He aha ka Invasive Lobular Carcinoma? Nā Hōʻailona, Nā Kumu, a me ka Lapaʻau

ʻO ka invasive lobular carcinoma (ILC) ka lua o ka maʻi ʻaʻai umauma maʻamau loa, aia ma kahi o 10-15% o nā maʻi ʻaʻai umauma a pau. ʻAʻole like me nā maʻi ʻaʻai umauma ʻē aʻe e hana i nā ʻōpuʻu kūikawā, ulu ka ILC ma ke ʻano hoʻokahi i loko o ka ʻiʻo umauma, hiki ke paʻakikī ke ʻike ma nā hoʻokolohua kino a me nā hoʻokolohua kiʻi.

Hoʻomaka kēia ʻano maʻi ma nā gland waiū (lobules) o kou umauma a laila pālahalaha i ka ʻiʻo umauma kokoke. ʻOiai ua lohe ʻia ka huaʻōlelo "invasive" he weliweli, ʻo ia wale nō ke ʻano ua neʻe nā cell maʻi ma mua o kahi i hoʻomaka ai. He nui nā kānaka me ka ILC e pane maikaʻi loa i ka lapaʻau, ʻoi aku hoʻi i ka wā i hopu ʻia ai i ka wā mua.

He aha nā hōʻailona o ka invasive lobular carcinoma?

ʻAʻole pinepine ka ILC e hana i ka ʻōpuʻu paʻakikī maʻamau e pili ana ka hapa nui o nā kānaka i ka maʻi ʻaʻai umauma. Ma kahi o kēlā, ulu ia ma ke ʻano e hiki ai ke manaʻo ʻia he mānoanoa a piha paha i loko o kou ʻiʻo umauma.

Eia nā hōʻailona āu e ʻike ai, e hoʻomanaʻo ana ʻaʻole hiki i ka ILC mua ke hana i kekahi hōʻailona:

• Kahi mānoanoa iki a paʻa paha ma kahi hapa o kou umauma ma mua o kahi ʻōpuʻu kūikawā
• Loli i ka ʻano a me ka manaʻo paha o kou ʻiʻo umauma
• ʻO ka pehu umauma a hoʻonui paha ma kekahi ʻaoʻao
• ʻO ka ʻili dimpling a puckering paha e like me ka ʻili ʻalani
• ʻO ka waiū mai ka nipple ʻaʻole waiū umauma
• ʻO ka nipple e huli ana i loko i ka wā ʻaʻole ia i hana ma mua
• Loli i ke ʻano a me ka nui paha o ka umauma
• ʻEha umauma mau a palupalu paha ma kahi wahi

No ka mea hiki ke mālie ka ILC, loaʻa ka nui o nā hihia i nā mammogram maʻamau ma mua o ka ʻike ʻia o nā hōʻailona. He lono maikaʻi kēia no ka mea ʻo ia hoʻi ua hopu ʻia ka maʻi ʻaʻai i kahi kahua mua, ʻoi aku ka maʻalahi o ka mālama ʻana.

He aha nā ʻano o ka invasive lobular carcinoma?

ʻO ka hapa nui o nā invasive lobular carcinomas e komo i loko o ke ʻano maʻamau, akā aia kekahi mau ʻano ʻokoʻa ʻaʻole maʻamau e hiki i kāu kauka ke ʻike. Ke hoʻomaopopo ʻia kēia mau ʻano e kōkua i ka hoʻolālā ʻana i kāu papa hana lapaʻau.

ʻO ke ʻano maʻamau e hana i kahi 80% o nā hihia ILC a pau. ulu kēia mau cell maʻi ma ke ʻano hoʻokahi maʻamau a ʻano hormone receptor-positive, ʻo ia hoʻi e pane maikaʻi lākou i nā lapaʻau hormone therapy.

ʻO nā ʻano ʻaʻole maʻamau e komo pū me ka pleomorphic lobular carcinoma, kahi e ʻano aggressive a ʻaʻole paha e pane i ka hormone therapy. Aia nō hoʻi ka solid lobular carcinoma a me ka alveolar lobular carcinoma, akā he mea maʻamau loa kēia. E hoʻoholo kāu pathologist i ke ʻano pololei āu e loaʻa ai ma ka nānā ʻana i nā laʻana ʻiʻo ma lalo o ka microscope.

He aha ka mea e hoʻokumu ai i ka invasive lobular carcinoma?

E like me ka hapa nui o nā maʻi ʻaʻai umauma, ulu ka ILC i ka wā e loli ai nā cell umauma maʻamau i kā lākou DNA e hoʻokumu ai i ka ulu a me ka mahele ʻana i ka manaʻo ʻole. Eia naʻe, ʻaʻole mākou i hoʻomaopopo piha i ke kumu o kēia mau loli kūikawā i nā cell lobular.

Hiki i kekahi mau mea ke kōkua i ka hoʻomohala ʻana o ka ILC, ʻoiai ʻaʻole ʻo ka loaʻa ʻana o kēia mau mea e ʻōlelo ai e loaʻa nō ʻoe i ka maʻi ʻaʻai:

• Makahiki - ʻoi aku ka nui o nā hihia i nā wāhine ma luna o 50
• Mōʻaukala ʻohana o ka maʻi ʻaʻai umauma a i ʻole ovarian
• Nā loli gene hoʻoilina e like me BRCA1 a i ʻole BRCA2
• Mōʻaukala pilikino o ka maʻi ʻaʻai umauma a i ʻole kekahi mau kūlana umauma benign
• Hoʻohana lōʻihi o ka hormone replacement therapy
• ʻIʻo umauma mānoanoa
• Hōʻike radiation i ka wahi umauma
• Nā mea ola e like me ka inu waiʻona a me ka nele o ka hana kino

He mea nui e hoʻomanaʻo he nui nā kānaka me kēia mau mea pilikia ʻaʻole loaʻa i ka maʻi ʻaʻai umauma, ʻoiai kekahi poʻe me nā mea pilikia ʻike ʻole e hana.

I ka wā e ʻike ai i ke kauka no ka invasive lobular carcinoma?

Pono ʻoe e hoʻokaʻaʻike i kāu kauka inā ʻike ʻoe i kekahi mau loli mau i kou umauma, ʻoiai inā he mea liʻiliʻi lākou. No ka mea hiki ke mālie ka ILC, ʻoi aku ka maikaʻi o ka nānā ʻana i nā pilikia ma mua o ka kali ʻana e ʻike inā e hele lākou.

E hoʻonohonoho i kahi ʻaha kūkā koke inā ʻike ʻoe i kekahi mau loli umauma e lōʻihi ma mua o hoʻokahi pōʻai menstrual. ʻO kēia e komo pū me nā wahi hou o ka mānoanoa, nā loli i ka nui a i ʻole ke ʻano paha o ka umauma, nā loli ʻili, a i ʻole ka waiū nipple. ʻOiai inā ua loaʻa iā ʻoe kahi mammogram maʻamau i kēia manawa, pono nō e loiloi ʻia nā hōʻailona hou.

Inā loaʻa iā ʻoe kahi mōʻaukala ʻohana o ka maʻi ʻaʻai umauma a i ʻole ovarian, e noʻonoʻo e kūkākūkā me kāu kauka e pili ana i ka genetic counseling. Hiki iā lākou ke kōkua iā ʻoe e hoʻomaopopo i kou pilikia a hoʻoholo inā kūpono ka hoʻokolohua gene no ʻoe.

He aha nā mea pilikia no ka invasive lobular carcinoma?

Ke hoʻomaopopo ʻia i ka wā mua a mālama ʻia me ka kūpono, loaʻa i ka hapa nui o nā kānaka me ka ILC nā hopena maikaʻi loa. Eia naʻe, e like me kekahi maʻi ʻaʻai, aia nā pilikia hiki ke ʻike ʻia i hiki iā ʻoe ke hana pū me kāu hui olakino e nānā a hoʻoponopono iā lākou.

ʻO ka manaʻo nui me kekahi maʻi ʻaʻai umauma invasive ka hiki ke pālahalaha i nā lymph nodes kokoke a i ʻole nā ​​​​wahi ʻē aʻe o ke kino. Loaʻa i ka ILC kahi ʻano kiʻekiʻe ma mua o kekahi mau maʻi ʻaʻai umauma e kū ma nā umauma ʻelua, i ka manawa like a i ʻole nā ​​​​makahiki ma hope. ʻO ia ke kumu e hiki ai i kāu kauka ke ʻōlelo aku i ka nānā pinepine ʻana i nā umauma ʻelua.

Hiki i nā pilikia pili i ka mālama ʻana ke komo pū me nā hopena ʻoki kino, e like me nā loli i ka manaʻo umauma a i ʻole ka neʻe ʻana o ka lima ma hope o ka wehe ʻana i nā lymph node. Hiki i ka chemotherapy a me ka radiation therapy, inā pono, ke hana i nā hopena manawa pōkole e like me ka luhi, ka nausea, a i ʻole nā ​​​​loli ʻili. ʻO ka hormone therapy lōʻihi, ʻoiai he mea maikaʻi loa, hiki ke hoʻonui i ka pilikia o nā clots koko a i ʻole ka nalowale o ka iwi i kekahi poʻe.

Hiki i nā pilikia maʻamau ke komo pū me ka hoʻomohala ʻana o ka lua, ʻano maʻi ʻaʻai ʻē aʻe ma hope i ke ola, ʻoiai he haʻahaʻa kēia pilikia. E kūkākūkā kāu hui olakino i kou kūlana kūikawā a kōkua iā ʻoe e hoʻomaopopo i nā pilikia e pili ana i kou hihia.

Pehea e pale aku ai i ka invasive lobular carcinoma?

ʻOiai ʻaʻohe ala i hōʻoia ʻia e pale aku ai i ka ILC, hiki iā ʻoe ke lawe i nā hana e hoʻemi ai i kou pilikia maʻi ʻaʻai umauma holoʻokoʻa a hopu i nā pilikia i ka wā mua i ka wā maʻalahi loa e mālama ʻia.

ʻO nā hoʻololi ola e hiki ke kōkua e komo pū me ka mālama ʻana i kahi kaumaha olakino, ka hoʻoikaika kino maʻamau, ka palena ʻana i ka inu waiʻona, a me ka pale ʻana i ka hormone therapy pono ʻole. Inā e noʻonoʻo ana ʻoe i ka hormone replacement therapy no nā hōʻailona menopause, e kūkākūkā i nā pilikia a me nā pono me kāu kauka.

ʻO ka nānā maʻamau kāu pale maikaʻi loa e kūʻē i ka ILC. E hahai i nā kuhikuhi mammogram no kou hui makahiki, a mai haʻalele i nā ʻaha kūkā. Inā loaʻa iā ʻoe ka ʻiʻo umauma mānoanoa a i ʻole nā ​​​​mea pilikia ʻē aʻe, hiki i kāu kauka ke ʻōlelo aku i nā hoʻokolohua kiʻi hou aku e like me ka breast MRI a i ʻole ultrasound.

No ka poʻe i pilikia nui ma muli o ka mōʻaukala ʻohana a i ʻole nā ​​​​mea pilikia gene, hiki i nā hana pale ke komo pū me ka nānā pinepine ʻana, ka genetic counseling, a i nā hihia maʻamau, ka ʻoki kino pale. He mea pilikino loa kēia mau hoʻoholo a pono e hana ʻia me ka manaʻo mai nā loea e hoʻomaopopo i kou kūlana kūikawā.

Pehea ka hōʻoia ʻana o ka invasive lobular carcinoma?

Pono pinepine ka hōʻoia ʻana o ka ILC i nā ʻanuʻu he nui no ka mea hiki ke paʻakikī ke ʻike i kēia ʻano maʻi ma nā hoʻokolohua kiʻi maʻamau. E hoʻomaka paha kāu kauka me kahi hoʻokolohua kino a nānā i kou mau hōʻailona a me ka mōʻaukala lapaʻau.

ʻO nā hoʻokolohua kiʻi e komo pū me ka mammogram, ʻoiai ʻaʻole hiki ke ʻike maopopo ʻia ka ILC ma kēia hoʻokolohua. Hiki i kāu kauka ke kauoha aku i kahi ultrasound umauma a i ʻole MRI, hiki ke ʻoi aku ka maikaʻi i ka ʻike ʻana i nā maʻi lobular. He mea pono loa ka MRI no ka ILC no ka mea hiki iā ia ke hōʻike i ka nui o ka maʻi ʻaʻai a nānā i ka maʻi ʻaʻai ma ka umauma ʻē aʻe.

Pono kahi hōʻoia hōʻoia i kahi biopsy ʻiʻo, kahi e wehe ʻia ai kahi laʻana liʻiliʻi o ka ʻiʻo kānalua a nānā ʻia ma lalo o ka microscope. Hiki ke hana ʻia kēia me kahi core needle biopsy, kahi i hana pinepine ʻia i ke keʻena o ke kauka me ka anesthesia kūloko. E hoʻoholo ka pathologist ʻaʻole wale inā aia ka maʻi ʻaʻai akā he mau hiʻohiʻona nui e like me ka hormone receptor status a me ka ulu ʻana.

Hiki i nā hoʻokolohua hou ke komo pū me ka hana koko e nānā i kou olakino holoʻokoʻa a me nā haʻawina kiʻi e ʻike inā ua pālahalaha ka maʻi ʻaʻai i nā wahi ʻē aʻe o kou kino. E wehewehe kāu hui olakino i kēlā me kēia hoʻokolohua a me ka manaʻo o nā hopena no kāu papa hana lapaʻau.

He aha ka lapaʻau no ka invasive lobular carcinoma?

He mea pilikino loa ka lapaʻau no ka ILC ma muli o ka nui a me ka wahi o kāu maʻi ʻaʻai, inā ua pālahalaha, a me kāna mau hiʻohiʻona biological. ʻO ka lono maikaʻi, pane maikaʻi loa ka ILC i ka lapaʻau, ʻoi aku hoʻi i ka wā i hopu ʻia ai i ka wā mua.

ʻO ka ʻoki kino ka hana mua pinepine a hiki ke komo pū me ka lumpectomy (wehe wale i ka maʻi ʻaʻai a me kekahi ʻiʻo a puni) a i ʻole mastectomy (wehe i ka umauma). No ka mea hiki ke ʻoi aku ka nui o ka ILC ma mua o ka mea i ʻike ʻia, hiki i kāu kauka ʻoki ke ʻōlelo aku i ka ʻoki kino MRI-guided e hōʻoia i ka wehe piha ʻana. Pono kekahi poʻe i ka wehe ʻana i nā lymph node e nānā i ka pālahalaha ʻana o ka maʻi ʻaʻai.

E loaʻa i ka nui o nā kānaka me ka ILC ka hormone therapy no ka mea he hormone receptor-positive pinepine kēia ʻano maʻi ʻaʻai. Hiki i kēia ke komo pū me nā lāʻau lapaʻau e like me ka tamoxifen a i ʻole aromatase inhibitors, ka mea e pale ai i nā hormones e hoʻoulu ai i ka ulu ʻana o ka maʻi ʻaʻai. Lawe pinepine ʻia kēia mau lapaʻau no 5-10 mau makahiki a he mea maikaʻi loa ia i ka pale ʻana i ka hoʻi hou ʻana.

Ma muli o kou kūlana kūikawā, hiki i kāu oncologist ke ʻōlelo aku i ka chemotherapy, radiation therapy, a i ʻole nā ​​​​lāʻau lapaʻau targeted therapy. ʻO ka hoʻoholo e hilinaʻi ana i nā mea e like me ka nui o ka tumor, ka komo ʻana o ka lymph node, a me kou olakino holoʻokoʻa. E hana pū kāu hui lapaʻau me ʻoe e hana i kahi hoʻolālā e hāʻawi iā ʻoe i ka manawa maikaʻi loa o ka hopena holomua ʻoiai e mālama ana i kou maikaʻi o ke ola.

Pehea e mālama ai i ka invasive lobular carcinoma ma ka home?

ʻO ka mālama ʻana i ka ILC ma ka home e komo pū me ka mālama ʻana i kou olakino kino a me ka manaʻo ʻoiai e hahai ana i kāu papa hana lapaʻau. Hiki i nā hana liʻiliʻi, mau ke hana i kahi ʻokoʻa nui i kou manaʻo i ka wā o ka mālama ʻana a me ka hoʻōla ʻana.

E kau i ka manaʻo ma ka ʻai ʻana i nā meaʻai momona e hāʻawi iā ʻoe i ka ikehu a kōkua i kou kino e hoʻōla. ʻAʻole kēia manaʻo e hahai i kahi meaʻai koʻikoʻi, akā ʻo ka koho ʻana i nā hua, nā mea kanu, nā protein lahilahi, a me nā cereals holoʻokoʻa i ka hiki. E noho hydrated a mai hopohopo inā loli kou makemake i ka wā o ka mālama ʻana - he mea maʻamau kēia.

