Izimpawu, Ukuqwashisa, Nokuthuthuka Kwokwelapha
Umdlavuza we-Lung waziwa ukuthi usakazeka ebuchosheni ngamacala angu-40 amacala lapho kwenzeka khona i-metastasis. I-Metastasis yigama lezokwelapha elisetshenziselwa ukuchaza umdlavuza osakazeke ngaphesheya kwe-tumor yokuqala ukuya ohlelweni oluhlukile olukude. Ngomdlavuza wamaphaphu, lokhu kubhekwa njengesigaba 4 sesifo.
Sibutsetelo
Uma izidakamizwa zenzeka kubantu abanomdlavuza wamaphaphu, ukulimala okwesibini akubhekwa njengengqondo "yomdlavuza womqondo" kodwa kunalokho "umdlavuza wamaphaphu emaphashini" noma "umdlavuza wamaphaphu onama-brainstorms." Ngokuphambene nalokho, igama lomdlavuza wobuchopho lisetshenziselwa lezo zicubu ezivela ebuchosheni njengesiyaluyalu, okuyisisekelo sesibili.
Ngamanye amazwi, uma ngabe uthatha isampula yamangqamuzana omdlavuza ebuchosheni babezoba amangqamuzana emaphaphu omdlavuza, hhayi amangqamuzana ebuchopho obuchopho.
Ngokudabukisayo, umdlavuza wamaphaphu onama-metastases kuya ebuchosheni unamahlumela amancane, kepha lokhu kuyashintsha kwabanye abantu. Ngokungafani nemithi eminingi ye-chemotherapy, ezinye zezokwelapha ezintsha ezithintekayo zomdlavuza wamaphaphu ziyakwazi ukungena emkhakheni we-brain-brain futhi zingasiza ukulwa nezicubu zamaphaphu eziye zasakazeka ebuchosheni. Kukhona futhi izinketho ezintsha ezitholakalayo kulabo abanemibono embalwa kuphela ebuchosheni (ngezinye izikhathi bachazwa njenge-oligometastases). A
Isikhathi sokusinda esiphakathi nama-metastase ebuchosheni ngokuvamile singaphansi konyaka, kodwa lapho kutholakala khona imithi ehlanganisiwe (i-oligometastases) futhi ingalashwa, abangaphezu kwamaphesenti angu-60 abantu bangasinda iminyaka emibili noma ngaphezulu.
Uma unomdlavuza wamaphaphu nesifo se-foast, isibhedlela sakho kanye nesandulela-ngculazi kungenzeka ukuthi uhlukile kunomuntu onesimo esifanayo nje ngonyaka noma emibili eyedlule.
Kubalulekile ukufunda konke ongakwenza futhi ube ngummeli wakho.
Izimpawu
Ama-metastase we-Brain angenziwa nomdlavuza omncane we-cell wamaphaphu noma umdlavuza we-cell wamaphaphu ongewona omncane . Umdlavuza omncane wamangqamuzana omzimba uvame ukuluhlukumeza ekuqaleni kwezinyathelo, futhi ngenxa yalokho, ungasakazeka ebuchosheni ngaphambi kokuba kutholakale ukuxilongwa.
Amanqamu angasona amancane amancane angasakazeka ebuchosheni kodwa ajwayele ukwenza kanjalo ngokuhamba kwesikhathi lesi sifo ngemuva kokutholakala kwe-tumor yokuqala.
Izimpawu zingashintsha ngokusho uhlobo lomdlavuza wamaphaphu futhi lapho ebuchosheni khona kutholakala izidakamizwa. Ngokudabukisayo, abaningi abangaphezu kwesithathu kubo bonke abantu abanomdlavuza wesibili wesibili ngeke babe nezimpawu. Uma kwenzeka, ngokuvamile zihlanganisa:
- Izinsizwa
- Ukukhathala
- Ukulahlekelwa ibhalansi
- I-nausea nokuhlanza
- Kunzima ukuhamba
- Ukulahlekelwa kokusebenzisana
- Izinkinga zokukhuluma
- Izinguquko zombono, kuhlanganise nokulahlekelwa umbono noma umbono ophindwe kabili
- Ubuthakathaka bemiphakathini (okwenzeka ohlangothini olulodwa lomzimba)
- Ukulahlekelwa kwememori
- Izinguquko zomuntu
- Ukuzizwa
Ukuxilongwa
Uma udokotela wakho esolwa ukuthi umdlavuza wakho wamaphaphu usakaze ebuchosheni bakho, uzobe eyala ukuhlola izithombe ezifana ne- computed tomography (CT scan) esebenzisa i-X-ray ukudala izithombe zokuxilonga noma ukufaniswa kwe-magnontic resonance (MRI) eyenza okufanayo ngamagagasi amakhulu. Ngenkathi i-MRI ibhekwa njengenembile kakhulu, ingase ingasetshenziselwa abantu abanezimpande ezithile zensimbi (kubandakanya izinhliziyo zokuphepha ezingaphephile).
Olunye uhlobo lwethuluzi lokucabanga lwakwenza i-positron emission tomography (i-PET scan) ekwazi ukuhlukanisa phakathi kwe-cell metabolism evamile kanye nalabo abonakala bengasebenzi (njengamaseli omdlavuza).
Uma i-lesion esolisayo itholakale kodwa ukuxilongwa akuqinisekisiwe, i-biopsy ingenziwa ukuze ithole isampula yesikhumba sokuhlola.
Ukwelapha
Ukwelashwa kwe-metastases yobuchopho kuncike eziningana zezici kubandakanya ukuthi ubuchopho obuningi buhilelekile kanye nempilo yakho yonke. Uma i-metastase yobuchopho isakazeke, ukwelashwa kugxile ekulawuleni izimpawu nezinkinga ukuze kulungiswe ikhwalithi yokuphila. Uma kunemithi embalwa kuphela, ukwelashwa kwendawo ukuqeda imithi ngokuphelele kuqhutshwa njalo.
I-steroids njenge-Decadron (dexamethasone) ingasetshenziselwa ukulawula noma yikuphi ukuvuvukala kobuchopho, kanti imithi ye-anticonvulsive (izidakamizwa zokuthatha izidakamizwa) inganciphisa izigameko nokuqina koguquko.
Ezinye izindlela zokwelashwa zingaphulwa zibe zokwelapha ezijwayelekile zesigaba 4 somdlavuza wamaphaphu, ukwelashwa kokusabalalisa kwe-brainstream okubanzi, kanye nokwelashwa kwendawo ye-oligometastases.
Ukwelapha okujwayelekile ngomdlavuza nomaphi lapho ukhona kungabandakanya:
- I-Chemotherapy: Imithi eminingi ye-chemotherapy ayinakulungiswa ekwelapheni imithi ye-brainstress ngenxa yokutholakala kwesithintelo segazi-ingqondo, inethiwekhi enamandla yama-capillari ekhonza ukugcina ubuthi (okubandakanya izidakamizwa ze-chemotherapy) ngaphandle kobuchopho. Kodwa-ke, i-chemotherapy inganciphisa ubukhulu bezinsalela emaphashini ngakhoke ukunciphisa amandla abo ekusakazeni ebuchosheni.
- Ukwelapha okuhloswe : Izidakamizwa ezihlosiwe zezinguquko ze-EGFR, ukulungiswa kwe-ALK, ukulungiswa kabusha kwe-ROS1 nokuningi ngezinye izikhathi bakwazi ukungena emkhawulweni wegazi. Ezinye zezidakamizwa ezintsha zibonakala ziphumelela ngokwengeziwe ukwenza kanjalo. Njenge-chemotherapy, lezi zidakamizwa nazo zilawula isisu esikhulu futhi ngaleyo ndlela ziwehlise ikhono layo lokusabalalisa ebuchosheni.
- I-Immunotherapy : Sekushesha kakhulu ukuthi ukwazi okuningi (isidakamizwa sokuqala semithi yomdlavuza wamaphaphu samukelwa ngo-2015) kodwa imithi emithathu yokuzivikela emithanjeni yemikhapha yemaphaphu ibonisa ukwethembeka kwabo ekunciphiseni i-metastases yobuchopho. Kubantu abathile, lezi zidakamizwa ziye zaholela kokubili ukulawulwa kwe-metastases kanye "nokuphendula okuqinile" kumdlavuza wonke.
Ukwelapha okubhekiselele ngokuqondile kwi-metastase yobuchopho kodwa oklanyelwe ukwelapha izidakamizwa eziphezulu:
- I-radiotherapy enomqondo wonke: Uma kunezibalo eziningana ze-metastases ezikhona manje (izikhungo zomdlavuza ziyahlukahluka ekuchazeni lokhu futhi inombolo ingaba ngaphezu kuka-3 kuya kweyengu-20), i-radiotherapy yonke yobuchopho iye yanconywa ngokujwayelekile. Ukushisa komzimba wonke kungase kube yinto enhle kulabo abanezimpawu ezihlobene nobuchopho babo be-brainstorms noma abasengozini yokubhekana nezinkinga (njenge-stroke). Kungasetshenziswa futhi ngemuva kokuhlinzwa ukuze kunciphise ukusabalalisa komdlavuza. Ngenkathi ingahlelelwe ukwelapha umdlavuza, okungenani amaphesenti angu-50 abantu abaphethwe yi-radiotherapy ephelele yobuchopho bazobona ukuthuthukiswa kwezimpawu. Imiphumela emibi evamile ingabandakanya ukulahlekelwa inkumbulo (ikakhulukazi inkumbulo yemizwi), ukuqhuma isikhumba, nokukhathala. Ama-oncologists ama-radiation avame ukuncoma imithi ebonakala ibangela ukunciphisa ukukhubazeka kwengqondo okuhlobene nalokhu ukwelashwa.
Izinketho zokwelashwa eziqondene ne-Metastasis zihlanganisa:
- I-radiotherapy ebizwa ngokuthi i- Stereotactic: Eyaziwa nangokuthi i-radiosurgery ye- stereotactic noma i-SBRT, lokhu kuyilanga lemisebe ephezulu ehlinzekwe endaweni ethile yobuchopho. Njengoba imishanguzo ihloselwe, imiphumela emibi ingaphansi kakhulu futhi inikeza amazinga angcono okusinda kunokwelashwa okuphelele. Leli fomu le-radiotherapy livame ukugcinwa kubantu abanezinambuzane ezintathu noma ezimbalwa, nakuba abanye abantu beye lalashwa izicubu ezingafika ku-20.
- Ukwelashwa kweproton: Ukwelashwa kweproton kusetshenziswe ngendlela efana ne-SBRT, futhi kwenziwa ngomzamo wokuqeda ama-metastases akhona.
- Ukwelashwa: Ukuhlinza okusetshenziselwa ukuhlinzwa kungasetshenziswa kaningi kepha kungase kube inketho uma kunesifo esisodwa noma ezimbalwa ezifinyeleleka kalula, futhi azikho izimpawu zomdlavuza kwenye indawo. Ukuhlinzwa kungase kuhlanganise ukususwa okuphelele kwesisu noma ukususwa okuyingxenye ukuze kunciphise izimpawu. I-radial yonke ingqondo ilandela. Njengoba izicubu ezincane zamangqamuzana zithinta kakhulu i-radiotherapy yedwa, ukuhlinza kuvame ukusetshenziselwa ukukhipha ukwelashwa kwamangqamuzana okungewona amancane.
Uma izinketho ezihlukahlukene zokwelashwa zifakaza zingasebenzi, ukunakekelwa kwe-palliative kungasetshenziselwa ukunikeza ukukhululeka nokunciphisa ukucindezeleka okuhambisana nokuxilongwa okubulalayo. Lokhu kungabandakanya ukusetshenziswa kwezidakamizwa zobuhlungu, ukwelapha ngokomzimba nokusebenza, noma ukwelashwa okuhambisanayo ukuthuthukisa induduzo nokuthuthukisa ikhwalithi yokuphila.
Izwi elivela
Ama-metastases we-Brain ngenxa yomdlavuza wamaphaphu angasabisa. Kodwa, njengokwesaba njengokubalulekile, kubalulekile ukukhumbula ukuthi ayikho inkambo ehleliwe uma kuziwa ngomdlavuza. Ingahlukahluka komunye nomuntu, futhi izilingo "eziphakathi" noma "ezijwayelekile" ozolwazi ngazo azisebenzi kuwe njengomuntu ngamunye.
Uma ubhekene ne-metastases yobuchopho emdlalweni wamaphaphu, sebenzisana nodokotela bakho nabathandekayo ukuba benze ukhetho olunolwazi ngokusekelwe ngokugcwele ngokugcwele kolwazi. Ngokuvamile kuyasiza ukuthola umbono wesibili kwesinye sezikhungo zomdlavuza ezinkulu ezikhethekile ngomdlavuza wamaphaphu. Ngisho noma ukwelashwa kuyafana, wena nomndeni wakho ningase nizizwe niqiniseka kakhulu ukuthi nisesimweni esifanele.
Kubalulekile ukuzivumela ukuba uzizwe ozizwayo futhi ufune ukwesekwa ukusiza ukuhamba lolu hambo. Vele uthathe isinyathelo esisodwa ngesikhathi.
> Imithombo:
> Cohen, J., noHlu Kluger. Immunotherapy Systematic for the Treatment of Brain Metastases. Imingcele e-Oncology . 2016. 6:49.
> Jimenez, R., Alexander, B., Mahadevan, A. et al. Impact ye-Stereotactic Treatment Radiation Therapies Ihlaziya Ama-Metastase Ebuchopho Ngokulawulwa Kwendawo Nokudakayo. Intuthuko e-Radiation Oncology . 2017. 2 (3): 391-397.
> Loganadane, G., Hendriks, L., Le Pechoux, C. et al. I-Current Role ye-Whole Brain Treatment Radiation Therapy ezigulini ezingezona ezincane ze-Cancer Cancer Patients. I-Journal ye-Thoracic Oncology . 2017. 12 (10): 1467-1477.
> Zhu, Z., no-Y. Chai. Ukuphikiswa kwe-Crizotinib Kunqotshwa yi-Ceritinib ku-ALK-Positive Non-Small Cell Patient Lung Cancer Patient With Brain Metastases: Umbiko Wezehlakalo. Imithi (Baltimore) . 2017. 96 (45): e8652.