Gawo 3 Khansa Yam'mimba: Zizindikiro, Chithandizo, ndi Moyo Wopitirira

Zowona za Gawo 3 Khansa Yam'mimba

Ngati mwauzidwa kuti muli ndi kansa ya mapapo 3, mumakhala oopa komanso ochita mantha. Kodi izi zikutanthauza chiyani? Kodi ndi mankhwala otani omwe amagwiritsidwa ntchito pa siteji iyi ya khansa ya m'mapapo? Ndipo, kodi chiganizo ndi chiyani?

Tisanayambe kuyankhula za siteji iyi ya khansa ndizofunika kuzindikira kuti kupita patsogolo kwakukulu pa chithandizo cha kupulumuka kwa khansa ya m'mapapo yachitatu yachitika m'mzaka zingapo zapitazi.

Mukhoza kukhala ndi abwenzi kapena abwenzi omwe ali ndi khansara yamapapo m'mbuyomo kapena angaone kuti anthu akuyankha kwa inu ndi chisangalalo akamva kuti muli ndi kansa ya m'mapapo 3. Mungafunikire mwakumbukira okondedwa anu kuti mankhwala amakula bwino ndipo panopa pali njira zambiri zothandizira matendawa ndi njira zowonjezereka zowonongeka.

Tanthauzo

Khwerero 3 ya khansa ya m'mapapo yopanda mapapu ndi khansa yamapapu yambiri yomwe ikuphatikizidwira mu siteji 3A ndi siteji 3B . Popeza gawo 3A ndi 3B ali osiyana kwambiri ndipo nthawi zambiri amachiritsidwa mosiyana, tiyeni tiwone izi mosiyana.

• Gawo 3A Khansa ya m'mapapo - Gawo 3A Khansa ya m'mapapo imatengedwa ngati khansa yapakhungu yamapiri. Izi ndi zotupa zomwe sizinafalikire kumadera akutali a thupi (sizinayambe zowonongeka, koma zafalikira ku ziwalo zamkati mwa chifuwa), koma pambali imodzimodzi ya thupi monga khansara. Gawo 3A khansa ya m'mapapo ingaoneke ngati yogwira ntchito (yofanana ndi sitepe 1 ndi khansa ya mapapo 2 ya mapapo.)

• Gawo 3B Khansa ya m'mapapo - Pamodzi ndi kansa ya mapapo 4 yamapapo , siteji 3B khansa yamapapo imatengedwa kuti ndi khansa ya m'mapapo yapamwamba . Mankhwalawa amalowa kapena kufalikira kumatenda oyandikana kufika pamlingo wotere kuti opaleshoni sitingathe; mwina osati poyamba. Ngakhale kuti khansa sichizachiritsika, imachiritsidwa kwambiri ndipo pali mankhwala osiyanasiyana omwe alipo. M'kupita kwa nthawi, khansara ya mapaipi 3B imachepetsedwa kukula kwake kokwanira ndi mankhwala a chemotherapy komanso ma opaleshoni omwe amachititsa opaleshoni.

Kukula

Pafupifupi 30 peresenti ya anthu ali ndi khansara ya m'mapapo atatu pamtundu wa nthawi ya matenda. Pafupifupi 30 peresenti ya anthu amapezeka pa nthawi yoyamba (gawo 1 kapena gawo 2) ndipo 40 peresenti ya anthu ayamba kale kupita ku siteji ya khansa yamapapo 4, yomwe ili patsogolo kwambiri.

Kusinthana

Maphunziro a khansa ya m'magazi ndi ofunika kwambiri posankha njira zabwino zothandizira, makamaka kusiyana pakati pa gawo 3A ndi siteji 3B.

• Gawo 3A Khansa yamapapo yamapiko imaphatikizapo zotupa zomwe ndi zazikulu ndipo zafalikira ku maselo oyandikana nawo pafupi, kapena zotupa za usinkhu uliwonse zomwe zafalitsidwa ku maselo omwe ali kutali koma komabe pambali imodzi ya thupi ngati khansara.
• Gawo la 3B Khansa ya m'magazi imatanthawuza ngati chotupa cha kukula kwake kulikonse komwe kwafalikira kumatenda a kutali kwambiri kapena kuwononga ziwalo zina mu chifuwa (monga mtima kapena chifuwa ). Pakati pa mapepala omwe amapezeka m'mapapu) anasinthidwa kuchoka pa siteji 3B kupita ku stage 4 mu 2009.

Oncologists amagwiritsa ntchito njira ya TNM kufotokozera magawo a kansa ya m'mapapo. Malongosoledwe ophweka a TNM dongosolo akuphatikizapo:

T amatanthauza kukula kwa chotupa:

• T1 - Chotupacho sichichepera masentimita atatu mu kukula.

