Ukuphathwa kwe-Bone Metastases kusuka ku-Breast Cancer
Umdlavuza wesifuba usakazeka emathanjeni kaningi kakhulu. I-bone metastases ivele ngamaphesenti angaba ngu-70 abesifazane abanomdlavuza webele we-metastatic ( isiteleka se-4 sesifuba sesifuba ) futhi ngokuvamile bayisibonakaliso sokuqala sokuthi umdlavuza uphindele. Ngokuthakazelisayo, ama-metastase amathambo angase abe nokuhlushwa okungcono kunaleyo yomdlavuza webele oye wanda kwezinye izifunda, futhi kunezindlela eziningi zokwelapha ezingatholakali kuphela ubuhlungu kodwa zingase zithuthukise nokuphila.
Ake sibheke ukuthi amathambo omdlavuza wesifuba asakazeka kangakanani, izimpawu zamathambo asetsheni, izinketho ezahlukene zokwelashwa ezitholakalayo, kanye nezinkinga okungenzeka uzijwayele.
I-Cancer Isisu nge-Bone Metastases
Umdlavuza wesibeletho osakazeka emthanjeni ungumthombo wokudideka okukhulu, ngakho sizoqala ngokuchaza ukuthi lokhu kusho ukuthini. Umdlavuza wesibeletho osakazeka ( metastasizes ) kuya amathambo usengumdlavuza wesifuba. Uma uthatha isampula se-tumor ethambo bese uyibheka ngaphansi kwe-microscope, uzobona amangqamuzana esifuba somdlavuza.
Umdlavuza wesibeletho osakazeke emathanjeni akuwona umdlavuza wezithenga (ngaphansi komdlavuza wesifuba we-microscope ozoveza amathrekhi esifo somdlavuza). Lapho umdlavuza webele usakazeka emathanjeni igama elifanele elithi "isifo somdlavuza webele wesifuba". Uma umdlavuza utholakala emathanjeni cishe kunomdlavuza we-metastatic kusuka kwenye indawo yomzimba kunomdlavuza we-bone oyinhloko.
Ukubaluleka kweMetastases ye-Bone
Ukubhekana nezindaba zethambo namatastases amathambo kubalulekile kungakhathaliseki ukuthi yisiphi isigaba somdlavuza webele omuntu. Akukona kuphela ukuthi umdlavuza webele ungasakazeka emathanjeni, kodwa ukwelashwa komdlavuza wesifuba njengama-hormonal therapies kungaholela ekulahlekelweni kwethambo. Eqinisweni, imithi esetshenziselwa amathambo ama-metastases bisphosphonates) manje isacatshangelwa ngisho nalabo abanesifo somdlavuza wesifuba sokuqala njengendlela yokuqinisa amathambo futhi mhlawumbe ukuvimbela amathisaseli e-bone avela endaweni yokuqala.
Ubuhlungu obuvame ukuhambisana nama-metastase we-bone, okuhlangene nokunciphisa ukuhamba ngenxa yokwehlukana noma ukuhlukaniswa kwezidakamizwa, kungaba nomthelela omkhulu emkhakheni wokuphila kwabesifazane abaphila nomdlavuza webele we-metastatic. Noma kunjalo, ngokungafani nokubona okuvamile ukuthi kuncane ongakwenza uma unesifo somdlavuza wesifuba sesine, kukhona okuningi okungenziwa ukuze kunganciphisi nje ubuhlungu kanye nezinkinga zamathambo, kodwa ukwandisa impilo.
Umdlavuza Webele Usakaze Emthanjeni - Sibutsetelo
Njengoba kuphawuliwe ngenhla, amathambo ayisifo somdlavuza wesifuba yisayithi elivame kakhulu lezinsalela ezikude nomdlavuza webele. I-metastases ye-Bone ivame kakhulu kubantu besifazane abanesifo somdlavuza we-estrogen se-receptor esifanele (isibindi nobuchopho be-metastase buvame kakhulu kubantu besifazane abanomdlavuza we-HER2 / neu omuhle nesithathu omubi webele.
I-metastases ye-Bone ivame kakhulu kulaba besifazane abanomdlavuza webele we-ductal ongenawo umdlavuza webele we-lobular ongenayo (ku-lobular carcinoma, i-metastases kuya esiswini (i-peritoneal metastases) ivame kakhulu). Ku-subtypes ehlukene yesifo somdlavuza webele, ama-metastase amathambo avame kakhulu emangqamuzaneni omzimba.
Yimaphi Amabhontshi I-Cancer Breast Spread To?
Umdlavuza wesibeletho unomkhuba wokusabalalisa amathambo emzimbeni kaningi kunamanye, kepha lokhu kungashintsha futhi kufinyeleleke emasimini okwenzeka cishe kuwo wonke amathambo emzimbeni.
