Kuye kwathiwa ukuthi ukuhlakanipha kungomunye weminikelo yokuqala yempi. Umhlatshelo ofanayo ungase ube yingxenye yempi yonke yesiguli ngokumelene nomdlavuza, njengoba imithi eminingi ebulala umdlavuza iphinde ikhukhumeze izingqondo zethu futhi igxilise izinzwa ezithumela ulwazi ebuchosheni bethu.
Futhi njengempi, akulula ngaso sonke isikhathi ukutshela umngane esitheni. Ingabe uphawu oluthile ngenxa yomdlavuza, noma izidakamizwa ezinikezwe ukulwa nomdlavuza?
Noma ingabe kungenxa yokunye okuphelele?
Kunezinhlobo ezahlukene zezindlela ama-chemotherapeutic agents angalimaza isimiso sezinzwa. Okulandelayo akuphelelanga, kepha kunikeza ukubuka kabanzi ngezindlela ezithile ze-chemotherapy kungalimaza isimiso sezinzwa.
Izinkinga zingase zenzeke ngokushesha noma kamuva
Nakuba imiphumela eminye yezinzwa ze-chemotherapy ivele ngokushesha, abanye bangathatha iminyaka ukuthuthukisa. I-Busulfan, isibonelo, ivame ukusetshenziselwa ukulungisa iziguli ze-stem cell transplants kodwa futhi ivame ukuhambisana nokuhlukunyezwa phakathi nokuphathwa kwayo. Ngenxa yalesi sizathu, imishanguzo ye-antiepileptic efana ne-phenytoin ingahle isetshenziswe ngenkathi inikezwa ukuze kuvikelwe ukuwayeka. Kodwa-ke, ingozi yokugwinya iyancipha uma imithi ingasanikiwe.
Ngezinye izikhathi i-cytarabine isetshenziselwa ukwelapha i- leukemia ne-lymphomas , futhi ingabangela nezinkinga ngokushesha ngemuva kokuphathwa. Isibonelo, kungabangela ukudideka nokucindezeleka, kanye nokutholakala kwe-cerebellar njenge-blumsiness ( ataxia ).
Imithi kufanele imiswe ngokushesha uma lokhu kwenzeka. Ezinye iziguli zilulame, kepha ezinye iziguli azikwazi. I-Cytarabine ingabuye ijowe nge- intrathecally , kepha lokhu kungase kuholele esikhathini esithile ukuxilongwa okungahambisani nokukhubazeka komlenze nokukhubazeka kwe-sphincter. Futhi, imithi kufanele ishiywe ngokushesha uma lokhu kwenzeka.
Ukulimala komgogodla kusuka ku-cytarabine kuvame ukuhlala njalo.
I-Methotrexate ingasetshenziselwa ukwelapha izinhlobo eziningi zegciwane, futhi ibangele nemiphumela emibi eminingi engaba khona, ezinye zazo zingenzeka ekuseni futhi ezinye ziphuze. Isibonelo, kungabangela i- aseptic meningitis eyenzeka ngokushesha lapho umuthi unikezwa nge-intrathecally. I-meningitis ye-aseptic ivame ukulandela ukuphathwa kwe-intrathecal futhi isebenza ngamaphesenti angama-10 kuya kwangu-50 weziguli ezithola lesi sidakamizwa ngale ndlela. Izimpawu zihlanganisa inhloko kanye nentamo eqinile kanye nesicanucanu, ukuhlanza, nomkhuhlane. Ukwelashwa ngokuvamile akudingeki njengoba izimpawu zixazulula zodwa.
Ngokuphambene nalezi zinkinga ezinzima kakhulu, i-methotrexate nayo ibangela i-leukoencephalopathy, okusho ukuthi yi-disorder ye-cerebral ngenxa yezinguquko ezifundeni ezingenalutho zobuchopho, okungenzeka ngisho neminyaka ngemuva kokuthi izidakamizwa ziyeke. Lokhu ikakhulukazi uma i-methotrexate isetshenziselwa ukwelapha izifo zabantu abasha, njenge-leukemia yengane. Imiphumela emibi ingabuka ekukhubazekeni okuncane ukucindezeleka okukhulu. Ku-MRI, izilonda zesici zingabonakala.
Izinguquko ezingqondweni
Izinguquko ezinkulu ezinjenge-methotrexate leukoencephalopathy azihlukile kulowo muthi kuphela.
Eqinisweni, izinguquko zengqondo zivame kakhulu ekhemotherapy ukuthi igama elithi "chemofog," lihlelwe ukuchaza lo mkhuba. I-Chemofog ihlanganisa izinhlobo eziningi zemiphumela yocwaningo ngokuvamile ehlotshaniswa nemithi ye-chemotherapeutic, enezibonakaliso ezivela ekudidekeni okuncane kuya ekudemeni kwengqondo okukhulu. Ukuhlala kwalezi zinguquko kungaguquka.
Uma i-ifosfamide, isibonelo, i-agent esetshenziselwa ukuphatha izicubu eziqinile. Isidakamizwa ngezinye izikhathi singabangela ukucindezeleka, kodwa lokhu kuvame ukuphumula ngemuva nje kokuba i-ejenti ivaliwe. Amanye ama-encephalopathies, njenge-leukoencephalopathy of methotrexate, angabangela ukulahlekelwa okuhlala njalo.
