Tus qauv kev kho mob qog noj ntshav, chemotherapy yog raws li kev siv tshuaj sib txawv hauv kev kho tus kheej raws tu qauv. Qhov "tshuaj cocktail" no tawm tsam cov qog nqaij hlav cancer los ntawm kev rhuav tshem lawv lossis los ntawm kev thaiv lawv cov kev sib npaug. Tab sis vim nws kuj cuam tshuam rau cov hlwb noj qab haus huv, nws cov kev mob tshwm sim tsis tseem ceeb. Txawm li cas los xij, kev kho mob ntau ntxiv ua rau nws tuaj yeem txo lawv.

Chemotherapy yog ib qho kev kho mob yooj yim rau mob qog noj ntshav. Nws muaj kev tswj hwm cov tshuaj sib txawv uas yuav ua los ntawm kev tua cov qog nqaij hlav cancer lossis los ntawm kev tiv thaiv lawv los ntawm kev sib npaug.

Cov molecules sib txawv yog siv rau hauv kev kho mob, feem ntau ua ke (multidrug therapy). Lawv tawm tsam mob qog noj ntshav nrog ntau yam kev ua haujlwm. Qee qhov cuam tshuam rau kev sib txuas lossis kev ua haujlwm ntawm DNA, tiv thaiv lawv los ntawm kev faib; Lwm tus cuam tshuam nrog RNA thiab cov proteins. Yog li ntawd, muaj 4 yam tseem ceeb ntawm cov tshuaj chemotherapy raws li lawv hom kev ua:

• DNA modifiers, ntawm cov uas topoisomerase inhibitors, topoisomerase II inhibitors, anthracyclines (uas intercalate hauv DNA cell);
• spindle tshuaj lom, uas ua haujlwm los ntawm kev thaiv qhov tsim ntawm chromatic spindle tso cai rau kev sib cais ntawm chromosomes thaum lub sij hawm mitosis, yog li tiv thaiv cell division;
• Cov tshuaj alkylating, uas cuam tshuam cov txheej txheem ntawm kev rov ua dua thiab hloov pauv ntawm DNA los ntawm kev tsim cov kab mob sib kis ntawm cov kab DNA los ntawm cov nyhuv alkylation (ib qho hydrogen proton hloov los ntawm ib pawg alkyl, tsis ua haujlwm). Piv txwv li: Cyclophosphamide, Ifosfamide, Melphalan, Busulfan.
• antimetabolites, uas ua los ntawm inhibiting cov synthesis ntawm nucleic acids, thawj kauj ruam tsim nyog rau txhua cell multiplication. Qee cov tshuaj tiv thaiv metabolites: methotrexate, 5-fluorouracil, pyrimidic analogues, Tégafur, Capecitabine, Azacitidine ...

Feem ntau ntawm cov molecules no yog siv rau intravenously; lwm tus ntawm qhov ncauj, los ntawm kev txhaj tshuaj intramuscular lossis subcutaneous.

Chemotherapy tam sim no muaj ob lub ntsiab lus tseem ceeb:

• kev txhim kho ntawm qhov ncauj chemotherapy;
• precision tshuaj, nrog rau tus kheej kev kho mob raws li kev soj ntsuam ntawm cov kab mob lom thiab caj ces ntawm tus neeg mob cov qog.

Kev kho tshuaj khomob muaj nyob rau hauv cov tsev kho mob ib txwm muaj (thaum pib kho mob piv txwv lossis thaum siv tshuaj kho mob hnyav), ntawm tus neeg mob sab nraud lossis hauv tsev (HAD).

Cov txheej txheem kev kho mob yog tus kheej: cov molecules thiab lawv qhov ntau npaum li cas, tus naj npawb thiab zaus ntawm kev sib ntsib nyob ntawm seb hom qog, nws theem, lub xeev ntawm kev noj qab haus huv ntawm tus neeg mob, nws hnub nyoog, cov lus teb ntawm lub cev rau qhov kev kho mob no. Qee cov tshuaj khomob yog txhua hnub (tshwj xeeb yog cov uas tau txais los ntawm qhov ncauj), lwm qhov ib lub lim tiam, txhua 15 hnub, thiab lwm yam. Lub sijhawm ntawm kev sib kho nws txawv ntawm 10 feeb mus rau ntau tshaj 72 teev rau cov sijhawm ntev tshaj plaws.

Lo lus "lub voj voog" yog siv los xa mus rau lub sijhawm uas suav nrog cov hnub uas tau txais kev kho mob tiag tiag thiab "lub sijhawm so" rau cov hnub uas tsis tuaj yeem kho. Lub sijhawm so no yog qhov tseem ceeb kom cov hlwb noj qab haus huv muaj sijhawm los txuas ntxiv lawv tus kheej. Tus naj npawb ntawm cov voj voog ntawm kev siv tshuaj khomob kuj txawv nyob ntawm seb hom mob qog noj ntshav thiab tus neeg mob. Kev sab laj tau npaj thoob plaws hauv kev kho mob txhawm rau saib xyuas qhov kev loj hlob ntawm tus kab mob thiab kev ua siab ntev ntawm lub cev, thiab hloov kho cov txheej txheem kho yog tias tsim nyog.

