Uma sizwa ngomdlavuza webele, sishaqeka kakhulu. Futhi uma sizwa ukuthi sekuyisigaba sesine, okungukuthi, umdlavuza ususakazekele kwezinye izingxenye zomzimba, kuba yinto eyesabekayo futhi ewumthwalo omkhulu. Lesi yisimo esibucayi ngempela. Kodwa ngale sayensi yezokwelapha ethuthukisiwe, kunezindlela eziningi zokwelapha ezingenziwa kulesi sigaba, ezingasiza ekulawuleni lesi sifo futhi zandise impilo. Ngakho-ke ake sixoxe ngalokhu namuhla, ukuze sithole izimpendulo ezilula zemibuzo onayo engqondweni.
Yini ngempela iSigaba IV?
Kalula nje, isigaba sesi-4 sisho ukuthi amangqamuzana omdlavuza aqale ebeleni asakazeke ngegazi noma ngemithambo ye-lymph aye kwezinye izingxenye zomzimba. Lokhu kusabalala kubizwa ngokuthi 'i-Metastasis'. Izindawo ezivame kakhulu lapho umdlavuza ungasakazeka khona ngale ndlela amathambo, ubuchopho, amaphaphu, noma isibindi .
Into ebalulekile okufanele uyiqonde lapha ukuthi umgomo oyinhloko wokwelashwa kulesi sigaba akukhona ukwelapha lesi sifo ngokuphelele, kodwa ukulawula ukukhula komdlavuza, ukunciphisa izimpawu, nokukunikeza impilo enhle isikhathi eside ngangokunokwenzeka. Ezinye iziguli ziphila iminyaka eminingi nalokhu kwelashwa. Ngakho-ke, kubalulekile ukungesabi uma uzwa ngalokhu kungenzeka, kodwa ukukhuluma ngokucophelela nodokotela wakho ngezinketho zokwelapha ezitholakalayo.
Yiziphi izindlela zokwelapha eziyinhloko ezitholakalayo?
Esigabeni sesi-4, ngenxa yokuthi umdlavuza ususakazekele ezindaweni eziningi, kunzima ukuthola imiphumela ephumelelayo ngokwelashwa okuhlose indawo eyodwa kuphela, njengokuhlinzwa noma ukwelashwa ngemisebe. Ngakho-ke, ukwelashwa okusemzimbeni okuthinta umzimba wonke kuvame ukusetshenziswa.
Ukwelashwa ngamakhemikhali
Ukwelashwa ngamakhemikhali kuvame ukuba yindlela yokwelapha eyinhloko kulesi sigaba. Kusebenza ngokubulala amangqamuzana omdlavuza ahlukana ngokushesha. Lokhu kungalibazisa ukukhula komdlavuza. Ukwelashwa ngamakhemikhali kunikezwa ngezindlela ezahlukene. Ngezinye izikhathi kunikezwa njengamaphilisi, kodwa ngokuvamile kunikezwa ngemithambo yegazi (ngomthambo) .
Lokhu kwelashwa akukwenziwa njalo. Ngokuvamile kunikezwa ngemijikelezo eminingana. Ngemva kokuphela komjikelezo owodwa, umzimba unikezwa isikhathi esifushane sokuphumula ukuze ululame. Kulapho-ke kuphela lapho umjikelezo olandelayo uqala khona.
Ukwelashwa ngama-hormone
Lokhu kwelashwa akufanele wonke umuntu. Kusebenza kahle kakhulu kwabesifazane abanohlobo lomdlavuza olubizwa ngokuthi i-hormone receptor-positive . Lokhu kusho ukuthi ama-hormone afana ne-estrogen emizimbeni yabo akhuthaza ukukhula kwamaseli omdlavuza. Cabanga ngale ndlela: ama-hormone afana nesihluthulelo, kanti i-receptor esesiseleni somdlavuza ifana nesihluthulelo. Uma ufaka isihluthulelo, isihluthulelo siyavuleka bese umdlavuza uyakhula.
Ngakho-ke lokho okwenziwa yilezi zindlela zokwelapha ngama-hormone ukuvimba ukukhiqizwa kwaleso sihluthulelo (i-hormone), noma ukusivimba ukuthi singangeni esihluthulweni. Izinhlobo eziyinhloko zemithi enikezwayo yalokhu yilezi:
- "Tamoxifen"
- Ama-Aromatase inhibitors (kwabesifazane asebedlulile esikhathini sokuya esikhathini) - Izibonelo: I-Anastrozole (i-Arimidex), i-Exemestane (i-Aromasin)
- Izidakamizwa ezifana ne-`Fulvestrant (Faslodex)` ezivimba ama-hormone receptors.
Ngezinye izikhathi, ukususwa kwama-ovari ngokuhlinzwa kuyanconywa kwabesifazane abangakafiki esikhathini sokunqamuka kokuya esikhathini, njengoba kuyindlela enhle yokumisa ukukhiqizwa kwama-hormone asiza ukukhula komdlavuza.
Ukwelashwa Okuqondiwe
Lokhu kuyindlela yokwelapha entsha nephumelelayo kakhulu. Esikhundleni sokulimaza amangqamuzana anempilo njenge-chemotherapy, ihlasela futhi ihlasele amaprotheni noma izakhi zofuzo ezithile ezitholakala kumaseli omdlavuza kuphela . Lokhu kuphumela emiphumeleni embalwa kakhulu.
