Chirwere chepabonde ndechimwe chezvinhu zvinowanzovhiringidza zvinopisa, izvo zvinowanzokonzera rufu pakati pevakadzi. Zvisinei, kusiyana nemamwe marudzi mazhinji emakumbo, akadai semapapu emapapu kana pancreatic, izvo zvinokurumidza kutungamirira kurufu rwechizhinji chevarwere, mucheche rehapa, mushonga unogona kuitika muzvitatu zvevatatu. Muchikamu chinoti "Cancer Breast in Young Women" iwe uchawana ruzivo rwakakosha iwe pachako.
Risk boka
Kusiyana nekutenda kwakakurumbira, kenza yemazamu inowedzera kunyanya kuvakadzi vakwegura, kazhinji kazhinji mushure mokunge apera. Mikana yekuitika kwechirwere ichi kusvika makore 35 inenge 1: 2500. Pakazosvika makore makumi mashanu, njodzi iyi inokwira 1:50, uye nemakore makumi mapfumbamwe nemasere inosvika pakuramba kwe1:10. Kunyange zvazvo kazhinji zvisingaiti kutarisa chinonyatsokonzera kenza yemazamu, zvimwe zvipingamupinyi zvinokonzera kukura kwechirwere zvinonyatsozivikanwa:
• age;
• anamnesis wechirwere mumhuri kana murwere;
• maitiro emapfupa anonyanya kuora;
• Kuwedzeredza kwemadzimai evanhukadzi sex hormone estrogen (kutanga kuenda kumwedzi uye gare gare kunotanga kuenda kumwedzi), pamwe chete nekushandiswa kwehomoni inotsiviwa nehutachiona (HRT);
• zvikamu zvekudya uye kunwa doro.
Mukadzi, ane mhuri dzakawanda nhengo, kunyanya nhoroondo yehama (madzimai, hanzvadzi nevanasikana), vanotambura nekenza, iri pangozi yakakura yekuvandudza chirwere. Izvi zvinokonzerwa nenhaka yekenza yepamu yemazamu. Masayendisiti akacherechedza majini maviri anokonzera kenza, BRCA1 uye BRCA2. Dambudziko rekudzivirira chirwere chemafupa chinouraya kune vanotakura mazamu aya ndeye 87%. Nokuda kwechikonzero ichi, zvakakosha zvikuru kuziva mhuri dzakadaro uye kutungamira mazano ekuberekwa kwehupenyu. Ijini rekenza yemvere kubva kumukadzi anorwara inoparidzirwa kune vana vane mikana ye50%. Nhengo dzemhuri dzakagara nhaka iyi geni dziri pangozi yakakura yekugadzira dumbu.
Zvimwe zvinhu
Kunyange zvazvo kuvapo kwekenza yepamuti yebonde ndicho chikonzero chinonyanya kukosha chekukura kwechirwere, zvinokosha kunzwisisa kuti pakati pezvose zvinokonzerwa nekenza yebonde, chiyero chevarwere vari mumhuri avo mazamu aya anowanikwa ari pasi pe10%. Kune nzira dzakawanda dzekudzivisa chifuva chepamu. Kushandiswa kwavo kunowanzokosha kuvakadzi vari pangozi, uye kunyanya kune vanotakura imwe yevana vanorwara nekenza yevana.
Tamoxifen
Pamberi pekudzivirira kenza yemvere, chirwere che anti-tungsten tamoxifen chakashandiswa. Ongororo dzakaitwa muUnited States dzakaratidza kuti vakadzi vakatora mishonga kwemakore mashanu, vakarwara nekenza yemazamu kashoma pane avo vasina kuitora. Kune rumwe rutivi, kushandisa tamoxifen kwakawedzera mukana wekuve nekenza yemapetometri (mucous membrane ye chibereko) uye thromboembolism (kuumbwa kwe thrombi mumaketani emakumbo ezasi uye kuenda kwavo kumidziyo yemapapu). Mukuwedzera, zvakazoitika kuti kushandiswa kwechirwere hazvina kuderedza kuwandisa kwekufa kubva pamukamu webonde. Mhedziso yekutanga yezviongorori zvemazuva ano mune boka revakadzi vane nhoroondo yemhuri yekenza yekamu haisi kusimbisa hutano hwe tamoxifen. Zvinopesana nemigumisiro zvinokonzera kusasha kwehubatano hwehutano hwehutano. Vakadzi vanofunga nezvekugona kwekemoprophylaxis yekenza yemazamu vanofanira kuwana ruzivo rwakakwana kubva kune nyanzvi yakakodzera.
Kuvhiyiwa kwokudzivirira
- Mastectomy. Nzira yakanakisisa yekudzivirira nemigumisiro yakanakisisa ndeyomumwe mastectomy (kana mastectomy muvarwere vagara vambobatwa nekenza yemvere). Kubvisa hutano mammary glands chisarudzo chakasimba chinoda kunyatsofungisisa uye kuenzanisa kwezvimwe nzira. Kuderedzwa kwengozi yekenza yemazamu kunobatanidzwa zvakananga nehuwandu hwehutachiona hwakabviswa. Nokuda kwechikonzero ichi, kushandiswa kwemukati mastectomy nekuchengetwa kwembambo kazhinji hakunzwisiswi, sezvo inodarika anenge 10 muzana yezamu, zvichienzaniswa ne1% mushure mekushanda kwetsika.
