Mtundu wa mankhwala a SERM: Chithandizo chapadera cha khansa ya m'mawere ndi kufooka kwa mafupa (Selective Estrogen Receptor Modulators - SERMs)

Ngati inu kapena munthu amene mumamudziwa wapezeka ndi khansa ya m'mawere, n'zachibadwa kumva mantha ambiri komanso kudabwa. Mofananamo, pamene tikukalamba, mafupa amafooka ndipo ngakhale kugwa pang'ono kungawaswe. Komabe, chifukwa cha kupita patsogolo kwa mankhwala, pali mankhwala othandiza pa matenda amenewa. Lero, tikambirana za mankhwala amodzi otere.

Mwachidule, kodi ma SERM awa ndi chiyani?

Ma SERM ndi chidule cha Selective Estrogen Receptor Modulators . Uwu ndi mtundu wa mankhwala a mahomoni. Izi zimaphatikizapo kuyang'anira momwe hormone ya estrogen m'thupi lathu imagwirira ntchito. Taganizirani izi ngati woyang'anira wanzeru. Zimaletsa zotsatira za estrogen m'mbali zina za thupi, ndipo zimagwira ntchito ngati estrogen m'mbali zina kuti zithandize thupi.

Mankhwala awiri akuluakulu m'gulu lino ndi Tamoxifen ndi Raloxifene . Mankhwalawa amagwiritsidwa ntchito ngati mankhwala othandiza kwambiri pa mitundu ina ya khansa ya m'mawere ndi osteoporosis.

Kodi mankhwala a SERM awa amagwira ntchito bwanji mkati mwa thupi?

Izi zingawoneke zovuta kumvetsa, koma kwenikweni n'zosavuta. Tiyeni timvetse izi ndi chitsanzo.

• Mu khansa ya m'mawere: Maselo ena a khansa ya m'mawere (otchedwa Hormone Receptor positive kapena ER-positive cancers) amafunika uthenga wochokera ku kiyi yotchedwa estrogen kuti akule ndikugawikana. Mankhwala a SERM amagwira ntchito potseka chitseko (receptor) pa maselo a khansa awa. Zili ngati kuyika china chake mu bowo la kiyi la chitseko. Kenako estrogen yeniyeni singathe kufika pa kiyi ndikutsegula chitseko. Zotsatira zake, maselo a khansa amataya uthenga woti akule, ndipo kukula kwawo kumayima kapena kuchedwa.

• Mu mafupa: Nthawi yomweyo, mankhwala a SERM akapita ku mafupa athu, amagwira ntchito ngati estrogen pamenepo. Ndiko kuti, amapita ku zitseko m'mafupa ndikutsegula zitsekozo, kuthandiza kuti mafupa akhale olimba ndikusunga calcium. Izi zimateteza ku osteoporosis.

Kodi mwawona luso lodabwitsa la mankhwala awa? Mankhwala omwewo amagwira ntchito m'njira ziwiri zosiyana kwambiri m'malo awiri. Ndicho chifukwa chake amatchedwa "Selective".

Kodi ntchito zazikulu za SERMs ndi ziti?

Madokotala amalimbikitsa chithandizochi makamaka m'mikhalidwe iwiri.

1. Za khansa ya m'mawere

Ma SERM ndi mankhwala ofunikira kwambiri, makamaka khansa ya m'mawere yomwe imakhudzidwa ndi mahomoni (ER-positive).

• Kwa iwo omwe ali pachiwopsezo chachikulu cha khansa: Ngati wina m'banjamo adadwalapo khansa ya m'mawere, kapena ngati mayeso a majini atsimikizira kuti ali ndi kusintha kwa majini komwe kumawonjezera chiopsezo cha khansa, amapatsidwa mankhwalawa kuti apewe khansa.
• Pambuyo pa opaleshoni ya khansa: Pambuyo pochotsa khansa, ma SERM amagwiritsidwa ntchito poletsa khansa kuti isabwererenso (`kubwereranso`) komanso kupewa khansa kuti isakule m'bere lina.
• Mu DCIS: Kuletsa kubwereranso kwa khansa ya m'mawere (Ductal Carcinoma in Situ (DCIS), khansa yoyambirira yomwe imapezeka m'machubu a m'mawere.
• Khansa yomwe yafalikira m'thupi lonse: Kuletsa khansa yomwe yafalikira ku ziwalo zina m'thupi (Metastatic Breast Cancer).
• Kwa khansa ya m'mawere ya amuna: Ngakhale kuti nthawi zambiri amuna amadwala khansa ya m'mawere, mankhwalawa amagwiritsidwanso ntchito ngati ichitika.

