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36.स्तन क्यान्सरवाट कसरि बच्न सकिन्छ ? के गर्ने अब ??_ Breast Cancer, What to do ?? By Dr Surya Parajuli


पृष्ठभूमि
snfjtL /fh+jzL -gfd kl/jt{g_ jif{ #%, dlxnf emfkfdf w]/} pkrf/ ul/;s]kl5 klg v'§fsf] dflyNnf] efudf /x]sf] x•L (Femur) sf] km\ofSr/ lgsf] x'g;Sbf sf7df8f}+ hfg] ;Nnfx kfP/, sf7df8f}+sf] Ps d]l8sn sn]hdf hfg'eof] . ToxfF pxfFnfO{ xf8hf]gL{ ljefudf egf{ ul/of] / pkrf/ yflnof] . ToxfF klg pxfFsf] /f]u lgbfg tkm{ hfg ;s]g . d]l8sn sn]hsL Ps hgf 5fqfn] cWoogsf qmddf pxfFsf] s]z :68L ubf{ kf] yfxf eof] ljut gf} dlxgf b]lv pxfFsf] bfofF :tgdf ufF7f] -Breast Lump_ cfPsf] /x]5 . To;kl5 zNo lrlsT;f ljefu;Fu ;dGjo u/L pxfFsf] :tg hfFr ubf{ pQm ufF7f] ;fFRr} b'vfO{ /lxt /x]5 . gb'v]s} sf/0f pxfFn] :tgsf] ;d:of atfpg' ePsf] /x]g5 . cGTodf 8fS6/sf] 8fOUgf]l;; o:tf] lyof]M–:tg SofGt/ / To;sf] sf/0f Femur sf] Fracture( CA of breast with pathological fracture of femur)

/f]usf] klxrfg -Diagnosis_ k|lqmof 
d'Voto # k|sf/ -Triple Assessment_ åf/f hfFr ul/G5 .
!_ :tgnfO{ 5fd]/ hfFr ug]{ M
:tgdf luvf{÷ufF7f]÷8Nnf]sf] klxrfg ug{sf nflu :tgnfO{ 5fd]/ hfFr ug{'k5{ . :tgnfO{ 5fd]/ -Palpation_ hfFRbf luvf{sf] agf}6, cfsf/, gfk, ;fx|f] jf g/dkg, b'Vg] jf gb'Vg], sfvLdf ufF7f] 5 ls 5}g egL hfFlrG5 .8fS6/nfO{ b]vfpg' cufl8 dlxnfx?n] ;/n tyf ;xh ?kdf 3/d} a;L cfkm\gf] :tg hfFr ug{ ;S5g\ . h;nfO{ :jo+ :tg k/LIf0f -Breast self examination-BSE_ elgG5 .
:jo+ :tg k/LIf0f tl/sfx? M
@) jif{ pd]/ k'u]sf dlxnfx?n] of] hfFr ug]{k5{ . lgoldt dlxgfaf/L x'g] dlxnfdf dlxgfjf/L /f]lsPsf] % cf} lbgdf of] hfFr pko'Qm  5 . lsgsL dlxgfjf/Lsf] ;dodf :tg s8f, xNsf ;'lGgPsf] tyf b'Vg] x'Fbf kl/jt{g kQf nufpg clns sl7g x'G5 .
clgoldt dlxgfjf/L x'g] dlxnfsf] xsdf k|To]s dlxgfsf] lglZrt lbgdf of] hfFr ug{ ;lsG5 h:t} kmu'g &, r}t &, a}zfv & ===
k/LIf0f ;do M– sk8f km]bf{, g'xfpFbf jf cGo, P]gf cufl8 pleP/ jf cf]5\ofgdf kN6]/ .
:tgnfO{ 5fDbf xTs]nfsf] k|of]u ug'{ h?/L 5 . bfFof xftn] jfFof :tg / afFof xftn] bfFof :tg hfFr ug'{kb{5 .:tgsf rf/} s'gf nufot b'j} sfvLd'lg 5fDg kb{5 .
gf]6M s'g} ufF7f] of kl/jt{gsf] z+sf nfu]df c:ktfn uP/ lrlsT;snfO{ b]vfpg} k5{ .

