Kurapa kweBrain Metastases Kubva paKana Breast Cancer
Chii chinoitika kana kenza yako yepamu inopararira kuuropi yako? Dzimwe nguva, hutano hwehupi hunowanikwa apo kenza yemazamu inotanga kuongororwa, asi nguva yakawanda yenguva, uropi hutachiona hunoitika sekudzoka kure kwekenza yepabonde yepakutanga yakarapwa munguva yakapfuura. Ndezvipi zviratidzo zvinogona kuitika, uye ndeapi nzira dzokurapa dziripo kana kenza yako yepamu inopararira kuuropi yako?
Pasi pose, hutachiona hunokonzerwa nehupi hunowanikwa mumapfumbamwe kusvika ku24 kubva kuzana zvevakadzi vane kenza yemasasa. Sezvo kupona kuri nani, zvakadaro, nhamba iyi inotarisirwa kuwedzera.
Tsanangudzo uye Zvakaitika
Uropi ndeimwe yenzvimbo dzinowanzowirirana iyo kenza yepamu inopararira , pamwe nemapfupa , mapapu, uye chiropa . Kana kenza yemazamu inopararira kune uropi inofanirwa sero 4 kana kenza yemasitamende yepabonde. Kunyange zvazvo zvisingachagadziriswi panguva ino, inorapwa, uye kurapwa kunogona kuvandudza zviratidzo, kubatsira nehuhu hwehupenyu, uye dzimwe nguva kuponesa.
Apo kenza yemazamu inokonzera kuuropi iyo ichiri kenza yemvere. Kana iwe waizotora muenzaniso wehuta kana masasa muuropi, angave ane kenza yemazamu, asi kwete masero europi. Utachiona hwemasimba hauna kunzi "kenza yehupfungwa" asi panzvimbo ye "kenza yepamusoro yepabonde kuuropi" kana "kenza yemazamu neuropi metastases." Nokudaro, kurapwa ndeiyo inoshandiswa pakukura kwekenza yepamu, kwete iyo inoshandiswa mukenza hwepfungwa.
Munguva yakapfuura, metastases dzeuropi dzaiwanzoonekwa sechirwere chechirevo chisina kunaka uye chinangwa chekurapa chaive "chinopisa," zvinoreva kuronga zviratidzo asi kwete kuedza kuporesa tsvina. Mumakore achangobva kupfuura, pfungwa ye "oligometastase" yakatariswa. Izvi zvinoreva kuti, kana munhu ane mastasiti imwechete kana mashoma, uye pasina maitiro anokosha kune dzimwe nzvimbo dzomuviri, nzira yekurapa kubvisa zviratidzo zvinogona kuedzwa.
Mune mamwe mazwi, apo kurapwa kunowanzosimbiswa, kunyanya kune avo vane maitiro akawanda kana kuti akapararira, kune vamwe vanhu, nzira inogona kunge yakagadziriswa inogona kunge yakasarudzwa.
Zviratidzo
Pane zviratidzo zvakasiyana-siyana zvinogona kuzivisa kuvepo kwehutano hwemagetsi. Dzimwe nguva hapana zviratidzo, uye izvi zvinowanzowanikwa apo kuongorora kwekufungidzira, kwakadai sePET scan kana brain MRI yakaitwa. Apo zviratidzo zviripo zvinogona kusanganisira:
- Musoro wemusoro: Musoro wepamusoro pamusana pehutachiona hwemagetsi hunogona kunge hwakafanana nehutano hwemusoro kana kuti misoro yepamusoro, asi inogona kuendeswa kune dzimwe zviratidzo zvehupenzi pamwe chete (ona pasi apa). Mune kumwe kuongorora, misoro yepamusoro yakanga iripo muzana 35 muzana yevanhu apo maitiro europi akawanikwa. Musoro wepamusoro wakabatana nehutachiona hwemagetsi hunowedzera kuipa nekurara pasi, zvakanyanya mangwanani kana kuti mushure mokunge uchinge wanyarara, uye zvakanyanya kukura nekukanganiswa, kunyunyuta, kana kutakura pasi nekufamba kwechirwere. Izvozvo zvakati, zvingava zvakaoma kusiyanisa pakati pe "zvinoti" musoro musoro uye izvo zvichienderana nemasisita pasina kufungidzira zvidzidzo.
- Kuputika: Kuputika (kana kuti pasina kushungurudza) kwaiva chiratidzo chechipiri chinowanzoonekwa cheuropi metastases mune imwe chidzidzo. Izvo zvinogona kuitika kamwe-kamwe pasina chekuita chisati chaitika uye kazhinji kacho chakaipa mushure mokuvata pasi uye mangwanani. Kuputika pamusana pehutano hwemagetsi kunowedzera kuipa uye kuwedzerwa nguva nenguva.
- Kushaya simba kwerumwe rutivi rwemuviri, kupera, kana kusungirirwa mumagumo: Hemiparesis, kushaya simba kana kuparara kweimwe rutivi rwemuviri, ndiyo yechitatu inowanzoonekwa neurological chiratidzo chehutano hwemagetsi mune imwe chidzidzo.
- Zviratidzo zvinoshanduka : Matambudziko akadai seakaratidzwa kaviri, maonero asina kunaka, kuona chiedza chechiedza, kana kurasikirwa kwemaonero kunogona kuitika.
- Kugumburwa: Kugumburwa kunogona kuva tonic-clonic (grand mal) umo muviri wose unodedera uye munhu anorasikirwa nokuziva, kusagadzikana zvishoma, mune imwe nhengo, yakadai sesimba rinodedera, kana mamwe marudzi ekukundwa, somuenzaniso, iyo munhu anoita seanotarisa kuti aende kunzvimbo isina kuona.
- Kurasikirwa: Kurasikirwa kunogona kutanga kuonekwa sekunonoka, nekusvika mumatareji kana kuti fender benders sezviratidzo.
- Kuchinja kwepfungwa: Unhu hunochinja, unhu hunochinja, mafungiro echinje, kana kutadza kutonga kunogona kuitika.
Njodzi Zviitiko / Zvinokonzera
Hapana anoziva kuti sei vamwe vanhu vachikudzidza uropi hwemagetsi uye vamwe havasi. Isu tinoziva nezvimwe zvinokonzera njodzi, zvisinei, izvo zvinofanotaura kuti vanhu uye zvipi zvingave zviri nyore kupararira kuuropi. Maitiro ehutano anowanzove ari madzimai maduku ane kenza yemazamu , uye izvi zvinowanikwa zvakanyanya kune avo vanoongororwa vasati vava nemakore makumi matatu nemaviri. Mishonga inowanzopararira kune uropi inosanganisira avo vane chikwata chepamusoro chepamusoro, avo vane HER2 positive uye estrogen receptor negative, uye iyo iyo yakaipa katatu.
Maitiro emakumbo anowanzoitika kune avo vane matumbo makuru (akareba kupfuura 2 cm muupamhi), pamwe chete nevanhu vane lymph node dzakanaka panguva yavanotanga kuongorora. Nguva shomanana pakati pepakutanga kenza yemusana-kutanga uye kudzoka kunobatanidzwawo nehuwandu hukuru hwehutano hwemagetsi.
Kuziva
Kufungidzira zvidzidzo zvinonyanya kuonekwa neuropi metastases zvinosanganisira uropi MRIs uye PET kuongorora. CT kuongorora kwemusoro kunogona kushandiswa kune avo vasingakwanisi kuva neMRI yakaitwa (somuenzaniso, avo vane mapemakers), asi CT maitiro haatombobudiriri mukugadza kuvapo kwehutano hwemagetsi. Kuongororwa kunowanzoitwa kubva pakufungidzira kufungidzira uye nhoroondo yekenza yemazamu, asi chidimbu chinogona kudiwa. Kubvira sezvo mamiriro ekugamuchira zvinogona kuchinja (kana chirwere chiri estrogen receptor, progesterone receptor, kana HER2 positive) nemasitosita, biopsy inogona kudiwa kusarudza nzira yakakodzera yekurapa.
Nzvimbo dzakajairika dzehuropi metastases ndiyo cerebellum (chikamu cheropi chinotarisa kuenzanisa) uye lobes inotangira . Inenge hafu yevanhu vakawanikwa nehutachiona hwehupombwe kubva pamukamu webonde kuchava nemasipasi akawanda aripo.
Kurapa
Kurapa maitiro europi metastases kunogona kuputsika muhutachiona hwehutachiona, iyo inobata kenza mukati pose mumuviri, uye mishonga yemunharaunda, iyo inonyatsopindura maitiro europi. Mukuwedzera kune mishonga inoshandiswa kugadzirisa kenza pachayo, steroid inowanzoshandiswa kuderedza uropi kuputika, uye dzimwe nguva inogona kuderedza zvakanyanya migumisiro.
Chimwe chinetso chikuru mukurapa uropi hwemashupusi ndechokuti mishonga yakawanda haigone kupindira muropa reropi. Ropa-uropi hunopfigira isimbi yakasimba ye capillaries yakagadzirirwa kuchengetedza chekisi kubva muuropi. Zvinosuruvarisa, zvinoshandawo pakuchengetedza chemotherapi mishonga, nemamwe mishonga kunze kweuropi. Dzidzo iye zvino iri kutarisa nzira dzekuwedzera kukwana kwehupombwe-yeropa.
Mukuwedzera kune steroid uye zvirongwa zvehutachiona kana zvemunharaunda zvehutano hwemauropi, zvakakosha kutarisa zvimwe zviratidzo zvine chokuita nekenza yemasitasi, kukonzera kwakadaro, kurasikirwa kwechido, kushushikana, nezvimwewo. Your oncologist inogona kukurudzira kutarisa kwekutarisa , uye izvi zvinogona kutyisa kana iwe usingazivi nemunda. Kunyatsotarisirwa hazvifananidzi nehutachiona, asi inzira yekurapa inoshandiswa kuratidzira zviratidzo zvepanyama, zvepfungwa, uye zvepamweya zvinoenda pamwe nekuongororwa kwekenza. Kuchengetedza kunobatsira kunogona kubatsira kunyange nemakumbo ekurapa.
Zvimwe Zvisarudzo
Nzira dzokugadzirisa zvirongwa zvinoshandiswa kugadzirisa kenza yako yepabonde pasinei nokuti iri kupi mumuviri wako. Ungave uine kana usina maitiro ekurapa kwehuropi hwako, maitiro ekurapa kazhinji anowanzorapa. Zvirongwa zvekugadzirisa zvirwere zvekenza yemasasa zvinogona kusanganisira:
Chemotherapy
Chemotherapy inowanzoshandiswa pakutsvaga kenza yemasasa, kazhinji kushandisa madhiragi akasiyana-siyana kupfuura iwe wakanga uine chemotherapy kare. Kune zvakawanda zvakasiyana-siyana zvingasarudzwa kana "mitsara" yerapi inogona kushandiswa. Sezvakataurwa, mazhinji chemotherapi anoshandiswa haapindi mukati meuropi-yeropa, asi kazhinji metastases kune dzimwe nzvimbo dziripo pamwe neuropi metastases. Inogonawo kubatsira kuderedza dambudziko rekuwedzera mamwe maitiro kuuropi.
Hormonal therapy
Hormonal therapies yekemiti yemasitrasi yemamate inogona kukurudzirwa kana bundu rako riri estrogen receptor positive. Kushandiswa kwemishonga iyi kunobva pakuti iwe wakanga uine hormonal therapy kare, uye kana zvakadaro, mishonga ipi yawaitora. Kana kenza yemazamu ichinge ichinge ichinyanya kugadziriswa kuti mamiriro ekugamuchira achinje, somuenzaniso, pane zvekare anestrogen receptor chine tumarara inogona kuva estrogen receptor isina kunaka uye zvakasiyana. Zvinowanzofungidzirwa kuti dai iwe wakanga uri pane imwe saroni inorapwa kana kenza yako yakagadziriswa, kuti chironda chacho chinopesana nemishonga iyoyo. Kusiyana nekusarudzwa kwemishonga yakawanda, tamoxifen uye aromatase inhibitors vanoita sevanopinda muropa-hutano hwepfungwa
Targeted therapies
Mishonga yekusarudzwa kwehutachiona HER2 kenza yakanaka yepamu inobva pane izvo, kana zviripo, mishonga yawakanga uripo apo bundu rako rakagadziriswa. Kufanana neserogen receptor status, HER2 chimiro chinogona kuchinja, kuitira kuti chiremara chaive HER2 chitubu chisati chave chingave chakaipa HER2 kana ichipararira kuuropi uye zvakasiyana. Kune avo vasina kumbobvira vagamuchira HER2 vachida kurapwa, kurapwa naHerceptin (trastuzumab) kana Perjecta (pertuzumab) kunogona kuponesa kupona. Kana uropi hutachiona hunokura apo mumwe munhu ari kutora Herceptin (kana mukati memwedzi gumi nemaviri ekumisa mushonga), chirwere cheT-DM1 (trastuzumab emtansine) chakawanikwa kuti chivandudzire zvikuru kuponesa. Zvinosuruvarisa, HER2 inotarirwa mishonga isingawanzoyambuka ropa-brain brain.
Kusanganiswa kweTykerb (lapatinib) uye Xeloda (capecitabine) inogona kushandiswawo, asi inoratidzika kutungamirira kukudziridza zvishoma nezvishoma nehuwandu hwehutachiona (kunyange zvazvo mishonga iyi inoita seyayambuka ropa reuropi-chiremera). Zvinoratidzika kuti Tykerb inogona kushandira zviri nani kana ichibatanidzwa neXeloda kupfuura apo inoshandiswa yoga.
Clinical trials
Kurwisana kwemishonga inoratidzwa pamusoro apa, pamwe chete nemapoka matsva emishonga yakadai sekuzivikanwa kwemishonga uye muPAR inhibitor, vari kuongororwa mumakiriniki ekuedzwa kwepakati 4 kanzvadzi yepabonde
Sarudzo dzeMunharaunda
Mishonga yemunharaunda ndeye yakagadzirirwa kurapa huropi metastases zvakananga uye inonyanya kurudzirwa kana brainstast metastases iri kukonzera zviratidzo zvikuru, kana kana chete masastases mashoma aripo nechinangwa chokudzora masastases. Apo vazhinji vane metastases varipo, chinangwa ndeche kuderedza zviratidzo (palliative). Zvine maitiro mashomanana chete, kuparadzwa kwemasastase kunogona kuedza nechinangwa chekuvandudza kupona (nechinangwa chokurapa). Kazhinji, zvinonzwika kuti kurapwa kwakanyanya kwepanyika (zvakadai seSBRT uye metastasectomy) kunofanira kufungwa zvikuru kune avo vanotarisirwa kurarama kwemwedzi inopfuura 6 kusvika ku12.
Whole Brain Radiotherapy (WBRT)
Uropi hupi hwehurootherapy hwave husingafadzi mumakore achangopfuura nekuda kwemigumisiro. Inowanzotaurirwa ikozvino kune vanhu vakapararira hutano hwemashupusi huri kuunza zviratidzo zvikuru. Kugadziriswa kwepfungwa, dzakadai sezvinetso neyekuyeuka, kuyeuka nokukurumidza, uye kutaura kwemashoko zvakajeka, uye kunoshungurudza kune avo vanofanira kutsungirira zviratidzo izvi. Sezvo hupenyu hwakanaka hwehupenyu hunova chinangwa chakakosha mukurapa kenza yepamusoro yepamuviri, kushandiswa kweWBRT kunofanira kuongororwa zvakaenzana pamusoro pezvipo uye njodzi. Munguva pfupi yapfuura, kushandiswa kweNamenda (memantine) pamwe chete neWBRT kwave kuwanika kuderedza kusagadzikana kwepfungwa kunowanzoonekwa.
Kuvhiya (Metastasectomy)
Kuvhiya kubvisa imwechete kana kuti mashomanana mashoma (anonzi metastasectomy) yakashandiswa mumakore achangopfuura uye inogona kuwedzera kupona kana yakashandiswa kune vanhu vanozvigadzirira kurongeka (vane maitiro mashoma chete uye mune zvimwewo utano hwakanaka). Kuvhiya kunogona kunge iri nzira yakanakisisa (kupfuura SBRT iri pasi) kwemasimusi makuru (makuru kupfuura 3 cm muupamhi). Kusiyana neSBRT, kuvhiyiwa kunobatsira nokukurumidza izvo zvinogona kuderedza uropi kuputika. Kune, kunyange zvakadaro, mungozi mukuru wekuvhiringidza kwepfungwa, uyewo pangozi ye "tumarara spill" (kupararira kenza masero kuburikidza neuropi) nekuvhiyiwa.
Stereotactic Body Radiotherapy (SBRT)
Iyo inonziwo "Cyberknife" kana "gamma knife," steroticothe body radiotherapy kana SBRT inoshandisa mizinga yakakura yemirairo kuenda kunzvimbo duku yezvigunwe kuedza kupedza masitasti. Inowanzoshandiswa kana maitiro mashomanana chete aripo, asi dzimwe nzvimbo dzakabata vanhu vane maminisita gumi panguva imwe. Iyo nzira inogona zvakare kudzokororwa kuti iite mamwe maitiro anobatsira kana aripo kana anoitika kwenguva. SBRT inogona kuva sarudzo iri nani kupfuura kuvhiyiwa kwemasastases iyo yakadzika muuropi, kana munzvimbo dzisina kunaka apo kuvhiyiwa kunokonzera kukanganisa kwakanyanya kune utano hwehutano hwakanaka. Inonyanya kubudirira nematokisi maduku, uye kuvhiwa kunogona kuva sarudzo yakanaka ye metastase yakawanda kupfuura masendimita matatu paupamhi. Ikoko kunononoka kuderera kunzwisisana kunoonekwa neSBRT kupfuura nehupi hwehutano radiotherapi, kunyange zvazvo mamwe emigumisiro, yakadai sedhiation necrosis, inogona kuitika.
Zvimwe Zvingaita Zvimwe
Zvimwe zvinogona kurapa maitiro europi zvisati zvave zvakasimbiswa zvinosanganisira radiofrequency ablation (RFA) uye hyperthermia.
Metastases muZvipfuura Chimwe Chikamu
Kunyange munguva yakapfuura, kurapwa kwemuropi hutano metastases kwaiwanzofungidzirwa dai pakange pasina dzimwe nzvimbo dzemasastasis, vamwe vanotenda kuti kurapwa kweiligometastases mune nzvimbo imwe chete kunogonawo kuguma nekupfuurira kupona. Mishonga yakadai, iyo inonzi "radical radiation" yeairometastatic kansa yepamu, ikozvino iri kuongororwa mumakiriniki ekuedza. Kusvika ikozvino, zvinofungidzirwa kuti, kune vanhu vakasarudzwa zvakasununguka, kusingaperi-kusununguka-kusununguka-kusununguka kusina tsvina kunogona kuve yakakwanisa kune vamwe vanhu vane mashomanana mashoma kune dzimwe nzvimbo zvakasanganisira uropi, mapapu, mapfupa, uye chiropa.
Prognosis
Kufanirwa kwemutiro wekenza yepamu 4 yemazamu yakapararira kune uropi hakusi izvo zvatinoda, kunyanya kana zvikafu zvakakura zviripo. Izvozvo zvakati, hutano hwemashupusi hunokonzerwa nechirwere chemuzamu hunove huri nani huri nani kupfuura hutano hwemashupusi nekuda kwehumwe humwe hutano hwakasimba hwekenza.
Nhoroondo yekare, kupona neuropi metastase kwaingova kwemwedzi mitanhatu chete asi izvi zviri kuchinja. Chidzidzo che 2017 chakawana kuti kuponeswa kwekenza yepese neuropi metastases (dzose dzakasiyana pamwe chete) kwaiva kwemakore anopfuura 2, ane tarisiro yeupenyu hwemakore matatu kune avo vane HER2 matumbo akanaka. Zvirikurumidza kuziva kuti izvi zvichachinja sei nemishonga yakadai saSBRT uye metastasectomy, asi zvidzidzo zvepakutanga zvinopika. Zvakakoshawo kuziva kuti pane vapenyu venguva refu, uye vanenge 15 kubva muzana yevanhu vane kenza yemasasa inowedzera makore 10.