I-post-reversible encephalopathy syndrome (PRES) enye ingcindezi engase ibe khona yamakhemikhali amaningi we-chemotherapeutic, ikakhulukazi i-cyclosporine ne-tacrolimus. Le mithi ivame ukusetshenziselwa ukulungiselela abantu ukuguqula izitho. Izimpawu zingabandakanya ukuphathwa ikhanda, ukudideka, ukuhlukunyezwa , noma ukulahleka kwezinto eziphathelene negazi. Uma kuhlolwa i-MRI, ukuqina okufana nefu kungase kubonakale ukuthi ngokuvamile kuvame eduze komhlane. Imithi kufanele imiswe noma ishintshwe uma i-PRES ikhona.
Izibhamu
I-Cancer ivame ukudala ukuthi yini odokotela abayibiza ngokuthi i-hypercoagulable state, okusho ukuthi ama-clots wegazi ajwayele ukufometha izikhathi nezindawo ezingafanele. Isibonelo, i-clot ingase ifake ebuchosheni, ibangele isifo . Ngeshwa, ezinye ze-chemotherapies nazo zingabangela imivimbo, njenge-methotrexate, i-cisplatin, i-imatinib nokuningi.
Amanye ama-agent, njenge-bevacizumab ne-sunitinib, ahlose ukuhlose imithwalo yegazi kusukela ngamathumba ngokuvamile adala izitsha ezintsha zokuthumela izakhi ekukhuleni okungavamile. Ngeshwa, imiphumela emibi ingabandakanya ukulimala noma imivimbo ye-ischemic. Njengesinye isibonelo, i-L-asparaginase isetshenziswa njalo ukuphatha i-acute lymphoblastic leukemia (YONKE) futhi ngezinye izikhathi ibangela ukuhlukunyezwa kwe-sinus ye-venus ukwakha ngisho nasezinganeni. Lokhu kuvame ukuxazulula ngekhefu emgomweni wezokwelapha. Uma i- blood thinner isetshenziswa ngaleso sikhathi, ngezinye izikhathi imithi ingabuyekezwa.
I-Peripheral Neuropathies
I-peripheral neuropathies ingumphumela ovamile ohlangothini lwe-chemotherapy, ikakhulukazi kuma-agent ase-platinum aqukethe njenge-cisplatin ne-oxaliplatin. I-peripheral neuropathy eyabangelwa i-cisplatin ibangela ukuguguleka okuqhubekayo nokuhamba nge- paresthesias okuqala emaphethelweni eminwe nasezinzwaneni futhi isakaze ngaphakathi. Ngenkathi ukuzwa komzimba esikhaleni kubonakalisiwe, ukuzwa ubuhlungu nokushisa kuhlale kusindiswa, okuhlukanisa i-cisplatin neuropathy kusuka ezinhlobonhlobo eziningi ze-neuropathies ezingabangelwa umdlavuza uqobo. Izingozi zokunciphisa i-dose noma ukushintshela kwesikhungo esincane se-neurotoxic efana ne-carboplatin kumele silinganiswe nezinzuzo zokuqhubeka ne-cisplatin therapy. I-neuropathy ingaba yingozi nakakhulu noma iqale izinyanga emva kokuba i-cisplatin ivaliwe.
I-Oxaliplatin ihlotshaniswa nokuqala okungazelelwe kwama-paresthesias esandleni, ezinyaweni nasemlonyeni, konke okubuhlungu kakhulu emakhazeni. Kungase kubangele neuropathy efanayo naleyo ebangelwa i-cisplatin, nakuba i-neuropathy ye-oxaliplatin ishintsha kalula kalula.
Ezinye i-chemotherapeutics ezihlobene ne-peripheral neuropathy zifaka i-docetaxel, i-vincristine, ne-paclitaxel, phakathi kwamanye amaningi.
Ukulimala kwe-Neuromuscular
Ukulimala kwe-neuromuscular akuvamile kakhulu kune-neuropathy ye-peripheral, kodwa kungenzeka kusengenzeka ngenxa ye-chemotherapy. I-Doxorubicin, i-cisplatin, i-etoposide, nabanye ingabangela ngempela uphawu kufinyelele ku- myasthenia gravis . I-Imatinib esetshenziselwa ukwelapha ezinye izinhlobo ze-leukemia, ingabangela ukuhlukunyezwa kwe-muscle kanye ne-myalgias, kodwa ngokuvamile kuvamile futhi kuyasabela imithi efana ne-calcium noma i-magnesium.
Akuyona imfihlo ukuthi i-chemotherapy imithi enamandla kakhulu enezingozi ezinkulu zemiphumela emibi. Lokho engikubhalile lapha kuwuhlaka olubanzi kakhulu. Kunesizathu sokuthi le mithi ivame ukugcinwa izifo ezinjenge-cancer, lapho izinzuzo zokuthatha ukungalingani kwemithi ngisho nezingozi ezinkulu. Inhloso yalesi sihloko akumele ichithe labo abadinga le mithi ukuthi bangayithathi, kodwa ukuqinisekisa ukuthi abantu bayazi ukuthi kungenzeka yini imiphumela emibi ukuze bakwazi ukuhamba kahle ngezinkinga zokwelashwa komdlavuza.
Imithombo:
I-EQ Lee, i-IC Arrillaga-Romany, i-PY Wen. Izinkinga Neurologic ze-Cancer Medical Treatment. Ukuqhubeka kwe-Learning Lifelong Neurol 2012; 18 (2): 355-365.
I-EQ Lee, PY Wen. Izinkinga ze-neurologic ye-platinum-based chemotherapy Ku: DMF Savarese, Ed
I-EQ Lee, PY Wen. Izinkinga ze-neurologic ze-cancer-non-platinum umdlavuza we-chemotherapy. Ku: DMF Savarese, Ed UpToDate.