Izikhombandlela kanye nokubikezela
Ukuhlinzwa akukwenziwa njengokujwayelekile kumdlavuza omncane we-cell wamaphaphu njengomdlavuza ongasona omncane wamaphaphu, futhi abantu abaningi bayazibuza ukuthi kungani. Ake sikhulume uma kungenzeka, futhi izizathu zokuthi kungani i-chemotherapy ne-radiation therapy zivame ukhetho olungcono ukwelashwa.
Kungenziwa Yini?
Esikhathini esidlule, ukuhlinzwa komdlavuza omncane we-cell wamaphaphu akubhekwa njengento yokukhetha.
Ngokuvamile, lapho umdlavuza omncane wamaphaphu wesitholakala, usuvele usakazeka ezindaweni ezingaphezu kwamapayipi (okusetshenziselwa imithi) noma ukhona kuzo zombili amaphaphu. Kulezo zilungiselelo, ukwelashwa kwe-chemotherapy kanye nokwelashwa kwemisebe kungcono ukhetho lwezokwelapha.
Kodwa odokotela baphinde babheke i-subset encane yabantu abangase bazuze, futhi baphile isikhathi eside, emva kokuhlinzwa okuphumelelayo ngomdlavuza omncane we-cell lung.
Lapho Ukuhlinza Kungavunyelwe
I-akhawunti encane yomdlavuza wamaphaphu amancane cishe ngamaphesenti angama-15 emdlavuza wamaphaphu. Ihlelwe phansi zibe yizigaba ezimbili: isigaba esilinganiselwe nesigaba esiphezulu. Uma umuntu enesifo somdlavuza omncane wamangqamuzana omzimba wamaphesenti amancane (okukhona ngamaphesenti angaba ngu-70 abantu ngesikhathi sokuxilongwa), ukuhlinzwa akukhulisi isikhathi sokuphila. Ngomdlavuza omncane we-cell lung wamaphaphu, ukuhlanganiswa kwe-chemotherapy kanye nokwelapha imisebe kungasebenza kahle, okungenani ekuqaleni. Uma ukuhlinzekwa kwakudingeka kwenziwe kuphela ngeke kusebenze kodwa kungaphazamisa ukwelashwa okusiza.
Lapho Ukuhlinzwa Kungase Kuphumelele
Ukuhlinzwa kungahlinzeka ithuba lokusinda isikhathi eside kwabanye abantu abanomdlavuza omncane wamaphaphu omncane ongenamkhawulo lapho:
- Umdlavuza ukhona emaphashini owodwa kuphela.
- Umdlavuza awubandakanyi i-lymph nodes noma ukhona kuphela kuma-lymph nodes eseduze. (Ngamanye amazwi, ukuhlinzwa akuyona into enhle kubantu abane-N2 isifo somdlavuza we-TNM wesifo somdlavuza , okubhekisela emagqabeni anesifo somdlavuza onomdlavuza endaweni emkhatsini wamaphaphu (i-lymph node mediastinal).
- Ukuhlinzwa kungase kube yinketho uma umdlavuza usezingxenyeni zangaphandle zamaphaphu.
Izinhlobo Zokuhlinzwa
Kunezinhlobo ezine eziyinhloko zokuhlinzwa ezenziwa umdlavuza wamaphaphu:
- I-pneumonectomy. I- pneumonectomy yindlela yokuhlinza okubandakanya ukususwa kwephasi lonke. Abanye abantu bayamangala ukuthi lokhu kuhlinzeka kungenzeka, kodwa kubantu abanomsebenzi omuhle ngokuhlukile, abantu abaningi baye babekezelela le nqubo kahle.
- Lobectomy. I- lobectomy yinkqubo lapho isisindo samaphaphu sisuswa khona. Iphaphu elilungile linama-lobes angu-3 futhi ipulaphu lesobunxele linama-2.
- Hlanganisa umthengisi noma i-segmentectomy. Ukuthengiswa komgogodla kungukuhlinzwa lapho isisu kanye nendawo enemibala yezincubu ezizungezile kususwa. Lokhu kubangela ukuthi izicubu ezincane zilahleke kunokwakheka kwe-lobectomy, kodwa zingase zithwale ingozi ephakeme yokuphindaphindiwe.
- Ukubuyisana kwemikhono.
Kulezi, i-lobectomy ibonakala inemiphumela emihle kakhulu kubantu abanomdlavuza omncane wamaseli weseli.
Ngaphambi Kokuhlinzwa
Uma ukucutshungulwa kubhekwa, ukuhlolwa okucophelela kuyodingeka kwenziwe, kufaka phakathi i- mediastinoscopy (inqubo ehlola umdlavuza endaweni emkhatsini wamaphaphu), ukuqinisekisa ukuthi umdlavuza awusakazeki kuma-lymph nodes kule ndawo (i-lymph N2 izakhi). I-PET / CT ingase ibe yindlela ehlukile ku-mediastinoscopy kwabanye abantu.
Ukuhlolwa komsebenzi wepulmonary kuzokwenziwa futhi ukuqinisekisa ukuthi umuntu uzobekezelela ukuhlinzwa futhi abe nokusebenza okwanele kwamaphaphu ngemva kokuhlinzwa.
Njengoba ukusinda ekuhlinzekeni komdlavuza omncane wamaphaphu kubonakala sengathi kungcono emitholampilo yomdlavuza eyenza kakhulu ukuhlinzwa, kubalulekile ukucwaninga umdlavuza wakho ngaphambi kokuhlinzwa kwakho futhi ucabange ukuthola umbono wesibili esikhungweni somdlavuza omkhulu .
