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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 !