimo se- hormone receptor yomhlaza wakho.
Ezi ndlela zonyango ziya kuxhomekeka kwisimo sakho se-receptor emva kwe- " rebiopsy " ye-tumor yakho okanye i-metastasis, kungekhona ukuba imeko yakho yamukeli yintoni xa wawufumanisa okokuqala ukuba i-tumor yakho iphindaphinda. Ukuba isifo sakho somhlaza sasisifo se-estrogen siphumelele, sisenokungabikho nto, kwaye ngokufanayo.
Kwakhona kubalulekile ukuqaphela ukuba injongo yonyango lomdlavuza weemetastatic ngokuqhelekileyo ukusebenzisa ixabiso elincinci lonyango elinokwenzeka ukuzinzisa nokulawula eso sifo. Oku kwahlukileyo kuneendlela "zokunyanga" ezisetyenziselwa i-cancer yebele.
Imizekelo yezokwelapha zokuqala zokuqala ezisekelwe kwisimo se-receptor ziquka:
I-Estrogen Receptor (ER) I-Canast Metastatic Breast Cancer
Uqala unyango lwe-esrogen receptor yesifo sengqondo somhlaza ngokuqhelekileyo unyango lwama-hormone, kwaye oku kudla ngokusetyenziswa kwedwa. Ukukhethwa kweziyobisi kuya kuxhomekeka ekubeni unobungozi be-hormone xa umhlaza wakho ubuya.
Kubafazi be-premenopausal, i-tamoxifen iyadingeka kuba uninzi lwe-estrogen oluveliswa ngumzimba luvela kuma-ovari. Ngaphandle koko, ukunyuswa kwe-ovari kunye ne-Zoladex (goserelin) okanye ngaphantsi, ukususwa kwama-ovari, kunokulandelwa unyango kunye ne-tamoxifen okanye enye ye-aromatase inhibitors.
Kubafazi besimo se-postmenopausal, enye ye-aromatase inhibitors isetyenziselwa yodwa, ngaphandle kokuba kuphinda kwenzeka kwakhona xa usebenzisa enye yala mayeza. Ukuba i-tumor yakho iphindaphindiwe ngexesha elithile kwi- inhibitor ye-aromatase , inketho eyahlukileyo isenokusebenzisa isalathisi-anti-estrogen iFaslodex (fulvesrant).
Ukuba i-tumor yakho i-receroor receptor efanelekileyo kodwa iqhubekela phambili ngokukhawuleza, kukho iindlela ezininzi. Ukuba i-tumor yakho nayo i-HER 2 efanelekileyo, unyango olujoliswe kwi-HER 2 lungafakwa kwi-hormonal therapy. I-Chemotherapy ingasetyenziselwa ukongeza kwi-hormonal therapy kulabo abaneemvumi ezikhula ngokukhawuleza.
Ukuba unempawu eziphawulekayo ezinxulumene neemastastases, ezinye iindlela zonyango zingongezwa kwakhona. I-boneastases yamathambo, unyango lwe-radiation okanye isicatshulwa esisigxina-thambo singasetyenziselwa ukunciphisa umngcipheko wokuqhaqhazela, ukunyanzeliswa kwentambo yomgudu, okanye ukuphatha intlungu ebuhlungu.
Ngokufanayo, i-metastases ukuya kwimiphunga edala ukuphaphaza okanye ukuphazamiseka, okanye i-brainast metastases ezenza iimpawu ezibalulekileyo zingaphathwa unyango kunye nolwaphulo lwe-radiation okanye utyando.
I-HER2 I-positive Metastatic Breast Cancer
Ukuba une-tumor e-estrogen receptor efanelekileyo kunye ne-HER 2 enokuthi, unyango lokuqala lungaqala ngonyango lwe-hormonal kuphela okanye udibaniso lweziyobisi ze-hormonal kunye ne-HER 2.
Umhlaza wokuqala we-HER 2 yesifo somhlaza we-metastatic breast uxhomekeka nokuba ngaba awukhatyathwa ngenye yale myeza xa ufumana ukuphindaphinda. Ukuba umhlaza wakho uphindwe ngexesha likaHerceptin, enye yeminye imishanguzo i-HER 2 ingasetyenziswa. Ukuba i-tumor yakho ikhula ngokukhawuleza, i-chemotherapy ingaqwalaselwa.
Njengaye i-tumoror positive tumor tumors, i-metastase yeempawu ifuna ukunyango kwendawo. Ngokomzekelo, i-boneastatic bone of metastases okanye i-metastases eyandisa ingozi yokuba unokuphuka ithambo ingaphathwa ngonyango lwe-radiation okanye i-agent-modifying agent.
I-Cancer Breast Cancer
Umdlavuza wesifuba we-metastatic we-Triple unzima kakhulu ukuwuphatha, ngokuqhelekileyo kunomdlavuza we-estrogen okanye i-HER 2 enhle, kodwa kusekho ukhetho.
I-Chemotherapy isoloko isetyenziswe umgca wokuqala wale kliniki, kwaye ukhetho lwamachiza ludla ngokuxhomekeke ekubeni i-chemotherapy yayisetyenziswe ngaphambili.
Amadoda
Umdlavuza webele we-Metastatic kumadoda unemibono emininzi ebalulekileyo, kodwa ngokubanzi, indlela efanayo ithathwa. Unyango lunokuqala nge-tamoxifen kulabo abane-tumoror receptor positive tumors, okanye nge-chemotherapy.
Eyona Mpilo Yonyango
Yintoni oyifunayo ukuze ukwazi ukwenza izigqibo ezintle malunga nokonyango lwakho?
Isinyathelo sokuqala uzifundisa ngesifo sakho. Funda ngeenkcukacha ezibonelelwe apha, kunye naluphina ulwazi olwalufunyenwe kwiziko lakho lomhlaza.
Gcina uluhlu oluthile lwemibuzo ukubuza i-oncologist yakho, kwaye uze nabo kunye nokuqokwa. Ukuba usenzima ukuqonda into ethile, cela kwakhona.
Kukho ulwazi oluninzi lokugaya ixesha elifutshane, kunye neengxaki ezinzima ezihamba kunye nomhlaza we-metastatic diagnostic, i-oncologist yakho ayiyi kuthukuthela xa ufuna ukubuza imibuzo efanayo ngokuphindaphindiweyo. Okuqhelekileyo.
Abantu abaninzi bakuthola kuncedo ukuthetha nabantu "bebekhona." Ukongezelela kumaqela axhasayo kuluntu , ngoku sinokuxhaswa nge-24/7 inkxaso eyenziwa ngumphakathi woluntu lwe-cancer lwebele. Kukho uluntu olwenziwa ngabantu abodwa abanomdlavuza webele, onokuba luncedo kakhulu njengoko ujongene nalezi zigqibo.
Thetha nabahlobo bakho kunye nosapho, kwaye ucele igalelo labo, kodwa izigqibo ezigqwesileyo ziphezulu kuwe. Le nto ingaba lixesha elinzima, ngakumbi xa amalungu entsapho yakho engavumelani nezigqibo zakho.
Mamela abathandekayo bakho kwaye ubathokoze ngegalelo labo, kodwa khumbuze ukuba, ukuba kuyimfuneko, ukuba kufuneka ukhethe indlela ehlonipha kakhulu iimfuno zakho kunye nezifiso zokunyamekela kwakho.
Izinto ezichaphazela ukukhetha
Kukho izinto ezininzi ezinokuqwalaselwa ekukhetheni unyango olufanelekileyo lomhlaza wakho, zombini ekuqaleni, kwaye njengoko ixesha liqhubeka. Ezinye zezi ziquka:
- Isimo sommkeli we-tumor
- Izonyango zangaphambili (iintsholongwane zebele zisoloko zixhatshazwa kunyango ngokuhamba kwexesha)
- Umthwalo wokuxhamla (ubunzima bakho bunjani kunye nendlela enkulu ngayo)
- Iimpawu ezithile ezichazwe ngumhlaza wakho kunye nendlela ezixhalabisa ngayo le nto
- Ukukhawuleza umhlaza uqhubeka njani
- Izikhetho zakho zokwenza lula unyango (ngomlomo vs IV umzekelo), nokunyamezela imiphumo emibi (abanye abantu bafumana ezinye iziphumo ezixinzezelayo kunabanye)
- Ingaba okanye uthatha inxaxheba kwilingo lekliniki
Imibuzo Yokuzibuza
Kuza kuba nemibuzo emininzi yokubuza malunga nophatho oluthile, kodwa kukho imibuzo enokufuna ukuyiqwalasela phambi kokuba uyihlose iindlela ezahlukeneyo.