@= X–ray k/LIf0f
s= Dofdf]u|fd
of] ljz]if k|sf/sf] hfFr xf] . *) k|ltzt SofG;/ o; k/LIf0faf6 kQf nfUb5 . 5ftLsf] gd{n X-ray eGbf cln leGg k|sf/sf] of] X-ray ubf{ :tgnfO{ b'O{j6f Kn]6sf] aLrdf Psl5g lylrG5 . s]xL c;lhnf] ePklg o;n] s'g} v/faL ub}{g\ . ;d"xut Mammogram k/LIf0f xfd|f] h:tf] ;dfhdf cfjZos x'Fb} uO/x]sf] 5 lsgls :tg SofG;/nfO{ Psbd} ;'?sf] cj:yfdf kQf nufO{ #% k|ltzt d[To'b/nfO{ sd 36fpg ;lsg]5 .k|To]s $) jif{ k'u]sf dlxnfn] x/]s @ jif{df / %) jif{ k'u]sf dlxnfn] x/]s jif{ tyf zª\sf nfu]df Dofdf]u|fd ug'}pko'Qm b]lvG5 .

v_ :tgsf] cN6«f;f]gf]u|fd -USG of Breast_
#% jif{ eGbf sd pd]/sf dlxnfsf] nflu of] hfFr pko'Qm b]lvG5 . k]6sf] lel8of] PS;–/] h:t} :tgsf] hfgsf/L u/fpg] o; hfFrnfO{ Bresat Ultrasonogram elgG5 . o;af6 luvf{ kfgL e/]sf] -Cystic_ jf 7f]; -Solid_ eGg] hfgsf/L kfO{G5 . h;af6 c? hfFr tyf pkrf/ k|lqmofdf ;xof]u k'Ub5 .

#_ sf]if÷tGt'sf] hfFr -Cytology and Biopsy_
cGo k/LIf0faf6 z+sf nfu]df :tg SofG;/ g} xf] egL ls6fg ug{ of] hfFr cfjZos b]lvG5 . t;y{M of] k/LIf0f ;a}eGbf k|d'v, ljZj;gLo / clGtd hfFr xf] .

k/LIf0f k|lqmofx?
s_ FNAC -Fine Needle Aspiration Cytology
of] k|lqmofdf pQm ufF7f]af6 l;l/~hsf] k|of]u u/L clnslt t/n kbfy{ -h;df sf]ifx? x'G5g\_ lgsflnG5, tt\kZrft\ o;nfO{ ;"Idbz{s oGq af6 hfFr ul/G5 . OPD d} of] ;/n k|lqmofåf/f ul/g] hfFr Pp6f pko'Qm ljlw xf] .

v_ Open Biopsy -ck|]zg u/]/_
o; k|lqmofdf ;fgf] ck|]zg u/L k'/} luvf{ jf s]xL c+z lems]/ ljz]if1 -Pathologist_åf/f hfFr ul/G5 .

:tg SofG;/sf] pkrf/ k|lqmofx? 
;dod} k/LIf0f u/]/ of] /f]u kQf nufPdf pkrf/ k|lqmof ;xh b]lvG5 . SofG;/sf] cj:yf -Stage_ cg';f/ ljleGg k|sf/sf pkrf/ k4ltx? x'G5g\ .
!_ :tgsf] hfFrx? -dfly elgP em}+_
@_ SofG;/sf] c? cËdf km}nfj6 -Metastasis_
  s_ /utsf ljleGg k/LIf0fx?
  v_ 5ftLsf] PS;–/]  
  u_ k]6sf] lel8of] PS;–/]       
  3_ l;6L :Sofg
  ª_ af]g :Sofg

pkrf/ k4ltx?
!_ SofG;/ ePsf] 7fpFsf] dfq} pkrf/ -Local Treatment_
@_ ;Dk"0f{ pkrf/ -Systemic Treatment_

Local Treatment:
!_ zNolqmof
:tgnfO{ dfq sf6]/ kmflng] zNolqmof -Simple Mastectomy_.

:tg / To;} kl§sf] sfvLsf] u|lGy -Axillary Lymph node_ lems]/ kmflng] zNolqmof -Modified Radical Mastectomy_.