Ngemuva kokuhlinzwa
Uma ukuhlinzwa kuphelile, kubalulekile ukuthi ukwelashwa kwamakhemikhali kanye nokwelashwa kwama-radiation ngokuvamile kusetshenziswe emva kokuhlinzwa, ngoba lokhu kuthuthukisa ukusinda.
I-prophylactic irradiation cranial (PCI) , uhlobo lwemisebe eyenzelwe ukusiza ekuvimbeleni ukusakazeka komdlavuza ebuchosheni, ingasetshenziselwa ukunciphisa ingozi yomdlavuza esakaze ebuchosheni ngemuva kokuhlinzwa.
Ingozi ye-metastases yobuchopho eyenzeka eminyakeni emithathu emva kokuhlinzwa ikhuphuka ngesigaba se-tumor, kanti ucwaningo olulodwa lathola ukuthi le ngozi ingaba amaphesenti angu-9.7 esigabeni 1, amaphesenti angu-18.5 esigabeni sesibili, kanti amaphesenti angu-35.4 wesigaba sesithathu.
Isibikezelo
Ucwaningo lubonisa ukuthi kubantu abanesisindo sokuqala (isigaba esincane) amancaysi amancane amaphaphu amaphaphu (T1 noma T2), ukuhlinzwa kuthuthukisa izinga lokusinda. Ekubuyekezeni okukhulu, kwatholakala ukuthi ukusinda kwabantu abanezifo zendawo kanye nesifunda kwakhuliswa ngokuhlinzwa.
Kulabo abanezifo zendawo ababenalo i-lobectomy, isilinganiso sokusinda esiphakathi kwaba yizinyanga ezingu-65 kanti isilinganiso sokusinda kweminyaka engu-5 sasingaphezu kwamaphesenti angu-52. Lezi zinombolo zingase zizwakale zisabisa uze uziqhathanise namanani okusinda abantu abangenalo ukuhlinzeka okubandakanya izinga lokusinda eliphakathi kwezinyanga ezingu-25 kanye nesilinganiso seminyaka engu-5 yokusinda samaphesenti angu-31.8.
Okuphawula ukuthi ukwelashwa kwe- metastases yobuchopho ngenxa yomdlavuza wamaphaphu kuyashintsha, kanti ezinye izimo abantu abanomzimba kuphela ("oligometastases") bangase baphathwe ngenhloso yokwelapha nge- radiotherapy yomzimba (stereotactic body radiotherapy) noma i- proton beam therapy .
Ngaphansi
Esikhathini esidlule, ukuhlinzwa kwakungavamile ukubhekwa njengendlela yokuphatha umdlavuza omncane wamangqamuzana wamaphaphu. Lokhu kubonakala sengathi kuyashintsha njengoba izifundo ezintsha zithole inzuzo yokuphila kwabanye abantu abanesifo. Ikakhulukazi, abantu abanomdlavuza wamaphaphu omkhawulo banempilo engcono kakhulu yokuphila iminyaka engu-5 ngokuhlinzwa ngaphandle kwekhemotherapy kanye nokwelashwa kwemisebe kuphela. Kwezinqubo ezahlukene ezikhona, i-lobectomy inemiphumela emihle kakhulu.
Kubalulekile ukukhumbula ukuthi wonke umuntu uhlukile. Esinye isigaba sokuqala (isigaba esincane) amagciwane amancane amaphaphu amaphaphu angase abe nzima noma angenakwenzeka ukwelashwa ngokuhlinzwa ngenxa yendawo yokudla. Ukutholakala kwezinye izimo zezokwelapha kungase kuholele nasengozini yokuhlinzwa ngaphezu kwezinzuzo ezikhona.
Uma uhlala nomdlavuza wamaphaphu kubalulekile ukuba ube ngummeli wakho ekunakekeleni kwakho. Izinketho zokwelapha emdlavuza omncane we-cell wamaphaphu ziyathuthuka futhi izindlela zokwelapha ezintsha zihlolwa ngezivivinyo zokwelashwa. Ezinye zalezi zonyango, ezifana nalabo abasebenzisa izidakamizwa ezintsha zokuzivikela ziletha isithembiso semiphumela ephuthumayo kakhulu esikhathini esizayo. Ngenkathi abantu abaningi besaba ukuvivinywa kwemitholampilo, kubalulekile ukukhumbula ukuthi yonke imithi esiyitholile manje yayisengxenye yesilingo somtholampilo.
> Imithombo:
> Kulungile, C. Umphumela wevolontiya yokuvotela ekukhethweni kwenqubo emisebenzini engeyona emincane yesifo somdlavuza wamaphaphu. I-Journal ye-Thoracic and Surgery Cardiovascular . 2016. 151 (4): 1219.
> Koletsis, E., Prokakis, C., Karanikolas, M., Apostolakis, E., noD. D. Dougenis. Indima yamanje yokuhlinzwa iyinkimbinkimbi yamaphaphu carcinoma. I-Journal of Cardiothoracic Surgery . 2009. 4:30.
> National Cancer Institute. Ukwelashwa Kwemdlavuza Yamangqamuzana Amancane (PDQ) - Isiguli Esineziguli. Kubuyekezwe 11/09/17.
> Schreiber, D., Rineer, J., Weedon, J. et al. Imiphumela yokusinda kanye nokusetshenziswa kokuhlinza emkhakheni omncane wesifo samaphaphu wamaphaphu: ingabe indinganiso yayo kufanele ihlolwe kabusha? I-Cancer . 116 (5): 1350-7.
> Zhu, J., Bi. Y., Han A. et al. Izingozi ze-metastases zobuchopho zisetshenziswe ngokuphelele umdlavuza wamaphaphu omncane we-cell: ukutadisha okuhloswe ukukhomba iziguli okungenzeka zizuze ku-prophylactic irradiation cranial. I-Radiation Oncology . 2014. 9: 216.