Te Ārai i te Mate Pukupuku o te Uma

Ngā Mōhiotanga Whānui mō te Mate Pukupuku o te Uma

Ko te mate pukupuku o te ū he mate e puta ai ngā pūtau kino (matepukupuku) i roto i ngā kiko o te ū.

He mea hanga te ū i ngā pūwero me ngā awaawa. E 15 ki te 20 ngā wāhanga o ia ū e kiia nei ko ngā pūwero, ā, he maha ngā wāhanga iti ake e kiia nei ko ngā pūwero. Ka mutu ngā pūwero ki ngā tini pūwero iti ka taea te whakaputa waiū. Ka honoa ngā pūwero, ngā pūwero, me ngā pūwero e ngā ngongo angiangi e kiia nei ko ngā awaawa.

Kei ia ū anō hoki ngā oko toto me ngā oko lymph. Kei roto i ngā oko lymph he wai wai, tata kore tae, e kiia nei ko te lymph. Kei roto i ngā oko lymph te lymph i waenganui i ngā pona lymph. He hanganga iti, āhua pīni ngā pona lymph e tātari ana i te lymph, e penapena ana i ngā toto toto mā e āwhina ana ki te whawhai i te mate me te mate. Kei te taha o te ū ngā rōpū pona lymph i roto i te axilla (i raro i te ringa), i runga ake i te wheua kara, me te uma.

Ko te mate pukupuku o te ū te tuarua o ngā momo mate pukupuku e tino kitea ana i roto i ngā wāhine o Amerika.

I te Hononga o Amerika, he nui ake te pānga o te mate pukupuku ū ki ngā wāhine i tētahi atu momo mate pukupuku, engari ko te mate pukupuku kiri. Ko te mate pukupuku ū te tuarua o ngā take e mate ai ngā wāhine o Amerika i muri i te mate pukupuku pūkahukahu. Heoi, kua heke te maha o ngā mate mai i te mate pukupuku ū i ia tau i waenga i te tau 2007 me te tau 2016. Ka pā anō hoki te mate pukupuku ū ki ngā tāne, engari he iti noa te maha o ngā kēhi hou.

Te Ārai i te Mate Pukupuku o te Uma

Mā te karo i ngā āhuatanga mōrearea me te whakanui ake i ngā āhuatanga tiaki ka āwhina pea ki te ārai i te mate pukupuku.

Mā te karo i ngā āhuatanga mōrearea o te mate pukupuku ka āwhina pea ki te ārai i ētahi mate pukupuku. Ko ngā āhuatanga mōrearea ko te momi hikareti, te taumaha rawa, me te kore e nui te whakakori tinana. Mā te whakanui ake i ngā āhuatanga tiaki pērā i te whakamutu momi hikareti me te whakakori tinana ka āwhina pea ki te ārai i ētahi mate pukupuku. Kōrero ki tō tākuta, ki tētahi atu tohunga hauora rānei mō te whakaiti i tō mōrearea ki te mate pukupuku.

Ko ngā mea e whai ake nei ko ngā āhuatanga mōrearea mō te mate pukupuku o te ū:

1. Te pakeketanga

Ko te kaumātuatanga te tino take mō te nuinga o ngā mate pukupuku. Ka piki ake te tūponotanga ka pāngia koe e te mate pukupuku i a koe e kaumātua ana.

2. He hītori whaiaro mō te mate pukupuku o te ū, te mate ū pai rānei (ehara i te mate pukupuku)

Ko ngā wāhine e whai ana i tētahi o ēnei e whai ake nei ka nui ake te tūponotanga ki te pāngia e te mate pukupuku ū:

• He hītori whaiaro mō te mate pukupuku ū urutā, te ductal carcinoma in situ (DCIS), te lobular carcinoma in situ rānei (LCIS).
• He hītori whaiaro mō te mate ū pai (ehara i te matepukupuku).

3. Te mōrearea tuku iho o te mate pukupuku o te ū

Ko ngā wāhine he hītori whānau mō te mate pukupuku ū kei roto i te whanaunga tuatahi (whaea, tuahine, tamāhine rānei) he nui ake te mōrearea ki te mate pukupuku ū.

Ko ngā wāhine kua riro i a rātou ngā huringa o ngā ira tuku iho o te me te , o ētahi atu ira rānei, he nui ake te tūponotanga ki te pāngia e te mate pukupuku o te ū. Ko te tūponotanga o te mate pukupuku o te ū i puta mai i ngā huringa ira tuku iho, e whakawhirinaki ana ki te momo whakarerekētanga ira, te hītori whānau o te mate pukupuku, me ētahi atu āhuatanga.

4. Ngā ū matotoru

Ko te matotoru o te kiko o te ū i runga i te mammogram he take mō te mōrearea o te mate pukupuku o te ū. Ko te taumata o te mōrearea ka whakawhirinaki ki te matotoru o te kiko o te ū. He nui ake te mōrearea o ngā wāhine he tino matotoru ō rātou ū ki te mate pukupuku o te ū i ngā wāhine he iti te matotoru o ō rātou ū.

Ko te pikinga o te mātotoru o ngā ū he āhuatanga tuku iho i te nuinga o te wā, engari ka pā anō hoki ki ngā wāhine kāore anō kia whānau tamariki, kua hapu tuatahi i te mutunga o te ora, kei te tango homoni kua mutu te paheketanga, kei te inu waipiro rānei.

5. Te pānga o te kiko o te ū ki te estrogen i hangaia i roto i te tinana

He homoni te Ētorogen e hangaia ana e te tinana. Ka āwhina i te tinana ki te whakawhanake me te pupuri i ngā āhuatanga ira wahine. Mā te roa o te wā e pāngia ana e te Ētorogen ka piki ake te mōrearea o te mate pukupuku o te ū. Ko ngā taumata Ētorogen te mea teitei rawa atu i ngā tau e pāngia ana te wahine e te paheketanga.

Ka piki ake te pānga o te estrogen ki te wahine i ngā huarahi e whai ake nei:

• Te paheketanga tōmua: Mā te tīmatanga o te paheketanga i te 11 tau te pakeke, iti iho rānei, ka nui ake ngā tau e pāngia ai te kiko o te ū e te estrogen.
• Ka tīmata i te pakeketanga o muri mai: Ka roa ake te paheketanga o te wahine, ka roa ake te pānga o te estrogen ki te kiko o tōna ū.
• Te pakeketanga i te whānautanga tuatahi, te kore rānei i whānau: Nā te iti iho o ngā taumata o te estrogen i te wā e hapu ana, ka nui ake te estrogen e pāngia ana e te kiko o te ū i roto i ngā wāhine e hapu ana mō te wā tuatahi i muri i te 35 tau te pakeke, kāore rānei i hapu.

6. Te tango i te rongoā homoni mō ngā tohu o te menopause

Ka taea te hanga i ngā homoni, pērā i te estrogen me te progesterone, hei pire i roto i te taiwhanga. Ka taea te hoatu i te estrogen, te progestin, ngā mea e rua rānei hei whakakapi i te estrogen kāore i hangaia e ngā ovaries i roto i ngā wāhine kua pāngia e te menopause, i ngā wāhine rānei kua tangohia ā rātou ovaries. Ka kiia tēnei ko te whakaora whakakapinga homoni (HRT) te whakaora homoni rānei (HT). Ko te whakakotahitanga o te HRT/HT he estrogen me te progestin. Ka whakanui ake tēnei momo HRT/HT i te mōrearea o te mate pukupuku o te ū. E whakaatu ana ngā rangahau ina mutu te tango a ngā wāhine i te estrogen me te progestin, ka heke te mōrearea o te mate pukupuku o te ū.

7. Te rongoā irahiko ki te ū, ki te uma rānei

Mā te rongoā irahiko ki te uma hei rongoā i te mate pukupuku ka piki ake te mōrearea o te mate pukupuku ū, ka tīmata i te 10 tau i muri i te rongoā. Ko te mōrearea o te mate pukupuku ū ka whakawhirinaki ki te horopeta o te irahiko me te tau e hoatu ana. Ka nui rawa te mōrearea mēnā i whakamahia te rongoā irahiko i te wā o te pakeketanga, i te wā e hangaia ana ngā ū.

Te āhua nei kāore te rongoā irahiko hei rongoā i te mate pukupuku i te ū kotahi e whakapiki ake i te mōrearea o te mate pukupuku i te ū kē.

Mō ngā wāhine kua riro mai i a rātou ngā panonitanga o ngā ira BRCA1 me BRCA2, ko te pānga o te irahiko, pērā i te mea mai i ngā hihi-X o te uma, ka nui ake pea te mōrearea o te mate pukupuku o te ū, inā koa mō ngā wāhine i tangohia te hihi-X i mua i te 20 tau te pakeke.

8. Te momonatanga

Ka piki ake te mōrearea o te mate pukupuku ū i te momonatanga, inā koa mō ngā wāhine kua mutu te pāheketanga kāore i whakamahi i te rongoā whakakapinga homoni.

9. Te inu waipiro

Ka piki ake te mōrearea o te mate pukupuku ū i te inu waipiro. Ka piki ake te taumata o te mōrearea i te pikinga ake o te nui o te waipiro e inumia ana.

Ko ngā mea e whai ake nei ko ngā āhuatanga tiaki mō te mate pukupuku o te ū:

1. He iti ake te pānga o te kiko o te ū ki te estrogen i hangaia e te tinana

Mā te whakaiti i te roa o te wā e pāngia ana te kiko o te ū o te wahine e te estrogen ka āwhina pea ki te ārai i te mate pukupuku o te ū. Ka whakaitihia te pānga ki te estrogen mā ēnei huarahi e whai ake nei:

• Te haputanga tōmua: He iti ake ngā taumata o te estrogen i te wā e hapu ana. Ko ngā wāhine e hapu ana i mua i te 20 tau te pakeke, he iti ake te tūponotanga ki te mate pukupuku ū i ngā wāhine kāore anō kia whānau tamariki, i ngā wāhine rānei e whānau ana i tā rātou tamaiti tuatahi i muri i te 35 tau te pakeke.
• Te whāngai ū: Tērā pea ka noho iti iho ngā taumata o te estrogen i te wā e whāngai ū ana te wahine. He iti ake te tūponotanga o te mate pukupuku ū mō ngā wāhine e whāngai ū ana i ngā wāhine kua whānau tamariki engari kāore i whāngai ū.

2. Te tango i te rongoā homoni estrogen-anake i muri i te tangohanga o te kōpū, ngā kaiwhakatikatika kaiwhiwhi estrogen whiriwhiri, ngā aukati aromatase me ngā kaiwhakakore rānei

Te rongoā homoni me te estrogen anake i muri i te tangohanga o te kōpū

Ka taea te hoatu i te rongoā homoni me te estrogen anake ki ngā wāhine kua tangohia te kōpū. Mō ēnei wāhine, mā te rongoā estrogen anake i muri i te paheketanga ka whakaiti i te tūponotanga o te mate pukupuku ū. He nui ake te tūponotanga o te whiu me te mate ngakau me ngā uaua toto i roto i ngā wāhine kua mutu te paheketanga e tango ana i te estrogen i muri i te wehenga kōpū.

Ngā kaiwhakatikatika i ngā kaiwhakawhiwhi estrogen whiriwhiri

Nō te whānau rongoā e kiia nei ko ngā selective estrogen receptor modulators (SERMs) a Tamoxifen me te raloxifene. He rite te mahi a ngā SERM ki te estrogen i runga i ētahi kiko o te tinana, engari ka ārai i te pānga o te estrogen ki ētahi atu kiko.

Mā te maimoatanga ki te tamoxifen ka whakaiti i te mōrearea o te mate pukupuku ū e pai ana ki te estrogen receptor (ER-positive) me te ductal carcinoma in situ i roto i ngā wāhine kei mua i te wā pāheketanga me ngā wāhine kua pāheketanga me te mōrearea nui. Mā te maimoatanga ki te raloxifene ka whakaitihia hoki te mōrearea o te mate pukupuku ū i roto i ngā wāhine kua pāheketanga. Mō tētahi o ngā rongoā, ka roa te mōrearea mō ētahi tau, neke atu rānei i muri i te whakamutua o te maimoatanga. Kua kitea he iti ake te maha o ngā wheua whati i roto i ngā tūroro e tango ana i te raloxifene.

Mā te tango i te tamoxifen ka piki ake te mōrearea o te werawera, te mate pukupuku endometrial, te whiu, te katarata, me te toto totoka (ina koa i roto i ngā pukahukahu me ngā waewae). Ka piki ake te mōrearea o ēnei raruraru i roto i ngā wāhine neke atu i te 50 tau te pakeke ki te whakaritea ki ngā wāhine taitamariki. Ko ngā wāhine kei raro iho i te 50 tau te pakeke he nui te mōrearea ki te mate pukupuku ū ka tino whai hua mai i te tango i te tamoxifen. Ka heke te mōrearea o ēnei raruraru i muri i te whakamutu i te tamoxifen. Kōrero ki tō tākuta mō ngā mōrearea me ngā painga o te tango i tēnei rongoā.

Mā te tango i te raloxifene ka piki ake te mōrearea o te toto totoka i roto i ngā pukahukahu me ngā waewae, engari te āhua nei kāore e piki ake te mōrearea o te mate pukupuku endometrial. Mō ngā wāhine kua mutu te pāheketanga me te osteoporosis (he iti te kiato o te wheua), ka whakaitihia e te raloxifene te mōrearea o te mate pukupuku ū mō ngā wāhine he nui, he iti rānei te mōrearea o te mate pukupuku ū. Kāore i te mōhiotia mēnā ka rite te pānga o te raloxifene ki ngā wāhine kāore he osteoporosis. Kōrero ki tō tākuta mō ngā mōrearea me ngā painga o te tango i tēnei rongoā.

Kei te rangahauhia ētahi atu SERM i roto i ngā whakamātautau haumanu.

Ngā aukati aromatase me ngā mea whakakore

Ka whakaitihia e ngā aukati aromatase (anastrozole, letrozole) me ngā inactivators (exemestane) te mōrearea o te hokinga mai me te puta o ngā mate pukupuku ū hou i roto i ngā wāhine kua pāngia e te mate pukupuku ū i mua. Ka whakaitihia hoki e ngā aukati aromatase te mōrearea o te mate pukupuku ū i roto i ngā wāhine me ēnei āhuatanga e whai ake nei:

• Ngā wāhine kua mutu te pāheketanga me te hītori whaiaro o te mate pukupuku ū.
• Ko ngā wāhine kāore he hītori whaiaro o te mate pukupuku ū, 60 tau te pakeke, neke atu rānei, he hītori o te ductal carcinoma in situ me te mastectomy, he nui rānei te mōrearea ki te mate pukupuku ū i runga i te taputapu tauira Gail (he taputapu e whakamahia ana hei whakatau tata i te mōrearea o te mate pukupuku ū).

Mō ngā wāhine he nui ake te mōrearea ki te mate pukupuku o te ū, ka whakaitihia te nui o te estrogen e hangaia ana e te tinana e te tango i ngā aukati aromatase. I mua i te paheketanga, ka hangaia te estrogen e ngā ovaries me ētahi atu kiko i roto i te tinana o te wahine, tae atu ki te roro, te kiko ngako, me te kiri. I muri i te paheketanga, ka mutu te hanga estrogen e ngā ovaries, engari kāore ngā kiko kē atu. Ka aukatihia e ngā aukati aromatase te mahi a te whākōkī e kiia nei ko te aromatase, e whakamahia ana hei hanga i te estrogen katoa o te tinana. Ka aukatihia te mahi a te whākōkī e ngā mea whakakore aromatase.

Ko ētahi o ngā kino ka pā mai i te tango i ngā aukati aromatase ko te mamae o ngā uaua me ngā hononga, te osteoporosis, te werawera, me te tino ngenge.

3. Te tango i te mastectomy hei whakaiti i te mōrearea

Ko ētahi wāhine he nui te mōrearea ki te mate pukupuku o te ū, ka whiriwhiri pea rātou kia tangohia ngā ū e rua ina kore he tohu o te mate pukupuku. He iti ake te mōrearea o te mate pukupuku o te ū i roto i ēnei wāhine, ā, he iti ake te manukanuka o te nuinga mō te mōrearea o te mate pukupuku o te ū. Heoi, he mea nui kia aromatawaihia te mōrearea o te mate pukupuku me te whai kōrero tohutohu mō ngā huarahi rerekē hei ārai i te mate pukupuku o te ū i mua i te whakatau i tēnei whakatau.

4. Te tango i te ovarian

Ko ngā ovaries te nuinga o te estrogen e hangaia ana e te tinana. Ko ngā maimoatanga hei aukati, hei whakaiti rānei i te nui o te estrogen e hangaia ana e ngā ovaries ko te pokanga hei tango i ngā ovaries, te radiotherapy, te tango rānei i ētahi rongoā. Ka kiia tēnei ko te ovarian ablation.

Ko ngā wāhine kei mua i te wā pāheketanga, ā, he nui te mōrearea ki te mate pukupuku ū nā ētahi huringa o ngā ira BRCA1 me BRCA2, ka whiriwhiri pea rātou kia tangohia te oophorectomy hei whakaiti i te mōrearea (te tango i ngā ovaries e rua ina kāore he tohu o te mate pukupuku). Ka whakaitihia e tēnei te nui o te estrogen e hangaia ana e te tinana, ā, ka whakaitihia hoki te mōrearea ki te mate pukupuku ū. Mā te tango oophorectomy hei whakaiti i te mōrearea ka whakaitihia hoki te mōrearea ki te mate pukupuku ū i roto i ngā wāhine kei mua i te wā pāheketanga noa, me ngā wāhine he nui ake te mōrearea ki te mate pukupuku ū nā te irahiko ki te uma. Heoi, he mea tino nui kia aromatawaihia te mōrearea o te mate pukupuku me te whai tohutohu i mua i te whakatau i tēnei whakatau. Ko te hekenga ohorere o ngā taumata estrogen ka tīmata pea ngā tohu o te pāheketanga. Kei roto i ēnei ko ngā mura wera, te uaua ki te moe, te manukanuka, me te pouri. Ko ngā pānga roa ko te hekenga o te hiahia moepuku, te maroke o te tara, me te hekenga o te kiato o te wheua.

5. Te whiwhi i te nui o te whakakori tinana

He iti ake te mōrearea o te mate pukupuku ū mō ngā wāhine e whakakori tinana ana mō ngā hāora e whā, neke atu rānei, i te wiki. Ko te pānga o te whakakori tinana ki te mōrearea o te mate pukupuku ū ka nui rawa atu pea i roto i ngā wāhine kāore anō kia pāngia e te pāngia e te taumaha tinana noa, he iti rānei.

Kāore i te mārama mēnā ka pāngia te mōrearea o te mate pukupuku o te ū e ēnei mea e whai ake nei:

1. Ngā ārai hapūtanga homoni

Kei roto i ngā ārai hapūtanga homoni te estrogen, te estrogen rānei, me te progestin. Kua whakaatuhia e ētahi rangahau he iti noa te pikinga o te mōrearea o te mate pukupuku ū ki ngā wāhine e whakamahi ana i ngā ārai hapūtanga homoni. Kāore i whakaatuhia e ētahi atu rangahau he pikinga ake o te mōrearea o te mate pukupuku ū i roto i ngā wāhine e whakamahi ana i ngā ārai hapūtanga homoni.

I roto i tētahi rangahau, i paku piki ake te mōrearea o te mate pukupuku ū i te roa o te whakamahinga a te wahine i ngā ārai hapūtanga homoni. I whakaatuhia e tētahi atu rangahau ko te paku pikinga o te mōrearea o te mate pukupuku ū i heke i roto i te wā i mutu ai te whakamahi a ngā wāhine i ngā ārai hapūtanga homoni.

Me nui ake ngā rangahau hei whakatau mena ka pāngia te wahine e ngā ārai hapūtanga homoni ki te mate pukupuku o te ū.

2. Taiao

Kāore anō kia whakamātauhia e ngā rangahau ka piki ake te mōrearea o te mate pukupuku o te ū mēnā ka pāngia koe e ētahi matū o te taiao, pērā i ngā matū.

Kua whakaatuhia e ngā rangahau he iti, he kore rānei he pānga o ētahi āhuatanga ki te mōrearea o te mate pukupuku o te ū.

He iti noa iho, kāore rānei he pānga o ēnei e whai ake nei ki te mōrearea o te mate pukupuku o te ū:

• Te whakatahe.
• Te whakarerekē i te kai pēnei i te whakaiti i te ngako, te nui ake rānei o ngā hua me ngā huawhenua e kainga ana.
• Te tango i ngā huaora, tae atu ki te fenretinide (he momo huaora A).
• Te momi hikareti, ngā mea kaha me ngā mea kore mahi (te hongi i te auahi tuarua).
• Te whakamahi i te deodorant, i te antiperspirant rānei i raro i te ringa.
• Te tango i ngā statin (ngā rongoā whakaheke cholesterol).
• Te tango i ngā bisphosphonates (ngā rongoā hei rongoā i te osteoporosis me te hypercalcemia) mā te waha, mā te werohanga rānei ki roto i te uaua.
• Ngā panonitanga o tō manawataki circadian (ngā panonitanga ā-tinana, ā-hinengaro, me ngā whanonga e pāngia ana e te pōuri me te māramatanga i roto i ngā huringa 24 hāora), ka pāngia pea e te mahi i ngā huringa pō, e te nui rānei o te māramatanga i roto i tō rūma moe i te pō.

Pūtake:http://www.chinancpcn.org.cn/cancerMedicineClassic/guideDetail?sId=CDR257994&type=1