Izimpawu Neziphakamiso Ekuhlinzeni I-Cancer
I-adenocarcinoma yama-lung yindlela yomdlavuza ongasona omncane wamaphaphu , uhlobo oluvame kakhulu lomdlavuza wamaphaphu. I-akhawunti engekho emincane yamangqamuzana amaphaphu amaphaphu ama-80 amaphesenti amaphaphu amaphaphu, futhi kulawa, cishe amaphesenti angu-50 ayi-adenocarcinomas.
I-Adenocarcinoma namuhla uhlobo oluvame kakhulu lomdlavuza wamaphaphu kwabesifazane, abase-Asia, nabantu abangaphansi kweminyaka engu-45 . Ngokudabukisayo, kungenzeka ukuthi abashaye abangabhemi (mhlawumbe ababhemayo noma ababhemayo ngaphambili) kunabantu abangabhema okwamanje.
Ngenkathi izinga liye lahleka emadodeni futhi lilinganisa nabesifazane, izinombolo ziyaqhubeka zikhuphuka kwabesifazane abasha, abangenandaba, futhi asiqiniseki ukuthi kungani. Ngokuyinhloko bakholelwa ukuthi izakhi zofuzo, ukubhema umsizi kanye nokudonswa kwe-radon ekhaya yizo zonke izici ezibangela.
Izimpawu
Ama-adenocarcinomas ama-lung ngokuvamile aqala ngezicubu eziseduze nengxenye yangaphandle yamaphaphu futhi angase abe khona isikhathi eside ngaphambi kokuba izimpawu zivele. Uma ekugcineni zivela, izimpawu ngokuvamile zibonakala zingacacile kunezinye izinhlobo zomdlavuza wamaphaphu, zibonisa ukukhwehlela okungapheli kanye ne- sputum enegazi kuphela ngokuhamba kwesikhathi, izigaba eziphambili kakhulu.
Ngenxa yalokhu, ezinye zezibonakaliso ezijwayelekile, izimpawu zokuqala (njengokukhathala, ukuphefumula okucashile, noma ubuhlungu obungenhla kwesifuba) kungase kungabikho noma kubangelwa ezinye izimbangela. Ngenxa yalokho, ukuxilongwa kuvame ukuphuza, ikakhulukazi kubantu abasha nabangabhemi abangase bangakaze bacabange ukuthi umdlavuza uyingozi.
Ukuxilongwa
Umdlavuza we-Lung uvame ukutholwa kuqala uma ukungabonakali kubonakala kwi-X-ray, ngokuvamile ngesimo sesithunzi esingacacisiwe . Ngenkathi idabukisayo, okutholakala okungenani kuhlinzeka ithuba lokuxilongwa ngokushesha. Ezingamaphesenti angama-25 amacala omdlavuza wamaphaphu, i-X-ray yesifuba ngeke ithole noma yikuphi ukungalungi futhi ibuyisele ukuxilongwa "okujwayelekile" okuphelele.
Uma kunomdlavuza, ezinye izifo zokuxilonga ezibucayi zingasetshenziswa, kubandakanya:
- I-tomography ehlanganisiwe (CT scan) , iskena sekhanda esingahlola okungavamile kakhulu kunesifo se-x-ray
- Imaging resonance magnetic (MRI) esebenzisa izinkinobho zamagnetic ukunikeza izithombe
- I-bronchoscopy , inqubo lapho umthamo oguquguqukayo ufakwa khona emphinjeni ukuze kuhlolwe ukubonwa kwemigwaqo emikhulu emaphashini
- I-Positron emission tomography (i-PET scan) engabonakala ngeso lengqondo izindawo zokungcolisa umzimba, njengokungenzeka ngamangqamuzana omdlavuza
I-cytology ye-sputum , lapho isampula yamathe namakhakheni ahlambulukile ehlolwa ngayo, ingasetshenziswa futhi kodwa ibhekwa njengento ewusizo ekutholeni umdlavuza wokuqala.
Ngokuya ngemiphumela, udokotela wakho angase athole ukuthola isampuli yamathishu emaphaphu ukuqinisekisa ukuxilongwa. Ukwengeza kokunye okungavamile kwamapayipi ama-lung wegazi, ukuhlolwa okusha kwegazi okubizwa ngokuthi i- biopsy yamanzi kungakwazi ukulandela ukungafani okwezifiso ezithile kumangqamuzana omdlavuza wamaphaphu, njengokuguqulwa kwe-EGFR.
Ukuhlolwa kwe-Genetic Profiling kanye ne-PD-L1
Enye yezinyathelo ezithuthukisayo kakhulu ukusetshenziselwa ukuhlolwa kofuzo kumaseli omdlavuza wephrofayela. Ngokwenza kanjalo, odokotela bangakhetha ukwelashwa okukwazi ukubhekisisa lezo zinhlobonhlobo ezithile zofuzo.
