Ngokuningiliziwe kwesigaba 3 I-Cancer Lung
Uma utshelwe ukuthi unomdlavuza wesigaba 3 wamaphaphu, kungenzeka ukwesaba nokwesaba. Kusho ukuthini lokhu? Yiluphi uhlobo lwezokwelapha ezisetshenziselwa lesi sigaba somdlavuza wamaphaphu? Futhi, yikuphi ukubikezela?
Ngaphambi kokuba siqale ukukhuluma ngalesi sigaba somdlavuza kubalulekile ukuqaphela ukuthi ukuthuthuka okuphawulekayo kokubili ukwelashwa kwesilinganiso sokusinda kumdlavuza we-lungeni wesithathu kwenzeka eminyakeni nje embalwa edlule.
Ungaba nomndeni noma abangane abaye banomdlavuza wamaphaphu esikhathini esidlule noma bangabona ukuthi abantu baphendule kuwe ngokugcoba lapho bezwa ukuthi unemdlavuza yesigaba se-3. Kungase kudingeke ukuthi ukhumbule ngenhlonipho abathandekayo bakho ukuthi ukwelashwa kuye kwaphuthuka futhi manje kunezindlela eziningi zokwelapha lesi sigaba sesifo ngezinye izindlela ezitholakalayo ezivivinyweni zomtholampilo.
Incazelo
Umgudu wesi-3 wesifo samangqamuzana omaphaphu awuncane kakhulu uyisigaba esiphezulu nesinezinhlobo zamangqamuzana emaphaphu aphinde aphule esiteji 3A nesigaba 3B . Njengoba isigaba 3A no-3B zihluke kakhulu futhi zivame ukuphathwa ngendlela ehluke kakhulu, ake sizichaze ngokuhlukile.
- Isigaba 3A Umdlavuza wamaphaphu - Isigaba 3A Amanqamu amaphaphu ahlonishwa njengama kansela amaphaphu asephambili. Lezi zicubu ezingazange zisakaze ezifundeni ezikude zomzimba (azizange zifakwe emzimbeni, kodwa zisakaze kuma-lymph nodes endaweni ethile esifubeni, kodwa kuhlangothini olufanayo lomzimba njengomdlavuza. Isigaba se-3A se-cancer yamaphaphu singabhekwa njenge-operable (esifana nesigaba 1 nesigaba 2 se-cancer yamaphaphu.)
- Isigaba 3B Umdlavuza wamaphaphu - Kanye nesifo somdlavuza wesifo samaphaphu , isigaba 3B somdlavuza wamaphaphu kubhekwa njengomdlavuza wamaphaphu ophakeme . Lezi zomshukela ziye zahlasela noma zasakazekela ezinhlobonhlobo eziseduze ngezinga elithile lokuthi ukuhlinzwa akunakwenzeka; okungenani hhayi ekuqaleni. Ngenkathi lezi zomshukela zingavamile ukuphulukiswa, ziyaphilika kakhulu futhi ziningi zokwelapha ziyatholakala. Ngokuhamba kwesikhathi, umdlavuza wesifo se-3B wehliswa ngosayizi okwanele nge-chemotherapy kanye nemisebe yokuhlinzwa-ngakho-ke, ithuba lokuphulukiswa-kungenzeka.
Ukuvama
Abantu abangamaphesenti angu-30 banomdlavuza wamaphaphu wesigaba 3 ngesikhathi sokuxilongwa. Abantu abangamaphesenti angama-30 bathola ukuthi babhekene nesigaba sokuqala (isigaba 1 noma isigaba 2) kanti amaphesenti angu-40 abantu asebevele beqhubekela phambili emdlalweni wesifo somdlavuza wesigaba 4, isigaba esiphezulu kakhulu sesifo.
Isiteji
Isigaba somdlavuza we-Lung yisinyathelo esibaluleke kakhulu ekukhetheni izinketho zokwelashwa ezinhle kakhulu, ikakhulukazi okwenza umehluko phakathi kwesigaba 3A nesigaba 3B.
- Isigaba 3A Umdlavuza wamaphaphu uhlanganisa izicubu ezinkulu futhi zisakaze ezithombeni eziseduzane, noma izicubu zanoma yisiphi isayizi eziye zasakazeka kuma-lymph nodes ezikude kodwa zisehlangothini olufanayo lomzimba njengomdlavuza.