Cov tshuaj feem ntau yog muab tso rau hauv cov hlab ntsha. Txhawm rau zam kom tsis txhob muaj prick tus neeg mob ntawm txhua qhov kev kho tshuaj khomob, lub catheter lossis lub chaw cog qoob loo (hauv cov hlab ntsha nyob hauv lub caj dab) tuaj yeem muab tso rau hauv qhov chaw thoob plaws hauv kev kho mob. Cov kev kho mob ntxiv tuaj yeem muab tau, ua ntej lossis tom qab kev txhaj tshuaj, txhawm rau txo cov kev mob tshwm sim.

Ib tug ncej ntawm kev kho mob qog noj ntshav, chemotherapy yog siv nyob rau hauv ntau cov qog nqaij hlav ntawm ntau theem.

Raws li tsab ntawv tshaj tawm txog kev kho mob qog noj ntshav hauv Fabkis, xyoo 2014, tsib hom mob qog noj ntshav ua ke ze li ntawm 87% ntawm kev nyob thiab ntu rau / nrog tshuaj kho mob:

• mob qog noj ntshav ntawm lub plab zom mov: 26,7%;
• mob qog noj ntshav mis: 21,9%;
• cov qog nqaij hlav hematological: 18,3%;
• mob qog noj ntshav ntawm lub ntsws: 12,6%;
• Gynecological qog nqaij hlav: 7,0%.

Kev siv tshuaj khomob tuaj yeem siv ib leeg lossis ntxiv rau kev phais (cov qog tshem tawm lossis tumeroctomy). Peb mam li paub qhov txawv:

• neoadjuvant chemotherapy : ua ntej kev phais, nws lub hom phiaj txo qhov loj ntawm cov qog thiab yog li pab txhawb nws abalation, nrog rau txo qhov kev pheej hmoo ntawm kev rov tshwm sim ntawm tus kab mob;
• chemotherapy adjuvant : tshuaj tom qab phais, nws lub hom phiaj txo qhov kev pheej hmoo ntawm kev rov tshwm sim ntawm qhov chaw ntawm cov qog nqaij hlav qub lossis lwm qhov hauv lub cev.

Kev siv tshuaj khomob kuj tseem siv tau yog tias muaj cov kabmob metastasis, uas yog thaum cov qog nqaij hlav qog noj ntshav tau loj hlob hauv thaj chaw uas tsis yog tus kabmob qub. Qhov no hu ua metastatic chemotherapy.

Kev siv tshuaj khomob tuaj yeem siv nrog rau kev kho hluav taws xob, thiab rau qee hom mob qog noj ntshav, kev tiv thaiv kab mob, kev kho mob loj tshaj plaws hauv xyoo tas los no hauv kev tawm tsam mob qog noj ntshav.

Cov molecules siv rau hauv cov tshuaj khomob kuj ua rau cov hlwb noj qab haus huv ntawm lub cev, tshwj xeeb tshaj yog cov uas sib txuas tau sai (cov pob txha, plaub hau, tawv nqaij, thiab lwm yam), uas ua rau muaj kev phiv ntau yam:

• txo qis hauv qee cov qe ntshav dawb thiab yog li ua kom tsis muaj zog tiv thaiv kab mob;
• platelets tsawg thiab cov qe ntshav liab;
• xeev siab thiab ntuav uas tuaj yeem tshwm sim tam sim tom qab kev kho mob thiab hauv 5 hnub tom ntej;
• zawv plab;
• o ntawm qhov ncauj (mucositis);
• plaub hau poob;
• tawv nqaij thiab ntsia thawv hloov;
• venous fragility;
• nkees nkees.

Cov teebmeem tshwm sim txawv nyob ntawm cov molecules siv tab sis kuj rau tus neeg mob, vim hais tias txhua yam kabmob sib txawv.

Cov tshuaj tuaj yeem txwv cov kev mob tshwm sim no, ib yam li lwm cov tshuaj, xws li auriculotherapy lossis acupuncuture, siv hauv qee lub tsev kho mob. Qhov kev saib xyuas no, hu ua "kev saib xyuas kev txhawb nqa", yog qhov tseem ceeb rau tus neeg mob lub neej zoo, txij li kev tswj xyuas mob qog noj ntshav tsis tuaj yeem nres ntawm kev kho tus kab mob nkaus xwb. Kev txhawb nqa kev puas siab puas ntsws kuj tseem ceeb, xws li kev tswj xyuas cov duab zoo ntawm kev saib xyuas, los ntawm kev cob qhia lossis kev kho kom zoo nkauj piv txwv.