Ziyini izicubu ze-Pancoast futhi zihluke kanjani kwezinye izinhlobo zomdlavuza wamaphaphu kude nezimpawu, kanye nokwelapha?
Amathumba e-pancoast angama-cancer wamaphaphu aqala phezulu kwesiphepha sokunene noma kwesokunxele futhi ahlasela udonga lwesifuba. Zibizwa nangokuthi izikhumba eziphakeme kakhulu ze-sulcus . Izifo ezivame ukwanda zivame ukuza nezimpawu eziyingqayizivele eyaziwa ngokuthi "i-Pancoast syndrome," equkethe ubuhlungu ehlombe nasingaphakathi kwengalo nesandla.
Amathumba omzimba anesifo esiphakathi kwamaphesenti amathathu nesishiyagalolunye samaphasitiki emaphaphu futhi ahluke kwezinye izinhlobo zomdlavuza wamaphaphu ngezindlela eziningi ezibalulekile.
Izicubu zomzimba ziwuhlobo lomdlavuza wamaphaphu okungenzeka ungaphuthelwa isikhathi esithile ngenxa yobunzima bokubona lezi zicubu ezifundweni ze-x-ray nangenxa yezibonakaliso zabo ezingavamile.
Izimpawu
Izimpawu ze-tumor Pancoast zibangelwa ukucindezelwa kwezakhiwo (izinzwa) ezihlala eduze kwengxenye engenhla yamaphaphu lapho umdlavuza ukhona khona. Izimpawu zakudala zibizwa nge-Pancoast-Tobias syndrome futhi zifaka:
- Ubuhlungu be-Arm kanye namahlombe buvame ukugqama phansi ingalo (ikakhulukazi ingxenyeni yangaphakathi yengalo kanye nohlangothi olubomvu lwezandla.) Ubuhlungu buvame ukuba bunzima futhi bungapheli. Ubuhlungu bungaphinde bukhanye emgqeni noma emgodleni wehlombe. ( Ubuhlungu bezinzwa kungaba uphawu lokuqala lomdlavuza wamaphaphu , ikakhulukazi kulabo abanezinambuzane zePancoast.)
- Ukungabi namandla emisipha yezandla .
- Ukuzizwa nokuzizwa okuthinta kakhulu akuyona isandla, ikakhulukazi iminwe neyindilinga.
- "I-Horner's syndrome " efaka i-ptosis (ijwabu leso le-droopy) i-anhidrosis (okungeke kube khona ukungabi nokujuluka ngakolunye uhlangothi lwesbuso okuvame ukulandelwa ukuqhuma nokujuluka ngakolunye uhlangothi lwesimo) kanye ne-miosis (umfundi obambezelekile wehlo. )
Ngesinye isikhathi kukhona nokuvuvukala kwengalo engenhla ngenxa yecindezelo kwi-veclavia vein (umvuthwandaba ogijima ngaphansi kwe-collarbone).
Uma unamanye izimpawu ezibonisa ukuthi isifo se-pancoast, khuluma nodokotela wakho noma uthole umbono wesibili. Eziningi zalezi zicubu zilahlekelwa okokuqala ngenxa yezibonakaliso zabo eziyingqayizivele futhi ngoba kungaba nzima ukubona emidlalweni yama-x.
Indawo kanye ne-Anatomy
Amathumba e-pancoast ayenzeka engxenyeni engenhla ye-lung yangakwesokudla noma kwesokunxele (isifunda se-apical) futhi ahlasele izakhiwo eduze nale ndawo. Lezi zingabandakanya:
- Ama-Ribs (ngokuvamile ama-namba wokuqala no-2) kanye nama-vertebrae.
- I-plexus ye-brachial - iqoqo lezinzwa eziseduze ne-armpit.
- Imizwa noma imithwalo yegazi eduze nenhla yamaphaphu (isibonelo, umthambo we-subclavia, i-nerve phrenic, i-nerry laryngeal nerve, kanye ne-vagus nerve.)
