Ukubhekana Nezidakamizwa Ezinamandla Ezivela Emdlalweni We-Lung Cancer
Uma utshelwe ukuthi umdlavuza wakho wamaphaphu (noma omunye umdlavuza) usakaze emathangeni akho adrenal (adrenal metastases) ungase uzizwe udidekile. Ngokungafani nokusakazeka komdlavuza kwezinye izindawo, ezifana nesibindi, isakazeka ezigulini eziyingozi akukhulunywa ngaso njalo. Lokho kusho ukuthi izidakamizwa ezinamandla zivame kakhulu nomdlavuza wamaphaphu. Zingaphi izigulane eziyingozi futhi kusho ukuthini uma umdlavuza wakho wamaphaphu usakazeka kule ndawo?
Funda ukuthi kungani ama-metastases ezigulini ezinama-adrenal angase ahlasele kangcono kunamanye amasayithi e-metastases, ikakhulu uma ekhona ohlangothini olufanayo lomzimba njengomdlavuza.
Sibutsetelo
Izithobezi ezinama-adrenal ziyizinhlayiya ezincane ezinomunwe ezincane ezikhona ngaphezulu kwezinso. Lezi zingqungquthela ze-endocrine zinomthwalo wokuvimba ama-hormone, okufaka "ama-hormone okucindezeleka" afana ne-cortisol, i-epinephrine (i-adrenaline), ne-norepinephrin.
Amanqamu Aphelela Ezingxenyeni Zama-Adrenal
Cishe noma imuphi umdlavuza ungasakazeka kuma-gland, kodwa ezinye izicubu zinamathuba amaningi kunokuba ezinye zifinyelele kulesi sifunda. Kwesinye isifundo, umdlavuza ovame kakhulu ophethwe yi-metastases eyinhloko kwakuyiphaphu (amaphesenti angu-35) alandelwa umdlavuza wesisu (amaphesenti angu-14) umdlavuza wokuqeda (amaphesenti angu-12) nomdlavuza wesibindi / ubungwane (amaphesenti ayishumi). Ezinye izifo zomdlavuza ezivamile kule ndawo zihlanganisa umdlavuza wezinso, i-melanoma, umdlavuza webele, umdlavuza we-colon, kanye ne-lymphoma.
Uma umdlavuza wamaphaphu usakaze emangqamuzaneni adrenal, kubhekwa njengesigaba somdlavuza wesifo samangqamuzana wesine (non-small cell lung lung cancer). Esikhathini esidlule, kwakungekho okuncane ukukwenza uma umdlavuza wamaphaphu uphelelwe amandla. Eminyakeni yamuva, kuye kwaphawula ukuthi kubantu abathile-ikakhulukazi labo abane-metastasis eyingqayizivele-ukwelashwa okunamandla kwe-metastasis kungabangela ukuhlala isikhathi eside.
Njengoba kuxoxwe kabanzi ngezansi, ukuchazwa kwe-metastases emangcwabeni emdlavuza wamaphaphu kungase kube ngcono kunokuchazwa kwamanye ama-metastases - afana nalawo asesibindi, ubuchopho namathambo.
Isimo se-Adrenal Metastases
Kuze kube ngamaphesenti angama-40 abantu abanomdlavuza wamaphaphu bazokwakha ama-metastases amaningi ngesikhathi esisodwa, futhi ngamaphesenti angu-10 abantu abanomdlavuza wamangqamuzana ongewona omncane, lesi sifo sisakazeka kuzo zombili izigulane eziyingozi. Lezi zinsizakalo zikhona ngamaphesenti amabili kuya kwangu-3 abantu ngesikhathi sokuxilongwa, futhi ngezikhathi ezingavamile yilona uphawu lokuqala lomdlavuza wamaphaphu.
Izimpawu
Esikhathini esiningi lapho umdlavuza usakazeka ezigulini eziyinkimbinkimbi azikho izimpawu. Eqinisweni, esifundweni esisodwa kuphela Amaphesenti angu-5 abantu abanezidakamizwa ezinama-adrenal anezibonakaliso. Abantu bavame ukukwazi kuphela lezi zibalo ngenxa yezifundo ze-radiology ezifana ne-CT scan, i-MRI, noma i-PET scan.
