Tanthauzo, Zizindikiro, Chithandizo, ndi Kugonjetsa kwa Gawo IIIA Khansa Yam'mimba
Khwerero 3A kansa yaing'ono ya mapapu ya mapapu imatengedwa kuti ndi "khansa yapamwamba", kutanthauza kuti chotupacho sichinafalikire kumadera akutali a thupi koma chafalikira ku maselo amodzi pambali imodzi ya thupi ngati chotupa. Pafupifupi 10 peresenti ya anthu ali ndi kansa ya mapaipi ya mapaipi 3A pa nthawi ya matenda, ndipo 60 peresenti ya anthu omwe ali ndi matenda oyamba kwambiri.
Mwachidule
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.
Oncologists amagwiritsa ntchito njira ya TNM kufotokozera magawo a kansa ya m'mapapo. Malongosoledwe ophweka a TNM dongosolo akuphatikizapo:
T - Izi zikutanthauza kukula kwa chotupa:
- T1 - Chotupacho sichichepera masentimita atatu mu kukula.
- T2 -Thusa imakula kuposa masentimita atatu koma osachepera 7 cm mu kukula.
- T3 - Chotupacho chiposa 7 cm kapena chimalowa mwachindunji mwa izi: Khoma la chifuwa, chifuwa, mitsempha yosasunthira chingwe (phrenic nerve), memphane yomwe imaphimba malo pakati pa mapaipi awiri (mediastinal pleura), kapena imodzi ma memphane amaphimba mtima parietal pericardium); kapena chotupa cha bronchus chachikulu chili 2 cm pansi pa carina; kapena zimagwirizananso ndi kugwa ( atelectasis ) ya mapapo onse kapena zosiyana ndi zotupa za m'mimba m'matumbo omwewo.
- T4 - Kutupa kwa msinkhu uliwonse umene umalowa mkati mwa izi zilizonse: malo pakati pa mapapu ( mediastinum ), mtima, ziwiya zazikulu, trachea, imodzi mwa mitsempha yomwe imakhala ndi mitsempha yowonjezereka (mitsempha yowonongeka), malo amodzi, kapena malo kumene trachea imagawanika mu bronchi yaikulu (carina); kapena kusiyanitsa chotupa chamagazi (s) mu mapulogalamu ena ammapapo pambali imodzi ya chifuwa.
N amatanthauza maselo:
- N0 - Palibe ma lymph nodes omwe amakhudzidwa.
- N1 - Chotupacho chafalikira kumadera oyandikana nawo mbali imodzi ya chifuwa.
- N2 - Chotupacho chafalikira ku nodes patsogolo koma pambali imodzi ya chifuwa.
- 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 M0 - Chotupacho chafalikira (chogonjetsedwa) kumadera ena a thupi kapena mapapo ena.
Pogwiritsa ntchito TNM System, Gawo la 3A kansa yamapapo imatchulidwa monga:
- T1N2M0 - Kutanthauza kuti chotupacho n'chosachepera 3 masentimita mu kukula ndipo chafalikira ku maselo amphongo kupita kutali koma pambali imodzi ya thupi ngati chotupa.
- T2N2M0 - Chotupacho n'choposa masentimita 3 koma osachepera 7 masentimita, ndipo chimafalikira ku maselo amphongo kupita kutali koma pambali imodzi ya thupi.
- T3N1M0 - Chotupachi chiposa 7 cm kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndipo ma lymph nodes omwe ali pafupi amakhudzidwa. (onani tanthauzo la pamwamba la T3). Chotupacho chikuposa 7 cm kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndipo maselo omwe ali kutali kwambiri koma pambali imodzi ya thupi amakhudzidwa. Chotupacho ndi kukula kwake koma chili pafupi ndi pandege kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndipo maselo omwe ali kutali kwambiri koma pambali imodzi ya thupi amakhudzidwa (onani tanthauzo la pamwamba la T3).
- T3N2M0 - Chotupacho ndi kukula kwake koma chili pafupi ndi pandege kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndi ma lymphodes omwe ali kutali koma pambali imodzi ya chifuwa amakhudzidwa.
Zizindikiro
Zizindikiro za siteji 3A Khansa ya m'mapapo imakhala yosiyana kuyambira nthawi ya 3A imakhala ndi khansa yambiri. Zizindikiro chifukwa cha khansa m'mapapu monga chifuwa chokhazikika , kupuma pang'ono , ndi matenda obwerezabwereza monga chibayo kapena bronchitis, ndizofala. Kufalikira kumadera ngati khoma la chifuwa ndi diaphragm kungabweretse ululu mu chifuwa, nthiti, mapewa, ndi kumbuyo.Zotsutsana ziri pafupi ndi ndege zingayambitse hemoptysis ( kukhwima magazi ), kupuma , ndi mantha .
Kuchiza
Mankhwala a kansa ya 3A khansa ya m'mapapo ndi yotsutsana kwambiri pamagulu onse a khansa yamapapo, makamaka chifukwa gululi ndi losiyana kwambiri. Chifukwa cha kupulumuka kosauka, National Cancer Institute imati aliyense yemwe ali ndi siteji ya 3A khansa ya m'mapapo ayenera kuyesedwa kuti ndi woyenera pa zochitika zachipatala - maphunziro omwe amafufuza mankhwala atsopano kapena kuphatikiza kwa mankhwala a kansa ya m'mapapo.