:tg, sfvLsf] u|GyL / :tg d'lgsf b'O{a6f df+;k]zL -Petoralis major/Pectoralis minor_;a}nfO{ lems]/ kmflng] zNolqmof (Radical mastectomy_.

gofF k4ltM:tgnfO{ gkmnL 8Nnf] dfq} lemSg] / Tot} kl§sf sfvLsf] u|GyLx? lemSg] zNolqmof-Breast Conservation Surgery-BCS_

gf]6M :tg kmfNg'kg]{ zNolqmof kZrft k'gM s[lqd :tg agfpg ;lsg]5 .
dflysf ljleGg zNolqmofx? lrlsT;sn] /f]usf] k|s[lt x]/L lg0f{o lng'x'G5 .

@_ /]l8of] y]/fkL -Radio Therapy_
ljls/0f (X-ray_ n] SofG;/ ;]N;nfO{ ;]s]/ gi6 ug]{ k4lt xf] . o;sf klg ljleGg k|lqmofx? 5g\ .

Systemic Treatment
!_ lsdf]yf]/fkL -Chemotherapy_
ljleGg k|sf/sf Anticancer/Cytotoxic drugs k|of]u u/L ul/g] pkrf/ k4lt xf] . pkrf/ kZrft ;fdfGo sf]ifx? k'gM klxn]s} :j:y cj:yfdf cfO{ k'Ub5g\ tyflk SofG;/ sf]ifx? gi6 x'Fb} hfG5g\ .

@ _ xdf]{g y]/fkL -Hormon Therapy_
of] pkrf/ k4lt ljlzi7 k|sf/sf] xf], hxfF xdf]{g o'Qm cf}ifl3 vfg] jf xdf]{g pTkfbg ug]{cËnfO{ operation u/L lemlsG5 .h;sf sf/0f SofG;/ sf]ifx? a9\gnfO{ rflxg] xdf]{gaf6 al~rt /xG5g\ .
                                                                            
Follow up
c? /f]u÷SofG;/ h:t} lgoldt hfFr cfjZos 5 lsgls  
s_ :tgd} /f]u aNem]sf] 5 jf 5}g . 
v_ z/L/sf] cGo efudf /f]u km}lnPsf] 5 ls 5}g .
   
ul/g] k/LIf0fx? M–
!_ ;Dk"0f{ z/L/sf] ljz]if1åf/f hfFr
@_ ck|]zg If]q, csf]{ :tg, sfvL / 3fF6Lsf] hfFr 
#_ 5ftLsf] PS;–/] 
$_ kf7]3/ tyf dnåf/sf] hfFr 
%_ csf]{ :tgsf] Dofdf]u|fd 
^_ jf]g cyfjf l;6L :Sofg

उपसंहार 
!_ :jo+ :tg k/LIf0f ljlw cfh}af6 ;'? u/f}+ .  
@_ lrlsT;ssf] k/fdz{ lng nfh gdfgf}+ .  
#_ /f]u nfu]df pko'Qm 7fpFdf uO{ t'?Gt pkrf/ u/fpmF .  
$_ /f]unfO{ 3[0ff u/f}+, /f]uLnfO{ dfof u/f}+ .

kl/jf/, ;dfhsf] dfof, ;befj cfjZos 5 ,la/fdLnfO{ l5Ml5 / b'/b'/ gu/L p;sf] cfTdan a9fpg tkfO{ xfdL ;a} ldnL Ps;fy nfUg' h?/L 5 . tkfO{sf] :j:y hLjgsf] sfdgf  . wGojfb !



35.कार्बन मोनोअक्साईड पोईजनिङ ( Carbon Mono-oxide Poisoining)