Le ndlela ehlosiwe ayiyona into ejwayelekile kakhulu kunezokwelapha ezizukulwaneni zangaphambilini ezahlasela ngokubanzi amaseli angempilo anempilo, okuholela emiphumeleni emibi kakhulu futhi engenakubekezeleleka.
Imikhombandlela yamanje ikhuthaza ukuthi bonke abantu abane-advanced adenocarcinoma ephuthumayo noma e- metastatic behlolwe ngokofuzo futhi babe nokuhlolwa kwe-PD-L1 ukuveza umdlavuza wabo othize.
Imithi ekhethekile ayitholakali kuphela kulabo abanokuguqulwa kwe-EGFR , ukulungiswa kabusha kwe-ALK , nokulungiswa kabusha kwe-ROS1 , kodwa i-BRAF, ERBB2, i-MET ukuguqulwa kwezakhi nokukhulisa, ukulungiswa kabusha kwe-RET, nokuningi. Ngaphezu kwalokho, ukuvivinywa kwemitholampilo kusetshenziselwa ukubuka ezinye izinguquko kanye nezinqubo ezithintekayo.
Ukuhlolwa kwe-PD-L1 kwenziwa ukuze kubikezelwe ukusebenza okungenzeka okukhona kwezidakamizwa ezintathu zokuzivikela ezivunyelwe umdlavuza wamaphaphu. Ukuxoxa ngokuhlolwa kwakho kwamangqamuzana nokuhlolwa kwe-PD-L1 kungenye yezinyathelo ezibaluleke kakhulu uma uthola ukuthi unesiphammende se-lung adenocarcinoma, njengoba le ndawo ishintsha ngokushesha. Isibonelo, isidakamizwa sokuqala se-immunotherapy samukelwa ngo-2015.
Izigaba
Uma kutholakala ukuthi ukuhlolwa kwesifo somdlavuza kuqinisekiswe, udokotela uzosungula lesi sifo esekelwe uchungechunge lwezivivinyo ezijwayelekile. Inhloso yokwenza isiteleka ukuthola ukuthi umdlavuza uthuthuke kangakanani, ngabe usakazekile yini, nokuthi yini, uma ikhona, ezinye izicubu zingase zihileleke. Ukuncintisana kusiza ukwelashwa ngokuqondile ngendlela efanelekile, futhi kungenzi ukulimala noma ukungenelela futhi kubangele ukulimala kunokuhle.
Izigaba ezine zihlukaniswa njengezilandelayo:
- Isiteji sesi-0 : Umdlavuza awusabonakali, kodwa kunalokho i- carcinoma-in-situ .
- Umdlavuza wesifo samaphaphu: Umdlavuza wamaphaphu wesimanga uthathwa ukuthi ukhona uma umdlavuza utholakala ku-sputum kodwa isifo singatholakali emaphashini ngezifundo zokucabanga.
- Isigaba 1 : Umdlavuza usendaweni yangakini futhi awusakazeki kunoma yiziphi izitho zamagciwane. Lesi yisigaba sokuqala somdlavuza we-"invasive" wamaphaphu.
- Isigaba sesi-2 : Umdlavuza usakaze kuma-lymph nodes, uhlaka lwamaphaphu, noma imigwaqo emikhulu yamaphaphu.
- Isigaba sesi-3 : Umdlavuza usakaze emathangeni aseduze. Isigaba sesi-3 siphinde saphulwa sibe sesiteji 3A nesigaba 3B esivame ukuphathwa ngendlela ehluke kakhulu.
- Isigaba sesi-4 : Umdlavuza usakazekile (okufakwe emzimbeni) kwezinye izifunda zomzimba noma kukhona ukungcoliswa kwamaphutha okulimazayo . Umdlavuza wegciwane lomzimba unamathela kaningi emathanjeni, ebuchosheni, esibindi nasezigulini eziyingozi.
Uma ufunda ngezinketho zokwelapha cishe uzwa ngomdlavuza wamaphaphu uchazwa ngenye yezindlela ezilandelayo:
- Umdlavuza wamaphaphu okuqala : Isigameko sokuqala esasetshenziselwa ukuchaza amakhondomu emaphaphu asesiteji 1, isigaba sesi-2, nesigaba 3A. Lezi zicubu ezinokuphulukiswa ngokuhlinzwa.
- Umdlavuza wamapapu ophuthumayo: Leli gama livame ukusetshenziselwa ukuchaza ukwelapha okuyisigaba 3A. Ukwelashwa kungenzeka, kodwa ukwelashwa kwe-adjuvant nge-chemotherapy kanye nokwelashwa kwemisebe ngokuvamile kuvunyelwe ukulawula lesi sifo.