Uma izimpawu zikhona, zingabandakanya:
- Ubuhlungu besikhathi emuva (esifundeni sangaphakathi).
- Ubuhlungu besisu.
- Ukukhipha isisu ngaphakathi kwesisu (ukubola kwesisu).
- Isifo esingenalutho ( isifo sika-Addison ): Izimpawu zesifo se-Addison zingabandakanya ubuthakathaka, ukucindezela kwegazi okuphansi (hypotension), ushukela ophansi wegazi ( hypoglycemia ), izinga eliphansi le-sodium egazini (hyponatremia), nezinga eliphezulu le-potassium ( hyperkalemia ).
Ukuxilongwa
Uma une-scan esolisayo yamatastases adrenal, ngeke nakanjani udinga ukuhlolwa okungaphezulu, ikakhulukazi uma unemastastase kwezinye izifunda zomzimba wakho. Kwezinye izimo, udokotela wakho angase afise ukuqinisekisa ukuthi inqwaba ye-grenal adrenal yakho ingenxa yomdlavuza we-metastatic, futhi uncoma i-biopsy eqondiswa yi-CT.
Ukwelapha
Ukwelashwa okunconywe nge-adrenal metastases kungahluka kuye ngezici eziningana. Kuzo zonke izinsizakalo zokunakekelwa okusekelayo kubalulekile. Kubantu abanezimpawu ezinjenge-hemorrhage, ukwelashwa okungase kudingeke ukulawula izimpawu. Kwamanye abantu, ukwelashwa ngenhloso yokuphulukisa umdlavuza kungase kwenzeke.
Ukunakekelwa okusekelayo: Kungakhathaliseki ukuthi wena nodokotela wakho unqume yini uma ukwelashwa okuqhubekayo komdlavuza wakho noma imithi yakho ye-adrenal, ukukhathalela izimpawu zakho kubalulekile. Abantu abanomdlavuza bafanelwe ukuphathwa kahle nobuhlungu bezinye izimpawu ezihlobene nomdlavuza.
Ukwelashwa Kwezimpawu: Njengoba kuphawuliwe ngenhla, i-metastases engakaze ibe yilapho engabangela izimpawu. Uma i-metastasis iphuma (i-hemorrhaging) noma isengozini enkulu yokuphuma kwegazi, ukuhlinzwa ukukhipha isisu kanye ne-adrenal gland (adrenalectomy) inganconywa. Uma i-metastasis ibangele ukungakwazi kahle, ukwelashwa nge-steroids kungadingeka. Uma ubuhlungu bomhlane noma ubuhlungu besisu bukhona, lokhu kufanele kuphulukwe.
Ukunakekelwa kwe-Primary Tumor kanye nezinye iziMetastases: Ukwelapha isigaba somdlavuza wesine wamaphaphu kungabandakanya i-chemotherapy, imithi yokwelashwa, i-immunotherapy, kanye / noma imithi yokwelashwa. Abanye abantu bayabamba iqhaza ekuhlolweni kwemitholampilo ngokutadisha izidakamizwa nezinqubo ezintsha. Ukwengezwa kwemithi ethintekayo kanye ne-immunotherapy, kushintshile ubuso bomdlavuza wamapapu ophuthumayo kubantu abaningi eminyakeni yamuva. Uma izidakamizwa ezithintekayo zikhona, izidakamizwa ezihlosiwe ngezinye izikhathi zingavumela odokotela ukuba baphathe isigaba somdlavuza wesine 4 njengesifo esingelapheki. Ngenkathi ukumelana kwenzeka kulezi zidakamizwa ngokuhamba kwesikhathi, kwezinye izimo isizukulwane sesibili futhi manje izidakamizwa zezizukulwane zesithathu ziyatholakala uma lokhu kwenzeka. I-Immunotherapy, uma iphumelela, ngezinye izikhathi iye yabangela "impendulo ehlala njalo," inomdlavuza wamaphaphu ukuhlola isikhathi eside. Njengoba umuthi wokuqala kuleso sigaba uvunyelwe kuphela ngo-2015, asikaze sazi ukuthi izimali esizibona ngezinye izikhathi zizohlala, noma yiziphi imiphumela yesikhathi eside.
