Chii chinonzi Mushonga Wakanyatsorongwa weKenza yeMazamu? Chinangwa, Maitiro & Mhedzisiro

Mushonga wakanyatsorongwa wekenza yemazamu inzira yakagadzirirwa munhu mumwe nemumwe inoshandisa magadzirirwo ejeni etumor yako kutungamira sarudzo dzekurapa. Panzvimbo pokushandisa chirongwa chimwe chete chekurapa, vanachiremba vanoongorora hunhu chaihwo hwemasero ako ekenza kuti vasarudze marapirwo anonyanya kushanda kwauri.

Nzira iyi inomiririra shanduko huru kubva kumaitiro ekurapa kenza echinyakare. Chikwata chako chekurapa chinoongorora ese ari maviri DNA yako yekenza uye dzimwe nguva chimiro chako chejeneti kuti chigadzire zano rekurapa rakagadzirirwa zvakananga mamiriro ako. Funga nezvazvo sekunge uine chirongwa chakadzama chekenza yako chinobatsira vanachiremba kusarudza zvombo zvinonyanya kushanda kurwisa.

Chii chinonzi mushonga wakanyatsorongwa wekenza yemazamu?

Mushonga wakanyatsorongwa wekenza yemazamu inzira yekurapa inoongorora maitiro emamorekuru uye majeneti etumor yako chaiyo. Chiremba wako anoshandisa ruzivo urwu kusarudza marapirwo akatarwa anonyanya kushanda kurwisa rudzi rwako rwekenza yemazamu.

Nzira iyi inoenda kure kupfuura kutarisa saizi nenzvimbo yetumor yako. Panzvimbo pezvo, inoongorora masero ekenza pasi pemicroscope uye inoita bvunzo dzejeni kuti inzwisise kuti kenza yako inokura sei uye inopararira. Chinangwa ndechekukwanisa kurapwa kunotarisa nzira chaiyo iyo kenza yako inoshandisa kurarama nekukwana.

Chimiro chejeneti chekenza yako chinoita semunwe wakasiyana netumor yako. Dzimwe kenza yemazamu inovimba nemahomoni seestrogen kuti ikure, nepo dzimwe dziine protein yakawanda inonzi HER2. Vamwe vachiri vane shanduko dzejeni dzinoita kuti vapindure zviri nani kumishonga yakati wandei. Nekuziva hunhu uhu, chikwata chako chekurapa chinogona kusarudza marapirwo anorwisa nzvimbo dzisina simba dzekenza yako.

Nei mushonga wakanyatsorongwa wekenza yemazamu uchiitwa?

Mushonga chaiwo unobatsira vanachiremba kusarudza mishonga inoshanda zvakanyanya vachidzivisa mishonga isingashande kune gomarara rako. Nzira iyi inogona kuvandudza mhedzisiro yekurapa kwako uye kuderedza mhedzisiro isina kufanira kubva kumishonga isingakubatsire.

Kurapa gomarara rezamu kwechinyakare kazhinji kwaibatanidza kuyedza mishonga yakajairika uye kuona maitiro ako. Nemushonga chaiwo, vanachiremba vanogona kufanotaura kuti ndeipi mishonga inogona kushanda zvakanyanya usati watotanga. Izvi zvinochengetedza nguva inokosha uye zvinokubatsira kudzivisa mutoro wemuviri uye wepfungwa wemishonga isingashande.

Chimiro chemajini egomarara rako chinogona zvakare kubatsira kufanotaura kuti rinogona kuve rakanyanya sei uye kana richizodzoka mushure mekurapa. Ruzivo urwu runobatsira timu yako yezvokurapa kugadzira chirongwa chekurapa chakanyanya kukwana chinogadzirisa kwete chete gomarara rako razvino, asiwo chinoshanda kudzivirira kudzoka kwemunguva yemberi.

Ndeipi nzira yekuyedzwa kwemushonga chaiwo?

Kuyedzwa kwemushonga chaiwo kunotanga nekuongorora sampuli yematishu ako etumor, anowanzo kutora panguva yebiopsy yako kana kuvhiyiwa. Laboratori inoongorora tishu iyi ichishandisa nzira dzepamusoro dzekuyedza majini kuti ijekese shanduko chaiyo uye hunhu hwemasero ako egomarara.

Chiremba wako achatanga kuunganidza sampuli yematishu kana isingatowanikwi kubva pakuongororwa kwako kwekutanga. Sampuli iyi inoenda kulaboratory yakakosha uko vanachiremba vanobvisa DNA neRNA kubva kumasero ako egomarara. Vanobva vaita bvunzo dzakazara dzemajini, dzinowanzo kunzi tumor profiling kana genomic sequencing, kuti vaone shanduko chaiyo uye mazinga eprotein.

Maitiro ekuyedza anowanzo sanganisira ongororo yakakosha inobatsira kupenda mufananidzo wakakwana wegomarara rako:

• Kuedzwa kwe hormone receptor kuti uone kana kenza yako ichikura nekuda kwe estrogen kana progesterone
• Kuedzwa kweHER2 protein kuti uone kana kenza yako iine protein iyi inokurudzira kukura yakawanda
• Kuongorora kwe genetic mutation kuti utsvage shanduko dzakatarwa mumajini ane chekuita nekenza
• Tumor mutation burden testing kuti uone kuti kenza yako ine shanduko ngapi dzemajini dzese
• Microsatellite instability testing kuti uone matambudziko ekugadzirisa DNA

Nzira yese yekuedzwa inowanzo tora vhiki imwe kana mbiri, kunyangwe mamwe mhedzisiro angawanikwa nekukurumidza. Chikwata chako chekurapa chichaongorora mhedzisiro yese pamwechete kuti vagadzire chirongwa chako chekurapa chakagadzirirwa iwe pachako.

Maitiro ekugadzirira precision medicine testing?

Kuedzwa kwakawanda kwe precision medicine kunoda tishu yakatove yakaunganidzwa panguva yebhayopsi yako kana kuvhiyiwa, saka iwe haudi kugadzirira kwakakosha. Zvisinei, chiremba wako angangoda kuwana mamwe masampuli etishu kana sampuli yekutanga isina kukodzera kuyedzwa kwakazara.

Kana iwe uchida sampuli itsva yetishu, chikwata chako chekurapa chichatsanangura maitiro chaiwo uye chero kugadzirira kunodiwa. Izvi zvinogona kusanganisira needle biopsy kana maitiro madiki ekuvhiya, zvichienderana nenzvimbo uye kuwanikwa kwetumor yako.

Kusati kwatanga kuyedzwa, zvinobatsira kuunganidza ruzivo nezve nhoroondo yemhuri yako yekenza, kunyanya mazamu, ovarian, uye mamwe makenza ane hukama. Ruzivo urwu runogona kubatsira mupi wako we genetic counselor uye oncologist kududzira mhedzisiro yako yekuedzwa zvakarurama. Unogonawo kuda kugadzirira mibvunzo nezvekuti kuyedzwa kuchazivisa chii uye kuti zvingakanganisa sei sarudzo dzako dzekurapa.

Maitiro ekuverenga mhedzisiro yako ye precision medicine?

Mushumo wako we precision medicine uchazivisa chaiwo genetic mutations, mazinga eprotein, uye zvimwe zvinoratidza maseru ako ekenza. Oncologist wako achatsanangura kuti chero chimwe nechimwe chinorevei kune sarudzo dzako dzekurapa uye prognosis.

Mushumo wacho kazhinji unosanganisira ruzivo nezve hormone receptors, izvo zvinokuudza kana kenza yako ichikura nekupindura estrogen kana progesterone. Kana kenza yako iri hormone receptor-positive, ungangobatsirwa nekurapa kunodzivisa mahomoni. Kana iri hormone receptor-negative, kurapa uku hakuzoshandi kwauri.

HER2 status chimwe chinhu chakakosha chinowanikwa mumushumo wako. Anenge 20% ekenza yemazamu ane mapuroteni akawandisa eHER2, izvo zvinoita kuti akure zvakanyanya. Zvisinei, mhando idzi dzekenza dzinowanzopindura zvakanaka kune targeted therapies senge trastuzumab (Herceptin) iyo inonyanya kuvharira HER2.

