Okwenza Ukwelashwa Kwendawo Kube Nciphisa Ukusetshenziswa Emdlalweni We-Breast Metastatic Breast
Ukushiswa kwemishanguzo nokuhlinzwa yizinto zokwelapha zendawo, futhi ngaleyo ndlela kunomkhawulo wokusetshenziswa kubantu abanomdlavuza webele we-metastatic. Esikhundleni salokho, ukwelashwa kwesistimu-ukwelashwa okufana nemithi yokwelashwa , i- chemotherapy , imithi yokwelashwa , ne-immunotherapy, ekhuluma nomdla noma ngabe ikuphi emzimbeni-yiyona ndlela yokwelapha.
Uma ama- metastase emathanjeni akho, isibindi, amaphaphu, noma ubuchopho abangela izimpawu, noma uma bengakubeka engozini yezinkinga ezifana nokuphuka, ngokuvamile ziphathwa njengengxenye yokwelashwa kwakho jikelele ngomdlavuza webele nezokwelapha .
Ngabe Izindlela Zokwelashwa Zendawo Zisetshenziswa Ngani?
Nokho, kunezikhathi, lapho ukwelashwa ngokuqondile kwe-metastase ngokuhlinza, ukwelapha imishanguzo, noma ezinye izindlela zokwelapha kuyasiza. Izizathu lezi zindlela zokwelashwa ezingasetshenziswa zihlanganisa:
- Ukulawula ubuhlungu (ikakhulukazi nge-metastases amathambo)
- Ukweqa noma ukuvinjelwa emigwaqweni yomoya okubangelwa ama-metastases amaphaphu
- I-metastases ye-Bone ephakamisa ingozi yokuphuka noma ingabangela ukucindezeleka komgogodla
- Imizwa ye-Brain ephawulekayo kakhulu, njengalezo ezibangela ukukhanda ikhanda, izinguquko zobuntu, ukuphazanyiswa okubukwayo, ukuphazamiseka okubonakalayo (ukuvinjelwa kwegazi-ukuvimbela imishanguzo eminingi njengezidakamizwa ze-chemotherapy ukungena ebuchosheni noma intambo yomgogodla)
- Ukukhipha imithanguzo ebuhlungu emadwaleni esikhumba noma esifubeni
- Ukwelashwa kwama-Oligometastases - I-Oligometastase yigama elisetshenziselwa ukuchaza indawo eyodwa noma ezimbalwa kuphela zezifo zamathambo. Ngokuvamile umdlavuza webele unomthelela omkhulu we-metastase ezindaweni eziningi zomzimba. Ezimweni ezingavamile, ukwelashwa ngokuhlinzeka, ukwelapha imishanguzo, ukukhishwa kwe-radiofrequency (RFA), noma i-microembolization ingacatshangelwa kulabo abanezinto eziyisithupha kuphela (noma mhlawumbe ezimbalwa) ezitholakala esiswini esisodwa kuphela.
Nakuba lokhu kungakaze kuboniswe ukuthuthukisa ukusinda kwabesifazane namadoda anomdlavuza webele we-metastatic, kuye kwaboniswa, ngezikhathi ezingavamile, ukuthuthukisa ukusinda kwabantu abane-metastase ehlobene nezinye izicubu eziqinile.
I-Bone Metastases
Ukwelashwa kwamathambo ayisifo esivela emdlalweni webele webele kuncike ekutheni izinga le-metastases, izimpawu ezibangelwayo, nezinye izifo ozitholayo. Imithi yokwelashwa yama-Hormonal, izifo ezithintekayo, kanye ne-chemotherapy kungenzeka ukuthi zonke zinganciphisa izimpawu ezisuka kumdlavuza wesifuba oye wanda emathanjeni.
Kodwa, ngezinye izikhathi, lezi zindlela zokwelapha ezivamile aziwanele. Izindlela zokwelashwa zasendaweni ezifana nokwelashwa kwemisebe kungasetshenziselwa ubuhlungu obungalawulwa kahle ngemithi yokwelashwa, noma ukuvimbela ama-fracture noma ukucindezelwa komgogodla ngenxa yamathambo ayisithupha. Udokotela wakho angancoma uhlobo lwemisebe noma izidakamizwa ezibizwa ngokuthi "ama-agent modifying agents." Izinketho zifaka:
- Ukwelashwa kwezidakamizwa - Ukwelashwa kwezidakamizwa kuvame ukusetshenziselwa ukwelapha i-metastases yomdlavuza wesifu emathanjeni okwehlisa ithambo nokukhulisa ingozi yokuphulwa.
