Umdlavuza wamaphaphu kubadala asebekhulile uphathwe kanjani futhi ingabe isifo esibi kakhulu sibi kakhulu kunabantu abasha? Ingabe ikhona isikhathi lapho umuntu omdala kakhulu ukuhlinzwa noma i-chemotherapy? Ngumaphi umdlavuza wamaphaphu ohlukile kubantu asebekhulile, isibonelo, labo abangaphezu kweminyaka engama-80?
I-Cancer Lung Kudala Abadala
Enye yezinkolelo zomdlavuza wamaphaphu bekulokhu ukuthi abadala asebekhulile abanakho ukhetho lokuphathwa komdlavuza wamaphaphu abasha abasebasha abanomdlavuza wemaphaphu.
Kubonakala sengathi kunomqondo ojwayelekile ukuthi abadala asebekhulile abakwazi ukubekezelela imiphumela emibi yokwelashwa, noma ukuthi ukwelashwa kufanele okungenani "kukhonjiswe phansi."
Izifundo zithini ngempela? Ngemuva kwalokho, sizwa ukuthi 50 ngu-30 omusha, kanti 70 ngu-50 omusha.
Ayikho incazelo ecacile yalokho ubudala okushiwo "abadala asebekhulile" noma "asebekhulile" iziguli ezinomdlavuza wamaphaphu, kodwa izifundo eziningi zivela ukuthi zisebenzise ukunqunywa kweminyaka engu-70. Uma ukhona kule nkathi yobudala, sicela ufunde kuqhubeke. Sithola ukuthi isikhathi sokulandelana asibaluleki kangcono kunezinye izici ekunqumeni impendulo kanye nokukwazi ukubekezelela ukwelashwa. Futhi yisikhathi esithandekayo kakhulu, njengoba eziningi zokwelapha ezivuthwa umlomo ezivunywa ukwelashwa komdlavuza wamaphaphu, kanye nalabo abavivinywa ekuvivinyweni komtholampilo, ngokuvamile kuvame ukubekezelela kunokwelashwa kwemithi ejwayelekile.
Ezinye izifundo zisebenzisa igama elithi "iziguli ezigugile" ukuchaza labo abangaphezu kweminyaka engu-80.
Ngisho nasezifundweni ezisebenzisa lesi sizukulwane esikhundleni sokuthi u-70 ubudala ojwayelekile ukuchaza "abadala asebekhulile" ungase umangale ukwazi ukuthi abaningi balaba bantu bangabekezelela kanjani ukwelashwa ngomdlavuza wamaphaphu.
Yeka Indlela Ejwayelekile Ye-Cancer Lung Kudala Abadala?
Ngesikhathi samanje, abangaphezu kwamaphesenti angu-40 abantu abatholakala benomdlavuza wamaphaphu baneminyaka engu-70 noma ngaphezulu.
Izinkinga Ngokusebenzisa Isikhathi Esilandelanayo Ekukhetheni Ukwelashwa
Kunezinkinga ezimbili eziyinhloko ngokusebenzisa iminyaka yokulandelana ekucabangeni ukwelashwa komdlavuza wamaphaphu. Okokuqala, sekutholwe ukuthi iminyaka yodwa ayisho okuningi ngokuthi umuntu uzobekezelela kanjani le mithi. Isimo somsebenzi , isilinganiso "senhlalakahle" sisekhona esimweni sokubikezela ukuthi umuntu uzokwenza kanjani. Odokotela babheka ezinye izindlela zokunquma ukuthi umuntu uzobekezelela kanjani ukwelashwa, njengokuhlola okuphelele kwe-griatric (CGA). Lawa mathuluzi abheka izici zesiguli ukuze aqagele ukubekezelelana ukwelashwa nokusinda futhi afaka:
- Isimo somsoco
- Ukuba khona kwezinye izimo zezokwelapha
- Izinga lomsebenzi
- Umsebenzi wokuphila kwansuku zonke (i-ADL)
- Ukusekelwa komphakathi
- Imvelo yasekhaya
Enye inkinga ebheka isikhathi sokulandelana yilezi ukuthi asikwazi nje lokho okuningi. Izidakamizwa eziningi kanye nokwelashwa kuye kwacutshungulwa ekuvivinyweni kwamakhambi kweziguli ezincane.
