Uhlolo Lokuqala Lwezinketho Zezokwelapha Zokuqala Zomdlavuza weMetastatic Breast Cancer
Ngaphambi kokuba ukhulume ngazo zonke izinhlobo zokwelashwa ongakhetha kuzo umdlavuza webele we- metastatic , kusiza ukukhuluma ngezinhlobo zokwelashwa, izinhloso zokwelashwa, nokuthi yiziphi izindlela zokwelashwa ezivame ukusetshenziswa kuqala ukubhekana nomdlavuza we-metastatic.
Ungase uzibuze ukuthi ungaqonda kanjani ukuthi yiziphi izindlela zokwelashwa ezingcono uma ungenayo imithi emithi, kodwa kungenzeka ukwazi ukufunda ngokwanele ukwenza izinqumo ezikuhle kuwe njengomuntu ngamunye.
Imigomo Yokwelashwa
Ngokungafani ne-early stage isifo somdlavuza webele, akunakwenzeka ukwelapha umdlavuza webele we-metastatic, kodwa kubalulekile ukucabangela imigomo yakho ekwelapheni.
Isibonelo, abanye abantu bafisa ukuzama ukuhlala isikhathi eside ngangokunokwenzeka ngomdlavuza wabo kungakhathaliseki imiphumela emibi. Abanye bangase babe nomuzwa wokuthi izinga lokuphila kwabo kubaluleke ngaphezu kokulingana, futhi bakhethe ukwelashwa ngemiphumela emibi embalwa.
Sifisa ukuthi wonke umuntu abe nomgomo wokuphila isikhathi eside nomdlavuza webele we-metastatic, kodwa okungenani okwamanje, lokho akuyona inketho kubantu abaningi. Ngomdlavuza we-metastatic, izinga lakho lokuphila libaluleke kakhulu, kepha lokho kusho ukuthi kungashintsha ngokuphawulekayo kusuka komunye nomuntu.
Njengoba ucabanga ngezinketho zakho, cabangela lezi zinhloso:
- Ingabe lokhu ukwelashwa kuyongandisa ukuphila kwami?
- Ingabe lokhu ukwelashwa kuzobambezela ukuqhubeka komdlavuza wami?
- Le nqubo yokwelapha izoyithinta kanjani izinga lami lokuphila? Ingabe kulindeleke ukuba ngcono izimpawu engizizwayo?
- Uma kunemiphumela emibi, yimiphi imiphumela emibi ongase uyenze kakhulu ukubekezelelana nokubekezeleleka okungenani?
Izinhlobo zokwelashwa
Ngisho noma manje sinezinhlobo eziningi zokwelashwa zomdlavuza, lezi zingaphulwa zibe yizigaba ezimbili eziyinhloko.
Ukwelashwa Kwendawo
Imithi yokwelashwa yendawo ikhuluma nomdlavuza endaweni lapho iqala khona (noma kumatastasis eyodwa enhlanganweni.) Lezi zindlela zihlanganisa:
- Ukuhlinzwa
- Ukwelashwa kwamafutha
I-Treatment System
Ngokuphambene nalokho, lezi zindlela zokwelapha zikhuluma namangqamuzana omdlavuza nomaphi lapho kwenzeka khona emzimbeni. Lokhu kufaka:
Ngomdlavuza webele we-metastatic, ukwelashwa okuhleliwe kudlala indima enkulu ekwelapheni. Izindlela zokwelapha zendawo ezifana nokuhlinzwa noma imisebe zisetshenziselwa ukwelapha imishanguzo uma lezi zimbangela izimpawu, njengama-metastase amathambo abangela ingozi yezinsalela noma izidakamizwa esikhwameni sesikhumba noma esikhwameni esilaphayo futhi esibuhlungu.
Abantu abaningi bazibuza ukuthi kungani ukuhlinzwa kwebele kunjenge- lumpectomy noma i- mastectomy akuvamile ukwenza kubantu abanomdlavuza wesifuba we-metastatic, okungenani ngamaphesenti amahlanu kuya kwayishumi abantu abanomdlavuza we-metastatic ngesikhathi sokuxilongwa. Ukucabanga kwalokhu ukuthi nge-metastases, umdlavuza usuvele usakaze kahle ngaphezu kwebele.
Lezi zokwelapha azikwazi ukuphulukisa umdlavuza osakazekile. Esikhundleni salokho, ukuhlinzwa-ngenxa yezikhathi zokuphumula kanye nokucindezelwa kwesimiso somzimba-kungase kusho ukuphuza imithi yokwelashwa, okugcina idlala indima enkulu ekuphatheni umdlavuza wakho.
