Umdlavuza Webele Usakaze Emapulazini

Ukulawulwa Kwemayinetha Yengwenya Kusukela Emdlalweni Webelevuza

Kusho ukuthini uma umdlavuza wakho webele usakazeka (imetastasizes) emaphashini akho? Yiziphi izinhlobo zezimpawu ongazilindela, futhi yiziphi izifo ezitholakalayo? Kungakhathaliseki ukuthi ukhathazeka ukuthi umdlavuza wakho kungenzeka usakazeke, noma uma ufunde ukuthi unayo, cishe unemibuzo eminingi. Nakuba umdlavuza wesifuba we-metastatic awuphilwanga, usaqhubeka ukhathazeka kakhulu, futhi ukhetho olusha lwezokwelapha luye lwathuthukisa ukubikezela.

Incazelo

Amapayipi yindawo yesibili evame kakhulu lapho umdlavuza webele usakazeka ngemuva kwamathambo. Amanye amasayithi avamile we-metastasis yisibindi nobuchopho, nakuba umdlavuza webele ungasakazeka cishe noma yisiphi isifunda somzimba.

Lapho umdlavuza webele usakazeka emaphashini kusengumdlavuza webele. Uma ngabe uthatha isampula yamaseli atholakale emaphashini babeyoba amangqamuzana omdlavuza webele, hhayi amangqamuzana omdlavuza wamaphaphu. Abanye abantu bathi ngekhanda lomdlavuza wamaphaphu, kodwa kunalokho, uvame ukubizwa ngokuthi "isifo somdlavuza webele wesifuba emaphashini" noma umdlavuza wamabele ngamaphaphu wesifo samaphaphu. "Kungase kuthiwa" umdlavuza wesifuba wesibili . "

Amaseli omdlavuza wesibeletho angasakazeka noma yizikebhe ze-lymphatic noma igazi legazi. Njengoba wonke igazi lidlula emaphashini ukuthola umoya ophefumulayo, akumangazi ukuthi amaphaphu ayisayithi elivamile lama-metastases.

Ngisho noma imitholampilo yamaphaphu ijwayelekile, akuzona zonke izigulane zamaphaphu kulabo besifazane abaye banomdlavuza webele. (Bheka ngezansi), nokuhlolwa okuqhubekayo futhi kuvame ukuba ne-biopsy edingekayo ukuze kuqinisekiswe ukuthi lokho okubonakala kubonakala kungenjalo umdlavuza wamaphaphu noma ukuvuvukala).

Ukukhubazeka Nezici

Esinye isifundo esikhulu, sabesifazane abanomdlavuza webele we-metastatic, amaphesenti angu-36.4 anama-lungastas amaphaphu, kanti amaphesenti angu-10.5 anama-lungastases kuphela. Lokhu kusho ukuthi izingxenye ezimbili kwezintathu zabesifazane abathuthukisa imishanguzo yamaphaphu zinemigodi yezinye izifunda zomzimba futhi.

Abanye abantu abanomdlavuza wesifuba banamathuba amaningi okuthuthukisa amaminerase amaphaphu kunabanye.

Ngokuqinisekile, labo abanezigaba eziphambili kakhulu zomdlavuza wesifuba we-early-stage cishe banokuphindaphinda okude, futhi lokhu kuyiqiniso kulabo abanezibalo eziphezulu zamathumba . Isikhathi esiphezulu sesikhathi phakathi kokuqala kokuqala (okuyisisekelo) somdlavuza webele wesifuba futhi ukuthuthukiswa kwamaminithi ayisifo samaphaphu kuyinyanga engu-68.6.

Ama-metastases angama-lung ajwayelekile kakhulu kubantu besifazane kunamadoda anomdlavuza wesifuba, e-African Americans vs eCaucasians, nakwabo abanezinambuzane ezingenayo i-estrogen receptor negative ne- HER2 enhle , labo bobabili i- estrogen receptor ne-HER2 positive, nalabo abane-triple umdlavuza wesifuba omubi.

Izimpawu

Uma umdlavuza webele usakazeka kuqala emaphashini, kungase kungabangeli izimpawu. Uma izimpawu zenzeka, ngokuvamile zihlanganisa:

• Ukuphefumula (ekuqaleni kungase kube okucashile, kuphela ngomsebenzi): Lesi yisimpawu sokuqala esivame kakhulu
• Ukukhwehlela okuqhubekayo
• Ubuhlungu besifuba, noma ubuhlungu obunomoya ojulile ( ubuhlungu besifuba se-pleuritic )
• Izifo zesifuba ezifana ne-bronchitis noma i-pneumonia

Ezinye izimpawu zingase zibandakanye ukuhamba, ukuthuka, ukukhwehlela igazi, ukukhathala nokulahlekelwa kwesisindo okungenhloso .