Cishe ama-20% abesifazane abanomdlavuza webele baneprotheyini eningi kakhulu ebizwa ngokuthi i-'HER2'. Lokhu kubangela ukuthi umdlavuza usabalale ngokushesha. Kulezi zinhlanzana 'ezine-HER2', kunikezwa imithi efana ne-'Trastuzumab (Herceptin)'. Ivimba iphrotheyini 'ye-HER2' ukuthi isebenze futhi ilawula ukukhula kwamaseli omdlavuza.
Khumbula, isigaba sesine asisho ukuphela kokwelashwa. Lesi yisikhathi sokugxila ekwelashweni okusiza ukulawula lesi sifo nokugcina impilo isezingeni elihle.
Ake sibheke ezinye izinhlobo zokwelapha eziqondiwe kuthebula elingezansi.
| Uhlobo lokwelapha oluqondiwe | Umgomo kanye nomsebenzi | Izimo zokusetshenziswa |
|---|---|---|
| Ama-CDK4/6 Inhibitors | Ivimba amaprotheni abizwa ngokuthi i-CDK futhi ilawula ukuhlukaniswa kwamaseli omdlavuza. Isibonelo: i-Palbociclib (Ibrance), i-Ribociclib (Kisqali) | Kumdlavuza one-hormone receptor-positive kanye ne-HER2-negative. |
| Izithibi ze-PARP | Ihlose iphrotheni ye-PARP, esiza amangqamuzana omdlavuza ukukhula. Isibonelo: i-Olaparib (Lynparza) | Kumdlavuza ongenawo ama-HER2 futhi one-BRCA gene mutation. |
| Izithibi ze-mTOR | Ivimba iphrotheni ye-mTOR futhi imise ukukhula nokusabalala kwamaseli omdlavuza. Isibonelo: I-Everolimus (i-Afinitor) | Ngokwelashwa ngama-hormone kwezinhlobo ezithile zomdlavuza. |
| Ama-antibody-drug conjugates | Umuthi we-chemo unamathiselwe ku-antibody, ohambisa umuthi ngqo engqamuzaneni lomdlavuza bese ulibhubhisa. Isibonelo: I-Sacituzumab govitecan (Trodelvy) | Ngomdlavuza webele othuthukile. |
Ukwelashwa nge-immunotherapy
Lokhu futhi kuyindlela yokwelapha esezingeni eliphezulu kakhulu. Esikhundleni sokunikeza imithi evela ngaphandle ukubulala umdlavuza, kuvuselela amasosha omzimba wakho ukuthola nokubhubhisa amangqamuzana omdlavuza. Amanye amangqamuzana omdlavuza ayazi ukuthi angacasha kanjani ohlelweni lokuzivikela komzimba. Ngakho-ke le mithi ikhubaza lezo zindlela zokufihla futhi ivumele amangqamuzana omzimba ukuba abone umdlavuza.
Ukuhlinzwa kanye Nokushiswa Kwemisebe
Njengoba sishilo ngaphambili, lokhu akusetshenziswa njengokwelashwa okuyinhloko kulesi sigaba. Kodwa-ke, uma kukhona ubuhlungu obukhulu endaweni lapho umdlavuza usakazeke khona, isibonelo ethanjeni, ukwelashwa ngemisebe kunikezwa ukulawula ubuhlungu nezinye izimpawu . Futhi, ukuhlinzwa kungenziwa kuphela uma kudingeka ukulawula noma yiziphi izinkinga.
Amanye amaphuzu abalulekile
- Ukuphathwa kwemiphumela emibi: Zonke lezi zindlela zokwelapha zingaba nemiphumela emibi, njengesicanucanu, ukuhlanza, kanye nokukhathala. Kodwa kunemithi etholakalayo yokuzilawula. Ngakho-ke tshela udokotela wakho nganoma yikuphi ukungakhululeki okuzwayo.
- Izivivinyo Zemitholampilo: Ngezinye izikhathi, ungase ukwazi ukuhlanganyela 'Ezivivinyweni Zemitholampilo', ezihlola ukwelashwa okusha okungakasetshenziswa kabanzi. Lokhu kungakunika ithuba lokuthola ukwelashwa okuphambili. Buza udokotela wakho ngalokhu futhi.
Lolu hambo akuyona into odlula kuyo wedwa. Umndeni wakho, abangani, odokotela, abahlengikazi, kanye nethimba lonke lezokwelapha bakanye nawe. Thola ukwesekwa kwabo. Yabelana ngemizwa yakho. Kuzoba amandla amakhulu ukudlula kulesi sikhathi esinzima.
Umlayezo Wokuya Nawe Ekhaya
- Umdlavuza webele weSigaba IV usho ukuthi umdlavuza ususakazekele kwezinye izingxenye zomzimba.
- Umgomo oyinhloko wokwelashwa kulesi sigaba akukhona ukwelapha lesi sifo ngokuphelele, kodwa ukulawula umdlavuza, ukunciphisa izimpawu, nokwandisa impilo ngekhwalithi enhle yokuphila.
- Ukwelashwa ngamakhemikhali, ukwelashwa ngama-hormone, ukwelashwa okuqondiwe, kanye nokwelashwa nge-immunotherapy yizona zindlela eziyinhloko zokwelapha.
- Udokotela wakho uzonquma ukwelashwa okufanele kakhulu kuwe ngokusekelwe kuhlobo lomdlavuza wakho (isb., i-HER2-positive noma i-hormone receptor-positive).
- Kukhona nemithi yokulawula imiphumela emibi evela ekwelashweni, ngakho-ke khuluma nodokotela wakho nganoma yikuphi ukungakhululeki okungenzeka ukuthi ubhekene nakho.
- Kubaluleke kakhulu ukuhlala uqinile engqondweni futhi ufune ukwesekwa emndenini kanye nethimba lezokwelapha.
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