Uma uhlala nomdlavuza wesigaba 4 wamaphaphu, i-oncologist yakho cishe ixoxe ngenhloso yokwelashwa okwenziwe. Noma kunjalo sifunda ukuthi lokho abantu abangalindela kwezinye izindlela zokwelashwa kuhluke kulokho okuyi-oncologists abakulindele. Iyini iqiniso mayelana ne-chemotherapy kanye nokwelapha imisebe yesigaba somdlavuza wesine 4 futhi yiziphi ezinye izinkolelo ezingalungile?
Ithemba kanye nethemba lamanga nokubikezela
Kukhona ithemba elingaphezulu kulabo abanomdlavuza wesigaba se-4 kunangaphambili. Kubalulekile ukuthi uqaphele phambili ukuthi ukuchazwa kwabantu abantu abanesifo somdlavuza wesigaba se-4 kuthuthukiswa; izindlela ezintsha zokwelapha ziyazitholakala, futhi izindleko zokusinda ziyathuthuka. Kukhona abantu abaningi ababhekwa njengabantu "abasinde isikhathi eside" abasinda esigabeni 4 somdlavuza wamaphaphu, futhi lelo nani landa ngonyaka ngamunye.
Lokho kusho ukuthi ukuchazwa kwesifo somdlavuza wesigaba 4 kumanje akusikho esikufisa ukusifisa, kanti ezinye izindlela zokwelapha azisebenzi ngendlela esifuna ngayo. Ekuxoxeni ngalezi zindlela zokwelapha, kukhona ibhalansi elungile phakathi kokugxilisa ithemba nokuletha ithemba lamanga.
Ithemba lamanga mayelana nezinketho zokwelashwa lingase liholele abantu ukuthi bafinyelele ezinyathelweni ezinezindleko ezinkulu ngokuphathelene nekhwalithi yokuphila . Ithemba lamanga lingabenza abantu bangaphathi izindlela ezahlukene zokwelashwa ezingase zisebenze kangcono. Ithemba langempela, ngokuphambene, libandakanya ngobuqotho ukuhlola ukuthi ngabe ukwelashwa kuyasiza yini kodwa indlela ongase uzizwe unamandla ngayo ekwenzeni izinqumo zokuphila kwakho.
Imigomo Yobungqingili Nezilindelwe Zabagulayo
Kuze kube yamuva sasizicabange ukuthi odokotela neziguli babenokulinganisa okufanayo uma kufika ekulindeni ngesigaba 4 somdlavuza wamaphaphu emaphaphu. Kodwa-ke, izifundo ezimbalwa ziye zaphulukisa leyo bubble, okungenani ngokulindela okulindelekile okuhlobene ne-chemotherapy kanye nokwelashwa kwemisebe.
(Imithi ehlosiwe, i-immunotherapy, kanye nohlobo oluthile lwe-radiation therapy enye indaba futhi sizoxoxwa ngezansi ngezansi.) Ake sihlole lokho esikufundile.
I-Chemotherapy Results Nezilindelwe
Ngocwaningo olwenziwe ngo-2012, abacwaningi baphakamisa ukuthi babone ukuthi ukulindela iziguli kanye ne-oncologists kwakungavumelani ngokulindela okuhlobene ne- chemotherapy emdlalweni wesigaba se-4 . Imiphumela yocwaningo yayiyinkimbinkimbi.
Kubo bonke, amaphesenti angu-69 esiteji sesineziguli ezingama-4 emdlalweni wamaphaphu (futhi amaphesenti angu-81 esiteji sesineziguli ezine-cancer) ayengaqondi ukuthi i-chemotherapy yayingeke ikwazi ukuphulukisa umdlavuza wabo. Ngamanye amazwi, iningi lalaba bantu abanomdlavuza wamaphaphu babethwele ithemba lamanga lokuthi i-chemotherapy ingase ilaphe isifo sabo.
Olunye ucwaningo olwenziwe ngo-2015 lwaqinisekisa ukuthi lokhu okungafani nokulindeleke kwaqhubeka, ukuthi cishe izingxenye ezimbili kwezintathu zeziguli ezine-stage 4 emaphashini noma emdlalweni wekoloni azizange ziqonde ukuthi i-chemotherapy yayingeke neze iphulukise umdlavuza wabo.
I-Chemotherapy, uma isetshenziselwa abantu abane-stage 4 yomdlavuza wamaphaphu ingase isandise ukuphila. Abantu abaphathwa ngalezi zidakamizwa bahlala, ngokwesilinganiso, amasonto ambalwa noma izinyanga ezimbalwa. I-chemotherapy ingase isetshenziswe njengendlela yokwelapha, ukunciphisa izimpawu ezifana nokuphefumula.
