Ulawulo lwe-Bone Metastases ukusuka kwiCanscer Breast
Umhlaza wesifuba usasazeka kumaxesha amaninzi. I-Boneastas i-Bone ivela kuma-70 ekhulwini kwabasetyhini abanomhlaza wesibeletho se-metastatic ( isigaba se-4 somhlaza wesifuba ) kwaye kaninzi ngaba ngumqondiso wokuqala wokuba umhlaza uphindele. Ngombulelo, i-boneastases yamathambo ingaba nesifo sengqondo esilungileyo kunesifo somhlaza wesifuba esasasazeka kwezinye iindawo, kwaye kukho unyango oluthile olufumanekayo olungagcini nje ukunciphisa intlungu kodwa lunokuphucula nokuphila.
Makhe sibone ukuba yeyiphi imfuyo yomhlaza isifuba isasazeka kakhulu, iimpawu zeethambo zesifo, iindlela ezahlukeneyo zonyango ezikhoyo, kunye neengxaki ezinokuthi uziqhelane nazo.
I-Cancer yaBestile ngeT Bone Metastases
Umhlaza wesifuba osulela kwithambo ungumthombo wokudideka okukhulu, ngoko siya kuqala ngokuchaza ngokucacileyo oko kuthetha ukuthini. Umhlaza wesifuba osabalalayo ( isistimasi ) kwisithambo sisengumdlavuza webele. Ukuba uthe wathatha isampuli yesisu ngaphakathi kwithambo kwaye ubujonge phantsi kwe-microscope, uza kubona amangqamuzana esifuba somhlaza.
Umhlaza wesifuba oye wasasazeka emathanjeni awusona umdlavuza wesifuba (ngaphantsi kwe-microscope umhlaza wesifo wawuza kubonisa iiseli zesifo somhlaza). Xa umdlavuza webele usasazeka kumathambo isigama esilungileyo "sisifo se-metastatic bebele". Xa umhlaza utholakala emathanjeni kunokwenzeka kakhulu ukuba ngumhlaza wesi-metastatic kwenye indawo yomzimba kunomdlavuza wesifuba.
Kubaluleka kweMetastases yeThambo
Ukujongana neengxaki zethambo kunye namathambo e-boneastas kubalulekile kungakhathaliseki ukuba yintoni isigaba somhlaza wesifuba umntu analo. Akunakwenzeka nje ukuba umdlavuza webele usasazeke kumathambo, kodwa unyango lomhlaza wesifuba njengemithi yokwelapha i-hormonal lungakhokelela ekulahlekelweni kwethambo. Enyanisweni, imithi esetyenziselwa i-metastases i-bisphosphonates) ngoku ixutyushwa nakwabo abanesifo somhlaza wesifuba sokuqala njengendlela yokuqinisa amathambo kunye nokuthintela amathambo e-boneastases ukuba avele kwindawo yokuqala.
Intlungu esoloko ihamba kunye namathambo e-boneastase, ehlangene nokuncipha kokuhamba ngenxa yokuphuka okanye ukuxhomekeka kwintsimbi, ingaba nomthelela omkhulu kumgangatho wobomi kubasetyhini abaphila nomhlaza wesibeletho se-metastatic. Nangona kunjalo, ngokungafani nembono oqhelekileyo yokuba unganokukwenza ukuba unayo isigaba se-4 somhlaza wesibele, kuninzi into enokuyenza ukuze unganciphisi nje intlungu kunye neengxaki zeethambo zesifo, kodwa ukwandisa ubomi.
Isifo seKesibindi sisasaza kwi-Bone-Overview
Njengoko kuphawuliwe ngasentla, i-boneastases yamathambo ebelethwe ngumhlaza yindawo eqhelekileyo yeemastastas ezikude kunye nomhlaza webele. I-Boneastast i-Boneastas iyinto eqhelekileyo ngakumbi kubasetyhini abanesifo somhlaza wesibeletho se-estrogen ( isifo kunye neengqondo zesifo sengqondo ziqhelekileyo kubasetyhini abane- HER2 / neu ne- triple negative negative cancer).
I-Boneastast ye-Bone iyinto eqhelekileyo kubasetyhini abanomdlavuza webele we-ductal ongenawo umdlavuza webele we- lobular ongenayo (kwi-lobular carcinoma, i-metastases kwisisu (i-peritoneal metastases) iqhelekileyo). Kwimihlulo ehlukeneyo yomhlaza wesifuba, i-boneastas yamathambo ixhaphake kakhulu kwiisifo zomhlaza.
Ziziphi Iimpawu Zomdlavuza Webele Zasasazeka?
