Magungunan ciwon magungunan su ne matakai na farko a zalunta ciwon ƙwayar ciwon daji, wanda akayi ga wadanda ke da ciwon sukari wanda ke da karfin sifofin estrogen . Yanyan magungunan za su dogara ne akan ko kai ne premenopausal ko postmenopausal, da kuma idan ciwon daji ya sake dawo yayin da kake amfani da ɗaya daga cikin wadannan magunguna. (Idan ciwon daji ya sake dawowa yayin da kake shan daya daga cikin wadannan kwayoyi, ana tsammani cewa ciwon daji zai yiwu ya dace da magani.)
Matsayi na Estrogen
Ga masu ciwon kwakwalwa na zazzabi na isrogen-estrogen, isrogen yana aiki kamar man fetur, wanda ke tare da masu karuwa mai ciwon isrogen a kan jikin kwayar cutar ciwon daji kuma yana ƙarfafa girma da kuma cigaban ciwon daji. Wannan aikin na estrogen akan kwayoyin cututtuka za a iya iyakance a wasu hanyoyi daban-daban; ta rage yawan adadin estrogen a cikin jiki, ko ta hanyar hana masu karɓar isrogène don haka estrogen ba zai iya ƙarfafa ci gaban kwayoyin ba. Ya bambanta da kwayoyin cutar shan magani wanda ke kai tsaye a jikin kwayoyin cutar kanjamau (sau ɗaya), magungunan hormonal suna aiki ne ta hanyar "yunwa" da kwayoyin cutar ciwon sukari na estrogen.
Kafin yin jima'i, ovaries su ne manyan masu samar da estrogen. Bayan mazaunawa, mafi girma asalin estrogen a cikin jiki shine daga yin jujjuya da androgens zuwa estrogen. Wannan juyin juya halin yana haɓaka ta hanyar enzyme aromatase da aka samu a cikin mai da tsoka. Masu hana maganin rashin lafiya su ne magunguna wanda ke toshe aromatase don haka wannan canji na androgens zuwa estrogens ba zai iya faruwa ba, yadda ya rage karfin isrogen.
Magunguna marasa lafiya ba su da tasiri ga wadanda suka sami karfin mai ciwon isrogen da kuma kwayar cutar kwakwalwa.
Yana da mahimmanci a lura cewa wasu masu ciwon sukari masu ciwon isrogen sune HER 2 tabbatacce . A cikin kututtukan da suke da kyau ga masu karɓa guda biyu, ana iya amfani da maganin isrogen din tare da ko ba tare da kwayoyi ba wanda ke aiki a HER 2.
Premenopausal far
Idan kun kasance mai tsaka-tsakin zuciya, your ovaries har yanzu shine mafi yawan asrogirin, saboda haka man fetur, don ciwon nono. Makasudin magani a cikin matan auren mata shine don rage yawan isrogen don taimakawa ci gaban ciwon daji ta hanyar rage yawan yawan isrogen din (magungunan ciwon daji) da kuma tsangwama tare da ikon isrogen don ɗaukar masu karɓar isrogen a kan ciwon nono Kwayoyin.
Magunguna irin su tamoxifen ana kira su SERMS-masu zazzabi na zazzabi na isrogen receptor, da kuma aiki ta hanyar ɗaure ga kwayoyin cutar ciwon daji don isrogene a cikin jiki ba zai iya ɗaure zuwa tantanin halitta ba kuma ya nuna tantanin halitta yayi girma.
Ana tsammanin cewa masu hanawa na aromatase na iya zama mafi tasiri fiye da tamoxifen, amma wadannan baza'a iya amfani da su a cikin mata masu auren mata ba saboda aikin ovaries. Don rage estrogen da ovaries suka samar, kuma ba ka damar yin amfani da injinta na aromatase, likitan ka na iya bayar da shawara ga farfadowa na yarinyar.
Ovarian suppression za a iya kammala by:
- Amfani da magani Zoladex (goserelin) - Wannan magani ne wanda aka ba da sashin jiki kuma ya hana samar da isrogen ta jikin jiki, kuma an san shi azaman mai cin gashin jini na gonadotropic. Ƴan ovaries samar da estrogen a cikin amsa ga wani hormone da aka sani da gonadotropin stimulating hormone ɓoye ta wurin pituitary gland shine. Zoladex ya hana ikon gonadotropin stimulant hormone don tayar da ovaries.
- Yau da yawa - Ƙananan, wasu mata suna son su cire ovaries su (ta hanyar hanyar da ake kira "oophorectomy") maimakon amfani da Zoladex. An yi wannan tiyata sau da yawa saboda mummunar haɗari da ke hade da tiyata, amma wasu mata zasu fi son wannan hanya, musamman ma wadanda suke da tsinkaye ga ciwon daji na ovarian da kuma ciwon nono.
Zai yiwu a yi sau da yawa a matsayin hanyar laparoscopic kuma yawanci shine aikin tiyata ɗaya. A cikin laparoscopic oophorectomy, an sanya wasu ƙananan ƙwayoyin ciki a cikin ciki kuma an cire ovaries tare da taimakon kayan kayan fasaha.
Bayan maganin farfadowa na yara, sai a iya magance mata masu amfani da mata kafin suyi da magungunan magungunan magungunan mata da maza a cikin kasa ko kuma tare da tamoxifen.
Postmenopausal far
Bayan mazaunewa, mafi yawan asrogirin a cikin jikin mutum ya fito ne daga karfin maganin inrogen zuwa estrogen. Za a iya magance cutar ciwon nono tare da tamoxifen (don toshe zartar da ciwon haɗin gwiwar ciwon daji tare da kwayar cutar ciwon daji) amma nau'i na magunguna da ake kira masu kwantar da ƙananan aromatase sun fi tasiri tare da ƙananan sakamako masu illa.
Masu haɓaka na aromatase sun haɗa da:
- Arimidex (anastrozole)
- Femara (letrozole)
- Abun (misali)
Za a iya amfani da masu hana masu kwantar da hanzari kawai, ko a hade tare da magani na chemotherapy . Alal misali, haɗuwa da Femara (letrozole) da Ibrance (palbociclib) da kuma Aromasin (exemestane) tare da Afinitor (everolimus). Akwai ko yaushe ma'auni lokacin ƙara ƙarin magani. Yayinda haɗuwa zai iya zama mafi tasiri, akwai kuma karuwa a cikin illa mai laushi yayin hada fiye da ɗaya magani.
Yana da muhimmanci a sake lura cewa burin magani yana da bambanci da ciwon nono fiye da yadda yake da ciwon nono. Da farko cutar ciwon daji, makasudin mawuyacin hali, kuma falsafar shine "janye manyan bindigogi" don magance cutar. Falsafar da ciwon ƙwayar nono, wanda ya bambanta, shine sau da yawa don sarrafa ci gaban ciwon daji tare da adadin magani mai yiwuwa, ajiye sauran magunguna don lokacin da magunguna farko ba su aiki ba.
Sauran Hanyoyin Hormonal
Bugu da ƙari, masu maganin tamoxifen da masu aromatase, akwai wasu magungunan maganin hormone wanda za a iya amfani dasu don ciwon ƙirjin nono. Idan ciwon nono na ci gaba da girma ko yadawa a kan magungunan da ke sama da shi an dauke su da yawa ga magunguna. Magungunan ƙwayar ƙwayar cutar ciwon tazarar kusan ci gaba da zama magungunan wadannan magunguna a tsawon lokaci. Lokacin da wannan ya faru, zaɓuɓɓuka sun haɗa da:
- Faslodex (Fulvestrant) -Sai matan da suka kamu da matsanancin ciwon daji na ciwon daji a kan tamoxifen ko mai cin zarafin aromatase, wani zaɓi yana amfani da Faslodex magani. Faslodex a halin yanzu ne kawai magani wanda aka yarda da cutar ciwon nono a cikin wani nau'i da aka sani da SERD-masu zabin mai karɓar estrogen receptor downregulators.
Ana amfani da wannan magani a matsayin "antiestrogen" mai tsabta kuma yana kirkiro tasirin estrogen a kan kwayoyin cututtukan ciwon ƙirjin nono mai saukin isrogen ne kawai amma a wata hanya dabam fiye da tamoxifen (yana da antagonist mai karɓar estrogen.) Ana iya amfani da faslodex kadai ko a haɗa tare da Ibrance (palbociclib), maganin ƙwayar cutar shan magani, kuma an ba shi a matsayin allura.
Magunguna marasa amfani
Akwai wasu hanyoyin warkaswa waɗanda aka yi amfani da su amma ba a kan la'akari da su a matsayin wani layi na 3 ko 4th line treatment. Wadannan sun haɗa da:
- Fareston (toremifene) - Fareston magani ne kamar maganin tamoxifen da kuma la'akari da wani mai daukar nauyin azzakari na estrogen na iya daukar wani lokaci akan matan da suka kamu da su a cikin asibiti wanda ke dauke da ciwon kwakwalwa na karuwanci, musamman ga matan da ba su da wani enzyme wanda ya canza tamoxifen zuwa hanyar aiki jiki.
- Masarautar - Megace (megestrol) wani nau'i ne na kwayar cutar da ake amfani da shi a wasu lokuta don mutane masu ciwon ciwon ciwon ciwon estrogen-tabbataccen kwayar cutar wanda ya zama mai rikici ga tamoxifen. An yi amfani da shi sau da yawa a baya kafin magunguna sun samo asali.
- Hanyoyin hawan mahaukaci na jima'i - Ba'a yi amfani da hauka kamar su estrogen da androgens ba tare da amfani da ciwon nono ba, amma ana iya amfani dashi a wasu lokuta idan sauran maganin hormone sun gaza.
Magunguna ga maza
Mutanen da ke fama da ciwon ƙirji wanda ke dauke da kwayar cutar ta hormone yana da yawa tare da tamoxifen.
Hanyoyin Gaba
Tamoxifen
Tamoxifen yana da nau'ayi daban-daban, duka suna nuna sakamakon yaduwar estrogen a wasu sassa na jiki kuma yana musanta shi a wasu. Mafi yawan bayyanar cututtuka sun hada da walƙiya da ƙuƙwalwar jiki da aka sanya "tsohuwar mahaifa" ko da yake waɗannan ƙwayoyin jiki sun fi sauƙi fiye da masu kwantar da aromatase.
Hanyoyi masu illa masu haɗari sun haɗa da ƙari ƙarar jini a ƙafafu (thromboembolism venous) wanda, idan ba tare da magani ba, yana da yiwuwar karya kyauta kuma tafiya zuwa ga huhu (gwanon mahaifa). A tsawon lokaci, tamoxifen na iya haifar da zub da jini a cikin mahaifa kuma an hade shi tare da karamin kara yawan ci gaban ciwon daji.
Wasu mata (da maza) shan tamoxifen zasu iya ci gaba da ƙara tsanantawa da alamun su (alal misali, ƙara yawan ƙwayar fata na fata ko ƙara ƙuƙwalwar ƙwayar nama daga kasusuwan kasusuwan) a cikin 'yan kwanaki na fara magani.
Idan ka ci gaba da waɗannan bayyanar cututtuka, za su iya yin sulhu a cikin makonni hudu zuwa shida, ko da yaushe wani magani ana bukatar katsewa. Ginawar azurfa idan kana da wannan karfin shi ne cewa karfin abin da ya dace yana dauke da alamar cewa magani na aiki kuma yana da tasiri. Zoladex na iya haifar da irin wannan yanayin.
Lura cewa Tamoxifen na iya haifar da gwajin aikin hanta mai haɗari, anemia, da ƙananan platelets kuma an hade da haɗarin ƙwayar cutar ciwon endometrial. Tattaunawa da likita idan wannan zaɓi yafi kyau a gare ku.
Masu haɓaka na Aromatase (AI)
AI na iya haifar da jiki, tare da kimanin kashi 40 na mutanen da ke lura da wasu tsokoki da haɗin gwiwa. Rashin hasara na da tasiri, kuma likitanku zai iya yin umurni da kashi mai yawa don duba ku don osteoporosis, a farkon jiyya kuma daga bisani. Fractures na iya faruwa saboda lalacewar asara, ko da ba tare da kasuwa na kasusuwa ba. AI na iya ƙara haɗarin cututtukan zuciya.
Faslodex
Faslodex yana da kyau sosai a jure, tare da tasirin da yafi rinjaye na yaudarar da kuma hawan aikin gwajin aikin hanta.
Zoladex (kullun)
Ɗaya daga cikin abubuwan da yafi rinjaye na wannan magani shine ainihin abin da ake so. Makasudin magani shi ne kawar da ovaries, a wasu kalmomi, dakatar da ovaries daga sakewa daga estrogen. Yin hakan yana haifar da tsauraran matakan da ke haifar da kwakwalwa kuma haka ne, al'ada bayyanar cututtuka na mazaunawa irin su walƙiya mai zafi da kuma busassun bushewa sune na kowa.
Kamar yadda tamoxifen, wasu mutane zasu iya samun karfin fuska lokacin da suka fara fara magani, misali, kara yawan ciwo mai zafi a wadanda suke da sulusin kasusuwa.
Oophorectomy
Abubuwa na farko da suka danganci cire ovaries suna, kamar yadda maganin cututtuka na cututtukan kiwon lafiya, da al'ada bayyanar cututtukan da suke tare da menopause kamar su walƙiya mai zafi da kuma bushewa. Har ila yau, akwai mawuyacin sakamako da hadari game da tiyata. Za a iya yin aiki a yanzu tare da tiyata mai mahimmanci (a laparscopy) ta hanyar ƙananan ƙananan cututtuka a cikin fata kuma anyi amfani da ita azaman aiki na rana daya.
Faslodex (fulvestrant)
Tunda wannan wata maganin isrogen ne, mafi yawan bayyanar cututtukan suna kama da wadanda aka samu tare da menopause, kamar su tamoxifen da masu haɓakar aromatase. Kusan kashi ɗaya cikin uku na mutanen da ke fama da miciyar jiki, amma in ba haka ba, wannan magani yana da kyau sosai.
> Sources:
> Cibiyar Nazarin Harkokin Kwayoyi ta Amirka. Cancer.Net. Hormonal hanyoyin kwantar da hankali don Metastatic nono Ciwon daji. Updated 05/2016. https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/hormonal-therapy-metastatic-breast-cancer
> Martin, M., Lopez-Tarruella, S., da Y. Gilarranz. Endocrine Far for Hormone Jiyya-Naïve Advanced Breast Ciwon daji. Dairy . 2016. (Epub gaba da bugawa).