- Isigaba 3B Umdlavuza wamaphaphu uchazwa njengesifo sobunzima noma yibuphi ubukhulu obusakazeke emaphethini omzimba obude noma bufake ezinye izakhiwo esifubeni (njengenhliziyo noma isisindo .) Izicubu ezibandakanya ukungcoliswa kwamapulanka okungalungile (ukwakheka kwamanzi amangqamuzana anomdlavuza emgodini wezinyembezi phakathi kwezingxenye zokufaka amaphaphu) ashintshiwe kusukela esiteji 3B kuya esigabeni 4 ngo-2009.
I-oncologists isebenzisa isimiso se- TNM sokuqhubeka sichaza izigaba zomdlavuza wamaphaphu. Incazelo elula yesistimu ye-TNM ihlanganisa:
T ibhekisela kwisayizi yethambo:
- I-T1 - I-tumor ingaphansi kuka-3 cm (1 ½ amasentimitha) ngobukhulu.
- I-T2 -I-tumor ingaphezu kuka-3 cm.
- I-T3 - I-tumor ingaba yisayizi, kodwa iseduze nomoya womoya noma isakaze ezindaweni zendawo ezifana nodonga lwesifuba noma i- diaphragm .
- I-T4 - I-tumor yinoma yisiphi isayizi, kodwa itholakala emoyeni noma ihlasela izakhiwo zendawo ezifana nenhliziyo, noma isisindo.
N ibhekisela kuma-lymph nodes:
- N0 - Azikho izakhi ezithintekayo.
- I-N1 - I-tumor isakaze emaqenjini aseduze ohlangothini olufanayo lomzimba.
- I-N2 - I-tumor iye yasakazeka kumagqabha ahamba phambili ngaphandle kohlangothi olufanayo lomzimba.
- I-N3 - Amangqamuzana omdlavuza akhona ema-lymph nodes ngakolunye uhlangothi lwesifuba esivela ku-tumor, noma ezindaweni eziseduze ne-collarbone noma imisipha yentamo.
M imelela isifo se-metastatic :
- M0 - Ayikho imetastases ekhona.
- I-M1 - I-tumor isakaze (isetshenzisiwe) kwezinye izifunda zomzimba noma enye emaphaphu.
Ukusebenzisa uhlelo lwe-TNM, isigaba somdlavuza wesifo se-3A sichazwa kanje:
- I-T1N2M0 - I-tumor ingaphansi kuka-3 cm usayizi futhi isakaze kuma-lymph nodes ngokuqhubekayo kodwa ngaphandle kolunye uhlangothi lomzimba njenge-tumor.
- I-T2N2M0 - I-tumor ikhulu kunama-3 cm futhi isakaze kuma-lymph nodes ngokuqhubekayo kodwa ngaphandle kolunye uhlangothi lomzimba.
- I-T3N1M0 - I-tumor yinoma yisiphi isayizi kodwa iseduze nendawo yomoya noma isakaze endaweni yangakini njengodonga lwesifuba noma i-diaphragm, futhi ama-lymph nodes aseduze athintekile.
- I-T3N2M0 - I-tumor yinoma yisiphi isayizi kodwa iseduze nendawo yomoya noma isakaze endaweni yangakini njengodonga lwesifuba noma i-diaphragm, kanye namagciwane wesibindi asemaphandleni kodwa ehlangothini olufanayo lomzimba ayathinteka.
Ukusebenzisa uhlelo lwe-TNM, isigaba 3B sichazwa kanje:
- Noma iyiphi i-T, N3, i-M0 - I-tumor yanoma yisiphi isayizi esesakaze kuma-lymph nodes ngakolunye uhlangothi lwesifuba esivela ku-tumor noma ukuya kuma-node eduze kwe-collarbone noma imisipha yentamo, kodwa ayisakaze ezindaweni ezikude zomzimba.
