Uphi I-Cancer Yomama Esabalalisa?

Izindawo Eziningi Ezivamile Zase-Breast Breast Cancer Metastases

Uma uthola ukuthi unomdlavuza wesifuba we-metastatic, noma uma unesifo somdlavuza webele esifushane esikhathini esidlule futhi unesimpawu esisha, kungokwemvelo ukuthi ube nemibuzo. Ezinye zezinto ongazibuza ngazo zihlanganisa:

• Uphi umdlavuza webele?
• Yiziphi izingosi ezivame kakhulu zomdlavuza webele webele?
• Ngaki kaningi umdlavuza wesikhumba uhambela kulezi zifunda zomzimba?

• Ziyini izimpawu okufanele ziqaphele?
• Ulashwa kanjani umdlavuza webele uma usakazeka?

Ukubaluleka kweMetastases yeCans Breast Distant

Ngamaphesenti angama-85 abesifazane, ukusakazeka komdlavuza ezindaweni ezikude zomzimba ( imithi eseduze) kwenzeka iminyaka futhi mhlawumbe ngisho namashumi eminyaka emva kokuxilongwa kwangempela. Kulaba besifazane abayishumi namashumi ayisishiyagalolunye kwabesifazane, izibalo ezikude zikhona kakade ngesikhathi sokuxilongwa.

Umdlavuza wesibeletho ungase uphinde ufike endaweni yangakini (esifubeni), esifundeni (ezindaweni zamakhansela emgqeni, ngaphezu kwe-collarbone, noma phakathi kwesifuba) noma kude. Kule ngxoxo, sizokhuluma ngokuyinhloko mayelana namagciwane asakaze kumasayithi akude.

Amasastases asekude okuvela emdlalweni webele webele abaluleke kakhulu ngoba anesibopho samaphesenti angama-90 abantu abafa kulolu sifo. Lokho kusho, noma ngabe uhlakulela ama-metastases kwenye yalezi zindawo, ukwelashwa kuyatholakala; ukwelapha okungase kwandise impilo.

Umdlavuza webele wezinsalela ezikude ubizwa ngokuthi umdlavuza webele wesisu (MBC) noma isigaba somdlavuza webele wesigaba 4 . Uma ujwayele isiteleka se-TNM somdlavuza webele , lokhu kuzobhekisela kumdlavuza ongu-M1 (esikhundleni se-M0 okusho ukuthi akukho methasesis.) Isibungu esinesimiso semithamo singaba nenombolo ye-T (ubukhulu besisu) no-N (inani lama-lymph nodes elihle nokuthi likhona kuphi).

Uphi I-Cancer Yomama Esabalalisa?

Umdlavuza wesibeletho ungasakazeka cishe kunoma yisiphi isifunda somzimba kodwa kungenzeka ukuthi usakaze kwezinye izindawo kunabanye. Amagciwane angasakazeka ngegazi noma ngokusebenzisa isimiso se-lymphatic, ngakho-ke kuvame ukusabalalisa ezindaweni eziphethe ukuphazamiseka kwegazi noma i-lymphatic flow. (Ungafunda kabanzi mayelana nokuthi umdlavuza usakazeka kanjani .)

Izindawo zomzimba lapho umdlavuza webele usakazeka nazo zingahlukahluka kuye ngokuthi uhlobo oluthile lomdlavuza webele nesimo se-hormonal / HER2. Izingosi ezivame kakhulu zihlanganisa:

• Ama-lymph nodes
• Amathoni
• Amapulazi (kufaka phakathi ama-pleural effusions)
• Isibindi
• Ubuchopho
• Ama-metastases (nge-lobular carcinoma)

Indawo evamile kakhulu yokuqala ye-metastases ibhekwe ekutadisheni kuka-2013. Abesifazane abanesifo somdlavuza webele wezinsana baqala ukuhlola ukuthi yikuphi indawo eyayiyindawo evamile kakhulu ye-metastasis nomdlavuza wabo. Ukuphazamiseka kwaba:

• Amathoni - amaphesenti angu-41
• Amapulazi - amaphesenti angu-22
• Isibindi - amaphesenti angu-7.3
• Ubuchopho - amaphesenti angu-7.3
• Amanye amasayithi kwakuyizindawo zokuqala ze-metastasis kubantu abasele

I-lobular carcinoma evamile ijwayele ukuba nephethini ehlukene kakhulu ye-metastases kunomdlavuza webele we-ductal. Esifundweni esisodwa, cishe amaphesenti angu-70 abantu abane-metastases abavela ku-lobular carcinoma babenemithi yokushisa e-peritoneal.

Cishe ingxenye yesithathu yabesifazane (namadoda, njengamadoda athola umdlavuza webele ) futhi , umdlavuza usakazeka ezithombeni eziningi ngesikhathi esisodwa. Ake sibuke lezi zindawo ezivamile, kanye nezinye izindawo ezingavamile lapho umdlavuza webele usakazeka khona. Ngenkathi ukhetho lwezokwelapha lomdlavuza webele lwe-metastatic lufana nanoma ngabe umdlavuza usakazeke kangakanani, kunezinye izindlela zokwelashwa ezisetshenziselwa izindawo ezithile zemetastasis kanye.

Umdlavuza Webele Usabalala I-Lymph Nodes

Ukusabalala komdlavuza webele kuma-lymph nodes akusho ukuthi umdlavuza webele unemetastatic. Ngisho noma umdlavuza uphindela emanzini amancane (okungenani ama-lymph nodes eduze nesifuba) kuthathwa njengokuphindaphinda kwesifunda hhayi ukuphindaphinda okude .

Siphakamisela ukusabalala kwamakhansela amancane ngoba abantu abaningi bayadideka uma bezwa ukuthi banomdlavuza webele we- lymph node-positive . Kule ndaba, umbiko we-pathology ungase uthi: "Umdlavuza webele we-metastatic kuya kuma-lymph nodes" kodwa njengoba kuphawuliwe, lokhu kusho ukuthi umdlavuza webele unemetastatic. Umdlavuza wesibeletho osuke usakazeka kuma-lymph nodes kungaba isigaba II, isigaba III, noma isigaba IV.

I-Cancer Yamabele Iqhubekela Emabhonzini (I-Bone Metastases kusuka e-Breast Cancer)

Indawo evamile kakhulu yomdlavuza webele wesifuba esivelele, okwenzeka kumaphesenti angama-70 abantu abanomdlavuza webele we-metastatic, kungamathambo. Emathanjeni okusabalala ngawo umdlavuza webele, izindawo ezivame kakhulu zihlanganisa umgogodla, izimbambo, i-pelvis, namathambo amade wezingalo nemilenze. I-bone metastases ijwayele ukuhlaselwa kahle ngokuphathelene nama-metastase kwezinye izifunda zomzimba.

I-metastases ye-Bone ingatholakala kuthekisthi okwenziwe ukuze ifune imetastase (uma kungekho zibonakaliso ezikhona) noma zitholakale ezikwenzeni ezenzelwe ukuhlola izimpawu ezifana nobuhlungu. Abanye abantu abazi ukuthi bane-metastasis yethambo kuze kube yilapho behluleka ukuhlukumezeka okubangelwa ukuhlukunyezwa okuncane kuphela. Ama-fractures ngengxenye yethambo eluthakathaka ngumdlavuza we-metastases abizwa ngokuthi ama- fracture we-pathologic .

Kunezinhlobo eziningana zokwelapha ezitholakalayo emathisasini e-bone kusuka emdlalweni webele webele, kanti ezinye zazo zingakwazi ukulawula lesi sifo isikhathi esithile. Ukwelashwa kwezidakamizwa kuvame ukwenziwa uma kunesidingo esiphuthumayo esidingekayo, futhi singasebenza kakhulu ekwelapheni kwamathambo asekhaya. Izidakamizwa ezinjengeStrontium 89 zihlanganisa i-particle yemisebe enamathele kwenye ikhemikhali ejojelwe egazini. Lezi zokwelapha, ngokungafani nokwelapha imishanguzo, zivame ukusebenza uma umuntu enama-metastases amaningi noma amaningi egazini. Ngezinye izikhathi ukuhlinzwa kuyadingeka ukuze kuqiniswe ithambo eliye laphuka noma lisengozini yokukhwabanisa ngenxa yamathambo.

Eminyakeni yamuva, imishanguzo yokuguqula amathambo ingeziwe emithonjeni etholakalayo ye-metastases yamathambo futhi ingaba yimpumelelo kakhulu.

Ama-bisphosphonates afana ne-Zometa (zoledronic acid) awasebenzeli kuphela ekunciphiseni ubuhlungu obuvela emasethini kodwa abonakala sengathi anemiphumela ye-anticancer. Le mithi inganciphisa futhi amathuba okuthola amathisaseli eminye yethambo futhi ithuthukise ukusinda. Imithi i-Xgeva (denosumab) ingase iphumelele nasekuphatheni ama-metastases emathambo ngenkathi kuthuthukiswa ukusinda.

Umdlavuza Webele Usakaze Esibindi (I-Metastases ye-Liver from Cancer Breast)

Umdlavuza webele we-Breast isifo esivindiwe nawo.

I-metastases yesibindi ingase ibe khona ngaphandle kwezimpawu futhi ivame ukutholakala kumatshwayo njengokukhipha i-PET. Ngesinye isikhathi lezi zimpawu zesola zibhekwa ngokususelwa ekuhlolweni kokusebenza kwesibindi okungavamile. Izimpawu zesimiso se-fostas zingase zihlanganise ubuhlungu besisu, isicanucanu, isching (okungaba nzima) kanye ne- jaundice , ukuchithwa okwesibhakabhaka kwesikhumba kanye nabamhlophe bamehlo.

Izindlela zokwelashwa ezijwayelekile zomdlavuza we-metastatic (njenge- chemotherapy , ukwelashwa kwama-hormonal, kanye nezinqubo ezithintekayo) zinganciphisa lezi zindlela zokuvimbela umzimba, kodwa njengoba isibindi sisebenza njengendawo yokuxoshwa komzimba, kungaba khona ibhalansi elungile, futhi ngezinye izikhathi ama-metastase we-fover anciphisa ikhono lokubekezelela i-chemotherapy.

Ukwelapha imithi esibindi kunganciphisa ubuhlungu futhi kungase kuthuthukise ukusinda. Ngezinye izikhathi ezinye izindlela zokwelashwa zendawo zingasetshenziswa ekwelapheni izidakamizwa zesibindi ezifana nokuhlinzwa, i-radioembolization, i-chemoembolization, i-radioprequency ablation, noma i-radiotherapy yomzimba wesimo stereotactic.

Umdlavuza Webele Usakaze Emapungwini (Amangalisa Amangqamuzana Kusuka Emdlalweni Webele)

Njengoba nje igazi lihlungwa ngesibindi, igazi lidlula emaphashini, okwenza lokhu kube isayithi elivamile le-metastasis.

Ama-metastate angama-lung angase asolwa ngokususelwa kuskena, okuvame ukukhombisa izindawo ezincane ze-metastase (ngokungafani nomdlavuza wamaphaphu, isibonelo, okungenzeka ukuthi ubonakale njengesisindo esikhulu esisodwa). Uphawu oluvame kakhulu ukuphefumula, okungaba mnene futhi kwenzeke ngokuzivocavoca ekuqaleni. Ezinye izimpawu zingafaka ukukhwehlela okuqhubekayo noma ubuhlungu ngokuphefumula .

Ngaphezu kokusakazeka emaphashini, umdlavuza wesifuba we-metastatic ngokuvamile uvame ukuqhuma kwamapulangwe-ukwakheka kwamanzi okugeleza esikhaleni phakathi kwezingqimba ( pleure ) ezibeka emaphashini. Ama-pleural effusions ayenzeki kuphela uma umdlavuza webele usakazeka emaphashini, kodwa uma usakazeka emaphethini omzimba emkhatsini wamaphaphu (i- mediastinum ). I-fluid ingaba yinhle (ngaphandle kwamangqamuzana omdlavuza) futhi ihlobene nezinguquko zokuvuvukala, noma kunalokho, iqukethe amangqamuzana omdlavuza (i- effusion ye-pleural injusion ).

Ama-metastases ama-lung avame ukuphathwa ngemithi ejwayelekile yomdlavuza wesifuba we-metastatic, kodwa ukwelashwa kwe-radiation kungasiza, ikakhulukazi uma i-metastase ibangela ukuvimbela emoyeni (bronchi).

Ukusebenza kwe-Pleural kungaba mkhulu kakhulu futhi kubangele ukuphefumula okukhulu. Umkhuhlane uvame ukukhishwa ngokubeka inaliti emgqeni wesifuba nasesigodlweni sokuxosha amanzi. Ngeshwa, ama-pleural effusions avame ukuphindaphinda. Uma lokhu kwenzeka, kukhishwa i-shunt, noma i- pleurodesis isinconywa (inqubo lapho izingxenye ze-pleura zishaywa ndawonye ndawonye ngakho-ke amanzi angakwazi ukuphindaphinda).

I-Cancer Isakaze Kubuchopho (Ama-Brain Metastases Kusuka Emdlalweni We-Cancer)

Umdlavuza wesibeletho usakazeka ebuchosheni kubantu abangaba ngu-10 kuya kwangu-15 emaphesenti abantu abanomdlavuza webele we-metastatic jikelele. I-metastase ye-Brain iyavame kakhulu kwabesifazane abane- HER2 emihle yesifo somdlavuza nomdlavuza wesifuba kathathu omubi , okwenziwe ubuchopho be-brainstor occur in cishe ingxenye yesithathu yabantu abane- CANER / neu positive yamabelevuza webele.

Izimpawu zobuhlungu be-brain metastases ngokuvamile zihlanganisa ikhanda, izinguquko ezibonakalayo, isizungu noma ukuqubuka (ngezinye izikhathi ukuthumba kuyisibonakaliso sokuqala). Ezinye izimpawu zingabandakanya ubuthakathaka ohlangothini olulodwa lomzimba, izinkinga zokuxhumana, noma izinguquko zobuntu.

Ngokungafani nama-metastases kwezinye izindawo, ukwelashwa okunjenge-chemotherapy kanye nemithi ehlosiwe ngokuvamile kuvame ukungasebenzi ngokumelene nama-metastase ebuchosheni ngenxa yokuvinjelwa kwegazi. Isivinini segazi-ingqondo inethiwekhi enamandla yama-capillari aklanyelwe ukuvikela ubuchopho ebuchosheni (njenge-chemotherapy).

Ukwelashwa kwama-metastase ngokuvamile kuhlanganisa i-steroids ukunciphisa ukuvuvukala ebuchosheni. Umshini wobuchopho obuphelele obungasetshenziselwa ukubhekana nezidakamizwa, noma uma kuphela noma "amachashaza" ambalwa we-metastasis akhona, i-radiotherapy yomzimba (stereotactic radiotherapy) ( SBRT ) ingasetshenziswa ngomzamo wokubhubhisa ngokuphelele imetastasis. I-SBRT, eyaziwa ngokuthi i-Cyber ​​ummese noma i-gamma umese yinkqubo lapho ama-radiation aphezulu ahanjiswa khona endaweni encane futhi eqondile yezincubu.

Amasayithi ajwayelekile ajwayelekile aMetastases asele

Njengoba kuphawuliwe ngenhla, umdlavuza webele ungasakazeka cishe noma yisiphi isifunda somzimba. Ezinye zezindawo ezingavamile (ngaphandle kwe-lobular carcinoma) ye-metastasis zihlanganisa:

• Umnkantsha we-Bone - Umdlavuza webele womzimba osakazeke emathanjeni uvame ukubandakanya umnkantsha wamathambo kanye (umthambo wamathambo uvame ukukhiqizwa emathanjeni cishe okubandakanyeka nomdlavuza webele). Izimpawu zingafaka iseli eliphansi legazi elimhlophe noma isibalo segazi elibomvu elingahlanganiswa ne-chemotherapy.
• Ama-metastases - Ama-two-thirds abantu abane-metastatic lobular carcinoma bathuthukisa imithi e-peritoneal.
• Isifuba esingehlukile
• I-ovary
• Izigulane eziyingozi
• I-pancreas
• Izikhumba nezicubu ezithambile
• Izingosi ezingavamile ze-metastases zifaka izindawo ezivela esibelethweni kuya kweso.

Amasayithi weMetastase kanye Nezinhlobo ZeCanscer Breast

Njengoba kuphawuliwe ngenhla, ama-cancer angu-HER2 anemiphumela emihle neyesithathu engalungile kungenzeka ukuba asakaze ebuchosheni nasesibindi, kanti izidumbu zesisu ze-estrogen zivame ukusabalalisa amathambo. Ama-carcinomal lobular anomkhuba wokusabalalisa esiswini.

Kungani I-Cancer Isakazeka?

Asiqiniseki ukuthi kungani umdlavuza uphindela futhi usakazeka , nokuthi ungabonakala kanjani ulele iminyaka eminingi ngisho nangamashumi eminyaka bese uphinde ubuyeke. Njengoba izidakamizwa ezikude ziyizimbangela zokufa kweziningi ze-kansa, ucwaningo oluningi lwenziwa ngokubheka ukuthi kungani i-metastases ikhona, kanye nezindlela ezingavimbela ukusabalala kwamagciwane.

Ukubhekana Ne-Canast Metastatic Breast Cancer

Uma uthola ukuthi unomdlavuza wesifuba we-metastatic, cishe uzwe ukwesaba futhi mhlawumbe ugxilwe lonke ulwazi olunikeziwe. Umdlavuza webele we-Metastatic uhlukile kunomdlavuza webele wesifuba ngezindlela eziningi. Khuluma nabangani bakho nomndeni wakho. Abantu abaningi bakuthola kuwusizo ukuba bahlanganyele eqenjini lokusekela noma umphakathi wokusekela owenziwe ikakhulukazi labo abanomdlavuza we-metastatic. Funda konke ongakwenza mayelana nesifo sakho. Ukwelashwa, ngisho nalawo wesifo somdlavuza webele, kuthuthukiswa, futhi ukusinda kuyanda. Enye yezinyathelo ezibaluleke kakhulu ongayithatha ukuthi ube ngummeli wakho siqu ekunakekelweni komdlavuza wakho . Kunezinqumo eziningi zokwenza mayelana nezinketho zokwelashwa, futhi wazi kuphela ukuthi yikuphi okukhethwa kukho okungcono kuwe.

Kubangani Nomndeni

Uma othandekayo wakho etholakele ukuthi unemitha yokushisa ede kakhulu (mhlawumbe yena) mhlawumbe ukhululekile. Uma yena noma wayenomdlavuza webele, ngaphambili kuyindaba ehlukile okwesibili nxazonke. Othandekayo wakho uzodinga ukwesekwa kwakho ukuthi ulungele ukubhekana nalokhu futhi.

Kubalulekile ukuveza ngokushesha ukuthi ukwelashwa komdlavuza wesifuba we-metastatic uhlukile, futhi ifilosofi mayelana nokwelashwa komdlavuza webele we-metastatic ihluke kakhulu kusuka kulokho kusengaphambili isifo somdlavuza webele. Njengoba isifo somdlavuza webele sesisencane, umgomo uvame ukuba nobudlova ngangokunokwenzeka ukunciphisa ithuba lokuthi umdlavuza uzobuya. Ngomdlavuza wesifuba we-metastatic, noma kunjalo, ifilosofi ngokuvamile isebenzisa inani elincane lezokwelapha ezidingekayo ukuze lilawule lesi sifo. Ukwelapha lesi sifo ngokucindezelayo akuphuculisi ukusinda, kodwa kwandisa imiphumela emibi futhi kunciphise izinga lokuphila.

Ukuntula ukuqonda okubanzi kwalezi zingxabano kuye kwabangela izikhathi eziningi ezibuhlungu ngokomzwelo kulabo ababhekana nomdlavuza webele we-metastatic. Thatha isikhashana ukuthi ufunde ngalokho ongakusho kumuntu onomdlavuza webele we-metastatic .

> Imithombo:

> Berman, A., Thukral, A., Hwang, W., Solin, L., noN. Vapiwala. Indawo kanye Nezibonelo Ze-Metastase Ezikude Ezigulini Ezinezifo Zokuqala Zesifo Sebele Emva kokubeletha kwebele. I-Cancer Clinical Cancer . 2013. 13 (2): 88-94.

> Coleman, R. Impact ye-Bone-Targeted Treatments ku-Skeletal Morbidity and Survival in Cancer Breast. I-Oncology (i-Williston Park) . 2016. 30 (8): pii: 218394.

> Inoue, M., Nakagomi, H., Nakada, H. et al. Amasayithi aqondile weMetastases emdlalweni we-Lobular Carcinoma: I-Retrospective Cohort Study of Cancer Metastatic Breast Cancer. Umdlavuza webele . 2017 Jan 20. (Epub ngaphambi kokuphrinta).

> Yeung, C., Hilton, J., Clemons, M. et al. I-Estrogen, i-Progesterone, ne-HER2 / neu I-Recomorcial Discordance Phakathi Kwama-Primary and Metastatic Breast Tumors - Ukubuyekeza. Izibuyekezo ze-Cancer Metastasis . 2016. 35 (3): 427-37.