- I-Radiopharmaceutics - I- Radiopharmaceutics yizidakamizwa ezithwala izinhlayiya ezivuthayo emathanjeni. Isibonelo yi-strontium 89.
- Ama-Bone-Modifying Agents - Kunezigaba ezimbili zamathambo aguqukayo amathambo angase asetshenziselwe amathambo ayisithupha. Amanye alawa asetshenziselwa abantu abane-osteoporosis. Njengomuthi wokwelashwa, angase asetshenziselwe ukuvimbela ama-fractures, ukuvimbela ukucindezeleka kwentambo yomgogodla, nokuphatha amazinga aphezulu e-calcium egazini ngenxa yokwehla kwethambo ngamathambo ayisifo (hypocalcemia of malignancy).
Izibonelo ze-bisphosphonates zifaka:
- I-Aredia (i-pamidronate)
- I-Zometa (i-zolendronic acid)
- I-Boniva (ibandronate)
I-RANK (i-receptor activator ye factor factor kappa B) i-ligand inhibitors ihlanganisa:
- I-Xgeva (i-denosumab)
Ama-Metastase we-Liver
Izidakamizwa zesibindi zingase zingabangeli noma yiziphi izimpawu, futhi ungazi kuphela lokhu ngenxa yokwanda kwezivivinyo zokusebenza kwesibindi ekuhlolweni kwegazi noma ngokuthola lokhu ekuhlolweni kwe-imaging.
Uma zinezifo ezizwakalayo, izindlela zokwelashwa zendawo ezifana nokuhlinzwa noma ukukhipha imishanguzo zingacatshangelwa ngaphezu kwemithi ejwayelekile yomdlavuza wesifuba we-metastatic.
Ama-Metastases Amapayipi / Ama-Pleural Effusions
Njengamanye amasayithi we-metastases, ukwelashwa kwamaphasethi wesifo sephaphu kuhlanganisa nokwelashwa komdlavuza wesifuba we-metastatic ngokuvamile. Ngezinye izikhathi, amaminerase amaphaphu angabangela ukuvinjelwa kwendiza noma ukuphaphaza emoyeni.
Uma lokhu kwenzeka, ukwelashwa kwemisebe kungase kuphumelele ekunciphiseni izimpawu.
Ama-pleural effusions (ukwakhiwa kwamanzi aphakathi kwamabhande ahlanganisa amaphaphu) nawo avamile nomdlavuza wesifuba we-metastatic. Ukususwa kwalesi sitshalo nge-sindle (thoracentesis) kunganciphisa kakhulu izimpawu, kodwa ukukhishwa ngokuvamile kubuyele. Uma lokhu kwenzeka, i-stent ingafakwa emgodini we-pleural oxhunywe yi-tube kuya ngaphandle komzimba wakho (ngokusebenzisa udonga lwesifuba sakho) okuvumela ukuthi uketshezi lukhishwe.
Abantu abaningi abane-stent bavunyelwe ukukhipha uketshezi ngokwabo ekhaya (ngosizo lomuntu othandekayo) uma uketshezi kwandisa izimpawu zabo zansuku zonke.
I-Brain Metastases
Ama-metastases enesibindi angaba nzima ukwelapha ngomdlavuza webele we-metastatic njengoba imithi eminingi ye-chemotherapy ingakwazi ukungena ebuchosheni nasendongeni yomgogodla. I-network of capillaries ezinamaqabunga ohlangothini lobuchopho obubizwa ngokuthi i-blood brain barrier iklanyelwe ukuvimbela ubuthi bekungena ohlelweni lwesimiso esiphakathi. Ngeshwa, le nsika ivame ukuvimbela izidakamizwa zomdlavuza ukuba zingene kule ndawo.
Kunezilungiselelo ezimbili lapho ukwelapha noma ukuhlinzwa kwe-radiation kungase kubhekwe njengokuphatha imithi ye-brain.
- Izimpawu zesimiso - Uma ubuchopho bakho be-metastases bubangela izimpawu ezibalulekile, ukwelashwa kwendawo kungathuthukisa izinga lakho lokuphila. Lokhu kungabandakanya lonke ukwelapha kwama-radiation we-brain for metastase ehlukahlukene kanye neminye imisebe yendawo ephakeme futhi ephakeme kakhulu ye-metastase eyodwa kodwa enkulu.