- Ufuna kuphi ukunyamekela kwakho?
- Ngaba uzimisele ukuhamba kwilingo leklinikhi xa kufuneka, okanye ukhetha ukuba kufuphi nekhaya lakho?
- Ukuba wenza isigqibo sokuhamba, ngaba kukho isikhungo somhlaza esisondele kufuphi nabahlobo okanye nosapho onokuhlala kuyo?
- Uya kuphi na inshurensi yakho?
- Ukuba ucinga ngababoneleli benethiwekhi, oko kuya kuthetha ntoni kuwe ngemali?
- Ngaba unokucinga ukuba uthatha inxaxheba kwilingo lekliniki (uvavanyo lweeklinikhi ngomhlaza wesisu lwe-metastatic zixutyushwa kamva.)
- Ziziphi izihlobo ezikhoyo ukukunceda ngemicimbi efana nokunakekela abantwana kunye nokunye?
Ukuxhalabisa nge / Ngaphandle kwonyango
Abanye abantu bafuna ukwazi ukugxekwa kwabo; ukuba yintoni umphumo "ophakathi" ngowomntu onesifo sakhe. Abanye abantu abafuni ukwazi, kwaye oku kuhle. Inyaniso kukuba asikwazi ukuxelela indlela umntu oyedwa oya kwenza ngayo emva kokuba efumene ukuba unomdlavuza webele we-metastatic.
Sinezibalo ezingasinika ingcamango malunga nendlela umntu azakwenza ngayo unyango oluthile, kodwa kukho iingxaki ezininzi kunye neenombolo. Enye kukuba ukuba manani manani, kungekhona abantu. Singakwazi ukuthetha ngamanani abantu, ngokuqhelekileyo, abahlala kwiminyaka okanye iminyaka eyi-10 ngomhlaza wesisu se-metastatic, kodwa asikho na indlela yokuqikelela ukuba ngubani abo bantu.
Esinye isizathu sokuba amanqaku asithintele kukuba ayingqinisiso yendlela abantu abayenzayo ngayo ngaphambili. Unyango lomhlaza wesifuba we-metastatic uphucula, kwaye asikwazi ngokwenene ukuba umntu uza kwenza njani ngamathambo amatsha. Uninzi lwamanani esetyenzisiweyo ukugweba ukugxekwa okungenani iminyaka emihlanu ubudala. Nangona kunjalo ezininzi iziyobisi ezifumanekayo kwisifo somhlaza wesifo se-metastatic asizange zifumaneke kwiminyaka emihlanu edlulileyo.
Ngexesha elikhoyo (ngokusekelwe kulo, ngokuqinisekileyo, kwiimanani, ukusinda komlambo womhlaza wesifo se-metastatic (kuquka zonke iintlobo) unyango lubonwa njengeenyanga ezili-18 ukuya kwezi-24. Oku kuthetha ukuba iinyanga ezingama-24 emva kokuxilongwa, isiqingatha sabantu siya Wafa kwaye isiqingatha siya kuhlala sisaphila. Umlinganiselo weminyaka emi-5 wokusinda umdlavuza webele we-metastatic iipesenti ezingama-22. Kukho abantu abaninzi abaye bahlala nomhlaza webele wesifo seminyaka eyi-10 okanye ngaphezulu.