Isikhathi Singahle Sithinte Ukwelashwa Kwemfudu Ye-Lung
Kubalulekile ukuthi uqale ukhombise ukuthi iminyaka ayinciphisi izinzuzo zokwelapha, kodwa ukwelashwa kungenzeka kungabekezelelwanga abanye abadala asebekhulile. Ukuvumelana ngokubanzi kubonakala sengathi leyo minyaka yodwa akumele ikwazi ukuthi iziphi izinkinga ezingakwazi ukuzisebenzisa noma zingasetshenziselwa umdlavuza wamaphaphu.
Lokho kusho ukuthi kunezizathu eziningana zokuthi kungani ezinye iziguli ezikhulile zingeke zibekezelele ukwelashwa kanye neziguli ezincane.
- Iziguli ezindala zivame ukuba nezimo zezokwelapha ezikhona kakhulu (ukuhlukunyezwa) kuneziguli ezincane. Umlando wesifo senhliziyo, isibonelo, unganciphisa ukusetshenziswa kwezidakamizwa ezithile ze-chemotherapy. Ngokufanayo, izimo ezivimbela umsebenzi wephunga, njenge-emphysema, zingenza ukuhlinzekwa komdlavuza wamaphaphu kuncane kakhulu.
- Iziguli ezindala cishe ziye zancipha umsebenzi wezinso noma umsebenzi wesibindi, futhi izidakamizwa eziningi ezisetshenziselwa ukwelapha umdlavuza zihlungwa ngezinso noma isibindi.
- Iziguli ezindala zivame ukuba nesisindo somzimba esincane kakhulu, okwenza kube lula ukubekezelela isisindo ngezinye izindlela zokwelapha, futhi kusengozini yokugcina i- cachexia .
- Iziguli ezindala zivame ukuba nesitoreji esincane sezintambo zamathambo, ziphakamisa ingozi yezinkinga ezihlobene nokucindezelwa komnyoba osuka kumakhemikhali .
Ukubikezela ukuthi Umlando Uzokwenza kanjani Ukwelashwa
Iziguli ezindala zisengcupheni kokubili ukuxhaswa ngenxa yokwesaba mayelana nokubekezelelana okuhlobene neminyaka yokwelashwa, kanye nobuthi ngenxa yokwelapha ngokweqile. Kubalulekile lapho ukhetha ukwelashwa ukugcina izinto ezimbili engqondweni: cabangela umphumela, bese ucabangela okulindelwe njengesiguli.
Ukwelashwa kwabadala abadala
Ukubheka okukhethwa kukho ukwelapha, lesi sihloko sizokwehla izigaba zomdlavuza wamaphaphu zibe ngumdlavuza wamaphaphu ekuqaleni, umdlavuza wamapapayi ophuthumayo, nesigaba sesine (imetastatic) yomdlavuza wamaphaphu . Nakuba kungavamile ukuthi abantu abanomdlavuza omncane wamangqamuzana wamaphaphu badinga ukwelashwa, i-chemotherapy ivame ukwelashwa okuyinhloko.
Kube nomcabango ovamile phakathi kwabanye abantu ukuthi abantu abangaphezu kweminyaka ethile ngeke bafune ukuphishekela ukwelashwa okufutheka, futhi kunokuba babe "nokunakekelwa okusekelayo" kuphela, kodwa lokhu kubonakala kungenjalo. Lapho bebuzwa mayelana nokuhlinzwa ocwaningweni olulodwa, izimpikane ezingu-50 zeziguli asebekhulile zibeka phambili ekusindeni kunokuba kutholakale izifo.
I-Can Stage Cancer Cancer In Adult Adults
- Ukubekezelela Ukwelashwa Nokusinda - Nakuba kubonakala sengathi kunomuzwa phakathi komphakathi ukuthi ukuhlinzwa komdlavuza wamaphaphu kungaba yingozi kubantu abadala, izifundo azisekeli lokhu. Eqinisweni, akukho umehluko oqhubekayo wokusinda phakathi kweziguli ezindala neziguli ezincane ezihlinzwa ngenxa yomdlavuza ongasona omncane wamaphaphu. Ngaphezulu kwalokhu, amazinga aphezulu okuhlinzwa ahambisana namazinga aphakeme okusinda iziguli asebekhulile ezinomdlavuza wamaphaphu ekuqaleni.
- Izinhlobo zokuhlinza umdlavuza wamangqamuzana - Nakuba kubonakala sengathi inzuzo yokusinda yeziguli ezindala ezihlinzekwe umdlavuza wamaphaphu okuqala, akuzona zonke izinhlobo zokuhlinzwa zomdlavuza wamaphaphu ezifanayo. Ucwaningo olubheka ukuthengiswa komgqa noma lobectomy njengokwelashwa lithole ukuthi abantu abadala abadala bayakwazi ukubekezelela ukuhlinzwa kahle. Kodwa-ke, izifundo ziye zathola ukushona okuphezulu kubantu abadala asebekhulile bethola i- pneumonectomy (ukususwa kwayo yonke iphaphu,) nakuba kubalulekile ukusho ukuthi lezi zifundo zinikeza izibalo, futhi kwezinye izimo, udokotela ohlinzayo angacabanga ukuthi umuntu omdala uzozuza kulolu hlelo. I-VATS (ukuhlinzekwa nge-thoracoscopic) esesimweni esiyisisindo esingaphansi kokususa i-lobe noma ingxenye ye-lobe futhi ingaba yisinqumo esihle kuziguli ezikhethiwe (le nqubo ayikwenzeka njalo.Ukufundwa kuka-2018 kuphinde kwaqinisekisa ukuthi abadala asebekhulile (ngaphezulu abaneminyaka engama-80) bathambekele ekuhlinzekeni ukuhlinzwa kwamathumbu amaphaphu kanye nabantu abadala, kodwa bathola ukuthi izingxenye ezithile (ukuguqulwa kwemigqa) zihambisana nemiphumela engcono.
- I-SBRT / Radiofrequency Ablation - Kubantu abanesifo somdlavuza wamaphaphu esifundazwe esingenakusebenza noma uma umuntu engafuni ukuhlinzwa, ngezinye izikhathi i- radiotherapy yomzimba (stereotactic radiotherapy) (i-SBRT) noma i-radiation of ablation ingasetshenziswa ukuzama ukwelapha umdlavuza wamaphaphu. Inani lokusinda labantu asebekhulile nge-SBRT lingaphansi kokuhlinzwa kodwa kungcono kunokuba kube nokunakekelwa okusekelayo kuphela. I-radiation pneumonitis (ukuvuvukala kwamapayipi okubangelwa imisebe) kuvamile kuziguli ezindala ezinenqubo kodwa ngokuvamile zilashwa.
- Ukuvuselelwa Kwamapulmonary - Ukuvuselelwa kwepulmonary ngaphambi noma emva kokuhlinzwa komdlavuza wamaphaphu kungabasiza abantu bazo zonke ubudala, kodwa ikakhulukazi kubantu abadala.
I-Cancer Advanced Lung Cancer In Iziguli Ezigugile
Ubudala bodwa akuyona into ephikisanayo (isizathu sokungenzi) ngokususwa komdlavuza wamaphaphu (ukuvuselela) kanye ne-adjuvant chemotherapy (i-chemotherapy eyenzelwe ukuqeda umzimba we-micrometastases-amangqamuzana omdlavuza ongase abe khona kodwa amancane kakhulu ukuba angabonwa ekuhloleni izithombe .) Iziguli ezindala ezinezigaba 1 , isigaba sesi-2 , nesigaba se-3A somdlavuza wamaphaphu , ukuhlinzwa kungacatshangelwa (bheka ngenhla ngaphansi kwesigaba somdlavuza wamaphaphu mayelana nokuhlinzwa).
