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Radykalne leczenie raka piersi – metody i możliwe powikłania

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Mastektomia u 90% pacjentek z rakiem piersi jest skuteczną metodą leczenia. Niesie jednak za sobą ryzyko wystąpienia powikłań takich jak krwiaki, torbiele, martwica i bóle fantomowe. Pacjentki muszą liczyć się również z licznymi skutkami ubocznymi po radioterapii.

Pacjentki z rakiem piersi, u których wykonano mastektomię, narażone są na wystąpienie skutków ubocznych we wczesnej lub późnej fazie usunięcia piersi. Pacjentki, które leczone są radioterapią, muszą liczyć się z powikłaniami skórnymi.

Wczesne i późne skutki uboczne mastektomii

W początkowej fazie rekonwalescencji po chirurgicznym usunięciu piersi może dojść do zakażenia rany, pojawienia się krwiaka, a także wystąpienia martwicy płatów skórno-podskórnych, co może doprowadzić do konieczności przeprowadzenia kolejnej operacji. Pacjentki po zabiegu mastektomii narażone są również na rozejście się rany oraz tworzenie się torbieli chłonno-przesiękowej. Niektóre pacjentki skarżą się również na bóle fantomowe amputowanej piersi.

Po chirurgicznym wycięciu piersi dochodzi również do późnych powikłań. Te występują częściej na tle nerwowym lub mięśniowym. Wyróżnia się wśród nich uszkodzenie unerwienia obwodowego czy osłabienie siły mięśni i ograniczenie ruchomości kończyny górnej oraz pasa barkowego. Wśród późnych powikłań mastektomii obserwuje się także obrzęk limfatyczny kończyny górnej po stronie operowanej piersi. Następstwem obrzęku może być rozwój mięsaka naczyń krwionośnych.

Powikłania po radioterapii

Radioterapia stanowi ważny element leczenia raka piersi. Może być stosowana samodzielnie, zamiast leczenia chirurgicznego, lub jako element uzupełniający, jeżeli podczas operacji nie udało się usunąć wszystkich komórek nowotworowych. W trakcie radioterapii mogą pojawiać się działania niepożądane. Jednym z najczęstszych jest odczyn popromienny, objawiający się zaczerwienieniem skóry. Popromiennemu zapaleniu skóry towarzyszyć może świąd i łuszczenie się skóry. W niektórych przypadkach może dochodzić do martwicy tkanek lub owrzodzeń i włóknień. Odczyn skórny należy do powikłań wczesnych – pojawia się w trakcie napromieniania i utrzymuje się do 3 miesięcy. Innymi skutkami radioterapii mogą być odczuwanie zmęczenia, a także rzadko występujące zapalenie przełyku. Może też pojawić się obrzęk chłonny kończyny górnej.

Postępowanie po radioterapii

Pacjentkom leczącym się za pomocą radioterapii zaleca się ostrożność w zakresie pielęgnacji skóry poddawanej działaniom promieni. Przede wszystkim należy unikać stosowania środków o działaniu drażniącym lub mocno perfumowanych. Pacjentki powinny również unikać intensywnych ćwiczeń nadwyrężających obszar poddawany promieniowaniu – rozciągających czy z dużym oporem, ponieważ w tym miejscu tkanki są wyjątkowo delikatne, osłabione i miękkie. Niewskazane są również masaże, zabiegi cieplne i mobilizacji blizny. By zapobiec procesom włóknienia tkanek, pacjentkom zalecana jest gimnastyka ogólnousprawniająca.

W okresie kilku miesięcy lub nawet lat po zakończeniu terapii promieniami jonizującymi pacjentki narażone są na wystąpienie hipo- lub hiperpigmentacji skóry. Skóra może się nadmiernie przesuszać, dochodzi też do nadmiernego rogowacenia, teleangiektazji, zaniku i przerwania ciągłości skóry.

Źródła: pol.onkol.kielce.pl, portal.abczdrowie.pl

Przeczytaj także: Coraz więcej osób ze stanami zapalnymi skóry wywołanymi restrykcyjną higieną rąk

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