Umhlaza wesifuba unomdla wokusasaza kwamanye amathambo emzimbeni ngokuphindaphindiweyo kunabanye, kodwa oku kuyahluka kunye neentlobo ze-metastases zenzeke phantse wonke amathambo emzimbeni.
I-Metastase ivela ngokuqhelekileyo kwi:
- Isihlwele
- Iibhere
- Pelvis
- Amathambo amathambo emilenze nemilenze (i-humerus kunye ne-femur)
Akuqhelekanga ukuba amathambo ahlasele ngamathambo ambalwa ngexesha elifanayo, njengomthi womlenze kunye ne-pelvis. Iimetastase zingaphinde zenzeke kwezinye iindawo zomzimba (ezifana nesibindi, imiphunga, okanye ingqondo) ngexesha elifanayo ziyabonwa ngamathambo.
Kutheni I-Cancer Isasazeka Kwizityalo?
Okwamanje asiyiqondi isizathu sokuba umhlaza wesifuba usasazeka kumathambo. Amathambo atyebile ngemithambo yegazi, kodwa kunjalo nesibindi kunye nemiphunga, indawo apho umhlaza wesifuba usasazeka khona kodwa ngexesha eliphantsi kunothambo.
Ekubeni i-metastase ibaluleke kakhulu (i-metastases yimbangela yokufa ngamaphesenti angama-90 amabhinqa abafa ngesifo somhlaza wesibeleko), le ndawo isenziwa uphando.
Kukho imfundiso yokuba umhlaza wesifuba unokuhlala ulele emnxeni wethambo , kwaye amathambo enomdlavuza wesifuba ngokuqhelekileyo usasazeka kubo abo batyebileyo emnxeni wethambo. Ukuba unomdla, ungafunda okungakumbi malunga neengcamango zesifo somhlaza wesifo kunye ne-dormancy njengengcaciso ecacileyo yokuba kutheni umdlavuza webele usenokufihla iminyaka okanye emashumi emva koko uphinde ubuye.
I-Bone Metastases ivela njani kwiCatcer Cancer Diagnosed?
I-Boneastases ye-Boneastas isifo somhlaza wesifuba ingafumaneka kwiindlela ezahlukeneyo. Ngamanye amaxesha i-metastase ibonakala xa i-x-ray eyenziwa ngenxa yokuphuka okwenzekayo kunye nokuxhatshazwa kakhulu (ngenxa yokudakalisa kwethambo ngenxa yemetastasis, i- pathologic fracture ). Ngamanye amaxesha, i-boneastas i-boneastases ifunyanwe ngephanya-zithe xa uvavanyo olunjenge-PET scan luyenzelwa esinye isizathu. Iimvavanyo zenzelwe ngokukodwa ukujonga amathambo e-boneastases ziquka ukuhlolwa kweethambo kunye ne-PET ukuhlola, ngokudibanisa kwe-PET / CT, SPECT / CT, umzimba wonke we-MRI, kunye ne-PET / MRI ebonisa ukuvakalelwa. Kukho ingxoxo malunga novavanyo olungcono, kodwa i-oncologist yakho iya kuthatha ingqalelo kwiinkalo ezininzi xa wenza isinconywa.
Unyango lwe-Bone Metastases
Uninzi lwezonyango ezahlukeneyo luyafumaneka kwiithambo zesifo. Inketho efanelekileyo kakhulu kuncike kwizinto ezininzi ezifana nenani kunye nendawo yamathambo achaphazelekayo, ubukho bezinye iimastastas, kunye nempilo yakho jikelele.
Izinketho zonyango ngokubanzi ngomhlaza wesifo se-metastatic ezifana ne- chemotherapy , i-hormonal therapies, kunye nemichiza ejoliswe kuyo isetyenziselwa ukusetyenziswa, kodwa ezinye iindlela ezikhethwe ngokukodwa ukuphatha ukusasazeka komhlaza kumathambo zisetyenziselwa ukusetyenziswa, kwaye zihlala zikhokelela ekulawuleni umhlaza. ixesha elithile. Ezi ziquka:
Ukulawula ubuhlungu - I-Metastases kumathambo inokuba buhlungu kakhulu, kodwa kukho iindlela ezininzi ezahlukahlukeneyo zokuphelisa intlungu. Ukufumana amayeza afanelekileyo kunye nokucwangcisa iziphumo ezichaphazelekayo zala machiza enokuncedwa kwintlungu enokuba yinto enzima. Ukuba oku kuba nzima, abanye abantu basebenza ngogqirha wokunakekelwa ngentsholongwane okanye ingcali yentlungu yokujongana nokuphathwa kakuhle kweentlungu zabo.