डाक्टर साथी 
@)^& ;fn k'; @% ut] cfOtaf/ Ps /fli6«o b}lgsdf k|sflzt ;dfrf/  lg:;fl;P/ cfdf5f]/Lsf] d[To' . pQm 36gfdf 5f]/LnfO{ ;]sfpg /fte/ sf]7fdf cfuf] /fVbf z'qmaf/ /ftL nlntk'/sf] rfkfufpFdf b'O{ hgfsf] Hofg uPsf] 5 . cfdf @( aifL{of t'n;L l3ld/] / @ dlxgfsL 5f]/Lsf] d[To' ePsf] 5 eg] kltsf] cw{r]tg cj:yfdf p4f/ ePsf] b]lvG5 . sf]Onfsf] cfuf] aflx/ lgsfNg la;{bf pQm 36gf ePsf] xf] . ;f; k]mg{ ufx|f] ePkl5 dWo/flt PSsf;L p7]sf kltn] xtkQ em\ofn 9f]sf vf]n]sf lyP . 9f]sf vf]n] nuQ} >ldtL / 5f]/LnfO{ p7fpg] k|of; ubf{ b'j}n] xnrn gu/]kl5 pgsf] tTsfn k|x/Lsf] ;xof]udf p4f/ u/L b'j}sf] d[To' eO;s]sf] hgfP / To;sf] sf/0f sf]7fdf afn]sf] cfuf]sf] sf/0f clS;hgsf] sdL eO{ sfj{gdf]gf]cS;fO8 UofF; sf]7fdf el/bf d[To' ePsf] atfP . lxpFbsf dlxgfx?df k|sflzt / ck|sflzt o:Tf} w]/} 36gfx?, w]/} 7fpFdf xfdLn] ;'g]sf 5f}+ eg] sltkon] ef]u]sf] b'vb cj:yf 5 . aGb sf]7f d'Votof kSsL 3/x?df tftf]sf] nflu k|of]u ul/g] sf]Onf cfuf] tyf cGo ;|f]tsf] sf/0faf6 la:tf/} cS;Lhgsf] dfqf 36\g hfG5 eg] laiffQm UofF; sfj{gdf]gf]cS;fO8 a9\g hfG5 / o;}sf sf/0f dflg;sf] d[To' x'G5 .
sfa{g df]gf]cS;fO8 s] xf]  <
Pp6f o:tf] laiffQm /;folgs Uof; xf] h;df sfj{g -c_ / clS;hg -o_ ldl;Psf] x'G5 . h;nfO{ ;'qfTds?kdf co n]lvG5 . of] UofF; xfjfeGbf # u'0ff xn'sf] x'G5 . o;sf] d'Vo ;|f]tx?df bfp/fsf] cfuf], uf8Lsf] OGhLg, Uof;, t]n, sf]Onf, k]6«f]n, :6f]e, cflb x'G5 .
kf]O{hlgª s;/L ;'? x'G5 <
d'Votof hf8f] dlxgfx?df xfjfsf] cfbfgk|bfg sd x'g] 3/ sf]7fdf of] b]lvG5 . sfa{g df]gf]cS;fO8n] /utdf /x]sf] x]df]Unf]lagaf6 clS;hgnfO{ x6fOlbG5, h;sf] sf/0f sf]ifdf x'g] cfGtl/s Zjf;k|Zjfz k|lqmof aGb x'g hfG5 eg] d'6'df klg k|ToIf v/faL ub{5 .

ktf nufpgsf nflu s]xL nIf0f tyf lrGxx?
rSs/ nfUg], jfsjfs nfUg], dGb 6fpsf] b'Vg], sdhf]/Lkg, pN6L x'g], cfFvf wldnf] x'Fb} hfg],l56f] l56f] Zjf;sf] ult a9\g], d'6'sf] w8\sg a9\b} hfg], hLp sfDg yfNg], a]xf]; cyjf cw{r]tg x'g] clg d[To' x'g] ub{5 .
c:ktfn pkrf/ k|lqmof
!)) k|ltzt clS;hg lbg ;'? ug]{ . la/fdLdf b]lvg] l;h/ tyf d'6'sf] pkrf/ k|lqmof ;Fu;Fu} ug'{k5{ .
36gf:yn pkrf/ k|lqmof
tTsfn em\ofn9f]sf vf]Ng] . sf]Onf, bfp/f, :6f]e cflb t'?Gt aGb ug]{, x6fpg] . l5d]sLnfO{ ;xof]usf] nflu cfJxfg ug]{ .  ;a} ldnL la/fdLnfO{ t'?Gt c:ktfn nfg] .
s;/L aRg] <
;'Ts]/L ePsf 3/x?df ttfpgsf nflu k|of]u ul/Psf :6f]e, sf]Onf, Uof; k"0f{ ?kdf aGb u/]/ dfq ;'Tg] . sf]7fdf xfjf cfbfgk|bfgsf] nflu em\ofn cf+lzs ePklg v'Nnf /fVg] . Pp6f sf]7fdf le8ef8 u/]/ w]/} dflg; ga:g] .
;f+/fz
cd"No hLjgnfO{ sfa{g dfgf]cS;fO8sf] lzsf/ agfpg of aGg' k"j{ g} ;fjwfgL tyf ;t{stf lnFb} hLjg ;'vdo agfpg'xf];– d]/f] sfdgf .