Hiki i ka hoʻoikaika kino mālie, e like me ka ʻae ʻana o kāu kauka, ke kōkua i ka hoʻemi ʻana i ka luhi a hoʻomaikaʻi i kou manaʻo. Hiki paha kēia e like me ka hele wāwae pōkole a i ʻole ka hoʻolōʻihi māmā. E hoʻomaha i ka wā e pono ai ʻoe, a mai manaʻo he hewa ke lawe ʻana i ka manawa e hoʻōla ai.

He mea nui ka mālama ʻana i nā hopena no kou ʻoluʻolu a me ka holomua o ka mālama ʻana. E mālama i nā hōʻailona a kamaʻilio mau me kāu hui olakino. Hiki iā lākou ke hāʻawi i nā lāʻau lapaʻau a i ʻole nā ​​​​hana e kōkua ai i nā pilikia e like me ka nausea, ka luhi, a i ʻole ka ʻeha. Mai kānalua e hoʻokaʻaʻike ma waena o nā ʻaha kūkā inā loaʻa iā ʻoe nā pilikia.

Pehea ʻoe e hoʻomākaukau ai no kāu ʻaha kūkā kauka?

Hiki i ka hoʻomākaukau ʻana no kāu ʻaha kūkā ke kōkua iā ʻoe e hana i ka hapa nui o kou manawa me kāu hui olakino a hōʻoia iā ʻoe e loaʻa nā ʻike āpau āu e pono ai. E hoʻomaka ma ka kākau ʻana i kou mau nīnau ma mua o kou hiki ʻana.

E lawe mai i kahi papa inoa o nā lāʻau lapaʻau āpau āu e lawe nei, me nā lāʻau lapaʻau over-the-counter a me nā mea hoʻohui. E ʻohi pū i nā moʻolelo lapaʻau pili, ʻoi aku hoʻi nā mammograms mua a i ʻole nā ​​​​haʻawina kiʻi umauma. Inā hiki, e lawe mai i kahi hoaaloha a i ʻole ʻohana hilinaʻi e kōkua iā ʻoe e hoʻomanaʻo i nā ʻike nui i kūkākūkā ʻia i ka wā o ka kipa.

E noʻonoʻo i kou mau hōʻailona a me ka wā i hoʻomaka ai lākou. E mākaukau e wehewehe i nā loli āu i ʻike ai i kou mau umauma, ʻoiai inā he mea liʻiliʻi lākou. Makemake nō hoʻi kāu kauka e ʻike e pili ana i kou mōʻaukala ʻohana o ka maʻi ʻaʻai a me nā pilikia umauma mua āu i loaʻa ai.

E kākau i kou mau nīnau nui loa ma mua, inā he pōkole ka manawa. Mai makaʻu e noi i ka wehewehe inā ʻaʻole ʻoe i hoʻomaopopo i kahi mea - makemake kāu hui olakino e hōʻoia iā ʻoe ua ʻike piha ʻoe i kou kūlana a me nā koho lapaʻau.

He aha ka lawe nui e pili ana i ka invasive lobular carcinoma?

ʻO ka mea nui loa e hoʻomaopopo ai e pili ana i ka ILC ʻo ia kahi ʻano maʻi ʻaʻai umauma hiki ke mālama ʻia loa, ʻoi aku hoʻi i ka wā i hopu ʻia ai i ka wā mua. ʻOiai paha he mea paʻakikī ke ʻike ma mua o nā maʻi ʻaʻai umauma ʻē aʻe, ua hoʻomaikaʻi nui nā holomua i ka kiʻi ʻana a me ka mālama ʻana i nā hopena no nā kānaka me kēia kūlana.

ʻO ka ʻike mua ma o ka nānā maʻamau a me ka nānā ʻana i nā loli umauma kāu mea hana maikaʻi loa no ka hopena maikaʻi. Mai hoʻokuʻu i ke ʻano mālie o nā hōʻailona ILC e hoʻopaneʻe iā ʻoe mai ka ʻimi ʻana i ka mālama lapaʻau inā ʻike ʻoe i kekahi mau loli i kou mau umauma.