- Izidakamizwa ezixubileyo - Ukuze uthole imithi emikhulu engabodwa eveza izimpawu, noma uma unomzimba owodwa (noma obambalwa) we-metastase kodwa ungabikho ubufakazi bokuthi imithini ye-metastase enye indawo emzimbeni wakho, izinhlobo ezikhethekile zemisebe eyaziwa ngokuthi i-radiotherapy yomzimba (SBRT noma i-Cyberknife) noma i-stereotactic body body radiotherapy noma I-radiofrequency ablation (RFA) ingasetshenziswa. Lezi zokwelapha ziqondisa izinga eliphezulu lemisebe endaweni ecacile ebuchosheni. Esikhundleni salokho, ukuhlinzwa kungase kubhekwe njengokwelapha lezi zinhlelo zokusebenza.
Ezinye zokwelapha
Kunezinye izindlela zokwelapha ezihlolwe ukwelashwa okuqondile kwe-metastases ngenxa yomdlavuza webele. Izindlela ezinjenge-microembolization nokuningi zinganikeza ngemithi engcono esikhathini esizayo. Kunezilingo eziningana zokwelapha okwamanje eziqhubekayo ukutadisha ukwelashwa kwamathambo.
Ukuphatha Imiphumela Yecala
Ukwelashwa kwezidakamizwa, njengezinye izindlela zokwelapha, kungabangela imiphumela emibi. Imiphumela emibi ethize nokuthi indlela ehlupha ngayo kuyohlukahluka kuye ngezici eziningi ezihlanganisa indawo yomzimba wakho othola imisebe. Eminye yemiphumela emibi kakhulu ihlanganisa:
- Ukucasula isikhumba - Indawo othola ngayo imishanguzo ye-radiation ingathuthukisa ubomvu futhi ngezinye izikhathi igxuma, efana nokushisa kwelanga. I-oncologist yakho ye-radiation izokukhuluma ngezimpawu zokubukela futhi ingase ibeke isililo okufanele usebenzise.
- Ukukhathala - Ukukhathala kuyindlela ejwayelekile kakhulu yokwelashwa kwemishanguzo, ethinta abantu abaningi abanalo lalashwa ngezinga elithile. Lokhu ukhathala kuvame ukwanda futhi kudlulele ngokuhamba kwesikhathi.
Njengokukhathala okuhlobene ne-chemotherapy, lezi zimpawu zingabangelwa nezinkinga eziguquguqukayo (njenge-anemia) futhi kubalulekile ukukhuluma ne-oncologist yakho ngezinga lakho lokukhathala.
Ukwelashwa okungcono kakhulu kokukhathala ngokuyinhloko ukuthola izindlela zokubhekana nokukhathala. Cela usizo futhi uvumele abanye ukuba bakusize. Ukuphumula lapho udinga. Futhi ukhulume nodokotela wakho nganoma yikuphi ubunzima bokulala okubangela ukukhathala kwakho. - Ukulahleka kwezinwele - Ukushona kwezinwele kwesibili kuya ekwelashweni kwe-radiation kuhluke ekulahlekeni kwezinwele ezihlobene ne-chemotherapy, ngoba kungasetshenziswa njalo. Ukulahlekelwa izinwele kuxhomeke endaweni yomzimba othola ngayo ukwelashwa kwama-radiation.
Isibonelo, imisebe yonke yobuchopho ekhanda lakho ingabangela ukulahlekelwa kwezinwele ekhanda lakho, kanti imishanguzo esifubeni sakho, emasiphasini amaphaphu, izobangele ukulahlekelwa kwezinwele esifubeni sakho. - Ukungasebenzi kahle kwengqondo - Ukwelashwa kwezidakamizwa ebuchosheni, ikakhulukazi ubuchopho be-radiotherapy, kungabangela izimpawu ezifana nezinkinga zememori kanye nobunzima bokuhlushwa (ukungasebenzi kahle kwengqondo.) Kubalulekile ukucubungula ngokucophelela izinzuzo zokwelapha imisebe ebuchosheni ngokumelene nalezi zimo ezimbi zokwelashwa .
Ukwelashwa kwezidakamizwa ebuchosheni bubeka ingozi yokulimala ezakhiweni ezivamile ezingxenyeni zobuchopho lapho i-radiation idlula khona.
> Imithombo:
> 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.