Izinkinga ezingenzeka ngeSigaba 4 Igciwane lesisu
Uma uhlala nomdlavuza webele wesifuba (i-metastatic noma isigaba 4) cishe awujabuli ukuzwa ngezinkinga ezingase zibhekane nazo. Phela, akuzona yini izimpawu noma umdlavuza wakho nemiphumela emibi yokwelapha ngokwanele? Ngenhlanhla, ngokungafani nemiphumela emibi ejwayelekile, lezi zinkinga ezingase zivame kakhulu, futhi ungase ungaboni okuningi, noma ngisho nanoma iyiphi yalezi zinkinga.
Ake sibuke ezinye izinkinga ezihlobene nesayithi ye-metastase, elandelwa ezinye zezinkinga ongase uzizwe nomdlavuza webele we-metastatic ( umdlavuza wesifuba we- 4 wesine) ngokujwayelekile.
Imiphumela emibi ngokumelene nezinkinga
Kubalulekile ukwenza umehluko ngaphambi kokuqala. Kungenzeka ukuthi uyazi nemiphumela eminingi emibi yezokwelapha zesifuba sebele, njengokulahlekelwa izinwele nge-chemotherapy, noma ukukhathala ngemisebe. Ngenhloso yengxoxiswano yethu sizobheka imiphumela emibi njengento ejwayelekile evame ukulindelwa.
Ngokuphambene nalokho, izinkinga ziyizinkinga ezingase zikumangele, futhi ukuthi ungakaze uzwe ngaphambi kokuphila nomdlavuza ngokwakho. Futhi kufanele sigcizelele ukuthi abantu abaningi abanakho konke (noma noma yikuphi) kulezi zinkinga, futhi sithemba ukuthi ngeke sidambise noma ubani ngokufaka kuhlu izinkinga ezingase zibe khona. Lokho kusho ukuthi eziningi zalezi zinkinga ziyaphathwa, futhi ukwelashwa kuphumelela kakhulu uma kuqalwa ngokushesha kunokuba kamuva.
Kwezinye izimo, ukuqaphela inkinga ngaphambi kwesikhathi kungavimbela izinkinga ezinkulu, ngisho nokukhubazeka noma ukufa.
Izimpikiswano Ezivamile Ze-Metastatic Breast Cancer
Kunezinye izinkinga ezijwayelekile ezihlobene nomdlavuza webele we-metastatic ezithwala ingozi kungakhathaliseki ukuthi umdlavuza wakho usakazeke kuphi, noma uhlobo lwezokwelapha ozitholile esikhathini esidlule noma ozitholayo manje.
Lokhu kufaka:
- Izindwangu zegazi: Izingozi zezingxenyeni zegazi zibandakanya ukuba nomdlavuza we-metastatic, ezinye zezokwelapha (njenge-chemotherapy) yesifo, ukulala embhedeni, nokuningi. Sifunda ukuthi igazi eligaya nomdlavuza livame kakhulu, futhi kubangelwa ukugula okukhulu futhi ngezinye izikhathi ngisho nokufa. Lezi zibazi zegazi zivame ukuqala emilenzeni noma kwesikhumba ( imfucuza ye-vein thrombosis ) futhi ingahle ihambe futhi ibheke emaphashini (i- pulmonary embolism ). Izimpawu zokuqaphela zihlanganisa noma yikuphi ukubomvu, ukuvuvukala, noma ububele bemilenze yakho, ukuphelelwa umoya okungazelelwe, ubuhlungu obukhulu be-chest, ubuhlungu obukhulu noma ngisho nokungazi lutho. Uma ibanjwa ngesikhathi, igazi elincane lingasetshenziswa ukuxazulula ama-clots.
- Ubuhlungu: Ubuhlungu benomdlavuza we-metastatic bungaba okuguquguqukayo futhi kuvame ukuxhomekeka endaweni yesifo se-metastatic (bheka amathambo ayisithupha ngezansi). Kodwa-ke, siyazi ukuthi ubuhlungu bungaphazamisa izinga lakho lokuphila, futhi izinga lokuphila umgomo oyinhloko ekwelapheni isigaba somdlavuza wesi-4. Khuluma nodokotela wakho mayelana nokulawulwa kobuhlungu kubantu abanomdlavuza . Kunezinketho eziningi ezehlukene ezitholakalayo, futhi abantu abaningi, ngisho nangesifo esibi kakhulu sokuphela kwesifo, bangakwazi ukukhululeka.
