Tsanangudzo, Kuziva, Kurapa, uye Kurapa
Kuongororwa kwechipi nechipi chepakati chekenza yemazamu kunogona kukonzera kutya uye kutya. Kunyange iwe ungave wakakurudzirwa kuti une chikamu chekutanga chekenza yemazamu unogona kunzwa uchitya uye uchinetseka. Takadzidza kuti manzwiro edu emanzwiro ehutachiona aya akafanana zvisinei nokuti chii chinonzi chirevo. Ndeipi tsanangudzo yemutambo wepamuviri, ndeapi maitiro ekurapa aripo, uye iwe unofunga nezvei?
Kunyange isu tisingakwanisi kuvimbisa kuti kuzvidzidzisa pachako kunoderedza kutya kwako kwose, kunogona kukubatsira kuti uzviise muchigaro chemufambisi uye unonzwa uwedzerwa simba mukutarisira kwako.
Tsanangudzo
Nhanho 1 kenza yemazamu ndiyo imwe yepakutanga ye "inopisa" kenza yemazamu. Kuona shoko risingaiti rinotyisa, asi shoko risingaiti maererano nechechi haritauri kuti kenza inopinda kune dzimwe nzvimbo dzomuviri. Kuvhiringidza kunongoreva kuti masero ari mumarara ako akapinda pane chimwe chinhu chinonzi chipande chepasi. Izvo izvi zvinoputika mberi kwemuviri wepasi unotsanangura chimwe chinhu sekenza.
Apo kenza yebonde inotanga kutanga, haisati yakura kupfuura iyi membrane. Mishonga pachigamba ichi haitorwi nekenza, asi panzvimbo yekodoma-in-situ . Izvo zvinodanwawo sezvikwata zvemasero 0. Carcinoma-in-situ ndiyo 100 muzana inoporesa nekuvhiyiwa sezvo masero aripo zvachose. Hapano mukana unogona kupararira.
Nhanho 1 mapfupa ndiwo mutsara wekutanga wekenza yechokwadi yemazamu. Izvi zvipembenene zviduku, uye kana zvakapararira zvachose kuti zvirwere zvinopararira zvinopararira zvishoma.
Dhigiriro yeTanho uye TNM
Kuti unzwisise kuti chiremba wako anogadza sei danho rekenza yako, uye kana uine danho rekutanga 1A kana chirwere chekutanga 1B, zvinobatsira kuziva zvishoma pamusoro pe "TNM" system yekugadzirisa.
Mumamiriro ezvinhu aya:
- T inomirira chiremera chemuviri: Chikamu cheT1 chinoreva kuti chirwere chako chiri 2 cm (inenge inch inch) kana zvishoma paupamhi. Nenzira yakawanda, matumbu eT2 akakura kudarika 2 cm uye maduku anodarika masendimita mashanu, uye matumasi eT3 ari makuru kupfuura 5 cm.
- Ni inomirira nodes: N0 zvinoreva kuti kenza haina kupararira chero ipi zvayo yemaitiro. N1 zvinoreva kuti kenza yakapararira kune lymph nodes pedyo, uye N2 zvinoreva kuti yakapararira kune lymph nodes zvishoma kure. Nechitsauko 1 matumbo, rimwe shoko rinowanzokosha. Izwi rokuti micrometastase rinoreva kuti kenza yakapararira kune lymph nodes asi inogona kuonekwa chete pasi pe microscope. Micrometastases aripo apo masero emukenza anowanika mu lymph node uye anopfuura 0.2 mm muupamhi asi anopfuura 2 mm (0.2 cm) muhupamhi. Kenza ine micrometastases mune lymph node iri pedyo inogona kutsanangurwa seT1mi. Macrometastases, zvakasiyana, inotaura nezvekenza mune lymph nodes iyo yakareba kupfuura 2 mm muhupamhi (uye inogona, muchirevo, inoonekwa neziso risina kure).
- M inomiririra mastasisita: M0 zvinoreva kuti kenza haina kuisa muviri (somuenzaniso, kumapfupa, uropi, kana chiropa). M1 rinoreva kuti rine.spread.
Zvinogona kuvhiringidza (uye zvinotyisa) kana iwe ukaverenga rondedzero yako yehutano uye ona kuti rinoti kenza ine "yakagadziriswa kune lymph nodes." Izvi hazvirevi kuti iwe une kenza yepamusoro yepabonde (shato yekenza yebonde 4).
Iwe unogona kuva ne lymph node metastases kunyange nehutachiona-epakati chirwere.
Kushandisa TNM system, chirwere chekutanga chekenza chinoparadzaniswa zvakare ku:
- Nhanho 1A: T1N0M0. Dumbu racho riri pasi pe20mm (2 cm) muhukuru uye hapana kupararira kune lymph nodes
- Nhanho 1B: T1N1miM0 kana T0N1miM0. Nekutanga kusanganiswa, tumarara iri pasi pe 20 mm (2 cm) muhukuru uye kune micrometastases mune imwe lymph node iri pedyo. Chimwe chiitiko hachiwanzozivikanwa uye chiripo kana pasina humwe uchapupu hwechirwere chepakutanga chiri muchipfuva asi kune micrometastases mu lymph node (kazhinji mu armpit).
Pasi pose, zvikamu zvepamuviri ndezviya zviduku kudarika masendimita masendimita masere uye zvisingambove neine lymph node kupinda kana kupararira kune lymph nodes dziri pedo asi nechepamusoro-kati.
Kana uchinge waziva danho rekenza yako yepabonde pane zvimwe zvakawanda zvezvinhu zvaunoda kuziva musati wasarudza nzira dzakanakisisa dzokurapa.
Aina
Kune mhando dzakasiyana dzakasiyana dzekenza yemazamu. Inosvitsa ductal carcinomas yakawanda kwazvo inoteverwa nemapapiro erbular. Zvimwe, zvisiri zvishoma zvinowanzozivikanwa zvekenza yepazamu zvinosanganisira chirwere chepamuviri chepamuviri, medullary carcinoma, tubular carcinoma, nezvimwewo.
Tumor Grade
Tumor grade ndiyo nhamba inorondedzera kushungurudzwa kwemarara. Vanachipatara vanotarisa masero emukenza anobva pabhiopsy uye / kana kuvhiyiwa pasi pe microscope kuti vaone zvinhu zvakadai sekushanda kwemasero. Mishonga inobva ipiwa chikamu che1, 2, kana 3, ne1 ichi chisina kukuvadza uye 3 chiri chirwere chinotyisa zvikuru. Hondo yako yegorosi hairevi kukuudza zvaunofunga, asi zvinokubatsira iwe uye chiremba wako kusarudza mishonga yakanakisisa.
MultigeneTesting
Mumakore gumi apfuura kana kuti takadaro tadzidza kuti matambudziko ose akasiyana sei pamatomu e molecular. Mune mamwe mazwi, mapundu maviri anenge ari danho 1 ductal carcinomas uye ane chiremera chema 2 anogona kuita zvakasiyana. Kana iwe usina mhando dzakanaka dzemuviri uye kamuviri kadiki, oncologist yako inogona kukurudzira kutarisa kuongororwa uku kuti uone kana kurapwa kweAdjuvant semakemikrasi inokosha. Miedzo yeM Multigene yakadai seOnotyotype DX uye MammaPrint inogona kushandiswa kuziva kana chemotherapi inodiwa nekodhi-isina hasi yepabonde chepabonde.
Receptor Status
Mukusarudza mishonga yakanakisisa yekenza yako yebonde, chiremba wako achada kuedza mamiriro ekugamuchira yekenza yako. Zvinogamuchirwa mapuroteni anowanika pamusoro pekenza masero uye anokosha mukukura kwemasero.
Estrogen Receptors
Estrogen receptors ndiwo mapuroteni (receptors) anowanika pamusoro pekenza masero. Mishonga yekenza inonzi Estrogen-receptor positive inokurudzirwa kukura apo estrogen inobatanidza nemapapiro aya.
Progesterone Receptors
Progesterone receptors kazhinji inowirirana nemaestro eestrogen.
HER2 Positive Cancers
Mimwe mishonga yekamu inotumidzwa seHER2 yakanaka. HER2 ipuroteni iri pamusoro pekenza masero. Kukura kwezvinhu kunosungira nemutumbi uyu kukurudzira kukura. Zvose zvinowanzoita mazamu ezviyo ane HER2 receptors, asi neHER2 dzakanaka kanzira, pane mazana anopfuura makumi matanhatu akawanda aya awa anogamuchira (unogona kuona mazwi akadai seHER2 kukurudzira kunoreva mamwe majeni ekunyorwa kweprotheni kana HER2 kunyanya kuwedzera, achitaura kuwanda kwenhamba yezvakagadziriswa pamasero ekenza).
Kune mishonga yakananga iyo inogona kutarisa idzi zvakagadzirisa zvinogona kuderedza dambudziko rekudzoka zvakare. Kana zvose zvekugamuchira kwako "zvisina kunaka" pakuedzwa, tsvina yako yaizoonekwa se "katatu isina kunaka" kenza yepamu.
Mishonga
Mishonga inotanga kuputsika muzvikamu zviviri zvikuru:
- Mishonga yemunharaunda: Mishonga yemunharaunda inobata kenza munharaunda, uye inosanganisira chirwere uye chirwere chemaawa
- Kurapa kwakarongeka: Mishonga inoshandiswa inobata kenza chirongwa kana mumuviri wose. Izvi zvinosanganisira chemotherapy, hormonal therapy, inorapwa, uye immunotherapy.
Kana chironda chiri chiduku zvikuru, mishonga yemunharaunda kazhinji inowanzodiwa. Kana chironda chacho chiri chikuru, chinotyisa (chinodarika chiremera chepamusoro), chakapararira kune lymph nodes, kana kuti ine majekitiki anoratidza kuti kenza ingangopararira, zvirongwa zvehutano zvinowanzokurudzirwa. Nechitsauko 1 mazamu emakemikari kushandiswa kwetachirongwa chetachiona kunofungidzirwa kuti adjuvant therapy (kuwedzera-kurapa) uye chinangwa ndechokubvisa chero kenza yemukenza yakapararira mberi kwechifu asi ishoma kudarika kuonekwa nekufungidzira miedzo yatinayo iye zvino.
Zvimwe zvinoshandiswa pakushandisa zvinogona kusanganisira:
Surgery
Kuvhiya kunokurudzirwa kune vazhinji vemazamu 1 kanzira. Zvimwe zvinosanganisira kana lumpectomy kana mastectomy . Kune zvikonzero zvakawanda zvinoita kuti vanhu vasarudze mumwe kune rimwe, uye rinogona kuva sarudzo yemunhu oga. Kana chirongwa chinonzi lumpectomus chinosarudzwa, chirwere chemazuva ano kune mamwe mazamu emvere anowanzokurudzirwa. Kana iwe uine chirwere chekuita, chiremba wako achakutaurira pamusoro pekusarudzwa kwekudzorerwa kwezamu. Kuvhiyiwa kweganda kunowedzera kuwanda, uye nemugadziriro iyi, kusungirwa kana kuti kushandiswa kwekutsvaga kunowanzoiswa panguva imwechete sekuita kwako mastectomy.
Nekuvhiyiwa, chirwere chinonzi node chinoshandiswa chinogona kuitwa. Munguva yakapfuura, lymph nodes yakawanda yaiwanzobviswa uye yobva iongororwa pasi pe microscope, asi isu zvino tinokwanisa kuona kuti lymph nodes kenza inotanga kupararira sei, uye inoshandiswa chete iyo node. Kana lymph nodes yako yakanaka inoreva kuti kenza yakanyatsoratidza kuti chinangwa chekupararira.
Chemotherapy
Chemotherapy yekenza yemazamu dzimwe nguva inoshandiswa sehuwandu hwehutachiwana nehutachiona 1 chirwere, kunyange zvave zvichange zvakaoma kuziva kuti ndiani achabatsirwa. Kune avo vane micrometastases kune lymph nodes, chemotherapy inowanzokurudzirwa. Chinangwa che chemotherapy ndechokurapa chero masero emukenza angangodaro akatsauka kubva muchifuva chako vasati vatange kukura mumasitosita. Cancers dzakapararira (kunyange zvishoma) kune lymph nodes dzakanyatsotsanangura chinangwa chazvo chokupararira mberi.
Nekodhi-negative nenyuchi dzekamu dzine 2 cm muhupamhi kana zvishoma (chigamba 1) hazvisi pachena. The Oncotype Dx Recurrence Score kana MammaPrint yakawanda ye genomic test inogona kubatsira. Vaya vanokwidziridza pamusoro pekuedza vakawedzera kukunda maitiro apo chemotherapy inopiwa. Vaya vane zvikoro zvakaderera havakwanisi kubatsirwa nemakemikrasi. Sezvo chemotherapy ine zvingava nemigumisiro (yakadai sekushaya mwoyo uye yechipiri yeukemukari kana zvisingawanzoitiki) zvakakosha kuongorora njodzi dzinogona kuitika uye zvinobatsira nemumwe munhu mumwe nomumwe.
Radiation Therapy
Kana uine lumpectomy, chirwere chemazuva ano chinowanzoshandiswa kurapa mazamu ako anoramba ari. Nechitsauko 1 kenza yemazamu, chirwere chemaawa hachiwanzodiwa mushure mekuita mastectomy.
Hormone Therapies
Kana chirwere chako chiri chestrogen receptor positive, hormonal therapy inowanzokurudzirwa kutevera kunyanya kushandiswa nekuvhiyiwa uye chemotherapy / radiation therapy. Chinangwa ndechokuderedza ngozi iyo kenza ichadzoka. Estrogen receptor matumbo akanaka anowanzova nekudzoka kwekupedzisira (mushure memakore mashanu nekupfuura). Pamadzimai e-premenopausal, tamoxifen inowanzoshandiswa. Kune vakadzi vanomira mumasopaopausal, kurapwa kunowanzove aromatase inhibitor yakadai saAromasin (exemestane), Arimidex (anastrozole), kana Femara (letrozole).
HER2 Targeted Therapies
Kana bundu rako riri HER2 rakanaka, chirwere cheHER2 chinotarisirwa zvakadai seHerceptin (trastuzumab) chinowanzotanga mushure mekutanga kurapwa.
Clinical Trials
Nzira chete yekufambira mberi kunoitwa mukurapa kenza yemazamu ndeyokudzidza mishonga mitsva nemitemo mumakiriniki ekuedza. Kune ngano dzakawanda pamusoro pekuongororwa kwechiremba , asi chokwadi ndechokuti mushonga wose watinoshandisa iye zvino wakambodzidza mune kliniki yekuedzwa.
Kusarudza Mushonga Wakanakisisa
Nechitsauko 1 kenza yemazamu chimwe chezvisarudzo chikuru ndechipi chirongwa chekuvhiya. Kune humwe hunobudirira uye hune hutano kune upi noupi hwekuvhiya, uye zvinhu zvakawanda zvinofanira kufungwa nezvakafanana nemhuri yako nhoroondo (mukana wekuti uwedzere imwe kenza yemazamu), apo maronda ako ari muzamu rako, uye chii chaunogona kutarisira cosmetically nemumwe maitiro. Zvakakosha kusarudza mishonga inonyanya kukubatsira iwe, pasinei nokuti mumwe munhu angasarudza. Zvakakosha zvikuru kuti iwe uve mupepeti wako mukuchengetedzwa kwekenza . Varwere uye vanachiremba vari kushanda pamwe chete zvakanyanya kuti munguva yakapfuura uye iwe uri nhengo inokosha yeboka rako rekenza.
Kutsungirira uye Kutsigira
Chimwe chezvinhu zvakanakisisa zvaunogona kuzviitira iwe mushure mekunge uongororwa ndeyekuunganidza ruviriro rutsigiro. Iwe unogona kuda kunyora pasi urongwa rwevamwe vanogona kupa rubatsiro. Kunyangwe iwe uri kunzwa zvakanaka kuburikidza nekurapa kwako zvinogona kutyisa kuwedzera idzi kurapwa kune mapurogiramu edu ose-akagadzirira-ku-busy. Kumbira kubatsirwa uye kubvumira vanhu kuti vabatsire.
Iwe unogona kuda kuisa gweta reCarlingBridge kana kuti mumwe munhu aite izvi kwauri. Iri inzira yakanakisisa yekuchengetedza mhuri yako yese neshamwari zvakanyatsoenderana nemamiriro ako ezvinhu usingashandisi maawa akawanda zuva roga roga pafoni. Shamwari dzako dzichaonga mukana wekutaura uye kukunyora manotsi pasina kunyunyuta nezvekuvhiringidza zororo rako. Panewo nzvimbo dzinobvumira vanhu kuti vasainire kuti vauye nezvokudya, kukuendesai kumashanyi ekudzoka, uye mamwe rubatsiro akadai sevatore Chikafu uye Lotsa Kubatsira Maoko.
Emotionally iwe unganzwa sokuti iwe uri kuputsika dzimwe nguva. Zvidzidzo zvinotitaurira kuti vanhu vanoita nenzira yakafanana mushure mekuongororwa kwekenza uye hazvina basa kana iri kutanga kwekutanga kana kupfuura. Usarega mumwe munhu achiita kuti iwe unzwe wakashamiswa nokutaura "inongova danho rega 1." Ndikenza, uye kenza inotyisa! Manzwiro ako angangotarisa kutarisa kubva pakutya kunetseka kuti kuve nokunyonganiswa kunetseka-dzimwe nguva nenzira yemaminitsi. Iwe hausi nguva dzose kuva nemafungiro uye zvakakosha kuratidza mafungiro ako akaipawo zvakare.
Kupindira muboka rekutsigira kana munharaunda yekutsigira kwepakombiyuta inogona kuva inokosha. Pane chimwe chinhu chakakosha pamusoro pekutaura kune vamwe vari kutarisana nematambudziko akafanana. Iyi mihara inopawo mukana wekudzidza nezvekutsvakurudza kwakapfuura kwekenza yepamu, sezvo pasina munhu anofanirwa seavo vanorarama nechirwere.
Prognosis
Mafungiro emutambo wekenza yepabonde akanaka. Kune avo vanogamuchira kurapwa nekuvhiyiwa uye chemotherapy kana remishonga inonzi radiation, kana yakarumbidzwa, makore mashanu ekupona kwemazuva ari pedyo ne100 muzana. Izvozvo zvakati, kuburikidza nekurapa kwechitsauko 1 kenza yemazamu haisi nyore. Migumisiro inowanzoonekwa, kunyanya nekemotherapy, uye kuneta kunenge kwese kwese.
Shoko Rinobva
Kuongororwa kwechitsauko 1 kenza yemazamu inotyisa. Kunyange zvazvo maitiro ekupona akanaka kwazvo, zvinogona kuva zvakaoma kufunga nezvematanho ose aunoda kutora kuti uende ikoko. Vimba nevamwe uye uvabvumirire kukubatsira. Kazhinji kenza zvikwata zvine mapoka ekutsigira kana vatungamiri kune avo vachangobva kuongororwa. Kutora nguva yekushanyira nevanhu vakapfuura nemishonga uye vanobuda kwete kungopona, asi kubudirira, kunogona kukurudzira mumazuva iwayo apo kuneta kwekenza kunokunda.
> Sources
> McVeigh, T., naMer Kerin. Kushandisa Kushandiswa kweOcotype DX Genomic Muedzo Wokutungamira Kurapa Zvisarudzo Zvevarwere Nevanokanganisa Kenza Yemazamu. Chirwere chepabonde (Dove Med Press) . 2017. 9: 393-400.
> National Cancer Institute. Breast Cancer Treatment (PDQ) -Health Professional Version.