Nthawi zina, opaleshoni ikhoza kuchitidwa pofuna kuchotsa chotupacho, ndipo nthawi zambiri amatsatira mankhwala a adjuvant chemotherapy (chemotherapy pambuyo pa opaleshoni). Kuchepetsa mankhwala opatsirana mankhwala (chemotherapy asanayambe opaleshoni) yapezeka kuti ikupulumuka kupitiriza maphunziro angapo. Kachitidwe kake kake (pogwiritsira ntchito mankhwala a chemotherapy) pamodzi ndi mankhwala opatsirana pogwiritsa ntchito mankhwala kapena mankhwala ena amagwiritsidwa ntchito ngati siteji 3A khansa ya m'mapapo ikuyesedwa yopanda mphamvu chifukwa cha malo ake, kaya yayendayenda bwanji, kapena ngati thanzi lanu lonse likuchita opaleshoni yowopsa. Kwa iwo omwe sangathe kulekerera opaleshoni kapena chemotherapy, mankhwala odzoza mazira amakhalabe mwayi.
Ndikofunika kuti aliyense amene ali ndi khansa ya m'mapapo yopanda makapu, makamaka mapapu adenocarcinoma ali ndi mayeso a maumunthu . Pali kusintha kochuluka "kusintha" monga EGFR kusintha , ALK rearrangements , ndi rearrangements ROS1 zomwe zinachititsa khansa ya m'mapapo kukhala matenda aakulu.
Immunotherapy ndi njira yosangalatsa kwa anthu ena , ndi oyamba omwe ali m'gululi ovomerezedwa kuti azitha kuchiza khansa ya m'mapapo mu 2015, pali mankhwala anayi omwe alipo. Ngakhale mankhwalawa sagwira ntchito kwa aliyense, anthu ena akhala akuletsa mankhwalawa kwa nthawi yaitali. Chithandizo cha mankhwala Infinga (durvalumab) chinavomerezedwa mu 2018 makamaka kuti chithandizo cha kansalu ya khansa ya m'mapapo yaing'ono yomwe siing'ono ingatheke. Pogwiritsidwa ntchito pakutsata mankhwala a chemotherapy ndi ma radiation, anapezeka kuti apitirize kupulumuka kwaufulu.
Kuthamangitsani
Kachilombo ka zaka zisanu ndi zisanu ndi zisanu ndi zisanu ndi zitatu (5), ndi khansa yamapapo ya mapaipi ndi 14 peresenti, koma izi zimasiyanasiyana pakati pa khansa zosiyanasiyana zomwe zimakhala ngati gawo 3A. Kumbukirani kuti ziwerengero zimatiuza momwe anthu anachitira zaka zapitazo, ndipo kupita patsogolo kwakukulu kunachitika pochiza khansa yamapapo muzaka zingapo zapitazi. Pali malo ambiri okhudzana ndi chiyembekezo cha chithandizo cha khansa ya m'mapapo.
- Kodi Gawo lachitatu la khansa ya moyo wodwalayo ndi yotani?
- Kukhalitsa Khansa Yam'mimba Kutengera ndi Mtundu ndi Gawo
Thandizo
Kafukufuku akusonyeza kuti kuphunzira zomwe mungathe pa khansara kumathandiza ndi zotsatira zake. Pa magawo onse a khansara yamapapo, siteji ya 3A ndi yosinthika kwambiri ndipo ili ndi mwayi wambiri wosankha. Funsani mafunso. Phatikizani okondedwa anu ndikuwalimbikitsa kuti afunse mafunso. Ganizirani kulowetsa gulu lothandizira . Phunzirani za mayesero a zachipatala zomwe zingakhale zoyenera pazochitika zanu. Kuphunzira za khansara yanu ndi kuchipatala kungatenge nthawi yambiri. Funsani, ndi kulola okondedwa anu ndi abwenzi kukuthandizani ndikukulimbikitsani ulendo wanu. Tengani kamphindi kuti muwone malingaliro awa momwe mungakhalire wanu woimira pa chisamaliro chanu cha khansa . Ndipo apa pali malangizo ena a njira zowonjezera kupulumuka kwa khansa yamapapo yomwe dokotala sangakuuze.
Pamene Wokondedwa Wanu Ali ndi Khansa Yamimba
Ngati ndi wokondedwa wanu yemwe watengedwa ndi khansara yamapapo, mwinamwake mukuwopa, ndipo kukhala wosamalira banja la munthu yemwe ali ndi matendawa kungakuchititseni kumva wokhumudwa komanso opanda thandizo. Tengani kamphindi ndikufufuze nkhaniyi kuti " Pamene wokondedwa wanu ali ndi khansara yamapapo " kuti amve zomwe anthu ali ndi kansa ya m'mapapo akuyembekeza okondedwa awo adziwa. Nazi malangizowo komanso pothandizira wokondedwa ndi khansa .
Zotsatira:
American Cancer Society. Zolemba ndi Kafukufuku wa Khansa 2014 . Atlanta: American Cancer Society; 2014. http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf
American Cancer Society. Khansa Yam'mimba (Cell Osati Small. 02/08/16. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-survival-rates
Komiti Yovomerezeka ya ku America ya Khansa. Khansara ya Khansa. Gulu lachisanu ndi chiwiri. Inapezeka pa 09/20/14. https://cancerstaging.org/references-tools/quickreferences/Documents/LungMedium.pdf
> 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.
Edge, S. et al (Eds). Buku la AJCC la Kukhazikitsa Khansa. Gulu lachisanu ndi chiwiri. Springer. New York, NY. 2010.
National Cancer Institute. Mankhwala Osakaniza Amtundu Wambiri Wopanda Khansa (PDQ) - Health Professional Version. http://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq#section/all
Santos, E. et al. Mikangano mu kayendetsedwe ka sitiroko yachiwiri ya kansa yaching'ono yaing'ono yaing'ono ya IIIA. Kufufuza kwa Akatswiri a Mankhwala a Anticancer . 2008. 8 (12): 1913-29.