Ukukhulelwa Nokuncelisa Ukubeletha Kuthinta Kanjani Ingozi Yomdlavuza Webele?
Ngesikhathi umama kaningi ukuxuba okuxubile kwenjabulo nokucindezeleka, abanye besifazane babhekene nokushaywa umxhwele kwesifo somdlavuza wesifuba. Abesifazane banoma yikuphi ubudala noma isigaba sokuphila bangatholakala ukuthi banomdlavuza-awunqunyelwe isihloko esiyinhloko sokukhulelwa nokuncelisa.
Ama-hormone, ikakhulukazi amahomoni wesifazane i- estrogen ne-progesterone, nomdlavuza wesifuba ubuhlobo obunzima kakhulu.
Ukushintshashintsha kwama-hormone wesifazane kwenzeka njalo ngenyanga phakathi nonyaka wokuzala wesifazane futhi kunciphise emva kokuya esikhathini. Ukuvezwa kwama-hormones okuphila komama wesifazane, ngokuvamile okulinganiselwe ngenani lemijikelezo yokuya esikhathini, kuyisimo esiyingcingo esincane sokudla komdlavuza webele.
Kodwa-ke, kunezici eziningi ezihlobene nokukhulelwa kanye nokulahla okunganciphisa ingozi yomdlavuza webele. Kodwa owesifazane oyedwa kwabangu-3 000, umdlavuza webele ngesikhathi noma ngemva kokukhulelwa kuba ngokoqobo.
Ezingxoxweni ne-Breast Cancer Research Foundation (i-BCRF), i-Elisa Port, MD, umbhali we-"The New Generation Breast Cancer Book" wabelane ngokuqonda okubalulekile ekubhekeleni okujulile komdlavuza webele webele ngesikhathi noma emva kokukhulelwa, ukuthi abesifazane bangaba kanjani qapha impilo, kanye nezinketho zokwelapha ezintsha. UDkt Port ungumphenyi we-BCRF noMqondisi weCreatery Breast and Director of the Dubin Breast Centre eNtabeni iSinayi Hospital eNew York.
Ukuthuthukiswa kwezibeletho ngesikhathi sokukhulelwa nokubeletha
Inqubo egcwele yokukhulelwa ekunceliseni futhi ekugcineni, ukuguquka, noma uma isifuba siphindela esimweni sayo sokukhulelwa, idala amangqamuzana amabele ukuba avuthwe futhi ashintshe izinhlobo zamahomoni asebenzayo esifubeni.
Le nqubo inciphisa ukuvezwa kwe-estrogen.
Kukholelwa ukuthi ukwehla kokutholakala kwe-estrogen namaseli asebele avuthiwe kunciphisa amathuba okuba umdlavuza ungakhula. Yingakho ukuqala kokuzalwa kokuzalwa kanye nenani lokuzalwa (eyaziwa ngokuthi ubunye) linganciphisa kancane kancane ingozi yomdlavuza webele kamuva ekuphileni lapho owesifazane eseneminyaka yawo-50, 60 noma 70.
Ukubeletha Kunciphisa Ingozi Yomdlavuza Webele Yomzimba Wonke
Ukubeletha kubangela nokushintsha kwamazinga e-hormone futhi ngoba kubambezela ukubuyela esikhathini ngemva kokukhulelwa, kunciphisa ukuvezwa kokujwayelekile kwesifazane ku-estrogen phakathi nomjikelezo wakhe wanyanga zonke, kunciphisa ingozi yomdlavuza webele, ikakhulukazi kwabesifazane be-premenopausal.
Uma kuqhathaniswa namanye amazwe, ukuncelisa e-US kuhlala phansi, ikakhulukazi kwabesifazane abamnyama uma kuqhathaniswa nabesifazane abamhlophe: amaphesenti angama-62 wabesifazane abamnyama uma kuqhathaniswa namaphesenti angu-79 abamhlophe abamhlophe baqala ukubeletha ngokushesha ngemva kokuzalwa kwedatha yakamuva etholakala ngo-2014. Noma kunjalo, ngo-6 izinyanga emva kokubeletha, kuphela amaphesenti angu-36 omama abamnyama uma kuqhathaniswa namaphesenti angu-52 omama abamhlophe ayesamncelisa. Lokhu kubhekisela ikakhulukazi, njengoba umbiko wamuva utholakale ukuthi abesifazane abamnyama babengabafa kakhulu ngenxa yesifo somdlavuza webele kunabalingani babo abamhlophe, ukungalingani okwandayo ezweni lonke.
