Izinyango zokwelashwa kunye nePrognosis
Ukuphindaphinda kwindonga yesifuba ngumhlaza wesifuba obuyela emva kwe- mastectomy . Ukuphindaphinda kwindonga yesifuba kungabandakanya isikhumba, i-muscle kunye ne-fascia phantsi kwesayithi sesisu sesifuba sokuqala, kunye ne- lymph nodes . Xa umhlaza uphindaphindwa eludongeni lwesifuba, unokuthi uhlelwe njengento ephindaphindiweyo yendawo, okanye idibaniswe ne- metastasis ede. Ukuba ukuphindaphinda kwindonga yesifuba kukuphindaphinda, kuthethwa ngokuba ngumhlaza wesibeleko se-nonastatic.
Phantse ama-5 ekhulwini kwabasetyhini abaye bafumana isifo se-mastectomy baya kuba nokuphindaphinda kwesithili kwiminyaka eyi-10 ezayo.
Ingaba yinkimbinkimbi yokudideka ekuphandeni kwiphakamiso yesifuba sokuphinda. Ziziphi iindibalo ezichanekileyo? Kutheni kukho unyango lubonakala luphikisana? Ngeenjongo zeli nqaku, sithetha ngabantu abaye banesifo somzimba. Ukuba umhlaza uphindaphinda kwibele emva kwe- lumpectomy , ehlukileyo kakhulu.
Iimpawu
Ukuphindaphinda kwindonga yesifuba kunokuqala kubonakala njengesihlungu esingaphilanga, kwaye mhlawumbi sidonsa. Kukho ukungahambi kakubi okanye ukutsalwa kwemizwa.
Ukuxilongwa
Ukuba ukuphindaphinda kwakho kubonakala, i- biopsy inokwenziwa ukuba kuqinisekiswe ukuba ingaba yinto yokuphindaphinda isifuba okanye cha. Ukuba kulungile, i-oncologists icebisa ukuphinda ukuvavanya iimvavanyo ukuze ubone ukuba ngaba i-estrogen receptor efanelekileyo, i-progesterone receptor positive, okanye i- H22 enhle . Oku kungabonakala kukumangalisa emva kokuba sele sele ihlolwe, kodwa ngokuphindaphindiweyo, imeko ye - receptor yeeseli zomhlaza ingatshintsha, ingakumbi ukuba ibe ngaphezu konyaka okanye amabini ukususela kwi-mastectomy yakho.
Ngamanye amagama, ukuba ekuqaleni wayenomdlavuza wesibeletho esiswini owawufumana i-estrogen receptor, ama-cell tumor isintshintshe kwaye abe yi-estrogen receptor. Ngokomzimba, oku kuthethwa ngokuthi "ukungahambisani kwesisu."
Abanye abantu banokumangaliswa kukuba i-biopsy iyanconywa ukuba ugqirha wakho uyaqiniseka ukuba ukuphindaphinda komhlaza wakho wokuqala.
Kungenxa yokungahambelani kwezi zinto, kwaye unokuba nefuthe elikhulu ekukhetheni ukhetho olungcono lwezokwelapha.
Ekubeni ukuphindaphinda kwendawo yokuhlala njengokwakhiwa kwindonga yesifuba kunokudibaniswa neemastastas ezikude, umsebenzi osebenzayo wokugadla ngokuphindaphindiweyo uphinde wenziwe kwaye ungabandakanya ukukhangela kwe-PET ukujonga ezinye iindawo ezisasazeka emzimbeni.
Unyango
Njengokuba ufumanisa unyango lokuqala lomhlaza webele, unyango lokuphindaphinda ngokuqhelekileyo ludibanisa unyango oluthile. Unyango luya kuphulwa phantsi:
- Iinkqubo zokonyango: Ezi ngonyango ezijongene namaseli omhlaza naphi na emzimbeni wakho, kwaye zibandakanya i-chemotherapy, iipilisi ezijoliswe kuyo, imithi yokwelapha, kunye nezinye zonyango olutsha olukhoyo kwizilingo zamachiza ezifana ne-PARP inhibitors kunye nokunye.
- Iinkonzo zonyango: Ezi zonyango zichaphazela umdlavuza apho zivela khona (okanye zisasazeka) kodwa azijongisi iiseli zomhlaza kwenye indawo emzimbeni. Iimzekelo ziquka unyango lwe-radiation, utyando kunye neyeza zeproton.
Isinyathelo sokuqala sinquma ukuba ukuphindaphinda kwindonga yesifuba kukuphindaphinda, okanye ukuba iinkalo ezongezelelweyo zokuphindaphinda, ngokukodwa zikhoyo zikhoyo.
I-Wall Chest Recurrence Plus Metastases ezide
Ukuba kukho ubungqina beemastastas ezikude, unyango lwe-metastatic cancer yomhlaza luya kuba yindlela yokuqala.
Ezi ziquka. Izonyango zendawo zingasetyenziselwa ukulawula umhlaza kwindonga yesifuba njengoko kuchaziwe ngezantsi. Ngokwe-2018 uphando malunga neepesenti ezingama-27 zabasetyhini abaphindaphindiweyo, ezifana nokuphindaphinda kwindonga yesibindi, baya kuba ne-metastasis ekude.
I-Metastase ye-Wall Chest Isolated (i-Non-Metastatic Recurrence)
Ukuba abukho ubungqina besifo se-metastatic esikude ekuhlolweni (akukho bungqina bomhlaza obuye lwasasazeka emathanjeni, kwimiphunga, isibindi, ingqondo okanye ezinye iindawo), unyango lwengingqi ukususa ukuphindaphinda luyinjongo yokonyango. Ekubeni i-tumor eye yasasazeka eludongeni lwesifuba sele "ivakalise injongo yayo" ukusasazeka kwezinye iindawo zomzimba, unyango lweenkqubo lubalulekile.
Ngaphambi kokuba uphathwe isisu, kubalulekile ukuba "i-bi-biopsy" yenziwe ukuze kuqinisekiswe ukuba imeko ye-receptor yokuphindaphinda. Khetha ziquka:
Chemotherapy
Ukuba indawo yokuphindaphinda ikhulu kakhulu ukuba isuswe ngokupheleleyo kunye nokuhlinzwa, i-chemotherapy ingasetyenziselwa kuqala ukunciphisa ubungakanani besifo sokuthi unyango lwengingqi lunokwenzeka.
Utyando lweyeza
Ukuba unyango lwe-radiation aluzange lusetyenziswe ngexesha lomhlaza wokuqala, le nto isetyenziswa (kunye nokuhlinzwa okanye ezinye iindlela zokususa i-tumor) ukuqinisekisa ukuba zonke iiseli zomhlaza ziphathwa (iiseli ezingenakubonwa kwi-imaging kodwa zicingwa ukuba mhlawumbi kubekhona. Ukuba unyango lwe-radiation lisetyenziswe ngaphambili, i-oncologist yakho ye-radiation iya kunciphisa inzuzo enokuthi iyintoni ixesha elide ukususela ekubeni unayo unyango lwe-radiation, kwaye ukuba i-dose ephantsi ifunekayo.
Ukuhlinzwa
Uphando luyintloko yokunyanga ukususa indawo yokuphindaphinda. Njengoko kuphawuliwe ngasentla, i-chemotherapy ingadinga ukunciphisa ubungakanani besisu phambi kokuhlinzwa, kwaye unyango lwamayeza luvame ukusetyenziswa emva kokuhlinzwa.
Kunokucetyiswa ukuthengiswa ngokugcwele xa kunokwenzeka, kwaye xa kwenziwa kubantu abafanelekileyo abaviwa, kukhokelela kwisilinganiso sokusinda kweepesenti ezingama-41 emva kweminyaka eyi-15 ngokufunda ngo-2018.
Unyango lweHormonal
Ukuba ukuphindaphindwa kukufumana i-estrogen receptor kwaye kwaye kwakungalunganga ngaphambili, unyango lwe-hormonal luya kunconywa. Le nto ingaba yi-tamoxifen, kubalabo abasengaphambili, okanye, kulabo abathumela i-postmenopausal okanye bangama-foremenopausal kwaye baye bafumana unyango lwe-ovarian, i- aromatase inhibitor njenge-Aromasin (exemestane), i-Arimidex (i-anastrozole), okanye i-Femara (i-letrozole). Ukuba i-tumor i-estrogen receptor efanelekileyo kwaye isisu sakho sangaphambilini sasifumanekile isrogen receptor, i-oncologist yakho iya kuqwalasela ngokuchanekileyo zakho iinketho. Xa ukuphinda kwenzeka xa ususelwa kwi-hormonal therapy, i-tumor ingaba yichasene. Amachiza ahlukeneyo anokucetyiswa, okanye
Unyango olujoliswe
Ukuba i-tumor yakho i-HER2 efanelekileyo kwaye i-tumor yakho yangempela yayiyi-HER2 engalunganga, i- HER2 ejoliswe kwiipilisi ezifana ne-Herceptin (trastuzumab) iya kucetyiswa. Ukuba i-tumor yakho i-H2 positive kwaye nayo i-H2 positive ngaphambili, i-HER2 inhibitor eyahlukeneyo ingasetyenziswa.
Unyango lweProton
Iprotro yokwelapha yinkqubo entsha yonyango, kwaye asinakho izifundo ezininzi. Olunye uvavanyo lwango-2017 lwafumanisa ukuba unyango lweprotton luphindaphinda udonga lwesibindi, xa unyango lwe-radiation lwenziwe ngomhlaza wokuqala, lwaluyinto enobungozi. Ugqirha ukuya eludongeni lwesifuba, nangona kunjalo, emva kwonyango lweproton, lunokubangela iingxaki ezibalulekileyo ekuphulukisweni kwilonda.
Prognosis
Isilinganiso seminyaka eyi-10 yokusinda komhlaza wesifuba ngokuphindaphinda kwindonga yesifuba siphezulu malunga neepesenti ezingama-50, kodwa oko kungatshintshwa ngoku ngeendlela ezingcono zonyango. Isixa sexesha elidlulileyo phakathi kwesifo somhlaza wesifuba sokuqala kunye nokuphindaphinda kwendawo yendawo kudlala indima ebalulekileyo ekusindisweni, kunye nalabo abanesigodlo sesibondlo phakathi kweminyaka emithathu yokuxilongwa abahlwempuzekileyo (malunga neepesenti ezingama-30), kanti abo baphinda emva kweminyaka emithathu , izinga lokusinda linokuba ngama-70 ekhulwini okanye ngaphezulu.
Ukujamelana
Ukuba umdlavuza wakho webele uyabuya, kunokuba ukwesabisa ngakumbi ukuba xa uqala ukufumanisa i-diagnostic. Inxalenye yale nto kukuba iipesenti ezingama-27 zesibindi se-chest wall are associated with metastases (i-metastatic breast cancer) ebonisa ukuba umhlaza awupheli. Nangona kunjalo, nokuba umhlaza awuphilwanga, usaphila kakhulu, kwaye kukho ukhetho oluninzi.
Kwabo abanokuhlala behlala kwimihlaba, ukutshatyalaliswa ngokupheleleyo kwe-tumor kungabangela ukuba baphile ixesha elide kubafundi abaviwa kulolu unyango.
> Imithombo:
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> D'Aiuto, M., Cicalese, M., D'Aiuto, G., noG. Rocco. Ugqirha lweKhotho yeSifuba sokubandakanywa yiCanscer Breast. Iiklinikhi zeeTraphic Surgery . 2010. 20 (4): 509-17.
> McGee, L., Iftekaruddin, Z., Chang, J. et al. I-Postmastectomy Chest Wall I-Reirradiation ne-Proton Therapy yeCarcer Breast. I-Radiation Oncology, Biology, kunye neFiziki . 2017. 99 (2): E34-E35.
> Neuman, H., Schumacher, J., Francescatti, A. et al. Ingozi yokuphindaphinda okuqhelekileyo kwixesha leNdawo yokuPhindwa kwezilwanyana eziPhezulu kwiSigaba II kunye neSigaba III seKesiti yesisu (AFT-01). Umbhalo we-Clinical Oncology . 2018. 2017.75.538.
> Shen, M. et al. I-Clinical Course of Breast Cancer Izigulane ezineziThuthi eziPhezulu eziPhezulu kunye neNyathelo eliPhezulu lokuPhelelwa kweeNtshontsho zokuThuthukiswa kweeNgqungquthela Ukubuyisana kunye nokungaxilwanga ngokugqithisileyo. I-Annals ye- Oncology yokugada . 2013. 20 (13): 4153-60.
> Wakeam, E., Acuna, S., no S. Keshavjee. Ukuhluthwa kweKhotho yeKhotho yeCarcer Breast ephindaphindiweyo kwi-Modern Era: Uhlolo lokuHlola kunye noHlelo lwe-Meta-Analysis. Annals of Surgery . 2018. 267 (4): 646-655.