2. Kwa osteoporosis

SERM yotchedwa Raloxifene imagwiritsidwa ntchito poletsa kutayika kwa mafupa, kulimbitsa mafupa, komanso kuchepetsa chiopsezo cha kusweka kwa mafupa, makamaka kwa amayi omwe atsala pang'ono kusamba.

Kodi chithandizochi chikuyenda bwino bwanji?

Inde, uwu ndi mankhwala othandiza kwambiri. Kafukufuku wasonyeza kuti mankhwala a Tamoxifen makamaka amatha kuchepetsa chiopsezo cha khansa ya m'mawere ndi pafupifupi 40% .

• Ngati munthu amene wachitidwa opaleshoni ya khansa m'bere limodzi akumwa Tamoxifen, chiopsezo chotenga khansa m'bere lina chimachepa ndi 50% .
• Kwa munthu amene wakhala ndi khansa asanayambe kusamba, chiopsezo choti khansa ibwererenso chikhoza kuchepetsedwa ndi pakati pa 30% ndi 50% .
• Raloxifene yapezekanso kuti imachepetsa kwambiri chiopsezo cha kusweka kwa msana chifukwa cha kufooka kwa mafupa pambuyo pa kusamba.

Kodi chimachitika ndi chiyani panthawi ya chithandizo?

Mankhwalawa nthawi zambiri amaperekedwa ngati piritsi kapena madzi omwe amatengedwa tsiku lililonse. Nthawi ya chithandizo ingasiyane malinga ndi vuto lanu komanso malangizo a dokotala wanu.

• Tamoxifen: Anthu omwe amamwa mankhwalawa kuti apewe kapena kuchiza khansa ya m'mawere nthawi zambiri amamwa mankhwalawa kwa zaka 5 motsatizana. Dokotala wanu angawonjezere nthawi imeneyi mpaka zaka 10. Muthanso kusinthidwa kukhala mankhwala ena (monga aromatase inhibitor) patatha zaka zingapo.
• Raloxifene: Amene akumwa kuti achepetse chiopsezo cha khansa ya m'mawere kapena matenda a mafupa ayenera kumwa ngati piritsi tsiku lililonse malinga ndi momwe dokotala wawo akulangizira.

Kodi zotsatirapo zake zingakhale zotani chifukwa cha chithandizochi?

Monga momwe zimakhalira ndi chithandizo chilichonse cha khansa, SERMs zingayambitse zotsatira zina zoyipa. Komabe, si aliyense amene angakumane nazo zonse. Zambiri mwa izi zitha kuthandizidwa.

Raloxifene ingakhale ndi zotsatirapo zofanana (monga kutentha thupi, kupweteka kwa miyendo), koma chiopsezo cha khansa ya m'chiberekero ndi chochepa poyerekeza ndi Tamoxifen. Dokotala wanu adzakufotokozerani izi mwatsatanetsatane.

Kodi ndingachite chiyani kuti ndithetse mavutowa?

Pali zinthu zingapo zomwe mungachite nokha kuti mukhale ndi zovuta izi mosavuta.

• Pa kutentha: Chepetsani zakumwa zokhala ndi caffeine monga khofi ndi tiyi. Anthu ena angapeze mpumulo podya zakudya zokhala ndi phytoestrogens monga soya, nyemba, ndi mphodza.
• Pa vuto la kusowa tulo: Kuchita masewera olimbitsa thupi nthawi zonse kungathandize kuti munthu agone bwino.
• Kuuma kwa nyini: Pali zodzoladzola zapadera za nyini zomwe zingagwiritsidwe ntchito pa izi. Funsani dokotala wanu za izi.

Kodi muyenera kufunafuna upangiri wa dokotala nthawi yomweyo liti?

Ngati zotsatirapo zoyipa zikukula kwambiri, uzani dokotala wanu. Komabe, ngati mukukumana ndi zizindikiro zotsatirazi, pitani ku dipatimenti yazadzidzidzi ya chipatala (ETU) nthawi yomweyo kapena imbani 1990. Izi zitha kukhala zizindikiro za matenda oopsa monga sitiroko kapena magazi kuundana m'mapapo (pulmonary embolism).

• Kusanza kapena kufooka mbali imodzi ya thupi kapena nkhope.
• Kuvuta kulankhula, kusalankhula bwino mawu.
• Mutu waukulu mwadzidzidzi.
• Kuvuta kupuma mwadzidzidzi.
• Kupweteka kwambiri pachifuwa, mkono, phewa, kapena nsagwada popanda chifukwa chodziwika.

Musanyalanyaze zizindikiro izi. Kuchitapo kanthu mwachangu kungapulumutse miyoyo.