Njengoba uhamba ngokusebenzisa ukwelashwa komdlavuza wesifuba we-metastatic, udokotela wakho uzolamula ukuhlolwa okuningi ukuze ubone ukuthi umdlavuza wakho uthuthukile noma uma uphendula ukwelashwa. Yikuphi ukuhlolwa okuvame kwenziwa, futhi ungabhekana kanjani nokubhekana nokuhlolwa kokukhathazeka ?
Ezinye zalezi zifundo ze-imaging kanye nezivivinyo zelabhu zisetshenziswe kokubili uma othile ehlonishwa ukuthi unesifo somdlavuza we-metastatic, kanti amanye angase abe omusha kuwe njengoba asetshenziselwa ukuqapha ukwelashwa komdlavuza webele we-metastatic.
Yeka ukuthi izicubu zingashintsha kanjani
Sivame ukucabanga ngamagciwane ashintshana, njengamaseli avamile ezibelethweni zethu ezingashintshi kakhulu isikhathi. Kodwa amagciwane angaguquka njalo. Lokhu kunguquko kulezi zifo, eqinisweni, ezibhekene nokuphikiswa esikubona ezithombeni ezifana nemithi yokwelashwa , imithi ehlosiwe, kanye ne-chemotherapy ngokuhamba kwesikhathi.
Izici ze-molecular of a tumor zingashintsha, kanye nesimo se-receptor samangqamuzana omzimba. I-Cancer ihlala iguquguquka endaweni yayo, ivame ukhiqiza amaprotheni amasha ukuvimbela amasosha ethu omzimba nokushintsha ukubonakala kwawo ukuze kusize ukusinda kwabo.
Kungenzeka ukuthi isifo se-estrogen sibucayi lapho uthola ukutholwa, kodwa kungenzeka ukuthi isamukeli se-estrogen asibi uma ivela emaphaphu. Isifo singase sibe ngu- HER 2 esihle uma kuqala sihlolwe, kepha sibe nesimanga esingu-HER 2 kamuva. Lezi zinguquko zivamile, ngamaphesenti angaba ngu-5 we-HER 2 amathumba amahle abe yi-HER 2 negative kamuva.
Ngaphezu kwezinguquko kumathumba kukhona umqondo we-tumor heterogenicity. Esikhundleni sokuba yisisindo sawo wonke amangqamuzana afanayo, izingxenye ezahlukene zesisu kungenzeka zibe nezici ezihlukile kunezinye, kuye ngokuthi lezi zinguquko. Ngezinye izikhathi ingxenye eyodwa ye-tumor phezu-ibonisa i-HER 2, kanti esinye isigaba se-tumor, noma i-metastasis endaweni ehlukile, ayikho.
Lona incazelo elula yalokho okwenzekayo, kodwa angasiza ukuchaza ukuthi yonke imdlavuza yebele ihlukile kanjani.
Biopsies
Esinye sezivivinyo zokuqala ezibaluleke kakhulu yi-biopsy yomdlavuza wakho. Esinye isizathu sokuthi udokotela wakho ufuna ukuphikisa isisu sakho ukuqinisekisa ukuthi umdlavuza wesifuba we-metastatic esikhundleni se-tumor engavumelani. Kodwa isizathu esibaluleke kunazo zonke se-biopsy, noma "i-re-biopsy," ukucacisa ukuthi umdlavuza wakho ungashintsha kanjani kusukela lapho uthola ukutholwa.
Ukucatshangelwa Ukuhlola
Isithombe esicabanga ukuthi udokotela wakho uyancoma sizoxhomeka ezintweni eziningi kusuka endaweni yezilambu zakho kuya ezitholweni ezisetshenzisiwe. Ukuhlolwa okuvamile (njengoba kuxoxwa ekuqaleni) kufaka:
- I-X-ray yezindawo okusolakala ukuthi unamathemaseli we-bone
- I-Bone scans: Ukuskena kwethambo kuhilela ukujova i-traceeractiveactive tracer, ebuye ihlolwe nge-imaging. I-bone scans ingaba usizo ekuhloleni amathambo ayisithupha.
- I-PET ihlola : Iskena se-PET yisilingo esibalulekile sokunquma ubukhulu kanye nezindawo ze-metastases emzimbeni wakho. Ngokungafani nezilinganiso ze-CT kanye nezilinganiso ze-MRI ezibukeka ngokuyinhloko ezakhiweni zesakhiwo, iskena se-PET sibheka ukusebenza kwamaseli emzimbeni wakho. Ushukela omsakazo lujojowe engxenyeni yakho yegazi futhi kuthathwa ngamathishu akhulayo asebenzayo njengamaseli omdlavuza. Ukucubungula ucwaningo kungavumela ama-radiologists ukuba abone ngeso lengqondo futhi athole lezi zindawo emzimbeni. Ngaphezu kokusiza ukuhlola ubukhulu bomdlavuza wakho, ukuhlola kwe-PET kuyasiza ekuhlukaniseni izindawo ezinjengezicubu ezincane kanye ne-fibrosis ezivela ezikhukhuleni ezimbi ezikhulayo.
- Ukuhlola kwe-CT : I-CT scan ingenziwa ukubuka isisu sakho, isikhumba sakho, isifuba sakho, noma ikhanda lakho
- I-MRIs: I- MRIs ingenziwa ukuze ibonakale ngokuqondile kunoma yimiphi imithwalo yokudla emqondweni wakho noma kwezinye izifunda zomzimba wakho.
Kuyasiza ukwabelana ngezinto ezimbalwa mayelana nokuhlolwa kwe-imaging nokulinganiselwa kwabo ekulandeleni umdlavuza odidekile abanye ngomdlavuza wesisu we-metastatic:
- Izinguquko ekusesheni zingabambezeleka - Uma nje usuqede ukwelashwa njenge- chemotherapy , ungase uzizwe udangele uma ukuskena komdlavuza wakho kungashintshi ngosayizi. Kuwusizo ukuqonda ukuthi izinguquko ekuhlolweni kwe-imaging zingathatha isikhathi ukubonisa. Isibonelo, ukunciphisa usayizi we-tumor ngenxa yokwelashwa kungabonakali ekuskena kuze kube amasonto ambalwa noma ngisho nezinyanga ngemuva kokuba ukwelashwa kwakho kugcwaliswe.
- Ama-scans awaphelele - Kungakhathaliseki ukuthi unjani uhlobo lokuskena, kunethuba lokuthi "uzothola" okuthile okungenakuba yinkinga. Uma uvivinywa ngokwengeziwe, cishe lokhu kuzokwenzeka. Isibonelo sibandakanya ama-nodules amaningi we-liver benver atholakala ku-CT scans esiswini okungaba nzima ukuhlukanisa nomdlavuza.
- Ukuhlola ngaphandle kokuhlola kwe-PET akukwazi ukukutshela uma "indawo" ikhula " - Kungase kube nzima ekuvivinyeni njenge-CT scan ukuthola ukuthi" indawo "imelela umdlavuza okhulayo, noma umane ulahle izicubu ushiye ngemuva kokuba indawo yomdlavuza iphathwe. Izilinganiso ze-PET zingasiza ukuhlukanisa amakhemikhali akhulayo avela ezinkampanini ezinobungozi, kodwa futhi angaba "namaqiniso amanga" - izindawo zokukhathazeka ezingapheli lutho.
- Ukushintsha okuncane ngobukhulu besisu kungaba okungenangqondo - Abanye abantu badikibala uma isisu sibonakala singamamentimitha amakhulu esikrinini kunokuba sisetshenziswe kuskena ngaphambilini. Uma ubhekene nokunye okufana nalokhu, cela i-radiologist yakho mayelana nokulinganiselwa kweskena esithile owawunayo. Kwezinye izimo, isisu esingase "sibonakale" sibe sikhulu noma sincane, singasashintsha ngosayizi uma ukwazi ukukala umdlavuza ngokuqondile.
Amakhamera we-Tumor (Ama-Biomarkers)
Ama-tumor marker noma ama-biomarker angama-proteine angabanjwa ngasese noma ngomzimba ekuphenduleni isisu. Ukuhlolwa kwegazi ukuhlola lezi proteins kungenziwa ukuze ulandele intuthuko yakho nomdlavuza webele we-metastatic.
Njengokuhlolwa kwe-imaging, lezi zivivinyo aziphelele. Akuzona zonke izibeletho zesifuba ezibangela ukuphakama kulezi zici, futhi uma seziphakanyisiwe, kungenzeka ngenxa yesimo esingenomdlavuza. Ushintsho emazingeni alawa makaki, njengalokhu ngezingqinamba, kungenziwa ukubambezeleka ngamasonto ambalwa ngemva kokuba isisu sanda noma sinciphisa usayizi.
Lezi zivivinyo azitholakali zisetshenziselwe yedwa ukuhlola ukuqhubeka komdlavuza wesifuba futhi ziyasiza kakhulu uma amazinga elandelwa ngokuhamba kwesikhathi. Ukugcoba okuphawula ukuthi udokotela wakho angalinganisa kufaka:
- I-antigen ye-cancer 15-3 (CA 15-3) - CA 15-3 yiprotheni eyenziwa ngamaseli omdlavuza wesifuba. Ingatholakala kumaphesenti angu-50 kuya kwangu-90 abantu abanomdlavuza webele we-metastatic, kodwa kuphela amaphesenti angu-30 abantu abanesifo somdlavuza wesifuba. Izinga laleli biomarker zivame ukuphakama ikakhulukazi kulabo abanamathemasi esithambo noma esibindi. I-CA 15-3 ingalinganiswa ukuze ihlolwe impendulo yomdlavuza wakho ukwelashwa, kodwa ushintsho ezingeni angeke lenzeke amasonto amaningana (ngokuvamile kuya kwesine kuya kweyisithupha) ngemuva kokuba isisu siphendule ukwelashwa noma ithuthuke.
