Izimpawu, Ukwelapha & Isibikezelo
Ukusakazeka komdlavuza we-Lung (metastatic) kwesibindi kuyadabukisa kakhulu. Abantu abangamaphesenti angaba ngu-40 abanomdlavuza wamaphaphu banemithi ehamba phambili esifundeni esiseduze somzimba ngesikhathi sokuxilongwa. Yini ongayilindela uma umdlavuza wakho wamaphaphu usakazeke esibindi sakho?
Sibutsetelo
Umdlavuza we-Lung oye wasakazeka esibindi ubizwa ngokuthi "umdlavuza wamaphaphu wamaphaphu esiqhingini" (ngokungafani nomdlavuza wesibindi se-metastatic, okuzobhekisela kumdlavuza owaqala esibindi futhi usakaze kwesinye isifunda somzimba).
Kubantu abanomdlavuza we-cell wamaphaphu okungewona omncane , ukusakazeka komdlavuza esibindi kungakubeka njengesigaba somdlavuza wesi-4 . Ngomdlavuza wamaphaphu amancane , uzobekwa njengesigaba esikhulu .
Umdlavuza we-Lung ungasakazeka kunoma yisiphi isifunda somzimba, kodwa ngokuvamile uvame ukusabalala esibindi, i-lymph nodes, ubuchopho, amathambo, nezigulane ze-adrenal. Ngokuvamile, umdlavuza wamaphaphu uzosakazeka endaweni engaphezu kweyodwa yomzimba. Isibonelo, kuvamile ukuba ne-metastase yesibindi kanye namasevisi we-brainstase.
Ake sibuke izimpawu zesifo se-foastus nesibindi sokuthi lezi ziphathwa kanjani. Ungase ube nesithakazelo ekufundeni mayelana nokuphathwa kwe:
- Imizwa ye-Brain esuka emdlalweni wamaphaphu
- I-bone metastases evela emdlalweni wamaphaphu
- I-adrenal gland ye-gastro-metastases evela kumdlavuza wamaphaphu
Izimpawu
Uma umdlavuza wakho wamaphaphu usakaze esibindi sakho, kungenzeka ukuthi awunayo izimpawu nhlobo. Eqinisweni, ukusakazeka (imetastasis) kuvame ukutholakala uma ukuhlola, okufana ne- CT scan noma i- PET scan kwenziwa ukunquma isigaba somdlavuza wakho.
Uma unayo izimpawu, lezi zingase zihlanganise ubuhlungu ngaphansi kwezimbambo zakho noma esiswini sakho ngakwesokudla somzimba wakho, kanye nezimpawu ezivamile, njengokulahlekelwa kwesidlo nesicefe. Uma unezinambuzane eziningi esibindi sakho noma uma i-metastasis inkulu ngokwanele ukuvimbela ama-bucts wakho we-bile, ungase uhlakulele i-jaundice, ukuguqulwa okwesibhakabhaka kwesikhumba sakho kanye nengxenye emhlophe yamehlo akho.
I-metastase ye-fover iphinde iphazamise umzimba we-bile obangela ukwakha ama-salti ebhilikini esikhumbeni. Lokhu kungaholela ekubambeni okukhulu nokukhungathekisa.
Ukuxilongwa
Izivivinyo ezingenziwa ukuze zibheke izidakamizwa zesibindi ezivela kumdlavuza wamaphaphu zifaka:
- I-CT scan yesisu
- I- ultrasound yesisu
- I-MRI yesisu
- Iskena se-PET
Ukungaqiniseki kokutholakala kwesibindi kuvamile
Kubalulekile ukuphawula ukuthi ukutholakala okungavamile kujwayelekile uma izikwenziwa zenziwa isibindi, futhi ngezinye izikhathi kungaba nzima ukuthola ukuthi indawo noma amabala esiqindi ngenxa yokusabalalisa umdlavuza noma esinye isizathu (isibangela). Uma udokotela wakho engaqiniseki ukuthi noma ukungajwayelekile kwesibindi sakho kuhlobene nomdlavuza wakho, futhi indlela yokwelashwa izohlukahluka ngokuya ngemiphumela, ingase iphakamise isibindi se-biopsy ukuze ubuke izicubu ukuze uqiniseke ukuthi uyazihlola.