- Ovariectomy. Kutakura kwemajeni eBCA kune mungozi yakanyanya uye kenza yemaawa, naizvozvo, inofanira kuonekwa sechinhu chekudzivirira ovariectomy (kubviswa kweiyo mavari).
Ovariectomy inoderedza dambudziko rekudzidzira chiremera chemazamu kuburikidza nekuderedza huwandu hwekushandiswa kweesrogen, kusanganisira mune vakadzi vanotakura geni re BRCA. Kushungurudzwa kwekenza yemazamu kunogona kuitika munyaya dzinotevera:
• kuonekwa kwechirwere chekudzivirira zvirwere mukuongorora screen mammography;
• kuonekwa kwechiremera nemurwere.
Zviratidzo zvinowanzozivikanwa zvekenza yemazamu zvinosanganisira kuvapo kwezvedzidzo, kuchinja mumamiriro ehutachiona, kusvibiswa kweganda nemukono, kubudiswa kubva mukoti. Kuongororwa kwechirwere kunowanikwa pamakiriniki ekuongorora, mammography uye kuguma kwechirwere chinopisa. Mune vamwe vakadzi, kunyanya kuvasikana vaduku, mammography hainyatsodzidzisi pamusana pehuwandu hwezvinyorwa zveglandular, mumamiriro ezvinhu akadaro, imwe nzvimbo yekutarisa kune ultrasound kuongorora kana magnetic resonance imaging. Mune varwere vazhinji vane chirwere chinorangarirwa chinotyisa, kenza yemazamu haisimbiswi. Nechitendero chakanaka, mukadzi anotarirwa kurapwa. Inoda chirongwa chekurapa maitiro anosanganisira chiremba, chiremba, physiotherapist nedzimwe nyanzvi. Basa rinokosha rinowedzerwa nevashandi vezvechiremba, avo vakarovedzwa kutarisira varwere vane kenza yemazamu, kuitira kuti vabatsirwe pane dzimwe nguva zvirwere zvakanyanya. Nzira itsva dzehutano hwekenza yemazamu dzakabvumidzwa kuderedza kufa kwehutachiwana hwechirwere ichi ne30%. Purogiramu yekurapa inogona kusanganisira chirwere, radiotherapy, hormonal kana chemotherapy.
Muvarwere vazhinji, nzira yekutanga yekurapa kenza yebonde ichivhiyiwa - kubviswa kwemuviri wekutanga.
Operation
Mune varwere vane chirwere chikuru, inonyanya kukosha kuita mastectomy (kubviswa kwezamu rose), mushure mokunge chirongwa chepurasitiki chinogona. Nekamudiki kadiki yekutuka, kushandiswa kwemakemikari kunowanzoitwa, mune chikamu cheglandanho chiri kubviswa. Kupindira kwakadaro kunonyanya kunakirwa kubva kune chinangwa chekuzora. Munguva yekushanda, sekutonga, chikamu kana kuti yese ye lymph nodes yechasillary region inobviswa. Zvadaro, kugadzirira kunoongororwa pasi pekroscope, mushure mokunge chirwere chechipatara chinopa mhedziso kuti inonyanya kukosha kwechiremera chepamuviri, chirwere chake chemaitiro, nhamba ye lymph nodes dzakagadziriswa uye kuwanda kwezvinyorwa zveestrogen. Iyo yakaoma yakaongororwa nemurwere kazhinji inosanganisira chifu che X-ray kuti ione kupararira kwemarara, kuongororwa ropa, uye, kana ichifungidzirwa kuti inoshanda, pfupa reko kana kuti ultrasound kuongororwa kwechiropa. Kubva pakuzara kwezvinhu izvi, chirongwa chekuwedzera kurapwa chinogadzirwa.
Radiotherapy
Postoperative radiotherapy inofungidzirwa kuti inomiririra chikamu chekurapa kune varwere vanoita sarudzo resection; kusvibiswa kwedunhu reAxillary kunogona kuva imwe nzira yokubvisa kushandiswa kwemakirini emakirini. Zvinonyatsozivikanwa kuti postoperative radiotherapy yemunharaunda yechironda, maitiro anowanikwa pasi uye mhepo inogadzirisa nzvimbo inoderedza ngozi yekudzoka, izvo zvinozoita kuti kuderedza kufa. Chemotherapy uye hormone therapy inorayirwa intravenously kana muromo mushure mekuvhiyiwa. Izvi zvakakosha kuti kuparadzwa kwe micrometastases - zviduku zviduku zvezvipembenene zvakaparadzaniswa kubva pane zvakanyanya kutarisa uye kupararira kuburikidza nemuviri. Iyo foci yekutsvaira tsvina inomirira kutyisidzira kwekudzoka kwechirwere.
