I-Chemotherapy isetshenziselwa ukwelashwa kubantu abaningi abanomdlavuza webele we-metastatic ngesikhathi esithile. Kungakhathaliseki ukuthi isetshenziswe umugqa wokuqala noma cha kuxhomeke esimeni sakho se-receptor, ukwelashwa kwangaphambilini, nezinye izici.
I-Chemotherapy iyindlela yokwelapha ehlelekile ehlasela amangqamuzana omdlavuza noma ngabe ikuphi emzimbeni. Kodwa okunye okuhlukile kulokhu, kodwa-ke, ubuchopho, kanti iningi lalezi zidakamizwa lilinganiselwe ngokuba khona kwenkinga yegazi-yobuchopho.
Indlela Esebenza ngayo
I-Chemotherapy isebenza ngokuhlasela amangqamuzana akhula ngokushesha njengama- cell cell . Iningi lemithi yokwelapha i-chemotherapy liphazamisa amangqamuzana omdlavuza ngesikhathi esithile esimisweni sokuhlukaniswa, kodwa izingxenye ezahlukene zomjikelezo weseli ziphazanyiswa ngezidakamizwa ezahlukene.
Njengoba lezi zindlela zokwelapha zithinta noma yiziphi izinqamuzana ezikhula ngokushesha, nazo zivame ukulimaza amangqamuzana avamile emzimbeni afana nalawo asegayini ( isicupucu ), izinwele zezinwele (ukulahleka kwezinwele), kanye nomnkantsha wamathambo (i-anemia ne-low white cell cells counts).
Uma Kusetshenziswa
Ngokushesha imithi ye-chemotherapy inconywa ukuthi ukwelashwa incike kakhulu kulomhlobo oluthile lomdlavuza wesifuba onayo, kungakhathaliseki ukuthi i-tumor yakho isamukeli se- estrogen noma i- HER 2 receptor emihle , nokuthi ngabe imithi yokwelashwa ye-hormone ingasebenza yini noma iyasebenza ngempumelelo yakho.
I-Chemotherapy ivame ukuphakanyiswa umugqa wokuqala (njengokwelashwa kokuqala komdlavuza we-metastatic):
- Kwabesifazane abane-tumor e-receptor-positive eziye zaba ukumelana nemithi ye-hormonal efana ne- tamoxifen noma i-aromatase inhibitors.
- Kulabo besifazane abane-HER2 emihle kakhulu (kanye nokwelashwa okuhlosiwe okunjenge-Herceptin) okungenayo i-estrogen receptor.
- Kulabo besifazane abanezinambuzane ezitholakala kokubili i-estrogen receptor kanye ne-HER2 engalungile (amathrensi webele we-triple negative).
- Kungasetshenziswa kanye nemithi yokwelapha ye-hormonal kulabo abanesifo se-estrogen se-receptor esabelayo emithini ye-hormonal uma kudingeka ukunciphisa ngokushesha isisu.
Ukuvama
I-Chemotherapy ivame ukunikezwa ngemijikelezo ehlukaniswe ngezinsuku ezingu-21 kuya kwezingu-28. Inombolo yemijikelezo oyitholayo iyoxhomeka ezintweni eziningi, kufaka phakathi impendulo yakho kumuthi noma izidakamizwa.
I-chemotherapy ingasebenza kahle kumdlavuza wesifuba we-metastatic, nakuba izicubu cishe zihlale zingamelana nanoma yisiphi isidakamizwa esinikezwe noma ukuhlanganiswa kwezidakamizwa ngokuhamba kwesikhathi. Akuvamile ukuthi abantu bathole okungenani izinhlobo ezintathu zemithi yokwelapha i-chemotherapy ngesikhathi sokwelashwa.
I-Chemotherapy yomdlavuza wesifuba we- metastatic inganikezwa njalo (inhlanganisela eyodwa yezidakamizwa emva komunye ngaphandle kwekhefu) noma nge-intermittently futhi kunezinzuzo nezinyathelo kwindlela ngayinye. Kutholakale ukuthi i-chemotherapy eqhubekayo inganciphisa ukukhula komdlavuza ngendlela ephumelela kakhulu kunezokwelapha okuphakathi, nakuba kungabonakali umehluko omkhulu ekusindeni jikelele.