Ukuhlaziywa okuhlanganisiwe kwezingu-47, ukuqhathanisa omama abanamabele okomama abangakaze baluse, bathola ukuthi:
- Abomama ababelethe isikhathi sokuphila (isikhathi esihlanganisiwe sokuncelisa izingane zonke) ngonyaka ongu-1 babencane amathuba okuthola umdlavuza webele.
- Isikhathi seminyaka engu-2 esiphila ngaso sonke isikhathi sathola izikhathi ezingaba ngu-2 ukunciphisa inzuzo / inengozi kunelabo ababeletha unyaka owodwa.
Ucwaningo olukhishwe kwi-Annals of Oncology lwathola ukuthi ukubeletha kungase kube kuhle kakhulu ekunciphiseni ingozi ye-ER / / yomdlavuza wesifuba we-triple omzimba, uhlobo oluthile olwedlulele lwesifo.
Ukuncelisa ukubeletha kunganciphisa ingozi yomdlavuza webele kamuva ekuphileni futhi ibe nezinzuzo eziningi zokunakekelwa komntwana, futhi kuyasiza umama ngokunciphisa ingozi yomdlavuza we- ovarian , ukucindezeleka kwangemva kokubeletha, ngisho nohlobo lwesifo sikashukela sesibili .
I-Cancer-Related Related Cancer
Ezimweni ezingavamile, ukukhulelwa kungabangela umdlavuza webele. Umdlavuza wesibeletho okwenzeka ngesikhathi noma ngemuva kokukhulelwa kuvame ukutholakala esiteji esicindezelayo, ngokwengxenye ngoba abesifazane abaningi abawubhekeli futhi bahlolwe kamuva, noma bangaphathwa kabi ngezinye izinkinga ezihlobene nokuncelisa, njenge-mastitis.
Nazi izindlela ezimbalwa ongaqaphela ngayo impilo yakho yebele:
- Yazi njalo "okuvamile". Yazi umzimba wakho kanye nanoma yiziphi izinguquko ezenzeka ngaphambili, ngesikhathi nangemva kokukhulelwa (futhi ngokuvamile kulo lonke impilo, kusukela ekuqaleni kwentsha).
- Uma kukhona okusolisayo, qinisekisa ukuyibeka kudokotela wakho - kufaka phakathi izimpawu ngaphandle kwezimbane, njengokungena kwe-ingono, ukujula kwesikhumba, noma ukukhishwa kwimbimbo ngaphandle kobisi lwebele.
- Ingozi yomdlavuza webele iyakhula iminyaka engaba ngu-4 kuya kwengu-5 emva kokukhulelwa. Umthetho ojwayelekile wukuthi abesifazane kufanele baqaphele ngokukhethekile izinguquko ezingavamile esifubeni sabo kuze kube yilapho ingane yabo ingena enkulisa.
Ukwelashwa Kwe-Cancer-Related Related Cancer
Lapho umdlavuza webele usenzeka ngesikhathi sokukhulelwa, ukwelashwa kuba nzima nakakhulu. Kungakhathaliseki ukuthi ukuhlinzwa kanye / noma i-chemotherapy kungase kuxhomeke ku-trimester.
Ukuxilongwa kwesibili kanye neyesithathu kwezinto ezintathu kuneziphumo ezinhle kakhulu zokuba nokukhulelwa okunamandla nokuphatha umdlavuza webele. Ukwelapha phakathi ne-trimester yokuqala yisikhathi esibucayi nesinkimbinkimbi sokunquma ukhetho lwezokwelapha, ngakho-ke kubalulekile ukulinganisela ukwelashwa kumama ngezingozi ezingase zibe khona kumntwana.
Ukwelapha I-Hormone Drived Breast Cancer
Ngenxa yokucwaninga nge-BCRF ekhokhelwa nguDkt. Charles Perou nabanye abaningi ososayensi emhlabeni wonke, manje sazi ukuthi umdlavuza webele awusona isifo esisodwa, kodwa eziningi. Odokotela banganquma ukuthi yiliphi uhlobo lomdlavuza wesifu owesifazane oye wahlaziya amaprotheni kanye ne-DNA emaqenjini amathumba asuswe yi-biopsy futhi ngokugcwele-pathology ngemuva kokuhlinzwa.
Ukwelapha ngokuvamile kulandela umumo wokuhlinzwa, imisebe kanye / noma i-chemotherapy, kodwa ukwazi i-subtype kuye kwavuselela ukwelashwa okuhloswe ukuthi kungcono ukuzenzela ukwelashwa kwesifo somuntu ngamunye.
Imithi ehlosiwe ye-subtype ngayinye ihlanganisa:
- Umdlavuza wesifuba we-triple negative ( TNBC ), amaphesenti angu-10 kuya kwangu-15 wamakhansela webele: Azikho izindlela zokwelashwa ezihlosiwe ezivunyelwe i-TNBC. Noma kunjalo, ukupheka kwe-chemotherapy kungasebenza ngempumelelo ekuphatheni i-TNBC futhi kwezinye izimo kudala izimpendulo ezinamandla.
- I-HER2 + yomdlavuza webele, amaphesenti angu-15 kuya kwangu-20 amancaysi webele : I- HER2 + yayixilongwa ngokufutheka kuze kube yilapho isidakamizwa esibizwa ngokuthi i-Herceptin ® sakhiwe.
- Kuvunyelwe ngo-1998. Umdlavuza webele we-HER2 + usuvele usengozini yokuphulukiswa, mhlawumbe uphephile kwezinye iziguli.
- Umdlavuza webele we-HER2 + ungabuyela esithombeni esisha, futhi ungaba umelana ne-Herceptin ® . Imithi emisha yokwelapha i-HER2 + ibandakanya i-Tykerb, i-Perjeta ® ne-Kadcyla ® (T-DM1) ingasiza ekunqobeni ukumelana kuka-Herceptin.
- Isibonelo, ocwaningweni lwakamuva lomdlavuza webele we-metastatic, iziguli ezinomdlavuza webele we-HER2 + zinomsoco ongcono wokuphila (ezinyangeni ezingu-56 kuya kwezinyanga ezingu-40) lapho u-Herceptin ehlangene nePerjeta ® , uma kuqhathaniswa neziguli ezithola i-Herceptin ® kuphela.
- Umdlavuza we-ER + webele, amaphesenti angama-60 kuya kwangu-70 wamanqamu webele: I-ER + ifomu elivame kakhulu lomdlavuza webele kanye nomthelela ngamaphesenti angu-60 kuya kwangu-70 wamacala amasha angu-250,000 unyaka ngamunye. Kungaphathwa ngokuhlinzwa, imisebe, i-chemo EMINYE imithi yokwelapha-estrogen. Senze intuthuko enkulu ekwelapheni umdlavuza webele we-ER +: Izidakamizwa ezintsha ezibizwa ngokuthi i-mTOR inhibitors kanye nama-inhibitors e-CDK4 / 6 ahloswe ngamaprotheni akhethekile futhi zibonisa izithembiso ezivivinyweni zomtholampilo, futhi eziningana ezivunyiwe eminyakeni yamuva kufaka phakathi i-mTOR inhibitor [faka mTOR igama], futhi CDK4 / 6 inhibitors Ibrance® ne-Kisaqli®.
Ukuzala emva kokulashwa
Nakuba ukuzala emva kokuxilongwa komdlavuza wesifuba kuyinkinga enkulu, abesifazane abaningi baphuthunyiswe ngokuphumelelayo ngemva komdlavuza webele. Izinhlelo eziningi zokwelapha zihlanganisa umuthi wezidakamizwa ezifana ne-tamoxifen iminyaka engu-5-10 emva kokuhlinzwa kanye / noma i-chemotherapy ukunciphisa ingozi yokuphindaphinda futhi njengoba isidakamizwa singabangela ukukhulelwa kokukhulelwa kufanele sigwenywe. Ezinye izifo zokwelapha-estrogen zinikezwa ngomuthi ovimbela umsebenzi we-ovarian ukulondoloza ukuzala. Ukuqhwaza amaqanda noma imibungu kujwayelekile futhi kungenzeka kube yindlela enconyiwe.
Izinketho kumele zixoxwe ngaphambi kokwelashwa ukuze owesifazane akwazi ukwenza kahle kakhulu yena nomndeni wakhe.
Ukuthatha okubalulekile
- Ukukhulelwa nokondla ngokuvamile kunciphisa ingozi yomdlavuza webele kamuva ekuphileni.
- Ingozi yomdlavuza webele isanda kancane iminyaka emihlanu emva kokukhulelwa. Qaphela impilo yakho yesifuba ngalesi sikhathi.
- Uma umdlavuza webele unzeka ngesikhathi noma emva kokukhulelwa, ukwelashwa kuyinkinga eyinkimbinkimbi yemingcipheko engozini kumama nengane.
- Izindlela ezintsha zokwelapha umdlavuza webele we-hormone ezithuthukiswe nge-hormone zithuthukise ukuphumelela kokwelashwa.