- I-cachexia: I- cachexia yomdlavuza yinkinga enzima ngomdlavuza ophakeme. Kuyisifo sokulahlekelwa kwesisindo sokuzibophezela, ukulahleka kwemisipha nokunciphisa ukudla. Iyanciphisa ikhwalithi yokuphila futhi ibonakala sengathi iyimbangela eqondile yokufa ngamaphesenti angu-20 abantu abanomdlavuza. I-syndrome ye-cachexia, nakuba iqaphela ukulahlekelwa isisindo, ibonakala iqalile ngisho nangaphambi kokuba ukulahlekelwa kwesisindo kuqale. Kukhona ucwaningo oluphawulekayo enkambweni yokufuna izindlela zombili zokuvimbela nokuphatha i-cachexia. Uma unenkinga yokulahlekelwa ukudla , noma ulahlekelwe isisindo, ulethe lokhu nodokotela wakho. Ukungaqapheli, ukuzivocavoca kuyasiza. I-Cachexia iyisimpawu esisodwa somdlavuza obonakala sengathi usizwa kakhulu ngophuzo lwezokwelapha uma lokhu kungokomthetho esifundazweni sakho.
Izinkinga ezihlobene ne-Bone Metastases
Amathambo yindawo ejwayelekile kunazo zonke lapho umdlavuza webele usakazeka khona. Intuthuko yenziwa nje kuphela ekuphatheni lezi zimiso zokudla kodwa kubheka izindlela zokuvimbela amathisaseli e-bone endaweni yokuqala. Kulabo abanomdlavuza wesifuba nge-metastases yamathambo , izidakamizwa ezishaye amathambo ezinjenge-bisphosphonates ne-denosumab zinganciphisa ingozi yezinkinga ezifana nokuhlukana. Izinkinga ezingenzeka nge-bone metastases zifaka:
- Ubuhlungu: Ubuhlungu obubangelwa ama-metastase we-bone bungaba lukhulu, futhi siyazi ukuthi ubuhlungu bukhulu kakhulu buthakathaka izinga lomuntu lomuntu. Ngesikhathi esifanayo, imithi eminingi esinayo ngenxa yobuhlungu obunzima ibangela ukukhathala nokulala. Ngaphezu kokusebenzisa imithi yobuhlungu, ukwelapha imishanguzo kuyasebenza kakhulu ekunciphiseni ubuhlungu ngenxa yalezi zinhlelo zokusebenza. Izidakamizwa eziguqula umzimba azinciphisi ubuhlungu ngesilinganiso esifanayo, kodwa ngokuhambisana nalezi zingenhla ziwusizo (nakwezinye izizathu).
- Ukuphazamiseka kwemvelo: Ukuphulwa kwamathambo kwenzeka lapho amathambo ephuka (amaphuzu) endaweni ebuthakathaka. Kuye ngendawo, ukwehlukana kwalolu hlobo kungancipha kakhulu ukuhamba.
- Ukucindezeleka kwentambo yomgogodla: Uma i-boneast metastase ivela emgodleni ophansi, ingabangela umgogodla ukucindezela futhi ucindezele izinzwa ezibalulekile ekusizeni ukuba sihambe, siguqule, futhi sidlule amathumbu ethu. Ifomu elibi kakhulu le "microfractures" emgodleni lingabangela ukuba ama-vertebrae ngemuva awale phansi, ukuhlukumeza ukucindezeleka. Lapho amangqamuzana omdlavuza kule ndawo abangela ukucindezelwa kwemizwa, okuphuthumayo kwezokwelapha okubizwa ngokuthi i-cauda equina syndrome kungenzeka kwenzeke. Ngaphandle kokwelashwa okusheshayo ukuze kuqiniswe intambo yomgogodla, umuntu angagcina ekhubazekile emaphethelweni aphansi ngaphezu kokungakwazi ukumbamba isisulu noma amathumbu.