Izimpawu Ze-Pleural Effusion

Lapho umdlavuza webele usakazeka emlonyeni we- pleura (umgwamanda wamaphaphu), uketshezi lukwakha emgodini we-pleural (i-pleural effusion) engakwazi ukucindezela amaphaphu futhi ngezinye izikhathi kubangela ukuphuza ukuphefumula ngokushesha.

Imfucuza yesikhukhula ingenzeka lapho umdlavuza webele usakazeka emaphashini, kepha kungenzeka futhi ngaphandle kwamaphasethi wesifo samaphaphu uma umdlavuza usakazeka kuma-lymph nodes ku- mediastinum , indawo yesifuba phakathi kwamaphaphu.

Ukuxilongwa

Kunezinketho eziningi ezehlukene ezitholakalayo zokuxilonga amaminerase amaphaphu.

• I-x-ray yesifuba: I-x-ray yesifuba ivame ukuhlolwa kokuqala, kepha ingaphuthelwa ama-metastases amancane noma amantombazane amancane okuphuza amaphaphu.
• I-Chest CT scan: Isifo se-CT scan singathatha ama-nodules amancane kakhulu kunalawo abonwe kwi-x-ray yesifuba, futhi angakwazi ukuveza noma yikuphi okungajwayelekile.
• Iskena se-PET: Iskena se-PET yisilingo esibheka izindawo zezicubu ezikhula ngokushesha, futhi luvivinyo olunembile kakhulu lokuthola amametasethi.

• I-MRI: Ebizwa ngokuthi i-magnetic imaging resonance isetshenziswa kaningi, kodwa ngezinye izikhathi iyasiza.
• I-bronchoscopy: I- bronchoscopy iyimvivinywa lapho ithubhu eguquguqukayo ifakwa khona emlonyeni futhi iphinde ibe ngaphansi kwe-bronchi. Kungasiza ekutholeni izicubu eduze nemikhumbi ehamba phambili.

I-Biopsy

Ngisho noma ama-metastases amaphaphu asolwa ngokuqinile ngokususelwa kwizifundo zokucabanga, i-lung biopsy ivame ukwenza. Lokhu kubaluleke kakhulu ngezizathu ezimbili:

1. Akuwona wonke amaphaphu aphethwe ngamantombazane kwabesifazane abaye banomdlavuza webele. Kwesinye isifundo, ama-nodules amaphaphu aphawulwe ngabesifazane abake baphathwe isifo somdlavuza webele wesandulela-ngculazi, amaphesenti angu-47 kuphela ama-nodules amelela amametasti webele. Eminye amaphesenti angu-40 ama-nodules kwakuyi- primitive cancer ( isifo se- lung adenocarcinoma) , uhlobo lomdlavuza wamaphaphu luvame kakhulu kubantu abangabhemi), kanti amaphesenti angu-13 ayenobuthi (ukuvuvukala noma isibhamu).
2. Ngenxa yokuhlukana. Lapho abantu beqala ukuphathwa ngekhanda lomabele, bazofunda ukuthi ngabe i-estrogen receptor noma i-HER2 enhle. Lokhu kungashintsha. Amanqamu akuyona nje i-clone engaguquki yamaseli, kodwa njalo uthuthukise ukuguqulwa okusha okusha futhi ushintshe iphrofayili yawo yamangqamuzana. Esifundweni esikhulu, abantu abangamaphesenti angama-20 isimo se-receptor somdlavuza wesibeletho sokuqala sasihlukile kunesimo sokwamukelwa kwamaseli omdlavuza wesifuba esasungulwe emaphashini.

Izinketho ze-lung biopsy zihlanganisa i-percutaneous needle biopsy (uvivinyo lapho inaliti efakwe khona emapulazini ukuze uthole isampula yamathambo) noma i-transbronchial biopsy (inqubo efanayo kodwa eyenziwa ngodonga oluqhekekile ngesikhathi se-bronchoscopy) .