Ukunyangwa kwamayeza - Ukusetyenziswa kwamayeza aqhelekileyo kusetyenziswa kwaye kunokuncedisa kokubili ukunciphisa intlungu kunye nokunciphisa ingozi yezahlulo. Iyeza zonyango "zonyango lwengingqi" elithetha ukuba lusebenza kakuhle kwiindawo ezizimeleyo zeemastastases kunokuba zixhaphake.
I-Radiopharmaceuticals - I-Radiopharmaceuticals yile mithi equka i-particle ye-radiation efakwe kwenye ikhemikhali, enokuthi ifakwe kwigazi. I-radiation ihanjiswa ngqo kwi-boneastases. Imizekelo ibandakanya iStrontium-89 kunye neRadium-223. I-Radiopharmaceuticals inokuba luncedo kakhulu kulabo abanamathole amaninzi okanye amathambo amaninzi okuza kuba nzima ukunyanga kunye nezokwelapha zendawo ezifana neyeza zonyango. Zinemiphumo embalwa yecala kwaye ingaba luncedo kakhulu ekulawuleni iintlungu zethambo.
I-agents-modifying agents - I-agents-modifying agents (drugs-modifying agents) zingasetyenziswa ngomlomo okanye ngejoza ukunciphisa i-metastases yeethambo. Ezi ziquka:
- I-Bisphosphonates - i-Bisphosphonates yimishanguzo eyavunywa kuqala ukuba i-osteoporosis ize ifunyaniswe ukuba iyasebenza kakhulu ekuphatheni i-boneastas. Umzekelo nguZometa (zoledronic acid). Ukongeza ekunciphiseni iingxaki ezivela kumathambo ama-boneastases, ezi zonyango zibonakala zineempembelelo ezinamandla ezichasayo. Ngenxa yeso sizathu, ngoku bathatyathwa njengabesetyhini abanomdlavuza wesibeleko (abo baxhomekeke kwi-postmenopausal okanye i-foremenopausal kwi-ovarian suppression cure), njengoko bobabini bancedisa ukulahleka kwethambo kubangelwa yimithi ye-hormones (njenge-aromatase inhibitors) kwaye inqanda i-metastases kwi bone. I-Bisphosphonates ithwala umphumo ongathandekiyo wohlobo lwe-osteonecrosis yomhlathi.
- I-Xgeva (denosumab) - I-Denosumab yintsholongwane efunyenwe ukuba isebenze ekunciphiseni iingxaki (ezifana neziqhekeza) kubantu abaneethambo zesifo esivela kumdlavuza webele. Kwakhona kubonakala kunempawu zokulwa nomhlaza. Inikwa njengenjoza engaphantsi kweeveki ezine.
Ugqirha - Ukusetyenziswa ngokugqithiseleyo kusetyenziswa rhoqo ukuzinzisa iifracture okanye iindawo zethambo engozini yemfucu (jonga ngezantsi).
Iingxaki ezinokwenzeka kwi-Bone Metastases
I-Boneastast ye-Bone ingakhokelela kwiimpawu ezininzi ezahlukeneyo kunye neengxaki. Ezi ziquka:
Unzima ukuphatha intlungu - Intlungu ehamba kunye namathambo e-boneastases anokuba nzima. Ubuhlungu buvame ukuphathwa ngokudibanisa kunye neyeza kunye nezokwelapha eziye zenzelwe ukunciphisa amathambo. Ukongezelela kwiimvumi zentlungu, iingcali zentlungu zinamanye amachiza athile, kubandakanywa nemibhobho yesibindi efunwa ngamanye amaxesha.
Iifractures / mngcipheko weeqhekeza - Akuqhelekanga ukuba umntu aqale afunde ukuba anethambo lesifo emva kokuba ehlulwa. (Nantsi umzekelo wowesifazane onomdlavuza wesifuba kunye ne-pathologic hip fracture ngenxa yokudityaniswa kwemitha .) Ukuhlinzwa kudlalwa rhoqo ukulungisa izifucu. Ngamaqhekeza amathambo amathambo amathambo okanye imilenze ende, intonga ihlala ibeka. Oku akukona nje kuphela ukubonelela ngenkxaso ithambo elibuthathaka, kodwa kunokuvumela ukuba usebenze ngokukhawuleza. I-Vertebroplasty okanye "i-samente" ingasetyenziselwa ukuqhuma komgudu okanye imivumba ezayo.