- Umdlavuza wamaphaphu ophuthumayo: Igama lomdlavuza wamaphaphu ophuthumayo uvame ukusetshenziselwa isigaba 3B nesigaba se-khansa yesigaba 4, futhi yisigaba lapho ukwelapha okungewona ukwelashwa kuyindlela engcono kakhulu.
Izinketho zokwelapha
Kuye ngesigaba sesifo, ukwelashwa kungafaka eyodwa noma inhlanganisela yalokhu okulandelayo:
- Ukuhlinzwa kungahlinzeka ngezigaba zakuqala, kungaba yedwa noma kuhambisane ne-chemotherapy kanye / noma ukwelashwa kwemisebe.
- I-Chemotherapy ingasetshenziswa yedwa, ngokubambisana ne-radiation therapy, noma ngaphambi noma emva kokuhlinzwa.
- Imithi yokwelashwa ehlosiwe imithi eyenzelwe ukuhlasela ukushintshashintsha kwezakhi zofuzo ezithile. Basebenza ngokuqaphela amaprotheni akhethekile emangqamuzaneni yomdlavuza futhi kuvimbela amandla eseli ukuphindaphinda. Izinketho zifaka i-Tarceva (erlotinib), Iressa (gefitinib), i-Gilotrif (afatinib), i- Xalkori (crizotinib), iZykadia (ceritinib), i-Alectinib (alecnensa), ne-Tagrisso (osimertinib).
- Ukwelashwa kwezidakamizwa kungasetshenziswa noma ukwelapha umdlavuza noma ukulawula izimpawu kulabo abanomdlavuza we-metastatic. Izinhlobo eziningi zokwelashwa ezihlosiwe, ezaziwa ngokuthi i- radiotherapy yomzimba (stereotactic body radiotherapy (SBRT) , noma ukwelashwa kweproton kungasetshenziselwa ukwelashwa amancane okuyinto ukuhlinzwa kungakwazi ukufinyelela.
- I-Immunotherapy yindlela yokwelapha ehlose ukuhlanganisa amasosha omzimba omzimba ukulwa nomdlavuza. Izinketho zamanje zifaka i-Opdivo (nivolumab), i-Keytruda (i-pembrolizumab), ne-Tecentriq (i-atezolizumab).
Izwi elivela
Ngenxa yokuthi izimpawu zokuqala ze-lung adenocarcinoma zivame ukubonakala, isilinganiso seminyaka emihlanu sokusinda sinamaphesenti angu-18 kuphela. Kulabo abathintekayo ekuqaleni, isimo sengqondo sithembise kakhulu.
Lokho okuvelele kuyisidingo sokuqwashisa okukhulu mayelana nezimpawu ezingenasiphakamiso noma ezingenasidingo somdlavuza wamaphaphu. Ngokwabo, izimpawu zingase zilulahleke kalula. Ngokubambisana, zingase zidale ifulege elibomvu elingabangela kokubili ukuxilongwa kwangaphambili nokuqala, ukwelashwa okuphumelelayo.
Ukwelashwa kwe-lung adenocarcinoma kuthuthuka izinga lokuphila kanye nokusinda liyakhula futhi. Kwezinye izimo, ngisho nezicubu ezithuthukisiwe zingagcinwa isikhathi esithile ngezokwelapha ezihlosiwe. Ngamaphesenti amancane abantu, ukwelashwa kwama-immunotherapy kuye kwabangela "impendulo ehlala njalo" okusho ukuthi odokotela baqaphela ngokucophelela ukuthi kungenzeka baphulukiswe yini. Njengoba kunzima ukutholakala kwamathambo, kuyasiza kakhulu ukuthola i-oncologist ekhethekile ngomdlavuza wamaphaphu. Kubaluleke kakhulu ukuthi ube ngummeli wakho ekunakekelweni komdlavuza wakho .
> Imithombo:
> I-American Cancer Society. "I-Cancer Lung (I-Cell Non-Small.) I-Non-Small Cell Lung Cancer Ukusinda Amanani nge Stage." I-Atlanta, Georgia; ibuyekeziwe ngoMeyi 16, 2016.
> Chalela, R., Curull, V., Enriquez, C. et al. I-Adenocarcinoma ye-Lung: Kusuka ku-Molecular Basis kuya ku-Gym-Guided Therapy kanye ne-Immunotherapy. I-Journal ye-Thoracic Diseases . 2017. 9 (7): 2142-2158.
> DiBardino, D., Sagi, A., Elvin, J. et al. Ukukhiqiza Nokusebenza Kwemitholampilo Yesizukulwane Esilandelayo Elandelana Neziguli Ezikhethiwe Nge-Adenocarcinoma Lung. Cancer Cancer Clinic . 2016. 17 (6): 517-522.e3.
> I-Sholl, i-L. I-Molecular Diagnostics ye-Cancer Cancer emtholampilo. Ucwaningo lwe-Cancer Research . 2017. 6 (5): 560-569.