Imizila Yokuphathwa
Mhlawumbe uzokuzwa udokotela wakho ekhuluma nge "ukwelashwa komugqa wokuqala," "ukwelashwa kwamasekhondi wesibili," nokunye.
Leli gama lisho nje ukwelashwa kokuqala noma ukwelashwa, ukwelapha okwesibili, nokunye okungahle kusetshenziswe ngokulandelana ukuze ukhethe umdlavuza wakho.
Kuvame kakhulu ngomdlavuza wesifuba we-metastatic ukuba ube "imigqa" ehlukahlukene yokwelapha. Ukwelashwa kokuqala kwekhondla kuvame ukukhethwa ngokusekelwe kulokho okwelashwa okungenzeka ukuthi kuphumelele ngemiphumela emibi kakhulu, kepha kunezinketho eziningi ezitholakalayo.
Ukwelashwa Okuyisisekelo Okokuqala
Wonke umuntu onomdlavuza we-metastatic uhlukile, futhi yonke imdlavuza ihlukile ngakho kunzima ukukhuluma nge-"typical" yokwelashwa komdlavuza. Lokho kusho ukuthi izifo zokuqala ezikhethwe umdlavuza we-metastatic zivame ukuhlobene nesimo se-receptor yesifo somdlavuza wakho.
Lezi zindlela zokwelashwa zixhomeke esimeni sakho se-receptor ngemuva kokuthi "i- rebiopsy " ye-tumor yakho noma i-metastasis, hhayi ukuthi isimo sakho se-receptor sini lapho utholakala khona uma ngabe isifo sakho siphumelele. Uma umdlavuza wakho wokuqala kwakuyi-estrogen receptor emihle, kungenzeka manje kube yinto engalungile, futhi ngokufanayo.
Kubuye kubalulekile ukuthi uqaphele ukuthi umgomo wokwelapha umdlavuza we-metastatic ngokuvamile usebenzise okungenani ukwelashwa okungenzeka ukuthi uzinzile futhi ulawule lesi sifo. Lokhu kuhluke kunendlela "yokuphefumula" esetshenziselwa ukwelashwa kwebele.
Izibonelo zezindlela zokwelapha zokuqala zokuqala ezisekelwe esimeni se-receptor zihlanganisa:
I-Estrogen Receptor (ER) I-Positive Metastatic Breast Cancer
Ukwelashwa kokuqala komdlavuza wesifuba we-estrogen wemithi kaningi kuvame ukwelashwa kwe-hormonal, futhi lokhu kuvame ukusetshenziswa kuphela. Ukuzikhethela kwezidakamizwa kuzoxhomeke ekutheni ngabe ukwelashwa kwama-hormone uma umdlavuza wakho ubuya.
Kwabesifazane be-premenopausal, i-tamoxifen iyadingeka ngoba iningi le-estrogen elikhiqizwa ngumzimba livela kuma-ovaries. Ngaphandle kwalokho, ukucindezelwa kwe-ovarian nge-Zoladex (goserelin) noma okungavamile, ukususwa kwama-ovari, kungalandelwa ukwelashwa nge-tamoxifen noma enye ye-aromatase inhibitors.
Kwabesifazane be-postmenopausal, enye ye-aromatase inhibitors ivame ukusetshenziswa kuphela yodwa, ngaphandle uma kwenzeka ukuphindaphinda ngenkathi usebenzisa enye yale mithi. Uma isisu sakho siphindaphinda ngenkathi ku- aromatase inhibitor , ukhetho oluhlukile lungase lusebenzise isidakamizwa sokulwa ne-estrogen Faslodex (fulvesrant).
Uma i-tumor yakho i-estrogen receptor enhle kodwa iqhubekela phambili ngokushesha, kunezinketho eziningi. Uma i-tumor yakho nayo i-HER 2 enhle, ukwelashwa okuhlosiwe kwe-HER 2 kungangeniswa ekwelapheni kwe-hormonal. I-chemotherapy ingase isetshenziswe ngaphezu kwelashwa ye-hormonal kulabo abanezinambuzane ezikhula ngokushesha.
Uma unezimpawu eziphawulekayo ezihlobene nama-metastases, ezinye izindlela zokwelashwa zingase zengezwe futhi. Ukuze uthole i-metastases yamathanga, ukwelapha imisebe noma izidakamizwa ezishintsha amathambo kungasetshenziswa ukunciphisa ingozi yokuphuka, ukucindezelwa komgogodla, noma ukuphatha ubuhlungu obukhulu.
