Kuvhiya, Chemotherapy, Radiation, uye Clinical Trials
Zvirongwa zvekurapa kwekenza yemuvhisi zvinotarisa padanho rechirwere pamwe nezvimwe zvinhu uye zvinogona kusanganisira kuvhiyiwa, chemotherapy, zvinotarisirwa, kana kliniki miedzo. Kunze kwekutanga kwepamuviri tumakumbo, kusanganiswa kwemishonga iyi kunowanzoshandiswa. Mishonga inogonawo kuchinja kana kenza yako ichidzoka kune kenza yapfuura kana kana iwe uri nepamuviri.
Kanzura Rako RweKenza
Nhanho yako yekutanga pakusarudza nzira dzakanakisisa dzokurapa ndeyekuti unzwisise boka rako rekuchengetedza kenza. Zvakakosha kuziva kuti ndiani anopa mukana wekutarisira kutarisira kwako uye waunofanira kudana nemibvunzo.
Kazhinji kacho, kenza yemaawa inotanga kuwanika, kana kuti kunyunyuta, nechiremba-gynecologist (OB / GYN) kana mumwe chiremba wekutarisira. Paunosarudza nzira dzokurapa, zvisinei, zvinokurudzirwa kuti ubvunze gynecologic oncologist usati watanga regimen.
Dzimwe nhengo dzeboka rako rekutarisira hutano dzinogona kusanganisira chiremba wako wekugadzirira, chiremba wehutano hwehupfumi kana mupi wezano, mutanogist (uyo anotarisa chero mhuka dzinobviswa panguva yekuvhiyiwa), uye zvichida chiremba wokurapa (anotarisa kubvisa zvirwere zvine chokuita nekenza) kana nyanzvi yekubereka.
Treatment Options
Kune mhando mbiri dzemhando dzekurapa kwekenza yevanai:
- Local Treatments: Zvirwere zvakadai sokuvhiya uye remishonga inonzi radiation ndiyo mishonga yemunharaunda. Vanotarisa kenza iyo yakatanga asi haikwanise kugadzirisa chero mishonga yemukenza yakapararira kunze kwenzvimbo yekutanga yekenza.
- Zvirwere Zvirongwa: Kana kenza inopararira kupfuura nzvimbo yayo yepakutanga, zvirongwa zvinoshandiswa zvakadai semakemotherapy, zvinotarisirwa kurapwa, kana kuti hormonal therapy (nezvisina maronda epistlial) zvinowanzodiwa. Iyi mishonga inotaura nezvemasero ekenza pasinei nokuti iri kupi mumuviri wako.
Vanhu vakawanda vane kenza yemukati epithelial ichava nekubatanidzwa kwezvirapa izvi.
Dzimwe nguva, dzakadai semagemukisi esero uye stromal cell tumorum, kana kuti kutanga kwekutanga (zvakadai sesero reAA) epithelial tumor, chirwere choga, pasina chemotherapy, inogona kuva yakashanda.
Surgery
Kuvhiya ndiyo inonyanya kukosha yekurapa kwevanhu vazhinji vane kenza yemaawa. Inogona kusiyanisa zvose nerudzi rwekenza yevhisi uye chirwere. Zvidzidzo zvakawana kuti kana chirwere chekenza chevana chirwere chinoshandiswa ne gynecologic oncologist, zvigumisiro zvinowanzove zviri nani pane apo kuvhiyiwa kunoitwa navanachiremba vezvimwe zviitiko, sezvo izvi zvakaoma nzira.
Kunyange zvakadaro, kunyange painoona gynecologic oncologist, vanhu vazhinji vanozviona zvichibatsira (uye kazhinji vanovimbisa) kuwana mhinduro yechipiri. Kana uri kufunga kuita kudaro, ungada kufungidzira imwe yenyika huru yeCancer Cancer Institute-yakasarudzwa nemukenza, iyo inowanzove nevanovhiya vanoita mune imwe nzira yekuvhiya.