Ingcamango yokugqibela ukugcina engqondweni kukuba sisenza inkqubela ngokwenene kwonyango lomhlaza wesifo se-metastatic. Uvavanyo lwezonyango luhlola yonke into ukusuka kwi-immunotherapy kumigonyi yomhlaza yesifo somhlaza wesibeleko ngoku. Kuthemba ukuba ezi ntlobo ezintsha zonyango ziza kutshintsha utshintsho lweenkcukacha zamandulo malunga nomhlaza wesifuba.
Ukuzikhuthaza
Indawo efanelekileyo yokuqala ukuthetha ngonyango indima yakho njengelungu elibalulekileyo leqela lakho lononophelo lwempilo. Mhlawumbi sele uvile ukuba kubalulekile ukuba ngummeli wakho ekunyamekeleni kwakho, kodwa oko kuthetha ntoni oko?
Ukuba ngummeli wakho kuthetha ukuthatha inxaxheba ebalulekileyo kwizigqibo ezihamba kunye nonyango lwakho. Kuthetha ukubuza imibuzo xa ungayiqondi into ethile, kwaye uqhubeke ucela uze uqonde.
Xa sithetha ngokuba ngummeli wakho nomhlaza asichazi ukuba uya kuba nobudlelwane obuchaseneyo kunye ne-oncologist yakho kunye namanye amalungu eqela lakho lezempilo . Ngokwahlukileyo, ukuba ngummeli wakho kukukunceda ukuba uncede i-oncologist yakho ibone oko kubaluleke kakhulu kuwe njengomntu.
Kwixesha elidlulileyo, bekukho amaxesha ambalwa okhethwe ngabantu abafumene umhlaza wesifo semitha. Oku kuye kwatshintsha ngokugqithisileyo kwiminyaka yamuva nje, kwaye ngoku kukho ukukhetha iindlela ezahlukeneyo ezinokulingana neenjongo zakho zonyango.
Awuyi kucelwa ukuba ukhethe phakathi kwonyango olulindeleke ukuba lusebenze kakuhle kunye nemiphumo emibini kunye nomnye ongasebenzi okanye unempembelelo enkulu. Iinyaniso kukuba ezininzi zezi zigqibo ziza kwehla kwiintlukwano kwiimfuno zakho.
Umzekelo, unokufuna ukhethe phakathi kokufumana unyango kufuphi nekhaya okanye kwisiko somhlaza ngaphandle kwedolophu, okanye mhlawumbi ukhethe phakathi kweetekisi ezimbini ezahlukeneyo zomphumo.
Abanye abantu bakuthola kunzima kunabanye ukuzithethelela. Ukuba uhlala uthetha kwaye uthele-umenzi woxolo mhlawumbi-unokufumana kunzima ukuvumela iqela lakho lononophelo lwempilo xa izinto zingahambi njengoko unqwenela. Ukuba oku kufana nobuntu bakho, kudla ngokukunceda ukhethe umhlobo okanye ilungu lentsapho ukuba ube ngummeli kwaye unokubuza nayiphi na imibuzo enzima onokufumanisa kunzima ukuyibuza.
ILizwi
Imimiselo yonyango lokuqala lonyango luyimimiselo, kwaye i-oncologist yakho ingancoma indlela eyahlukileyo ngokusekelwe kwiimpawu zesifo sakho esithile. Zininzi iziyobisi zivavanywa kwizilingo zekliniki, kwaye enye yeendlela zingabonisa indlela eyahlukileyo.
Into ebalulekileyo kukuthetha nodokotela wakho malunga nokuba kutheni izidakamizwa ezithile ziya kunconywa kwaye ziqonde ezi zikhetho kunye nezinye iindlela ezikhoyo. Abantu abaninzi banokufumana ukuba luncedo ukubuza malunga nezo kunyango eziya kucetyiswa ukuba le regimen ayiyikulawula i-tumor.
Ukuba sisisombululo esisodwa kwingqondo yakho kunokukunceda ukujamelana nokulula okulula kunye nokuxhalabisa okunxulumene nezinto ezingaziwa ngaphambili.
Imithombo:
Hayes, D. Imfundo yesineke: Unyango lomhlaza wesibeletho se-metastatic (Ngaphandle kweZiseko). UpToDate .
> 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.