Hormonotherapy
Cyclic inoshandiswa muzvinyama zvemazamu zviri pasi pesimba reestrogen. Mumakumi makumi matanhatu ematatu ematambudziko, isrogen receptors inowanikwa mumakumbo emvere, saka tamoxifen, iyo inovhara aya anogamuchira zvirwere zvekenza, inogona kushandiswa kurapwa. Izvi zvinoderedza ngozi yekupararira nekudzoka kwechirwere. Zvidzidzo zvemazuva ano zvinoratidza kuti vakadzi vane chirwere chesaurogen-sensitive mushure vanotora tamoxifen kwemakore mashanu mushure mekuvhiyiwa vane maitiro akanaka zvikuru.
Chemotherapy regimens
Mune varwere vari pasi pemakore makumi mashanu nemakore nekenza yebhumbu, chiitiko chakanaka cheAdjuvant (kuwedzera) chemotherapy yakaratidzwa. Shanduro yakarurama kwazvo yeyi nzira yekurapa kune varwere vane ngozi yakawanda yekudzoka. Zvimwe zvakasiyana-siyana zvemakemikrasi zvakagadzirirwa izvo zvinoratidzwa kuderedza dambudziko rekuorazve kwechirwere. Rimwe rinowanzoshandiswa regimen inonzi CMF uye inosanganisira cyclophosphamide, methotrexate uye 5-furouracil. Kuwedzera mishonga yakadai yemazuva ano se doxorubicin uye paclitaxel, inobatsira kuvandudza migumisiro ye chemotherapy.
Mune varwere vane kenza yemastastatic breast - kupararira kwemarara kune muviri - chirwere hachigoneki. Kunyange zvakadaro, kune nzira dzokurapa dzinotarirwa kuderedza zviratidzo, uye zvinoitika zvemazuva ano zvinowedzera kuwedzera mukana wekupona. Zvinosuruvarisa, pasinei nekufambira mberi kwakakosha kunoitwa mukurapa kenza yemazamu mumakumi emakore achangopfuura, kwete murwere wese ane mukana wekuwanazve. Varwere vane kuvapo kwemasastases panguva yekuongororwa kwekenza kana avo vane zvivako zvavo zvakabuda pashure pokutanga kurapwa vane maitiro asina kunaka. Nzvimbo dzinowanzowanikwa munzvimbo dzekugadzirisa zvirwere zvinokwana mapfupa, chiropa, mapapu, ganda uye zviduku zvinoputika, pamwe neuropi.
Zvinangwa zverapi
Kurapa kwevakadai vakagadzirirwa kuwedzera nguva refu uye kuderedza zviratidzo (palliative therapy). Kunyange zvazvo vamwe varwere vane zvikamu zvepamusoro zvekenza vanogona kupona uye makore akawanda, kutaura pamusoro pemishonga mumamiriro ezvinhu akadaro hazvidiwi. Kushanda kwekuvhiya uye radiotherapy muhupo hwemasastases hauna kukosha kupfuura chemo uye hormone therapy, sezvo zvinodhaka zvinogona kuparadza tumori masero mumuviri wose. Chimwe chete chinokonzerwa nemasitasase emapfupa, ayo anonyanya kufarira radiotherapy. Kuti kuderedze njodzi yemapfupa uye zvinetso zvakafanana, kusanganisira fractures, shandisa boka remishonga inozivikanwa se bisphosphonates. Kusarudzwa kwenzira yekurapa inobva pane nzvimbo yekenza yekenza, kurapwa kwakapfuura, maitiro ehutu uye huwandu hwehutano hwomurwere.
Unhu hwehupenyu
Pavanoronga chirongwa chekurapa, vanotora nzira imwe neimwe kumurwere mumwe nomumwe, nekusimbiswa pakuvandudza hupenyu hwehupenyu. Kuti zvive zvakanyanya kugadzikana kuderedza zviratidzo zvechirwere, zvinokurudzirwa kusanganisira vanachiremba uye vanamukoti vakarovedzwa kuti vatsigire kutarisira. Kudzora kwemarwadzo ekurwadziwa uye mamwe matanho anotsigira panguva iyi anova anokosha zvikuru. Masayendisiti uye vanachiremba pasi pose vari kushingaira vachigadzira nzira itsva dzekurwisana nekenza, uye varwere vanowanzokokwa kuti vabatane mukutsvakurudza kwekliniki. Kazhinji kazhinji mumamiriro ezvinhu akadaro, kuenzanisa nekuenzanisa kwehutachiona huripo uye huripo. Zvimwe zvidzidzo, zvisingaenzanisi nezvakave zvakashandiswa zvakanyanya, kuedza shanduro itsva, kuongorora basa rayo uye chepfu.
Clinical trials
Zvidzidzo zvekuchipatara zvinosarudza mushonga unoshanda zvakanyanya uye inopa ruzivo rwakakosha yekutsvaga mishonga mitsva mumichina inodhura. Mhemberero dzinoratidza zvibereko zvakanakisisa zvekurapa kune ivavo varwere vanotora muzviedzo. Maitiro emangwana anozivikanwa nekubva pamasikirini emakemikari kune kushandiswa kwezvinodhaka zvinodhaka zvinosangana nezvinodiwa nemurwere.