Mitundu / bere / wodwala / wamkulu / woyamwitsa-pdq

Chithandizo cha Khansa ya m'mawere (Achikulire) Mtundu

Zambiri Zokhudza Khansa ya M'mawere

MFUNDO ZOFUNIKA

• Khansa ya m'mawere ndimatenda momwe ma cell owopsa (khansa) amapangika m'matumba a m'mawere.

• Mbiri ya banja la khansa ya m'mawere ndi zinthu zina zimawonjezera chiopsezo cha khansa ya m'mawere.

• Khansa ya m'mawere nthawi zina imayamba chifukwa cha majini obadwa nawo (kusintha).

• Kugwiritsa ntchito mankhwala ena ndi zinthu zina kumachepetsa chiopsezo cha khansa ya m'mawere.

• Zizindikiro za khansa ya m'mawere zimaphatikizapo chotupa kapena kusintha kwa m'mawere.

• Kuyesa komwe kumayesa mawere kumagwiritsidwa ntchito kuzindikira (kupeza) ndikuzindikira khansa ya m'mawere.

• Ngati khansa ipezeka, amayesedwa kuti aphunzire za maselo a khansa.

• Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Khansa ya m'mawere ndimatenda momwe ma cell owopsa (khansa) amapangika m'matumba a m'mawere.

Chifuwacho chimapangidwa ndi lobes ndi ducts. Chifuwa chilichonse chili ndi magawo 15 mpaka 20 otchedwa lobes. Lobe iliyonse ili ndi zigawo zing'onozing'ono zambiri zotchedwa lobules. Ma Lobules amatha ndi mababu ang'onoang'ono angapo omwe amatha kupanga mkaka. Maloboti, lobulu, ndi mababu amalumikizidwa ndi machubu owonda otchedwa ducts.

Anatomy ya bere lachikazi. Nipple ndi areola amawonetsedwa kunja kwa bere. Ma lymph node, lobes, lobules, ducts, ndi mbali zina zamkati mwa bere zimawonetsedwanso.

Chifuwa chilichonse chimakhalanso ndi mitsempha yamagazi ndi zotengera zamitsempha. Mitsempha ya mitsempha imakhala ndi madzi opanda mtundu, amadzi otchedwa lymph. Zombo zamagulu zimanyamula ma lymph pakati pa ma lymph node. Ma lymph lymph ndi ang'onoang'ono, mawonekedwe a nyemba omwe amapezeka mthupi lonse. Amasefa ma lymph ndikusunga maselo oyera amwazi omwe amathandiza kulimbana ndi matenda ndi matenda. Magulu a ma lymph node amapezeka pafupi ndi bere mu axilla (pansi pa mkono), pamwamba pa kolala, komanso pachifuwa.

Mtundu wodziwika bwino wa khansa ya m'mawere ndi ductal carcinoma, yomwe imayamba m'maselo am'mimbamo. Khansa yomwe imayambira mu lobes kapena lobules imatchedwa lobular carcinoma ndipo imapezeka m'mabere onsewa kuposa mitundu ina ya khansa ya m'mawere. Khansa ya m'mawere yotupa ndi mtundu wachilendo wa khansa ya m'mawere momwe bere limakhala lofunda, lofiira komanso lotupa.

Onani zidule zotsatirazi za kuti mumve zambiri za khansa ya m'mawere:

• Kuteteza Khansa ya m'mawere

• Kuyeza Khansa Ya m'mawere

• Kuchiza Khansa ya M'mawere Mimba

• Chithandizo cha khansa ya m'mawere amuna

• Kuchiza Khansa Ya m'mawere

Mbiri ya banja la khansa ya m'mawere ndi zinthu zina zimawonjezera chiopsezo cha khansa ya m'mawere.

Chilichonse chomwe chimakulitsa mwayi wanu wodwala chimatchedwa chiopsezo. Kukhala ndi chiwopsezo sikutanthauza kuti udzakhala ndi khansa; kusakhala ndi zoopsa sikutanthauza kuti simudzakhala ndi khansa. Lankhulani ndi dokotala ngati mukuganiza kuti mutha kukhala pachiwopsezo cha khansa ya m'mawere.

Zowopsa za khansa ya m'mawere ndi izi:

• Mbiri ya khansa ya m'mawere yowopsa, ductal carcinoma in situ (DCIS), kapena lobular carcinoma in situ (LCIS).

• Mbiri yaumwini ya matenda oopsa (osakhala ndi khansa).

• Mbiri ya banja la khansa ya m'mawere mwa wachibale woyamba (amayi, mwana wamkazi, kapena mlongo).

• Zosintha zobadwa mu majini a BRCA1 kapena BRCA2 kapena mitundu ina yomwe imawonjezera chiopsezo cha khansa ya m'mawere.

• Minofu ya m'mawere yomwe ndi yolimba pa mammogram.

• Kuwonetsedwa kwa minofu ya m'mawere ku estrogen yopangidwa ndi thupi. Izi zitha kuyambitsidwa ndi:

• Msambo adakali aang'ono.

• Ukalamba pakubadwa koyamba kapena osabereka konse.

• Kuyambira kusamba msinkhu pambuyo pake.

• Kutenga mahomoni monga estrogen kuphatikiza ndi progestin pazizindikiro zakusamba.

• Kuchiza ndi mankhwala a radiation ku bere / pachifuwa.

• Kumwa mowa.

• Kunenepa kwambiri.

Ukalamba ndiwo chiopsezo chachikulu cha khansa yambiri. Mwayi wokhala ndi khansa ukuwonjezeka mukamakula.

Chida cha NCI chowunika za khansa ya m'mawere chimagwiritsa ntchito zomwe amayi amaziyesa poyerekeza chiopsezo cha khansa ya m'mawere pazaka zisanu zikubwerazi mpaka zaka 90. Chida chapaintaneti ichi chimayenera kugwiritsidwa ntchito ndi othandizira azaumoyo. Kuti mumve zambiri za chiopsezo cha khansa ya m'mawere, itanani 1-800-4-CANCER.

Khansa ya m'mawere nthawi zina imayamba chifukwa cha majini obadwa nawo (kusintha).

Majini omwe ali m'maselo amanyamula choloŵa chomwe amalandira kuchokera kwa makolo a munthu. Khansa ya m'mawere yobadwa nayo imapanga pafupifupi 5% mpaka 10% ya khansa yonse ya m'mawere. Mitundu ina yosinthika yokhudzana ndi khansa ya m'mawere imapezeka kwambiri m'magulu ena.

Amayi omwe amasintha mitundu ina, monga kusintha kwa BRCA1 kapena BRCA2, ali ndi chiopsezo chowonjezeka cha khansa ya m'mawere. Amayi awa amakhalanso ndi chiopsezo chowonjezeka cha khansa ya m'mimba, ndipo atha kukhala ndi chiopsezo chowonjezeka cha khansa zina. Amuna omwe ali ndi jini yosinthidwa yokhudzana ndi khansa ya m'mawere amakhalanso ndi chiopsezo chowonjezeka cha khansa ya m'mawere. Kuti mumve zambiri, onani chidule cha pa Chithandizo cha Khansa ya M'mawere Amuna.

Pali mayeso omwe amatha kuzindikira (kupeza) majini osinthidwa. Mayesero amtunduwu nthawi zina amachitika kwa mabanja omwe ali ndi chiopsezo chachikulu cha khansa. Onani chidule cha pa Genetics of Breast and Gynecologic Cancers kuti mumve zambiri.

Kugwiritsa ntchito mankhwala ena ndi zinthu zina kumachepetsa chiopsezo cha khansa ya m'mawere.

Chilichonse chomwe chimachepetsa mwayi wanu wodwala chimatchedwa chitetezo.

Zinthu zodzitetezera ku khansa ya m'mawere ndi izi:

• Kutenga izi:

• Mankhwala a estrogen okhawo atachotsedwa mchiberekero.

• Kusankha ma modulators a estrogen receptor (SERMs).

• Aromatase zoletsa.

• Kuchepetsa kuchepa kwa minofu yamawere ku estrogen yopangidwa ndi thupi. Izi zitha kukhala zotsatira za:

• Mimba yoyambirira.

• Kuyamwitsa.

• Kuchita masewera olimbitsa thupi okwanira

• Kukhala ndi njira izi:

• Mastectomy kuti achepetse chiopsezo cha khansa.

• Oophorectomy kuchepetsa chiopsezo cha khansa.

• Kuchotsa pamimba.

Zizindikiro za khansa ya m'mawere zimaphatikizapo chotupa kapena kusintha kwa m'mawere.

Zizindikiro izi ndi zina zimatha chifukwa cha khansa ya m'mawere kapena zina. Funsani dokotala ngati muli ndi izi:

• Kutupa kapena kukhathamira mkati kapena pafupi ndi bere kapena malo okhala ndi mikono.

• Kusintha kukula kapena mawonekedwe a bere.

• Kukhazikika pakhungu la m'mawere.

• Nipple anatembenukira mkati mwa bere.

• Zamadzimadzi, kupatula mkaka wa m'mawere, kuchokera pamabele, makamaka ngati ali ndimagazi.

• Khungu lofiira, lofiira, kapena lotupa pachifuwa, nipple, kapena areola (mdima wakhungu mozungulira nsonga).

• Zofooka m'chifuwa zomwe zimawoneka ngati khungu la lalanje, lotchedwa peau d'orange.

Kuyesa komwe kumayesa mawere kumagwiritsidwa ntchito kuzindikira (kupeza) ndikuzindikira khansa ya m'mawere.

Funsani dokotala wanu ngati muwona kusintha kwa mabere anu. Mayeso ndi njira zotsatirazi zitha kugwiritsidwa ntchito:

• Kuyezetsa thupi komanso mbiri yaumoyo: Kuyesedwa kwa thupi kuti muwone zizindikiritso zaumoyo, kuphatikizapo kuyang'ana ngati pali matenda, monga zotupa kapena china chilichonse chomwe chikuwoneka chachilendo. Mbiri yokhudzana ndi thanzi la wodwalayo komanso matenda am'mbuyomu komanso chithandizo chamankhwala adzachitidwanso.

• Clinical breast test (CBE): Kuyesedwa kwa bere ndi dokotala kapena katswiri wina wazachipatala. Dokotala amamva mosamala mabere ndi pansi pa mikono chifukwa cha zotumphukira kapena china chilichonse chomwe chimawoneka chachilendo.

• Mammogram: X-ray ya m'mawere.

Zolemba pamanja. Chifuwa chimakanikizidwa pakati pa mbale ziwiri. X-ray amagwiritsidwa ntchito kujambula zithunzi za minofu ya m'mawere.

• Kuyesa kwa Ultrasound: Njira yomwe mafunde amawu amphamvu (ultrasound) amachotsedwa pamatumba kapena ziwalo zamkati ndikupanga mawonekedwe. Zolembawo amapanga chithunzi cha matupi amthupi otchedwa sonogram. Chithunzicho chimatha kusindikizidwa kuti chiwonedwe pambuyo pake.