- I-T4, Noma yiyiphi i-N, M0 - I-tumor yanoma yisiphi isayizi esitholakala emoyeni, noma ihlasela izakhiwo zendawo ezifana nenhliziyo noma isifo. Ama-node angase ahlanganyele noma angabandakanyeki, futhi uma ethintekile, angasondeza isisu noma aqhubeke esesifubeni noma entanyeni, kepha isisu asizange sisakaze ezindaweni ezikude zomzimba.
Izimpawu
Isigaba somdlavuza wamaphaphu wesithathu sivame ukutholakala lapho umuntu ebona udokotela wakhe ngolunye uhlobo lwezimpawu. Izimpawu zomdlavuza wamaphaphu ezivamile ngesigaba sesithathu somdlavuza wamaphaphu zihlanganisa:
- Ukukhwehlela okuqhubekayo
- Ukuphelelwa umoya
- Ukushaya igazi
- Ukushisa
- Ukuphindaphinda izifo zokuphefumula ezifana ne-pneumonia noma i-bronchitis.
Ukugaya nokukhwehlela igazi kuvame kakhulu emathunjini aseduze nemigwaqo emikhulu yamaphaphu (i- bronchi ne-bronchioles) kanti ukuphefumula kufana nokuvama okuphakathi kwamaphaphu. Izicubu ezisezindaweni zangaphandle zamapayipi eduze kwamapayipi (i- pleura ) zingabangela i- pleurisy , uhlobo oluvame ukuhlunguphazwa kwesifuba esibuhlungu okubuhlungu ngokuphefumula.
Njengoba eziningi zalezi zomshukela zisakaze endaweni, abantu bangase babe nezimpawu zobuhlungu esifubeni, izimbambo, amahlombe, noma emuva. Uma i-tumor ihilela izindawo ezinjengezakhiwo nezinye izakhiwo zesifuba, i-dysphagia (ubunzima bokugwinya) nokukhathazeka kungenzeka.
Izimpawu ezijwayelekile zomdlavuza ezifana nokukhathala nokulahlekelwa kwesisindo okungenhloso kungase kube khona.
Ukwelapha
Ukwelashwa kwesigaba somdlavuza we-3 emaphashini kunengxabano kunazo zonke izigaba zomdlavuza wamaphaphu, ngenxa yokuthi leli qembu lihlukile kakhulu. I-National Cancer Institute incoma ukuthi noma ubani onomdlavuza wesigaba 3 wamaphaphu ucabange ukuhlanganyela ekuhlolweni komtholampilo, ucwaningo oluhlola izindlela ezintsha zokwelashwa.
Enye yezinyathelo ezibaluleke kakhulu ekwelapheni umdlavuza wamaphaphu, ikakhulukazi umdlavuza wesifo samangqamuzana ongewona amancane, bekulokhu ukwengezwa kwezikhungo ezibhekiswe kuzo. Manje kunezinhlobo eziningi zokwelashwa ezitholakalayo ezibhekene ngqo namaseli omdlavuza wamaphaphu. Ngaphezu kwalokho, izidakamizwa ze-immunotherapy ziye zamukelwa ukuthi, lapho esebenza kahle, kuye kwabangela ukuhlala isikhathi eside kwabanye abantu abanezigaba eziphambili zomdlavuza wamaphaphu. Izinketho zokwelapha zihlanganisa:
Ukuhlinzwa
Kwezinye izigaba zesifo se-3A zamaphaphu, ukuhlinzwa komdlavuza wamaphaphu kungenziwa ukuze kususwe isisu. Njengoba ingozi yokuphindaphinda iphezulu, lokhu kuvame ukulandelwa yi-adjuvant chemotherapy (i-chemotherapy ngemuva kokuhlinzwa) ukubhekana nanoma yimaphi amangqamuzana omdlavuza okungenzeka asakazeke kude nesisu. Ukuze isifo se-3B sesifo segazi, ukuhlinzwa akuvamile ukwelashwa okungcono kakhulu. Nokho, kwabanye abantu, i-chemotherapy (i-neoadjuvant chemotherapy) inganciphisa ubukhulu be-tumor ukuze kutholakale ukuhlinzwa.