Ngokuphambene nalokho, labo abathola ukwelashwa okuhamba phambili bavame ukuba nekhwalithi yokuphila engcono kakhulu. Kungenxa yezizathu eziningi ezifana nalezi ukuthi i- oncologist yakho izofuna ukuqonda okuthandayo ngokuqondene nokuphatha umdlavuza wakho.
Imigomo
Imigomo yokwelashwa kwe-chemotherapy yomdlavuza webele we-metastatic ngokuvamile ihlukile kunezinhloso zokwelashwa kwe-chemotherapy ngezifo zakuqala, futhi lokhu kungadideka kakhulu.
Ngomdlavuza wesifuba osencane, i-chemotherapy ivame ukunikezwa ngenhloso yokwelapha lesi sifo. Isibonelo, uma i-chemotherapy inikezwa ngemuva kokuhlinzwa komdlavuza wesifuba, kulindeleke ukuthi lezi zidakamizwa zizohlasela noma yiziphi izinsalela zamangqamuzana emzimbeni (ezingenakubonwa kwizifundo ze-imaging,) ngethemba lokuthi umdlavuza uzokwelashwa. Esetshenziswa ngale ndlela, i-chemotherapy ibizwa ngokuthi yi-adjuvant therapy.
I-chemotherapy ingase isetshenziselwe umdlavuza webele wesandulela-ngculazi ukuze unciphise ubukhulu besisu ukuze kutholakale ukuhlinzwa. Esetshenziswa ngale ndlela, i-chemotherapy ibizwa ngokuthi i-neoadjuvant therapy, futhi umgomo uyiphilisi.
I-Chemotherapy yomdlavuza webele we-metastatic, noma kunjalo, isetshenziselwa imigomo ehlukene. Le migomo yilezi:
- Ukwandisa impilo yakho
- Ukuthuthukisa izinga lakho lokuphila
- Ukuze unciphise izimpawu zakho
Ngamanye amazwi, ngokungafani ne-chemotherapy emdlalweni webele wesifuba, isifo se-chemotherapy somdlavuza wesifuba se-metastatic asihlinzeki ngenhloso yokwelapha lesi sifo, kodwa kunalokho ukulawula lesi sifo isikhathi eside ngangokunokwenzeka.
Kungani Kungabi Ukwelapha Injongo?
Kungaba buhlungu kakhulu futhi kuyamangalisa uma uqonda umehluko phakathi kokuthi imithi ye-chemotherapy inganikeza isifo somdlavuza wesifuba sokuqala kanye nokuthi yini engayifeza ngomdlavuza webele we-metastatic.
Akukhona ukuthi odokotela abafuni ukuzama ukwelapha umdlavuza webele wesifuba nge-chemotherapy. Benza. Yilokho kuphela ngezidakamizwa esinazo okwamanje, nokuphikiswa okwenzeka ngokuhamba kwesikhathi, izinkinga ze-chemotherapy eziphulukisa umdlavuza ophakeme ziphansi kakhulu. Lokhu kuyiqiniso ngisho noma ngabe kufanele uphathwe ngendlela ephakeme kakhulu futhi enobudlova eziningana kulezi zidakamizwa.
Ngeshwa, ngokusho kocwaningo, abesifazane abaningi (namadoda) balindele impendulo ehlukile kune-oncologists, futhi banethemba lokuthi i-chemotherapy izokwelapha umdlavuza wabo we-metastatic. Sihlanganyela lokhu ukuze singasusi ithemba lakho. Kunabantu abathile abaphendulayo futhi baqhubeke bephendula i-chemotherapy isikhathi eside. Noma kunjalo, kubalulekile ukuqonda ukuthi yiziphi i-chemotherapy ezingakwazi futhi ezingenakuzenza ngezidakamizwa esinazo okwamanje.
Uma usalindele ukwelashwa, khuluma nodokotela wakho. Ngalesi sikhathi azikho imithi evunyelwe ukuthi ingaphilisa umdlavuza webele we-metastatic, nakuba imishanguzo emisha ihlala ihlolwa ngezilingo zemitholampilo. Kubantu abambalwa, ezinye zala mithi emisha, njengezidakamizwa ze-immunotherapy, zingase (kodwa asazi futhi yingakho zifundiswa) zinikeza ithuba elikhulu lokusinda isikhathi eside.
