Chikonzero nei Kurapa Kwemunharaunda Kwakagadziriswa Kushandiswa muMatastatic Breast Cancer
Mazairo uye kuvhiyiwa ndiwo mazano ekurapa, uye saizvozvo akadaro kushandiswa kwevanhu vane kenza yepamusasa yemasasa. Pane kudaro, zvirongwa zvehutachiona-zvirwere zvakadai semishonga inonzi hormonal therapies , chemotherapy , inorapwa , uye immunotherapy, iyo inotarisana nekenza chero ipi inenge iri mumuviri-ndiyo inonyanya kurapa.
Kana zvirwere zvepfupa kumapfupa ako, chiropa, mapapu, kana uropi hazvisi kukonzera zviratidzo, kana kuti hazvisi kukuisa pangozi yezvipingamupinyi zvakadai sekuputsika, zvinowanzobatwa sechikamu chetachiona chetachiona chepachifu chemucheche nemishonga inorapwa .
Ndeapi Maitiro Emunharaunda Anoshandiswa?
Pane dzimwe nguva, zvisinei, apo kurapa kwakananga kwemasimisita nekuvhiya, chirwere chemaawa, kana mamwe marapirwo anobatsira. Zvikonzero izvi zvinogona kushandiswa zvinoshandiswa zvinosanganisira:
- Kudzora marwadzo (zvikurukuru nemasitemu emapfupa)
- Kushambadzira kana kuvhiringidza mumhepo inokonzerwa nemapapu emasipasi
- Bone metastases inokonzera njodzi yekuputsika kana kuti inogona kukonzera kugadzirwa kwemutsipa wepelinha
- Utachiona hwemhando dzezvirwere hunoita zviratidzo zvikuru, zvakadai sevaya vanokonzera misoro, unhu hunochinja, kuvhiringidzika kunoonekwa, kana kukanganisa (ropa-uropi zvinodzivirira zvinodzivirira mishonga yakawanda seyochemotherapy mishonga kuti isapinda muuropi kana musipinha)
- Kuchenesa marwadzo anorwadza kumuranda weganda kana chechifu
- Kurapa kweOligometastase - Oligometastase izwi rinoshandiswa kurondedzera imwechete kana kuti mashoma ematenda echivi. Kazhinji kazhinji kenza yemazamu inokonzera maitiro ekupararira kune dzimwe nzvimbo imwe yemuviri. Muzviitiko zvisingawanzoitiki, kurapwa nokuvhiyiwa, remishonga yehutachiona, radiofrequency ablasion (RFA), kana microembolization inogona kufungwa kune avo vane chete (kana kuti zvimwe zvishoma) zvinoshandiswa mune imwe nhengo.
Kunyange zvazvo izvi zvisingati zvaratidzwa kuvandudza kupona kwevakadzi nevarume vane kenza yemasasa, yakaratidzwa, pazviitiko zvisingawanzoitiki, kuvandudza kupona kwevanhu vane metastase dzine chokuita nezvimwe zvironda zvakasimba.
Bone Metastases
Kurapa kwemasitema emapfupa kubva mumukaka webonde kunobva pauwandu hwemasimisita, zviratidzo zvinokonzera, uye mamwe marapirwo aunogamuchira. Hormonal therapies, zvinotarisirwa kurapwa, uye chemotherapy zvingaita kuti zvose zvideredze zviratidzo kubva pamucheche wehasi zvakapararira kumapfupa.
Asi, dzimwe nguva, izvi zvese zvinorapwa hazvina kukwana. Mishonga yemunharaunda yakadai sedhiraireti inogona kushandiswa pakurwadziwa kusingatongorongedzwi zvakanaka nemaitiro ekuronga, kana kuti kudzivirira kuputika kana musana wechipfupa kudzvinyirira nekuda kwemasitosita emapfupa. Chiremba wako anogona kukurudzira chimiro chemirasi kana mishonga inonzi "bone kugadzirisa avo." Zvimwe zvinosanganisira:
- Radiation Therapy - Radiation therapy inowanzoshandiswa kurapa kenza yemazamu yemapfupa kumapfupa ayo ari kuderedza bone uye kuwedzera ngozi yekuparara.
- Radiopharmaceutics - Radiopharmaceutics mishonga inotakura radioactive particles zvakananga kumapfupa. Muenzaniso ndiwo strontium 89.
- Bati-Maitiro Anoshandura - Kune zvikamu zviviri zvepafupa-zvinogadzirisa zvinoshandiswa zvinogona kushandiswa pfupa remasitema. Zvimwe zvezvi zvinoshandiswa kuvanhu vane osteoporosis pamwe chete. Sezvakaita neradio inonzi radiation, inogona kushandiswa kudzivirira kuputsika, kudzivirira musana wechipfupa kushandiswa, uye kurapa yakakwirira ye calcium muropa nekuda kwekuparara kwemapfupa nemapfupa emastafu (hypocalcemia of malignancy).
Mienzaniso ye bisphosphonates inosanganisira:
- Aredia (pamidronate)
- Zometa (zolendronic acid)
- Boniva (ibandronate)
RANK (receptor activator ye nyukireya factor kappa B) ligand inhibitors inosanganisira:
- Xgeva (denosumab)
Chiropa Metastases
Chiropa chemasimusi hachigoni kukonzera zviratidzo, uye iwe unogona kungoziva izvi nekuda kwekuwedzera kwechiropa chekushanda kweropa kuongororwa kweropa kana nekuwana izvi pamifananidzo yekufungidzira.
Kana zviine zviratidzo, zvirwere zvekune dzimwe nzvimbo zvakadai sokuvhiya kana kuti kupisa kwemaawa zvinogona kufungwa pamwe chete nekurapa kwakanyanya kwekenza yepamusasa yematenda.
Mwenje Metastases / Pleural Effusions
Sezvimwe kune dzimwe nzvimbo dzemasimisita, kurapwa kwemasipisita emapapu kunosanganisira kurapwa kwekenza yemasitema inowanikwa mumatambudziko. Pane dzimwe nguva, mapepa emapapu anogona kukonzera kudzivirira kwemhepo kana kubuda mumhepo.
Kana izvi zvikaitika, remishonga inonzi radiation inogona kubudirira mukuderedza zviratidzo.
Pleural effusions (iyo kuvaka-up yehutachiona pakati pemabhanana akavhara mapapu) inowanzonwa nekenza yemasitamende yepabonde. Kubviswa kwechirwere ichi neine tsono (thoracentesis) kunogona kuderedza zviratidzo zvikuru, asi kubudiswa kunowanzodzoka zvakare. Kana izvi zvikaitika, simbi inogona kuiswa mumumvuri wechipupuriro unobatana nehuputi kusvika kunze kwemuviri wako (kuburikidza nemadziro ako echifuva) iyo inobvumira kuti mvura inenge yakasvibiswa.
Vanhu vazhinji vane stent yakaiswa vanobvumirwa kukonzera mvura yakachena ivo pachavo pamba (pamwe nekubatsirwa nemunhu waunoda) apo ruzivo runowedzera zviratidzo zvezuva nezuva.
Brain Metastases
Utachiona hwemhando dzepamusoro hunogona kuva hwakaoma kurapa nekenza yemasitamende yepabonde sezvo mishonga yemakemikrasi isingagoni kupinda muuropi nemutsipa wepelinha. A network of caplyry tightly knit at the edge of the brain that called blood brain obstruction is designed to prevent the toxins from entering central central nervous system. Zvinosuruvarisa, izvi zvipingamupinyi zvakare zvinodzivirira kenza mishonga kuti isisvike munzvimbo ino.
Pane zvirongwa zviviri umo chirwere chinonzi radiation kana chirwere chinogona kuonekwa sechirapa hutano hwemashupusi.
- Zviratidzo zvechiratidzo - Kana hutano hwako huchiita zviratidzo zvikuru, kurapwa kwemukati kunogona kuvandudza hupenyu hwako. Izvi zvinogona kusanganisira utano hwehutano hwehutachiona hwehutachiona hwakawanda uye hwakawanda, kana humwe huno huripo uye huri hwepamusoro hunoti huri hwemasero mashoma asi makuru.