Ngokufanayo, imishanguzo eya emaphashini okubangelwa ukuphuma kwegazi noma ukuvinjelwa, noma imetastases yobuchopho ebangela izimpawu ezibalulekile futhi ingaphathwa ngemithi yokwelapha njengokwelashwa noma ukuhlinzwa.
HER2 I-Positive Metastatic Breast Cancer
Uma une-tumor etholakalayo i-estrogen receptor futhi i-HER 2 enhle, ukwelashwa kokuqala komgwaqo kungase kuqale nge ukwelashwa kwe-hormone yedwa noma ukuhlanganiswa kwezidakamizwa ze-hormonal kanye nomuthi omuhle we-HER 2.
Ukuphathwa kokwelashwa kokuqala kwe-HER 2 umdlavuza webele we-metastatic positive futhi kuncike ekutheni ngabe uphathwe ngenye yale mithi noma cha. Uma umdlavuza wakho uphindela ngenkathi ku-Herceptin, omunye weminye imithi ye-HER 2 ingasetshenziswa. Uma i-tumor yakho ikhula ngokushesha, i-chemotherapy ingacatshangwa.
Njengama-tumor e-receptor positive, ama-metastase anezimpawu angadinga ukwelashwa kwendawo. Isibonelo, i-metastases yamathambo ebuhlungu noma i-metastase eyandisa ingozi yokuthi ungaphula ithambo ingelashwa ngelashwa lokushisa noma i-agent eguqule amathambo.
I-Cancer Negative Breast Cancer
Umdlavuza webele we-metastatic we-triple omubi kunzima kakhulu ukwelapha, ngokujwayelekile kunomdlavuza webele we-estrogen receptor noma i-HER 2 enhle, kodwa kusekhona izinketho.
I-Chemotherapy ivame ukusetshenziswa umlayini wokuqala walezi zomshukela, futhi ukukhetha imithi ngokuvamile kuxhomeke ekutheni i-chemotherapy yasetshenziswa ngaphambili.
Kubantu
Umdlavuza webele we-Metastatic kumadoda unemibono eminingana ebalulekile, kodwa ngokuvamile, indlela efanayo iyathathwa. Ukwelashwa kungase kuqale nge-tamoxifen kulabo abanesifo se-estrogen se-receptor positive, noma nge-chemotherapy.
I-Treatment Best
Yini okudingeka ukwazi ukuze wenze izinqumo ezinhle kakhulu mayelana nokwelashwa kwakho?
Isinyathelo sokuqala ukuzifundisa ngesifo sakho. Funda ngokusebenzisa ulwazi olunikeziwe lapha, nanoma yiluphi ulwazi olutholile kusuka esikhungweni sakho somdlavuza.
Gcina uhlu olusebenzayo lwemibuzo yokubuza i-oncologist yakho, futhi ulethe nawe ekuqokweni kokubili. Uma usaluthola kunzima ukuqonda okuthile, cela futhi.
Kunolwazi oluningi lokugaya isikhathi esifushane, futhi luhlangene nemizwelo enzima ehamba nomdlavuza we-metastatic diagnosis, i-oncologist yakho ngeke ikhubeke uma udinga ukubuza imibuzo efanayo ngokuphindaphindiwe. Lokho kuvamile.
Abantu abaningi bakuthola kuwusizo ukukhuluma nabantu "ababekhona." Ngaphezu kwamaqembu asekela emphakathini , manje sinosizo lokusekelwa kwe-24/7 olunikezwa imiphakathi yokusekela umdlavuza webele. Kukhona imiphakathi eyenziwe ngabantu ababenomdlavuza webele we-metastatic, ongasiza kakhulu njengoba ubhekene nalezi zinqumo.
Khuluma nabangani bakho nomndeni wakho, bese ucela ukufaka kwabo, kodwa izinqumo zokugcina zifika kuwe. Lokhu kungaba yisikhathi esinzima, ikakhulu uma amalungu omndeni wakho engavumelani nezinqumo zakho.
Lalela kulabo abathandekayo bakho futhi ubathokoze ngokufaka kwabo, kodwa khumbulani, uma kudingeka, ukuthi kudingeka ukhethe indlela ehlonipha izidingo zakho kanye nezifiso zokunakekelwa kwakho.