Oophorectomy (yeGerman uye Stomal Cell Tumor)
Germ cell and stromal cell tumor zvinowanzowanikwa mumatangiro ekutanga. Vanhu vazhinji vane tumavara iyi vari vaduku, uye kuvhiyiwa kubvisa chete chirwere chinokanganiswa (oophorectomy) chinogona kuita kuti kuchengetwa kwechimwe chirwere uye chibereko. Kuvhiya ndoga kunogonawo kushanda mumatumbu makuru epakutanga.
Kana zvose mazai ezvo achida kubviswa, pane zvimwe zvingasarudzwa zvekuchengetedza kubereka , zvakadai sekuvhenekera mazai. Kana iwe uchida kuita izvi kana zvichikwanisika, taura nachiremba anonyanya kuchengetedza kubereka musati watanga kurapwa.
Cytoreduction / Debulking Surgery (yeEpithelial Ovarian Cancer)
Inenge 80 muzana yemakondombera epithelial ovarian anowanikwa mune zvikamu zvekare zvechirwere (danho III nechitanhatu IV). Kusiyana nekenza yemukomana neyemapapu, apo kuvhiyiwa kwechitambo IV chirwere hachivandudzi kutarisira hupenyu, kuvhiyiwa kunogona kuwedzera hupenyu kune avo vane kenza yevheji yevana vechitanhatu.
Iyo inovandudzawo gare gare inobatsirwa chemotherapy.
Kuvhiya kwechirwere chepentelial ovarian yakakurumbira kunonzi chirongwa chekuroreductive chirwere (debulking surgery). "Cyto" ndiro izwi remusero uye "kuderedza" rinoreva kuderedza, saka chinangwa chekuvhiya uku ndechekuderedza nhamba yekenza masero aripo, pane kubvisa kese.
Pane zvikamu zvitatu zvinogoneka zvekuvhiya uku:
- Zvose: Mushonga wose unooneka unobviswa.
- Zvakanakisisa: Kanzera inoramba iripo, asi nzvimbo dzose dzisingasviki 1 masendimita (iyo inowanzonzi chirwere chemaradhi).
- Sub-optimal: Nodules iyo yakakura kudarika 1 cm muhupamhi inogara.
Kuvhiyiwa kwechiroreductive chirwere chakareba uye chakaoma, uye njodzi dzenguva refu inowanzopfuura zvakabatsiri. Naizvozvo, "zvakanakisisa" cytoreduction kazhinji chinangwa chekuvhiyiwa.
Mukuwedzera pakubvisa mavari mavari uye ma fallopian tubes (inobatanidza salpingo-oophorectomy) uye chiberekero (hysterectomy), mamwe maviri anowanzobviswa kana kuiswa mairi pamwe chete. Semuenzaniso, omentum , kana humwe hutema hwehutu hunoputira mazai uye mapepa, anowanzobviswa (omentectomy).
Kushambidza, chirongwa umo saline inorohwa mukati mamuviri nemapapu uye inobva yabviswa kuitira kutarisa kuvapo kwekenza masero ayo "akasununguka" mudumbu nepabonde, inoitwawo.
Lymph nodes mudumbu nemapapu zvinowanzonyorwa kana kuti kubviswa (lymph node dissection). Mukuwedzera, sampuli dzinogona kutorwa kubva pamusoro pezvipembenene zvakawanda zvemuviri nepamuviri, zvakadai sechirwere, utumbo, chiropa, chirwere, dumbu, gallbladder, kana pancreas. Nezvipembenene zvakanyanya zvepentelial, appendix inowanzobviswa.
Apo sampuli dzinotorwa kubva mumatumbo, zvikamu zviviri kumativi ose emunharaunda zvakabviswa zvinosanganiswa kana zvichibvira. Kana zvisina kudaro, kuguma kwemukati musati nzvimbo yekuvhiya yakasungirirwa paganda kuitira kuti chifukidzo chisvike kune kunze (kusikwa kwe stoma).
Zvose izvi zvinovhiyiwa zvinogona kuitwa pakarepo, kana kuti panzvimbo pacho pashure pokunge chemotherapy inopiwa kana shure kwekudzoka kwekenza.
Zvikamu zvinowanzovhiringidzika zvekuvhiya zviri kubuda ropa, zvirwere, uye kuchinja kune anesthesia. Sezvo chirwere chekutoreduction chinowedzera kuva chirwere chakareba, zvinokurudzirwa kuti avo vari panjodzi vane tsvarakadzi yepamwoyo uye mapapu vasati vavhiyiwa.
Chemotherapy
Nekenza yevana, inenge isingagoni kubvisa kese yese. Kunyangwe kana kuvhiyiwa kuchibvisa zvose masero emukenza anooneka (akadai nematanho epamberi), kuwedzerwa kwepamusoro kwakanyanya zvikuru kune inenge 80 muzana. Izvi zvinoreva kuti kunyange kana kenza inoratidzika isingaonekwi, nzvimbo shoma dzekenza dzinosara shure. Nokudaro, chemotherapy inowanzopiwa kune vose asi zvikamu zvekutanga zvekenza epithelial ovarian. Chemotherapy inowanzoshandiswa pamatanho akakwirira ejemukirini yemakumbo pamwe chete.
Zvinodhaka Zvinoshandiswa
Mishonga inowanzoshandiswa inosanganisira kusanganiswa kwe:
- Zvirwere zvePlatinum: Paraplatin (carboplatin) kana Platinol (cisplatin).
- Mitero: Taxol (paclitaxel) kana Taxotere (docetaxel).
Kune mimwe mizhinji mishonga inogona kushandiswawo zvakare, kusanganisira Doxil (liposomal doxorubicin) uye Gemzar (gemcitabine).
Ne germin cell tumor, chemotherapy kazhinji inosanganisira kusanganiswa kwePlatinol (cisplatin), VP-16 (etoposide), uye bleomycin.
Nzira dzekutungamirira
Chemotherapy inogona kupiwa mune imwe yenzira mbiri:
- Intravenously (IV): IV chemotherapy inowanzopiwa masvondo matatu kusvika mana uye inodzokororwa katatu kusvika matanhatu. Izvi zvinogona kupiwa kuburikidza ne catheter yakaiswa mumaoko ako, kana kuburikidza nechikwata chemotherapy kana PICC.
- Intraperitoneal chemotherapi: Mune nzira iyi, chemotherapy inopiwa kuburikidza nesingano inowanikwa zvakananga mumuviri wechipfu.
Utungamiri hweV IV hwakawanda, asi vatsvakurudzi iye zvino vanodavira kuti intraperitoneal chemotherapy yakanyanya kushandiswa pamusana wekenza yevana. Iwe unogona kuda kubvunza pamusoro pazvo.
Mukuongorora kwe 2016, vatsvakurudzi vakawana kuti intraperitoneal chemotherapy inowedzera kupona nekenza yevanai kupfuura ye IV chemotherapy. Muchidzidzo ichi, zvakanzi "intraperitoneal chemotherapy" yakakonzera kudarika kwemigumisiro yemigumisiro, fever, marwadzo, uye utachiona, asi yakanga isiri kudarika IV chemotherapy inokonzera kurasikirwa kunzwa (ototoxicity).
Izvozvo zvakati, intraperitoneal chemotherapi haibvumiri uye IV chemotherapy uye haigoni kushandiswa kana kune zvinetso zvepvo kana kuti zvikafu zvinopisa mumimba, naizvozvo inowanzochengeterwa vakadzi vane chirwere chechitanhatu IV uye avo vaiva ne-sub-optimal cytoreduction .
Migumisiro Yechiri
Chemotherapy mishonga inovhiringidza nesero kupatsanurwa pane zvakasiyana-siyana mumhepo uye inobudirira pakuuraya masero anowedzera nokukurumidza, akadai sekenza masero. Zvinosuruvarisa, kurapwa kunobata zvisizvo, nekuparadzanisa masero mashoma zvakare, zvichikonzera kusagadzirisa mhinduro.
Zvipembenene zvakanyanya zvinowanzoitwa chemotherapy zvinoshandiswa mukenza yevarivha zvinosanganisira:
- Nausea uye kurutsa: Kurapa chemotherapy-induced nausea uye kurutsira kwakashamisika zvikuru mumakore achangobva kupfuura, uye mishonga yekudzivirira ikozvino inowanzobvumira vanhu kuti vapfuurire chemotherapy pasina kana kurutsa.
- Irosa marora kukanganisa kunotungamirira kumazinga mashoma emasero eropa eropa, masero matsvuku eropa, uye maplatelet. Icho chirwere chakaderera chechimiro chechichena cheropa chinonzi neutrophils chinokonzera vanhu kuhutachiwana munguva yekemotherapy .
- Kuneta
- Kuora bvudzi
Nguva yakareba-migumisiro yemigumisiro yechemotherapy inogona kusanganisira mhirizhonga yeuropathy (kurira, kurwadziwa, uye kupera mumaoko nemaoko) uye kurasikirwa kunzwa (ototoxicity). Panewo mukana muduku wekuvandudza kenza yepamusoro pasi pemutsara.
Iyo migumisiro uye zvinetso zve chemotherapy, zvisinei, kazhinji, zvinowanzopfuura zvakanyanya nekupona kunobatsira kwezvirapa izvi.
Targeted Therapies
Targeted therapies mishonga inopesana nematanho chaiwo mukukura kwekenza. Sezvo ivo vachitungamirirwa zvakananga nekenza masero, dzimwe nguva (asi kwete nguva dzose) vane zvishoma zvinokonzera kupfuura chemotherapy. Mishonga inogona kushandiswa nekenza yemuvha inosanganisira:
- Angiogenesis inhibitors: Kanzira inofanira kusika midzi mitsva yeropa kuitira kuti ikure nekupararira. Angiogenesis inhibitors inobvisa izvi, zvichida kushaya nzara yeropa idzva. Avastin (bevacizumab) dzimwe nguva inogona kuderedza kukura kwekenza yemaawa asi inogona kuva nemigumisiro yakakomba yakadai sekubuda ropa, kuvhara ropa, uye hofu yakaputika.
- PARP Inhibitors: Yokutanga PARP inhibitor yakagamuchirwa nekenza yevavari mu 2015. Kusiyana nekemotherapy, mishonga iyi inogona kupiwa mupiritsi yepiritsi panzvimbo yeiyo IV. PARP inhibitors inoshanda nekuvhara nzira yemagetsi inokonzera masero ane BRCA gene mutation kufa. Zvinodhaka zvinosanganisira Lynparza (olaparib), Rubraca (rucapraib), uye Zejula (niraparib).
Iyi mishonga inowanzoshandiswa kune vakadzi vane mutsauko weBBRCA, asi zvose zvinonzi Lynparza neZejula zvinogona kushandiswa kune vakadzi vasina mutsika inochinja BRCA mukurapa kenza yevarivha yekudzoka shure kwechemotherapy. Migumisiro inogona kusanganisira kubatana pamwe nekusuruvara, kurwadziwa kwepfungwa, uye anemia pakati pevamwe, asi zvinowanzorerurirwa zviri nani kupfuura chemotherapy. Panewo pangozi shoma (semakemikirwo emakemikari) echipiri chekenza yakadai seyeukemia.
Zvimwe Zvirwere
Mamwe marudzi emishonga anogona kushandiswa nemhando dzakasiyana dzekenza yevavari kana yezvirwere zvakapararira. Hormonal therapy mishonga inonyanya kushandiswa pakenza yepamu. Asi zvinodhaka zvakadai sekuvhara madhiragi, tamoxifen, uye aromatase inhibitor zvinogona kushandiswa pamakumbo emakumbo esimba, uye zvisingawanzoitiki, epithelial cell tumorum. Radiation therapy haina kufanirwa kushandiswa chekenza yevarivha asi inogona kushandiswa kana pane zvipembenene zvakakura mumimba.
Clinical Trials
Kune vakawanda varikufambira mberi kwekliniki miedzo inotarisa kusanganiswa kwemashoko ekurapa, pamwe chete nemishonga mitsva, zvose zvekutanga kuongororwa kwekenza yevarivha uye yekudzokorora. I National Cancer Institute inokurudzira kutaura nachiremba wako pamusoro pezvinhu zvingave zvakakodzera kwauri.
Dzimwe nguva nzira chete yekushandisa mushonga mushanduro itsva ndeyekuti uve chikamu cheimwe yezvidzidzo izvi. Kune ngano dzakawanda pamusoro pekuongororwa kwechiremba , asi chokwadi ndechokuti mushonga wose watinayo iye zvino nokuda kwekenza yakambodzidza nenzira iyi.
Mishonga Inobatsira Inobatsira (CAM)
Kusvika iye zvino, hakuna hutsvakurudzo hunoratidza kuti chirongwa cheCAM chinogona kurapa kenza yevana. Kufanotaura kurapwa kwemazuva ano kunobatsira zvingasarudzwa kunogona kuve kwakakuvadza.
Izvozvo zvakati, vamwe vanogona kubatsira nezviratidzo zvekenza uye marapirwo ayo, kuvandudza hupenyu hwehupenyu. Nokuda kwechikonzero ichi, vazhinji vanorwara nekenza zvino vanopa maitiro akasiyana- siyana emishonga . Zvisarudzo izvo zvakaratidza kumwe kubatsirwa mune zvishoma zvidzidzo zvitsvakurudzo zvinosanganisira kugadziriswa , kufungisisa , yoga , therapy therapy , uye pet therapy .
Zvokudya uye Zvokudya
Taura neoncologist yako usati waedza chero vitamini kana mineral supplement . Zvose zvinokonzerwa nechiropa kana kuti itsvo uye zvingangodaro zvishoma nezvishoma kana kuti zvinokurumidza kuisa metabolism chemotherapy remishonga, iyo inobatsira kurapwa. Vamwe, kunyanya, kurongedza kuchenjerera kwakakwana: Vitamin E (pamwe nemiriwo Ginkgo biloba) inogona kuwedzerwa kubuda panguva uye mushure mekuvhiyiwa, nezvimwe zvinowedzera zvinogona kuwedzera njodzi yekushaya moyo miviri kana kuti kukanganisa kwakabatana neanesthesia.
Uyezve, antioxidant magadzirira angaguma apedza kuchengetedza masero emakemikrasi uye remishonga inonzi radiation inoparadza kuparadza; idzi mishonga inoshanda kuburikidza nekukonzera kukuvadza kwehutachiona kuhutachiona huri mumasero ekenza. Vose oncologists vanodavira kuti kudya mishonga ye antioxidant-yakawanda hakusi dambudziko panguva yekurapa, zvakadaro.
Omega-3 fatty acids, zvisinei, inogona kubatsira kune vamwe. Izvi zvinogona kubatsira kuchengetedza misi miviri mune avo vane kenza cachexia , mamiriro ekubatanidza kuora, kurasikirwa kwemasimba, uye kurasikirwa kwechido chinokanganisa 80 muzana yevanhu vane kenza yakawanda.
Kune chimwe chido mune turmeric (uye chidimbu chayo, curcumin), chinhu chinowanzogadzirwa mu curry nemasayadhi anopa izvozvi zvokudya yavo yellow yellow. Imwe mabhuku inotsvakurudza inoratidza kuti turmeric inogona kukurudzira kufa kwekenza yekenza, asi haisi yakarongeka, uye kuti kenza yemukenza ye "ovary" inofanirwa "kudyisa" inogona kunge isingakwanisi kusagadzikana chemotherapy. Uku kutsvakurudza hakusi kugadzirisa maererano nekushanda kwayo mukati mevanhu, asi hapana chakaipa pakushandisa zvinonhuwira.
Kurapa Kwekudzoka
Zvinosuruvarisa, zvinenge makumi mapfumbamwe nezana makumi mapfumbamwe ematatu emakondomu evanhu vanorapwa nemishonga inowanikwa pamusoro apa ichadzoka. Nzira yekurapa yekudzoka inobva pane nguva yayo:
- Kudzokorora pakarepo mushure mekurapa: Maitiro akadaro anonzi platinum anoratidzira, kana kusagadzikana ne platinum chemotherapy. Zvisarudzo zvinosanganisira kudzokorora chemotherapy nemishonga imwechete (kunyange izvi zvinowanzokonzera kupindura kwakashata), vachishandisa mamwe maitiro echemotherapy regimen (kune maitiro akasiyana-siyana), kana kuongorora kliniki yekuedzwa.
- Kudzokorora mumwedzi mitanhatu yekurapa: Mhosva dzakadaro dzinonzi platinum inogadziriswa. Zvisarudzo panguva ino zvingave zvakasiyana-siyana chemotherapy mishonga kana regimen, kana kliniki yekuedzwa. Kuvhiya hakuwanzokurudzirwa.
- Kudzokorora kwemwedzi mitanhatu kana kupfuura mushure mekunge kurapwa kwapera: Kana chemotherapy yepakutanga yaisanganisira kushandiswa kweplatinum chemotherapy drug (Platinol kana Paraplatin), chironda chinonzi platinum senzwi. Mishonga inorayirwa zvinowanzosiyana asi inogona kusanganisira chirwere chekurotoreduction pamwe nekurapwa neyakabva chemotherapy mishonga.
Mushonga mukudzivirira
Mazino evanhu vakawanda anowanzobuda panguva yekuzvimba ndeyejeresi yemasero kana masero emakumbo. Izvi zvinowanzobatanidza rimwe chete, uye chirwere chinobvisa kuvhara kunogona kuitika panguva yekuzvitakura, kunyange kumirira kusvikira wechipiri chetatu ichidiwa.
Kune vakadzi vane pamuviri vane kenza yema epithelial ovarian uye yakanyanya kufambira mberi stromal cell kana germ germ cell tumor, chirwere chinonzi cytoreduction chinogoneka. Kumirira kusvikira mushure mokutanga katatu kwakanaka, asi kuvhiyiwa kunogona kutaridzirwa kare. Chemotherapy haina kuchengeteka mushure mekutanga kwetatu uye kazhinji inotanga kumativi anenge masvondo gumi nematanhatu. Kune kenza yema epithelial ovarian, kusanganiswa kweParaplatin (carboplatin) uye Taxol (paclitaxel) inowanzoshandiswa, pamwe nekubatana kwePlatinol (cisplatin), Velban (vinblastine), uye bleomycin inoshandiswa kwezvipembenene zvisiri zvepithelial.
> Sources:
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> Jaaback, K., Johnson, N., naT. Lawrie. Intraperitoneal Chemotherapy nokuda kwekutanga Kutungamira Kwepamukuru Pepanarial Ovarian Cancer. Cochrane Database yekuongorora kwakarongeka . 2016. (1): CD005340.
> National Cancer Institute. Ovarian Epithelial, Fallopian Tube, uye Primary Peritoneal Cancer Treatment (PDQ) -Health Professional Version. Updated 01/19/18. https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq
> van Driel, W., Koole, S., Sikorska, K. et al. Hyperthermic Intraperitoneal Chemotherapy muOvarian Cancer. The New England Journal of Medicine . 2018. 378 (3): 230-240.