Mushumo wako unogonawo kuzivisa shanduko dzakasiyana dzejeni dzinokanganisa sarudzo dzekurapa. Dzimwe shanduko dzinoita kuti kenza inyanye kupindura kune mamwe madhiragi echemotherapy kana targeted therapies. Vamwe vangaratidza kuti kenza yako ine njodzi yakakwira kana yakaderera yekupararira kana kudzoka mushure mekurapa.

Mutoro we tumor mutation, kana TMB, unokuudza kuti mangani shanduko dzejeni kenza yako yese ine. Kanzera dzine TMB yakakwira dzimwe nguva dzinopindura zviri nani kune immunotherapy kurapa kunobatsira immune system yako kurwisa kenza. Chiremba wako achatsanangura kuti ruzivo urwu runoshanda sei kune mamiriro ako chaiwo.

Maitiro ekuvandudza kurapwa kwako kwemishonga chaiyo?

Kushanda pedyo nechikwata chako cheoncology kunovimbisa kuti unowana zvakanyanya kubva kune precision medicine approaches. Chirongwa chako chekurapa chinofanira kuongororwa nguva dzose uye kugadziriswa zvichibva pakuti kenza yako inopindura sei uye chero mhedzisiro mitsva yekuedzwa.

Ramba uchibatanidzwa muzvisarudzo zvako zvekutariswa nekubvunza mibvunzo nezvekuti nei mamwe marapirwo achikurudzirwa kune genetic profile yekenza yako. Kunzwisisa chikonzero chiri kuseri kwechirongwa chako chekurapa kunogona kukubatsira kuti unzwe wakavimbika uye uchibatanidzwa mukutarisirwa kwako.

Fungai kutora chikamu mumiedzo yekiriniki inoenderana nemaitiro ako e genetic ekenza. Kurapa kwakawanda kwemishonga chaiyo kunowanikwa kutanga kuburikidza nemiedzo yekiriniki, uye kutora chikamu kunogona kukupa mukana wekuwana marapirwo ekucheka-cheka asati awanikwa zvakanyanya.

Chengeta zvinyorwa zvakadzama zvemhinduro dzako dzekurapa uye chero mhedzisiro yaunowana. Ruzivo urwu runobatsira timu yako yezvokurapa kugadzirisa chirongwa chako chekurapa uye kuita shanduko sezvinodiwa. Dzimwe nzira dzemishonga chaiyo dzinosanganisira kuchinjana pakati pemarudzi akasiyana ekurapa kwakanangana zvichienderana nekuti kenza yako inopindura sei nekufamba kwenguva.

Ndeipi nzira yakanakisa yemishonga chaiyo?

Nzira yakanakisa yemishonga chaiyo inoenderana zvachose nemaitiro ako chaiwo e genetic ekenza uye mamiriro ako ehutano hwese. Hapana imwe chete

Zvimwe zvinhu zvinogona kuita kuti kurapwa kwemishonga yechokwadi kushande zvishoma, kunyangwe zvakawanda zvezvi zvinogona kutariswa nekuchenjerera uye kugadzirisa kurapwa. Kunzwisisa izvi zvinhu zvine njodzi kunobatsira timu yako yezvokurapa kuti ivandudze chirongwa chako chekurapa.

Masero ekenza anogona kuita kuramba kurapwa kwakatarwa nekufamba kwenguva nekutora shanduko itsva kana kutsvaga nzira dzimwe dzokukura. Ichi ndicho chikonzero chiremba wako angakurudzira kudzokorora kuyedzwa kwekenza yako nguva nenguva kuti aone kana chimiro chayo chemajini chakachinja panguva yekurapa.

Zvimwe zvinhu zvinogona kukanganisa kuti kurapwa kwemishonga yechokwadi kunoshanda sei kwauri:

• Kurapwa kwechemotherapy kana radiation kwakamboitwa izvo zvingave zvakakonzera shanduko dze genetic mukanza yako
• Mamiriro ehutano hwese anokanganisa kuti muviri wako unogadzirisa sei mishonga
• Danho uye huwandu hwekenza yako apo kurapwa kwemishonga yechokwadi kunotanga
• Kukurumidza kukura uye kupararira kwekenza yako
• Kuvapo kweshanduko dzakawanda dzemajini dzinogadzira kusarudzwa kwekurapa kwakaoma

Timu yako yezvokurapa ichashanda kuderedza izvi zvinhu zvine njodzi uye kugadzirisa chirongwa chako chekurapa sezvinodiwa. Kuongorora nguva dzose uye kutaurirana nevapi vako vehutano zvakakosha pakuchengetedza kushanda kwemaitiro emishonga yechokwadi.

Zviri nani kuva nekushanduka kwakatarwa kana kusina kutariswa?

Kuva nekushanduka kwakatarwa mukanza yako yemazamu kunowanzoonekwa sechinhu chakanaka nekuti zvinoreva kuti kune mishonga yakagadzirirwa kurwisa shanduko idzodzo dzemajini. Zvisinei, zvose zvakatarwa uye zvisina kutariswa zvinogona kubudirira kurapwa nemaitiro emishonga yechokwadi iripo.

Kuchinja kunotarisirwa ndiko kuchinja kwemajini ayo masayendisiti akagadzira mishonga yakatarwa. Semuenzaniso, kana kenza yako iine PIK3CA mutation, unogona kubatsirwa nemishonga yakaita se alpelisib iyo inonyanya kutarisisa nzira iyi. Mapepa aya akatarwa anowanzoita mashoma mativi emishonga kupfuura chemotherapy yechinyakare apo ichinyanya kushanda kurwisa rudzi rwekenza yako chaiyo.

Kushanduka kusingatarisirwi hakuna mishonga yakatarwa yakagadzirirwa yavo, asi izvi hazvireve kuti sarudzo dzako dzekurapa dzakaganhurirwa. Chikwata chako chekurapa chinogona kushandisa ruzivo urwu rwemajini kutungamira sarudzo dzekurapa, senge kusarudza mishonga yechemotherapy inoshanda zviri nani kurwisa kenza ine mamwe maitiro ekushanduka.

Munda wemushonga chaiwo uri kukura nekukurumidza, uye vatsvakurudzi vanogara vachigadzira mishonga mitsva yakatarwa. Kushanduka kunoonekwa sekusingatarisirwi nhasi kungave nemishonga yakatarwa iripo munguva pfupi iri kutevera. Oncologist wako achakuchengeta iwe uchiziviswa nezve sarudzo itsva dzekurapa dzinowanikwa kune yako kenza genetic profile.

Ndezvipi zvingaitika zvekugadzirisa mushonga wekurapa?

Kurapa kwemishonga chaiyo kunogona kukonzera mativi emishonga, kunyangwe achiwanzove akanyanya kubata kupfuura mativi echinyakare echemotherapy. Chikwata chako chekurapa chichakutarisa zvakanyanya uye chichagadzirisa kurapwa sezvinodiwa kuderedza matambudziko.

Mishonga yakatarwa inogona kukonzera mativi chaiwo ane chekuita nemapuroteni kana nzira dzavanovhara. Semuenzaniso, HER2-yakatarwa mishonga dzimwe nguva inogona kukanganisa basa remoyo, nepo kurapwa kunodzivirira mahomoni kungakonzera zviratidzo zvemenopausal kana kuonda kwemapfupa. Chiremba wako achatarisa izvi zvinokonzeresa uye achapa rutsigiro rwekutarisira sezvinodiwa.

Mamwe marapirwo emishonga chaiyo anogona kukonzera matambudziko anoda kutarisirwa zvakanyanya:

• Kushatirwa kweganda senge mburwa kana kunzwa chiedza chezuva kubva kune mamwe marapirwo akatarwa
• Manyoka kana matambudziko ekugaya kubva kune mamwe mishonga yekurapa inotorwa nemuromo
• Kuchinja mumawerengero eropa ayo anoda kugadziriswa kwemadosi kana kumisa kurapwa
• Kuchinja kwekuita basa rechiropa uko kunoda kuongororwa nemiedzo yeropa yenguva dzose
• Kuneta kana kusava nesimba izvo zvingakanganisa mabasa ako ezuva nezuva

Mhedzisiro zhinji kubva kumishonga yekurapa yakarurama inogona kubatwa nekutarisirwa kunotsigira uye kugadziriswa kwemadosi. Chikwata chako chekurapa chichashanda newe kuti uwane chiyero chakakodzera pakati pekurapa kunobudirira uye mhando yehupenyu.