Ngesikhathi esifanayo, noma kunjalo, kukhona okungaziwa, futhi kuze kube yilapho izidakamizwa zivunywa asikwazi ukuthi ngeke zenze izinto zibe zimbi nakakhulu.
I-Chemotherapy Izidakamizwa
Uma umdlavuza wakho ukuphindaphindiwe futhi ube ne-chemotherapy okokuqala ngqa, izidakamizwa ezahlukene zivame ukusetshenziswa. Kucatshangwa ukuthi amangqamuzana omdlavuza aphikelele ngaphesheya kokwelapha kwakho kokuqala cishe ayengafuni imithi. Ngamanye amazwi, i-chemotherapy kungenzeka ukuthi yabulala amaningi amangqamuzana omdlavuza kodwa amaseli asele ayengamelana nalo muthi ashiywa ngemuva.
Akuvamile ukuthi othile abe nezinhlobo ezintathu ezihlukene zokwelashwa kwamakhemikhali asetshenziselwa ukuphatha umdlavuza wabo. Ukuhlukanisa lezi zindlela zokwelashwa, i-oncologists ivame ukubhekisela emgomweni we-chemotherapy njengowokuqala, umugqa wesibili, umugqa wesithathu, njalonjalo. I-Chemotherapy ijwayele ukuphumelela kangcono ngokuhamba kwesikhathi njengoba kunemigomo eminingi edingekayo.
Izigaba zemithi
Kunezigaba eziningi ezahlukene zemithi engasetshenziswa. Eminye yale mithi yokwelapha i-chemotherapy esetshenziselwa umdlavuza webele we-metastatic ehlehliselwe ngezigaba ezihambisanayo ihlanganisa:
- Anthracyclines - i-Adriamycin (doxorubicine), i-Ellence (i-epirubicine)
- Ama-alkylating agents - iCytoxan (cyclophosphamide)
- AmaTela - I-Taxol (paclitaxel), i-Taxotere (docetaxel)
- Inhibitors yamaMitotic - i-Halaven (i-eribulin)
- Imithi ye-Nucleoside analog - iGemzar (gemcitabine) ne-DNA synthesis inhibitors Xeloda (capecitabine)
- Antimetabolites - methotrexate
- I-Microtubule inhibitors - Ixempra (ixabepilone), i-Navelbine (i-vinorelbine)
- Izidakamizwa zePlatinum - Platinol (cisplatin), iParaplatin (carboplatin)
- Izidakamizwa ze-Topoisomerase - i-etoposide
Ukwelashwa Okungashadile Nokuhlangana
Ngokungafani nokwelashwa kwe-adjuvant kumdlavuza wesifuba we-early-stage okuyinto cishe njalo kuhlanganisa ukusebenzisa inhlanganisela yezidakamizwa, ukwelashwa okulodwa-agent ngokuvamile kuvame ukusetshenziswa kumdlavuza webele we-metastatic. Ukusetshenziswa kwe-chemotherapy ehlangene kuvame ukulingana nezikhathi lapho umdlavuza ushuthuka ngokushesha ukuze ukwazi ukulawula lesi sifo.
Izinhlanganisela ezimbalwa ezivame ukusetshenziswa zihlanganisa i-Xeloda (capecitabine) ne-Taxotere (docetaxel) ne-Gemzar (gemcitabine) ne-Taxol (paclitaxel).
I-Brain Metastases
Nakuba i-chemotherapy ikwazi ukwelapha amangqamuzana omdlavuza cishe yonke indawo emzimbeni, imithi eminingi ye-chemotherapy ayikwazi ukufinyelela ebuchosheni. Lokhu kungenxa yezingqimba ezikhethekile ze-capillari eyaziwa ngokuthi i-blood-brain brain.
Isivimbelo segazi-senzelwe ukuvimbela amathonsi ukungena ezicubu ezibucayi zobuchopho nomgogodla, kodwa ngeshwa, zingavimbela izidakamizwa ze-chemotherapy ukuze zithole ukufinyelela. Okunye okukhethwa kukho ukwelashwa, okufana nokwelashwa okuphelele kwengqondo, kungase kudingeke ukwelapha umdlavuza webele oye wasakazeka ebuchosheni.
Imiphumela Ejwayelekile Ejwayelekile
Abantu abaningi bayazi ukuthi izidakamizwa ze-chemotherapy ziba nemiphumela emibi. Yize lokhu kuyiqiniso, kuye kwaba nokuthuthuka okuphawulekayo ekulawuleni imiphumela emibi ye-chemotherapy eminyakeni yamuva, ikakhulukazi izimpawu ezifana nesicanucanu nokuhlanza.
Imiphumela emibi yezokwelapha ezihlukahlukene ingahluka, futhi kubalulekile ukukhuluma nodokotela wakho mayelana nokuphendula okunzima okungenzeka ukuthi ulindele.
Ukukhathala - Ukukhathala kungenye yemiphumela emibi kakhulu ye-chemotherapy, futhi okunye okhathazayo kakhulu. Ngisho noma singenayo imithi ethile yokukhathala, njengoba senza ngenxa yokuzihlambalaza, kunezinto eziningi ongayenza ukuze wenze kube lula ukubekezeleleka.
Izinyathelo ezilula, njengokuzibandakanya ngosuku, ukubeka phambili imisebenzi, nokufunda ukuthumela, kungasiza kakhulu. Khumbula ukuthi ngesikhathi esifanayo njengoba ubhekene nokukhathala, abathandekayo bakho cishe babhekene nomuzwa wokungabi namandla. Ukufunda ukuthumela abanye, nokucela nokuthola usizo akusize nje kukusize ngokukhathala kwakho kodwa kuzovumela abathandekayo bakho indlela yokubhekana nemizwa yabo yokungabi namandla.
Ukulahleka kwezinwele - Ukulahlekelwa izinwele kuvame kakhulu nemithi eminingi ye-chemotherapy. Kulabo ababenokhemotherapy "okokuqala ngqa" lokhu kungaba nzima nakakhulu ngalesi sikhathi nxazonke. Futhi ngokungafani ne-adjuvant chemotherapy, ngokuvamile akuyona ukuphela okucacile emehlweni.
Uma ungazange utshale imali ku-wig ngaphambili, lokhu kungaba yisikhathi esihle sokwenza kanjalo. Umshwalense uvame ukuhlanganisa ingxenye yalokhu, futhi izinhlangano eziningana zinikeza ama-wigs mahhala kusuka ezintweni ezinikeziwe. Ama-scarves kanye nezigqoko nakho kuyindlela yokukhetha, futhi kuvame ukukhululeka.
Kuye kwacwaningwa eminyakeni yamuva kubheka izindlela zokuvimbela izinwele. Ngenkathi lezi zindlela, ezifana nokugqoka i-ice cap ngenkathi ukufakelwa kwakho, zinganciphisa izinwele zakho, zingase zingakhululekile.
I-nausea nokuhlanza - Nakuba izidakamizwa eziningi ezisetshenziselwa umdlavuza webele we-metastatic zingabangela isicanucanu nokuhlanza, kunezindlela eziningi zokubhekana nalokhu. Eqinisweni, kunabantu abaningi abanobuhlungu obuncane noma obungenanjongo obuhlobene nokwelapha.
Kunezigaba eziningana ezihlukene zemithi esetshenzisiwe, ezinye ezenzelwe ukuvimbela isicanucanu kuqala, nezinye ezingasetshenziselwa ukwelapha isiyaluyalu. Qinisekisa ukuthi ukhuluma nodokotela wakho uma uhlangabezana nanoma yisiphi isiyaluyalu.
Ngenkathi kunezinhlobo eziningi zokwelashwa, ezinye zisebenza kangcono kwabanye abantu kunabanye, futhi kungaba nzima ukwazi ukuthi yiziphi izidakamizwa zokulwa nesisulu ezizosebenza kangcono kunoma yimuphi umuntu. Ungase uzwe abantu bekhuluma ngama-acupressure bands, i-ginger, nezinye izinto ezibizwa ngokuthi "ezinye" zokwelapha ngenxa yezinyosi ezenziwe ngamakhemikhali.
