Ukuhlolwa Nezinqubo Zokuthola I-Cancer Lung
Ukuxilongwa komdlavuza wamaphaphu kungase kuqale nge-x-ray yesifuba, kodwa kusukela kulesi sivivinyo singaphuthelwa i-cancer yokuqala, isifo se-CT scan, futhi ekugcineni i-biopsy uma i-nodule noma ubuningi itholakala, kuyadingeka.
Umdlavuza we-Lung uvame ukusola ngemuva kokuba indawo engavamile itholakala e-x-ray yesifuba eyenziwe ukuhlola ubuhlungu bokukhwehlela noma isifuba. Phakathi nalesi sikhathi esesabekayo, kuyasiza ukwazi ezinye izinqubo ezingase zinconywe ukuthola ukuthi ukungajwayelekile kuyinto enobungozi (engewona umdlavuza), noma oyingozi (umdlavuza).
Uma ukungajwayelekile kuyingozi, izifundo ezengeziwe zenziwa ukuze ubone ukuthi umdlavuza usakazeke yini (kwezinye izindawo) emzimbeni futhi uthola isigaba sesifo.
Ukuhlolwa kwesifo somdlavuza
Kulabo abangenayo izimpawu, ukuhlolwa komdlavuza wamaphaphu manje sekuvunyelwe ukutholakala kokuqala kubantu abaneminyaka engama-55 no-80 ubudala, bebheke okungenani iminyaka engu-30 yepakethe, futhi bayabhema noma bayeke ukubhema phakathi neminyaka engu-15 edlule. Kubalulekile ukuthi uqaphele ukuthi ukuhlolwa kuhloswe ukuba kube ukuhlolwa okwenzelwe labo abangenayo izimpawu. Uma uneminye yempawu yomdlavuza wamaphaphu, ukuhlolwa okuqhubekayo, kuhlanganise ne-CT ephelele kuyadingeka.
Amalunga "Amachashazi" nezinye Izincazelo
Ngaphambi kokuba ungene ekuxilongweni komdlavuza wamaphaphu, ungase uzizwe ukhululekile yizimpawu zakho, futhi noma yikuphi ukungajwayelekile udokotela wakho akubone noma uzobona ku-x ray noma CT scan. Njengokubuyekezwa okusheshayo, Njengokubuyekezwa okusheshayo, i-nodule yamaphaphu ibhekwa ngokuthi "indawo" epulazini elingu-3 cm (intshi nengxenye) noma ngaphansi ububanzi.
Amapayipi amaphepha abhekisela ekungajwayelekile okungaphezu kuka-3 cm ububanzi. Indawo endaweni yamapayipi noma "i-lung lesion" ingaba yinto enobungozi noma eyingozi. "Isithunzi" kwi-x-ray singase sibe yinhlonipho noma singathandeki, noma nje ukuqoqwa kwezakhiwo ezijwayelekile esifubeni.
Umlando kanye noMzimba
Uma kwenzeka umdlavuza wamaphaphu emaphaphu, udokotela uzoqala ukwenza umlando ophelele nokuhlolwa ngokomzimba.
Lokhu kwenziwa ukuhlola izimpawu nezingozi ze-cancer yomaphaphu , nokuhlola noma yiziphi izimpawu zomzimba eziphakamisa i-Cance r. Lezi zingabandakanya imisindo engavamile yamapayipi, ama-lymph node ekhulisiwe, ukulahlekelwa kwesisindo okungenhloso, noma ukubhuka kwezinhlamvu zeminwe (izinhlamvu zomunyu).
I-laboratory kanye ne-Radiology Studies
Ucwaningo oluthile lwezifundo ezihlukahlukene lungadingeka, kuye ngezibonakaliso zakho ezithile kanye nokuthola okuhlolwayo ekuhlolweni. Lokhu kungafaka:
I-X-Ray yekhanda
I-x-ray yesifuba ivame ukuhlolwa kokuqala okwenziwe ukuhlola noma yikuphi ukukhathazeka ngokusekelwe emlandweni oqaphileyo nangokwenyama.Lokhu kungabonisa ubukhulu emaphashini noma amantombazane amancane avuliwe. Ngezinye izikhathi i-x-ray yesifuba iyinto evamile, futhi ukuhlolwa okuqhubekayo kuyadingeka kubheka umdlavuza wamangcwaba osolwa. Ngisho noma inqwaba itholakele, lezi azizona njalo izifo zomdlavuza futhi kudingekile izifundo eziqhubekayo. Kumele kugcizelelwe ukuthi i-x-ray yesifuba yedwa ayanele ukulawula umdlavuza wamaphaphu, futhi amantombazane okuqala angabhekwa kalula nalezi zivivinyo.
