Ukukhulelwa kunye nokuncelisa ukubeleka kuthintela njani ingozi yakho yomhlaza webele?
Nangona ububele buvame ukuba ngumxube obunzima wovuyo kunye noxinzelelo, abanye besetyhini bajamelana nokutshatyalaliswa okongezelelweyo kwesifo somhlaza wesifuba. Abasetyhini banoma yiphina iminyaka okanye isigaba sobomi banokuthi bafumaneke benomdlavuza-akukhawulelwanga kumxholo oyintloko wokukhulelwa nokuncelisa.
IiHormone, ngokukodwa i-hormone yabesifazane i- estrogen kunye ne-progesterone, kunye nomhlaza wesibeleko unxulumano olunzima.
Iintlukwano kwi-hormone yabasetyhini zenzeka rhoqo ngenyanga kwiinyanga zokuzala zowesifazane kwaye zinciphise emva kokumisa umva. Ubomi bebhinqa bobudlelwane be-hormones, ngokulinganiswa ngokulinganiselwa kwinani lemijikelezo yokuya esikhathini, yinto engumngcipheko wokuba nomhlaza wesifuba.
Nangona kunjalo, kukho ezininzi izinto ezinxulumene nokukhulelwa kunye ne-lactation ezinokunciphisa ingozi yomdlavuza webele. Kodwa kuba-1 kwabasetyhini abangama-3 000, umdlavuza webele ngexesha okanye emva kokukhulelwa kuya kuba yinyani.
Kwiingxoxo kunye neSiseko soPhando lwe-Cancer Foundation (i-BCRF), i-Elisa Port, MD, umbhali we-"New Generation Cancer Book Book" wabelana ngolwazi olubalulekileyo kwiimpembelelo ze-breast cancer emva kwexesha okanye emva kokukhulelwa, indlela abafazi abanako ngayo qaphele ngempilo, kunye neendlela ezintsha zokonyango. UDkt Port ungumphandi we-BCRF kunye noMphathi oyiNtloko yoBuqhwaba besisu kunye noMlawuli we-Dubin Breast Centre kwiNtaba yaseSinayi yase-New York.
Ukuphuhliswa kwamaBabele ngexesha lokukhulelwa kunye nokuxiliswa
Inkqubo epheleleyo yokukhulelwa ekunceliseni kwaye ekugqibeleni, i-involution, okanye xa isifuba sibuyela kwisimo sokuqala sokukhulelwa, kubangela ukuba iiseli zebele zikhule kwaye zitshintshe iintlobo zama-hormone ezisebenza kwibele.
Le nkqubo inciphisa ukutyhila kwi-estrogen.
Kukholelwa ukuba ukuncipha kwe-esrogen ukutyhila kunye neeseli ezibelekileyo zengxube kunciphisa amathuba okuba umhlaza ungakhula. Yingakho ubudala bokuqala bokuzalwa kunye nenani lokuzalwa (elibizwa ngokuba lilungu) linganciphisa umngcipheko wesifo somhlaza wesifuba kamva xa umphefumlo wesifazane usema-50s, 60s okanye 70s.
Ukuxiliswa kweNtsholongwane kunciphisa Ingozi yomhlaza webele
Ukuncelisa isisu kubangela ukuba utshintsho kumazinga e-hormone kwaye ngenxa yokulibazisa ukubuyela esikhathini emva kokukhulelwa, kunciphisa i-estrogen ngokuqhelekileyo kwimijikelezo yakhe yenyanga, ukunciphisa umngcipheko wesifo somhlaza, ikakhulukazi kubhinqa be-premenopausal.
Ukuthelekiswa kwamanye amazwe, ukuncelisa e-US kuhlala kusezantsi, ngokukodwa kubasetyhini abamnyama xa kuthelekiswa nabesifazane abamhlophe: ngamaphesenti angama-62 amabhinqa abamnyama afana ne-79 ekhulwini abafazi abamhlophe baqala ukuncelisa emva kokuzalwa kwidatha yakutshanje efumaneka ngo-2014. Nangona kunjalo, ngo-6 Kwiinyanga emva kokuzalwa, ama-36% kuphela omama abamnyama athelekiswa nama-52 ekhulwini omama abamhlophe besalusalisayo. Oku kubaluleke ngokubhekiselele, njengengxelo yakutshanje ifumene ukuba abafazi abamnyama banokufa ngenxa yomdlavuza webele kunabalingani babo abamhlophe, ukungalingani okwandayo kulo lonke ilizwe.
Uhlalutyo oludibeneyo lwezifundo ezingama-47, ukuthelekisa oomama abancinci kumama abangakhange babele, bafumanisa ukuba:
- Ama-mama abancinci ixesha lokuphila elipheleleyo (ixesha elidibeneyo lokuncelisa abantwana bonke onyaka-1) babengenakuncinci ukufumana umdlavuza webele.
- Ubomi beminyaka engama-2 bufumana ixesha elimalunga nama-2 ukufumana inzuzo / ukunciphisa umngcipheko kunabantwana ababelethwe unyaka omnye.
Uphononongo olukhishwe kwi-Annals of Oncology lufumene ukuba ukuncelisa ibele kunokuba kukuhle kakhulu ekunciphiseni ingozi ye-ER / / yesithathu yomhlaza wesifuba, isifo esichukumisayo sisifo.
Ukuncelisa ibele kunganciphisa ingozi yomhlaza wesifuba kamva ebomini kwaye kunemivuzo eninzi yokuncedisa umntwana, kuya kunceda umama ngokunciphisa ingozi yomhlaza we- ovari , ukuxinezeleka kwe-postpartum, kunye nohlobo lwe-2 lweswekile .
I-Cancer-Related Related Cancer
Kwiimeko ezinqabileyo, ukukhulelwa kungabangela umdlavuza webele. Umdlavuza wesifuba owenzeka ngexesha okanye emva kokukhulelwa kudla ngokufumaneka kwinqanaba elinobudlova, inxalenye yokuba ininzikazikazi ayifuni ukuyijonga kwaye ifunyaniswa emva koko, okanye ingakwazi ukunyanzeliswa ngeminye imiba enxulumene nokuncelisa, njenge-mastitis.
Nazi iindlela ezimbalwa ongaqaphela ngayo impilo yakho yebele:
- Njalo uyazi "oqhelekileyo." Qwayelana nomzimba wakho kunye naluphi na utshintsho olwenzeka ngaphambili, ngexesha kunye nangemva kokukhulelwa (kwaye ngokubanzi ebomini, ukususela kwintsholongwane).
- Ukuba kukho nayiphi na into enokukrokra, qi niseka ukuba uyifake kwingqalelo yogqirha wakho - kuquka iimpawu ngaphandle kwezinye izilwanyana, ezifana nokuguquka kweengono, ukutshatyalaliswa kwesikhumba, okanye ukukhutshwa kwimbumba ngaphandle kobisi lobisi.
- Umngcipheko wesifo somhlaza wesifuba ukwanda malunga ne-4 ukuya kwe-5 kwiminyaka emva kokukhulelwa. Umgaqo oqhelekileyo wesohlwayo kukuba abesifazana bamele baqaphele ngokukodwa ukutshintsha okungavamile kwibele yabo kude kube umntwana wabo angena esikolweni.
Unyango lweCancer Breast-Related Breast Cancer
Xa umdlavuza webele usenzeka ngexesha lokukhulelwa, unyango luba nzima nakakhulu. Ingaba utyando kunye / okanye i-chemotherapy inokuxhomekeka kwi-trimester.
Uvavanyo lwesibini nolwesithathu luba neziphumo ezilungileyo zokuba nokukhulelwa okufanelekileyo kwaye unyango lomhlaza wesifuba. Unyango ngexesha le-trimester yokuqala lixesha elinzima kwaye linzima kakhulu ukugqiba ukhetho lwezonyango, ngoko kubalulekile ukulinganisela unyango kumama onobungozi obusemngeni.
Unyango lweHormone eqhutywe ngumhlaza webele
Ngenxa yocwaningo lwe-BCRF oluxhaswa ngemali nguDkt. Charles Perou kunye nezinye ezininzi izazinzulu emhlabeni jikelele, ngoku siyazi ukuba umdlavuza wesifuba asisinye isifo, kodwa sininzi. Oogqirha banako ukuchonga uhlobo luni lomhlaza wesifuba umfazi onalo ngokuhlalutya iiprotheni kunye ne-DNA kwiisensi ze-tumor zisuswe yi-biopsy kwaye zizaliswe ngokupheleleyo emva kokuhlinzwa.
Unyango ngokubanzi lulandela urhulumente wokuhlinzwa, i-radiation kunye / okanye i-chemotherapy, kodwa ukwazi i-subtype kuye kwaphazamisa uphuhliso lwezilwanyana ezijoliswe kuzo ezikwazi ukwenza ngcono unyango lwe-tumor.
Iipilisi ezijoliswe kumhlathi ngamnye ziquka:
- Umhlaza wesibeleko sesifuba esinezintathu ( TNBC ), i-10 ukuya kwi-15 yeepesenti zeengcingo zebele: Azikho iipilisi ezijoliswe kuzo zivunyiwe kwi-TNBC. Nangona kunjalo, i-cootherapy cocktails inokusebenza kakuhle ekuphatheni i-TNBC kwaye kwezinye iimeko yenza izimpendulo ezinamandla.
- I-HER2 + yomhlaza wesifuba, i- 15 ukuya kuma-20 ekhulwini lweengcingo zebele : i- HER2 + yayisichengululo sokutshatyalaliswa kwaze kwaba yilapho iprojekthi ebizwa ngokuba yi-Herceptin ® yaphuhliswa.
- Kuvunywe ngo-1998. Umhlaza wesibeletho se-HER2 + ususelwa ekubeni usongela ubomi ukuba unyango, mhlawumbi uphilise kwezinye izigulane.
- Umhlaza wesibeletho se-HER2 + unokubuyela kwisigqeba esitsha, kwaye unokumelana ne-Herceptin ® . Amachiza amatsha ukuphatha i-HER2 + ibandakanya iTykerb, i-Perjeta ® kunye neKadcyla ® (T-DM1) inokunceda ukunqoba ukuxhathisa kuka-Herceptin.
- Ngokomzekelo, kuphando olutshanje kumdlavuza webele we-metastatic, izigulane ezine-HER2 + zesifuba somhlaza zazinokuphila ngokubanzi (ezinyangeni ezingama-56 kunye neenyanga ezingama-40) xa uHerceptin behlanganiswe nePerjeta ® , xa kuthelekiswa nezigulane ezithobela i-Herceptin ® kuphela.
- Umhlaza wesibeletho se-ER +, i- 60 ukuya kuma-70 ekhulwini lomhlaza webele: I-ER + yindlela eqhelekileyo yomhlaza wesifuba kunye nempembelelo malunga nama-60 ukuya kuma-70 ekhulwini kwimiba engama-250,000 ngonyaka. Iyakwazi unyango ngokuhlinzwa, i-radiation, i-chemo KWI-anti-estrogen therapies. Senze intuthuko enkulu ekuphatheni umdlavuza webele we-ER +: Izidakamizwa ezitsha ezibizwa ngokuba yi-MTOR inhibitors kunye ne-CDK4 / 6 inhibitors ezijoliswe kwiiprotheni ezithile kwaye zibonisa izithembiso kwiimvavanyo zonyango, kunye neendidi ezivunyiweyo kwiminyaka yamuva nje kubandakanya i-MTOR inhibitor [faka igama le-MTOR], kunye ne-CDK4 / 6 inhibitors i-Ibrance® ne-Kisaqli®.
Ukunyameka emva kokuba unyango
Nangona ukuzala emva kokuxilongwa komhlaza wesifuba kuyinkxalabo enkulu, abaninzi abafazi banokukhulelwa ngokuphumelelayo emva komhlaza wesifuba. Uninzi lwezicwangciso zonyango lubandakanya irejimeni yeziyobisi ezifana ne-tamoxifen iminyaka emi-5 ukuya kwe-10 emva kokuhlinzwa kunye / okanye i-chemotherapy ukunciphisa umngcipheko wokuphindaphinda kwaye ekubeni izidakamizwa zingabangela ukukhulelwa kwezibeleko zokukhulelwa kufuneka zigwenywe. Ezinye iindlela zokulwa nezi-anti-estrogen zinikezwa ngeziyobisi ezinqanda umsebenzi we-ovarian ukulondoloza ukuzala. Amaqanda amaqanda okanye ama-embryos aqhelekileyo kwaye anokuthi kube yindlela ekhuthazwayo.
Izinketho kufuneka zixoxwe ngaphambi kokuba unyango ukuze owesifazane enze ukhetho oluhle kuye nakwintsapho yakhe.
IItrakthi ezibalulekileyo
- Ukukhulelwa kunye nokuncelisa kuncitshisi kakhulu ukunciphisa umngcipheko wesifo somhlaza wesifuba kamva ebomini.
- Umngcipheko wesifo somhlaza wesifuba ukwanda kancane iminyaka emihlanu emva kokukhulelwa. Hlalani nilindile ngempilo yakho yebele ngexesha leli xesha.
- Ukuba umdlavuza webele usenzeka ngexesha okanye emva kokukhulelwa, unyango luyinkqubo ebunzima yengozi kumama kunye nomntwana.
- Iinkqubo ezintsha zokwelapha umdlavuza webele we-hormone zithuthunyiswe ukuphumelela kwonyango.