Ukwelashwa Nokuguqulwa Kwegazi Uma I-Cancer Lung Spreads
I-bone metastases esuka emdlalweni wamaphaphu (ukusakazeka komdlavuza wamaphaphu emathanjeni) kujwayelekile kakhulu ngomdlavuza wamaphaphu, okuphazamisa amaphesenti angu-30 kuya kwangu-40 abantu abanomdlavuza wamapapu ophakeme . Eqinisweni, njengoba izinga lokusinda lomdlavuza wamaphaphu landa, inani labantu abahlala ne-bone metastases liyanda.
Ngaphezu kokubangela ubuhlungu obukhulu nokungahambi kahle, ama-metastase amathambo angabangela ukwehlukana okuphazamisa imisebenzi yansuku zonke nokunciphisa izinga lakho lokuphila.
Ziyini izimpawu, ukwelashwa, nokubikezelwa komdlavuza wamaphaphu nge-metastases yamathambo?
Sibutsetelo
Umdlavuza we-Lung ne-boneast metastase ibhekisela kumangqamuzana omdlavuza wamaphaphu asakaze emathanjeni noma ngegazi noma nge-lymphatics (izitsha ezithwala amangqamuzana elwa nokutheleleka emzimbeni). I-Cancer metastatic kuya amathambo ihlukile kunomdlavuza wezinyosi-iziqhwa ezivela emathanjeni futhi zakhiwa ngamangqamuzana amathambo angavamile. I-Cancer metastatic kuya ethambo yenziwe ngamaseli avela emdlalweni oyinhloko- kulokhu, amaphaphu. Uma lokhu kudideka, ungafunda kabanzi mayelana nokuthi umdlavuza usakazeka kanjani emzimbeni .
Yiziphi Amathuna Ayenziwa Ngomdlavuza Wegazi?
Umdlavuza we-Lung yiyona uhlobo lwesithathu oluvame kakhulu lomdlavuza ukusakazeka emathanjeni (emva komdlavuza webele kanye nomdlavuza wesifo sofuba), futhi lapho imithini ye-metastases itholakele ngaphandle komthombo ocacile, ingxenye yesikhathi ihlobene nomdlavuza wamaphaphu angaphansi. Amathambo avame kakhulu lapho umdlavuza wesifo wamaphaphu usakazeka khona kufaka:
- Umgogodla (ikakhulukazi ama-vertebrae esifubeni nasezindaweni ezingaphansi kwesisu)
- Isikhumba
- Amathambo aphezulu wezingalo nomlenze (i-humerus ne-femur)
Umdlavuza we-Lung uhlukile nakakhulu ngoba ungasakazeka emathanjeni ezandleni nasezinyaweni.
Izimpawu
Ubuhlungu ngokuvamile buyisimpawu sokuqala somdlavuza wamaphaphu ngamathambo ayisithupha.
Ubuhlungu bungase buzwe ekuqaleni njengokudonswa kwemisipha noma ubunzima, kodwa kancane kancane bubuhlungu futhi bungaba nzima. Uma ama-metastases amathambo ahlanganisa izingalo nemilenze, ubuhlungu buvame ukuqhuma ngokunyakaza. Ubuhlungu ngenxa yokusakazeka komdlavuza wamaphaphu emgodleni ngokuvamile kubi nakusihlwa nangemva kokulala embhedeni.
Uma i-boneast metastases ihilela umgogodla, ukucindezela komgogodla ngenxa yesikhumba kungabangela ubuhlungu ngokuhamba nobuthakathaka noma ukugoqa emilenzeni. Uma imbangela yomgogodla ingcindezi inzima emgodleni ophansi (cauda equina syndrome), ubuhlungu nobubuthakathaka emilenzeni kungenzeka kanye nokulahlekelwa kwesilonda noma isisindo somzimba. Lokhu kuyiphuthumayo kwezokwelapha, futhi izimpawu zingaba unomphela ngaphandle kokwelashwa okusheshayo.
Ngezinye izikhathi isibonakaliso sokuqala ukuthi umdlavuza wamaphaphu usakaze emthanjeni ukuphuka ( ukwephulwa kwamathambo ) Kulesi simo, amangqamuzana omdlavuza athatha isikhundla sesisindo samathambo avamile, asinciphisa ngakho kungenzeka ukuthi aphule. Lezi fracture zingase zenzeke ngaphandle kokuhlukunyezwa okuphawulekayo (ngisho nokugqekeza embhedeni) nangemisebenzi evamile yansuku zonke.
Ngenxa yokwehla kwethambo, okukhipha i-calcium, izinga eliphakeme eliphakeme le-calcium egazini (hypercalcemia) lingabangela ukudideka, ukucabangela nokuhlanza, ukoma, kanye nobuthakathaka bemisipha.
Izinkinga
Njengoba kuphawuliwe ngenhla, amathambo ayisithupha angabangela izinhlobo eziningana zezibonakaliso, eziningi zazo ezinciphisa izinga lokuphila kubantu abaphila nomdlavuza wamaphaphu.
- Ubuhlungu - Ubuhlungu obuhlobene ne-bone metastase bungaba nzima kakhulu, kuphazamise ikhwalithi yokuphila. Ngaphezu kwalokho, imithi yokwelapha ubuhlungu ingaholela ekukhathaleni okuqhubekayo, kanye nokuqothulwa.
- Ama-Fractures - Ama-Fractures ajwayelekile, ngokuvamile abuhlungu, kodwa anciphisa izinga lokuphila kanye. Ukuhlanganiswa nomdlavuza, ukwehla ukuhamba ngenxa yokwehlukana kwandisa ingozi yokuthuthukisa i-blood clots kanye ne-pulmary emboli .
- Umgogodla Wokucindezeleka - Ngaphezu kokubangela izimpawu, ukucindezeleka komgogodla kuyisimo esiphuthumayo sezokwelapha esingabangela ukukhubazeka nokulahlekelwa kwesilonda nokulawula kwesisu.
- I-hypercalcemia - Ngaphezu kokubangela izimpawu ezingenhla, i- hypercalcemia ezigulini zomdlavuza kuyisimo esiphuthumayo, futhi ingabangela izinhliziyo ezingavamile, ukuphazanyiswa, ngisho nokufa. Izimpawu ze-hypercalcemia zingase zihlanganise ukunxanxathela nokuhlanza, ukoma okwandisiwe, kwehla ukuvuthwa, ukuncipha kwemisipha nokuhlanganyela, ubuthakathaka nokudideka.
- Ukwelashwa okungeziwe, Ukuhlinzwa, Nemithi - Uma ukwelashwa kwemisebe, ukuhlinzwa noma imithi isetshenziselwa ukwelapha izidakamizwa zamathambo, imiphumela emibi yalezi zonyango ingezwe emiphumeleni yemithi yokwelashwa esetshenziselwa ukwelapha umdlavuza kuqala.
- Ukwelashwa Okungekho Emthethweni - Enye inkinga engavamile ukujongwa, indlela ama-metastase amathambo angase aphikise ngayo kwezinye izifo zomdlavuza. Ngale ndlela, izenzakalo ezihlobene nama-squelette (njengama-fractures) zingaba yingxenye yombuthano ononya lapho umdlavuza ubangela inkinga (isibonelo ukwehlukana) okunye okungahle kunciphise ukusetshenziswa kwemithi nokuhlinzwa ukuphatha umdlavuza.
Ukuxilongwa
Izivivinyo ezisetshenziselwa ukubheka amathambo ama-metastase zingabandakanya:
- I-Bone scans : Izilinganiso ze- Bone zisetshenziselwa njalo ukuba zibheke ama-metastase amathambo kunakudala, futhi ngezinye izikhathi kungaba nzima ukuhlukanisa umdlavuza kwezinye izimo zethambo.
- I-PET ihlola : Izilinganiso ze- PET zibucayi kakhulu ekutholakaleni kwe-bone metastases , njengoba zibuka izindawo zokukhula kwe-tumor esetsheni.
- I-MRI ihlola
- Ukuhlola kwe-CT
Ukwelapha
Ukwelashwa komdlavuza wamaphaphu ngamathambo ayisifo se-bone ngokuyisisekelo-okusho ukuthi kuhloswe ukukhulula izimpawu, kodwa hhayi ukwelapha umdlavuza. Umgomo oyinhloko wokwelashwa ukunciphisa ubuhlungu obubangelwa yi-metastases nokuphatha noma ukuvimbela ama-fractures nezinye izinkinga. Lokho kusho, kubantu abaneemetastases ezimbalwa kuphela (okuthiwa i-oligometastatic), odokotela bangase bacabange ukuphatha imithi ngokuhlukumeza nethemba lokuphila isikhathi eside (bona ngezansi).