Izinto Ezithonya Ukukhetha
Kunezici eziningi ezingase zibhekwe ekukhetheni ukwelashwa okufanele komdlavuza wakho, kokubili ekuqaleni, futhi njengoba isikhathi siqhubeka. Ezinye zazo zihlanganisa:
- Isimo somamukeli we-tumor
- Izindlela zokwelashwa zangaphambili (izibeletho zesifuba zivame ukuphikisana nesikhathi sokwelapha)
- Umthwalo we-tumor (ukuthi ukhulu kangakanani izidumbu zakho nokuthi zinkulu kangakanani)
- Izimpawu eziqondile ozihlobanise nomdlavuza wakho nokuthi uzikhathaza kangakanani lokhu
- Ukushesha umdlavuza uqhubeka kanjani
- Izintandokazi zakho zokuthola ukwelashwa kalula (ngomlomo vs IV isibonelo), nokubekezelela imiphumela emibi (abanye abantu bathola eminye imiphumela emibi kakhulu kunezinye)
- Kungakhathaliseki ukuthi uhlanganyela noma yini ekuhlolweni komtholampilo
Imibuzo Yokuzibuza
Kuyoba nemibuzo eminingi okufanele uyibuze mayelana nemithi ethile, kepha kunemibuzo ongase ufune ukuyihlola ngisho nangaphambi kokuzijabulisa izinketho ezahlukene.
- Ufuna kuphi ukuthola ukunakekelwa kwakho?
- Ingabe uzimisele ukuhamba ucwaningo lwezokwelapha uma kudingeka, noma ngabe ukhetha ukuba usondele ekhaya lakho?
- Uma ukhetha ukuhamba, ingabe kukhona isikhungo somdlavuza esiseduze nabangane noma umndeni onokuhlala nani?
- Ungahamba kuphi nomshuwalense wakho?
- Uma ucabangela abahlinzeki benethiwekhi, lokhu kuyosho ukuthini kuwe ngokwezezimali?
- Ungacabanga ukuthi uhlanganyela ekuhlolweni komtholampilo (ukuhlolwa kwemitholampilo yomdlavuza webele we-metastatic kuxoxwa kamuva.)
- Iziphi abangane abangatholakala ukukusiza ngezinkinga ezifana nokunakekela izingane nokunye?
Isibikezelo Nge / Ngaphandle Ukwelashwa
Abanye abantu bafuna ukwazi ukuchazwa kwabo; lokho okushiwo yi-"average" imiphumela yomuntu onesifo sakhe. Abanye abantu abafuni ukwazi, futhi lokho kuhle. Iqiniso liwukuthi asikwazi ngempela ukusho ukuthi umuntu oyedwa uzokwenzenjani ngemuva kokuthola ukuthi unomdlavuza webele we-metastatic.
Sinezibalo ezingasinika umqondo othile mayelana nokuthi umuntu uzokwenzenjani ngemithi ethile, kodwa kunezinkinga eziningana nezibalo. Enye ukuthi izibalo ziyizinombolo, hhayi abantu. Singakwazi ukukhuluma ngezinombolo zabantu, ngokwesilinganiso, abahlala ngonyaka noma iminyaka eyishumi ngomdlavuza webele we-metastatic, kodwa asinayo indlela yokubikezela ukuthi labo bantu bayobani.
Esinye isizathu sezibalo esisihluphayo ukuthi ziyisilinganiso sendlela abantu abayenzile ngayo esikhathini esidlule. Ukwelashwa komdlavuza wesifuba we-metastatic kuyathuthuka, futhi asazi ngempela ukuthi umuntu uzokwenzenjani ngezokwelapha ezintsha. Izibalo eziningi esizisebenzisayo ukwahlulela ukubikezela okungenani zineminyaka emihlanu ubudala. Kodwa eziningi izidakamizwa ezitholakalayo emdlalweni webele we-metastatic azitholakali eminyakeni emihlanu edlule.
Esikhathini samanje (ngokusekelwe kulokhu, ngezibalo, ukusinda okuphakathi komdlavuza webele we-metastatic (kubandakanya zonke izinhlobo) ukwelashwa kuthathwa njengezinyanga ezingu-18 kuya kwezi-24. Lokhu kusho ukuthi izinyanga ezingu-24 ngemuva kokuxilongwa, ingxenye yabantu ukufa kanye nengxenye izobe isaphila. Umdlavuza webele we-metastatic wamaphesenti angama-5 uneminyaka emihlanu. Kukhona nabantu abaningi abaye bahlala nomdlavuza webele we-metastatic iminyaka eyishumi noma ngaphezulu.