Kungaba ukukhathazeka uma udokotela wakho engaqiniseki mayelana nokuthola esibindi sakho, futhi lokhu kungakwenza uzizwe ukhathazekile futhi ungaqiniseki ukunakekelwa kwakho. Kungaba usizo ukwazi ukuthi lokhu kuyinto evamile nokuthi kunezinqwaba eziningi phakathi kwezimo ezivamile "ezivamile" esibhedlela sesibindi nesibindi.
Ukwelapha
Ngokomlando, ukwelashwa komdlavuza wamaphaphu osakaze esibindi kwakuyinhloko enkulu, okusho ukuthi umgomo wokwelapha ukukhulula izimpawu kunokuzama ukuphilisa lesi sifo.
I-Chemotherapy ingasetshenziselwa ukuphatha isigaba 4 ngokujwayelekile.
Ukwamukelwa kokubili kwezidakamizwa ezithintekayo (izidakamizwa ezikhomba ukuguqulwa kwe-EGFR , ukulungiswa kabusha kwe-ALK , nokulungiswa kabusha kwe-ROS1 kwabanye) kanye nokuzivikela kwe-immunotherapy kuqala ukushintsha leyo paradigm, futhi kwezinye izimo, le mithi ingabangela ukulawula isikhathi eside umdlavuza wamaphaphu we-metastatic .
Ukuphathwa kokwelashwa kuyaqhubeka kuyindlela eyinhloko lapho kunezinhlelo eziningi zokusebenza kwamabindi, kepha kulabo abanezinsalela ezimbalwa-okuthiwa "i-oligometastase" -yashintsha.
I-Metastase Specific Treatment
Esikhathini esidlule, uma kuphela i-metastasis eyodwa ekhona esibindi, ukuhlinzeka kwakungavamile ukucatshangwa ukukhipha isisu, kodwa amasu omuthi wokwelapha omusha asanda kuthuthukiswa ngalokhu.
Kulabo abane-oligometastases, echazwe njengento eyodwa noma embalwa "amabala" wezifo ze-metastatic, ikakhulukazi labo abanokuguqulwa okuguqukayo ekuprofethweni kwezakhi zofuzo , amasu amabili emisakazo eyinhloko aboniswe ukuthuthukisa umphumela endaweni ekhethiwe yeziguli. Lokhu kufaka:
- I-SBRT - I-radiotherapy yomzimba ka-stereotactic (SBRT) yindlela yokwelashwa okukhulu kwe-radiation ehanjiswa endaweni encane nendawo eqondile enethemba lokuqeda imishanguzo.
- I-SABR - Imisebe ye-abelative e-stereotactic enye inqubo ye-radiology esetshenziselwa "ukubhubhisa" noma ukubhubhisa ngokuphelele indawo encane njengemetastasis.
Uma kuqhathaniswa nokuhlinzwa, kokubili lezi zinqubo (ezibizwa ngokuthi i-metastasectomy) zingengozini encane futhi zinezinga eliphezulu lokulawula imetrasi. Nge-SBRT imiphumela yokuqala ibonise ukusinda okuphakathi okuthuthukisiwe (isikhathi lapho isigamu sabantu siphila khona futhi isigamu siphelile) kanti cishe amaphesenti angama-25 okusinda isikhathi eside ngeziguli ezikhethiwe ngokucophelela. Ukuvivinywa kwemitholampilo kuyaqhubeka nokuhlola ukuhlomula kwe-metastasectomy ye-oligometastases ngesifo somdlavuza wesibindi, futhi ukuguqulwa kwepharagim ekwelapheni kwalesi simo kwenzeka.
Abantu abanemiphumela engcono nale hlobo yokwelashwa kufaka nalabo abanezinsalela ezimbalwa, labo okuphathwa kulowo muntu kuwo wonke amasayithi omdlavuza, nalabo abanesikhathi eside esingenaso izifo.
Isibikezelo
Umdlavuza wegciwane oye wasakazeka esibindi, ngokudabukisayo, unesifo esibi kakhulu.Ukusinda okuphakathi kwabantu abahlala nesigaba 4 esingenalo encane (imetastatic) yomdlavuza wamaphaphu kungakapheli izinyanga eziyisishiyagalombili kuphela, nakuba kukhona ithemba lokuthi izibalo ezintsha zisekelwe kubantu ne-metastase encane yebindi ephathwe ngamasu amasha okushisa ayoholela ekusindeni okuphakeme. Isikhathi sokuphila esiphezulu sabantu abanesifo esikhulu somdlavuza omncane (metastatic) emaphashini emaphaphu sekuyizinyanga ezimbili kuya kwezine ngaphandle kokwelashwa kanye nezinyanga eziyisithupha ngomnyaka ukwelashwa.
Ukusekela
Kungaba yinkimbinkimbi ukuzwa ukuthi umdlavuza wakho usezingeni eliphezulu. Futhi ngaphezu kokudabuka kwakho, kunezinto eziyikhulu ozizwa uzidingayo. Okokuqala, khumbula ukuthi ukwelashwa komdlavuza wamaphaphu kuyathuthuka-ngisho nezigaba eziphambili kakhulu. Uma uzizwa kahle futhi unemithi embalwa kuphela, khuluma nodokotela wakho mayelana nezinqubo zokwelapha manje ezikhona. Kunezinhlobo eziningi zokwelapha ezintsha, kodwa ngeshwa, lezi zishintsha ngokushesha kangangokuthi kunzima kunoma ubani ukuba ahlale engahambisani nentuthuko.
I-National Cancer Institute incoma ukuthi abantu abanomdlavuza wamaphaphu aphezulu bacabange ukuthi bahlanganyele ekuvivinyweni komtholampilo. Kungaba nzima kakhulu ukuzama ukuzulazula lezi zinto, kodwa ngokubonga izinhlangano eziningana zomdlavuza wamaphaphu zisebenze ndawonye ukuze zinikeze isevisi yomlinganiso wokuhlola umtholampilo wamaphaphu wamahhala, lapho umhambi angasiza ekufaniseni umdlavuza wakho wamaphaphu kanye nokuvivinywa kokwelashwa okutholakala kuphi emhlabeni.
Uma umdlavuza ungeke uphulukiswe noma impilo ikhulisiwe, kusekhona izinketho eziningi zokugcina abantu bekhululeke ngokwanele ukuze bajabulele izinsuku zabo zokugcina nabathandekayo. Hlola lezi zeluleko zokubhekana nomdlavuza wokugcina.
> Imithombo:
> Bergsma, D. et al. Ukuguquka Kwama-Radiotherapy ekwelapheni kwe-Oligometastatic NSCLC. Ukubuyekezwa kochwepheshe ku-Antiticancer Therapy . 2015. 15 (12): 1459-71.
> Guerrero, E., no-M.Ahmed. Indima ye-Sterotactic Ablative Radiotherapy (i-SBRT) ekulawuleni i-Oligometastatic Non-Small Cell Lung Cancer. I-Cancer Lung . 2016. 92: 22-8.
> Rusthoven, C., Yeh, N., noL. Gaspar. Ukwelashwa Kwemithi Ye-Oligometastatic Cell-Non-Small Cell Lung Cancer: Theory and Practice. I-Cancer Journal . 2015. 21 (5): 404-12.
> Salama, J., noS S. Schild. Ukwelashwa Kwemithi Ye-Oligometastatic Non-Small Cell Lung Cancer. Ukubukeza kwe-Canast Metastasis . 2015. 34 (2): 183-93.
> Ueda, J. et al. Ukuhlwithwa Okuhlinzekwa Kwesibindi SeMetastatic Esasolwandle Isisu Esivela Emdlalweni We-Lung Cancer: A Case Series. I-Hepatogastroenterology . 2012. ini: 10.5753 / hge12000. (I-Epub ngaphambi kokuphrinta).