• MRI (magnetic resonance imaging): Njira yomwe imagwiritsa ntchito maginito, mawailesi, komanso kompyuta kuti ipange zithunzi zingapo za mabere onse. Njirayi imatchedwanso nuclear magnetic resonance imaging (NMRI).

• Kafukufuku wamagazi: Njira yoyeserera magazi kuti ayese kuchuluka kwa zinthu zina zomwe zimatulutsidwa m'magazi ndi ziwalo ndi minyewa mthupi. Kuchuluka kwazinthu zosazolowereka (zakumwamba kapena zochepa) kungakhale chizindikiro cha matenda.

• Biopsy: Kuchotsa kwa maselo kapena ziphuphu kotero kuti amatha kuwonedwa ndi microscope ndi wodwalayo kuti aone ngati ali ndi khansa. Ngati chotupa cha m'mawere chikupezeka, kafukufuku amatha kuchitidwa.

Pali mitundu inayi ya biopsy yomwe imagwiritsidwa ntchito poyang'ana khansa ya m'mawere:

• Chisankho chodabwitsa: Kuchotsa mtanda wonse wa minofu.

• Incopal biopsy: Kuchotsa gawo limodzi kapena chotupa cha mnofu.

• Core biopsy: Kuchotsa minofu pogwiritsa ntchito singano yayikulu.

• Chotsatira cha singano yabwino (FNA) biopsy: Kuchotsa minofu kapena madzi, pogwiritsa ntchito singano yopyapyala.

Ngati khansa ipezeka, amayesedwa kuti aphunzire za maselo a khansa.

Zosankha zamankhwala abwino zimachokera ku zotsatira za mayeso awa. Mayesowa amapereka chidziwitso cha:

• khansara imatha kukula msanga.

• ndizotheka bwanji kuti khansara ifalikira mthupi lonse.

• mankhwala ena angagwire ntchito bwino.

• momwe khansara imatha kubwereranso (kubwerera).

Mayesowa ndi awa:

• Mayeso a Estrogen ndi progesterone receptor: Kuyesa kuyeza kuchuluka kwa zotengera za estrogen ndi progesterone (mahomoni) mumisempha ya khansa. Ngati pali zowonjezera za estrogen ndi progesterone kuposa zachilendo, khansara amatchedwa estrogen ndi / kapena progesterone receptor positive. Khansara yamtunduwu imatha kukula msanga. Zotsatira zoyeserera zikuwonetsa ngati chithandizo choletsa estrogen ndi progesterone chitha kuletsa khansa kukula.

• Chiyeso cha epidermal kukula kwa mtundu wa 2 receptor (HER2 / neu): Kuyesa kwa labotale kuti mupeze kuchuluka kwa majini a HER2 / neu komanso kuchuluka kwa mapuloteni a HER2 / neu omwe amapangidwa munthupi. Ngati pali mitundu yambiri ya HER2 / neu kapena kuchuluka kwa mapuloteni a HER2 / neu kuposa mwakale, khansara amatchedwa HER2 / neu positive. Khansara yamtunduwu imatha kukula msanga ndipo imatha kufalikira mbali zina za thupi. Khansara imatha kuchiritsidwa ndi mankhwala omwe amalimbana ndi mapuloteni a HER2 / neu, monga trastuzumab ndi pertuzumab.

• Mayeso a Multigene: Kuyesa komwe zitsanzo zamatenda zimawerengedwa kuti ziwone momwe majini ambiri amagwirira ntchito nthawi imodzi. Mayeserowa atha kuthandiza kudziwitsa ngati khansa idzafalikira mbali zina za thupi kapena kubwereranso.

Pali mitundu yambiri ya mayesero osiyanasiyana. Mayesero angapo otsatirawa adaphunziridwa m'mayesero azachipatala:

• Oncotype DX: Kuyesaku kumathandizira kudziwa ngati khansa ya m'mawere yoyambira yomwe ndi estrogen receptor zabwino komanso mfundo zosavomerezeka zidzafalikira mbali zina za thupi. Ngati chiopsezo choti khansa ifalikire ndi chachikulu, chemotherapy itha kuperekedwa kuti ichepetse ngozi.

• MammaPrint: Kuyesa kwa labotale komwe zochitika za majini osiyanasiyana 70 zimayang'aniridwa mu minofu ya khansa ya m'mawere ya azimayi omwe ali ndi khansa ya m'mawere yoyambilira yomwe siyinafalikire ku ma lymph node kapena yafalikira ku ma lymph node atatu kapena ochepa. Magwiridwe antchito amtunduwu amathandizira kudziwa ngati khansa ya m'mawere idzafalikira mbali zina za thupi kapena kubwerera. Ngati kuyesaku kukuwonetsa kuti chiwopsezo choti khansa ifalikire kapena kubwerera ndi chachikulu, chemotherapy itha kuperekedwa kuti ichepetse ngozi.

Kutengera mayesowa, khansa ya m'mawere imanenedwa kuti ndi imodzi mwanjira izi:

• Hormone receptor positive (estrogen ndi / kapena progesterone receptor positive) kapena hormone receptor negative (estrogen ndi / kapena progesterone receptor negative).

• HER2 / neu zabwino kapena HER2 / neu zoipa.

• Katatu kolakwika (estrogen receptor, progesterone receptor, ndi HER2 / neu negative).

Izi zimathandiza adokotala kusankha mankhwala omwe angathandize kwambiri khansa yanu.

Zinthu zina zimakhudzanso madandaulo (mwayi wochira) ndi njira zamankhwala.

Njira zakulosera zamankhwala ndi chithandizo zimadalira izi:

• Gawo la khansa (kukula kwa chotupacho komanso ngati chili m'mawere kokha kapena chafalikira kumatenda am'mimba kapena malo ena m'thupi).

• Mtundu wa khansa ya m'mawere.

• Estrogen receptor ndi progesterone receptor mu chotupa.

• Matenda a epidermal kukula kwa mtundu wa 2 receptor (HER2 / neu) mu minofu yotupa.

• Kaya chotupacho chimakhala cholakwika katatu (ma cell omwe alibe ma estrogen receptors, progesterone receptors, kapena HER2 / neu).

• Kuthamanga chotupa kumakula.

• Momwe chotupacho chingabwererenso (kubwerera).

• Msinkhu wa mkazi, thanzi labwino, komanso kusamba kwa msambo (ngakhale mkazi akadali ndi msambo).

• Kaya khansa yapezeka kumene kapena yabwereranso (bwererani).

Magawo a Khansa ya m'mawere

MFUNDO ZOFUNIKA

• Khansa ya m'mawere itapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mkati mwa bere kapena mbali zina za thupi.

• Pali njira zitatu zomwe khansa imafalikira mthupi.

• Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

• Mu khansa ya m'mawere, gawo limadalira kukula ndi malo omwe ali ndi chotupacho, kufalikira kwa khansa kumalo am'mimba oyandikira kapena ziwalo zina za thupi, kalasi yamatenda, komanso ngati pali ma biomarker ena.

• Njira ya TNM imagwiritsidwa ntchito pofotokoza kukula kwa chotupa choyambirira komanso kufalikira kwa khansa kumatope oyandikira kapena ziwalo zina za thupi.

• Chotupa (T). Kukula ndi malo a chotupacho.

• Lymph mfundo (N). Kukula ndi malo am'mimba momwe khansa yafalikira.

• Metastasis (M). Kufalikira kwa khansa kumadera ena a thupi.

• Njira yoyikirayo imagwiritsidwa ntchito pofotokozera momwe chotupa cha m'mawere chingakule ndikufalikira mofulumira.

• Kuyesa kwa biomarker kumagwiritsidwa ntchito kuti mudziwe ngati maselo a khansa ya m'mawere ali ndi zolandilira.

• Ndondomeko ya TNM, dongosolo loyika, komanso mawonekedwe a biomarker amaphatikizidwa kuti apeze gawo la khansa ya m'mawere.

• Lankhulani ndi dokotala wanu kuti mudziwe momwe khansa yanu ya m'mawere ilili komanso momwe amagwiritsidwira ntchito pokonzekera chithandizo chabwino kwambiri kwa inu.

• Chithandizo cha khansa ya m'mawere chimadalira gawo lina la matendawa.

Khansa ya m'mawere itapezeka, amayesedwa kuti apeze ngati maselo a khansa afalikira mkati mwa bere kapena mbali zina za thupi.

Njira yomwe imagwiritsidwa ntchito pofufuza ngati khansara yafalikira mkati mwa bere kapena mbali zina za thupi imatchedwa staging. Zomwe amapeza kuchokera pakukonzekera zimatsimikizira gawo la matendawa. Ndikofunikira kudziwa siteji kuti mukonzekere chithandizo. Zotsatira za mayeso ena omwe amagwiritsidwa ntchito pozindikira kuti ali ndi khansa ya m'mawere amagwiritsidwanso ntchito popanga matendawa. (Onani gawo la General Information.)

Mayeso ndi njira zotsatirazi zitha kugwiritsidwanso ntchito pokonza:

• Sentinel lymph node biopsy: Kuchotsa kwa sentinel lymph node panthawi yochita opareshoni. Sentinel lymph node ndiye njira yoyamba yam'magulu am'magazi kuti alandire madzi m'mimba kuchokera pachotupa choyambirira. Ndi lymph node yoyamba yomwe khansa imafalikira kuchokera ku chotupa choyambirira. Mankhwala a radioactive ndi / kapena utoto wabuluu amabayidwa pafupi ndi chotupacho. Katunduyu kapena utoto umadutsa m'mitsempha yam'mimba kupita kumalo am'mimba. Nthenda yoyamba yolandila mankhwala kapena utoto imachotsedwa. Wodwala amayang'ana minofu pansi pa microscope kuti ayang'ane maselo a khansa. Ngati maselo a khansa sapezeka, mwina sikofunikira kuchotsa ma lymph node ambiri. Nthawi zina, sentinel lymph node imapezeka m'magulu angapo am'magulu.

• X-ray pachifuwa : X-ray ya ziwalo ndi mafupa mkati mwa chifuwa. X-ray ndi mtundu wa mphamvu yamphamvu yomwe imatha kupyola thupi ndikupita mufilimu, ndikupanga chithunzi cha madera omwe ali mthupi.

• CT scan (CAT scan): Njira yomwe imapanga zithunzi zingapo zamatupi amthupi, zojambulidwa mosiyanasiyana. Zithunzizo zimapangidwa ndi kompyuta yolumikizidwa ndi makina a x-ray. Utoto ukhoza kulowetsedwa mumtsempha kapena kumeza kuti ziwalo kapena ziwalo ziwoneke bwino. Njirayi imatchedwanso computed tomography, kompyuta tomography, kapena kompyuta axial tomography.

• Kujambula mafupa: Njira yowunika ngati pali magawo omwe amagawa mwachangu, monga maselo a khansa, m'mafupa. Katundu wocheperako kwambiri wa jakisoni amalowetsedwa mumtsempha ndikuyenda m'magazi. Zinthu zowononga nyukiliya zimasonkhanitsa m'mafupa omwe ali ndi khansa ndipo imadziwika ndi sikani.

• PET scan (positron emission tomography scan): Njira yopezera maselo oyipa mthupi. Gulu laling'ono la shuga (radio) limabayidwa mumtsempha. Chojambulira cha PET chimazungulira thupi ndikupanga chithunzi cha komwe glucose imagwiritsidwa ntchito mthupi. Maselo otupa owopsa amawonekera pachithunzichi chifukwa amakhala otanganidwa ndipo amatenga shuga wambiri kuposa momwe maselo amachitira.

Pali njira zitatu zomwe khansa imafalikira mthupi.

Khansa imatha kufalikira kudzera mu minofu, ma lymph system, ndi magazi:

• Minofu. Khansara imafalikira kuchokera pomwe idayamba ndikukula kupita kumadera oyandikana nawo.

• Lymph dongosolo. Khansara imafalikira kuchokera pomwe idayamba polowa m'mitsempha. Khansara imadutsa m'mitsempha yamafuta kupita mbali zina za thupi.

• Magazi. Khansara imafalikira kuchokera pomwe idayamba ndikulowa m'magazi. Khansara imadutsa m'mitsempha yamagazi kupita mbali zina za thupi.

Khansa imatha kufalikira pomwe idayamba kupita mbali zina za thupi.

Khansa ikafalikira mbali ina ya thupi, imatchedwa metastasis. Maselo a khansa amachoka pomwe adayamba (chotupa choyambirira) ndikuyenda mumitsempha kapena magazi.

• Lymph dongosolo. Khansara imalowa mumitsempha, imadutsa m'mitsempha yamafuta, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

• Magazi. Khansara imalowa m'magazi, imadutsa m'mitsempha yamagazi, ndikupanga chotupa (chotupa cha metastatic) gawo lina la thupi.

Chotupa cha metastatic ndi khansa yofanana ndi chotupa chachikulu. Mwachitsanzo, ngati khansa ya m'mawere imafalikira mpaka fupa, maselo a khansa omwe ali m'mafupawo ndi maselo a khansa ya m'mawere. Matendawa ndi khansa ya m'mawere, osati khansa ya m'mafupa.

Mu khansa ya m'mawere, gawo limadalira kukula ndi malo omwe ali ndi chotupacho, kufalikira kwa khansa kumalo am'mimba oyandikira kapena ziwalo zina za thupi, kalasi yamatenda, komanso ngati pali ma biomarker ena.

Kuti mukonzekere chithandizo chabwino kwambiri ndikumvetsetsa momwe mungadziwire, ndikofunikira kudziwa gawo la khansa ya m'mawere.

Pali mitundu itatu yamagulu a khansa ya m'mawere:

• Clinical Prognostic Stage imagwiritsidwa ntchito koyamba kupangira gawo la odwala onse kutengera mbiri yazaumoyo, kuyesa thupi, kuyerekezera kulingalira (ngati kwachitika), ndi ma biopsies. The Clinical Prognostic Stage ikufotokozedwa ndi dongosolo la TNM, grade grade, ndi biomarker status (ER, PR, HER2). Pazipatala, mammography kapena ultrasound amagwiritsidwa ntchito poyang'ana ma lymph node ngati ali ndi khansa.

• Gawo lodziwitsa za matendawa limagwiritsidwa ntchito kwa odwala omwe akuchitidwa opaleshoni ngati chithandizo chawo choyamba. Gawo la Pathological Prognostic Stage limakhazikitsidwa pazidziwitso zonse zamankhwala, momwe zimakhalira ndi biomarker, komanso zotsatira zoyesa zasayansi kuchokera kumatumba am'mimba ndi ma lymph node omwe amachotsedwa pakuchita opaleshoni.

• Gawo la Anatomic limatengera kukula ndi kufalikira kwa khansa monga momwe tafotokozera ndi dongosolo la TNM. Anatomic Stage imagwiritsidwa ntchito m'malo ena padziko lapansi komwe kuyesa kwa biomarker sikupezeka. Sigwiritsidwe ntchito ku United States.

Njira ya TNM imagwiritsidwa ntchito pofotokoza kukula kwa chotupa choyambirira komanso kufalikira kwa khansa kumatope oyandikira kapena ziwalo zina za thupi. Kwa khansa ya m'mawere, dongosolo la TNM limafotokoza chotupacho motere:

Chotupa (T). Kukula ndi malo a chotupacho.

Makulidwe a zotupa nthawi zambiri amayesedwa mu milimita (mm) kapena masentimita. Zinthu zomwe zingagwiritsidwe ntchito posonyeza kukula kwa chotupa mu mm ndi monga: cholembera chakuthwa (1 mm), cholembera chatsopano (2 mm), chofufutira pamwamba pensulo (5 mm), nsawawa (10 mm), a chiponde (20 mm), ndi mandimu (50 mm).

• TX: Chotupa choyambirira sichingayesedwe.

• T0: Palibe chizindikiro cha chotupa choyambirira m'mawere.

• Matenda: Carcinoma in situ. Pali mitundu iwiri ya bere carcinoma in situ:

• Tis (DCIS): DCIS ndi momwe ma cell osazolowereka amapezeka m'mbali mwa bere. Maselo achilendo sanafalikire kunja kwa ngalandeyo kumatenda ena a m'mawere. Nthawi zina, DCIS imatha kukhala khansa ya m'mawere yomwe imatha kufalikira kumatenda ena. Pakadali pano, palibe njira yodziwira kuti ndi zilonda ziti zomwe zitha kuwononga.

• Tis (Matenda a Paget): Matenda a paget a nipple ndimavuto omwe khungu lachilendo limapezeka m'maselo a khungu ndipo amatha kufalikira ku areola. Sichikonzedwa molingana ndi dongosolo la TNM. Ngati matenda a Paget NDI khansa ya m'mawere yomwe ilipo, njira ya TNM imagwiritsidwa ntchito poyambitsa khansa ya m'mawere.

• T1: Chotupacho chili ndi mamilimita 20 kapena ochepera. Pali magawo anayi a chotupa cha T1 kutengera kukula kwa chotupacho:

• T1mi: chotupacho ndi 1 millimeter kapena ocheperako.

• T1a: chotupacho ndi chachikulu kuposa 1 millimeter koma osaposa 5 millimeter.

• T1b: chotupacho chimakhala chachikulu kuposa mamilimita 5 koma osaposa mamilimita 10.

• T1c: chotupacho ndi chachikulu kuposa mamilimita 10 koma osaposa 20 millimeters.

• T2: Chotupacho chimakhala chachikulu kuposa mamilimita 20 koma osaposa mamilimita 50.

• T3: Chotupacho ndi chachikulu kuposa mamilimita 50.

• T4: Chotupacho chimafotokozedwa kuti ndi chimodzi mwa izi:

• T4a: chotupacho chakula mpaka kukhoma pachifuwa.

• T4b: chotupacho chakula mpaka pakhungu — chilonda chakhazikika pamwamba pakhungu pa bere, timinatumba tating'onoting'ono tomwe timapanga pachifuwa chimodzimodzi ndi chotupa choyambirira, ndipo / kapena pali kutupa kwa khungu pabere .

• T4c: chotupacho chakula mpaka kukhoma pachifuwa komanso pakhungu.

• T4d: Khansa ya m'mawere yotupa-gawo limodzi mwa magawo atatu kapena kuposerapo pakhungu pa bere ndi lofiira komanso lotupa (lotchedwa peau d'orange).

Lymph mfundo (N). Kukula ndi malo am'mimba momwe khansa yafalikira.

Pamene ma lymph node amachotsedwa ndi opareshoni ndikuphunziridwa ndi microscope ndi katswiri wamatenda, njira yamagwiritsidwe ntchito imagwiritsa ntchito kufotokozera ma lymph node. Magawo am'magazi amfotokozedwe pansipa.

• NX: Ma lymph node sangayesedwe.

• N0: Palibe chizindikiro cha khansa m'matumba am'mimba, kapena timagulu tating'onoting'ono ta maselo a khansa osaposa mamilimita 0,2 m'matumba am'mimba.

• N1: Khansa imanenedwa kuti ndi imodzi mwazinthu izi:

• N1mi: khansara yafalikira ku axillary (armpit area) lymph node ndipo ndi yayikulu kuposa mamilimita 0.2 koma osaposa 2 millimeters.
• N1a: khansara yafalikira mpaka 1 mpaka 3 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters.
• N1b: khansa yafalikira ku ma lymph node pafupi ndi chifuwa cha bere mbali yomweyo ya thupi ngati chotupa choyambirira, ndipo khansayo ndi yayikulu kuposa milimita 0.2 ndipo imapezeka ndi sentinel lymph node biopsy. Khansa sichipezeka mu ma axillary lymph node.

• N1c: khansara yafalikira mpaka 1 mpaka 3 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters.

Khansara imapezekanso ndi sentinel lymph node biopsy mu ma lymph node pafupi ndi chifuwa cha bere mbali yomweyo ya thupi ngati chotupa choyambirira.

• N2: Khansa imanenedwa kuti ndi imodzi mwazinthu izi:

• N2a: khansara yafalikira ku ma 4 mpaka 9 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters.
• N2b: khansa yafalikira ku ma lymph node pafupi ndi chifuwa cha m'mawere ndipo khansa imapezeka poyesa kujambula. Khansa sichipezeka m'mazira am'mimba mwa sentinel lymph node biopsy kapena lymph node dissection.

• N3: Khansa imanenedwa kuti ndi imodzi mwazinthu izi:

• N3a: khansara yafalikira mpaka ma 10 kapena kuposa ma axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters, kapena khansa yafalikira ku ma lymph node pansi pa kolala.

• N3b: khansara yafalikira mpaka 1 mpaka 9 axillary lymph node ndipo khansa imodzi mwazomwe zimakhala zazikulu kuposa 2 millimeters. Khansa yafalikiranso ku ma lymph node pafupi ndi chifuwa cha m'mawere ndipo khansa imapezeka poyesa kujambula;

kapena

khansara yafalikira ku ma 4 mpaka 9 axillary lymph node ndi khansa mulimodzi mwamatenda akulu kuposa 2 millimeter. Khansara yafalikiranso ku ma lymph node pafupi ndi chifuwa cha bere mbali yomweyo ya thupi ngati chotupa choyambirira, ndipo khansayo ndi yayikulu kuposa milimita 0.2 ndipo imapezeka ndi sentinel lymph node biopsy.

• N3c: khansa yafalikira ku ma lymph node pamwamba pa kolala mbali yomweyo ya thupi ngati chotupa choyambirira.

Ma lymph node akafufuzidwa pogwiritsa ntchito mammography kapena ultrasound, amatchedwa staging staging. Magawo azam'mimba samatchulidwa pano.

Metastasis (M). Kufalikira kwa khansa kumadera ena a thupi.

• M0: Palibe chisonyezo chakuti khansara yafalikira mbali zina za thupi.

• M1: Khansa yafalikira mbali zina za thupi, nthawi zambiri mafupa, mapapo, chiwindi, kapena ubongo. Ngati khansara yafalikira kumatenda akutali, khansa yomwe imapezeka m'mimba imaposa mamilimita 0,2. Khansara amatchedwa khansa ya m'mawere ya metastatic.

Njira yoyikirayo imagwiritsidwa ntchito pofotokozera momwe chotupa cha m'mawere chingakule ndikufalikira mofulumira.

Dongosolo loyikiramo limafotokoza chotupa potengera momwe ma cell a khansa ndi minofu zimawonekera pansi pa microscope komanso momwe ma cell a khansa amatha kukula ndikufalikira mwachangu. Maselo a khansa otsika kwambiri amawoneka ngati maselo abwinobwino ndipo amakula ndikufalikira pang'onopang'ono kuposa ma cell apamwamba a khansa. Pofotokoza momwe maselo a khansa ndi minofu yake ilili yovuta, wodwalayo adzaunika zinthu zitatu izi:

• Kuchuluka kwa chotupacho kumakhala ndi timitsempha ta m'mawere.

• Kukula ndi mawonekedwe a mtima m'maselo otupa.

• Maselo akugawana omwe alipo, omwe ndi muyeso wa momwe ma chotupa a chotupa amakulira ndikugawana mwachangu.

Pa chilichonse, wodwalayo amapatsa 1 mpaka 3; mphambu wa "1" amatanthauza kuti maselo ndi zotupa zimawoneka ngati maselo abwinobwino ndi minofu, ndipo mphambu wa "3" amatanthauza kuti ma cell ndi minofu zimawoneka zachilendo kwambiri. Zotsatira zachigawo chilichonse zimaphatikizidwa kuti mupeze zigoli zonse pakati pa 3 ndi 9.

Sukulu zitatu ndizotheka:

• Chiwerengero chonse cha 3 mpaka 5: G1 (Gulu lotsika kapena kusiyanitsidwa bwino).

• Chiwerengero chonse cha 6 mpaka 7: G2 (Gulu lapakatikati kapena kusiyanitsidwa pang'ono).

• Chiwerengero chonse cha 8 mpaka 9: G3 (Gulu lapamwamba kapena losiyanitsidwa bwino).

Kuyesa kwa biomarker kumagwiritsidwa ntchito kuti mudziwe ngati maselo a khansa ya m'mawere ali ndi zolandilira.

Maselo abere athanzi, ndi ma cell ena a khansa ya m'mawere, ali ndi ma receptors (biomarkers) omwe amalumikizana ndi mahomoni a estrogen ndi progesterone. Mahomoni amenewa amafunika kuti maselo athanzi, komanso maselo ena a khansa ya m'mawere, kuti akule ndikugawana. Kuti muwone ngati opangira ma biomarkers, zitsanzo za minofu yomwe ili ndi maselo a khansa ya m'mawere amachotsedwa panthawi yopanga opaleshoni kapena opaleshoni. Zitsanzozo zimayesedwa mu labotale kuti ziwone ngati ma cell a khansa ya m'mawere ali ndi estrogen kapena progesterone receptors.

Mtundu wina wa receptor (biomarker) womwe umapezeka pamwamba pamaselo onse a khansa ya m'mawere umatchedwa HER2. Ma HER2 receptors amafunika kuti maselo a khansa ya m'mawere akule ndikugawana.

Pa khansa ya m'mawere, kuyesa kwa biomarker kumaphatikizapo izi:

• Estrogen receptor (ER). Ngati maselo a khansa ya m'mawere ali ndi zotengera za estrogen, ma cell a khansa amatchedwa ER positive (ER +). Ngati ma cell a khansa ya m'mawere alibe ma estrogen receptors, ma cell a khansa amatchedwa ER negative (ER-).

• Progesterone receptor (PR). Ngati maselo a khansa ya m'mawere ali ndi mapulogalamu a progesterone, maselo a khansa amatchedwa PR positive (PR +). Ngati maselo a khansa ya m'mawere alibe ma progesterone receptors, ma cell a khansa amatchedwa PR negative (PR-).

• Kukula kwa khungu kwa anthu kwamtundu wa 2 receptor (HER2 / neu kapena HER2). Ngati maselo a khansa ya m'mawere ali ndi zikuluzikulu kuposa zolandirira za HER2 pamtunda wawo, maselo a khansa amatchedwa HER2 positive (HER2 +). Ngati maselo a khansa ya m'mawere ali ndi HER2 yofanana pamtunda, maselo a khansa amatchedwa HER2 negative (HER2-). Khansa ya m'mawere ya HER2 + imatha kukula ndikugawana mwachangu kuposa khansa ya m'mawere ya HER2.

Nthawi zina maselo a khansa ya m'mawere amatha kufotokozedwa kuti ndi opanda chiyembekezo kapena katatu.

• Katatu kolakwika. Ngati maselo a khansa ya m'mawere alibe zotengera za estrogen, progesterone receptors, kapena zokulirapo kuposa zolandirira za HER2, ma cell a khansa amatchedwa katatu katatu.

• Katatu katsimikizika. Ngati maselo a khansa ya m'mawere ali ndi zotengera za estrogen, progesterone receptors, komanso zokulirapo kuposa zolandirira za HER2, ma cell a khansa amatchedwa katatu katatu.

Ndikofunikira kudziwa kuti estrogen receptor, progesterone receptor, ndi HER2 receptor status kuti asankhe mankhwala abwino kwambiri. Pali mankhwala omwe amatha kuyimitsa olandila kuti asamangirire mahomoni a estrogen ndi progesterone ndikuletsa khansa kukula. Mankhwala ena atha kugwiritsidwa ntchito kutsekereza ma HER2 receptors pamwambapa maselo a khansa ya m'mawere ndikuletsa khansa kukula.

Ndondomeko ya TNM, dongosolo loyika, komanso mawonekedwe a biomarker amaphatikizidwa kuti apeze gawo la khansa ya m'mawere.

Nazi zitsanzo zitatu zomwe zimaphatikiza dongosolo la TNM, dongosolo loyika, komanso mawonekedwe a biomarker kuti mupeze gawo la khansa ya m'mawere ya Pathological Prognostic ya mayi yemwe chithandizo chake choyamba chinali opaleshoni:

Ngati chotupacho chili ndi mamilimita 30 (T2), sichinafalikire ku ma lymph node (N0), sichinafalikire kumadera akutali a thupi (M0), ndipo ndi:

• Gulu 1

• HER2 +

• ER-

• PR-

Khansara ndi gawo IIA.

Ngati chotupacho chili ndi mamilimita 53 (T3), chafalikira mpaka 4 mpaka 9 axillary lymph node (N2), sichinafalikire mbali zina za thupi (M0), ndipo ndi:

• Gulu 2

• HER2 +

• ER +

• PR-

Chotupacho ndi gawo IIIA.

Ngati chotupacho chili ndi mamilimita 65 (T3), chafalikira ku 3 axillary lymph nodes (N1a), chafalikira m'mapapu (M1), ndipo ndi:

• Gulu 1

• HER2 +

• ER-

• PR-

Khansara ndi gawo IV (khansa ya m'mawere).

Lankhulani ndi dokotala wanu kuti mudziwe momwe khansa yanu ya m'mawere ilili komanso momwe amagwiritsidwira ntchito pokonzekera chithandizo chabwino kwambiri kwa inu.

Pambuyo pa opareshoni, dokotala wanu alandila lipoti laza matenda lomwe limafotokoza kukula ndi malo a chotupacho, kufalikira kwa khansa kumalo am'mimba apafupi, chotupa, komanso ngati kuli ma biomarkers. Lipoti la kudwala ndi zotsatira zina zoyesedwa zimagwiritsidwa ntchito kuti mudziwe khansa yanu ya m'mawere.

Muyenera kuti muli ndi mafunso ambiri. Funsani dokotala wanu kuti akufotokozereni momwe masitepe amagwiritsidwira ntchito posankha njira zabwino zochizira khansa yanu komanso ngati pali mayesero azachipatala omwe angakhale oyenera kwa inu.

Chithandizo cha khansa ya m'mawere chimadalira gawo lina la matendawa.

Pazosankha za ductal carcinoma in situ (DCIS), onani Ductal Carcinoma ku Situ.

Pazomwe mungachite posankha gawo I, gawo lachiwiri, gawo IIIA, ndi khansa ya m'mawere yothandizira IIIC, onani Cancer Yoyambirira, Yapafupi, kapena Yogwira Ntchito ya Khansa ya M'mawere.

Pazomwe mungachite pakuthandizira gawo IIIB, gawo losagwira ntchito IIIC, ndi khansa ya m'mawere yotupa, onani Cancer Advanced or Inflammatory Breast Cancer.

Kuti mupeze chithandizo cha khansa yomwe yabwereranso pafupi ndi komwe idapangidwira, onani Cancoregional Recurrent Breast Cancer.

Kuti mupeze njira zochiritsira khansa ya m'mawere ya siteji IV (metastatic) kapena khansa ya m'mawere yomwe yabwereranso mbali zina za thupi, onani Khansa ya M'mawere ya Metastatic.

Khansa ya m'mawere yotupa

Mu khansa yotupa ya m'mawere, khansa yafalikira pakhungu la m'mawere ndipo bere limawoneka lofiira komanso lotupa ndipo limamva kutentha. Kufiira ndi kutentha kumachitika chifukwa maselo a khansa amatseka zotengera zam'mimba pakhungu. Khungu la bere limatha kuwonetseranso mawonekedwe opindika otchedwa peau d'orange (ngati khungu la lalanje). Mwina sipangakhale zotupa zilizonse m'mawere zomwe zingamveke. Khansa ya m'mawere yotupa ikhoza kukhala gawo IIIB, gawo IIIC, kapena gawo IV.

Khansa yotupa ya m'mawere ya m'mawere akumanzere ikuwonetsa peau d'orange ndi nsonga yotembenuka.

Khansa Yam'mimba Yam'mbuyo

Khansa yapamtima yaposachedwa ndi khansa yomwe yabwereranso (kubwerera) itachiritsidwa. Khansara imatha kubwereranso m'mawere, pakhungu la m'mawere, kukhoma lachifuwa, kapena m'malo am'mimba apafupi.

Chithandizo Chosankha Mwachidule

MFUNDO ZOFUNIKA

• Pali mitundu yosiyanasiyana ya chithandizo cha odwala khansa ya m'mawere.

• Mitundu isanu ndi umodzi yamankhwalawa amagwiritsidwa ntchito:

• Opaleshoni

• Thandizo la radiation

• Chemotherapy

• Thandizo la mahomoni

• Chithandizo chofuna

• Chitetezo chamatenda

• Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

• Chithandizo cha khansa ya m'mawere chingayambitse mavuto.

• Odwala angaganize zopita nawo kukayezetsa.

• Odwala amatha kulowa m'mayesero azachipatala asanayambe, asanayambe, kapena atayamba kulandira chithandizo cha khansa.

• Mayeso otsatirawa angafunike.

Pali mitundu yosiyanasiyana ya chithandizo cha odwala khansa ya m'mawere.

Pali mitundu yosiyanasiyana ya chithandizo kwa odwala omwe ali ndi khansa ya m'mawere. Mankhwala ena ndi ofanana (mankhwala omwe akugwiritsidwa ntchito pano), ndipo ena akuyesedwa m'mayesero azachipatala. Kuyesedwa kwachipatala ndi kafukufuku wofufuza wothandizira kusintha chithandizo chamakono kapena kupeza zidziwitso zamankhwala atsopano kwa odwala khansa. Pamene mayesero azachipatala awonetsa kuti chithandizo chatsopano ndichabwino kuposa chithandizo chamankhwala, chithandizocho chitha kukhala chamankhwala wamba. Odwala angaganize zopita nawo kukayezetsa. Mayesero ena azachipatala ndi otseguka kwa odwala omwe sanayambe kulandira chithandizo.

Mitundu isanu ndi umodzi yamankhwalawa amagwiritsidwa ntchito:

Opaleshoni

Odwala ambiri omwe ali ndi khansa ya m'mawere amachitidwa opaleshoni kuti athetse khansayo.

Sentinel lymph node biopsy ndikuchotsa kwa sentinel lymph node panthawi yochita opareshoni. Sentinel lymph node ndiye njira yoyamba yam'magulu am'magazi kuti alandire madzi m'mimba kuchokera pachotupa choyambirira. Ndi lymph node yoyamba yomwe khansa imafalikira kuchokera ku chotupa choyambirira. Mankhwala a radioactive ndi / kapena utoto wabuluu amabayidwa pafupi ndi chotupacho. Katunduyu kapena utoto umadutsa m'mitsempha yam'mimba kupita kumalo am'mimba. Nthenda yoyamba yolandila mankhwala kapena utoto imachotsedwa. Wodwala amayang'ana minofu pansi pa microscope kuti ayang'ane maselo a khansa. Ngati maselo a khansa sapezeka, mwina sikofunikira kuchotsa ma lymph node ambiri. Nthawi zina, sentinel lymph node imapezeka m'magulu angapo am'magulu. Pambuyo pa sentinel lymph node biopsy, dokotalayo amachotsa chotupacho pogwiritsa ntchito opaleshoni yosunga bere kapena mastectomy. Ngati maselo a khansa atapezeka, ma lymph node ambiri amachotsedwa kudzera padera. Izi zimatchedwa kuti lymph node dissection.

Mitundu ya maopareshoni ndi awa:

• Opaleshoni yosunga bere ndi opareshoni yochotsa khansa ndi minofu yabwinobwino pozungulira pake, koma osati bere lomwe. Gawo lina la khoma pachifuwa amathanso kuchotsedwa ngati khansara ili pafupi nayo. Kuchita opaleshoni kotereku kungathenso kutchedwa lumpectomy, pang'ono mastectomy, segmental mastectomy, quadrantectomy, kapena opaleshoni yoletsa mawere.

Opaleshoni yosunga bere. Chotupacho ndi minofu yabwinobwino pozungulira pake zimachotsedwa, koma osati bere lomwe. Ma lymph node ena pansi pa mkono atha kuchotsedwa. Gawo lina la khoma pachifuwa amathanso kuchotsedwa ngati khansara ili pafupi nayo.

• Chiwerengero cha mastectomy: Opaleshoni kuchotsa bere lonse lomwe lili ndi khansa. Njirayi imatchedwanso mastectomy yosavuta. Zina mwa zotupa zomwe zili pansi pa mkono zimatha kuchotsedwa ndikuwunika ngati ali ndi khansa. Izi zitha kuchitika nthawi yofanana ndi opaleshoni ya m'mawere kapena pambuyo pake. Izi zimachitika kudzera pachokha.

Chiwerewere chonse (chosavuta). Mzere wokhala ndi madontho umawonetsa komwe bere lonse limachotsedwa. Ma lymph node ena pansi pa mkono amathanso kuchotsedwa.

• Kusintha kwakukulu kwa mastectomy: Opaleshoni yochotsa bere lonse lomwe lili ndi khansa, ma lymph node ambiri pansi pa mkono, kulumikizana paminyewa ya chifuwa, ndipo nthawi zina, gawo la minofu yapachifuwa.

Kusintha kwakukulu kwa mastectomy. Mzere wokhala ndi madontho umawonetsa komwe mawere onse ndi ma lymph node amachotsedwa. Gawo lina la chifuwa cholumikizira pachifuwa amathanso kuchotsedwa.

Chemotherapy imatha kuperekedwa asanachite opaleshoni kuti achotse chotupacho. Mukaperekedwa musanachite opareshoni, chemotherapy imachepetsa chotupacho ndikuchepetsa kuchuluka kwa minofu yomwe imafunika kuchotsedwa pakuchita opaleshoni. Chithandizo choperekedwa asanachite opareshoni chimatchedwa preoperative therapy kapena neoadjuvant therapy.

Dokotala atachotsa khansa yonse yomwe imawoneka panthawi yochitidwa opaleshoni, odwala ena amatha kupatsidwa mankhwala a radiation, chemotherapy, mankhwala omwe amalimbikitsidwa, kapena mankhwala a mahomoni atachitidwa opareshoni, kuti aphe maselo amtundu uliwonse omwe atsala. Chithandizo chomwe chimaperekedwa pambuyo pa opareshoni, kuti muchepetse chiopsezo kuti khansa ibwererenso, amatchedwa postoperative therapy kapena adjuvant therapy.

Ngati wodwala ati adzakhale ndi minyewa, kumangidwanso kwa mawere (opaleshoni kuti amangenso mawonekedwe a bere pambuyo pa mastectomy) kungaganiziridwe. Kukonzanso kwa mawere kumatha kuchitika nthawi ya mastectomy kapena nthawi ina pambuyo pake. Chifuwa chomangidwanso chimatha kupangidwa ndi minofu ya wodwalayo (yopanda pachifuwa) kapena pogwiritsa ntchito implants yodzaza ndi saline kapena silicone gel. Asanapange chisankho chodzala, odwala amatha kuyimbira Center of Devices and Radiologic Health ku Center for Devices and Radiologic Health ku 1-888-INFO-FDA (1-888-463-6332) kapena pitani patsamba la FDA la zambiri pazodzala mawere.

Thandizo la radiation

Thandizo la radiation ndi chithandizo cha khansa chomwe chimagwiritsa ntchito ma x-ray amphamvu kapena mitundu ina ya radiation kuti iphe ma cell a khansa kapena kuti asakule. Pali mitundu iwiri ya mankhwala a radiation:

• Mankhwala ochiritsira akunja amagwiritsa ntchito makina kunja kwa thupi kuti atumize cheza chaku khansa.

• Njira yothandizira poizoniyu yamkati imagwiritsa ntchito mankhwala a radioactive otsekedwa ndi singano, njere, mawaya, kapena ma catheters omwe amayikidwa mwachindunji kapena pafupi ndi khansa.

Momwe mankhwala a radiation amaperekedwera zimadalira mtundu ndi gawo la khansa yomwe ikuthandizidwa. Thandizo la radiation lakunja limagwiritsidwa ntchito pochiza khansa ya m'mawere. Thandizo la radiation la strontium-89 (radionuclide) limagwiritsidwa ntchito kuthana ndi mafupa omwe amayamba chifukwa cha khansa ya m'mawere yomwe yafalikira m'mafupa. Strontium-89 imalowetsedwa mumtsempha ndikupita pamwamba pamafupa. Magetsi amatuluka ndikupha ma cell a khansa m'mafupa.

Chemotherapy

Chemotherapy ndi mankhwala a khansa omwe amagwiritsa ntchito mankhwala oletsa kukula kwa maselo a khansa, mwina popha ma cell kapena kuwaletsa kuti asagawane. Chemotherapy ikamamwa pakamwa kapena kulowetsedwa mumtsempha kapena minofu, mankhwalawa amalowa m'magazi ndipo amatha kufikira ma cell a khansa mthupi lonse (systemic chemotherapy). Chemotherapy ikaikidwa molunjika m'matumbo a cerebrospinal, chiwalo, kapena thupi ngati pamimba, mankhwalawa amakhudza kwambiri ma cell a khansa m'malo amenewo (chemotherapy am'madera).

Momwe chemotherapy imaperekedwa imadalira mtundu ndi gawo la khansa yomwe ikuchitidwa. Chemotherapy yeniyeni imagwiritsidwa ntchito pochiza khansa ya m'mawere.

Onani Mankhwala Ovomerezeka a Khansa ya m'mawere kuti mumve zambiri.

Thandizo la mahomoni

Thandizo la mahomoni ndi mankhwala a khansa omwe amachotsa mahomoni kapena amalepheretsa zochita zawo ndikuletsa maselo a khansa kuti asakule. Mahomoni ndi zinthu zopangidwa ndi tiziwalo timene timatuluka m'thupi ndipo timafalikira m'magazi. Mahomoni ena amatha kupangitsa khansa kukula. Ngati kuyesa kukuwonetsa kuti ma cell a khansa ali ndi malo omwe mahomoni amatha kulumikiza (receptors), mankhwala osokoneza bongo, opareshoni, kapena mankhwala a radiation amagwiritsidwa ntchito pochepetsa mahomoni kapena kuwaletsa kuti asagwire ntchito. Mahomoni a estrogen, omwe amachititsa kuti khansa zina za m'mawere zikule, amapangidwa makamaka ndi thumba losunga mazira. Chithandizo choletsa thumba losunga mazira kuti lisapangitse estrogen chimatchedwa kuti ovarian ablation.

Thandizo la mahomoni ndi tamoxifen nthawi zambiri limaperekedwa kwa odwala omwe ali ndi khansa ya m'mawere yoyambirira yomwe imatha kuchotsedwa ndi opaleshoni komanso omwe ali ndi khansa ya m'mawere (khansa yomwe yafalikira mbali zina za thupi). Mankhwala a mahormone okhala ndi tamoxifen kapena estrogens amatha kugwira ntchito pamaselo mthupi lonse ndipo atha kuwonjezera mwayi wokhala ndi khansa ya endometrial. Amayi omwe amatenga tamoxifen amayenera kuyezetsa m'chiuno chaka chilichonse kuti ayang'ane zizindikiro zilizonse za khansa. Kutuluka magazi kumaliseche konse, kupatula kutaya magazi msambo, kuyenera kufotokozedwa kwa dokotala posachedwa.

Mankhwala a mahormone okhala ndi luteinizing hormone-releasing hormone (LHRH) agonist amapatsidwa kwa azimayi ena omwe amatenga msambo omwe atangopezeka ndi khansa ya m'mawere yolandila. Agonist a LHRH amachepetsa thupi la estrogen ndi progesterone.

Thandizo la mahomoni ndi aromatase inhibitor limaperekedwa kwa azimayi ena omwe atha msinkhu omwe ali ndi khansa ya m'mawere yolandila mahomoni. Aromatase inhibitors amachepetsa estrogen ya thupi potseka ma enzyme otchedwa aromatase kuti asasinthe androgen kukhala estrogen. Anastrozole, letrozole, ndi exemestane ndi mitundu ya aromatase inhibitors.

Pofuna kuchiza khansa ya m'mawere yoyambirira yomwe imatha kuchotsedwa ndi opaleshoni, ma aromatase inhibitors ena amatha kugwiritsidwa ntchito ngati mankhwala othandizira m'malo mwa tamoxifen kapena patatha zaka 2 mpaka 3 za tamoxifen. Pofuna kuchiza khansa ya m'mawere, aromatase inhibitors akuyesedwa m'mayesero azachipatala kuti awafanizire ndi mankhwala a mahomoni ndi tamoxifen.

Amayi omwe ali ndi khansa ya m'mawere yolandila mahomoni, zaka zosachepera 5 za mankhwala owonjezera a mahomoni amachepetsa chiopsezo kuti khansa ibwereranso (kubwerera).

Mitundu ina yamankhwala othandizira mahomoni imaphatikizapo megestrol acetate kapena anti-estrogen therapy monga fulvestrant.

Onani Mankhwala Ovomerezeka a Khansa ya m'mawere kuti mumve zambiri.

Chithandizo chofuna

Chithandizo choyenera ndi mtundu wa mankhwala omwe amagwiritsa ntchito mankhwala osokoneza bongo kapena zinthu zina kuti azindikire ndikuukira maselo amtundu wa khansa osavulaza maselo abwinobwino. Ma monoclonal antibodies, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mammalian chandamale cha rapamycin (mTOR) inhibitors, ndi PARP inhibitors ndi mitundu ya mankhwala omwe amagwiritsidwa ntchito pochiza khansa ya m'mawere.

Thandizo la monoclonal antibody ndi khansa yomwe imagwiritsa ntchito ma antibodies opangidwa mu labotore, kuchokera ku mtundu umodzi wamatenda amthupi. Ma antibodies awa amatha kuzindikira zinthu zomwe zili m'maselo a khansa kapena zinthu zabwinobwino zomwe zingathandize ma cell a khansa kukula. Ma antibodies amalumikizana ndi zinthuzo ndikupha ma cell a khansa, amalepheretsa kukula kwawo, kapena amalepheretsa kufalikira. Ma antibodies a monoclonal amaperekedwa mwa kulowetsedwa. Angagwiritsidwe ntchito okha kapena kunyamula mankhwala osokoneza bongo, poizoni, kapena zinthu zowononga radio kupita kuma cell a khansa. Ma antibodies a monoclonal atha kugwiritsidwa ntchito limodzi ndi chemotherapy ngati othandizira othandizira.

Mitundu ya mankhwala a monoclonal antibody ndi awa:

• Trastuzumab ndi anti-monoclonal antibody yomwe imatchinga zomwe zimayambitsa kukula kwa protein HER2, yomwe imatumiza zizindikiritso zakukula kwa maselo a khansa ya m'mawere. Itha kugwiritsidwa ntchito ndi njira zina zochizira khansa ya m'mawere ya HER2.

• Pertuzumab ndi antioclonal antibody yomwe itha kuphatikizidwa ndi trastuzumab ndi chemotherapy pochiza khansa ya m'mawere. Itha kugwiritsidwa ntchito pochiza odwala ena omwe ali ndi khansa ya m'mawere ya HER2 yomwe yasintha (kufalikira mbali zina za thupi). Itha kugwiritsidwanso ntchito ngati neoadjuvant Therapy kwa odwala omwe ali ndi khansa yapakati, yotupa, kapena khansa ya m'mawere. Itha kugwiritsidwanso ntchito ngati mankhwala othandizira kwa odwala ena omwe ali ndi khansa ya m'mawere yoyambira ya HER2.

• Ado-trastuzumab emtansine ndi antioclonal antibody yolumikizidwa ndi mankhwala a khansa. Izi zimatchedwa anti-drug conjugate. Amagwiritsidwa ntchito pochiza khansa ya m'mawere ya HER2 yomwe yafalikira mbali zina za thupi kapena kubwereranso (kubwerera). Amagwiritsidwanso ntchito ngati mankhwala othandizira othandizira khansa ya m'mawere ya HER2 mwa odwala omwe ali ndi matenda otsalira atachitidwa opaleshoni.

• Sacituzumab govitecan ndi antioclonal antibody yomwe imanyamula mankhwala a anticancer ku chotupacho. Izi zimatchedwa anti-drug conjugate. Akuwerengedwa kuti azichiza azimayi omwe ali ndi khansa ya m'mawere yopanda katatu yomwe alandirako mitundu iwiri yamankhwala am'mbuyomu.

Ma Tyrosine kinase inhibitors amalimbana ndi mankhwala omwe amaletsa zizindikilo zofunika kuti zotupa zikule. Tyrosine kinase inhibitors atha kugwiritsidwa ntchito ndi mankhwala ena a khansa ngati othandizira. Tyrosine kinase inhibitors ndi awa:

• Lapatinib ndi tyrosine kinase inhibitor yomwe imatchinga zotsatira za protein ya HER2 ndi mapuloteni ena mkati mwa zotupa. Itha kugwiritsidwa ntchito ndi mankhwala ena kuchiza odwala omwe ali ndi khansa ya m'mawere ya HER2 yomwe yapita patsogolo atalandira chithandizo ndi trastuzumab.

• Neratinib ndi tyrosine kinase inhibitor yomwe imatchinga zotsatira za protein ya HER2 ndi mapuloteni ena mkati mwa zotupa. Itha kugwiritsidwa ntchito kuchiza odwala omwe ali ndi khansa ya m'mawere yoyambirira ya HER2 atalandira chithandizo ndi trastuzumab.

Ma cyclin-dependent kinase inhibitors amathandizidwa ndi mankhwala omwe amaletsa mapuloteni otchedwa cyclin-dependent kinases, omwe amachititsa kukula kwa maselo a khansa. Ma cyclin-dependent kinase inhibitors ndi awa:

• Palbociclib ndi cyclin-dependent kinase inhibitor yomwe imagwiritsidwa ntchito ndi letrozole yochizira khansa ya m'mawere yomwe ili ndi estrogen receptor positive ndipo HER2 ilibe ndipo yafalikira mbali zina za thupi. Amagwiritsidwa ntchito mwa azimayi omwe atha msinkhu omwe khansa yawo sinalandiridwe mankhwala a mahomoni. Palbociclib itha kugwiritsidwanso ntchito ndi fulvestrant mwa amayi omwe matenda awo afika poipa atalandira chithandizo chamankhwala.

• Ribociclib ndi cyclin-dependent kinase inhibitor yomwe imagwiritsidwa ntchito ndi letrozole pochiza khansa ya m'mawere yomwe imakhala ndi cholandilira ndi HER2 ndipo yabwerera kapena kufalikira mbali zina za thupi. Amagwiritsidwa ntchito mwa azimayi omwe atha msinkhu omwe khansa yawo sinalandiridwe mankhwala a mahomoni. Amagwiritsidwanso ntchito ndi fulvestrant mwa amayi omwe atha msinkhu omwe ali ndi khansa ya m'mawere yolandila ndi HER2 khansa ya m'mawere yomwe yafalikira mbali zina za thupi kapena yabwereranso. Amagwiritsidwanso ntchito kwa amayi omwe ali ndi premenopausal omwe ali ndi khansa yam'mimba yolandila ndi HER2 yomwe imafalikira mbali zina za thupi kapena yabwereranso.

• Abemaciclib ndi cyclin-dependent kinase inhibitor yomwe imagwiritsidwa ntchito pochizira khansa yam'mimba yolandila ndi HER2 khansa ya m'mawere yomwe yapita patsogolo kapena yafalikira mbali zina za thupi. Itha kugwiritsidwa ntchito yokha kapena ndi mankhwala ena.

• Alpelisib ndi cyil-dependent kinase inhibitor yomwe imagwiritsidwa ntchito ndi mankhwala osokoneza bongo kuti athetse khansa ya m'mawere ya HER2 ndi khansa ya m'mawere ya HER2 yomwe imasintha majini ndipo yapita patsogolo kapena yafalikira mbali zina za thupi. Amagwiritsidwa ntchito mwa azimayi omwe atha msinkhu omwe khansa ya m'mawere yawonjezeka kwambiri akamalandira chithandizo chamankhwala kapena atalandira chithandizo.

Cholinga cha mamalia cha rapamycin (mTOR) chimalepheretsa puloteni yotchedwa mTOR, yomwe imalepheretsa maselo a khansa kukula ndikuletsa kukula kwa mitsempha yatsopano yomwe zotupa zimayenera kukula. mTOR inhibitors ndi awa:

• Everolimus ndi mTOR inhibitor yomwe imagwiritsidwa ntchito mwa amayi omwe atha msinkhu omwe ali ndi khansa ya m'mawere yolandila bwino yomwe imakhalanso ndi HER2 yolakwika ndipo sinakhale bwino ndi mankhwala ena.

PARP inhibitors ndi mtundu wa mankhwala omwe amalimbana ndi kukonza kwa DNA ndipo amatha kupangitsa kuti maselo a khansa afe. PARP inhibitors ndi awa:

• Olaparib ndi PARP inhibitor yomwe imagwiritsidwa ntchito pochiza odwala omwe ali ndi kusintha kwa mtundu wa BRCA1 kapena BRCA2 komanso khansa ya m'mawere ya HER2 yomwe yafalikira mbali zina za thupi. Thandizo la PARP inhibitor likuwerengedwa pochiza odwala omwe ali ndi khansa ya m'mawere yopanda katatu.

• Talazoparib ndi PARP inhibitor yomwe imagwiritsidwa ntchito pochiza odwala omwe asintha m'thupi la BRCA1 kapena BRCA2 ndi khansa ya m'mawere ya HER2 yomwe yapita patsogolo kapena yafalikira mbali zina za thupi.

Onani Mankhwala Ovomerezeka a Khansa ya m'mawere kuti mumve zambiri.

Chitetezo chamatenda

Immunotherapy ndi chithandizo chomwe chimagwiritsa ntchito chitetezo cha mthupi cha wodwalayo kuthana ndi khansa. Zinthu zomwe thupi limapanga kapena zopangidwa mu labotale zimagwiritsidwa ntchito kukulitsa, kuwongolera, kapena kubwezeretsa chitetezo chamthupi cha khansa. Chithandizo cha khansa choterechi chimatchedwanso biotherapy kapena biologic therapy.