Incazelo yezokwelapha / i-Anatomic ye-Pancoast Syndrome
Kulabo abafuna incazelo ejulile ye-Pancoast syndrome, i-American College of Chest Physicians ichaza i-Pancoast syndrome njengama-tumors amaphaphu ahlasele noma yiziphi izakhiwo zesiphezulu (phezulu yamaphaphu) esifubeni, kuhlanganise nezimbambo zokuqala ze-thoracic , izimpande ezincane ezisezingeni eliphansi le-plexus ye-bronchial, i-chain sympathetic kanye ne-ganglelion eduze kwesigxobo sesifuba noma imikhumbi ye-subclavia (imikhumbi ye-subclavia ihlanganisa umthambo nesifuba esihamba ngaphansi kwe-collarbone noma i-clavicle.)
Izimbangela
Ukubhema kubangela eziningi zalezi zomshukela, kodwa kubalulekile ukuqaphela ukuthi ukuxilongwa komdlavuza wamaphaphu okwamanje kuvame kakhulu kulabo abababhemayo ngaphambili kunabantu abanjengamanje abhema. Ezinye izici ezingozini zomdlavuza wamaphaphu zibandakanya ukuchayeka kwe-radon , ukubhema komshini wesibhamu, nokukhishwa komsebenzi kwamakhemikhali kanye nezinto eziziwa ngenxa yomdlavuza wamaphaphu.
Ukuxilongwa
Ukuxilongwa kwezicubu ze-pancoast kuvame ukulibaziseka ngezizathu ezimbili. Lezi zinambuzane cishe azikwazi ukuthola izimpawu zempawu zomdlavuza wamaphaphu , ezifana nokuphefumula nokukhwehlela, futhi abantu bavame kuqala ukubona udokotela ohlinzayo wamazinyo noma i-neurologist yezibonakaliso zabo.
Izikhumba ezinzima nazo zikhuni ukubona emathunjini ama-x-ray ngenxa yendawo yawo.
Inhlanganisela ye-CT izikrini kanye nama-MRI avame ukusetshenziswa-nge-MRI ibalulekile ngaphambi kokuhlinzwa ukuze ubheke ukubandakanyeka kwesibindi. I- pulp biopsy yefomu elithile-kungakhathaliseki ukuthi i-chest biopsy evulekile (thoracotomy) noma nge-biopsy yama-lymph nodes ngaphezu kwe-collarbone (i-biracsy supraclavicular) ngokuvamile iyenziwa ukuze ihlolwe. Okunye ukuhlolwa, okufana ne- bronchoscopy kungenziwa futhi.
Isiteji
Ukuphangisa kuvamise kwenziwa ngenhlanganisela ye-PET scan / CT. Eziningi zalezi zomshukela ziyisifo somdlavuza we-IIB wesinxele esincane. Ngokusekelwe emdlalweni we- TNM wesifo somdlavuza , eziningi zazo ziyi-T3 noma i-T4.
Uhlobo lwe-Cancer Lung
I-tumorous tumors ngokuvamile ifomu lomdlavuza ongasona omncane wesifo samaphaphu. Kulezi, cishe 2/3 yi-lung adenocarcinoma kanti 1/3 yi-squamous cell carcinoma noma i-cell cell carcinoma. Njengoba kunezinhlobo eziningi zokwelashwa ezihlosiwe manje ezitholakala ku- lung adenocarcinoma , futhi manje ngenxa ye-squamous cell carcinoma, kubalulekile ukuthi uqiniseke ukuthi une- profiling ye-gene (ukuphrofayelwa kwamangqamuzana) okwenziwe ngesisu sakho.
Ukwelapha
Izinketho zokwelapha kubantu abanezinkinga ze-Pancoast zixhomeke ezingeni le-tumor. Njengamanje, kulabo abanezinambuzane ze-stage I kuya kwesigaba III, ukwelashwa "okulungile" kuhlanganisa ukuhlanganiswa kwe-chemotherapy kanye nokwelashwa kwemisebe okulandela ukuhlinzwa. Izinketho zihlanganisa:
I-Chemotherapy nezokwelapha ezithintekayo
Ukwelashwa kwe-tumor Pancoast kuvame ukuqala ngomuthi womdlavuza wamaphaphu , kungakhathaliseki ukuthi ukuhlinzeka noma ukuhlinzwa kungenzeka yini. Ngenxa yendawo engenza ukuhlinzwa kube nzima, umgomo ukunciphisa isisu ngokusayizi ngangokunokwenzeka ngaphambi kokuhlinzwa. Ngaphezu kwalokho, eziningi zalezi zicubu "zithintekayo" - izifo ezingezansi zofuzo ezitholakala ekuhlolweni kwezakhi zohlobo lwezokwelapha ezitholakalayo. Uma ungazange uhlole ukuhlolwa kwezakhi zofuzo, okubizwa ngokuthi ukuprofetha kwamangqamuzana noma ukuprofetha kwezakhi zofuzo, khuluma nodokotela wakho.