- I-antigen ye-Cancer 27.29 (i-CA 27.29 ) - i- CA 27.29 iyiprotheni (i-antibody monoclonal) eyenziwa yi-gene ebizwa ngokuthi i-MUC-1. Le phrotheni itholakala phezu kwamangqamuzana omdlavuza webele wesinye. Ngokuphambene nezinye izimpawu, i-CA 27.29 yiyona kuphela iprotheni ekhombisa ngokuqondile ukutholakala kwamangqamuzana omdlavuza webele. Yize lesi sivivinyo singasetshenziselwa ukuqapha abesifazane abanomdlavuza webele wesandulela-ngculaza ukuze babuyele emuva, kucatshangwa ukuthi ukuphakama kungase kwenzeke ezinyangeni ezinhlanu ngaphambi kokuthi umuntu azi ukuthi umdlavuza wabo uphindele. Njenge-CA 15-3, kunezimo ngaphandle komdlavuza webele ongabangela ukuphakama kule phrotheni, futhi ukuphakama kungase kuhlale isikhathi esiningi (ezinyangeni ezimbili kuya kwezintathu) ngisho nangemva kokuba umdlavuza uphethwe kahle. Udokotela wakho angalawula noma i-CA 15-3 noma i-CA 27.29, kodwa hhayi kokubili.
- I-Carcinoembryonic antigen (CEA) - i- CEA iyi-protein engenasiphakamiso engahle iphakanyiswe kubantu abanomdlavuza, kodwa ingaphakanyiswa ngokuphendula kwezinye izimo eziningana, kuhlanganise nokubhema.
- Ukujikeleza amangqamuzana e-tumor - Ukuqapha igazi ukujikeleza amaseli we-tumor (amangqamuzana amathumba noma izingxenye zamangqamuzana omzimba aphukile emzimbeni futhi angene egazini) kuyindlela entsha yokuhlola nokulandela umdlavuza we-metastatic. Nakuba kunjalo ikakhulukazi uphenyo, ukuhlolwa okulodwa sekuvunyelwe ukusetshenziswa kwabesifazane abanomdlavuza webele we-metastatic.
Ukubhekana Ne-Scanxiety
Iningi labantu lizozizwa likhulu lokukhathazeka ngenkathi lilindele imiphumela yokuhlolwa noma ukuhlolwa kwelabhorethri, kungakhathaliseki ukuthi yiphi iphuzu ekwelapheni okwenziwe ngalo. Ngomdlavuza wesifuba we-metastatic, ikakhulukazi, kunemiphumela eminingi yokuhlolwa okufanele ulinde.
Awusiye wedwa uma ingqondo yakho ikhula futhi igxila ezintweni ezesabisayo zalokho imiphumela ingaba khona-futhi okubaluleke nakakhulu, ukuthi zisho ukuthini.
Ungenza izinto eziningana ukuze ubhekane ne "scanxiety".
- Buza mayelana nesikhathi sokuthola imiphumela yakho nokuthi uzobazithola kanjani.
- Yiba nekhethelo mayelana nesikhathi sokuskena kwakho. Uma kusengaphambili ngosuku ongafundwa ngalo ekupheleni kosuku, ukugcina ukucindezeleka phakathi nobusuku. Ngaphambilini ngesonto kungase kusho ukusindisa ukucindezeleka ngempelasonto.
- Cela umuntu ukuthi akujoyine uma uya ekuhlolweni, njengokuphazamiseka.
- Hamba. Buka i-movie eyintandokazi eyintandokazi, iya kumbukiso wamahlaya, noma zama noma yini ezokwenza uzomomotheka.
Imithombo:
Graham, L., Shupe, M., Schneble, E. et al. Izinyathelo Namuhla Nezinselele Ekuqapha Ukwelashwa Izimpendulo Nge-Cancer Sebele. Journal of Cancer . 2014. 5 (1): 58-68.
> DeVita, Vincent., Et al. I-Cancer: Izimiso Nokusebenza Kwe-Oncology. Cancer of the Breast. I-Wolters Kluwer, ngo-2016.
> Liedtke, C., no H. Kolberg. Ukwelapha Okuhlelekile Kwe-Advanced / Metastatic Breast Cancer-Ubufakazi Besikhathi Esizayo kanye Nemicabango Yesikhathi Esizayo. Ukunakekelwa kwebele . 2016. 11 (4): 275-281.