Izinketho zokwelapha

Izinketho zokwelapha zizohlukahluka kuye ngezici eziningi, njengokuthi zingaki amamitha ayisithupha ekhona (angashadile, ambalwa, noma amaningi) nokuthi avuke kangakanani, kungakhathaliseki ukuthi amaphaphu yiwo kuphela indawo yesimiso semithambo noma uma amamitha ayisithupha ekhona nakwezinye izindawo. ezifana namathambo, isibindi, noma ubuchopho), yiziphi izinkathazo ozitholile esikhathini esidlule, isimo se-receptor ye-metastases (lokhu kungashintsha), impilo yakho jikelele, nokuningi. Izinketho zokwelashwa nazo zizoxhomeka ezifisweni zakho, nokuthi uthanda ubuhlungu kangakanani.

Izinketho zivame ukwehla zibe yizigaba ezimbili:

• Imithi yokwelapha: Izindlela zokwelashwa ezivamile zilawo amathrekhi omdlavuza atholakala noma kuphi emzimbeni.
• Ukwelashwa kwendawo: Ukwelapha kwendawo kulapha kuphela amangqamuzana omdlavuza oyingxenye yomzimba, kulokhu, amaphaphu.

Izinketho zokwelashwa zesistimu: Ukuzikhethela kwezinqubo zokwelapha kuzoxhomeka ezinkambweni eziningi. Kubalulekile ukuqaphela ukuthi umgomo jikelele wezokwelapha umdlavuza webele we-metastatic uhlukile kunomdlavuza webele wesifuba sokuqala, kanti lokhu kungabangela ukwesaba nokudideka. Ngomdlavuza wesifuba osencane, ukwelashwa kuvame ukuba nobudlova, ngenhloso yokwelapha lesi sifo. Umdlavuza we-Metastatic awusaphuluki, futhi umgomo wokulashwa ukulawula ukwanda kwe-tumor ngokungenakwelashwa okuncane ngangokunokwenzeka. Ukusebenzisa ukwelashwa okunamandla akuvame ukuthuthukisa ukusinda, kodwa kwandisa inani lemiphumela emibi futhi kunciphisa ikhwalithi yokuphila. Izinketho zihlanganisa:

• I-Chemotherapy: Kunezinhlobo eziningi ezihlukahlukene ezikhona, ngakho-ke noma ngabe une-chemotherapy ngaphambili, kunezinye izinketho eziningi.
• Ukwelashwa kwamahomoni: Ukukhetha ukwelashwa kwama-hormone kuncike ekutheni ngabe kusetshenziswe ngaphambili noma cha, ngoba isisu esakhula futhi sisakazeka ngemithi owatholayo (njenge-tamoxifen noma enye ye-aromatase inhibitors) cishe ayimelana nalowolokwelapha.
• Ukwelashwa okuhlosiwe: Izindlela zokwelapha ezi-HER2 ezivame ukusetshenziselwa ukuphatha izicubu ezihle ze-HER2. Kunezinketho eziningana zokwelashwa ezintsha emdlavuza webele we-HER2 we-metastatic .
• Izivivinyo zemitholampilo: Ngaphandle kokuhlanganiswa okusha kwezigaba ezingenhla zezidakamizwa, izidakamizwa ezintsha ezinjenge-immunotherapy kanye ne-PARP inhibitors zivivinywa ekuvivinyweni kwemitholampilo. Qinisekisa ukuthi ukhuluma nodokotela wakho mayelana nanoma yikuphi ukuvivinywa komtholampilo okutholakala, njengoba ukwelashwa kwamanqamu aphezulu kushintsha ngokushesha.

Izinketho zokwelashwa zendawo : Ikheli lendawo yokwelashwa yendawo yendawo kuphela yamaminithi wesiphaphu. Izindlela zokwelapha zendawo azijwayele ukusetshenziselwa uma kunezinombolo eziningi zamaphasethi, ikakhulukazi uma zihlanganiswa nama-metastase kwezinye izifunda zomzimba. Kodwa-ke, uma kunezibalo ezimbalwa kuphela, ukulawulwa kwendawo (njengokususwa kokuhlinzwa) kungase kuthuthukise ukusinda. Izinketho zihlanganisa:

• Ukwelashwa kwezidakamizwa: Indlela ekhethekile yokwelapha imishanguzo okuthiwa i-stereotactic radiation body radiation ( SBRT ) inikeza izinga eliphezulu lemisebe endaweni encane yezincubu (ehlukile kunendlela yokushisa imisebe isetshenziswa ngemva kwe-lumpectomy noma i-mastectomy). Kwezinye izimo, lokhu kufana nokukhishwa kwe-metastasis.
• Ukuhlinzwa: Ukwelashwa ukususa i-metastasis kubizwa ngokuthi i- metastasectomy , futhi kungacatshangwa ukuthi kukhona okunye okukhona, noma okuncane kuphela okukhona. Kwesinye isifundo esanda kutholakala, ukusinda kwe-metastasectomy isikhathi esiphelele kubantu abanikezwa le nketho. Inqubo evamile kakhulu esetshenziselwa ukuthengiswa kwemigqa .
• I-Radiofrequency ablation (RFA): I-RFA ingakafundiwe ngezinga elifanayo, kodwa ingasetshenziswa kwezinye izimo.

Ukwelashwa kwe-Pleural Effusions

Ama-pleural effusions angaba yinhlonipho, lapho uketshezi kuphakama khona endaweni yokukhalaza ngenxa yokuvuvukala, noma ukulimala okungalungile ( okunamangalisa emfuthini we-pleural ) oqukethe amangqamuzana omdlavuza.

Isinyathelo sokuqala ekwelapheni ngokuvamile i-thoracentesis, inqubo lapho inaliti ibekwa khona odongeni lwesifuba singene emgodleni wokuxosha isampula. Uma i-effusion iyinkulu, ithubhu yesifuba ingadinga ukufakwa ukuze ikwazi ukukhipha uketshezi.

Ngeshwa, ngisho noma uketshezi kususwe ku-pleural effusion, kuvame ukuqoqwa kabusha. Uma lokhu kwenzeka kukhona izinketho eziningana. Ngezinye izikhathi kutholakala i-stent ukuze umkhuhlane ungadlulela ngokuqhubekayo (abantu bangase bahambe ekhaya bakwazi ukukhipha umthamo ngokwabo). Enye indlela yi- pleurodesis . Kule nqubo, imakhemikhali ecasulayo (i-talc) ifakwa phakathi kwezingqimba ezibangela ukuba bahlukane ndawonye ukuze amanzi asakwazi ukuqoqa. Ezimweni ezimbi, i-pleura ingadinga ukususwa (i- pleurectomy ).

Ukuphatha Izimpawu

Ukufunda ukuthi unomdlavuza webele we-metastatic uyesabisa, futhi abantu abaningi bayazibuza ukuthi bazohlupheka yini. Ngenhlanhla, kunezindlela eziningi zokuphatha izimpawu ezivamile zamaphasethi we-lungs.

• Ubuhlungu: Amapayipi ngokwabo ayenawo ukuphela kwezinzwa ezithola ubuhlungu, kodwa ukucasuka kwe-pleural lining kusuka ku-effusion kungakhululekile kakhulu. Kunezinketho eziningi zokulawula ukungakhululeki. Abanye abantu banqabe imishanguzo yobuhlungu, besaba ukuthi ngeke babe nezinketho esikhathini esizayo uma ubuhlungu buba bubi nakakhulu. Lokhu akulona iqiniso, futhi kubalulekile ukuthi izinga lakho lokuphila libe nokulawulwa okuhle kobuhlungu.
• Ukuphefumula: Kunezinyathelo eziningi ezahlukene ezingasiza ngokuphefumula. Uma unesipasimali ezindizeni zomoya, i-inhaler ingasetshenziswa. Ama-steroids asetshenziswa ngomlomo noma nge-intravenously ayasiza kakhulu. I-Morphine ingaba ngempumelelo kakhulu ekunciphiseni uphawu lokuphefumula kanye nokukhathazeka okuhambisanayo. U-oksijeni akuvamile ukuwusizo kakhulu kepha kuyindlela yokukhetha.
• Ukukhukhuma: Izikhathi eziningi, imithi yokwelapha, ngisho nangokwenyuka okuncane, kungathulisa ukukhwehlela okucasulayo. Izindlela "zemvelo," njengokugwema ukuphefumula emoyeni abandayo, ukuzithoba lapho uhamba, ukugwema ukucasuka emvelweni onjengomusi nentombazane kusiza abantu abathile. I-isipuni soju kungasiza ekunciphiseni ukukhwehlela.
• Ukuvinjelwa kwe-Airway: Ngezinye izikhathi ama-metastases amaphaphu akhula abe yizindiza ezibangelwa ukuvimbela. Lokhu kungabangela ukuphefumula, futhi kwandise ingozi ye-pneumonia eqhubeka ngaphandle kokuvinjelwa. I-stent ingafakwa ukuze uvule umoya. Kukhona nezinye izinketho, njenge-radiation therapy.

Isibikezelo

Isikhathi sokuphila ngemva kokuxilongwa kwamaphasethi amaphaphu emdlalweni webele webele akusikho esikufisa, kodwa kuthuthuka. Isilinganiso sokusinda esiphakathi (isikhathi lapho isigamu sabantu esiphila khona nesigamu sesishonile) sasiyizinyanga ezingu-21, ocwaningweni olulodwa, kanti amaphesenti angu-15.5 abantu enza kahle emva kweminyaka emithathu.

Izinga lokusinda cishe liphakeme uma ama-metastase akwazi ukususwa noma aphathwe nge-SBRT, ukuhlinzwa (i-metastasectomy), noma i- RFA. Asinakho izifundo eziqinisekisa lokhu, kodwa ukubuyekezwa kwezifundo ezingu-2018 kuze kube yimanje kutholakale ukuthi izinga lokusinda kweminyaka emihlanu phakathi kwabesifazane abanamaphasethi wesifo samaphaphu baphathwe ngamaphesenti angu-46. Kulabo ababenesifo se-metastasectomy, ngokuqondile, ukusinda okuphakathi komphakathi kwanda cishe izinyanga ezingu-103.

Ngokuvamile, ukubikezelwa kwesibonakaliso kubonakala kungcono kwabesifazane abanama-tumor kokubili i-estrogen receptor ne-HER2 enhle, labo abanomshwalense wezokwelapha, nalabo abashadile.

Izwi elivela

Uma utshelwe ukuthi ungaba nesimiso se-lungs ekuhlolweni kwesithombe ngemuva kokuthola umdlavuza webele wesandulela esikhathini esidlule, kubalulekile ukuba ne-biopsy. Esikhathini sokucwaninga, isigamu, futhi kwaze kwaba yizintathu ezine zezine zamaphaphu amaphaphu atholakale engekho umdlavuza webele we-metastatic.

Zombili izinketho zokwelapha zesistimu nezendawo zitholakala, futhi uma ungumuntu ozokhethwa ukwelashwa kwendawo njengokwelashwa kokuhlinzwa kwe-metastase, noma i-SBRT, kungenzeka ukuthi ukusinda kuthuthukisa. Kunezilingo eziningana zokwelashwa endaweni lapho zihlola izindlela ezintsha zokwelashwa ezingcono futhi ezingcono ezingase zandise ukusinda esikhathini esizayo.

Uma usanda kufunda ukuthi unomdlavuza we-metastatic, finyelela kubangani. Buza imibuzo eminingi futhi ube ngummeli wakho siqu ekunakekeleni kwakho. Ngisho nalapho kungasakwazi ukuhlala isikhathi eside isikhathi eside, izimpawu zingavunyelwa ukunikeza ikhwalithi engcono kakhulu yokuphila lapho uhlala nomdlavuza we-metastatic.

> Imithombo:

> Berman, A., Thukral, A., Hwang, W., Solin, L., noN. Vapiwala. Isibalo Nezibonelo Ze-Metastase Ezikude Ezigulini Ezinezinsana Zokuqala Zesifo Sebele Sebele Emva kokubeletha kwesisu se-Breast Conservation Surgery. I-Cancer Clinical Cancer . 2013. 13 (2): 88-94.

> Jin, X., noP. Mu. Ukubhebhethekisa i-Breast Cancer Metastasis. I-Cancer Yamabele (Auckland) . 2015. 9 (Suppl 1): 23-34.

> Matsuura, K., Itamoto, T., Noma, M. et al. Ukubaluleka kwe-Lung Biopsy ye-diagnosis ecacile yama-Lung Nodules ku-Breast Cancer Patients. I-Molecular and Clinical Oncology . 2018. 8 (2): 250-256.

> Shackcloth M., Love S. (2018) Umsebenzi Wokuhlinza Ngama-Lung Metastases kusuka ku-Cancer Breast. Ku: Wyld L., Markopoulos C., Leidenius M., Senkus-Konefka E. (eds) Ukuphathwa Kwegciwane Lesifo Sezinsana Zezinambuzane. Springer, Cham.

> Xiao, W., Zheng, S., Liu, P. et al. Izingozi Zengozi Nemiphumela Yokusinda Ezigulini Zomdlavuza Webele Nama-Lung Metastases: Isifundo Esisuselwa Kwabantu. I-Cancer Medicine . 2018 Feb 23. (Epub ngaphambi kokuphrinta).