- I-Hypercalcemia . Uma i-tumor iphule phansi ithambo, kubangela ukukhululwa kwe-calcium engxenyeni yegazi, isimo esibizwa ngokuthi i- hypercalcemia yesifo esibi . (Kukhona nezinye izindlela zomdlavuza ezingakhuphula i-calcium egazini kanye). Ekuqaleni, lokhu kungabangela ukunxanxathela nokuhlanza, ukunyuka ukoma, ubuthakathaka, nobuhlungu besisindo, kodwa kungathuthuka ekudidekeni, izimo zenhliziyo ezingavamile, i-coma, nokufa.
Izinkinga ezihlobene nama-Lung Metastases
Amapayipi yindawo yesibili evame kakhulu lapho umdlavuza webele usakazeka khona, futhi amaminerase amaphaphu akhona ngesikhathi esithile cishe engxenyeni yesithathu yabantu abanomdlavuza wesifuba. Izimpawu zingahluka kunoma yikuphi (lapho ukutholakala kwamaphaphu kuphazamisi kutholakala kuphela ku-scan kuphela), ekuphefumuleni okuphawulekayo. Ngaphandle kokwelashwa okuvamile kumdlavuza wamaphaphu we-metastatic, izindlela zokwelapha zendawo manje zisetshenziselwa abanye abantu abanamaphesenti ambalwa okuphuza amaphaphu, futhi lokhu kubonakala kuthuthukisa isikhathi sokuphila. Izinkinga ezingenzeka ezinamaphasethi amaphaphu zihlanganisa:
- Ukuphefumula: Ukuphefumula kungavame ukulawulwa ngemithi efana ne-morphine. Uma ukuvinjelwa kuholele ekuphefumuleni okuncane, i-stent ingafakwa. Ngokumangazayo, i-oksijini ayibonakali iyasiza kakhulu ekunciphiseni ukuzwa okuphefumulayo.
- I-pneumonia: Ukutholakala kwemithambo emaphashini, ikakhulukazi eduze ne-airways, kungabangela ukuqoqwa kwamanzi nama-bacteria ajulile emaphashini. Ngokunciphisa imimoya yomoya, abantu bangase bahlakulele i-pneumonia ephindaphindiwe. Lokhu kungaba okungathí sina nakakhulu uma inani lakho legazi elimhlophe liyancipha ngenxa ye-chemotherapy, futhi ngokuvamile ludinga izifo zokulwa nezidakamizwa.
- Ukugcoba igazi: Ukukhuphuka igazi kungase kwenzeke, ikakhulukazi lapho imishanguzo iseduze ne-airways enkulu. Ukwehla ngisho negazi elincane-i-isipuni-kubhekwa njengesimo esiphuthumayo sezokwelapha. Ukuphuza ingxenye yesithathu yendebe yegazi kunenani lokufa labantu abangaba ngu-30%. Ngamanye amazwi, ungamnaki noma yiliphi igazi okhwehlelayo, noma ngabe liyingcosana kuphela. Uma kutholakala ngokushesha, inqubo ingavame ukuyeka ukuphuma, ngisho noma kunzima.
- Ukuxoshwa okubi kabi kwe-pleural: Ukuxoshwa okubi kabi kwesimemezelo yisimo lapho amangqamuzana asemzimbeni nomdlavuza akha khona phakathi kwamagundane (i-pleura) ebeka emaphashini. Ubukhulu buhlukahluka kuye ngokuthi inani lanikhona okwamanje futhi ukuthi kwenzeka kanjani ngokushesha. I-effusion encane ye-pleural ingase ingadingi ukwelashwa. Nokho, ukuxubha okukhulu kwe-pleural kungagcizelela amaphaphu, okuholela ebuhlungu obukhulu nokuphefumula. Isinyathelo sokuqala ngokuvamile i-thoracentesis, lapho inaliti efakwe khona ngodonga lwesifuba singene isikhala sokukhalaza ukuze sikhiphe amanzi. Ngeshwa, uketshezi kuvame ukuphindaphindiwe. Izinketho zihlanganisa ukukhipha okuphindaphindiwe, ukufaka i-stint ukuze abantu bakwazi ukukhipha amandla abo ekhaya, noma benze inqubo ebizwa nge-pleurodesis. Esikhathini se-pleurodesis, ikhemikhali ifakwe endaweni evulekile eyenza ukuvuvukala, okuholela ekutheni "ukugcoba" kwamagundane ndawonye ukuze umchamo ungase ungagcini.