Kodwa i-chemotherapy nje kuphela ayiphumelelanga empilweni yomdlavuza wamaphaphu.
I-Radiation Therapy
Njengomuthi we-chemotherapy, kubonakala sengathi abantu abaningi banemicabango engalungile mayelana nokuthola imithi yokwelapha emdlalweni wesigaba 4 somdlavuza . Ngocwaningo olwenziwe ngo-2012, kwatholakala ukuthi amaphesenti angu-64 abantu abazange aqaphele ukuthi imisebe yayingeke ikwazi ukuphulukisa umdlavuza wabo.
Ukwelashwa kwezidakamizwa, njenge-chemotherapy, kungase kwandise ukuphila, noma kusize ngezimpawu zomdlavuza, kodwa kungavamile ukuthi kubangele ukuhlala isikhathi eside. Ngokungafani nemithi ye-chemotherapy, noma kunjalo, imisebe ingase ibe usizo kakhulu ekulawuleni ukuphuma noma ukuvinjelwa kwemikhumbi yomoya ngenxa yomdlavuza wamaphaphu, noma ukwelapha amathisaseli emathambo angabangela ubuhlungu noma ukuhlukana.
Kukhona uhlobo olulodwa lwe-radiation therapy okuyinto esetshenziswa ngezinye izikhathi ngamathemba okuphila isikhathi eside phakathi kwalabo abanesifo somdlavuza wesigaba 4. Uma umuntu enesifo esisodwa noma ambalwa kuphela ebuchosheni , isibonelo, i- radiotherapy yomzimba ebizwa ngokuthi i- stereotactic radiotherapy (i-SBRT) eyaziwa nangokuthi i-CyberKnife, ngezinye izikhathi iholele ekulawuleni isikhathi eside lesi sifo.
Umthelela Wethemba Lamanga
Kuye kwaphawulwa ngezikhathi ezithile ukuthi ukuba nethemba lamanga ngomdlavuza kungcono kunekho ithemba. Kodwa lapho ebuzwa, kubonakala sengathi iningi labantu lingathanda ukunikezwa ithemba lamanga. Ithemba lamanga liphikisa abantu ithuba lokuzikhethela ngokugcwele izinqumo zabo noma babe ngabameli babo ekunakekeleni kwabo. Kunezizathu ezimbili eziphikisanayo zokuthi kungani leli themba elingamanga lingalimaza abantu abaphila nomdlavuza wamaphaphu ophakeme .
Esinye isizathu yilokho ithemba lamanga linikeza abantu abafuna ukwenza konke okusemandleni ukuphatha izifo zabo ukukholelwa ukuthi lokhu sekuvele kwenziwa. Sinezokwelapha manje ngaphezu kwe-chemotherapy, ukuhlinza, kanye nokwelashwa kwemisebe okungase kuhlinzeke ngethemba eliningi noma kungenzeka ukuthi kunabantu abaningi. Njengoba ezinye zalezi zindlela zokwelapha ezintsha zivunyelwe nje nje noma zitholakala kuphela ekuvivinyweni kwemitholampilo. Njengoba ezinye zalezi zindlela zokwelapha ezintsha zivunyelwe nje nje noma zitholakala kuphela ezinkulweni zokwelashwa, zithwele ithemba elingamanga lokuthi i-chemotherapy ingaba yindlela yokwelapha ingavimbela abantu ukuba bangene ekukhethweni okukhethwa kukho okungenzeka bakwazi ukuhlangabezana nokulindela kwabo.
Isizathu esithile, kodwa ukuthi umuntu angase azinike ekwelashweni okunciphisa ikhwalithi yabo yokuphila becabanga ukuthi kuzokwandisa inani lapho kungenakwenzeka. Ngale ndlela, ithemba lamanga liphika abantu ithuba lokukhetha ukuthi bangathanda ukuchitha kanjani izinsuku zabo zokugcina.
Isiguli / IsiNgisi Sokuxhumana
Ukubuka ukungafani phakathi kokulindela phakathi kweziguli nodokotela ongase ucabange ukuthi ukuxhumana kwakuyinkinga. Esikhundleni salokho, kutholakala ukuthi iziguli ezazithi zikhulumisana kahle nodokotela bazo zithwala kakhulu ithemba lokuthi amakhemikhali angase abe nokwelapheka. Yize izizathu zalokhu zingaziwa, kungenzeka ukuthi oncologists besaba ukuthi ukwabelana iqiniso mayelana chemotherapy kungasusa ithemba.
