Izinketho zokwelapha kanye nokubikezela
Ukuphindaphinda kwesikhumba sesifuba yisifo somdlavuza wesifuba esibuyisela emuva kwe- mastectomy . Ukuphindaphinda kodonga lwesikhumba kungabandakanya isikhumba, imisipha, kanye nesifo esingaphansi kwesiza sesisu sesifuba sokuqala, kanye nama- lymph nodes . Uma umdlavuza uphindela edongeni lwesifuba, kungase kubekwe njengokuphindaphinda kwendawo, noma kungaxhunyaniswa ne- metastasis eseduze. Uma ukuphindaphinda kwesikhumba sekhanda kungukuphindaphindiwe, kubhekiswa njengokuphindaphindiwe komdlavuza wesifuba we-breast.
Amaphesenti angu-5 abesifazane abene-mastectomy bazoba nokuphindaphinda kwesifunda eminyakeni eyishumi elandelayo.
Kungaba ukudideka okukhulu ekuphenyweni kwesikhumba sesifuba. Iziphi izibalo ezilungile? Kungani izinkinga zibonakala ziphikisana? Ngenhloso yale ngqungquthela, sikhuluma ngabantu abaye banesisindo somzimba. Uma umdlavuza uphindela esifubeni ngemuva kwe- lumpectomy , okuhlukile kakhulu.
Izimpawu
Ukuphindaphinda kwesikhumba sekhanda kungabonakala kuqala njengesifo esibuhlungu, futhi mhlawumbe sidonsa. Kungase kungabi kuhle noma ukudonsa inzwa.
Ukuxilongwa
Uma ukuphindaphindiwe kwakho kubonakala, i- biopsy ingenziwa ukuze inqume ukuthi ibuyisela isifuba noma cha. Uma kunjalo, ama-oncologists ancoma ukuphindaphinda ukuhlolwa ukuze ubone ukuthi ngabe i-estrogen receptor enhle, i-progesterone receptor positive, noma i- HER2 enhle . Lokhu kungase kubonakale kuyamangaza ngemuva kokuthi lezi zivivinywe kakade, kodwa ngokuphindaphindiwe, isimo se-receptor samaseli omdlavuza singashintsha, ikakhulukazi uma sekuphelile isikhathi esingaphezu konyaka noma emibili kusukela mastectomy yakho.
Ngamanye amazwi, uma kwasekuqaleni unesifo somdlavuza webele we-estrogen receptor positive, amangqamuzana akho omzimba angase ashintshe futhi abe nesisitho se-estrogen engenzi lutho. Ngokwemvelo, lokhu kubizwa ngokuthi "ukuhlukana kwesisu."
Abanye abantu bangamangala ukuthi i-biopsy inconywa uma udokotela wakho eqinisekile ukuthi ukuphindaphindiwe komdlavuza wakho wokuqala.
Kungenxa yokuthi lokhu kwenziwa ngokuhlukumeza, futhi kungaba nethonya elikhulu ekukhetheni izinketho zokwelashwa ezinhle kakhulu.
Njengoba ukuphindaphindiwe kwendawo efana nokuphindaphinda kwesikhumba kungaxhunyaniswa nemithambo emisiwe, umsebenzi wokwenza isiteji uvame futhi kwenziwe futhi ungabandakanya ukuskena kwe-PET okubheka ezinye izifunda ezisakazeka emzimbeni.
Ukwelapha
Njengokwakho ukuhlolwa kokuqala komdlavuza webele, ukwelashwa kokuphindaphindiwe kuvame ukuhlanganisa ukwelashwa okumbalwa. Ukwelashwa kungahlehliswa ku:
- Imithi yokwelashwa: Lezi yizokwelapha ezibhekana namangqamuzana omdlavuza noma yikuphi emzimbeni wakho, futhi kufaka phakathi i-chemotherapy, imithi ehlosiwe, ukwelashwa kwama-hormonal, nezinye zezokwelapha ezintsha ezitholakalayo ezivivinyweni zomtholampilo ezifana ne-PARP inhibitors nokuningi.
- Ukwelashwa kwendawo: Lezi zokwelapha zithinta umdlavuza lapho uqala khona (noma usakazeka) kodwa awubheki namagciwane omzimba kwenye indawo emzimbeni. Izibonelo zihlanganisa ukwelashwa kwemisebe, ukuhlinzwa, kanye nokwelashwa kweproton.
Isinyathelo sokuqala sinquma ukuthi ukuphindaphinda kwesikhumba se-chest kuyindlela ephindaphindiwe, noma uma kunezindawo ezengeziwe zokuphindaphindiwe, ukutholakala kwezidakamizwa ezikude kakhulu.