Ama-metastases ajwayelekile kakhulu ku:
- Isiphetho
- Ama-Ribs
- Pelvis
- Amathambo amade wezingalo nemilenze (i-humerus ne-femur)
Kuyinto evamile ukuba ama-metastases amathanga avele emathanjeni ambalwa ahlukene ngesikhathi esifanayo, njenge-spine kanye ne-pelvis. Ama-metastase angase ayenze nakwezinye izifunda zomzimba (njengobindi, amaphaphu, noma ubuchopho) ngesikhathi esifanayo abonakala emathanjeni.
Kungani Umdlavuza Webele Usabalala Emagqumeni?
Okwamanje asiqondi ukuthi kungani umdlavuza webele usakazeka emathanjeni. Amathambo acebile ngemithambo yegazi, kodwa kunjalo nesibindi namaphaphu, izindawo lapho umdlavuza webele usakazeka khona kodwa unomvuthwandaba ophansi kunothambo.
Njengoba amametastases abaluleke kakhulu (ama-metastases ayimbangela yokufa ngamaphesenti angu-90 abesifazane abafa ngesifo somdlavuza webele), le ndawo iyacwaningwa ngokucophelela.
Kukhona inkolelo yokuthi umdlavuza webele ungase ulele ematheni , futhi amathambo umdlavuza wesifuba uvame ukusabalala kulabo abacebile ematheni. Uma unesithakazelo, ungafunda kabanzi mayelana nenkolelo yesifo somdlavuza we-cancer kanye ne-dormancy njengendlela enokwenzeka yokuthi kungani umdlavuza webele ungazifihla iminyaka noma amashumi eminyaka bese ubuyela emuva.
I-Bone Metastases Ivela Kanjani Ne-Cancer Breast?
I-bone metastases evela emdlalweni webele wezinyo ingahlolwa ngezindlela eziningi ezahlukene. Ngezinye izikhathi ama-metastases abonakala uma i-x-ray isenzelwa ukuphuka okwenzeke ngokuhlukunyezwa okuncane (ngenxa yokwehlisa ithambo ngenxa yemetastasis, ukuhlukunyezwa kwe-pathologic ). Ngesinye isikhathi, i-metastases ye-bone itholakale yenzeke uma ukuhlola okufana ne-PET scan kwenziwa esinye isizathu. Izivivinyo zenzelwe ngokuqondile ukuthola amathambo asetsheni zihlanganisa ama-bone scans kanye nokuhlola kwe-PET, ngokuhlanganiswa kwe-PET / CT, SPECT / CT, wonke umzimba we-MRI, ne-PET / MRI enikeza ubuzwe obuningi. Kukhona impikiswano emayelana nokuhlolwa okuhle kakhulu, kodwa i-oncologist yakho izocabangela ukucabangela okuningi uma wenza isincomo.
Ukwelashwa kweMetastases ye-Bone
Kunezinhlobo eziningi zokwelapha ezihlukene ezitholakala emathambo ayisithupha. Okukhethwa okukuhle kuwe kuncike ezintweni eziningi ezifana nenombolo nendawo yamathambo abathintekile, ukuba khona kwamanye ama-metastases, kanye nempilo yakho jikelele.
Izinketho zokwelapha ezijwayelekile zomdlavuza webele we-metastatic ezifana ne- chemotherapy , ukwelashwa kwe-hormonal, kanye nemithi ehlosiwe ngokuvamile kuvame ukusetshenziswa, kodwa ezinye izinketho ezenzelwe ngqo ukuphatha ukusakazeka komdlavuza emathanjeni zivame ukusetshenziswa, futhi ngokuvamile zingabangela ukuphathwa komdlavuza ngempela isikhathi esithile. Lokhu kungafaka:
Ukulawulwa kobuhlungu - Amathemikhasi kuya emathanjeni angaba buhlungu kakhulu, kodwa kunezindlela eziningi ezahlukene zokukhulula ubuhlungu. Ukuthola imithi efanele kanye nokulinganisa imiphumela emibi yalezi zidakamizwa ezinokuphumula okwanele kungaba nobucayi. Uma lokhu kuba nzima, abanye abantu basebenza nodokotela wokunakekelwa kwezinhlungu noma isazi sobuhlungu ukubhekana nokuphathwa okuhle kakhulu kobuhlungu babo.
Ukwelashwa kwezidakamizwa - Ukwelashwa kwezidakamizwa kuvame ukusetshenziswa futhi kungasiza kokubili ukunciphisa ubuhlungu nokunciphisa ingozi yezinsalela. Imithi yokwelapha i-radiation "yindlela yokwelapha yendawo" okusho ukuthi isebenza kangcono ezindaweni ezikude ze-metastase kunokuba kube nokusabalalisa okubanzi.
I-Radiopharmaceuticals - I-Radiopharmaceuticals imithi efaka i-particle ye-radiation enamathele eminye yamakhemikhali, engabeka injected egazini. Ngakho-ke imisebe ihanjiswa ngokuqondile emathambo asetsheni. Izibonelo zifaka i-Strontium-89 ne-Radium-223. Ama-radiopharmaceuticals angase abasize ikakhulukazi kulabo abanamathemasi amaningi amathanga amaningi noma alula okungaba nzima ukuwaphatha ngezindlela zokwelashwa zendawo ezifana nokwelapha imishanguzo. Zinemiphumela emibi kakhulu futhi zingasebenza kakhulu ekulawuleni ubuhlungu be-bone.
Ama-bone-modifying agents - Ama- agent -modifying agents kukhona izidakamizwa ezingasetshenziswa ngomlomo noma ngomjovo ukunciphisa ama-metastases amathambo. Lokhu kufaka:
- Ama-bisphosphonates - ama-Bisphosphonates yimithi eyayiqala ukuvunyelwa ukuba i-osteoporosis iphinde itholakale isebenza kahle ekuphatheni ama-metastases amathambo. Isibonelo yi-Zometa (zoledronic acid). Ngaphandle kokunciphisa izinkinga ezivela emathisini asetsheni, le mithi ibonakala ibe nemiphumela enamandla yokulwa nesisu. Ngenxa yalesi sizathu, manje sekucatshangelwa ngisho nabesifazane abanesifo somdlavuza webele wezinsana zakudala (abakwa-postmenopausal noma i-premenopausal ekwelapheni kwe-ovarian suppression therapy), njengoba bobabili bangasiza ekulahlekelweni kwethambo okubangelwa ukwelashwa kwama-hormone (njenge-aromatase inhibitors) nokuvimbela i-metastases ithambo. I-bisphosphonates ithwala umphumela ongavamile we-osteonecrosis womhlathi.
- I-Xgeva (i-denosumab) - I-Denosumab iyi-antibody eyatholakala ukuthi iphumelela ekunciphiseni izinkinga (ezifana nokuhlukana) kubantu abanezinthambo zamathambo ezivela emdlalweni webele. Kubuye kubonakale kunendawo yokulwa nomdlavuza. Inikezwa njengomjovo we-subcuticular kanye namaviki amane.
Ukwelashwa - Ukuhlinzwa kusetshenziswe kaningi ukuze kuqiniswe ama-fractures noma izindawo zethambo engozini yokuhlukana (bheka ngezansi).
Izinkinga Ezingenzeka Kungenzeka Ezivela Emathunjini Amathambo
I-metastases ye-Bone ingabangela izimpawu eziningi nezinkinga eziningi. Lokhu kufaka:
Ubuhlungu obukhulu-ukuphatha ubuhlungu - Ubuhlungu obuhambisana ne-bone metastases bungaba nzima. Ubuhlungu buvame ukuphathwa ngokuhlanganiswa kwemithi yobuhlungu kanye nokwelashwa okuhloswe ukunciphisa amathisaseli amathambo. Ngaphandle kwemithi yobuhlungu, ochwepheshe bezinhlungu banamanye amakhemikhali amaningi, kuhlanganise namabhuloki amantombazane adingekayo ngezinye izikhathi.
I-Fractures / ingozi ye-fractures - Akuvamile ukuba umuntu aqale afunde ukuthi une-metastases emva kokuhlukumeza. (Nasi isibonelo somfazi onomdlavuza wesifuba kanye nokuhlukana kwe-hip pathologic ngenxa ye-metastase.) Kuvame ukuhlinzwa ukulungisa iziphuzo. Ngezinhlansi emathanjeni amade ezandleni noma emilenzeni, ngokuvamile kutholakala induku. Lokhu akugcini nje kuphela ukuhlinzeka ukusekela ithambo elibuthakathaka, kodwa kungakuvumela ukuba usebenze ngokushesha. I-vertebroplasty noma "i-samente" ingasetshenziselwa ukuqhuma komgogodla noma ukuqhuma okwenzekayo.
Ukucindezela kwentambo yomgogodla - Ukucindezeleka komgogodla kuyisimo esiphuthumayo sezokwelapha esingabangelwa ama-metastases amathambo. Ukwelashwa komdlavuza emgodini ophansi kungabangela ukuwa kwe-vertebrae, futhi futhi, ukucindezeleka kwezinzwa ezishiya umgogodla ukuze zihambele engxenyeni engezansi yomzimba. Izimpawu zingabandakanya ukuhlukumeza ubuhlungu obuphansi obuncane obungase buyeke phansi emilenzeni, ubuthakathaka noma obunzima emlenzeni owodwa noma zombili zombili, nokulahlekelwa kwesibindi kanye / noma isilonda lapho isifo somdlavuza sesifuba sifana nomgogodla. Izinqubo zokuhlinzwa zisetshenziselwa ukuzinzisa umgogodla.
I-hypercalcemia - Njengoba amathambo aphulwa ngumdlavuza, i-calcium ikhishwa egazini. Lokhu, kungaholela ekuqotheni, ukukhathala, ukoma okwedlulele, kanye nobuthakathaka bemisipha. Uma uketshezi olunzima okungalashwa okubangelwa umdlavuza kungaholela ekuhlulekeni kwezinso, ku-coma nokufa. Ukwelashwa kokuqala kwe-line kuhlanganisa ukuvuselelwa kwe-IV kanye ne-bisphosphonates. Ngezinye izikhathi ezinye izidakamizwa, ezifana ne-calcitonin, i-gallium nitrate, noma i-mithramycin zingasetshenziswa. Uma i-hypercalcemia inzima, i-dialysis enye inketho.
Ukulahlekelwa ukuhamba - Umthelela wokunciphisa umsebenzi ohlotshaniswa nokutakula kusuka ekuphukeni akukwazi ukugcizelela ngokwanele. Njengoba izifundo zisitshela ukuthi ukuzivocavoca kungabamba iqhaza ekusindeni, ngisho nangomdlavuza wesifuba we-metastatic, noma yini eyanciphisa ikhono lakho lokuzikhandla ngokomzimba ukuze libhekiswe ngokucophelela.
Ikhwalithi engafanele yokuphila - Phakathi kobuhlungu obuhlobene ne-metastases yamathambo, nokungahambi kahle okuhlobene nokuhlukana noma ingozi yokuhlukana, ama-metastase amathambo anganciphisa kakhulu izinga lakho lokuphila. Ngokujabulisayo, njengoba kuphawuliwe ngenhla, kunezinketho eziningi zokwelapha.
Ukubikezela Uma I-Cancer Isakazeka KuThambo
Ukuchazwa kwesifo somdlavuza wesifuba esasakazeka kuphela emathanjeni kungcono kakhulu kunama-cancer asakaze kwezinye izifunda zomzimba. Ukwelashwa kwamathambo ama-metastases ngezinye izikhathi kungalawula lesi sifo isikhathi eside. Ukuphila okujwayelekile komdlavuza webele we-metastatic izinyanga ezingu-18 kuya ku-24, kanti kuphela abantu abangamaphesenti angama-20 abasinda engaphezu kweminyaka emihlanu. Kubalulekile ukuphawula futhi, noma kunjalo, ukuthi ukuchazwa kahle kungcono kubantu abane-boneastas kuphela futhi kukhona nabasindile besikhathi eside besikhathi somdlavuza webele osakazeke emathanjeni.
Ngaphansi kwe-Bone Metastases Ngenxa Yomdlavuza Webele
Uma umdlavuza webele usakazeka emathanjeni ungaba ukwesabisa, ikakhulukazi uma kuyindlela othola ngayo ukuthi umdlavuza wakho uphindele futhi manje unomdlavuza webele we-metastatic.
Ngenkathi i-boneast metastase iqinisekisa ukuthi umdlavuza wakho usakaze futhi ungaba ubuhlungu, kunezinketho eziningi zokwelapha ezitholakalayo, ngezinye izindlela zokwelapha okwamanje ezihlolwe ezivivinyweni zomtholampilo .
Imithombo:
Coleman, R. Impact ye-Bone-Targeted Treatments ku-Skeletal Morbidity and Survival in Cancer Breast. I-Oncology (i-Williston Park) . 2016. 30 (8): pii: 218394.
Das, T., noS S. Banerjee. Ama-radiopharmaceuticals we-Metastatic Bone Pain Palliation: Izinketho ezitholakalayo ku-Domain Clinic kanye nokufaniswa kwazo. Metastasis yezokwelapha kanye nokuhlola . 2017. 34 (1): 1-10.
I-National Cancer Institute. I-Meta-Analysis Ithola Izinzuzo ze-Adjuvant Bisphosphonates ye-Postmenopausal Breast Cancer. 09/09/15. https://www.cancer.gov/types/breast/research/adjuvant-bisphosphonates-meta-analysis
U-O'Sullivan, uG., uCarty, F., noC. Cronin. Ukucabanga nge-Bone Metastasis: Isibuyekezo. World Journal of Radiology . 2015. 7 (8): 202-211.