Izinketho zokwelapha zamathambo asetsheni zibalwe ngezansi. Okubaluleke kakhulu ukukhumbula engqondweni yakho, noma kunjalo, ukuthi umgomo wokwelashwa kufanele ube ukukhulula noma yikuphi ubuhlungu noma ukunganaki okuhlangenwe nakho. Izifundo zisitshela ukuthi kunokwenzeka ukuphumula okuhle. Lokho kusho, izinto ezimbalwa zingenza ukuthi lokhu kwenzeke. Kubalulekile ukuthi abantu abanomdlavuza baqaphele ukuthi imishanguzo yobuhlungu, uma isetshenziselwa ukuqondiswa, ayifuni neze ukuphuza umlutha, futhi ngeke unciphise amathuba okuba ukhululeke ubuhlungu esikhathini esizayo uma usebenzisa imithi yobuhlungu manje. Kubalulekile nokuba ngummeli wakho ekunakekelweni komdlavuza wakho futhi uvumele udokotela wakho wazi uma unemihelo ephazamisa izinga lakho lokuphila.
Izinketho zokwelashwa zifaka kokubili systemic (kuwo wonke umzimba) nasendaweni (ekubhekaneni netastases bone kuphela) zokwelapha. Ake sibheke ngayinye yalezi ngokwehlukana.
Izinketho zokwelashwa zesistimu
Izindlela zokwelashwa ezivamile zomdlavuza wamaphaphu we-metastatic, ezifana ne-chemotherapy, ezithintekayo zokwelapha, kanye ne-immunotherapy, zinganciphisa ama-metastase amathambo. Isidakamizwa sokuqala se-immunotherapy yomdlavuza wamaphaphu samukelwa ngo-2015, kanti manje ezine izidakamizwa ezinjalo zitholakalayo ngomdlavuza wamaphaphu. Njengokutholwa okunamandla, isifundo se-2018 sathola ukuthi ukutholakala kwamathambo ama-metastases kwakungukuzimela okuzimele ukuthi i-Opdivo (nivolumab) ingase isebenze ngomdlavuza.
Izinketho zokwelapha zendawo
Kunezinketho eziningana ezitholakalayo zokwelapha izidakamizwa zamathambo ngaphezu kwanoma yikuphi ukwelashwa okwenzelwa umdlavuza uqobo. Lezi zindlela zokwelapha zingasetshenziswa zodwa noma zihlangene kuye ngokuthi ubuhlungu bakho bubuhlungu kangakanani kanye nezinkinga ezingase zenzeke. Izinketho zihlanganisa:
Imithi yobuhlungu - Yonke imithi elwa nokuvuvukala kanye nezidakamizwa, njenge-morphine, ingasetshenziselwa ukulawula ubuhlungu obusuka emathanjeni amathambo. Lapha ulwazi oluthe xaxa lokuphatha ubuhlungu ngenxa yomdlavuza.
Ukwelashwa kwezidakamizwa - I-radiation iyindlela yokwelapha evame kakhulu ukusetshenziselwa ukunciphisa ubuhlungu, ukuvimbela ama-fractures, nokunciphisa ukucindezeleka komgogodla ovela emathanjeni amathambo. Iningi labantu lithola ukukhululeka okukhulu kobuhlungu emitholampilo, futhi kubantu abaningi, imisebe ingakwazi ukukhulula ubuhlungu babo ngokuphelele.
Ukuhlinzwa - Ukuhlinza ngokuyinhloko kusetshenziselwa ukuqinisa amathambo uma kuphulwa, noma ukuvimbela ukuphuka ethangeni elithinteka kakhulu ngumdlavuza (ukuphulukana okuzayo). Ngezinye izikhathi ukuhlinzwa kungasetshenziswa uma lesi sifo sibangela ingcindezi enkulu emthonjeni wokugulisa, njengalokhu i-cauda equina syndrome.
I-Bone yayihlose ukwelashwa noma izifo zokwelapha amathambo - Ungase uzwe udokotela wakho akhuluma ngethambo lokuguqula amathambo . Lezi zindlela zokwelapha zihlanganisa kokubili ukusetshenziswa kwe-bisphosphates (okukhulunywe ngayo ngokulandelayo) nokusetshenziswa kwe-denosumab).
I-Bisphosphonates - I-Bisphosphonates yimithi eye yasetshenziselwa ukwelapha i-osteoporosis (amathambo amancane), kodwa ingasiza ekuvimbeleni ukwehla kwethambo kubantu abanezinthambo zamathambo ngenxa yomdlavuza. Imithi esetshenziselwa abantu abane-cancer yomaphaphu ihlanganisa i-Zometa (zoledronic acid) ne-Prolia (denosumab.)
Lezi mithi ziphephile, ezimweni ezingavamile zingabangela inkinga ebizwa ngokuthi i- osteonecrosis yomhlathi (ukuphuka kwethambo emhlathini) nokulimala kwezinso. Zingase zisetshenziswe ngemuva kokuhlukunyezwa kwamathambo asetsheni, noma ukuvimbela izinkinga endaweni yokuqala. I-Zometa ne-Prolia inomunye umhlomulo wokuba nezindawo ze-antiticancer. Zombili kanye ne-Prolia zinikezwa njengezindlela zokwelapha (IV) njalo emva kwamasonto amathathu kuya kwamane ngeZometa, noma onke amaviki amabili kuya kwamane nge-Prolia.