- Ukuqothuka kwesisu: Ukumiswa kwamapulmonary, noma ukuphuma emaphashini, akuvamile, kepha kungenzeka.
- Ukuvinjelwa kwemikhumbi yomoya: Uma izidakamizwa zikhula eduze noma zingena emoyeni, zingabangela ukuvinjelwa. Lokhu kungaholela ekuphefumuleni kokubili, kanye nezifo ezifana ne-pneumonia. Uma ukuvimbela kunzima, odokotela bangakwazi ukubeka i-stent emgwaqweni ukuze bawuvule.
Izinkinga ezihlobene nama-Metastases we-Liver
Izimpawu ze- foster zingase zingabangeli noma yiziphi izimpawu ngaphandle kokuthi izidakamizwa ziseduze nemikhumbi emikhulu namadayini esibindi. Uma unayo izimpawu, ungase ubone ukuthi ukukhishwa kwesikhumba sakho kuluhlaza okwesibhakabhaka kanye nabamhlophe bamehlo akho (i-jaundice), ubuhlungu besisu, ubuhlungu behlombe, kanye nemifucumfucu. Ngokuvamile, ingxenye enkulu yesibindi idinga ukushintshwa yi-tumor ukuze ibangele izimpawu ezibalulekile. Izinkinga ezimbalwa ezingase zibe khona zihlanganisa:
- Ama-Ascite: Nge-dysfunction yesibindi, uketshezi lungakha emgodini we-peritoneal ( ascites ). Uma isisu sakho sithinteka kakhulu, singaba buhlungu futhi sibangele ukuphefumula (ikakhulukazi uma uneziphazamisi zamaphaphu). Odokotela bangenza inqubo ebizwa ngokuthi i-paracentesis yilapho inaliti efakwe esikhumbeni nasesikhungweni esiswini ukuze kukhishwe uketshezi.
- Ukudideka: Ngama-metastases amaningi, ukudideka nokuxolisa kungaholela, ngenxa yokwakhiwa kwezinto ezimbi emzimbeni.
- Ukweqa: Isibindi sinesibopho sokwenza izici zokuvala. Uma isibindi singasebenzi kakhulu, inani elinganele lalezi zici zingase likhiqizwe eziholele ekukhenikeni nase-anemia.
- Ukunambitha : Ngeke ucabange ukubheka njengenkinga engathí sina, kepha ukucheka okungahambisana ne-metastases yesibindi kungaba nzima. Ukuhlunga kwenzeka ngenxa yokwakhiwa kwe-acidi ye-bile egazini nasesikhumba. Ngaphandle kokucela abathandekayo bakho ukuthi bakubuyisele emuva imivimbo, kukhona imithi enganciphisa lesi sibonakaliso.
Izinkinga ezihlobene ne-Brain Metastases
Ubuchopho buyindawo evamile yomdlavuza wesifu ukuba usakaze, futhi ukuqubuzana komzimba kungabangela noma iyiphi inombolo yezimpawu; ezinye ezingasongela impilo. Ngeke ukwazi ukuthi umdlavuza wakho webele usakazeke ebuchosheni bakho, noma esikhundleni salokho, ungase ubhekane nokunye kwezimo zobuchopho be-brainstase. Ezinye zazo zihlanganisa:
- Ukuzizwa: Ungase ujwayelane nenhlekelele enkulu, noma i-tonic-clonic seizures, uhlobo lapho umuntu engenazi lutho futhi izingxenyana zalo zithuthumela ngokufutheka. Ngezinye izikhathi izigameko zitholakala endaweni eyodwa yomzimba. Okunye ukubanjwa kungase kubangele izimpawu ezifana nomuntu oqala isikhala ebonakala engaboni lutho.
- Amapulazi: I- Brain metastases ingabangela ubuthakathaka, ukuphazamiseka, nokulahlekelwa phansi. Uma kutholakala ama-metastases obuchopho, kubalulekile ukuba uqaphele ngokukhethekile ukuvimbela ukuwa.
- Izinkinga ezibonakalayo: Izinkinga ezibonakalayo ezifana nombono ophindwe kabili, noma ngisho nokulahlekelwa kombono kungenzeka. Abantu baxwayiswa ngokushayela noma ukusebenzisa izinto ezingaba yingozi.
- Ukuguqulwa okungazelelwe kwesimo sengqondo : Izinguquko esimweni sengqondo, izinguquko zobuntu, noma ukulahleka kokuqonda kungenzeka.
Ukwelashwa kwezinkinga ezahlukene ze-metastases yobuchopho ngokuvamile kuvame ukushisa imisebe. Uma kutholakala isisindo esisodwa, noma se-metastase ezimbalwa kuphela, uhlobo oluthile lwe-radiation therapy olubizwa ngokuthi i-stereotactic body body radiotherapy (i-SBRT) lingasetshenziswa ngomzamo wokuqeda imetastasis.
Izinkinga Ngenxa Yamanye Amathemikhali
Umdlavuza wesibeletho ungasakazeka cishe kunoma yisiphi isifunda somzimba, futhi uma unesifo, ngisho noma ubonakala ungahambisani nomdlavuza wakho, qiniseka ukuthi ukhuluma ne-oncologist yakho. Ezinye izinkinga ezihlobene nezinye izifunda zokusakaza zifaka:
- Ukuhluleka kwezinso: Ukuhluleka kwezinso kungase kungenzeke kuphela ngenxa yezinsalela ezintsheni (hhayi isayithi engavamile) kodwa ngenxa yemithi oyithathayo, ukuphuma kwamanzi, nokuningi.
- Ukukhwabanisa kwe-Pericardial: Njengoba nje umdlavuza wesikhumba ungasakazeka emgodini wamapayipi, ungasakazeka emgqeni wenhliziyo. Uma uketshezi kuphakama phakathi kwezingqimba ezifake inhliziyo ( ukukhishwa kwe-pericardial effusion ) kwenza kube nzima ngokwengeziwe kwenhliziyo ukushaya (izinga lenhliziyo livame ukusheshisa ukwenza i-volume encane ifakwe emzimbeni wonke). Uma uketshezi kukhula ngokushesha noma kuvulekile, kungaholela esimweni esaziwa ngokuthi i-tamponade ye-pericardial (ngokuyisisekelo iwuvimbela inhliziyo kakhulu kangangokuthi ayikwazi ukushaya). Uma lesi simo senziwa ngenxa yesifo somdlavuza, owesithathu wabantu bafa ngaphambi kokuba kutholakale futhi baphathwe. Lokhu akuvamile, kodwa isizathu sokukhuluma nodokotela wakho uma ubhala noma yikuphi ukuphefumula okwenyukayo noma isilinganiso senhliziyo esisheshayo.
- Ukulimala kwe-Brachial plexus : Uma umdlavuza usakazeka emathisini ngaphansi kwengalo, ungalimaza iqembu lezintambo zomzimba ezibizwa ngokuthi i-plexus ye-brachial. Lokhu kungabangela ubuthakathaka noma ukukhubazeka endaweni efanayo. I-brachial plexopathy ngenxa yomdlavuza webele isithinta kuphela owesifazane kwaba-1 kuphela kwabangu-200 kodwa ngokuvamile kuyinkinga ekhungathekisa kakhulu.
Izinkinga Ngenxa Yokuphathwa Kwegciwane Lesisu Sekudala Nentsha
Ezinye izinkinga ezingase zenzeke zifana nalabo ngezinye izikhathi ezenzeka kubantu abanesifo somdlavuza wesifuba. Ezinye ezimbalwa kakhulu zihlanganisa:
- Isifo senhliziyo: Kokubili ukwelashwa kwamakhemikhali kanye nokwelashwa kwemisebe yomdlavuza webele kungalimaza inhliziyo. Isifo senhliziyo singase sibonakale eminyakeni eminingi emva kokwelapha kokuqala futhi singakwazi ukuvela e-coronary artery disease, ukuhlushwa ukuhluleka, ezinkingeni ze-valve. Okuvamile kakhulu ukuhluleka kwenhliziyo, okuyinto evame ukuziveza ngezimpawu zokuphefumula, ukuvuvukala kwamaphethelo, nokukhwehlela pink, sputum frothy.