Ndezvipi zvingaitika zvekushaikwa kwemishonga yakarurama?

Pasina nzira dzemishonga yakarurama, unogona kugamuchira mishonga isingashande zvakanaka kune rudzi rwako rwekenza yemazamu. Izvi zvinogona kutungamira mukunonoka kwemhinduro dzemishonga, mhedzisiro isingakoshi, uye zvingangodaro zvakanyanya kuipa.

Kushandisa nzira imwe-saizi-inokodzera-vose zvinoreva kuti unogona kupotsa mishonga yakatarwa iyo inogona kushanda zviri nani kune genetic profile yako yekenza. Semuenzaniso, kana kenza yako iine HER2 overexpression asi izvi hazvizivikanwe, unogona kusagamuchira HER2-targeted drugs iyo inogona kuvandudza zvakanyanya mhedzisiro yako.

Mishonga isina kukwana yakarurama inogona kukonzera mhedzisiro inonetesa:

• Kugamuchira chemotherapy apo kurapwa kwakatarwa kwaizobudirira uye kukonzera mhedzisiro shoma
• Kupotsa mikana yekurapa inodzivirira mahomoni mumakenza ane hormone receptor-positive
• Kunonoka kuzivikanwa kwemahereditary cancer syndromes ayo anokanganisa kuronga kurapwa
• Kurapwa kusina kukwana kunoderedza kushanda kwemishonga gare gare
• Kuwedzera njodzi yekudzoka kwekenza nekuda kwekushaikwa kwekushandiswa kwekutanga kwemishonga

Mashoko akanaka ndewekuti mushonga chaiwo uri kuve tsika yakajairika yekurapa gomarara rezamu. Zvipatara zvakawanda zvegomarara zvinoita bvunzo dzejinetic nguva dzose kuti vave nechokwadi chekuti unowana mishonga yakakodzera yegomarara rako.

Ndingatarisana riini nachiremba kuti nditaurirane nezvemushonga chaiwo?

Unofanira kukurukura nezve sarudzo dzemushonga chaiwo nachiremba wako weoncologist nekukurumidza mushure mekuongororwa kwegomarara rezamu rako. Kubvunza majinetic nekukurumidza uye kuongorora tumor kunogona kubatsira kutungamira sarudzo dzako dzekutanga dzekurapa uye kuvandudza mhedzisiro yako yese.

Kana usati wamboita bvunzo dzakazara dzejinetic yetumor yako, zvakakosha kubvunza timu yako yezvokurapa nezve sarudzo idzi. Kunyangwe iwe wakatotanga kurapwa, bvunzo dzemushonga chaiwo dzinogona kuramba dzichipa ruzivo rwakakosha rwekugadzirisa kurapwa kwako kwazvino kana kuronga kurapwa kwemangwana.

Funga kutsvaga kubvunzana kwemushonga chaiwo kana iwe ukasangana nechero mamiriro aya:

• Kurapa kwako kwazvino hakushande sezvaitarisirwa
• Uri kusangana nemigumisiro yakakomba kubva kumishonga yakajairika
• Gomarara rako radzoka mushure mekurapwa kwekutanga
• Une nhoroondo yemhuri yegomarara rezamu, ovarian, kana mamwe magomarara ane hukama
• Une chido chekutora chikamu mumiedzo yekiriniki yemishonga mitsva yakatarwa

Zvipatara zvakawanda zvegomarara zvine zvirongwa zvemushonga chaiwo vane nyanzvi dzinonyanya kutarisa pakufananidza varwere nemishonga yakatarwa yakakodzera. Zvirongwa izvi zvinogona kuve zvakakosha kana iwe uine rudzi rusingawanzoitiki kana rwakakomba rwegomarara rezamu.

Mibvunzo inowanzo bvunzwa nezvemushonga chaiwo wegomarara rezamu

M.1 Ko bvunzo dzemushonga chaiwo dzinovharwa neinishuwarenzi?