- Zvisikwa zvemasastases - Kukura kwemasimasi maitiro makuru ari kuita zviratidzo, kana iwe unongova ne (kana vashomanana) metastases yehuropi asi hapana humwe humwe humwe hutano hwemastastine kune imwe nzvimbo mumuviri wako, zvakasiyana-siyana zvemazuva ano anozivikanwa sa stereotactic body radiotherapy (SBRT kana Cyberknife) kana kuti radiofrequency ablation (RFA) inogona kushandiswa. Izvi zvinoratidzira huwandu hwemazuva ano kusvika panzvimbo chaiyo muuropi. Pane kudaro, kuvhiyiwa kunogona kufungwa kuti inobata zvirwere izvi.
Zvimwe Zvirwere
Kune dzimwe nzira dzokurapa dziri kuongororwa nokuda kwehutano hwemasastasiti nekuda kwekenza yemazamu. Nzira dzakadai se microembolization uye dzakawanda dzinogona kupa zvirwere zviri nani munguva yemberi. Kune mimwe miedzo yekuchipatara ikozvino iri kuenderera mberi kudzidza kurapwa kwemasimisita.
Kutarisira Maitiro Akashata
Kushandiswa kwechirwere, sezvimwe nezvimwe zvirwere zvekenza, zvingaguma nemigumisiro. Izvozvo zvinokonzerwa nemigumisiro uye kuti zvinoshungurudza sei zvichazosiyana zvichienderana nezvimwe zvinhu zvinosanganisira nzvimbo yemuviri wako unogamuchira mahara. Zvimwe zvinowanzovhiringidza zvinosanganisira:
- Kushatirwa kweganda - Nharaunda yaunogamuchira kurapwa kwemaawa inogona kuwedzera kubwinya uye dzimwe nguva kunonoka, zvakafanana nekupisa kwezuva. Majekesa ako oncologist achakutaurira pamusoro pezviratidzo zvekutarisa uye anogona kupa chirongwa chaunoshandisa.
- Kuneta - Kuneta ndechimwe chinhu chinowanzosvibisa chikamu chemishonga inonzi radiation, ichikanganisa vanhu vazhinji vane marapirwo aya kune imwe nguva. Uku kuneta kunowedzera kuwedzera uye kunotambudza kwenguva.
Kufanana nokuneta kunobatanidza chemotherapy, zviratidzo izvi zvinogonawo kukonzerwa nezvinetso zvinoshandiswa (zvakadai seanemia) uye zvakakosha kutaurira oncologist yako nezvekuneta kwako.
Kurapa kwakanakisisa kwekuneta kunonyanya kutsvaga nzira dzekutarisana nekuneta. Kumbira kubatsirwa uye kubvumira vamwe kukubatsira. Zorora apo unoda. Uye taura nachiremba wako pamusoro pehupi matambudziko ekurara ari kuita kuti uwedzere kuneta. - Kusuruvara kwebvudzi - Nyasha yekurasikirwa kwechipiri nechirwere chemazuva anosiyana nekusuruvara kwekiso kunokonzerwa nechemotherapy, pakuti inogona kuva yakasimba. Kusuruvara kwebvudzi kunoenderana nharaunda yemuviri wauri kugamuchira kurapwa kwemaawa.
Somuenzaniso, huro hwehutano huri pamusoro wako hunogona kukonzera kurasikirwa kwebvudzi pamisoro yako, asi mazamu anoiswa muchipfuva chako, pamapapu emapapu, anongokonzera kurasikirwa kwebvudzi pachipfuva chako. - Kuziva kusanzwisisika kwehupenzi - Radiation therapy kuuropi, kunyanya uropi hutachiona hwose, hunoita kuti zviratidzo zvakadai sezvinetso zvepamusoro uye zvinetso zvekufungidzira (kusanganisa kusagadzikana.) Zvakakosha kunyatsocherechedza kubatsirwa kwehutachiona hwehutano kuuropi pamusoro pemigumisiro iyi inogona kuitika .
Rhythrapiyrapiro yeuropi inopawo njodzi yekukuvadza kune zvivako zvakagadzirwa muhutachi tissue kuburikidza nemhepo inopera.
> Sources:
> DeVita, Vincent., Et al. Kanzira: Mitemo & Practice of Oncology. Kanzira yeBretiti. Wolters Kluwer, 2016.
> Liedtke, C., naH. Kolberg. Utachiona hweChirongwa Chekuwedzera / Metastatic Breast Cancer-Iyezvino Uchapupu uye Ramangwana Dhana. Breast Care . 2016. 11 (4): 275-281.