I-Chemotherapy
I-Chemotherapy ne-radiation therapy zivame ukusetshenziselwa ukwelapha isifo somdlavuza wesigaba 3. Njengoba kuphawuliwe ngenhla, i-chemotherapy ingase isetshenziswe ngaphambi noma emva kokuhlinzwa noma ingasetshenziswa yedwa kulabo abanomdlavuza abangenakulingathwa ngokuhlinzwa. I-Chemotherapy ingahle ihlanganiswe nezinye izindlela zokwelapha umdlavuza wamaphaphu.
I-Radiation Therapy
Njengoba kuphawuliwe ngenhla, ukwelashwa kwemisebe kaningi kuvame ukusetshenziswa kanye ne-chemotherapy ukuphatha izindawo ezibandakanyeka emdlashini wamaphaphu wesigaba 3 ezingenakuhlinzwa ngokuhlinzwa. Ukwelashwa kwezidakamizwa nakho kungasebenza ekubhekaneni nezinkinga ezihlobene nesigaba somdlavuza wamaphaphu wesigaba sesithathu, njengokuvinjelwa kwe-airways ngesisu.
Ukwelashwa okubhekiswe
Wonke umuntu onomdlavuza wesifo samangqamuzana ongewona omncane kufanele abe nokuprofetha kwamangqamuzana (ukuhlolwa kofuzo) okwenziwe ngesisu sakhe. ikakhulukazi labo abane- lung adenocarcinoma . Imithi ivunyelwe abantu abanezinguquko zomshayeli ezifana nezinguquko ze- EGFR , i- ALK rearrangements , kanye nokulungiswa kabusha kwe-ROS1 , futhi lezi zindlela ezithintekayo ngezinye izikhathi zingabangela ukulawula okuhle kwesifo. Ukuphikisa kuvame ukuqhubeka ngesikhathi, kepha imithi ezayo yesikhulumi ivunyiwe futhi ihlolwe ekuvivinyweni kokwelashwa lapho lokhu kwenzeka. Kulabo abanesifo se- squamous cell carcinoma yamaphaphu , ama-anti-EGFR antibodies angasetshenziswa. Izivivinyo zemitholampilo nazo zifunda imishanguzo ekhuluma nezinye izinguquko zofuzo emdlalweni wamaphaphu.
Immunotherapy
Izidakamizwa ezine ezintsha ze- immunotherapy ziye zavunywa kusukela ngo-2015 zokwelapha umdlavuza wamaphaphu. Le mithi isebenza ngokwenza ngcono amasosha ethu omzimba ukulwa nomdlavuza. Nakuba bengasebenzi kuwo wonke umuntu, abanye abantu baye bathola ukulawula isikhathi eside okungenasifo somdlavuza wabo. I-Imfinzi (durvalumab), ikakhulukazi, yavunywa ngoFebruwari 2018 yokwelashwa kwesifo somdlavuza wesifo somdlavuza we-4 emaphashini ngemuva kokwelashwa nge-chemotherapy nemisebe. Itholakala ngo-2017 ukuze kuthuthukiswe ngokuphawulekayo ukusinda okuqhubekayo okuqhubekayo kulaba bantu abanesifo sesigaba 3.
Ukulindela Ukuphila
Abantu abaningi bayazibuza ngokuchazwa kwesifo somdlavuza wabo, kodwa kubalulekile ukusho izinto ezimbalwa mayelana nokuthi izibalo zokuphila zithini mayelana nesigaba sesi-3.
Kunezinhlobonhlobo eziningi ezingathinta isikhathi sokuphila nomdlavuza wamaphaphu. Ezinye zazo zihlanganisa iminyaka yakho, ubulili bakho, indawo ye-tumor yakho, iphrofayili ye-molecular of your tumor, impilo yakho jikelele ngesikhathi sokuxilongwa, nokuthi uyasabela kanjani empilweni oyitholayo.
Kubalulekile futhi ukusho igama noma amabili mayelana nezibalo. Izibalo zisitshela ukuthi umuntu "ovamile" uzokwenza kanjani ngesifo, kodwa akekho "ophakathi." Ngaphezu kwalokho, izibalo ziyi-definition, ngokudala. Uma sikhuluma ngesilinganiso seminyaka emihlanu yokusinda esesifo, sibhekisela ekusebenzeni kahle kwabantu abaye babonwa okungenani eminyakeni emihlanu eyedlule. Njengoba kwakukhona izidakamizwa eziningi ezivunyelwe umdlavuza wamaphaphu phakathi kuka-2011 no-2017 kunokuba zivunyiwe eminyakeni engama-40 edlule, lezi zinombolo kungenzeka zingabi usizo kakhulu.