E hoʻomanaʻo ʻaʻole e hoʻomaopopo ʻia ʻoe e ka loaʻa ʻana o ka ILC, a me ka mālama kūpono a me ke kākoʻo, hele ka hapa nui o nā kānaka e ola i nā ola piha, olakino. Aia kāu hui olakino e alakaʻi iā ʻoe ma kēlā me kēia ʻanuʻu o ke kaʻina hana, a nui nā kumuwaiwai e loaʻa ana e kōkua iā ʻoe a me kou poʻe aloha e hoʻokele i kēia huakaʻi.

Nā nīnau pinepine e pili ana i ka invasive lobular carcinoma

Q1: ʻOi aku anei ka aggressive o ka invasive lobular carcinoma ma mua o nā maʻi ʻaʻai umauma ʻē aʻe?

ʻAʻole pinepine ka ILC he mea aggressive ma mua o ke ʻano maʻamau o ka maʻi ʻaʻai umauma (invasive ductal carcinoma). ʻO ka ʻoiaʻiʻo, ulu pinepine ka ILC i ka mālie a he hormone receptor-positive pinepine, ʻo ia hoʻi e pane maikaʻi ana i ka hormone therapy. Eia naʻe, hiki ke paʻakikī ke ʻike a hiki ke loaʻa kahi manawa kiʻekiʻe iki o ka loaʻa ʻana ma nā umauma ʻelua i ka manawa.

Q2: No ke aha i ʻike ʻole ai kaʻu mammogram i ka invasive lobular carcinoma?

ʻO ka ILC e ulu ana ma ke ʻano hoʻokahi ma o ka ʻiʻo umauma ma mua o ka hana ʻana i kahi mass kūikawā, ka mea e paʻakikī ai ke ʻike ma nā mammograms. ʻO ia ke kumu e hiki ai i kāu kauka ke ʻōlelo aku i nā kiʻi hou aku e like me ka ultrasound a i ʻole MRI, ʻoi aku hoʻi inā loaʻa iā ʻoe nā hōʻailona a i ʻole nā ​​​​mea pilikia. He mea maikaʻi loa ka MRI i ka ʻike ʻana i ka ILC a me ka hoʻoholo ʻana i kona nui piha.

Q3: Pono anei iaʻu i ka mastectomy inā loaʻa iaʻu ka invasive lobular carcinoma?

ʻAʻole pono. Hiki i ka nui o nā kānaka me ka ILC ke loaʻa ka ʻoki kino mālama umauma (lumpectomy) ma hope o ka radiation therapy. ʻO ke koho ma waena o ka lumpectomy a me ka mastectomy e hilinaʻi ana i nā mea e like me ka nui a me ka wahi o kāu maʻi ʻaʻai, inā aia ia ma nā wahi he nui, a me kou mau makemake pilikino. E kūkākūkā kāu kauka ʻoki i nā koho maikaʻi loa no kou kūlana kūikawā.

Q4: Ke hoʻonui nei ka loaʻa ʻana o ka invasive lobular carcinoma i ka pilikia o ka maʻi ʻaʻai i ka umauma ʻē aʻe?

ʻAe, lawe ka ILC i kahi pilikia kiʻekiʻe iki o ka hoʻomohala ʻana i ka maʻi ʻaʻai ma ka umauma ʻē aʻe i hoʻohālikelike ʻia i kekahi mau ʻano maʻi ʻaʻai umauma. ʻO ia ke kumu e ʻōlelo pinepine ai kāu kauka i ka nānā mau ʻana i nā umauma ʻelua me nā haʻawina kiʻi. Koho kekahi poʻe e hana i ka ʻoki kino pale ma ka umauma ʻaʻole i pilikia, akā he hoʻoholo pilikino loa kēia e pono e hana ʻia me ka noʻonoʻo pono a me ke alakaʻi loea.

Q5: Pehea ka lōʻihi e pono ai iaʻu e lawe i ka hormone therapy no ka invasive lobular carcinoma?

Lawe ka hapa nui o nā kānaka me ka hormone receptor-positive ILC i ka hormone therapy no 5-10 mau makahiki ma hope o kā lākou mālama mua. ʻO ka lōʻihi pololei e hilinaʻi ana i kou mau mea pilikia pilikino a me ka maikaʻi o kou hoʻomanawanui ʻana i ka lāʻau lapaʻau. E hana pū kāu oncologist me ʻoe e hoʻoholo i ka lōʻihi kūpono o ka mālama ʻana, e kaulike ana i nā pono o ka mālama mau ʻana me nā hopena āu e ʻike ai.