Imithi ehlosiwe
Wonke umuntu onomdlavuza wesifo samangqamuzana omncane wesigaba 4 awuncane kumele abe nokuprofetha kwamangqamuzana (ukuhlolwa kofuzo) kwesinye sezicubu zabo. Kulabo abanokuguqulwa kwe-EGFR , ukulungiswa kabusha kwe-ALK , ukulungiswa kabusha kwe- ROS1 , noma ezinye izinguquko, izinqubo ezithile ezithintekayo zingabangela ukulawula umdlavuza wazo ngaphezu kwalokho okulindeleke nge-chemotherapy.
Ngenkathi amagciwane kaningi ehlala emelana nalezi zidakamizwa ngesikhathi (ngokuvamile ezizungezile ngonyaka kodwa ngezinye izikhathi iminyaka eminingi), enye imithi (yesibili noma yesithathu) imithi ingase ibe inketho. Isibonelo, i-EGFR enhle ye-tumor tumor elawulwa okwesikhashana ku-Tarceva (erlotinib) kodwa iqhuma ukumelana, ingase izwele imishanguzo yesizukulwane sesithathu. Ngale ndlela, umdlavuza wamaphaphu, okungenani amagciwane e-lungs ngokushintshashintsha okuqondile, usondela ekuphatheni njengesifo esingelapheki: awuphilwanga, kodwa ulawulwa isikhathi esiningi.
Immunotherapy
Ngonyaka wezi-2015, izidakamizwa ezimbili ezintsha zokuzivikela nge-immunotherapy zavunyelwa ukwelashwa komdlavuza wamaphaphu. I-Immunotherapy isebenza ngokusebenzisa izimiso zamasosha ethu omzimba wokulwa namagciwane omdlavuza. Nakuba abantu abaningi bengaphenduli kulezi zidakamizwa, labo abaphendulayo ngezinye izikhathi bangathola ukulawula isikhathi eside somdlavuza wabo. Ngamanye amazwi, abantu abaphendula ngale mithi, njenge-Keytruda (pembrolizumab) noma i-Opdivo (nivolumab) bangaphila isikhathi eside kunalokho ababezobe bekulindele ukuhlala uma bephathwa nge-chemotherapy noma ukwelashwa kwemisebe kuphela.
Izingxoxo Mayelana Nokuphela Kokunakekelwa Kwezempilo
Ngaphandle kokusebenzisa izindlela ezintsha zokwelashwa ezingase zisebenze kangcono kunokhemotherapy, saphawula ukuthi ukwelashwa kwamakhemikhali noma imithi yokwelashwa-uma othile usebenzisa lezi zokwelapha elindele ukuthi angaphilisa umdlavuza wabo wamaphaphu aphakeme-anganciphisa amathuba okuxoxa ngokuthembeka i-oncologist yabo mayelana nezindaba zokuphela kokuphila.
Sifunda ukuthi ukunakekelwa okunamandla (ukunakekelwa kwezintambo kungasetshenziswa ngisho noma umuntu kulindeleke ukuthi aphuluke) hhayi kuphela ekuthuthukiseni ikhwalithi yokuphila kubantu abanomdlavuza wamaphaphu aphakeme, kodwa kungase kwandise nokusinda kanye. Ukunakekelwa kwezibhedlela kungenye indlela yokunakekelwa kwezinhliziyo, futhi ngokudabukisayo, abantu abaningi bakhetha lokhu ukunakekelwa kuphela ekupheleni kwesifo sabo futhi bafisa ukuthi babenze ngaphambili ngenxa yokwesekwa okuhambisana nalokhu kukhetha.
Umthombo:
Chen, A., Cronin, A., Amaviki, J. et al. Ukulindela Ngokusebenza Kwemithi Yokwelashwa Kwemithi Phakathi kweziguli ezine-Cancer Incungable Cancer. I-Journal ye-Clinical Oncology . 2013. 31 (21): 2730-5.
Mack, J., Walling, A., Dy, S. et al. Izinkolelo ezibekezelayo ukuthi i-Chemotherapy ingaba yiCalative and Care Received ekupheleni kokuPhila Phakathi kweziguli ezine-Mastasty Lung neColorectal Cancer. I-Cancer . 2015. 121 (11): 1891-7.
Amaviki, J., Catalano, P., Cronin, A. et al. Iziguli ezilindelwe ngemiphumela ye-Chemotherapy ye-Cancer Advanced. I-New England Journal of Medicine . 2012. 367: 1616-1625.