Ngaphandle kokuhlinzwa, i-adjuvant chemotherapy ivame ukuphakanyiswa kubantu abanomdlavuza wamapapu ophuthumayo wendawo. Kukhona ubufakazi obuncane bokuthi i-adjuvant chemotherapy yesigaba 2 noma isigaba se-3A somdlavuza wamaphaphu singase sithuthukise ukusinda kwiziguli ezigugile ezikhethiwe ngokucophelela. Kodwa-ke, izifundo azitholanga ukuthi imisebe yokuthunyelwa komzimba yaba nomthelela omkhulu kuleli qembu. (Futhi, kubalulekile ukuchaza ukuthi lezi zibalo, futhi kungase kube nezizathu ezinhle udokotela angancoma ukwelashwa kwemisebe.)
Okuthuthukisiwe noma iMetastatic (Isigaba sesi-4) I-Cancer Lung ku-Older Adult
Kusukela isigaba somdlavuza wesifo se-4 ngesifo sesisakaze ngaphezu kwamapayipi, ukuhlinzeka ngokuvamile akunconywa.
Kubantu abanamaphaphu adenocarcinoma , nabantu abangakaze babheke nanoma yiluphi uhlobo lomdlavuza wamaphaphu, ukuprofetha kwama-molecular (ukuhlolwa kofuzo) ukufuna ukuguqulwa kwezakhi zofuzo kubaluleke kakhulu. Kubantu abanokuguqulwa kwe-EGFR , ukulungiswa kabusha kwe-ALK ( umdlavuza wamaphaphu we-ALK ) noma ukulungiswa kabusha kwe- ROS1 , izinqubo ezibhekiswe kuzo zingase zithuthukise ukusinda okungaqhubeki kokuqhubeka, nemiphumela emibi yale mithi ivame kakhulu futhi imbalwa kunezidakamizwa zendabuko yamakhemikhali.
I-Chemotherapy ivame ukwelashwa okuyisisekelo somdlavuza wesigaba se-4, kanti neziguli ezincane, ukuhlanganiswa kwezidakamizwa ezimbili zamakhemikhali ngokuvamile kuvunyelwe. Iningi lalabagulayo asebekhulile abalashwa nge-chemotherapy, kodwa kunenzuzo ecacile yokuphila kulabo abakwazi ukubekezelela imiphumela emibi. Ngaphezu kwalokho, ukusebenzisa inhlanganisela yemithi emibili kungaholela ekukhungeni okukhulu kunokusebenzisa imithi eyodwa yokwelapha i-chemotherapy kuphela.
Immunotherapy
Isidakamizwa sokuqala se- immunotherapy yomdlavuza wamaphaphu samukelwa ngo-2015 kanti abanye bafundiswa emilenzeni yokuhlolwa kwemithi Imithi ye-Immunotherapy ingacatshangwa ngokulula nje njengezidakamizwa ezibuyisela futhi zivuselele amandla ethu omzimba omzimba wokulwa nomdlavuza. Le mithi ayisebenzi kuwo wonke umuntu onomdlavuza wamaphaphu, uthathe isikhathi sokuqala ukusebenza, kodwa uma usebenza kahle, ngezinye izikhathi kungase kuholele ekulawuleni isikhathi eside ngisho namanomdlavuza amaphaphu ethuthukile. Ngokuvamile zivame ukubekezelela kalula ukuthi izidakamizwa zendabuko ye-chemotherapy nazo.
Uma Ungumuntu Omdala Okhulile Ngomdlavuza We-Lung
Uma uneminyaka engaphezu kwengu-70 noma engu-80 ngomdlavuza wamaphaphu, khumbula ukuthi ubudala "owenzayo" nokuthi "uzizwe" cishe kubaluleke kakhulu kunaneminyaka ogcwalisa ngayo kumarekhodi akho ezokwelapha. Ngesikhathi esifanayo, ochwepheshe bezokwelapha abangakwazi wena kanye nokwazi ngokwakho bangase babheke ukuthi iminyaka ebhaliwe eshadini ibaluleke kakhulu. Yizo zonke okufanele basebenze nazo.
