Kunopi Kenza Yemapfupa Inopararira?

Yakawanda Nyaya Dzakabatana Dzepakati Chechirwere Chechirwere cheMatastases

Kana wakamboonekwa kuti une kenza yemasitrasi, kana kuti iwe wakanga uine kenza yepabonde kare kare uye uri nezviratidzo zvitsva, zvinongoitika kuva nemibvunzo. Zvimwe zvezvinhu zvaungangodaro zvinotsvaga zvinosanganisira:

• Ko kenza yemvere inopararira kupi?
• Ndezvipi nzvimbo dzinowanzozivikanwa dzemasamaseya echepabonde?
• Kazhinji kenza yemazamu inoenda kunzvimbo idzi dzomuviri?

• Ndezvipi zviratidzo zvinofanira kuziva?
• Ko kenza yemazamu inobatwa sei kana ichipararira?

Kukosha kweKana Breast Cancer Metastases

Nokuti inenge 85 muzana yevakadzi, kupararira kwekenza kune dzimwe nzvimbo dziri kure dzomuviri (kure nemasitasi ) kunoitika makore uye zvichida kunyange makumi emakore mushure mekutanga kuongororwa. Kune vakasara gumi kusvika ku15 kubva muzana yevakadzi, zvipatara zvakasara zviripo kare panguva yekuongororwa.

Kanzera yepabonde inogona kudzokera kune imwe nzvimbo (mukati memazamu), munharaunda (mune lymph nodes mu-armpit, pamusoro pemirasiro, kana pakati pebhokisi) kana kure. Muhurukuro ino, tichakurukura zvikuru nezvemakondombera akapararira kune nzvimbo dziri kure.

Mastastases ari kure kubva mukenza yepamuviri inokosha zvikuru pakuti ndeyemhosva yeanenge 90 kubva muzana yevakafa kubva pachirwere. Izvo zvakati, kunyange kana iwe uchikurira metastases kune imwe yezvivako izvi, kurapwa kuripo; mishonga inogona kuwedzera upenyu.

Kansa yepabhesi ine mastasti kure kure inonzi kanase yematenda (MBC) kana kuti ganda 4 kanama yepamu . Kana iwe uchiziva nhamba yeTMM nokuda kwekenza yepese , izvi zvinotarisa kune kenza iyo M1 (pane M0 iyo inoreva kuti hapana mastases.) Chirwere chinoshandiswa chinogona kunge chiine nhamba yeT (ukuru hwemuviri) uye N (nhamba ye lymph nodes iyo yakanaka uye iyo iri kupi).

Kunopi Kenza Yemapfupa Inopararira?

Chirwere chepabonde chinogona kupararira kusvika munharaunda chero ipi zvayo yemuviri asi zvinowanzopararira kune dzimwe nzvimbo kupfuura vamwe. Cancers inogona kupararira kuburikidza neropa kana kuti kuburikidza ne-lymphatic system, uye naizvozvo inowanzopararira kune zvikamu zvine ropa rinokosha kana lymphatic flow. (Unogona kudzidza zvakawanda pamusoro pekuti kanaya inopararira sei .)

Nzvimbo dzomuviri umo kenza yepamuti inopararira inogonawo kusiyana maererano nehutano chaihwo hwekenza yemazamu uye hormonal / HER2 chimiro. Nzvimbo dzakawanda kwazvo dzinosanganisira:

• Lymph nodes
• Mabones
• Makomba (kusanganisira pleural effusions)
• Chiropa
• Ubongo
• Peritoneal metastases (ne lobular carcinoma)

Chinyorwa chekutanga chekutanga chemasastases chakatariswa mumudzidzi wekudzidza muna 2013. Vakadzi vane chirwere chepabonde chepakutanga vakaongororwa kuti vaone kuti ndeipi nzvimbo yakawanda yekutanga nzvimbo ye metastasis nekenza yavo. Kuparara kwaiva:

• Mafupa - 41 muzana
• Makomba - 22 muzana
• Chiropa - 7.3 muzana
• Ubongo - 7.3 muzana
• Mimwe nzvimbo dzaiva nzvimbo yekutanga yemasastasi kune vanhu vakasara

Inosvitsa lobular carcinoma inowanzova netsika yakasiyana-siyana yemasitasitini kupfuura kenza yemahara. Mune imwe yedzidzo, inenge 70 muzana yevanhu vane metastases kubva ku lobular carcinoma yakanga ine peritoneal metastases.

Kune chikamu chetatu chevakadzi (uye varume, sezvinoita varume vanowana kenza yemverewo zvakare ), kenza inopararira kune dzimwe nhengo panguva imwechete. Ngatitarisei nzvimbo idzi dzakajairika, pamwe chete nedzimwe nzvimbo dzisina kufanana dzinogona kupararira nekenza yemazamu. Kunyange zvazvo zvirongwa zvekurapwa kwekenza yemasitema yemamashana zvakafanana pasinei nokuti kenza yakapararira, kune zvimwe zvirwere zvinoshandiswa kune dzimwe nzvimbo dzemasastasis pamwe chete.

Kenza Yemawere Inopararira kuLymph Nodes

Kupararira kwekenza yemazamu kune lymph node hakurevi kuti kenza yemazamu inoshandiswa. Kunyange kana kenza inowedzera mumakirini emakumbo (zvichida lymph nodes pedyo nefupa) inonzi inodzokorora zvakare uye kwete kudzoka kure .

Tinounza kupararira kune lymph nodes nokuti vanhu vazhinji vanovhiringidzika kana vanonzwa vane lymph node-positive kenza yemazamu . Muchiitiko ichi, mushumo wehutachiona ungati: "Kenza yemasitrasi yepamuviri kune lymph nodes" asi sezvakataurwa, izvi zvinoreva kuti kenza yemazamu isimba. Kenza yepabonde iyo yakapararira kune lymph nodes inogona kuva danho rekutanga, chigadziko chechitatu, kana chigadziko IV.

Kanama Yemawere Inopararira Kumakona (Bone Metastases kubva kuBrazil Cancer)

Nzvimbo yakakurumbira yemaserasi echepakati emuchembere, inowanikwa mumapfumbamwe makumi manomwe evanhu evanhu vane kenza yemasasa, ndiyo mapfupa. Pamapfupa ayo kenza yepamuti inopararira, nzvimbo dzinowanikwa dzakawanda dzinosanganisira musana, mbabvu, mapepa, uye mapfupa marefu emakumbo nemakumbo. Bone metastases inofanirwa kuva nehuwandu hwakanaka hwehutano hwemastastine kune dzimwe nzvimbo dzomuviri.

Bone metastases inogona kuwanika pane scan yakaitwa kutarisa metastases (kana pasina zviratidzo zviripo) kana kuwanika pane zvidzidzo zvinoitwa kuongorora zviratidzo zvakadai sekurwadziwa. Vamwe vanhu havazivi kuti vane bone masetasis kusvikira vasangana nekuputsika nematambudziko mashoma. Kuputsana kuburikidza nechikamu chepafu chinokonzerwa nekenza metastases kunonzi pathologic fractures .

Kune mhando dzakawanda dzehutano hunowanika pamasitoshe emapfupa kubva pamukamu webonde, uye zvimwe zveizvi zvinogona kudzora chirwere kwenguva yakati. Radiation therapy inowanzoitwa apo kunoridzirwa nokukurumidza kunodikanwa, uye kunogona kuva yakakosha pakurapa kweropa remasastases. Zvinodhaka zvakadai seStrontium 89 zvinosanganisira chidimbu chemavara anoiswa kune imwe ikemikari inopindwa muropa. Aya marapirwo, zvakasiyana nemishonga inonzi radiation, inowanzobudirira kana munhu ane zvakawanda kana kuti akapararira masitema emaspafu. Dzimwe nguva kuvhiyiwa kunodiwa kuti ugadzikane pfupa rakaputsika kana riri pangozi yekuputika nemhaka yemasisita.

Mumakore achangobva kupfuura, mishonga inogadzirisa-mapfupa yakawedzerwa kune mishonga inowanikwa pamasitema emapfupa uye inogona kuva yakabudirira.

Bisphosphonates yakadai seZometa (zoledronic acid) haisi kungoshanda chete pakudzivirira marwadzo kubva mumasitasitini asi inoita seine zvinoshandiswa zvekare. Iyi mishonga inogonawo kuderedza mukana wekuwedzera mapfupa emasasa nekuvandudza kupona. Mishonga Xgeva (denosumab) inogonawo kuva yakashanda mukurapa mapfupa emasasa apo ichivandudza kupona.

Kenza Yemawere Inopararira kuChiropa (Chiropa Metastases kubva kuBeast Cancer)

Chirwere chepabonde chemasamera chiropa kune chiropa chinowanikwawo.

Chiropa chinogona kunge chiripo pasina zviratidzo uye chinowanzowanikwa pane zviyero zvakadai sePET scan. Dzimwe nguva izvi zvinoshushwa zvinenge zvichifungidzirwa zvichibva pane zvisina kumira chiropa chekuedza . Zviratidzo zvechiropa zvinogona kusanganisira kurwadziwa kwepamuviri, kushungurudza, kutengesa (izvo zvinogona kuva zvakanyanya) uye jaundice , kuputika kwechivara kweganda uye vatsvene vemaziso.

Mishonga yakawanda yemakirini emasita ( semakemikari , hormonal therapies, uye zvinorapwa) zvinogona kuderedza zvirwere izvi, asi sezvo chiropa ichiita se "detoxification" pakati pemuviri, zvinogona kuva nehutano hwakanaka, uye dzimwe nguva masastases eropa anoderedza kukwanisa kutsungirira chemotherapy.

Kurapa kwechirwere kuchiropa kunogona kuderedza marwadzo uye kunogona kuwedzera kupona. Dzimwe nguva dzimwe mishonga dzinogona kushandiswa kubata chirwere chechiropa chinosanganisira chirwere, radioembolization, chemoembolization, radiofrequency ablation, kana stereotactic body radiotherapy.

Kenza Yemawere Inopararira Kumapopu (Mhembwe Metastases kubva paBeast Cancer)

Kungofanana neropa rakanatswa nechiropa, ropa rinopinda mumapapu, zvichiita iyi nzvimbo yakawanda yemasastasis.

Mastastates angasungirirwa angangodaro akafungidzirwa zvichibva pane scan, iyo inogara ichiratidza nzvimbo shomanana dzemasastases (zvakasiyana nekenza yemapapu, somuenzaniso, iyo inowanzoita seiri imwe huru huru). Chiratidzo chinowanzopfupi ndiko kupererwa kwemhepo, izvo zvingava zvinyoro uye zvinongoitika chete nekurovedza pakutanga. Zvimwe zviratidzo zvinogona kusanganisira kuora kunoramba kuripo kana kurwadziwa nekufema .

Mukuwedzera kupararira kumapapu, kenza yemasasa inokonzera kazhinji inokonzera mhemberero-yekuvaka-mvura yemvura mukati pakati pe membrane (the pleura ) iyo inoita mapapu. Pleural effusions inoitika kwete chete apo kenza yemazamu inopararira kumapapu, asi nekupararira kune lymph nodes munzvimbo iri pakati pemapapu ( medi mediinum ). Iyo inenge yakasviba inogona kunge iine bhendi (pasina kenza dzemasero) uye yakabatana nekuchinja kwezvokuvhiringidza, kana kuti panzvimbo iyo, ine kenza masero ( inonyangadza mutsindo ).

Mastastases anovhenekera anowanzobatwa nehutano huripo hwekenza yemasitema, asi remishonga inonzi radiation inogona kubatsira, kunyanya kana metastases inokonzera kugadzikana mumhepo (bronchi).

Pleural effusions inogona kunge yakakura zvikuru uye inokonzera kukurumidza kufema kufema. Fluid inowanzobviswa nekuisa sindano kuburikidza nemadziro echifuva uye mukati mechumity cavity kubvisa mvura. Zvinosuruvarisa, kushingaira kwekuchema kunowanzodzoka zvakare. Kana izvi zvikaitika, shunt inogona kuiswa, kana kuti pleurodesis inokurudzirwa (iyo nzira iyo mavara e pleura inopera pamwe chete kuitira kuti mvura isingagoni kuunganidzazve).

Kenza Yemawere Inopararira kuBongo (Brain Metastases Kubva muKenza Chepabonde)

Kansa yepabheti inopararira kune uropi inenge 10 kusvika ku15 muzana yevanhu vane kenza yepamusoro yepabonde. Maitiro ehutachiona anowanzoonekwa kune vakadzi vane HER2 vane tumarara dzakanaka uye kenza yepamusoro yepabonde katatu , nehutachiona hwehuropi hunoitika munenge chetatu chevanhu vane HER2 / neu positive mazamu emukaka anononoka.

Zviratidzo zvehutano hwemashupiti zvinowanzobatanidza misoro, maziso anoonekwa, chizungu kana kuti kugumburwa (dzimwe nguva kubatwa chiratidzo chekutanga). Dzimwe zviratidzo zvinogona kusanganisira kusimba kune rumwe rutivi rwemuviri, zvinetso nekubatana, kana humwe humwe hunochinja.

Kusiyana nemitambo kune dzimwe nzvimbo, kurapa kwakadai sechemotherapy uye zvakananga kurapwa kazhinji hazvigoni kupikisana neuropi metastases nemhaka yeropa rechechi. Ropa-uropi hunopfigira isimbi yakasimba ye capillaries yakagadzirirwa kuchengetedza uropi kubva kune chepfu (yakadai sechem chemotherapy).

Kurapa kwemasimasi kunowanzobatanidza steroids kuti kuderedze kubwinya mukati meuropi. Uropi hupi hupi hunogona kushandiswa kugadzirisa zvirwere, kana kana imwe chete kana mashoma "mavara" emasastasis aripo, stereotactic body radiotherapy ( SBRT ) inogona kushandiswa mukuedza kuparadza metastasis zvachose. SBRT, inozivikanwawo seCyber ​​knife kana gamma knife ndiyo nzira iyo mizinga yakakura yemayirasi inopiwa kune imwe nzvimbo uye yakajeka nzvimbo yezviviri.

Pasina Purogiramu Inowanzobatanidzwa NemaMetastases Akare

Sezvakataurwa pamusoro apa, kenza yemazamu inogona kupararira kusvika munharaunda ipi zvayo yemuviri. Dzimwe nzvimbo dzisina kufanana (kunze kwelobular carcinoma) yemasastasis dzinosanganisira:

• Bhoora marora - Kanzera yepabonde iyo yakapararira kune pfupa inowanzobatanidza mafupa pamwe chete (bone marrow inowanzobudiswa mumapfupa angangodaro ane chokuita nekenza yemvere). Zviratidzo zvinogona kusanganisira sero rechena rega rega rega kana kuti tsvuku dzeropa rekuverengeka risingawirirani ne chemotherapy.
• Peritoneal metastases - Munharaunda mbiri kubva kune zvitatu zvevanhu vane metastatic lobular carcinoma vanoita peritoneal metastases.
• Chifuva chakatarisana
• The ovary
• The adrenal glands
• The pancreas
• Ganda uye zvinyoronyoro
• Nzvimbo dzisina kujairika dzematastases dzinosanganisira nzvimbo dzinobva muchibereko kusvika kuziso.

Nzvimbo dzeMetastase uye Mhando dzeChancer Cancer

Sezvakataurwa pamusoro apa, HER2 zvakanaka uye katatu zvisina kunaka mazamu emukenza zvinowanzopararira kuuropi uye nechiropa, asi estrogen yakagadzirisa zvironda zvinowanzopararira kumapfupa. Lobular carcinomas vane tsika yekupararira kumimba.

Nei Kenza Inopararira?

Hatizivi kuti nei kenza inowedzera uye inopararira , uye kuti inogona kuonekwa sei yakarara kwenguva refu uye kunyange makumi emakore ndokudzoka zvakare. Sezvo maestastas ari kure ndiyo inokonzera rufu rwevamwe kanzira, kutsvakurudza kwakawanda kuri kuitwa kutarisa kuti nei metastases inowanikwa, uyewo nzira dzinogona kudzivisa kupararira kwekenza.

Kurarama neMatastatic Breast Cancer

Kana wakamboonekwa kuti une kenza yemasitamende, unenge uchinzwa uchitya uye zvichida uchinetseka nemashoko ose awakapiwa. Chirwere chematenda cheMetastatic chakasiyana nechepakutanga kwekenza yemazamu munzira dzakawanda. Taura neshamwari dzako nemhuri. Vanhu vazhinji vanozviona zvichibatsira kuti tibatanidzwe mumapoka ekutsigira kana munharaunda inotsigirwa yakagadzirirwa kune avo vane kenza yemasita. Dzidza zvose zvaunogona pamusoro peswere chako. Mishonga, kunyange iyo yekenza yemasasa, iri kuvandudza, uye kupona kuri kuwedzera. Chimwe chezviito zvakakosha iwe unogona kutora ndechokuti iwe uve mutongi wako mukutarisa kwekenza yako . Pane zvakawanda zvaunosarudza kuita pamusoro pezvokurapa zvinosarudzwa, uye iwe chete unoziva kuti ndezvipi zvasarudzo zvakakunakira iwe.

Kune Shamwari uye Mhuri

Kana mudiwa wako ave akaonekwa kuti ane metastases iri kure iye (kana kuti iye) zvichida akaora mwoyo. Kana iye kana aine kenza yepazamu zvisati zvaitika, iyo yakasiyana nenyaya yechipiri pfupi. Mudiwa wako achada rubatsiro rwako kuti ave akagadzirira kutarisana zvakare zvakare.

Zvakakosha kukurumidza kuratidza kuti zvirongwa zvinoshandiswa pamakemikari emuti wemasitendi zvakasiyana, uye uzivi hwekurapa kwekenza yepamusoro yepabonde yakasiyana zvikuru kubva kune iyo yekutanga kwekenza yepabonde. Nenguva yekutanga yekenza yebonde, chinangwa chinowanzova sehasha kana zvichibvira kuderedza mukana wekuti kenza ichadzoka. Nekenza yemasitatimendi yepabonde, zvisinei, filosofi kazhinji inoshandiswa kushandisa zvishoma zvishoma zvekurapa inodiwa kuitira kuti utungamirire chirwere chacho. Kurapa chirwere ichi nechisimba hakugadziri kuponesa, asi kunowedzera migumisiro uye kuderedza hupenyu hwehupenyu.

Kushayikwa kwekupararira kwakapararira kwekusiyana uku kwave kwakakonzera nguva dzakawanda dzinorwadza mupfungwa kune avo vanorwara nekenza yemazamu ematenda. Tora nguva yekudzidza pamusoro pezvinhu zvisingatauri kune mumwe munhu ane kenza yemukomana yemasastatic .

> Sources:

> Berman, A., Thukral, A., Hwang, W., Solin, L., naN. Vapiwala. Nharaunda uye Maitiro Emasetasisipo Ari Kure kune Varwere Vanotanga Kusangana Nechirwere Chepabonde Mushure meBast Conservation Treatment. Clinical Breast Cancer . 2013. 13 (2): 88-94.

> Coleman, R. Impact yeT Bone-Targeted Treatments paSkeletal Morbidity uye kupona muKenza yeAsawere. Oncology (Williston Park) . 2016. 30 (8): pii: 218394.

> Inoue, M., Nakagomi, H., Nakada, H. et al. Nzvimbo Dzakasiyana-siyana dzeMetastasia muIndasive Lobular Carcinoma: A Retrospective Cohort Chidzidzo cheMastastatic Breast Cancer. Chirwere chepabonde . 2017 Jan 20. (Epub mberi kwekudhinda).

> Yeung, C., Hilton, J., Clemons, M. et al. Estrogen, Progesterone, uye HER2 / neu Receptor Kuwirirana Pakati Pekutanga uye Metastatic Breast Tumors - Kuongorora. Cancer Metastasis Reviews . 2016. 35 (3): 427-37.