CT scan
Ukuskena kwe-CT (tomography yekhompuyutha) kuvamise isinyathelo sesibili sokulandela ukutholakala kwe-x-ray okungavamile noma ukuhlola izimpawu ezinzima kulabo abane-x-ray evamile yesifuba. Ukuskena kwe-CT kuhilela uchungechunge lwe-x-ray eyenza umbono we-3-dimensional wamaphaphu.
Uma i-CT ingavamile, ukuxilongwa komdlavuza wamaphaphu kusadinga ukuqinisekiswa ngokusebenzisa isampula yamathishu ngenye yezinqubo ezingezansi.
I-MRI (imaging resonance magnetic)
Kwabanye abantu, i-MRI (i-imagery magnetic resonance) izosetshenziselwa ukuhlola ukuthi kungenzeka yini umdlavuza wamaphaphu. Le nqubo isebenzisa magnetism futhi ayibandakanyi imisebe. Abantu abathile, njengalabo abanezinsimbi zensimbi (abenzi be-pacemaker, njll) akufanele babe ne-MRI ehlola. Uchwepheshe uzobuza imibuzo ukuqinisekisa ukuthi abangekho.
I-PET Scan
Iskena se-PET (positron emission tomography) sisebenzisa izinto ezisetshenzisiwe ukuze zidale izithombe ezimibalabala ezi-3 zesifunda somzimba.
Lolu hlobo lokuskena luhluke kwabanye ngoba luchaza izicubu ezikhula ngokukhulayo. Isamba esincane soshukela olusakazwa ngama-radio lijoqwe egazini, futhi linikezwe isikhathi sokuthathwa ngamaseli. Amaseli akhula ngokukhulayo athatha ushukela owengeziwe, futhi avele kumafilimu. Ukuhlolwa kuvame ukuhlanganiswa ne-CT scan (PET / CT). Njengokungezelela kwezinye izinqubo, abanye abacwaningi basikisela ukuthi ukuskena kwe-PET kungase kutholakale izicubu ekuqaleni, ngisho nangaphambi kokuba zibonakale ngokwezinye izifundo. Ukuhlola kwe-PET nakho kuyasiza ekuhlukaniseni phakathi kwezicubu kanye nezicubu ezinzima kubantu abaye bahluleka emaphashini nganoma yisiphi isizathu.
I-sputum Cytology
Ngemuva kokusola umdlavuza wamaphaphu ngokusekelwe ekucabangeni, isampula yamathambo siyadingeka ukuqinisekisa ukuxilongwa nokunquma uhlobo lomdlavuza. I-cytology ye- sputum iyindlela elula yokwenza lokhu, kodwa ukusetshenziswa kwayo kunqunyelwe kulawo mathambo afinyelela emoyeni. I-cytology yesi-sputum ayilungile ngaso sonke isikhathi futhi ingahle ilahlekelwe amanye amangqamuzana omdlavuza. Ukuhlolwa kuzuzisa kakhulu uma kulungile, kodwa kusho kancane uma kungalungile.
I-bronchoscopy
Ku- bronchoscopy , ochwepheshe bepulazi ufaka ithubhu ibe yizindiza ukuze zibone ngeso lengqondo futhi ithathe isampula yesisu. Le nqubo isetshenziselwa ukuthi i-tumor itholakale emigwaqweni emikhulu yezindiza futhi ingafinyelelwa ngokulingana. Iziguli zinikwe i-anesthesia ngale nqubo ukuze unciphise ukunganaki. Phakathi ne-bronchoscopy, i-biopsy ingathathwa nganoma yisiphi isisu noma ezinye izinto ezingavamile ezibonakala emoyeni we-airways.