Pali mitundu yambiri ya immunotherapy:

• Mankhwala oteteza ku chitetezo cha mthupi: PD-1 ndi mapuloteni pamwamba pa ma T omwe amathandiza kuti chitetezo cha mthupi chitetezedwe. PD-1 ikamangirira puloteni ina yotchedwa PDL-1 pakhungu la khansa, imayimitsa T cell kuti isaphe khungu la khansa. PD-1 inhibitors amadziphatika ku PDL-1 ndikulola ma T maselo kupha ma cell a khansa. Atezolizumab ndi PD-1 inhibitor yomwe imagwiritsidwa ntchito pochiza khansa ya m'mawere yomwe yafalikira mbali zina za thupi.

Chitetezo cha chitetezo cha mthupi. Mapuloteni owunika, monga PD-L1 pama cell a chotupa ndi PD-1 pama cell a T, amathandizira kuyang'anira mayankho amthupi. Kumanga kwa PD-L1 mpaka PD-1 kumapangitsa kuti ma T asaphe ma cell am'mimba (gulu lakumanzere). Kuletsa kumangiriza kwa PD-L1 mpaka PD-1 yokhala ndi chitetezo chodzitetezera (anti-PD-L1 kapena anti-PD-1) kumalola ma T maselo kupha ma cell a chotupa (gulu lamanja).

Mitundu yatsopano yamankhwala ikuyesedwa m'mayesero azachipatala.

Zambiri zamayeso azachipatala zimapezeka patsamba la NCI.

Chithandizo cha khansa ya m'mawere chingayambitse mavuto.

Kuti mumve zambiri zamankhwala oyambilira omwe amayamba mukalandira chithandizo cha khansa, onani tsamba lathu la Zotsatira Zotsatira.

Mankhwala ena a khansa ya m'mawere amatha kuyambitsa zovuta zomwe zimapitilira kapena kuwonekera miyezi kapena zaka mankhwala atatha. Izi zimatchedwa zotsatira zakuchedwa.

Zotsatira zakumapeto kwa mankhwalawa sizofala, koma zimatha kuphatikiza:

• Kutupa kwa mapapo pambuyo pochizira ma radiation kubere, makamaka ngati chemotherapy imaperekedwa nthawi yomweyo.

• Arm lymphedema, makamaka pamene mankhwala a radiation amaperekedwa pambuyo poti lymph node dissection.

• Amayi ochepera zaka 45 omwe amalandila chithandizo chama radiation pakhosi pachifuwa pambuyo pa mastectomy, atha kukhala pachiwopsezo chachikulu chotenga khansa ya m'mawere m'mawere ena.

Zotsatira zakumbuyo kwa chemotherapy zimadalira mankhwala omwe amagwiritsidwa ntchito, koma atha kuphatikizira:

• Mtima kulephera.

• Kuundana kwamagazi.

• Kusamba msanga msanga.

• Khansa yachiwiri, monga khansa ya m'magazi.

Zotsatira zakumapeto kwa mankhwalawa ndi trastuzumab, lapatinib, kapena pertuzumab zitha kuphatikizira:

• Mavuto amtima monga mtima kulephera.

Odwala angaganize zopita nawo kukayezetsa.

Kwa odwala ena, kutenga nawo mbali pakuyesa chithandizo chachipatala kungakhale njira yabwino kwambiri yothandizira. Mayesero azachipatala ndi gawo limodzi la kafukufuku wa khansa. Mayesero azachipatala amachitika kuti apeze ngati mankhwala atsopano a khansa ndi otetezeka komanso ogwira ntchito kapena abwinoko kuposa mankhwala wamba.

Njira zambiri zamankhwala zochiritsira khansa zimachokera kumayeso am'mbuyomu azachipatala. Odwala omwe amatenga nawo mbali pachipatala atha kulandira chithandizo chofananira kapena kukhala oyamba kulandira chithandizo chatsopano.

Odwala omwe amatenga nawo mbali pazoyeserera zamankhwala amathandizanso kukonza momwe khansa idzathandizire mtsogolo. Ngakhale mayesero azachipatala satsogolera kuchipatala chatsopano, nthawi zambiri amayankha mafunso ofunikira ndikuthandizira kupititsa patsogolo kafukufuku.

Odwala amatha kulowa m'mayesero azachipatala asanayambe, asanayambe, kapena atayamba kulandira chithandizo cha khansa.

Mayesero ena azachipatala amangophatikizapo odwala omwe sanalandire chithandizo. Mayesero ena amayesa chithandizo kwa odwala omwe khansa yawo sinakhale bwino. Palinso mayesero azachipatala omwe amayesa njira zatsopano zothetsera khansa kuti isabwererenso (kubwerera) kapena kuchepetsa zovuta zoyambitsidwa ndi khansa.

Mayesero azachipatala akuchitika m'malo ambiri mdziko muno. Zambiri zamayeso azachipatala othandizidwa ndi NCI zitha kupezeka patsamba lofufuza zamankhwala la NCI. Mayesero azachipatala othandizidwa ndi mabungwe ena amapezeka patsamba la ClinicalTrials.gov.

Mayeso otsatirawa angafunike.

Ena mwa mayesero omwe adachitika kuti apeze khansa kapena kuti adziwe momwe khansa iliri angabwerezedwenso. Mayesero ena adzabwerezedwa kuti awone momwe mankhwalawa akugwirira ntchito. Zisankho zakuti mupitilize, kusintha, kapena kusiya kulandira chithandizo zitha kutengera zotsatira za mayeso awa.

Kuyesaku kumangopitilira kuchitika nthawi ndi nthawi mankhwala atatha. Zotsatira zamayesowa zitha kuwonetsa ngati vuto lanu lasintha kapena ngati khansa yabwereranso (bwererani). Mayesowa nthawi zina amatchedwa kuyesa kutsata kapena kukayezetsa.

Njira Zothandizira Kuchiza Khansa ya M'mawere

M'chigawo chino

• Khansa Yoyambirira, Yopezeka Kwapafupi, kapena Yogwiritsidwa Ntchito

• Khansa Yam'mimba Yotsogola Kapena Yotupa Yam'deralo

• Khansa Yam'mimba Yam'mbuyo Yamakono

• Khansara ya M'mawere

Kuti mumve zambiri zamankhwala omwe atchulidwa pansipa, onani gawo la Chisankho Chachidule.

Khansa Yoyambirira, Yopezeka Kwapafupi, kapena Yogwiritsidwa Ntchito

Chithandizo cha khansa ya m'mawere yoyambirira, yakomweko, kapena yotheka ingaphatikizepo izi:

Opaleshoni

• Opaleshoni yosunga bere ndi sentinel lymph node biopsy. Ngati khansa imapezeka m'mitsempha yam'mimba, mungachite dissection.

• Kusintha kwakukulu kwa mastectomy. Opaleshoni yokonzanso mawere itha kuchitidwanso.

Thandizo la radiation la postoperative

Kwa amayi omwe anachitidwa opaleshoni yosamalira bere, mankhwala opatsirana pogwiritsa ntchito mankhwalawa amaperekedwa ku bere lonse kuti muchepetse mwayi womwe khansayo ingabwerere. Mankhwalawa amatha kuperekedwanso ku ma lymph node m'derali.

Kwa amayi omwe adasinthidwa bwino kwambiri, mankhwala amiseche amatha kuperekedwa kuti achepetse mwayi woti khansa ibwererenso ngati izi ndi zoona:

• Khansa imapezeka mu ma lymph node 4 kapena kupitilira apo.

• Khansara inali itafalikira kumatenda ozungulira ma lymph node.

• Chotupacho chinali chachikulu.

• Pali chotupa choyandikira kapena chotsalira m'thupi pafupi ndi m'mbali mwa chotupacho.

Thandizo la postoperative systemic

Mankhwala othandiza ndi kugwiritsa ntchito mankhwala omwe amalowa m'magazi ndikufikira maselo a khansa mthupi lonse. Mankhwala opatsirana pambuyo pa opaleshoni amaperekedwa kuti achepetse mwayi kuti khansara ibwererenso pambuyo pa opaleshoni kuchotsa chotupacho.

Thandizo la postoperative systemic limaperekedwa kutengera:

• Chotupacho ndi cholandilira cha mahomoni cholakwika kapena chabwino.

• Chotupacho ndi HER2 / neu cholakwika kapena chabwino.

• Chotupacho ndi cholandirira cha mahomoni cholandirira ndi HER2 / neu cholakwika (katatu cholakwika).

• Kukula kwa chotupacho.

Amayi omwe ali ndi premenopausal omwe ali ndi zotupa zotulutsa mahomoni, sipangakhalenso chithandizo chamankhwala kapena chithandizo chamankhwala chamtsogolo chitha kukhala:

• Thandizo la Tamoxifen kapena chemotherapy.

• Chithandizo cha Tamoxifen ndi mankhwala oletsa kapena kuchepetsa kuchuluka kwa estrogen yopangidwa ndi thumba losunga mazira. Mankhwala osokoneza bongo, opareshoni yochotsa thumba losunga mazira, kapena mankhwala a radiation ku thumba losunga mazira atha kugwiritsidwa ntchito.

• Mankhwala a Aromatase inhibitor ndi chithandizo choyimitsa kapena kuchepetsa kuchuluka kwa estrogen yopangidwa ndi thumba losunga mazira. Mankhwala osokoneza bongo, opareshoni yochotsa thumba losunga mazira, kapena mankhwala a radiation ku thumba losunga mazira atha kugwiritsidwa ntchito.

Amayi omwe ali ndi vuto la postmenopausal omwe ali ndi zotupa zotulutsa mahormone, sipangakhalenso chithandizo chamankhwala kapena chithandizo chamankhwala chamtsogolo chitha kukhala:

• Mankhwala a Aromatase inhibitor omwe alibe kapena chemotherapy.

• Tamoxifen yotsatira aromatase inhibitor therapy, yokhala ndi chemotherapy kapena yopanda mankhwala.

Amayi omwe ali ndi zotupa za hormone receptor negative, sipangakhalenso chithandizo chamankhwala kapena chithandizo chamankhwala chamtsogolo chingaphatikizepo:

• Chemotherapy.

Kwa amayi omwe ali ndi zotupa zoyipa za HER2 / neu, chithandizo cha postoperative chingaphatikizepo:

• Chemotherapy.

Amayi omwe ali ndi zotupa zazing'ono, za HER2 / neu, ndipo alibe khansa m'matenda am'mimba, sipangafunikire chithandizo. Ngati pali khansa m'matenda am'mimba, kapena chotupacho ndi chachikulu, chithandizo cha postoperative chingaphatikizepo:

• Chemotherapy ndi chithandizo chothandizira (trastuzumab).

• Thandizo la mahomoni, monga tamoxifen kapena aromatase inhibitor therapy, chifukwa cha zotupa zomwe zimakhalanso ndi receptor.

• Mankhwala opatsirana pogonana ndi ado-trastuzumab emtansine.

Amayi omwe ali ndi zotupa zazing'ono, zotengera ma hormone ndi HER2 / neu zotupa (zoyipa katatu) ndipo alibe khansa m'matumba am'mimba, sipangafunikire chithandizo. Ngati pali khansa m'matumbo kapena chotupacho ndi chachikulu, chithandizo chamankhwala opatsirana pambuyo pake chingaphatikizepo:

• Chemotherapy.