Zvirongwa zvakawanda zveinishuwarenzi, kusanganisira Medicare, zvinovhara kuyedzwa kwemishonga yakarurama yegomarara rezamu kana zvichionekwa zvakakosha zvekurapa nachiremba wako weoncologist. Zvisinei, kuvharwa kunogona kusiyana zvichienderana nechirongwa chako cheinishuwarenzi uye rudzi rwekuyedzwa kwakakurudzirwa.

Hofisi yechikwata chako chekurapa inogona kubatsira kusimbisa kuvharwa kweinishuwarenzi yako kuyedzwa kusati kwatanga. Makambani mazhinji ekuyedza anopawo zvirongwa zvekubatsira mari kana iwe uchisangana nematambudziko ekufukidzwa. Usarega kunetseka kwemutengo kukudzivisa kubvunza nezve sarudzo dzemishonga yakarurama nachiremba wako.

Mubvunzo 2. Ko mishonga yakarurama inoshanda kune ese marudzi egomarara rezamu here?

Nzira dzemishonga yakarurama dzinogona kubatsira ese marudzi egomarara rezamu, kunyangwe kurapwa kwakatarwa kunowanikwa kuchisiyana zvichienderana nemaitiro emagenetic egomarara rako. Mamwe marudzi egomarara rezamu ane zvakawanda zvekutarisisa kurapa sarudzo dziripo pane mamwe.

Gomarara rezamu rine triple-negative, iro raive nenzira dzishoma dzekurapa dzakatarwa, riri kuwedzera kubatsirwa kubva kunzira dzemishonga yakarurama. Vatsvagiri vari kuona zvitsva zvegenetic uye vachigadzira kurapwa kunoenderana nemagomarara aya akaoma.

Mubvunzo 3. Kuyedzwa kwemishonga yakarurama kunofanirwa kudzokororwa kakawanda sei?

Chiremba wako anogona kukurudzira kuyedzwa kudzokorora kana gomarara rako rikarega kupindura kurapwa kwazvino kana kana rikadzoka mushure menguva yekuregererwa. Masero egomarara anogona kuwana shanduko itsva nekufamba kwenguva, saka kuyedzwa kwemajini akagadziridzwa kunogona kuratidza sarudzo itsva dzekurapa.

Nguva yekuyedzwa kudzokorora inoenderana nemamiriro ako ega uye kuti gomarara rako rinopindura sei kurapwa. Chiremba wako weoncologist achakupa zano rekuti kuyedzwa kwakawedzerwa kungave kunobatsira rinhi kune yako chaiyo kesi.

Mubvunzo 4. Ko mishonga yakarurama inogona kubatsira kudzivirira kudzoka kwegomarara rezamu here?

Mushonga chaiwo unogona kubatsira kuderedza njodzi yekudzoka kwekenza yemazamu nekuona kuti unogamuchira kurapwa kwakanyanya kushanda kwekenza yako chaiyo. Zvimwe zvakawanikwa zvemajini zvinobatsirawo kufanotaura njodzi yekudzoka uye kutungamira sarudzo pamusoro pezvimwe zvirongwa zvekudzivirira.

Semuenzaniso, mamwe ma genetic tests anogona kubatsira kuona kana iwe uchizobatsirwa nekurapa kwakawedzerwa kwehomoni kana mamwe chemotherapy kuderedza njodzi yekudzoka. Chikwata chako chekurapa chinoshandisa ruzivo urwu kugadzira chirongwa chakazara chekupona chakagadzirirwa zvaunoda.

Q.5 Chii chinoitika kana pasina kurapwa kwakanangana kunowanikwa kune shanduko dzekenza yangu?

Kunyange kana pasina kurapwa kwakanangana kunowanikwa kune shanduko dzekenza yako, ruzivo rwemajini ruchiri kukosha pakuronga kurapwa. Chikwata chako chekurapa chinogona kushandisa ruzivo urwu kusarudza maitiro akakodzera echemotherapy kana kufunga nezve miedzo yekiriniki yekuyedza kurapwa kutsva kwakanangana.

Munda wemushonga chaiwo uri kukura nekukurumidza, nekurapwa kutsva kwakanangana kuchigadzirwa nguva dzose. Oncologist wako achakuchengeta iwe uchiziva nezve nzira dzekurapa dziri kubuda dzinogona kuwanikwa kune yako cancer genetic profile mune ramangwana.