Lokho kusho ukuthi isikhathi sokuphila esiphakathi komdlavuza wesigaba se-3 esingekho encane (umzuzu lapho amaphesenti angu-50 ephila futhi amaphesenti angu-50 adlula) uneminyaka eyizinyanga ezingu-15 kumdlavuza wesigaba se-3. Isilinganiso seminyaka engu-5 sokusinda-okungukuthi amaphesenti abantu abalindeleke ukuba baphile eminyakeni emihlanu emva kokuxilongwa kwesigaba somdlavuza wamaphaphu-isisindo samaphesenti angu-14 kuphela esigabeni 3A nakuma-5% esigaba sesigaba 3B.
Njengombhalo wokugcina, sekuyisikhathi sokuqeda ezinye izinkolelo mayelana nokuhlolwa kwemitholampilo .Umqondo wabantu abayizinkukhu zinezinkathazo esikhathini esedlule, njengoba imithi eminingi ihlolwe kuqala kubantu abanolwazi oluncane lokuthi bangasebenza kanjani. Lokhu kushintshile kakhulu. Manje, imishanguzo eminingi yomdlavuza omusha ohlolwe yenziwe ngokucophelela ukuze ikwazi ukubhekana nezinhloso ezithile emasethini omdlavuza noma izindima ezithile ukuthi amasosha omzimba adlala emdlalweni wokulwa nomdlavuza. Kuye kwashintsha kwaze kwaba yilapho izivivinyo zesigaba 1-izivivinyo zokuqala zokwelashwa lapho umuthi omusha uvivinywa kubantu-hhayi nje kuphela okuphephile kodwa ngokuvamile kuyindlela yokugcina isifo. Okuwukuphela kokukhetha ukuhlala uphila.
Izwi elivela
Ucwaningo lubonisa ukuthi ukufunda lokho ongakwenza mayelana nomdlavuza wakho kusiza umphumela. Buza imibuzo. Hlanganisa abathandekayo bakho futhi ukhuthaze ukuba babuze imibuzo futhi. Cabanga ngokujoyina iqembu lokusekela kanye / noma ukuxhuma nomdlavuza wamaphaphu omangalisayo online. Eminyakeni yamuva lo mphakathi uye wachuma futhi uzokwamukelwa ngezandla ezivulekile.
Funda mayelana nokuhlolwa kwemitholampilo okungase kuhambisane nesimo sakho. Eqinisweni, ku-Twitter, kunokuxoxa nge-tweet njalo njalo ngesonto lapho iziguli, abahlinzekeli, abacwaningi, kanye ne-oncologists bahlangana ndawonye ukuze baxoxisane nocwaningo lwamuva kanye nokuhlelwa okubanzi kokukhathazeka okuhlobene nomdlavuza wamaphaphu. Ukuze uthole umphakathi, sebenzisa i-hashtag "LCSM" emele umdlavuza wesifo somphakathi.
Cela futhi uvumele abathandekayo bakho nabangani ukuthi bakusize futhi bakukhuthaze ohambweni lwakho. Ungalahlekelwa ithemba-ngisho noma lelo themba lingaba likhululekile ngangokunokwenzeka ngenkathi ujabulela inkampani yabathandekayo bakho.
> Imithombo:
> Antonia, S., Villegas, A., Daniel, D. et al. I-Durvalumab Ngemuva kwe-Chemoradiotherapy e-Stage III engeyona encane-Cell Cell Lung Cancer. I-New England Journal of Medicine . 2017. 377: 1919-1929.
> Boffa, D., Fernandez, F., Kim, S. et al. I-Static Clinical Stage Stage IIIA-Clinical N2 Cancer Lung ku-Society of Thoracic Surgeons Database. Ama-Annal of Surgery Thoracic. 2017 Meyi 17. (Epub ngaphambi kokuphrinta).
> National Cancer Institute. Ukunakekelwa Kwemdlavuza Yamangqamuzana Angewona Amancane (PDQ) - I-Health Professional Version. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq.