Izimpawu, Ukuxilongwa, Ukwelapha, Nokuguqulwa Kwe-Cancer Squirous Lung Cancer
I-Squamous cell carcinoma yamaphaphu yindlela eyodwa yomdlavuza ongasona omncane wamaphaphu . I-akhawunti engekho emincane yamangqamuzana amaphaphu amaphaphu angama-80 amaphesenti e-lung cancer, futhi kulawa, cishe amaphesenti angu-30 ayi- squamous cell carcinomas.
Sibutsetelo
I-Squamous cell carcinoma iqala emahlakheni afaka amavesi emoyeni emaphashini. Kuyaziwa nangokuthi i-epidermoid carcinoma.
Iningi le-squamous cell carcinomas yamaphaphu liphakathi, ngokuvamile ku- bronchi enkulu ejoyina i- trachea emaphashini.
I-squamous cell carcinomas ixhunyaniswe kakhulu ngokubhema kunezinye izinhlobo zamangqamuzana amaphaphu wamaphaphu angewona amancane futhi avame kakhulu emadodeni kunabesifazane. Zivame ukukhula kancane, futhi ngenxa yendawo yazo zivame ukutholakala ngaphambi kweminye imifula yomdlavuza wamaphaphu. Isigameko se-squamous cell carcinoma yamaphaphu sehlile eminyakeni yamuva, kanti enye uhlobo lomdlavuza wamaphaphu, i- adenocarcinoma okwandayo. Abanye bacatshangwa ukuthi ukufakwa kwezihlungi kugwayi kuvumela umusi ukuba ugxilwe kakhulu emaphashini lapho i-adenocarcinomas ivame khona. Lezi zomshukela zingakhona ngisho nakubantu abangakaze baphuze.
Ama-subtypes
Amanqamu wamaphaphu amaphaphu asemangqamuzana aphinde ahlukaniswe ngama-subtypes angu-4 ngokuthi abukeka kanjani ngaphansi kwe-microscope nendlela abaziphatha ngayo.
Lokhu kufaka:
- I-Primitive
- Zasendulo
- Imfihlo
- Basal
Siyazi ukuthi kukhona ukungezwani okukhona phakathi kwalezi zinhlayiyana kodwa bafunda ngokuthi uhlobo ngalunye lungaphendula kanjani ngezidakamizwa ezahlukene. Iningi le-subtypes liphendula okungenani elilodwa lemithi esebenzisa imithi yamakhemikhali. Okuhlukile kungase kube umdlavuza we-secretory squamous cell lung.
Le nsizwa ingacabangi kakhulu emithini ye-chemotherapy ejwayelekile evame ukusetshenziswa ngoba ijwayele ukukhula kancane (futhi i-chemotherapy ngokuvamile iphumelela kakhulu kuma-cancer ekhula ngokushesha ngoba ihlose ukuhlukanisa amaseli).
Izimpawu
Izimpawu ezivamile zomdlavuza wamaphaphu zihlanganisa ukukhwehlela okuqhubekayo, ukukhwehlela igazi, ukuphefumula nokuphefumula. Njengoba i-squamous cell carcinomas ijwayele ukutholakala eduze nezindiza ezinkulu, ngokuvamile idala izimpawu ngaphambili kunezinye izinhlobo zomdlavuza wamaphaphu. Ukwakhiwa kwe-airway kungabangela izifo ezinjenge-pneumonia, noma ukuwa kwesinye sephamende ( atelectasis ), futhi ukutheleleka kokuphefumula okufana ne-pneumonia kungase kube uphawu lokuqala lokuthi kukhona into enhle.
I-Squamous cell carcinoma yimbangela evamile kakhulu yento eyaziwa ngokuthi i- Pancoast syndrome noma i-sulcus syndrome ephakeme kakhulu. I-pancoast syndrome ibangelwa ukwelashwa kwamaphaphu aqala eduze naphezulu kwamaphaphu futhi ahlasele izakhiwo eziseduzane, njengezinzwa. Izimpawu zivame ukufaka ubuhlungu bezinhlanzi ezingena ngaphakathi kwengalo, ubuthakathaka noma izinzwa ezithintekayo ezandleni, ukuqhuma noma ukujuluka ohlangothini olulodwa kobuso, kanye nejwabu le-droopy (Horner's syndrome).
Abantu abane-squamous cell carcinoma nabo banamathuba amaningi okuthola izinga eliphakeme le-calcium (i- hypercalcemia ) engabangela ubuthakathaka bemisipha kanye nama-cramps.
I-hypercalcemia ingenye yezibonakaliso ze- paraneoplastic syndrome futhi ibangelwa isisu esivimba imithi efana ne-hormone ephakamisa izinga le-calcium egazini.
Ukuxilongwa
I-squamous cell carcinoma yamaphaphu ngokuvamile iqala ukusola lapho ukungabonakali kubonakala kwi-x ray. Ukuhlolwa okwengeziwe kungabandakanya:
- I-Chest CT Scan
- I-sputum Cytology . Njengoba i-squamous cell carcinomas ivame ukungena emoyeni, isampula se-sputum ngezinye izikhathi ingathola amangqamuzana omdlavuza
- I-bronchoscopy
- I-PET Scan . I-PET scan is "test" yokusebenza eyenzelwe ukubuka izikhumba ezikhulayo futhi kuvame ukwenza ukubuka noma yibuphi ubufakazi bokusabalalisa (i-metastasis)
- I-Endobronchial Ultrasound . I-endobronchial ultrasound yenziwa ngokusebenzisa ipurethi ekhethekile ngesikhathi se-bronchoscopy.
Ngokuya ngemiphumela, udokotela wakho uyovame ukufuna ukuthola isampula ye-tishu (i- lung biopsy ) ukuqinisekisa ukuxilongwa futhi uzokwenza ukuhlolwa okuqhubekayo ukuhlola ukuthi ngabe umdlavuza wakho usakazeke yini.
Isiteji
I-squamous cell carcinoma yamaphaphu ihlehliselwe zibe yizigaba ezine:
- Isigaba 1 - Umdlavuza wendawo wangaphakathi emaphashini futhi awusakazeki kunoma iyiphi i-lymph nodes
- Isigaba sesi-2 - Umdlavuza usulele emakhanini amancane noma emgodini wamaphaphu, noma endaweni ethile ye-bronchus eyinhloko
- Isiteji sesi-3 - Umdlavuza usakaze emathisheni eduze kwamaphaphu
- Isiteji sesi-4 - Umdlavuza usakazekile (umonakalo) kwenye ingxenye yomzimba, amasayithi avamile kakhulu amathambo, ubuchopho, isibindi, noma izigulane
Odokotela basebenzisa enye indlela, indlela edidekayo kakhulu yokunquma ngesigaba somdlavuza wamaphaphu okuthiwa i- TNM staging . Kulezi zibuko ubukeka ubukhulu besisu (esimelwe yi-T), kungakhathaliseki ukuthi ama-node ashintshiwe, kuphi nokuthi mangaki (amelwa yi-N), nokuthi ngabe isifo sofuba sisakaze yini (sesisetshenziselwa ukuhlukanisa) ezindaweni ezingaphandle komzimba yamaphaphu, noma kwenye iphunga (elimelelwa yi-M). Isibonelo, udokotela wakho angase achaze umdlavuza wakho wamaphaphu njengo-T3N2M0.
Izimbangela
I-squamous cell carcinoma yamaphaphu uhlobo lomdlavuza wamaphaphu oluhlotshaniswa kakhulu nokubhema , kodwa ezinye izimbangela zingakwazi ukufaka isandla. Ukudonswa kwezidakamizwa ekhaya kungesibili esibangela umdlavuza wamaphaphu. Ukuchayeka emsebenzini, okufana ne-diesel fuel kanye nokunye nakho kuyingozi ezibalulekile ekuthuthukisweni komdlavuza we-cell pulmous squamous.
I-Genetics ingase idlale indima futhi ingozi yomdlavuza wamaphaphu yanda kubantu abanamalungu omndeni anesifo.
Ukwelapha
Ngokuya ngesiteji se-squamous cell carcinoma yamaphaphu, ukwelashwa kungase kuhlanganise nokuhlinzwa, i-chemotherapy, ukwelashwa kwe-radiation, ukwelashwa okuhlosiwe, ukuvikelwa kwe-immunotherapy, noma ukuhlanganiswa kwalokhu. Izilingo eziningi zokwelashwa ziqhubeka zifuna izindlela ezintsha zokwelapha lo mdlavuza nokusiza ukunquma ukuthi yiziphi izindlela zokwelashwa eziphumelela kakhulu.
Ukuhlinzwa
Ukuhlinzwa komdlavuza we-Lung kungase kwenzeke nge-squamous cell carcinoma. Ngesiteji 1A umdlavuza we-squamous cell lungamaphaphu, ukuhlinzeka yedwa kungase kube ukwelapha. Ukuhlinzwa kungacatshangelwa nalabo abanesiteji 1B, isigaba II, nesigaba se-3A somdlavuza wamaphaphu, ngokuvamile kuhlanganiswe ne-chemotherapy kanye nokwelashwa kwemisebe. Ngesinye isikhathi, isikhumba singase singenakwenzeka kodwa singancishiswa ngobukhulu nge-chemotherapy kanye / noma ukwelashwa kwe-radiation ukuze kutholakale ukuhlinzwa. Lapho i-chemotherapy yenzeka ukunciphisa ubukhulu besisu ngaphambi kokuhlinzwa, kubizwa ngokuthi "i-neoadjuvant chemotherapy." Muva nje, impumelelo iye yaboniswa ekusebenziseni i-immunotherapy ukunciphisa isisu esingenakusebenza ngendlela yobukhulu ukuze kwenziwe ukuhlinzwa.
I-Chemotherapy
I-Chemotherapy ingasetshenziswa yedwa, ngokuhambisana nokwelashwa kwemisebe, noma ngaphambi noma ngemva kokuhlinzwa komdlavuza wamaphaphu. I-Squamous cell carcinoma yamaphaphu isabela ngendlela ehlukile kunezinye izifo zomdlavuza we-lungs ezifana ne-adenocarcinoma imithi ye-chemotherapy. Imithi ejwayelekile esetshenziselwa lolu hlobo lomdlavuza ihlanganisa i-Platinol (cisplatin) neGemzar (gemcitabine). Kulabo abaphendula ukwelashwa, ukwelashwa okuqhubekayo (nge-Tarceva (erlotinib) noma i-Alimta (pemetrexed) ingasetshenziswa.
I-Radiation Therapy
I-Radiation Therapy ingasetshenziselwa ukwelapha umdlavuza noma ukulawula izimpawu ezihlobene nokwanda komdlavuza. I-radiation inganikezwa ngaphandle, noma ngaphakathi (i- brachytherapy ) lapho izinto ezisakazwayo zihambisa khona endaweni eqondile yamapayipi ngesikhathi se-bronchoscopy.
Ukwelashwa okubhekiswe
Kungenzeka ukuthi uzwile mayelana nokusetshenziswa kwezidakamizwa ezihlosiwe ukuphatha ukuguqulwa kwe-EGFR kumaphaphu adenocarcinoma. I-EGFR, noma i-epidermal growth factor receptor, iyiprotheni ehilelekile ekushayeni ukukhula komdlavuza. I-Squamous cell carcinoma yamaphaphu ingabuye iphathwe ngokubhekisa indlela ye-EGFR, kodwa ngendlela ehlukile.
Esikhundleni sokukhomba ukuguqulwa kwe-EGFR, amasosha omzimba we-anti-EGFR ayiklasi yezidakamizwa ezisetshenziswa ukubopha ku-EGFR ngaphandle kwamangqamuzana omdlavuza. Lapho i-EGFR iboshiwe kanjalo, indlela yokubonisa okutshela iseli ukuthi ikhule iphelile. I-Portrazza (necitumumab) yavunywa ngo-2015 ukuze isebenzise kanye ne-chemotherapy ye-cancer esele ye-squamous cell. Izivivinyo zemitholampilo zihlola ezinye izidakamizwa, ezifana ne-afatinib nokunye ukwelashwa komdlavuza we-cell wamaphaphu.
Immunotherapy
Izidakamizwa ze- Immunotherapy zavunyelwa kuqala ukuphathwa komdlavuza wamaphaphu ngonyaka ka-2015, futhi manje ukuhlanganiswa kwalezi zidakamizwa kusetshenziselwa ukuhlolwa kwemitholampilo.
Ngonyaka ka-2015, ukwelashwa kokuqala kwe-immunotherapy kwavunyelwa kubantu abanesifo. Umuthi Opdivo (nivolumab) uhlobo lwe-immunotherapy ukuthi, ngokulula kakhulu, luthuthukisa ikhono lomzimba womzimba wethu wokulwa namaseli omdlavuza.
Ukuze uqonde ukuthi lezi zidakamizwa zisebenza kanjani, kungasiza ukucabanga ngesistimu yakho yomzimba njengemoto. I "brakes" ilawulwa iphrotheni ebizwa nge-PD-1. I-Opdivo kulo mfanekiso usebenza ukuvimba i-PD-1-ama-brakes-okuvumela isimiso somzimba sokuzivikela omzimba ukuba silwe nomdlavuza ngaphandle kokuphazanyiswa-empeleni, ukuthatha amabhuleki emotweni. Ukwelashwa okwamanje kuvunyelwe abantu abane-metastatic squamous non-encane yomdlavuza wamaphaphu omdlavuza wabo oye waqhubekela phambili ngesikhathi noma ngemuva kwe-platinum standard based based chemotherapy. (I-Platinum-based chemotherapy ibhekisela kuhlobo lwe-chemotherapy oluhlanganisa i-Platinol (cisplatin) noma i- Paraplatin (carboplatin)).
Kusukela ngaleso sikhathi, kunezinye izidakamizwa ezimbili zokuzivikela ezitholakalayo, i-Keytruda (pembrolizumab), ne-Tecentriq (i-atezolizumab).
Isibikezelo
Ngaphambi kokuba uphendule umbuzo othi "kuyini ukuchazwa kwesifo somdlavuza wesifo samaphaphu?" Kubalulekile ukukhuluma ngalokho izinombolo ezichaza izinga lokusinda likusho ngempela. Okokuqala, wonke umuntu uhlukile. Izibalo zisitshela ukuthi inkambo "yokulinganisa" noma ukusinda, kodwa asitsheli lutho ngabantu abathile. Izinto eziningi zingathinta ukuchazwa kwesifo somdlavuza wesifo samaphaphu kufaka phakathi ubudala bakho ekuxilongweni, ubulili bakho, isimo sakho sempilo yakho jikelele, nendlela osabela ngayo empilweni.
Kuyasiza futhi ukukhumbula ukuthi izibalo zisekelwe kolwazi oluneminyaka eminingana ubudala. Njengoba izindlela ezintsha zitholakalayo, lezi zinombolo zingase zingabonakali ngokunembile lokho okushiwo yilokho okushiwo namuhla. Isibonelo, isilinganiso seminyaka emihlanu sokusinda komdlavuza wamaphaphu kubikwe ngo-2018 sisekelwe kubantu abaye baxilongwa ngo-2013 nangaphambili. Njengoba izindlela eziningi ezibalulekile ze-squamous cell carcinoma yamaphaphu zavunywa kuphela ngemva kuka-2013, izibalo azibonakalisi ukuthi umuntu uzokwenzenjani namuhla.
Ngesikhathi esifanayo, kuye kwaba nemithi emisha eminingi evunyelwe ukwelashwa komdlavuza wamaphaphu eminyakeni emihlanu edlule, kunaneminyaka engama-40 eyedlule. Isibonelo, i-Portrazza yezidakamizwa ayitholakali lapho abantu bezingcwaningo zabo betholakala. Lokhu kusho ukuthi amazinga okusinda okwamanje abikiwe akakwazi ukuthi umuntu uzolindelwa kanjani ukwenza noma iyiphi yalezi zelashwa ezintsha.
Kukhona ithemba eliningi kulabo abatholwa nomdlavuza wamaphaphu namuhla, kodwa ngeshwa, izibalo ozowifunda angeke zisize ekuqondeni leli themba.
Amanani omdlavuza wesifo samangqamuzana angasona amancane amancane ahlukene ngesigaba , kanti isilinganiso seminyaka emihlanu sisinda sibe ngamaphesenti angu-50 (noma okungcono) ngesigaba sesiguli 1, kodwa kuphela amaphesenti amabili kuya kwanguzine nesigaba sesine. Isilinganiso seminyaka emihlanu yokusinda komdlavuza wamaphaphu siyadabukisa kuphela ngamaphesenti angu-18 kuphela. Kubuye kubalulekile ukuthi uqaphele ukuthi izinombolo kula mazinga azibonakali ukuthuthukiswa nezidakamizwa nezinqubo ezintsha ezitholakalayo manje.
Ukulinganisa Isibikezelo Sakho
Uma ubheka ukubikezelwa kubalulekile ukuqaphela ukuthi wonke amagciwane e-squamous yamaphaphu amaphaphu awafani. Eqinisweni, uma kwakunabantu abangu-300 abane-squamous cell lung carcinoma ekamelweni, babezoba namagciwane angama-300 ahlukile. Umdlavuza wakho ungase ube nezici zamangqamuzana ezikhuphuka noma zinciphise ukubikezela kwakho. (Oncologist yakho ingaxoxa ezinye zazo nawe). Ngaphezu kwalokho, ucwaningo lufuna ezinye izindlela zokulinganisela ukuchazwa kwe-squamous cell carcinoma esekelwe ekufuneni okunjengokujikeleza amangqamuzana e-tumor atholakala ku- biopsy yamanzi nokuningi.
Ukubhekana
Ukuxilongwa kwe-squamous cell carcinoma yamaphaphu kuyesabisa futhi ungase uzizwe uwedwa. Inkulumo ethi "kuthatha idolobhana" yayingafaneleki nakakhulu kunokukhuluma ngomdlavuza wamaphaphu. Finyelela futhi uvumele (leyo ngxenye ngezinye izikhathi iyisihluthulelo) othandekayo bakho ukukusekela.
Thatha isikhathi sokufunda ngomdlavuza wakho. Ucwaningo lusitshela ukuthi abantu abaqonda kangcono umdlavuza wabo abazwa nje ukuthi banamandla kakhulu, kepha lelo lwazi ngezinye izikhathi lingenza umehluko ekusindeni. Bona ukuthi ungathola iqembu lokusekela labantu abanomdlavuza emaphashini emphakathini wakho, noma uthathe isikhathi sokuxhuma nomphakathi womdlavuza wamaphaphu omuhle online.
Laba bantu ngeke bakwamukele kuphela futhi bakusekele kodwa kungaba umthombo omkhulu wolwazi olusha kanye nocwaningo. Hlola izinhlangano zomdlavuza wamaphaphu ezifana neLUNGevity, i-American Lung Association Lung Force, ne-Lung Cancer Alliance. Lapho sifuna abanye ngomdlavuza wamaphaphu emithonjeni yezokuxhumana, i-hashtag yi-#LCSM emele umdlavuza we-lung emphakathini. Uma ungaphansi kweminyaka engama-50, qinisekisa ukuthi uhlola i-Bonnie J. Addario Lung Cancer Foundation, inhlangano ethatha isithakazelo esikhethekile emdlavuza wamaphaphu kubantu abadala .
Okungaphezu kwakho konke, yiba ngummeli wakho siqu ukunakekelwa komdlavuza wakho . Ukwelashwa komdlavuza wamaphaphu kuyashintsha ngokushesha, futhi abantu bayaqhubeka bebizwa ukuba babe yingxenye esebenzayo yeqembu labo lokwelapha. Eqinisweni, kunabaningi abasindile abaphila manje ngoba bafunda futhi babengummeli wokunakekelwa kwabo. Njengoba kunzima ku-oncologist jikelele ukungahambisani nezinguquko eziphuthumayo zokwelashwa, abasindile bomdlavuza bamaphaphu bancoma ukuthola umbono wesibili kwelinye leziko elikhulu leNational Cancer Institute-izikhungo zomdlavuza ezikhethiwe ezinolwazi lwekhanda lomaphaphu olutholakalayo.
Uma Othandekayo Enomdlavuza Wesifo Sengculazi Isifo Sengculaza
Ukubhekana nomdlavuza wamaphaphu kumuntu othandekayo kungaba yinselele. Akukona nje ukuthi ubhekene nalokho okuthandekayo wakho okusuka engxenyeni yakho, kodwa umqondo wokungabi nasizo kungabangela ukushaya inhliziyo. Ungaqinisekiswa ukuthi abantu abaningi abazi ukuthi bangasabela kanjani lapho othandekayo enomdlavuza wamaphaphu. Ukubuza ngezindlela ezithile ongasiza ngazo, kunokuba uthi "ngibize uma udinga mina," kuyindlela ongayibonisa ngayo ukunakekela kwakho futhi unciphise umthwalo wabo. Thatha isikhashana ukuthi ufunde ngalokho okuthandayo ngempela ukuhlala nomdlavuza wamaphaphu nokuthi ungamsekela kanjani othandekayo ngomdlavuza .
> Imithombo
- > Kawai, K., Saito, Y., Demura, R. Case ye-Advanced Pulmonary Squamous Cell Carcinoma Ephulukiswa Ngokunqunywa Ngokwe-Preoperative Induction ye-Immune Checkpoint Inhibitor. I-Cancer Thoracic . 2018 Feb 8. (Epub ngaphambi kokuphrinta).
- > National Cancer Institute. Ukunakekelwa Kwemdlavuza Yamangqamuzana Angewona Amancane (PDQ) - I-Health Professional Version. Kubuyekezwe 02/01/18. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq
- > Shum, E., Wang, F., Kim, S., Perez-Soler, R., no H. Cheng. Imithi yokwelapha ye-squamous Cell Lung Cancer: Kusukela Ezifundweni Zezilwane Kuya Ezingxenyeni Zezigaba II. I-Expert Opinion on Izidakamizwa Zokuphenya . 2017. 26 (4): 415-426./
- > Thakur, M., no A. Wozniak. Ukukhangisa ku-Necitumumab ekuPhilweni kwe-Cell-Non-Small Lung Carcinoma. I-Cancer Lung . 2017. 8: 13-19.