• Thandizo la radiation.

• Kuyesedwa kwachipatala kwa mtundu wa chemotherapy regimen.

• Kuyesedwa kwachipatala kwa mankhwala a PARP inhibitor.

Thandizo la preoperative systemic

Mankhwala othandiza ndi kugwiritsa ntchito mankhwala omwe amalowa m'magazi ndikufikira maselo a khansa mthupi lonse. Preoperative systemic therapy imaperekedwa kuti muchepetse chotupacho musanachite opareshoni.

Amayi omwe ali ndi postmenopausal omwe ali ndi zotupa zotulutsa mahomoni, chithandizo cha preoperative chingaphatikizepo:

• Chemotherapy.

• Thandizo la mahomoni, monga tamoxifen kapena aromatase inhibitor therapy, kwa azimayi omwe sangakhale ndi chemotherapy.

Amayi omwe ali ndi premenopausal omwe ali ndi zotupa zotulutsa mahomoni, chithandizo cha preoperative chingaphatikizepo:

• Kuyesedwa kwachipatala kwa mankhwala a mahomoni, monga tamoxifen kapena aromatase inhibitor therapy.

Kwa amayi omwe ali ndi zotupa zabwino za HER2 / neu, chithandizo cha preoperative chingaphatikizepo:

• Chemotherapy ndi chithandizo chothandizira (trastuzumab).

• Chithandizo choyenera (pertuzumab).

Kwa amayi omwe ali ndi zotupa zoyipa za HER2 / neu kapena zotupa zitatu zoyipa, chithandizo cha preoperative chingaphatikizepo:

• Chemotherapy.

• Kuyesedwa kwachipatala kwa mtundu wa chemotherapy regimen.

• Kuyesedwa kwachipatala kwa mankhwala opatsirana a monoclonal antibody.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansa Yam'mimba Yotsogola Kapena Yotupa Yam'deralo

Chithandizo cha khansa ya m'mawere yotupa kapena yotupa ndi njira zochiritsira zophatikizira izi:

• Opaleshoni (opaleshoni yosunga bere kapena mastectomy yathunthu) ndi lymph node dissection.

• Chemotherapy asanafike kapena / kapena atachitidwa opaleshoni.

• Thandizo la radiation mutatha opaleshoni.

• Thandizo la mahomoni mutatha kuchitidwa zotupa zomwe zimalandira estrogen receptor positive kapena estrogen receptor osadziwika.

• Mayesero azachipatala akuyesa mankhwala osokoneza bongo, mankhwala atsopano, ndi njira zatsopano zoperekera chithandizo.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansa Yam'mimba Yam'mbuyo Yamakono

Chithandizo cha khansa ya m'mawere yobwerezabwereza (khansa yomwe imabwerako mutalandira chithandizo m'mawere, m'chifuwa, kapena m'ma lymph node), ingaphatikizepo izi:

• Chemotherapy.

• Thandizo la mahormone zotupa zomwe zimalandira zabwino.

• Thandizo la radiation.

• Opaleshoni.

• Chithandizo choyenera (trastuzumab).

• Kuyesedwa kwachipatala kwa chithandizo chatsopano.

Onani gawo la Metastatic Breast Cancer kuti mumve zambiri zamankhwala omwe mungafotokozere khansa ya m'mawere yomwe yafalikira mbali zina za thupi kunja kwa bere, chifuwa, kapena ma lymph node.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Khansara ya M'mawere

Njira zochiritsira khansa ya m'mawere (khansa yomwe yafalikira kumadera akutali a thupi ingaphatikizepo izi:

Thandizo la mahomoni

Amayi a postmenopausal omwe adangopezeka kuti ali ndi khansa ya m'mawere yomwe imalandira cholandilira kapena ngati mkhalidwe wa mahomoni sudziwika, chithandizo chingaphatikizepo:

• Mankhwala a Tamoxifen.

• Aromatase inhibitor therapy (anastrozole, letrozole, kapena exemestane). Nthawi zina cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, abemaciclib, kapena alpelisib) amaperekedwanso.

Amayi omwe ali ndi vuto la premenopausal omwe adangopezeka kuti ali ndi khansa ya m'mawere yomwe imathandizira kulandira mahomoni, chithandizo chitha kukhala:

• Tamoxifen, agonist wa LHRH, kapena onse awiri.

• Cyclin-dependent kinase inhibitor therapy (ribociclib).

Kwa amayi omwe zotupa zawo zimakhala ndi cholandilira kapena chosalandirira cha mahomoni chosadziwika, chofalikira kumafupa kapena minofu yofewa kokha, ndipo omwe amathandizidwa ndi tamoxifen, chithandizo chitha kuphatikizira:

• Thandizo la Aromatase inhibitor.

• Mankhwala ena a mahomoni monga megestrol acetate, estrogen kapena mankhwala a androgen, kapena mankhwala a anti-estrogen monga fulvestrant.

Chithandizo chofuna

Amayi omwe ali ndi khansa ya m'mawere yomwe imalandira chithandizo cha mahomoni ndipo sanayankhe mankhwala ena, njira zomwe mungaphatikizepo ndi monga:

• Trastuzumab, lapatinib, pertuzumab, kapena mTOR inhibitors.

• Mankhwala opatsirana pogonana ndi ado-trastuzumab emtansine.

• Cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, kapena abemaciclib) yomwe itha kuphatikizidwa ndi mankhwala a mahomoni.

Azimayi omwe ali ndi khansa ya m'mawere yomwe ili ndi HER2 / neu zabwino, chithandizo chitha kuphatikizira:

• Njira zochiritsira monga trastuzumab, pertuzumab, ado-trastuzumab emtansine, kapena lapatinib.

Kwa amayi omwe ali ndi khansa ya m'mawere yomwe imayambitsa matenda a HER2, ndi kusintha kwa majini a BRCA1 kapena BRCA2, ndipo omwe amachiritsidwa ndi chemotherapy, chithandizo chingaphatikizepo:

• Chithandizo chojambulidwa ndi PARP inhibitor (olaparib kapena talazoparib).

Chemotherapy

Azimayi omwe ali ndi khansa ya m'mawere yomwe imalandira ma hormone receptor negative, sanayankhe mankhwala a mahomoni, yafalikira ku ziwalo zina kapena yadzetsa zizindikilo, chithandizo chitha kukhala:

• Chemotherapy ndi mankhwala amodzi kapena angapo.

Chemotherapy ndi immunotherapy

Azimayi omwe ali ndi khansa ya m'mawere yomwe imayambitsa matenda a hormone receptor ndi HER2 alibe, chithandizo chingaphatikizepo:

• Chemotherapy ndi immunotherapy (atezolizumab).

Opaleshoni

• Chiwerewere chonse cha azimayi omwe ali ndi zotupa za m'mawere zotseguka kapena zopweteka. Thandizo la radiation lingaperekedwe pambuyo pa opaleshoni.

• Kuchita opaleshoni kuchotsa khansa yomwe yafalikira ku ubongo kapena msana. Thandizo la radiation lingaperekedwe pambuyo pa opaleshoni.

• Kuchita opaleshoni kuchotsa khansa yomwe yafalikira m'mapapu.

• Kuchita opaleshoni yokonza kapena kuthandiza kuthandizira mafupa ofooka kapena osweka. Thandizo la radiation lingaperekedwe pambuyo pa opaleshoni.

• Kuchita opaleshoni kuti achotse madzi omwe asonkhana m'mapapu kapena pamtima.

Thandizo la radiation

• Chithandizo cha ma radiation kumafupa, ubongo, msana, bere, kapena khoma pachifuwa kuti muchepetse zizindikiritso ndikukhala ndi moyo wabwino.

• Strontium-89 (radionuclide) kuti athetse ululu wa khansa yomwe yafalikira m'mafupa mthupi lonse.

Njira zina zamankhwala

Njira zina zothandizira khansa ya m'mawere ndi monga:

• Mankhwala osokoneza bongo ndi bisphosphonates kapena denosumab kuti achepetse matenda am'mafupa ndi ululu khansa ikafalikira kufupa. (Onani chidule cha pa Cancer Pain kuti mumve zambiri za bisphosphonates.)

• Kuyesedwa kwachipatala kwa chemotherapy yayikulu ndi kuponyera ma cell a stem.

• Kuyesedwa kwachipatala kwa anti-drug conjugate (sacituzumab).

• Mayesero azachipatala akuyesa mankhwala osokoneza bongo, mankhwala atsopano, ndi njira zatsopano zoperekera chithandizo.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Njira Zothandizira Kuchita Ductal Carcinoma In Situ (DCIS)

Kuti mumve zambiri zamankhwala omwe atchulidwa pansipa, onani gawo la Chisankho Chachidule.

Kuchiza kwa ductal carcinoma in situ kungaphatikizepo izi:

• Opaleshoni yosamalira m'mawere ndi mankhwala a radiation, okhala ndi tamoxifen kapena wopanda.

• Kuchuluka kwa mastectomy wokhala kapena wopanda tamoxifen. Mankhwalawa amatha kuperekedwanso.

Gwiritsani ntchito kusaka kwathu kwamankhwala kuti mupeze mayesero azachipatala omwe amathandizidwa ndi NCI omwe akulandira odwala. Mutha kusaka mayesero kutengera mtundu wa khansa, zaka za wodwalayo, komanso komwe mayeserowo akuchitika. Zambiri pazokhudza mayesero azachipatala zimapezekanso.

Kuti mudziwe zambiri za khansa ya m'mawere

Kuti mumve zambiri kuchokera ku National Cancer Institute yokhudza khansa ya m'mawere, onani izi:

• Khansa ya m'mawere Tsamba

• Zosankha Opaleshoni kwa Akazi omwe ali ndi DCIS kapena Khansa ya m'mawere

• Opaleshoni Yochepetsa Kuopsa kwa Khansa ya M'mawere

• Kubwezeretsanso M'mawere Mutatha Kugonana

• Sentinel Lymph Node Zolemba

• Mabere Olimba: Mayankho a Mafunso Ofunsidwa Kawirikawiri

• Mankhwala Ovomerezeka a Khansa Ya m'mawere

• Thandizo la Hormone la Khansa ya m'mawere

• Njira Zochizira Khansa

• Khansa ya m'mawere yotupa

• Kusintha kwa BRCA: Kuopsa kwa Khansa ndi Kuyesa Kwachibadwa

• Kuyesedwa Kwachibadwa kwa Ma Syndromes Obadwa Ndi Khansa

Kuti mumve zambiri za khansa ndi zinthu zina zochokera ku National Cancer Institute, onani izi:

• Za Khansa

• Kusinthana

• Chemotherapy and You: Kuthandiza Anthu Omwe Ali Ndi Khansa

• Thandizo la Radiation ndi Inu: Thandizo kwa Anthu Omwe Ali ndi Khansa

• Kulimbana ndi khansa

• Mafunso oti mufunse dokotala wanu za khansa

• Kwa Opulumuka ndi Owasamalira