- Izifo: Uma usu-chemotherapy, kungenzeka ukuthi udokotela wakho wakuxwayisa ngokuthuthukisa umkhuhlane (umkhuhlane we-neutropenia). Umkhuhlane owawuvame ukwethusa, ungasongela ukuphila. Uma amasosha omzimba wakho egxiliwe, awugcini nje ukuthi unesifo sokutheleleka, kodwa amandla akho okulwa nesifo osukwenzile uyasungulwa. Ngisho nezifo ezincane zingadinga izifo zokulwa nezifo ezitholwa esibhedlela. Uma ukholelwa ukuthi unesifo, ungalindi. Shayela i-oncologist yakho.
Ukuphenduka kwe-allergenic
Uma uhlala nomdlavuza webele wesigaba 4, uzovame ukusebenzisa imithi eminingi. Lezi zingase zibe yingxenye yokwelashwa kwakho, kanye nemithi yokulawula izimpawu zakho. Lokho abanye abantu abangakuqapheli ukuthi ngisho noma uthathe imithi izikhathi ezingu-100, umthamo olandelayo owathatha ungabangela ukusabela okunzima kakhulu.
Ngokufanele, wonke umuntu kufanele aqaphele izimpawu ze-anaphylaxis, ukusabela okunzima kakhulu, njengoba lokhu kungasongela ukuphila. Uma ubona noma yikuphi ukuvuvukala kwentamo yakho, ulimi, noma ubuso, ukuthuthukiswa kwemihlathi, noma ukukhanya okulula, funa ukwelashwa.
Izinkinga Zengqondo
Abantu bavame ukucabanga ngokusinda komdlavuza njengokulwa kanzima, kepha kunezikhathi lapho abasindile bebuthaka kakhulu. Ukucindezeleka kungangena. Futhi ngokucindezeleka, abanye abantu baze bazibulale. Ingozi yokuzibulala ngomdlavuza iphansi emdlalweni webele webele kunezinye ezinye umdlavuza, kodwa ingozi isasekhona. Njengezinye zezimpawu "ezinamandla" ezingenhla, ungase ucabange ukucindezeleka njengengcindezi yomdlavuza we-metastatic, kodwa kubaluleke kakhulu. Umgomo wokwelapha ukwandisa impilo ngenkathi ikunika ikhwalithi engcono kakhulu yokuphila. Uma kukhona okuphazamisa ikhono lakho lokujabulela umndeni wakho nabangane, kufanele kuqondiswe, noma i-oncologist yakho, ezinye odokotela ezifana nochwepheshe wokunakekelwa nge-palliative, noma isazi somdlavuza.
Izwi elivela
Sinikeze ezinye izinkinga ezingase zihambisane nokuxilongwa komdlavuza wesifuba we-metastatic, nakuba kunezinye izinkinga ezingavamile ongase uzibhekane nazo. Iphuzu elibalulekile ukuqaphela umzimba wakho bese ukhuluma ne-oncologist yakho nganoma yikuphi ukukhathazeka. Ukuphila nomdlavuza wesigaba 4 akusona isikhathi sokuba yiqhawe. Ngokuvamile, ukucindezeleka okunzima kungelashwa uma kutholakala ngesikhathi esifanele.
Khumbula ukuthi abantu abaningi abahlangabezane nalezi zinkinga. Kukhona abantu abaningi abahlala nomdlavuza webele wesigaba 4 abaphila ngokugcwele nokuvuza, ngisho noma kukhona ukungaqiniseki ngekusasa.
> Imithombo:
> Hurria, A., Woza, S., noL. Pierce. Amaphethini Wokuphindaphindiwe Nezimo Ezinzima Zesikhathi Esizayo Abasindile Ngomdlavuza Webele. UpToDate . Kubuyekezwe 08/15/17.
> National Cancer Institute. I-Cannabis ne-Cannabinoids (i-PDQ) -Health Professional Version. Kubuyekezwe 11/30/17. https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq#link/_45_toc