I-Metastases Ephakathi Kokubuyiselwa Kwamapulangwe Okuphindaphindiwe Kakhulu
Uma kukhona nobufakazi bokuthi i-metastases eseduze, ukwelashwa komdlavuza webele we-metastatic kuzoba yindlela eyinhloko.
Lokhu kungafaka. Izindlela zokwelapha zendawo zingasetshenziswa ukulawula umdlavuza odongeni lwesifuba njengoba kuxoxwe ngezansi. Ngokwezibalo ezingu-2018 ezizungeze amaphesenti angu-27 abesifazane abaphindaphindiwe endaweni, njengokubuyiselwa kwendonga yesifuba, bayoba nemastasis elikude.
I-Metastases ye-Wall Chest ehlukanisiwe (Ukuphindaphindiwe kwe-Metastatic)
Uma kungekho ubufakazi bezifo ezikude ezivela ekuhlolweni (akukho bufakazi bokuthi umdlavuza usakaze amathambo, amaphaphu, isibindi, ubuchopho, noma ezinye izifunda), ukwelashwa kwendawo ukukhipha ukuphindaphinda kuwumgomo wokwelashwa. Njengoba i-tumor eye yasakazekela odongeni lwesifuba nayo "yabikezela ukuthi isisusa sayo" ukusakazeka kwezinye izifunda zomzimba, ukwelashwa kwesistimu kubalulekile.
Ngaphambi kokwelapha lesi sifo, kubalulekile ukuba "i-re-biopsy" yenziwe ukuze inqume isimo se-receptor sokuphindaphindiwe. Izinketho zihlanganisa:
I-Chemotherapy
Uma indawo yokuphindaphinda inkulu kakhulu ukuze isuswe ngokuphelele ngokuhlinzwa, i-chemotherapy ingasetshenziswa kuqala ukunciphisa ubukhulu besisu ukuze ukwelashwa kwendawo kwenzeke.
I-Radiation Therapy
Uma ukwelashwa kwama-radiation kwakungasetshenziswanga ngesikhathi umdlavuza wokuqala wawuphathwa, lokhu kuvame ukusetshenziswa (kanye nokuhlinzwa noma ezinye izindlela zokususa isisu) ukuqinisekisa ukuthi wonke amagciwane omhlaza aphathwayo (amangqamuzana angeke abukwe ekucatsheni kodwa acatshangwa ukuze kube khona lapho. Uma ukwelapha imishanguzo isetshenziswe ngaphambili, i-oncologist yakho yokushisa imisebe izokwenza isisindo esingakusiza sibheke ukuthi sekuyisikhathi eside kangakanani lapho unemithi yokwelashwa, futhi uma kungadingeka umthamo onciphile.
Ukuhlinzwa
Ukwelashwa yiyona ndlela yokwelashwa okuyisisekelo yokususa indawo yokuphindaphindiwe. Njengoba kuphawuliwe ngenhla, i-chemotherapy ingadingeka ukuze unciphise ubukhulu be-tumor ngaphambi kokuhlinzwa, futhi ukwelashwa kwe-ray ngokuvamile kuvame ukusetshenziswa ngemva kokuhlinzwa.
Ukuthengiswa okugcwele kokunciphisa kunconywa uma kunokwenzeka, futhi uma kwenziwa kubantu abafanele ukhetho, kubangele izinga lokusinda lamaphesenti angu-41 emva kweminyaka engu-15 ngokutadisha ngo-2018.
Ukwelashwa kwamaHormonal
Uma ukuphindaphindiwe kwe-estrogen receptor positive futhi kwakungakahle kube yinto engalungile, ukwelashwa kwe-hormonal kuyotuswa. Lokhu kungaba yi-tamoxifen, kulabo abano-premenopausal, noma, kulabo abangama-postmenopausal noma aba-premenopausal futhi baye bathola ukwelapha okukhipha ama-ovarian, i- aromatase inhibitor efana ne-Aromasin (exemestane), i-Arimidex (i-anastrozole), noma i-Femara (i-letrozole). Uma i-tumor is receptor positive futhi isifo sakho sangaphambilini se-estrogen receptor esihle, i-oncologist yakho izocabangela ngokucophelela izinketho zakho. Lapho ukuphindaphinda kwenzeka uma ususelwa ekwelashweni, i-tumor kungenzeka ibe yinkinga. Imithi ehlukile inganconywa, noma
Ukwelashwa okubhekiswe
Uma i-tumor yakho ingu-HER2 enhle futhi isisu sakho sangempela sasingu-HER2 okungalungile, izindlela zokwelapha ze-HER2 ezifana ne-Herceptin (trastuzumab) cishe zizonconywa. Uma i-tumor yakho i-HER2 enhle futhi ibuye i-HER2 enhle ngaphambili, i-HER2 inhibitor ehlukile ingasetshenziswa.
I-Proton Therapy
Ukwelashwa kweproton kuyindlela yokwelapha entsha, futhi asinayo izifundo eziningi. Ucwaningo olulodwa luka-2017 lwathola ukuthi ukwelashwa kwe-proton ukuphindaphinda udonga lwesifuba, lapho ukwelapha imishanguzo kwenziwa ngomdlavuza wokuqala, wawunobuthi obuyamukelekayo. Ukwelashwa edongeni lwesifuba, noma kunjalo, ngemuva kokwelashwa kweproton, kungabangela izinkinga ezibalulekile ekuphulukisweni okulimazayo.
Isibikezelo
Isilinganiso seminyaka eyishumi sokusinda komdlavuza wesifuba nokuphindaphinda kwesikhumba sesifuba sinamaphesenti angama-50, kodwa lokho kungashintsha manje ngezinketho zokwelashwa ezingcono. Isikhathi saphela phakathi komdlavuza wesifuba sokuqala kanye nokuphindaphinda kwendawo edlala indima ebalulekile ekusindeni, nalabo abanesibindi sokuphindaphinda kwesikhumba phakathi neminyaka engama-3 yokuxilongwa empofu (cishe amaphesenti angu-30), kanti labo abaphindaphindiwe ngemva kweminyaka emithathu , isilinganiso sokusinda singaba ngamaphesenti angu-70 noma ngaphezulu.
Ukubhekana
Uma umdlavuza wakho wesifuba ubuya, ungase ukwesabe nakakhulu ukuthi uma uthola ukutholwa kuqala. Ingxenye yalokhu ukuthi amaphesenti angu-27 e-wall recurrences ahlobene nesibindi ahlotshaniswa ne-metastases ezikude (umdlavuza wesisu we-metastatic) okusho ukuthi umdlavuza awusaphuluki. Noma kunjalo, noma ngabe umdlavuza awuphilwanga, usazophulukiswa kakhulu, futhi kukhona okunye ongakhetha kukho.
Kulabo abanokuphindaphindiwe kwendawo yangasese, ukususwa okugcwele kwe-tumor kungabangela ukusinda kwesikhathi eside kwabaningi abakhetha ukwelashwa.
> Imithombo:
> Cardoso, F., Fallowfield, L., Costa, A., uCatiglione, M., no-E. Senkus. I-Cancer Recent or Metastatic Breast Cancer: Iziqondiso Zokwelashwa ze-ESMO Clinical for Diagnosis, Treatment and Follow-up. Amanothi we-Oncology . 2011. 22 (Suppl 6): vi25-vi30.
> D'Aiuto, M., Cicalese, M., D'Aiuto, G., noG. Rocco. Ukwelashwa Kwebhande Lesifuba Ukubandakanywa Ngomdlavuza Webele. Imitholampilo yezokwelapha . 2010. 20 (4): 509-17.
> McGee, L., Iftekaruddin, Z., Chang, J. et al. I-Postmastectomy Chest Wall Reirradiation ne-Proton Therapy ye-Cancer Breast. I-Radiation Oncology, i-Biology, ne-Physics . 2017. 99 (2): E34-E35.
> Neuman, H., Schumacher, J., Francescatti, A. et al. Ingozi Yokuphindaphindiwe Okukude KwamaSikhathi Esikhathini Sokuphindaphindiwe Kwezilwane Ezineziguli Eziphethe Isigaba II no-Stage III Cancer Breast (AFT-01). I-Journal ye-Clinical Oncology . 2018. 2017.75.538.
> Shen, M. et al. I-Clinical Course of Breast Cancer Patients With Isolated Internal Outside and Thickness Chest Wall Ukuphindaphinda Ukuphathwa Ngaphandle Futhi Ngaphandle Surgery Okukhulu. Ama-Annal of Oncology Yokuhlinza . 2013. 20 (13): 4153-60.
> Wakeam, E., Acuna, S., no S. Keshavjee. I-Wall Resection Resection for Recurrent Cancer Yesikhashana Esikhathini Esikhathini Esimanje: Ukubuyekezwa Okuhlelekile Nokuhlaziywa Kwe-Meta-Analysis. Ama-Annal of Surgery . 2018. 267 (4): 646-655.