Nakuba lezi zinyathelo zingase zibe nomthelela othile, kufanele zisetshenziswe kuphela njenge-add-on emithi yokwelashwa, futhi hhayi njengengxenye.
I-diarrhea ingase ibonakale njengomphumela wecala. Sebenza nodokotela wakho ukuze ubuyekeze ukuthi ungenzenjani ukwehlisa lo mphumela ohlangothini.
Ukuxoshwa komnyoba we-Bone - Umphumela wezidakamizwa zamakhemikhali emathambo angabangela ukwehla kwamazinga azo zonke izinhlobo zamaseli egazi akhiqizwa emnothweni wethambo. Lokhu kungafaka amangqamuzana egazi abomvu (i-anemia), amaseli egazi amhlophe (i-leukopenia noma i-neutropenia), nama-platelets thrombocytopenia.
Ingozi enkulu kunazo zonke ngenxa yokunciphisa komnyoba we-bone umthamo we-white white. Lokhu kungakunikela ekutheleleni izifo ezinama-bacterium okungenangqondo, futhi kwenza kube nzima ukulwa nesifo uma kwenzeka. Uma uhlakulela umkhuhlane ngenkathi ku-chemotherapy (ngisho neyodwa ephansi njenge-100.5) kubalulekile ukubiza udokotela wakho ngokushesha.
Iningi lalezi zifo zitholakala kakhulu, kodwa ukwelashwa okusheshayo kungenza umehluko omkhulu. Udokotela wakho uzokukhuluma ngezindlela zokunciphisa ukutheleleka, futhi kubalulekile ukubukeza lokhu. Abantu abasebenzisa i-chemotherapy-kungakhathaliseki ukuthi inani labo elimhlophe legazi liphansi kangakanani-bavame ukutshelwa ukuba bagweme izindawo ezigcwele (ikakhulukazi phakathi nezinyanga zasebusika kanye nenkathi yempukane) nokunciphisa ukuxhumana nabathandekayo abagulayo. Ngezinye izidakamizwa ze-chemotherapy, udokotela wakho angase anikeze imithi yokwandisa isibalo sakho segazi elimhlophe.
I-anemia ingaba negalelo ekukhatheni kwakho. Xoxa nodokotela wakho mayelana ne-hemoglobin yakho futhi lapho ezocabangela ukuphatha izinga eliphansi. Inani eliphansi leplatelet lingakwandisa ingozi yokuphuma kwegazi. Uma izinga lakho liphansi, kungumqondo omuhle ukugwema imisebenzi engabangela ukuphuma noma ukulimaza.
I-peripheral neuropathy - Ezinye izidakamizwa ze-chemotherapy, zingabangela inhlanganisela engakhululekile yezimpawu ezibizwa ngokuthi i-peripheral neuropathy. Izimpawu zingabandakanya ukuvutha, ukugubha, nokwehliswa okwenzeka "ukusabalalisa nokubeka iglavu" ezandleni nasezinyaweni.
Njengoba ukwehla kwezinyawo zakho kunciphile kungase kuphazamise ukuhamba nokulinganisela, abantu abasebenzisa lezi zidakamizwa kufanele babheke ezungeze izindawo zabo zasekhaya ukuze banciphise amathuba abo okuwa, gwema ukusebenzisa izithiyo ezifana nokuphonsa amagundane futhi uqaphe lapho uhamba eqhweni naseqhweni . Ngenkathi i-peripheral neuropathy ingathuthuka ngokuhamba kwesikhathi, ezinye zalezi zimpawu zingase zihlale zihlala njalo emva kokuyeka ukwelashwa.
> Imithombo:
> DeVita, Vincent., Et al. I-Cancer: Izimiso Nokusebenza Kwe-Oncology. Cancer of the Breast. I-Wolters Kluwer, ngo-2016.
> Liedtke, C., no H. Kolberg. Ukwelapha Okuhlelekile Kwe-Advanced / Metastatic Breast Cancer-Ubufakazi Besikhathi Esizayo kanye Nemicabango Yesikhathi Esizayo. Ukunakekelwa kwebele . 2016. 11 (4): 275-281.