Okushiwo lokhu, ikakhulukazi phakathi kwezinganekwane ezivamile ukuthi abadala abadala abakwazi ukubekezelela imiphumela emibi yokwelapha, ukuthi kufanele uhlakulele ubuhlobo obuhle bokusebenza nodokotela wakho. Qinisekisa ukuthi uyazi ukuthi uneminyaka engama-85 ubudala kodwa uzizwa sengathi uneminyaka engu-70. Siyajabula ukuthi siphila esikhathini lapho ukwelashwa komdlavuza kuqhubeka ngokwengeziwe, futhi umehluko phakathi kweziguli uyahlonishwa. Lokho kusho ukuthi ukuthatha isikhathi sokufunda ukuba ngummeli wakho ekunakekelweni komdlavuza wakho kuzokusiza ukugeleza nezinselele zokuphila nomdlavuza kanye nemithi yokwelashwa kangcono, kodwa kungase kudlale indima emphumela wakho.
> Imithombo:
> Blanco, R. et al. Ukubuyekezwa kokuphathwa kweziguli asebekhulile nge-non-encane-cell cell lung cancer. Amanothi we-Oncology . 2015. 26 (3): 451-463.
> Chambers, A., Routledge, T., Pilling, J. noMnu Scarci. Kuziguli ezikhulile ezinomdlavuza wamaphaphu, isisombululo sivumelekile ngokubhebhetheka, ukufa kanye nekhwalithi yokunciphisa yokuphila? . I-Interactive Cardiovascular and Thoracic Surgery . 2010. 10 (6): 1015-21.
> Davidoff, A., Tang, M., Seal, B. no M. Edelman. I-Chemotherapy ne-Survival Benefit in Iziguli Ezikhulile Ezinezifo Eziphakeme Zezingqamuzana Zengculaza. I-Journal ye-Clinical Oncology . 2010. 28 (13): 2191-2197.
> Gaira, A. isikhangiso A. Jatoi. I-Non-Small-Cell Lung Cancer Iziguli Ezikhulile: Ingxoxo Yokukhethwa Kwokwelashwa. I-Journal ye-Clinical Oncology . Ishicilelwe ku-inthanethi ngaphambi kokuphrinta ngo-July 28, 2014.
> Gridelli, C. et al. Ukwelashwa Kwabaguli Abagugile Ngomakhalekhukhwini Ongewona Omncane I-Cancer Lung: Imiphumela Yomhlangano Wamaphaneli Wezizwe Zomhlaba Wonke we-Italian Association of Thoracic Oncology. Cancer Cancer Clinic . 2015 Mar 7. (i-Epub ngaphambi kokuphrinta)
> Maione, P. et al. Ukwelapha umdlavuza ongasemncane wesifo samaphaphu kulabo asebekhulile. Intuthuko Yezokwelapha Kwe-Medical Oncology . 2010. 2 (4): 251-260.
> I-Quiox, E. Izindlela ezifanele zokusebenzisa ama-pharmacotherapeutic kweziguli asebekhulile ezinomdlavuza ophuthumayo wesifo samangqamuzana. Izidakamizwa nokuguga . 2011. 28 (11): 885-94.
> Rivera, C. et al. Ukuphathwa okuhlinzekwayo kanye nemiphumela yeziguli asebekhulile ezinomdlavuza wesifo samangqamuzana omncane ongasencane. Isifuba . 2011. 140 (4): 874-80.
> Stamenovic, D., Messerschmidt, A., noT. Schneider. Ukuhlinzwa Kwezingculaza Zama-Lung Kubantu Abakhulile: Ukutadisha KwamaKhosi Okubuyiselwayo Emthonjeni Wezephuthumayo (Eminyakeni Engaphezu Kwengu-80) ekuthuthukiseni Izinkinga Ngokusebenzisa Isibonelo Somngcipheko We-Multivariate. I-International Journal of Surgery . 2018. 52: 141-148.