Kutsungirira
Kurwisana neuropi metastase kunogona kuva yakaoma kubva pakuona kwekuve nekenza yemasasa, uye zviratidzo zvingaita. Oncology iri kuchinja nokukurumidza, uye zvinobatsira kudzidza zvose zvaunogona nezvehosha yako kuitira kuti iwe unogona kutora basa rinoita basa rako. Bvunza mibvunzo yakawanda. Tora nguva kuti udzidze kutsvakurudza kenza yako . Bvunza nezvemhando ipi zvayo yemakiriniki inogona kuwanikwa. Panewo kuongororwa kwechiremba kunobatanidza mazano anowanikwa mune vanaki vanofamba-famba vanogona kukubatsira kuziva (kusununguka) kana kune chero keriniki miedzo kupi zvako munyika iyo inogona kushandiswa kune imwe kenza yako. Sezvakataurwa pamusoro apa, zvimwe zvidzidzo zviri kuona kuti kupona kwemazuva mazhinji kunogona kuitika kunyange nemasitosita, asi mazhinji emitambo itsva ichiri kuongororwa kuongororwa. Zvakakosha kuva mupepeti wako mukuchengetedzwa kwekenza.
Zvakakosha kuzvichengeta iwe pachako zvakare. Kumbira rubatsiro, uye bvumira vanhu kukubatsira. Hapana munhu anogona kutarisana nekenza yemasitasi chete. Funga kugovera muchikwata chekutsigira kana kubatanidza mumwe wevanhu vanogara mumatambudziko ekurasikirwa nekenza yepamusoro . Vanhu vazhinji vane kenza yemasasa inokonzerwa nekamuti vanoona zvichibatsira kuwana mapoka anonyanya kutaura nezvekenza yemasita, kune avo vanobatanidza vanhu vane zvikamu zvose zvekenza yebonde. Kune avo vari kutarisana nekenza yemasitemasi emasana nevana vaduku, ramba uchifunga kuti kune mapoka ekutsigira (uye makambi uye kudzorera) kune vana vane mubereki ari kurarama nekenza.
Dzimwe nguva hutachiona hwehupi hwakazara kana huchiendeswa nemasitosita akawanda mune dzimwe nzvimbo. Kunyangwe kana kutapira kenza yako yepabvu hakuchinazve kunzwisisika, kuchengetedza kwepamusoro kudzora zviratidzo zvako uye kukupa hupenyu hwakanakisisa hwehupenyu nenguva yawakasiya ichiri kukosha zvakakosha. Takadzidza kuti kukurukurirana kugadzirisa kuguma kwehupenyu kunetseka nekenza yepamusoro yepabonde inowanzoitika. Zvinosuruvarisa, vanhu vane kenza yakanyanya uye vanochengeta mhuri yavo kazhinji vanofanira kutanga hurukuro idzi.
Kusarudza kumira kurapwa hakurevi kuti uri kusiya. Pane kudaro, zvinoreva kuti uri kusarudza kuva nehutano hwakanakisisa hwehupenyu pakuguma kwerwendo rwako. Kana iri mudiwa wako ane kenza yepazamu, kutora nguva yekuverenga pamusoro pokutarisira wadikanwa nekenza yemasasa inogona kuita kuti mazuva anotevera ave nyore nyore kufamba.
Shoko Rinobva
Kana iwe wakamboonekwa uine hutano hwehuropi, unenge uchinzwa uchitya uye uchinetseka. Maitiro emakumbo anowanzoitika sechirwere chekare chinotevera mushure memakore ekutanga. Kunzwa kuti kenza yako yakadzoka uye haisisiri kurapa inoshungurudza mwoyo.
Zvose zvirongwa zvemaitiro uye zvekugara zvinowanika pakurapa maitiro europi. Apo maitiro mashomanana chete aripo uye kana hutano hwako huri hwakanaka, kurapa metastases nemitemo yakadai seSBRT kana chirwere chinogona kuwedzera kupona. Kana zviratidzo zvako zvakanyanyisa, pane zvimwe zvinhu zvakawanda zvinogona kuitwa kuti uvandudze hutano hwako hupenyu chero nguva yawakasiya.
Rwendo rwemunhu wese rwakasiyana, uye chii chakakunakira iwe chingave chisina kusarudzwa mumwe angaita. Ita chokwadi chekukudza zvido zvako pachako mune zvisarudzo zvaunoita. Gamuchira mhinduro kubva kune vamwe, asi yeuka kuti iyi ndiyo rwendo rwako .
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> Polivka, J., Kralickova, M., Polivka, J. et al. Mystery of the Brain Metastatic Disease in Breast Cancer Patients: Kuvandudzika Kushivirira Mwoyo, Kufanirwa Kwirwere Uye Kurwisa Kuzvidzivirira Pari Pfupi? . EPMA Journal . 2017. 8 (2): 119-127.
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