Umcabango wokugcina okumele ukhunjulwe wukuthi sithuthuka empeleni ekwelapheni umdlavuza webele we-metastatic. Ukuhlolwa kwemitholampilo ukutadisha konke kusuka ekuziphatheni kwamagciwane emithonjeni yomdlavuza yomdlavuza wesifuba kuyaqhubeka okwamanje. Kuthemba ukuthi lezi zigaba ezintsha zokwelapha zizoshintsha maduze izibalo ezindala mayelana nomdlavuza webele.
Ukuzikhuthaza
Indawo engcono kakhulu ukuqala ekukhulumeni mayelana nokwelapha yindlala yakho njengelungu elibalulekile leqembu lakho lokunakekela impilo. Cishe usuzwile ukuthi kubalulekile ukuba ngummeli wakho ekunakekeleni kwakho, kodwa lokho kusho ukuthini ngempela?
Ukuba ngummeli wakho uqobo kuthatha ukuthatha indima ebonakalayo ezinqumweni ezihambisana nokwelashwa kwakho. Kusho ukubuza imibuzo uma ungaqondi okuthile, futhi uqhubeke ucela uze uqonde.
Uma sikhuluma ngokuba ngummeli wakho siqu ngomdlavuza asisho ukuthi uzoba nobuhlobo obunzima ne-oncologist yakho namanye amalungu eqembu lakho lezempilo . Ngokuphambene, ukuba ngummeli wakho kukusiza ukuba usize i-oncologist yakho ukuthi ibone ukuthi yini ebaluleke kakhulu kuwe njengomuntu.
Esikhathini esidlule, kwakuvame ukukhetha okuncane abantu ababhekene nomdlavuza we-metastatic. Lokhu kushintshile ngokuphawulekayo eminyakeni yamuva, futhi manje kungenzeka kube nezinketho eziningana ezihlukene ezingafanelana nemigomo yakho yokwelapha.
Ngeke ucelwe ukuba ukhethe phakathi kokwelashwa okulindeleke ukuthi usebenze kahle ngemiphumela emibi embalwa futhi engasebenzi noma enemiphumela emibi kakhulu. Iqiniso liwukuthi eziningi zalezi zikhethelo zizokwehla umahluko phakathi kwezidingo zakho siqu.
Isibonelo, kungase kudingeke ukhethe phakathi kokuthola ukwelashwa eduze kwekhaya lakho noma esikhungweni somdlavuza ngaphandle kwedolobha, noma mhlawumbe ukhethe phakathi kwamasethi amabili ahlukene emibi.
Abanye abantu bakuthola kunzima kunabanye ukuzimela. Uma ukhulunywa kahle futhi uthule-umenzi wokuthula mhlawumbe-ungase uthole kunzima ukuvumela ithimba lakho lokunakekelwa kwempilo uma izinto zingahambi ngendlela ongathanda ngayo. Uma lokhu kuhambisana nobuntu bakho, kuvame ukusiza ukukhetha umngane noma ilungu lomndeni ukuba abe ummeli futhi angabuza noma yimiphi imibuzo enzima ongayithola kunzima ukuyibuza.
Izwi elivela
Izibonelo zezindlela zokwelapha zokuqala ezingenhla ziyizibonelo kuphela, futhi i-oncologist yakho ingancoma indlela ehlukile ngokusekelwe kwezici zesifo sakho esiyingqayizivele. Izidakamizwa eziningi zihlolwa ngezivivinyo zokwelashwa, futhi enye yalezi zindlela ingase inikeze indlela ehlukile.
Into ebalulekile ukukhuluma nodokotela wakho ngokuthi kungani izidakamizwa ezithile zinganconywa futhi ziqonde lezi zikhetho kanye nezinye izindlela ezingenzeka. Abantu abaningi futhi bakuthola kuwusizo ukubuza mayelana nezindlela zokwelashwa ezinganconywa uma lo mgomo ongeke ulawule isisu sabo.
Ukuba isinyathelo esisodwa engqondweni yakho kungakusiza ukuba ubhekane nokulula okuncane ngokukhathazeka okuhlobene nokungaziwa okuzayo.
Imithombo:
Hayes, D. Imfundo yeziguli: Ukwelashwa komdlavuza wesifuba we-metastatic (Ngaphandle Kwezingqalasizinda). UpToDate .
> 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.