Ukuhlinzwa
Ukwelashwa kungenziwa kaningi emathunjini asePancoast, kodwa kuvame ukwenziwa ngemuva kwekhemotherapy kanye / noma ukwelashwa okuhlosiwe kanye nokwelashwa kwama-radiation ukunciphisa izicubu. I-Chemotherapy ngaphambi kokuhlinzwa ibizwa ngokuthi "ukwelashwa kokungeniswa." Lokhu kuvulwa kungaba nzima kakhulu, futhi kubalulekile ukuthola isikhungo somdlavuza lapho odokotela abahlinzayo bajwayele lolu hlobo lwesisu. Ngokungafani namanye amagciwane anesifo esidluliselwa emathanjeni, abanye abantu abanezikhumba ze-pancoast eziye zahlasela ama-vertebrae zingaphathwa ngempumelelo ngokuhlinzwa. Ngesikhathi sokuhlinzeka, ama-lymph nodes esifubeni phakathi kwamaphaphu (okuthiwa ama-lymph node mediastinal) avame ukukhishwa.
Ukwelashwa kwamafutha
Uma ukwelashwa okuhlose ukwelashwa akunakwenzeka, ukwelapha imisebe kungakusiza njengendlela yokwelapha elula - eyodwa esetshenziselwa ukunciphisa ubuhlungu nezinye izimpawu. Ukwelashwa kwezidakamizwa nakho kungasetshenziswa kanye ne-chemotherapy ukuze "unciphise" isisu ngaphambi kokuhlinzwa.
Ukwelashwa okuhlosiwe
Njengoba kuphawuliwe ngenhla, wonke umuntu onomdlavuza wesifo samangqamuzana ongewona omncane futhi ikakhulukazi we-lung adenocarcinoma kufanele abe nokuprofiliswa kwamangqamuzana okwenziwe ngesisu sakhe. Imithi okwamanje ivunjelwe kulabo abanokuguqulwa kwe-EGFR , ukulungiswa kabusha kwe-ALK , ukulungiswa kabusha kwe-ROS1 , nokunye, ngokunye ukwelashwa okucutshungulwa ekuvivinyweni kwemitholampilo.
Immunotherapy
I-Immunotherapy iyindlela entsha ethokozisayo yokwelapha umdlavuza wamaphaphu, ngezokwelapha zokuqala ezivunyelwe kulesi sigaba ngo-2015. Nakuba kungasebenzi kuwo wonke umuntu, abanye abantu-ngisho nalabo abanomdlavuza wamaphaphu ethuthukile-baye baba nokulawula isikhathi eside ngesifo sabo lezi zokwelapha.
Izivivinyo zemitholampilo
Izicubu ezincane zitholakale zingavamile, kanti ukuhlolwa kwemitholampilo kuqhubeka ukuhlola izindlela ezintsha zokwelapha.
Isibikezelo
Ukuthuthukiswa okuphawulekayo ekusindeni kwezicubu zePancoast kuye kwafinyelelwa emashumini ambalwa eminyaka edlule. Ngokuvamile, izicubu ze-Pancoast zinezibikezelo ezingcono kunama-tumors atholakale kakhulu emaphashini, kanti izinga lokusinda lingcono kunezinye ukwelapha esigabeni esifanayo
Isilinganiso sokusinda seminyaka emibili sitholakale sibe phakathi kwamaphesenti angu-55 namaphesenti angama-70-okuphakeme kakhulu kunamanye amakhemikhali ephaphu, futhi kulabo abanezinambuzane zePancoast ezingelashwa ngokuhlinzwa, isilinganiso seminyaka emihlanu sokusinda sasiphakathi kuka-50 no-77 amaphesenti.
Kubalulekile ukuqaphela ukuthi lezi zindleko zokusinda zingase zibe ngcono kakhulu manje, ngoba izindlela zokwelapha ezintsha, kanye nezidakamizwa zokuzivikela, ziye zavunywa kusukela lezi zifundo zaqedwa.
Uma Uthola I-Diagnosed
Njengoba izifo ze-Pancoast zingavamile, futhi njengoba ukuhlinzeka kuyinkimbinkimbi, kubalulekile ukucabangela ukuthola umbono wesibili uma uthola ukuthi unesisu sePancoast. Izifundo zisitshela ukuthi ukufunda okuningi ngangokunokwenzeka ngomdlavuza wakho akusizi nje ukuthi uzizwe ukhululekile kepha kungasiza ngemiphumela yakho. Hlola lawa macebiso ngalokho okufanele ukwenze uma usanda kutholakala , kanye nendlela yokucwaninga umdlavuza wakho ku-intanethi .
Ukuba ummeli wakho siqu ukunakekelwa komdlavuza wakho kwenze umehluko kubantu abaningi, futhi ngokusho kweNational Cancer Institute, abantu abanomdlavuza wamaphaphu kufanele bacabangele ukhetho lwezilingo zomtholampilo.
Kungenzeka ukuthi uzwe okuningi mayelana nomdlavuza webele nesibhanki, kodwa umphakathi womdlavuza wamaphaphu usebenza futhi usekela kakhulu. Ngisho noma ungewona uhlobo lomuntu othanda amaqembu asekela noma abezindaba, cabanga ukuxhuma nabanye abaphila nesifo esifanayo.
Futhi, uma ngabe othandekayo wakho esitholiwe, kufanele ufunde ngalokho okufanele ukwenze uma othandekayo wakho enomdlavuza wamaphaphu .
> Imithombo:
> Caronia, F., Fiorelli, A., Ruffini, E. et al. Ukuhlaziywa okuqhathaniswa kwe-Pancoast tumor resection eyenziwe nge-video-assisted thoracic ukuhlinzwa versus izindlela evulekile evulekile. I-Interactive Cardiovascular and Thoracic Surgery . 2014. 19 (3): 426-35.
> Abahlaziyi, J., Tronc, F., noD Fortin. Ukuphathwa kwezidumbu ezibandakanya udonga lwesifuba kufaka phakathi izicubu ze-pancoast kanye nezicubu ezihlasela umgogodla. Imitholampilo yezokwelapha . 2013. 23 (3): 313-25.
> Foroulis, C., Zaraogoulidis, P., Darwiche, K. et al. I-sulcus Superior (Pancoast): ubufakazi bamanje ekuxilongweni nokuphathwa okunamandla. I-Journal ye-Thoracic Disease . 2013. 5 I-Suppl 4: S342-58.
> Nikolaos, P., Vasilios, L., Efstratios, K. et al. Izindlela zokwelapha izicubu ze-Pancoast. I-Journal ye-Thoracic Disease . 2014. 6 I-Suppl 1: S180-93.
> Ozmen, O., Yilmaz, Ul, Dadali, Y. et al. Ukusetshenziswa kwe-FDG PET / CT ezigulini ezine-Pancoast Tumors: Ingabe ihlanganisa noma yikuphi ukunikezwa kokuphathwa kweziguli? . I-Cancer Biotherapy ne-Radiopharmaceuticals . 2015. 30 (8): 359-67.
> Panagopoulos, N., Leivaditis, V., Koletsis, E. et al. Izicubu ezihamba phambili: izici nokuhlolwa kwangaphambili. I-Journal ye-Thoracic Disease . I-Suppl 1: S108-15.
> White, H., White, B., iBethel, C., no-A. Arroliga. I-Pancoast's syndrome eyesibili kuya etiologies ezithathelwanayo: okungeyona into engavamile kakhulu. I-American Journal ye-Medical Sciences . 2011. 341 (4): 333-6.
> Zarogoulidis, K., Porpodis, K., Domvri, K., Eleftheriadou, E., Ioannidou, D., noP. Zarogoulidis. Ukuhlonza nokuphatha i-Pancoast Tumors. Ukubukeza Ochwepheshe Emithi Yokuphefumula . 2016. 10 (12): 1255-1258.