Khansara ya m'mimba ndi imodzi mwa njira zosautsa kwambiri zomwe zimayambitsa imfa pakati pa akazi. Komabe, mosiyana ndi mitundu yambiri ya zotupa, monga khansa ya m'mapapo kapena pancreatic, yomwe imapangitsa kuti odwala ambiri afa, mu khansa ya m'mawere, mankhwala amatha kukhala awiri mwa atatu mwa odwala. Mu mutu wakuti "Khansa ya m'mawere aang'ono" mungapeze zambiri zothandiza kwa inu nokha.
Gulu la ngozi
Mosiyana ndi zomwe ambiri amakhulupirira, khansara ya m'mawere imakula makamaka kwa akazi achikulire, kawirikawiri atatha kusamba. Nthendayi yakupezeka kwa matendawa kwa zaka 35 ndi pafupifupi 1: 2500. Ali ndi zaka 50, ngoziyi imakula kufika pa 1:50, ndipo zaka 80 zimafika pafupipafupi 1:10. Ngakhale kuti nthawi zambiri n'zosatheka kudziwa chifukwa chenicheni cha khansa ya m'mawere, zifukwa zingapo zomwe zimayambitsa matendawa ndizodziwika bwino:
• zaka;
• anamnesis wa matendawa m'banja kapena wodwalayo;
• zotupa zowonongeka;
• Kupweteka kwambiri kwa mahomoni achikazi ndi estrogen (kumayambiriro kwa msambo komanso kumayambiriro kwa msambo), komanso kugwiritsa ntchito mankhwala otchedwa hormone replacement therapy (HRT);
• Makhalidwe abwino ndi mowa.
Mzimayi, amene m'banja lake amatha kukhala ndi mamembala angapo, makamaka achibale, alongo ndi alongo, omwe amavutika ndi khansa, ali pachiopsezo chachikulu chotenga matendawa. Izi zimachokera ku cholowa cha jini la khansa ya m'mawere. Asayansi apeza ma jini awiri omwe ali ndi khansa, BRCA1 ndi BRCA2. Vuto lokhala ndi chifuwa choyipa cha m'mawere m'zinthu zamoyozi ndi 87%. Pa chifukwa ichi, ndikofunika kwambiri kuzindikira mabanja ngati amenewa ndi kuphunzitsa uphungu wamatenda. Geni ya khansa ya m'mawere kuchokera kwa mayi wodwala imapitsidwira kwa ana omwe ali ndi mwayi wa 50%. Mabanja omwe adzalandira jini iri ali pachiopsezo chachikulu chokhala ndi chotupa.
Zina
Ngakhale kukhalapo kwa matenda a khansa ya m'mawere ndizofunikira kwambiri pa chitukuko cha matendawa, m'pofunika kumvetsetsa kuti pakati pazochitika zonse za khansa ya m'mawere, chiwerengero cha odwala omwe mabanja awo amadziwika ndi osachepera 10%. Pali njira zingapo zothandizira kutaya kwa m'mawere. Ntchito zawo zimakhala zofunikira kwambiri kwa amayi omwe ali pangozi, makamaka ogwira ntchito imodzi mwa mabadwa a khansa ya m'mawere.
Tamoxifen
Poyamba, pofuna kupewa khansara ya m'mawere, tamostifen yothana ndi tungsten inagwiritsidwa ntchito. Kafukufuku wopangidwa ku United States anasonyeza kuti amayi omwe adatenga mankhwala kwa zaka zisanu, adadwala ndi khansa ya m'mawere nthawi zambiri kusiyana ndi omwe sanatenge. Komabe, kugwiritsa ntchito tamoxifen kunachulukitsa chiopsezo chokhala ndi khansa ya m'magazi (mucous membrane ya chiberekero) ndi thromboembolism (mapangidwe a thrombi mu mitsempha ya m'munsi ndi miyendo ya m'mapapu). Kuwonjezera pamenepo, kugwiritsa ntchito mankhwala sikungachepetse imfa ya khansa ya m'mawere. Zotsatira zoyambirira za maphunziro a masiku ano m'magulu a amayi omwe ali ndi mbiri ya banja la khansa ya m'mawere samatsimikizira tamoxifen. Zotsatira zosiyana zimabweretsa kusowa kwa mgwirizano wothandizira umodzi. Azimayi akuganiza kuti mwina kansalu ya khansa ya m'mawere iyenera kukhala yodalirika ayenera kulandira zambiri kuchokera kwa katswiri woyenera.
Kuchitidwa opaleshoni
- Mastectomy. Njira yabwino kwambiri yopewera ndi zotsatira zabwino kwambiri ndizogwirizanitsa mimba (kapena mastectomy kwa odwala omwe kale akuchitidwa khansa ya m'mawere). Kuchotsa tizilombo toyambitsa matenda ndizofunikira kwambiri zomwe zimafuna kulingalira mosamala ndi kuyeza njira zina. Kuchepetsa chiopsezo cha khansa ya m'mawere kumagwirizana kwambiri ndi kuchuluka kwa minofu yochotsedwa. Pachifukwachi, kugwiritsira ntchito mankhwala osokoneza bongo ndi kusungidwa kwa khungu sikuyenera kutchulidwa, chifukwa chimachokera pa 10% pa bere, poyerekeza ndi 1% pambuyo pa ntchito ya chikhalidwe.
- Ovariectomy. Zinyamuliro za majeremusi a BRCA ali pa khansera yowopsa kwambiri komanso yowopsa kwambiri, choncho, iyenera kuonedwa ngati njira yothetsera ovariectomy (kuchotsedwa kwa mazira ochuluka).
Ovariectomy imachepetsa chiopsezo chokhala ndi chifuwa cha m'mawere mwa kuchepetsa kukula kwa isrogen, kuphatikizapo amayi omwe amanyamula majeremusi a BRCA. Mlandu wa khansa ya m'mawere ikhoza kuchitika m'mabuku otsatirawa:
• Kuzindikira kuti palibenso njira zochepetsera matendawa;
• kuzindikira kwa chotupacho ndi wodwalayo.
Zizindikiro zowopsa kwambiri za khansa ya m'mawere ndizo kukhalapo kwa maphunziro, kusintha kwa mawonekedwe a chikopa, zofooka za khungu ndi khunyu, kutuluka kuchokera ku nkhono. Kuzindikira kwa chotupacho kumayambira pa kafukufuku wamakono, mammography ndi mapeto a chiwonetsero chowombera. Azimayi ena, makamaka atsikana, mammography sadziŵika bwino chifukwa cha kuchuluka kwa minofu, m'madera otere, malo ena opita ku ultrasound kuyesa kapena kuganizira maginito. Kwa odwala ambiri omwe ali ndi chotupa chodziwika, khansa ya m'mawere sikutsimikiziridwa. Ndi zomveka bwino, mayi akuchiritsidwa. Amasowa njira yothandizira odwala opaleshoni, opaleshoni, odwala physiotherapist ndi akatswiri ena. Udindo wofunikira umasewera ndi odwala ambiri, omwe amaphunzitsidwa kuti azisamalira odwala khansa ya m'mawere, kuti awathandize nthawi zina mankhwala aakulu. Njira zatsopano zothandizira khansa ya m'mawere zathandiza kuchepetsa kufala kwa matendawa ndi 30%. Pulogalamu ya mankhwalayi ingaphatikizepo opaleshoni, radiotherapy, hormonal kapena chemotherapy.
Kwa odwala ambiri, njira yoyamba yochizira khansa ya m'mawere ndi opaleshoni - kuchotsedwa kwa chotupa chachikulu.
Ntchito
Kwa odwala omwe ali ndi chotupa chachikulu, ndi bwino kuti azichita masewera (kuchotsa chifuwa chonse), kenako nkukonzekera pulasitiki. Ndi kukula kwake kochepa, chigwirizano cha magulu chimagwiritsidwa ntchito nthawi zambiri, chomwe chimachotsedwa. Kulowetsa koteroko kumakhala kosangalatsa ku malo owonetsera zokongoletsera. Pa opaleshoni, monga lamulo, mbali kapena maselo onse am'midzi ya axillary amachotsedwa. Pambuyo pake, kukonzekera kumayang'aniridwa ndi microscope, pambuyo pake odwala matendawa amapereka chitsimikizo kuti amadziwika kukula kwa chifuwa chachikulu, mtundu wake wa mtundu wake, chiwerengero cha mitsempha yokhudzana ndi mitsempha ya m'mimba komanso ma receptor ambiri. Kuwunika kwa wodwala nthawi zambiri kumaphatikizapo chifuwa cha X-ray kuti adziwe kufalikira kwa chotupa, kuyezetsa magazi, ndipo ngati akuganiza kuti akuthamanga, fupa la fupa kapena kuyeza kwa chiwindi. Malingana ndi zonse za deta, ndondomeko yowonjezera chithandizo ikukonzedwa.
Radiotherapy
Radiotherapy Postoperative imaonedwa kuti ndilo gawo lovomerezeka la chithandizo kwa odwala omwe adagwirizanitsa ntchito; Kutsekemera kwa dera la axillary kungakhale njira yowonjezera kuchotsa opaleshoni ya ma lymph nodes. Zimadziwika kuti postoperative radiotherapy ya dera lachilonda, ziwalo zochepa zomwe zimayambira pansi ndi madera ozungulira zimachepetsa chiopsezo cha kubwereza, zomwe zimachepetsa kufa. Chemotherapy ndi mankhwala otchedwa hormone therapy amalembedwa mwakachetechete kapena pamlomo pambuyo pa opaleshoni. Izi ndizofunikira kuti chiwonongeko cha micrometastases - zigawo zing'onozing'ono za minofu yomwe yalekanitsidwa ndi cholinga choyamba ndi kufalikira kupyolera mu thupi. Matenda oterewa amaimira kuopsa kwa matendawa.
Hormonotherapy
Kusintha kwa mimba kumatenda a m'mawere kumayang'aniridwa ndi estrogens. Pakati pa 60%, mavitro a estrogen amapezeka m'mimba, choncho tamoxifen, yomwe imapangitsa anthu kulandira mankhwalawa, akhoza kugwiritsa ntchito mankhwala. Izi zimachepetsa chiopsezo chofalitsa ndi kubwereza. Kafukufuku wam'tsogolo akuwonetsa kuti amayi omwe ali ndi chifuwa cha m'mawere cha estrogen amene amatenga tamoxifen kwa zaka zisanu pambuyo pa opaleshoni ali ndi chithunzi chabwino kwambiri.
Chemotherapy
Kwa odwala omwe ali ndi zaka zoposa 50 ndi khansa ya m'mawere, zotsatira zabwino za mankhwala a adjuvant (othandizira) amathandizidwa. Kugwiritsa ntchito njira yoyenera kwambiri yothandizira njira imeneyi kwa odwala omwe ali ndi chiopsezo chachikulu cha kubwereranso. Mankhwala osiyanasiyana a chemotherapy apangidwa omwe akutsimikiziridwa kuchepetsa chiopsezo cha kupwetekanso kubwereza. Regimen imodzi yomwe amagwiritsidwa ntchito kwambiri imatchedwa CMF ndipo ikuphatikizapo cyclophosphamide, methotrexate ndi 5-furouracil. Kuonjezera mankhwala monga masiku ano monga doxorubicin ndi paclitaxel, kumathandiza kusintha zotsatira za chemotherapy.
Odwala omwe ali ndi kansa ya m'mawere - kufalikira kwa chotupa mthupi lonse - mankhwala sangatheke. Komabe, pali njira zothandizira zothandizira kuchepetsa zizindikiro, ndipo zochitika zamakono zimawonjezera mwayi wopulumuka. Mwamwayi, ngakhale kupititsa patsogolo kwakukulu kochiritsira khansa ya m'mawere m'zaka zaposachedwapa, sikuti wodwala aliyense ali ndi mwayi wochira. Odwala okhala ndi metastases pa nthawi ya matenda a kansa kapena omwe amayamba kupezeka pakapita koyambidwa mankhwala osokoneza bongo. Malo omwe amapezeka kawirikawiri popanga masastases ndi mafupa, chiwindi, mapapo, chikopa ndi kansalu, komanso ubongo.
Zolinga za mankhwala
Chithandizo cha odwala amenewa ndi cholinga chokhalitsa moyo wautali ndi kuchepetsa matenda (palliative therapy). Ngakhale odwala ena omwe ali ndi matenda oopsa a khansa angathe kukhala ndi moyo komanso zaka zingapo, akambirane za machiritso amenewa. Kuchita opaleshoni ndi ma radiotherapy pamaso pa metastases ndizosafunikira kuposa chemo ndi mankhwala omwe amachititsa mahomoni, chifukwa mankhwala akhoza kuwononga maselo a tumimba m'thupi lonse. Chinthu chokhacho ndi mafupa amthambo, omwe amakhala ovuta kwambiri kwa radiotherapy. Pochepetsa kuchepa kwa mafupa komanso mavuto ena, kuphatikizapo fractures, gwiritsani ntchito mankhwala osokoneza bongo omwe amatchedwa bisphosphonates. Kusankha njira ya chithandizo kumadalira malo omwe ali ndi khansa ya khansa, chithandizo cham'mbuyomu, maonekedwe a chotupa ndi boma la thanzi la wodwalayo.
Mtundu wa moyo
Polemba ndondomeko ya chithandizo, amatha kupita kwa wodwala aliyense payekha, ndikugogomezera kuti akhale ndi moyo wabwino. Pofuna kuthandizira kwambiri matendawa, ndibwino kuti aphatikize madokotala ndi anamwino omwe amaphunzitsidwa bwino kuti apereke chisamaliro. Kulamulidwa kwa matenda opweteka ndi zina zothandizira pa gawo lino zimakhala zofunika kwambiri. Asayansi ndi madokotala padziko lonse lapansi akupitirizabe kukhazikitsa njira zatsopano zothana ndi khansa, ndipo odwala nthawi zambiri amaitanidwa kukachita nawo kafukufuku wa zamankhwala. Kaŵirikaŵiri m'mayesero oterowo, kuyerekezeratu kwabwino kwa mankhwala omwe alipo kale ndi omwe ayesedwa. Maphunziro ena, osagwirizana ndi kale ntchito, yesani chida chatsopano, kuyesa ntchito yake ndi poizoni.
Zovuta zachipatala
Maphunziro a zachipatala amapeza mankhwala ogwira mtima kwambiri ndipo amapereka deta yofunikira kuti agwiritse ntchito mankhwala atsopano mu matekinoloje apamwamba. Zochitika zikuwonetsa zotsatira zabwino za chithandizo kwa odwala omwe amalowa nawo mayeso. Zochitika zam'tsogolo zatsopano zikudziwika ndi kuchoka ku mankhwala a chikhalidwe kumagwiritsidwe ntchito mankhwala osokoneza bongo omwe amakwaniritsa zosowa za wodwalayo.