I-Denosumab - I-Denosumab iyi-antibody yomuntu esetshenzisiwe ngempumelelo ethile kubantu abanomdlavuza webele kanye ne-prostate oye wasakazeka emathanjeni. Kuze kube manje kucatshangwa ukuthi kunganciphisa izinkinga, ezifana nokuhlukana, okuhlobene nomdlavuza wamaphaphu owusakaze amathambo. Kucatshangwa ukuthi kungaba nethonya elilodwa emdlalweni ngokwawo ngoba unezakhiwo zokulwa nezicubu. I-Denosumab inikezwa njengemjovo engaphansi (ngaphansi kwesikhumba) njalo emavikini amane.
I-Radionuclide Treatment - Ukwelashwa kwe- Radionuclide kuyindlela yokwelapha amathisasethi we-bone ngaphambilini asetshenziselwa ikakhulukazi i-prostate ne-cancer yamabele. Ukubuyekezwa kwezilingo ezimbalwa ezenziwe kuze kube yimanje bathole ukuthi lokwelashwa kwabangela ukukhululeka kobuhlungu kubantu abangamaphesenti angama-75 abanomdlavuza wamaphaphu kusukela ekuqaleni kwamasonto amahlanu emva kokwelashwa nokuhlala kuze kube izinyanga eziyisithupha. Kuthemba ukuthi izifundo ezinkulu zizohlola ukusetshenziswa kwalendlela esikhathini esizayo esiseduze.
Izivivinyo zemitholampilo - Izivivinyo zemitholampilo ziyaqhubeka zibheke izindlela ezingcono zokwelapha izidakamizwa zamathambo ngenxa yomdlavuza.
Ezinye izindlela zokwelashwa - Abacwaningi babheka izindlela zokuqeda ukwelashwa kwamathambo ngenxa yomdlavuza we-metastatic, futhi ukukhishwa kwesikhumba kungabamba isithembiso lapho kusetshenziswe ngaphezu kwalezi zinye imithi.
Ukwelashwa KwamaSulumane Nama-Oligometastases
Njengoba kuphawuliwe ngenhla, ezimweni ezingavamile kubantu abane-single or metastases ezimbalwa kuphela ezitheni zomdlavuza wamaphaphu, ukwelashwa kwama-stereotactic radiation ( SBRT ) kungacatshangwa. Kuze kube manje lokhu kwenziwe ngokuyinhloko kubantu abane-metastase eyodwa noma embalwa ebuchosheni noma esibindi.
Isibikezelo
Ukusinda okuphakathi- okungukuthi, isikhathi esilandelayo lapho amaphesenti angu-50 abantu ephila futhi amaphesenti angu-50 adlulile-kuyadabukisa izinyanga ezingaphansi kwezinyanga eziyisithupha kubantu abanesifo se-metastase emdlalweni wamaphaphu. Ukuphunyuka kungcono kakhulu kwabesifazane , labo abane- adenocarcinoma , abantu abane-metastasis eyodwa kuphela, nabanye abangenayo i-fractures. Lokho kusho ukuthi abanye abantu basinda futhi benza kahle iminyaka eminingi emva kokuxilongwa komdlavuza wamaphaphu nge-metastases yamathambo.
Izwi Elivela Ematetastases Wezitho Ezivela Emdlalweni We-Lung Cancer
Ukufunda ukuthi unamathambo ayisithupha emdlavuza wamaphaphu kuyabuhlungu kakhulu. Kusho ukuthi umdlavuza wakho isiteji sesi-4 (imetastatic) futhi awusaphuluki. Ngaphezu kwalokho, i-metastases yamathambo ingaba buhlungu kakhulu futhi ithinte ikhono lakho lokuhamba. Lokho kusho ukuthi ukwelashwa kuyathuthuka. Ukwelashwa komdlavuza we-metastatic, njenge-chemotherapy, ukwelashwa okuhlosiwe, kanye ne-immunotherapy kungasiza ngamathambo asetsheni. Ngaphezu kwalokho, i-metastases yamathambo ingaphathwa ezindaweni ezithinta izidakamizwa ezifana ne-bone-modifying drugs (okungenzeka ibe nemiphumela yokulwa nomdlavuza) kanye nokwelashwa kwemisebe. Ngenkathi ukudalulwa kwesibindi kungabantu abampofu jikelele, abanye abantu baye baphila iminyaka eminingi ngamathambo ayisifo somdlavuza wamaphaphu.
> Imithombo:
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