• T2 -Thusa imaposa 3 cm.
• T3 - Chotupacho chingakhale kukula konse, koma chiri pafupi ndi msewu wa pamsewu kapena kufalikira kumadera omwe akukhala ngati khoma la chifuwa kapena diaphragm .
• T4 - Chotupacho ndi kukula kwake, koma kuli panjira kapena kulimbana ndi zigawo zapansi monga mtima, kapena chiwonongeko.

N amatanthauza maselo:

• N0 - Palibe malo omwe amakhudzidwa.
• N1 - Chotupacho chafalikira kumadera oyandikana nawo mbali imodzi ya thupi.
• N2 - Chotupacho chafalikira ku nodes patsogolo koma pambali imodzi ya thupi.
• N3 - Maselo a khansa ali pamagulu a mitsempha kumbali ina ya chifuwa kuchokera ku chotupa, kapena m'madera pafupi ndi collarbone kapena minofu ya m'khosi.

M amaimira matenda oopsa :

• M0 - Palibe metastases alipo.
• M1 - Kutupa kwafalikira (kuchepetsedwa) kumadera ena a thupi kapena mapapo ena.

Pogwiritsa ntchito TNM System, siteji ya 3A khansa ya m'mapapo ikufotokozedwa monga:

• T1N2M0 - Chotupacho n'chosachepera 3 masentimita mu kukula ndipo chafalikira ku maselo amphamvu kwambiri kutali koma pambali imodzi ya thupi ngati chotupa.
• T2N2M0 - Chotupacho n'choposa 3 cm ndipo chikufalikira kumalo amphamvu kwambiri koma pambali imodzi ya thupi.

• T3N1M0 - Chotupacho ndi kukula kwake koma chili pafupi ndi pandege kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndipo ma lymph nodes omwe ali pafupi amakhudzidwa.
• T3N2M0 - Chotupacho ndi kukula kwake koma chili pafupi ndi pandege kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndipo maselo omwe ali kutali koma pambali imodzi ya thupi amakhudzidwa.

Kugwiritsa ntchito TNM System, siteji 3B ikufotokozedwa monga:

• Matenda onse T, N3, M0 - Chotupa cha kukula kulikonse komwe kwafalikira ku maselo amphongo kumbali ina ya chifuwa kuchokera ku chotupa kapena nodes pafupi ndi collarbone kapena mitsempha ya mitsempha, koma sinafalikira kumadera akutali a thupi.

• T4, iliyonse N, M0 - Chotupa cha kukula kulikonse kumene kuli pa airways, kapena chasokoneza zipangizo zapakhomo monga mtima kapena malo. Node ikhoza kukhala yosagwiritsidwa ntchito, kapena ikagwidwa, ikhoza kukhala pafupi ndi chotupa kapena kupitilira mu chifuwa kapena khosi, koma chotupacho sichinafalikire kumadera akutali a thupi.

Zizindikiro

Khansara ya m'magazi yachitatu imapezeka nthawi zambiri pamene munthu akuwona dokotala ali ndi zizindikiro zina. Zizindikiro za khansa ya m'mapapo ndi khansa ya m'mapapo 3 ya khansa ndi:

• Chifuwa chosatha
• Kupuma pang'ono
• Kudula magazi
• Kupuma
• Matenda opatsirana opatsirana monga chibayo kapena bronchitis.

Kupweteka ndi kukakamira magazi kumakhala kofala kwambiri m'mimbayi yomwe ili pafupi ndi mpweya waukulu wa mapapo ( bronchi ndi bronchioles) pomwe kupuma pang'ono kumakhala kofala kwambiri ndi zotupa zomwe zili mkati mwa mapapo. Matenda omwe ali kumadera akutali a mapapo pafupi ndi mapaipi ( pleuray ) angayambitse pleurisy , mtundu wa nthawi zambiri ululu wopweteka pachifuwa umene umapweteka ndi kupuma.

Popeza ambiri mwa khansawa afalikira kwanuko, anthu akhoza kukhala ndi zizindikiro za ululu m'mabofu, nthiti, mapewa, kapena kumbuyo. Pamene chotupa chimaphatikizapo malo monga mimba ndi ziwalo zina za chifuwa, dysphagia (vuto lomeza) ndi mantha amatha kuchitika.

Zizindikiro zowopsa za khansa monga kutopa komanso kutaya kwadzidzidzi kungakhalepo.

Kuchiza

Chithandizo cha khansa ya m'mapapo 3 ya pamapapo ndizovuta kwambiri pamagulu onse a khansara wamapapo, makamaka chifukwa gululi ndi losiyana kwambiri. Nyuzipepala ya National Cancer Institute imalimbikitsa kuti aliyense yemwe ali ndi khansa ya m'mapapo 3 ya m'mapapo ayese kutenga mbali mu mayesero a zachipatala, kufufuza komwe kumafufuza njira zatsopano zothandizira mankhwala.

Chinthu chimodzi chofunika kwambiri pa chithandizo cha kansa ya m'mapapo, makamaka kansa yaing'ono ya mapapu ya mapapu, yakhala yowonjezera mankhwala othandizira. Panopa pali mankhwala angapo omwe amapezeka makamaka m'maselo a khansa ya m'mapapo. Kuonjezera apo, mankhwala osokoneza bongo amavomerezedwa kuti, ngati ogwira ntchito, atha kukhala ndi moyo kwa nthawi yaitali kwa anthu ena omwe ali ndi magawo apamwamba a kansa ya m'mapapo. Njira zothandizira ndizo:

Opaleshoni

Kwa kagawo ka 3A kansa ya mapapo, opaleshoni ya khansa ya m'mapapo ikhoza kuchitidwa pofuna kuchotsa chotupacho. Popeza chiopsezo cha kubwereranso n'chokwanira, nthawi zambiri amatsatira mankhwala a mankhwala omwe amachititsa opaleshoni (mankhwala a chemotherapy pambuyo pa opaleshoni) kuti athetse khansa iliyonse yomwe ingafalikire ku chotupacho. Pa siteji ya 3B khansa ya m'magazi, opaleshoni si nthawi yabwino mankhwala opatsirana. Komabe, kwa anthu ena, chemotherapy (neoadjuvant chemotherapy) ingachepetse kukula kwa chotupa kotero kuti opaleshoni n'zotheka.

Chemotherapy

Chemotherapy ndi mankhwala opatsirana pogwiritsira ntchito mankhwalawa nthawi zambiri amagwiritsidwa ntchito pochizira khansa ya m'mapapo atatu. Monga tanena kale, chemotherapy ikhoza kugwiritsidwa ntchito musanayambe opaleshoni kapena mutatha opaleshoni kapena ingagwiritsidwe ntchito yokha kwa iwo omwe ali ndi khansa zomwe sizingakhoze kuchitidwa opaleshoni. Chemotherapy ikhozanso kuphatikizidwa ndi mankhwala ena a khansa ya m'mapapo.

Mankhwala Opanga Mafuta

Monga taonera kale, mankhwalawa amagwiritsidwa ntchito limodzi ndi mankhwala a chemotherapy kuti athetse khansa ya m'mapapo 3 yomwe sangathe kuchitidwa opaleshoni. Mankhwala othandizira ma ARV angathandizenso kuthana ndi mavuto okhudzana ndi khansa ya m'mapapo 3, monga kuwonongedwa kwa mpweya ndi chotupa.

Thandizo Lolinga

Aliyense amene ali ndi khansa ya m'mapapo yopanda maselo ayenera kukhala ndi majekesitomu (kuyesera kwa jini) pachithupa chawo. makamaka omwe ali ndi mapapu adenocarcinoma . Mankhwala avomerezedwa kwa anthu omwe ali ndi kusintha kwa chisendetsero monga kusintha kwa EGFR , ALK rearrangements , ndi rearrangements za ROS1 , ndipo izi zothandizidwa nthawi zina zimatha kulamulira bwino matendawa. Kutsutsana kawirikawiri kumawonekera mu nthawi, koma mankhwala am'badwo wotsatira amavomerezedwa ndi kuyesedwa m'mayesero a zamakono pamene izi zikuchitika. Kwa omwe ali ndi squamous cell carcinoma m'mapapu , anti-EGFR antibodies angagwiritsidwe ntchito. Mayesero am'zipatala akuphunziranso mankhwala omwe amayang'ana kusintha kwa chibadwa cha khansa ya m'mapapo.

Immunotherapy

Mankhwala anayi atsopano ogwiritsidwa ntchito m'thupi amavomerezedwa kuyambira 2015 kuti athe kuchiza khansa ya m'mapapo. Mankhwalawa amathandiza kwambiri kuti mphamvu zathu zoteteza mthupi zimenyane ndi khansa. Ngakhale kuti sagwira ntchito kwa aliyense, anthu ena atha kukhala ndi matenda a khansa yawo kwa nthawi yaitali. Imfinzi (durvalumab), makamaka, inavomerezedwa mu February 2018 pofuna kuchiza khansa ya m'magazi yopanda mphamvu 4 pambuyo pa mankhwala ndi chemotherapy ndi ma radiation. Anapezekanso mu 2017 kuti apititse patsogolo kupulumuka kwapadera kwa anthu awa omwe ali ndi gawo lachitatu.

Moyo Wopitirira

Anthu ambiri amadzifunsa za matenda a khansa yawo, koma ndizofunika kunena zinthu zochepa zokhudza momwe chiwerengero cha moyo wa moyo chimatanthauza pokhudzana ndi siteji yachitatu.