Ukwelashwa Ngenjongo Yokunciphisa: Kubantu abane-metastasis engavamile, ukwelashwa kungase kubangele ukusinda isikhathi eside. Izinketho zihlanganisa:
- Ukuhlinzwa: Kokubili i-adrenalectomy evulekile ne-laparoscopic (ukususwa kwe-grenal adrenal) ingenziwa ngenhloso yokwelapha kwabanye abantu.
- I-SBRT: Uma ukuhlinzeka kungenakwenzeka, ucwaningo lubonisa ukuthi i- radiotherapy yomzimba we-stereotactic (i-SBRT) ingasebenza futhi ibekezeleleke kahle. I-SBRT ihilela ukusebenzisa umthamo ophezulu wemisebe endaweni encane, futhi ngezinye izikhathi imiphumela inefana nokuhlinzwa.
- I-Ablation: Isithombe esinikezwe ukunikezwa kwe-percutaneous abesekunye ukhetho. Ucwaningo lwango-2018 lwathola ukuthi, nakuba ukusinda kwakumpofu kulabo abanomdlavuza wamangqamuzana omncane ongewona omncane owenza inqubo kunezinye ezinye zegciwane, ukukhishwa kwe-percutaneous percutaneous ye-metastase yangaphakathi kungase kwandise ukusinda okungahambisani nendawo kanye nokuphila okuphelele. Esikhathini sokucwaninga, ukusinda okujwayelekile okujwayelekile (kuwo wonke ama-tumor izinhlobo ahlangene) ku-1, 3, no-5 kuneminyaka engu-82, 44, kanye namaphesenti angu-34 ngokulandela inqubo.
Isibikezelo
Ngaphandle kokunakekelwa, ukusinda okuphakathi kokulandela ukuxilongwa kwe-metastases eyingozi kwakuyizinyanga ezintathu kuphela kwisifundo esisodwa. Lokhu kusho, futhi ngokungafani nama-metastases kwezinye izifunda zomzimba, ukwelashwa kwalezi zinqubo zokugaya izidakamizwa kubantu abakhethiwe abanomdlavuza wesifo samangqamuzana ongewona omncane kuye kwabangela ukuhlala isikhathi eside. Lezi zibalo zokusinda nazo zahlanganiswa ngaphambi kokwelashwa okusha okufana ne-immunotherapy, futhi eziningi zokwelashwa ezibhekene nazo manje, zavunyelwa umdlavuza wamaphaphu.
Ucwaningo oluthile oluncane oluhlola ukwelashwa kwe-metastases ekhulile lukhuthaze. Ngokwesibonelo, ocwaningweni olulodwa lweziguli ezingu-37, ukusinda okuphelele kwaba amaphesenti angu-34 kulabo abagulayo, kodwa amaphesenti angu-0 kulabo abangenalo ukuhlinzwa. Olunye ucwaningo lwamuva luthole ukuthi ukusinda kwesikhathi eside kwakungenzeka ngamaphesenti angu-25 alabo ababambe iqhaza ababenakekelwa izidakamizwa ze-adrenal.
Ngomdlavuza omncane we-cell lung , isifundo sathola ukuthi, ngokungafani nama-metastase esibindi, ubuchopho, amathambo, kanye no-pleural fluid, ama-metastases ku-grenal adrenal ayengeyena uphawu lokubikezela olungalungile.
Kungani Kungenzeka Ukuguqulwa Kungcono Kungcono Kwama-Metastase Kunama-Metastase?
Impendulo yombuzo mayelana nokuthi kungani ama-metastases adrenal enza ukubikezela okungcono, kungenzeka ukuthi umdlavuza usakazeka kanjani ukuze ufike ezinkimbeni eziyingozi. I-Cancer isakazeka ngezindlela ezintathu eziyinhloko. Omunye ungakini eduze nesisu. Enye iwukusebenzisa i-lymphatics. Futhi okwesithathu kungenxa yegazi. Lapho amangqamuzana omdlavuza engena egazini ahamba kuwo wonke umzimba. (Abanye abacwaningi bakholelwa ukuthi umdlavuza wamaphaphu ungasakazeka ngokweqile, noma ngezindiza.)