Ukunyanzeliswa kwentambo yomgca - Ukunyanzeliswa kwentambo yomgudu yongxamiseko lwezokwelapha ezingabangela i-boneastas. Ukungena komdlavuza emgceni ongaphantsi kunokukhokelela ukuwa kwe-vertebrae, kwaye kwakhona, ukunyanzeliswa kwezibilini ezishiya umlanjana ukuya kwisiqingatha esingaphantsi komzimba. Iimpawu zingabandakanya ukwanda kobuhlungu obungaphantsi obunokugqithisa emilenzeni, ubuthathaka okanye ukuphazamiseka kwelinye okanye emilenzeni yomibini, kunye nokulahlekelwa kwesibindi kunye / okanye ukulawula isisu xa umdlavuza webele unqabana nomgudu. Iinkqubo zokuphanda zisetyenziselwa ukuzinzisa umlenze.
I-Hypercalcemia - Njengoko amathambo aphulwa ngumhlaza, ikhalsiyumu ikhululwa egazini. Oku, kungakhokelela ekubambeni, ukukhathala, ukoma okwedlulele, kunye nobuthakathaka obuthathaka. Xa i- hypercalcemia engathandekiyo ebangelwa ngumhlaza ingakhokelela ekuphelelweni kwezintso, ku-coma, nokufa. Unyango lokuqala luquka ukwenziwa kwe-IV kunye ne-bisphosphonates. Ngamanye amaxesha amanye amayeza, njenge-calcitonin, i-gallium nitrate, okanye i-mithramycin ingasetyenziswa. Ukuba i-hypercalcemia iyingozi, i-dialysis yenye enye inketho.
Ukulahleka kokuhamba - Impembelelo yomsebenzi owehlayo ohambelana nokubuyiselwa kwiphulo awukwazi ukugxininiswa ngokwaneleyo. Ngezifundo ezitshilo ukuba umzimba unokudlala indima ekusindeni, nangomdlavuza webele we-metastatic, nantoni na eyenza ukunciphisa amandla akho okusebenza ngokunyanisekileyo ukuqwalaselwa ngokucophelela.
Impumelelo ebomini yobomi - Phakathi kweentlungu ezinxulumene namathambo e-boneastases, kunye nokungahambi kakuhle kwezinto ezinxulumene neziqhekeza okanye umngcipheko weeqhekeza, i-boneastases yamathambo inganciphisa kakhulu umgangatho wobomi. Ngombulelo, njengoko kuphawuliwe ngasentla, kukho iindlela ezininzi zokwenza unyango.
Ukuxhamla xa umdlavuza webele usasazeka kwiThambo
Ukugxekwa kwesifo somhlaza esiswini esasasazeka kuphela kumathambo kungcono kunokuba iidlers eziye zasasazeka kwezinye iindawo zomzimba. Ukunyangwa kwethambo lwe-boneastases ngamanye amaxesha kunokulawulwa kwesi sifo ixesha elide. Umyinge jikelele wokuphila komdlavuza webele we-metastatic iinyanga ezili-18 ukuya kwezi-24, kunye neepesenti ezingama-20 kuphela zabantu abaphila kwiminyaka engaphezu kwemihlanu. Kubalulekile ukuba uqaphele kwakhona, nangona kunjalo, ukuba ukuhlwayelwa komzimba kubhetele kubantu abanesifo seethambo kuphela kwaye baninzi abasinde kwixesha elide lomdlavuza webele.
Ngaphantsi kwi-Bone Metastase ngenxa yeCarcer Breast
Xa umhlaza wesifuba usasazeka kumathambo unokusongela, ingakumbi xa le ndlela ufumanisa ukuba umhlaza wakho uye waphinda kwaye unomdlavuza webele wesisu.
Nangona i-boneastas i-boneastases iqinisekisa ukuba umdlavuza wakho usasazeke kwaye unokuba buhlungu, kukho iindlela ezinokubakho zonyango ezifumanekayo, kunye nokunyango olongezelelweyo olwenziwe ngolu vavanyo kwizonyango zonyango .
Imithombo:
Coleman, R. Impact ye-Bone-Targeted Treatments kwi-Skeletal Morbidity and Survival kwi-Cancer Breast. I-Oncology (Williston Park) . 2016. 30 (8): i-pii: 218394.
Das, T., noS S. Banerjee. I-Radiopharmaceuticals kwi-Metastatic Bone Pain Palliation: Iinketho ezifumanekayo kwiSiklinikhi seKliniki kunye nokuThathaniswa kwazo. I-Metastasis yeZikliniki kunye neNzululwazi . 2017. 34 (1): 1-10.
National Cancer Institute. I-Meta-Analysis ifumana iingenelo ze-Adjuvant Bisphosphonates kwi-Postmopaopausal Breast Cancer. 09/09/15. https://www.cancer.gov/types/breast/research/adjuvant-bisphosphonates-meta-analysis
UOsullivan, uG., uCarty, F., noC. Cronin. Ukucingwa kweMetastasis yeT Bone: Isibuyekezo. I-World Journal ye-Radiology . 2015. 7 (8): 202-211.