I-Endobronchial Ultrasound
I-endobronchial ultrasound iyindlela entsha yokuthola umdlavuza wamaphaphu. Phakathi ne-bronchoscopy, odokotela basebenzisa iphenyo le-ultrasound ngaphakathi kwendiza ukuze bahlole amaphaphu kanye nendawo phakathi kwamaphaphu (mediastinum). Ngama-tumor asondelene ne-airways, i-biopsy ingenziwa nalesi sithombe.
Needle Biopsy
Ngesifiso esihle senaliti (FNA) biopsy, udokotela ufaka isidingo esingenalutho emdongeni wesifuba, ngokuvamile eqondiswa ukuboniswa kwe-CT, ukuthatha isampula se-tumor. Lokhu kungenziwa ngezicubu ezingenakufinyelelwa yi-bronchoscopy, ikakhulukazi lezo eziseduzane nemiphaphu.
Thoracentesis
Uma umdlavuza wamaphaphu uthinta umjikelezo wamapayipi, ungabangela uketshezi ukwakhiwa phakathi kwamapayipi kanye nokuphazamisa amaphaphu (i-pleura.) Nge-anesthesia yendawo, inaliti enkulu ifakwa emgodini we- pleural lapho okungenani inani lokuxilonga lomswakama (isamba esincane sokuhlolwa kwamangqamuzana omdlavuza, ama- effusion amahloni amancane ) noma inani elithinta uketshezi (isamba esikhulu sokuthuthukisa ubuhlungu kanye / noma ukuphefumula) kususiwe.
Mediastinoscopy
I- mediastinoscopy Le nqubo yenziwa ekamelweni lokusebenza ngaphansi kwe-anesthesia jikelele. Umthamo ufakwe ngaphezu kwe-sternum (ithambo lesifuba) esifundeni phakathi kwamaphaphu (i -mediastinum ) ukuthatha amasampula amathisipula kusuka kumalini amancane. I-PET scan manje ingase ihlinzeke ngemiphumela efanayo ukuthi i-mediastinoscopy yenza esikhathini esidlule.
Ukuhlola Ukunquma Uma I-Cancer Lung Isakazekile (I-Metastised)
Umdlavuza we-Lung uvame ukusabalala esibindi , izigulane eziyingozi, ubuchopho namathambo. Ukuhlolwa okuvamile kufaka:
- I-CT scan yesisu: Ukuhlola ukusakazwa kwesibindi noma izigulane ze-adrenal
- I-MRI yobuchopho: Ukubheka ama- metastase ebuchosheni
- Ukuskena kwe-Bone : Ukuhlola ama- metastases emathanjeni , ikakhulukazi ngemuva, izintambo, nezimbambo
- Iskena se-PET: Iskena se-PET singabheka ama-metastases cishe noma yikuphi emzimbeni, futhi ngezinye izikhathi singashintsha ezinye izivivinyo ezingenhla njenge-scan scan noma ama-CT scans.
Ezinye Izivivinyo Ngesikhathi Isifo
Ukuhlolwa okungeziwe okungenaso ukuxilongwa kuvame ukuqhutshwa ngenkathi kutholakala umdlavuza wamaphaphu. Lezi zingabandakanya:
- Ukuhlolwa kwemisebenzi yamapulmonary (PFTs): I-PFT yokuhlola umthamo wamaphaphu futhi inganquma ukuthi isifo sikhathazeka kangakanani ngokuphefumula, futhi ngezinye izikhathi, kungakhathaliseki ukuthi kuphephile yini ukuhlinzwa
- Ukuhlolwa kwegazi: Ukuhlola okunye kwegazi kungathola ukukhubazeka okubangelwa yi-biochemical okubangelwa amakhansela emaphaphu, futhi kungasikisela ukusabalalisa kwesisu
I-Biopsy ye-Lung
Uma ngabe umdlavuza wamaphaphu ucatshangelwa kwizifundo ze-imaging, isinyathelo esilandelayo kungukuthi kube nesifo se-lungs sochungechunge esenziwe ukuze kunqunywe ukuthi ngabe ukungajwayelekile kungumdlavuza ngempela yini, nokunquma uhlobo lomdlavuza wamaphaphu.
Iziningi ze-biopsies zenziwa ngama-sampuli amathishu, kepha ama-biopsies amanzi ayindlela entsha ethokozisayo yokulandela abanye abantu abanomdlavuza wamaphaphu. Kuvunyelwe ngo-June ka-2016, lezi zivivinyo zingenziwa nge-draw elula yegazi. Ngaleso sikhathi, zivunyelwe kuphela ukuthola izakhi zomzimba ze-EGFR, kodwa wonke umuntu, ziyisibonelo esihle sokuthi ukuxilongwa nokuphathwa komdlavuza wamaphaphu kuthuthuka njalo ngonyaka.
Uma umdlavuza wamaphaphu usakazeka, kubalulekile ukuba izicubu "zokuvuselela kabusha", njengoba i-khansela ingashintsha ngokuhamba kwesikhathi, futhi lezi zinguquko zingakusiza wena nodokotela wakho ukhethe okukhethwa kukho okungcono kakhulu kokwelapha.
Ukuhlolwa Kwama-molecular / Test Gene
Manje kunconywa ukuthi wonke umuntu onomdlavuza wesifo samangqamuzana ongewona omncane, futhi ikakhulukazi i-lung adenocarcinoma, abe nokuprofiliswa kwamangqamuzana okwenziwe ngesisu sakhe. Lokhu kuhlolwa kofuzo kubheka ukuguqulwa kwamangqamuzana omdlavuza lapho imithi ethize itholakala khona "eqondisa" lezo zinguquko.
Lezi akuzona izinguquko ozalelwa ngazo, futhi ngeke uzidlulisele ezinganeni zakho. Zinguquko ezenzeka enkambeni yeseli eba umdlavuza futhi "ukushayela" ukukhula komdlavuza.
Izindlela zokwelashwa ezilindelekile njengamanje zivunyelwe abantu abanezinguquko ze- EGFR , ukulungiswa kabusha kwe-ALK , ukulungiswa kabusha kwe-ROS1 , nezinye izinguquko ezimbalwa. Ngaphezu kwalokho, ezinye izindlela zokwelapha zifundiswa ngokuhlolwa kwezivivinyo .
Ukuhlolwa kwe-PD-L1
Njengoba imithi yokuqala ye-immunotherapy ivunyiwe ekwelapheni umdlavuza wamaphaphu ngo-2015, imithi eyengeziwe engu-3 isiyatholakala. Isivivinyo esibizwa ngokuthi i-PD-L1 singenziwa ukuze sinqume amaphesenti okukhulunywa kwe-PD-L1 kumaseli omdlavuza wakho. I-PD-L1 iyiprotheni evezwe ngokulingana kwamanye amangqamuzana omdlavuza wamaphaphu. Le protheyini isebenza ekwandiseni "amabhuleki" omzimba wokuzivikela, ukunciphisa ikhono layo lokulwa namaseli omdlavuza. Amanye amangqamuzana omdlavuza athole izindlela zokwenza "i-overexpress" le phrotheni njengendlela yokufihla emasosha omzimba. Imithi eyaziwa ngokuthi i-checkpoint inhibitors isebenza ngokuvimbela lesi senzo futhi ngokuyisisekelo ikhulule ama-brake kwisistimu yomzimba.
Asisazi ukuthi ukubaluleka kwe-PD-L1 kuzoba kanjani ekwelapheni umdlavuza wamaphaphu. Zombili izifo zomdlavuza we-lungs ezithwala kakhulu i-PD-L1 nalabo abangenakuphendula kulezi zidakamizwa. Ngesikhathi samanje kucatshangwa ukuthi kungabiza imali ukukwenza lezi zivivinyo, kodwa kunqanda ukusetshenziswa kwezidakamizwa kuphela kubantu abanezinambuzane ezithwala kakhulu i-PD-L1 ezinganciphisa inani labantu abangazuza kulo muthi.
> Imithombo:
> Aquiar, P., Perry, L., Penny-Dimr, J. et al. Umphumela we-PD-L1 Ukuhlolwa Ngokwezindleko-Impumelelo Nethonya Lomnotho We-Immune Checkpoint Inhibitors for the Second-Line Treatment of NSCLC. Amanothi we-Oncology . 2017 Juni 15. (Epub ngaphambi kokuphrinta).
> I-National Institute of Health. I-Medline Plus: I-Cancer Lung. Kubuyekezwe 02/21/18. https://medlineplus.gov/lungcancer.html