Esinye isifundo sokuhlola ukusebenza kwe-adrenalectomy ngokusinda, kwatholakala ukuthi "ngesifo sofuba" -ukuthi, ukusabalala komdlavuza kumgogodla owodwa ohlangothini olufanayo lomzimba njengomdlavuza wamaphaphu-isilinganiso seminyaka emihlanu yokusinda kwakungamaphesenti angu-83. Ngokuphambene nalokho, isilinganiso seminyaka emihlanu yokusindisa abantu abanesifo se-metastase "-asrenastases" engaphezulu kwe-body kusuka emdlavuza wamaphaphu, isilinganiso sokusinda seminyaka emihlanu ngokuhlinzwa kwakuyi-zero.
Kucatshangwa ukuthi uma umdlavuza wamaphaphu usakazeka emgodini we-adrenal ohlangothini olufanayo lomzimba, ufinyelela eguleneni le-adrenal ngendlela ye-lymphatic system. Ngokuphambene nalokho, uma isikhumba se-adrenal ohlangothini oluhlukile lomzimba sithintekile, cishe sihamba ngegazi (ukusabalala okukhulu) ukuze sifinyelele ezigulini ezinzima futhi umphumela awusizo.
Izwi elivela
Isibikezelo nge-metastatic (isigaba 4) umdlavuza wamaphaphu akusikho esikufisa ukukufisa. Lokho kusho ukuthi kuzo zonke izingosi ze-metastase, ama-metastases adrenal avame ukuba nesimo sokuhlonza okungcono kakhulu (futhi njengoba kuphawuliwe, ukubikezela kungcono nakakhulu uma umgogodla ohlosiwe ohlangothini olufanayo lomzimba njengomdlavuza wamaphaphu). Ngaphezu kwalokho, izinketho zokwelashwa nezinga lokusinda lomdlavuza wamaphaphu ethuthukile ngokuvamile ziphuthuka kancane kancane, ikakhulukazi uma izifo ezithintekayo zokuguqula izakhi zofuzo noma izidakamizwa ze-immunotherapy zingasetshenziswa ukuphatha lesi sifo.
Uma uthola ukuthi unesifo somdlavuza wesigaba 4 nesimiso se-adrenal, thatha isikhathi sokufunda ngomdlavuza wakho. Ukuhlanganyela emphakathini womdlavuza wemaphaphu ku-intanethi kuyasiza kakhulu. Izindlela zokwelapha ezintsha zithuthukisa izinga lokusinda, kodwa ukwelashwa komdlavuza wamaphaphu kuguquka ngokushesha kangangokuba kunzima ukuthi umuntu ahlale phezulu kwezinto ezitholakalayo zakamuva. Uma uzibuza ukuthi ungathola kanjani abantu "abasenqenqemeni" yokucwaninga komdlavuza wamaphaphu, ukusebenzisa i-hashtag #lcsm yomdlavuza wamaphaphu social media ayigugu.
Ungase ufise ukucabangela umbono wesibili kwenye ye-National Cancer Institute emikhulu-izikhungo zomdlavuza ezikhethiwe, lapho izifo ze-oncologists ezisebenza ngomdlavuza wamaphaphu zithola ukucwaninga kwakamuva kanye nezivivinyo zomtholampilo ezitholakalayo. Okubaluleke kakhulu, thatha ingxenye ekhuthele ekunakekeleni kwakho futhi ube ngummeli wakho . Sifunda ukuthi ukuzimela (noma nokuba nomngane noma othandekayo ongakucwaninga ngezifo futhi akukhuthazele), akugcini nje ekunciphiseni ukukhathazeka futhi kukusiza uzizwe ukhathazekile kakhulu ekulawuleni isifo sakho, kodwa kungase kuthuthukiswe imiphumela.
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> Hwang, E. et al. Izinto Zokubikezela Ukuphunyuka Okungapheli-Nokukhululeka Konke Ngemva kwe-Adrenalectomy ye-Metastatic Carcinoma: Isifundo Sokuqhutshwa Kwama-Cohort Retrospective. BMC Urology . 2014. 14:41.
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