Pali mitundu yambiri yomwe ingakhudze msinkhu wa moyo ndi khansa ya m'mapapo. Zina mwa izi ndi zaka zanu, kugonana kwanu, malo a chifuwa chanu, momwe thupi lanu limakhudzidwira, thanzi lanu pa nthawi ya matenda, ndi momwe mumamvera mankhwala omwe mumalandira.

Ndifunikanso kunena mawu kapena awiri pa ziwerengero. Ziwerengero zimatiuza momwe munthu "wamba" amachitira ndi matenda, koma palibe amene ali "wowerengeka." Kuwonjezera apo, chiŵerengero chiri, mwa tanthauzo, chakale. Tikakamba za zaka 5 zomwe zimatuluka ku matenda, tikukamba za momwe anthu omwe adapezekapo zaka zisanu zapitazo adakhalapo bwino. Popeza panali mankhwala ambiri ovomerezeka ndi khansara yamapakati pakati pa 2011 ndi 2017 kuposa momwe anavomerezedwa zaka makumi anayi zapitazo, manambalawa sangakhale othandiza kwambiri.

Izi zinati, chiyembekezo cha moyo wa pakati pa siteji 3 ya khansa ya m'mapapo yopanda makapu (nthawi yomwe odwala 50 peresenti ali moyo ndipo 50 peresenti yafa) ili pafupi miyezi khumi ndi iwiri ya khansa ya m'mapapo atatu. Kuchuluka kwa zaka zisanu ndi zisanu ndi ziwiri za anthu omwe akuyembekezeredwa kuti akhale ndi moyo 5 zaka zapitazo atapezeka kuti ali ndi khansa ya m'mapapo 3.

Monga ndondomeko yomalizira, ndi nthawi yothetsera zifukwa zina zokhudzana ndi mayesero a zachipatala . Lingaliro la anthu pokhala nkhumba linakhala ndi maziko ena m'mbuyomo, monga mankhwala ambiri adayesedwa kwa anthu omwe sadziwa pang'ono momwe angagwire ntchito. Izi zasintha kwambiri. Tsopano, mankhwala ambiri a kansa omwe akuphunziridwa akhala akukonzedwa mwaluso kuti athetsere zolinga zenizeni pa maselo a kansa kapena maudindo ena omwe chitetezo cha mthupi chimasewera pakamenyana ndi khansa. Zasintha mpaka kufika pamene mayesero a magawo 1 - mayesero oyambirira a mankhwala omwe mankhwala atsopano amayesedwa kwa anthu-sikuti ndi okhawo otetezeka koma nthawi zambiri ndiwo njira yokhayo yothetsera matendawa. Njira yokhayo yokhala ndi moyo.

Mawu Ochokera

Kafukufuku akusonyeza kuti kuphunzira zomwe mungathe pa khansara kumathandiza ndi zotsatira zake. Funsani mafunso. Phatikizani okondedwa anu ndikuwalimbikitsa kuti afunse mafunso. Ganizirani kulowetsa gulu lothandizira komanso / kapena kulumikizana ndi anthu omwe ali ndi khansa ya m'mapapo. Zaka zaposachedwa dera lino lakhala likukula ndipo mudzalandiridwa ndi manja.

Phunzirani za mayesero a zachipatala zomwe zingakhale zoyenera pazochitika zanu. Ndipotu, pa Twitter, pali mauthenga a tweet tsiku lirilonse limene odwala, osamalira, ochita kafukufuku, ndi oncologists onse amasonkhana kuti akambirane kafukufuku wamakono komanso kupanga kukambirana kwakukulu kokhudzana ndi khansa ya m'mapapo. Kuti mupeze ammudzi, gwiritsani ntchito hashtag "LCSM" yomwe imayimira khansa ya m'mapapo.

Funsani ndi kulola okondedwa anu ndi abwenzi kukuthandizani ndikukulimbikitsani ulendo wanu. Musataye chiyembekezo-ngakhale kuti chiyembekezo chimenecho chikhale chosangalatsa monga momwe mungathere mukakhala ndi anzanu.

> Zotsatira:

> Antonia, S., Villegas, A., Daniel, D. et al. Durvalumab Pambuyo pa Chemoradiotherapy mu Gawo III Lopanda Matenda Osakaniza Amtundu Wambiri. The New England Journal of Medicine . 2017. 377: 1919-1929.

> Boffa, D., Fernandez, F., Kim, S. ndi al. Kugonjetsedwa Kwachipatala Chachiwiri IIIA-Clinical N2 Khansa Yam'mimba mu Society of Thoracic Surgeons Database. Annals of Surgery Opera. 2017 May 17. (Epub patsogolo pa kusindikiza).

> National Cancer Institute. Mankhwala Osakaniza Amtundu Wambiri Wopanda Khansa (PDQ) - Health Professional Version. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq.