Izimpawu, Isiteji, Ukwelapha, Nokuguqulwa
Kusho ukuthini uma unomdlavuza wesigaba 3 wamaphaphu futhi lokhu kuhluke kanjani kwezinye izigaba? Yiziphi izindlela zokwelashwa ezingase zinconywe futhi yini okufanele wazi ukuze ube ngummeli wakho siqu ekunakekelweni komdlavuza wakho? Kuyini ukuchazwa kwalesi sigaba futhi lokhu kuguquka kanjani ngezokwelapha ezintsha?
Sibutsetelo
Umgudu wesi-3 wesifo samangqamuzana omaphaphu awuncane kakhulu uyisigaba esiphezulu nesinezinhlobo zamangqamuzana emaphaphu aphinde aphule esiteji 3A nesigaba 3B .
Ukuthuthukiswa Kwendawo Nendawo Okuthuthukisiwe 3 I-Cancer Lung
Kulula ukuchaza ukuhlukahluka kwegciwane lesandulela ngculazi yesigaba 3 ngokuphula zonke izinhlobo zomdlavuza wamaphaphu zibe yizigaba ezimbili eziyinhloko.
- Umdlavuza wamapapu ophuthumayo - I-Stage 3A ibhekwa njengomdlavuza wamapapu ophuthumayo. Lezi zicubu azizange zisakaze ezindaweni ezikude zomzimba, kodwa zisakaze kuma- lymph nodes ohlangothini olufanayo lomzimba njenge-tumor. Isiteji I ukuya esiteji 3A amaphavuza amaphaphu kubhekwa ngokuthi "asebenze" okusho ukuthi ukuhlinzwa kunika amathuba okuthola ukwelashwa.
- Umdlavuza wamaphaphu aphakeme - Kanye nesifo somdlavuza wesigaba se-4, isigaba 3B somdlavuza wamaphaphu kubhekwa njengomdlavuza omkhulu wamaphaphu . Lezi zinambuzane ziye zasakazeka ngezinga elithile lokuthi ukuhlinzwa akunakwenzeka (ngaphandle uma, futhi ngezinye izikhathi, ngemuva kokwelashwa nge-chemotherapy kanye nokwelashwa kwemisebe.) Lezi zicubu "azikwazi ukusebenza" futhi ngokuvamile aziphilwanga, kodwa ziyaphathwa, futhi eziningi zokwelapha ezintsha kuvunyelwe eminyakeni yamuva.
Ukuvama
Abantu abangamaphesenti angu-30 banomdlavuza wamaphaphu wesigaba 3 ngesikhathi sokuxilongwa, okushiya amaphesenti angu-30 abantu abatholakale esiteshini sangaphambili ( isigaba 1 noma isigaba sesibili sesifo) kanye namaphesenti angu-40 asevele eqhubekela phambili esigabeni 4 (umthamo) wesifo somdlavuza emaphashini isikhathi sokuxilongwa.
Isiteji
Isigaba somdlavuza we-Lung yisinyathelo esibaluleke kakhulu ekukhetheni izinketho zokwelashwa ezinhle kakhulu, ikakhulukazi okwenza umehluko phakathi kwesigaba 3A nesigaba 3B.
Umdlavuza wamaphaphu wesigaba se-3 ungcono kakhulu uchazwe ngokuhlukanisa izigaba zibe sesiteji 3A nesigaba 3B ngokwehlukana.
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
Izimpawu zesifo somdlavuza wamaphaphu esiteji sesi-3 ziyahlukahluka kusukela isigaba sesi-3 sihlanganisa inqwaba yezifo zomdlavuza. Izimpawu ngenxa yomdlavuza emaphashini afana nokukhwehlela okuqhubekayo , ukuphefumula , kanye nokutheleleka okuphindaphindiwe okufana ne-pneumonia noma i-bronchitis, kuvamile.
Ukusabalalisa ezindaweni ezifana nodonga lwesifuba kanye nesibindi kungabangela ubuhlungu esifubeni, izimbambo, amahlombe, nangemuva.Izikhalazo eziseduze nemikhumbi yezindiza zingabangela i-hemoptysis ( ukukhwehlela igazi ) nokushaya . Uma lesi sifo sihilela izindawo ezinjengezakhiwo nezinye izakhiwo zesifuba, i-dysphagia (ubunzima bokugwinya) nokukhathazeka kungenzeka. Ukubuhlungu ngemuva, isifuba, kanye nezimbambo kuvamile uma kutholakala i-pleural effusion, futhi lokhu kungaholela ekukhuphukeni kokuphefumula.
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. Ngenxa yesilinganiso sokusinda empofu, i-National Cancer Institute ithi wonke umuntu onomdlavuza wesigaba 3 wamaphaphu kufanele abhekwe njengomuntu ozokhethwa ukuhlolwa kwemitholampilo - izifundo ezihlola ukwelashwa okusha noma ukuhlanganiswa kokwelashwa komdlavuza wamaphaphu.
Isigaba 3A Ukwelashwa
Kwezinye izigaba zesifo se-3A zamaphaphu, ukuhlinzwa kungenziwa ukuze kususwe isisu futhi kuvame ukulandelwa nge- adjuvant chemotherapy (i-chemotherapy ngemuva kokuhlinzwa). Ukuhlinzwa kunika ithuba lokuthola ukwelashwa kepha akusi njalo njalo ngezicubu zalesi sayizi. Ingozi yokuphindaphinda umdlavuza wamaphaphu iphinde iphezulu kubantu abanesifo somdlavuza wamaphaphu esigabeni 3A.
Kulabo abanempilo enhle, inhlanganisela ye- chemotherapy noma i-chemotherapy kanye nokwelashwa kwemisebe ngokuvamile kuvuswa. Uma abantu bengakwazi ukubekezelela i-chemotherapy, ukwelashwa kwemisebe kungasetshenziswa yodwa ukuphatha izimpawu ezifana nobuhlungu nokuphefumula.
Manje kunconywa ukuthi ukuhlaziywa kwe-molecular (ukuhlolwa kofuzo) kwenziwe wonke umuntu onomdlavuza we-cell wamaphaphu okungewona omncane, ikakhulukazi i- 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. Ukuphikiswa kuvame ukukhula ngokuhamba kwesikhathi, kodwa imithi ezayo yenzalo manje 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.
Izidakamizwa ezine ezintsha ze- immunotherapy ziye zavunyelwa 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 yamukelwa ngoFebruwari 2018 yokwelashwa kwesifo somdlavuza wesifo samaphaphu ngemuva kokusebenza kwamakhemikhali kanye nemithi yokwelashwa. Uma isetshenziswe kulesi silungiselelo, itholakale ngokuphawulekayo ekuthuthukiseni ukusinda okungaqhubeki kokuqhubeka.
Isigaba 3B Ukwelashwa
Amagciwane e-Stage 3B, ngokungafani nesigaba 3A, akakwazi ukuphathwa ngokuhlinzwa. Ngamanye amazwi, azinakwenzeka- kodwa angenakuphelelwa amandla. Ukwelashwa kungabandakanya i-chemotherapy, ukwelapha imishanguzo, imithi ehlosiwe, kanye ne-immunotherapy njengezigaba zesifo se-3A.
Kwezinye izimo, ukusetshenziswa kwe-chemotherapy kanye nokwelapha imisebe kuyakwazi ukwehlisa ubukhulu besisu ukuze kutholakale ukuhlinzwa. I-Chemotherapy esetshenziswe ngale ndlela ibizwa ngokuthi "i-neoadjuvant chemotherapy."
Kubantu abanesifo somdlavuza wesigaba 3, imithi ingasetshenziselwa ukwelapha ngokweqile , okusho ukuthi ukugxila kokwelapha kunciphisa izimpawu ezifana nobuhlungu nokuphefumula kunokuzama ukulawula umdlavuza. Empeleni kutholakale ukuthi ukwelashwa okunamandla kubantu abanomdlavuza wamaphaphu kungase kuthuthukise ukusinda.
Isibikezelo
Isilinganiso seminyaka engu-5 sokusinda esigabeni 3A somdlavuza wamaphaphu singamaphesenti angu-14, kodwa singahluka kakhulu. Isilinganiso seminyaka emihlanu yokusinda ngesigaba 3B somdlavuza wemiphunga sinobuhlungu nje kuphela ngamaphesenti amahlanu Kubalulekile ukukhumbula ukuthi lezi zibalo zisekelwe endleleni abantu abazenza ngayo nomdlavuza wamaphaphu esikhathini esidlule. Njengoba sekuye kwaba nemithi eminingi evunyelwe ukwelashwa komdlavuza wamaphaphu phakathi kuka-2011 no-2015 kunanoma yiminyaka engamashumi amane ngaphambi konyaka ka-2011, lezi zibalo zithembekile ngokulinganisa isikhathi sokuphila namuhla.
Ukubhekana nokusekela
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 . Funda mayelana nokuhlolwa kwemitholampilo okungase kuhambisane nesimo sakho. Ukufunda ngomdlavuza wakho nokwelashwa kungathatha isikhathi esiningi kakhulu. 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
I-American Cancer Society. I-Cancer Lung (I-Cell Non-Small.) I- Non-Small Cell Lung Cancer Ukusinda Amanani nge Stage .
Ikomidi elihlangene laseMelika leCancer. Ukunyatheliswa komdlavuza we-Lung. I-7th Edition.
> 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.
Edge, S. et al (Eds.). I-AJCC Incwadi Yokusakaza Ngomdlavuza. I-7th Edition. Springer. ENew York, NY. 2010.
Faithi, A. noJer. Brahmer. I-Chemotherapy yesifo somdlavuza we-cell osaphazamisekile esingaphambili. Ama-Seminar ku-Thoracic ne-Cardiovascular Surgery . 2008. 20 (3): 210-6.
I-National Cancer Institute. Ukunakekelwa Kwemdlavuza Yamangqamuzana Angewona Amancane (PDQ) - I-Health Professional Version.