Gawo III Khansa Yam'mimba - Tanthawuzo, Chithandizo, ndi Kugonjetsa
Khwerero 3B Khansara ya m'mapapo yopanda makapu imatengedwa kuti ndi khansa yapakhungu yamapiri limodzi ndi siteji 4, ndipo ngakhale kuti nthawi zambiri sichirapa, imachiritsidwa. Pafupifupi 20 peresenti ya anthu ali ndi khansa ya m'magazi ya 3B pa nthawi ya matenda, ndipo 40 peresenti ya anthu omwe ayamba kale kupita ku gawo 4 .
Mwachidule
Gawo 3B Khansa ya m'magazi imatanthawuza ngati chotupa cha kukula kulikonse komwe kwafalikira ku maselo akutali kwambiri kapena chaphwanya ziwalo zina mu chifuwa (monga mtima kapena chifuwa).
Oncologists amagwiritsa ntchito njira ya TNM kufotokozera magawo a kansa ya m'mapapo. Malongosoledwe ophweka a TNM dongosolo akuphatikizapo:
T zomwe zikutanthauza kukula kwa chotupa:
- T1 : Chotupacho n'chosachepera 3 cm (mainchesi 1½) kukula.
- T2 : Chotupachi chikulirapo kuposa masentimita 3 koma osachepera 7 cm.
- T3 : Chotupachi chiposa 7 cm kapena chimalowa mwachindunji mwa izi: Khoma la chifuwa, chithunzithunzi , mitsempha yosasunthira nthata (phrenic nerve), memphane yomwe imaphimba malo pakati pa mapapu awiri (pleurinal pleura), kapena kamodzi kamene kamaphimba mtima ( parietal pericardium ); kapena chotupa pamutu waukulu bronchus pafupi 2 cm pansi pa carina; kapena zimagwirizanitsidwa ndi kugwa kwa 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, zotengera zazikulu, trachea , imodzi mwa mitsempha yomwe imakhala ndi mitsempha yochuluka (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 malo omwe amakhudzidwa.
- N1 : Chotupacho chafalikira ku nodes pafupi ndi mbali imodzi ya chifuwa.
- N2 : Chotupacho chafalikira ku nodes patsogolo koma pambali imodzi ya chifuwa.
- N3 : Selo la khansa lilipo m'magulu a mitsempha kumbali ina ya chifuwa kuchokera ku chotupacho, kapena m'madera pafupi ndi collarbone kapena minofu.
M amaimira matenda oopsa :
- M0 : Palibe metastases alipo.
- M1 : Chotupacho chafalikira (chogonjetsedwa) kumadera ena a thupi kapena mapapo ena.
Kugwiritsa ntchito TNM System Stage 3B ikufotokozedwa monga:
- T, N3, M0 : Tanthauzo la chotupa cha kukula kulikonse komwe kwafalikira ku mitsempha 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 : Kutanthauza chotupa cha kukula kulikonse kumene kuli pa airways, chasokoneza zipangizo zapakhomo monga mtima kapena chiwonongeko kapena zimakhala zosautsa zotsutsana. 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
Zisonyezero zomwe zimachitika pamsana wa khansa ya m'mapapo 3 imakhala ndi chifuwa chokhazikika komanso mpweya wochepa . Matenda pafupi ndi ndege angapangitse hemoptysis ( kukakamira magazi ). Pamene chotupacho chimaphatikizapo malo monga chiwindi ndi ziwalo zina za chifuwa, dysphagia (kuvutika kumeza) ndi mantha akhoza kuchitika. Kupweteka kumbuyo, chifuwa, ndi nthiti ndizofala ngati phokoso lamakono likupezeka, ndipo izi zingachititse kuti mpweya ukhale wochepa.
Zizindikiro zowopsa za khansa monga kutopa komanso kutaya kwadzidzidzi kungakhalepo.
Kuchiza
Ndi zosiyana ndi zosawerengeka, siteji ya 3B khansa ya m'mapapo imaganiziridwa kuti sichitha kugwira ntchito ( opaleshoni singachiritse khansara), koma sichivulazidwa. Kwa anthu omwe ali ndi thanzi labwino, kuphatikizapo mankhwala a chemotherapy kapena chemotherapy ndi mankhwala opatsirana pogwiritsa ntchito ma radiation nthawi zambiri amalimbikitsidwa. Ngati anthu sangathe kulekerera mankhwala a chemotherapy, mankhwalawa akhoza kugwiritsidwa ntchito okha. Ngakhale kuti mankhwala opangidwa ndi ma radiation saperekedwa mobwerezabwereza ndi cholinga chochiza khansa, zingakhale zothandiza kuchiza zizindikiro monga kupweteka, kupuma pang'ono, ndi kukakamira.
Mankhwala atsopano monga chithandizo chamankhwala ndi ma immunotherapy akupanga kusiyana kwa anthu omwe ali ndi magawo apamwamba a kansa ya m'mapapo. Aliyense amene ali ndi khansa ya m'mapapo yopanda maselo ayenera kukhala ndi majekesitomu (kuyesera kwa jini) pachithupa chawo. Mankhwala ochizira kusintha kwa EGFR , ALK rearrangements , ndi rearrangements za ROS1 zatsimikiziridwa, ndipo mankhwala osokoneza kusintha kwa mitundu ina akuwerengedwa m'mayesero a zamankhwala. Nthawi zina, mankhwalawa amalola anthu kukhala ndi khansara yamapapo ngati mtundu wa matenda osatha.
Immunotherapy ndi njira yosangalatsa , ndi mankhwala oyamba omwe amavomerezedwa mu 2015. Mankhwalawa adayambitsa "mayankho ogwira mtima" -matanthauzira azinthu omwe angatanthauzidwe kutanthawuza kuti atha kukhala ndi moyo kwa nthawi yayitali - kwa anthu ena omwe ali ndi khansara ya m'mapapo. Ena mwa mankhwalawa akugwiritsidwanso ntchito pamodzi kuti athetse khansa ya m'mapapo yapamwamba kwambiri. Mu 2018 mankhwala amodzi a immunotherapy, Imfinzi (durvalumab) adavomerezedwa mwachindunji kuti azitha kuchipatala mosadalirika 3 khansara yokhala yopanda makapu. Amagwiritsidwa ntchito pambuyo pa mankhwala a chemotherapy ndi mankhwala a radiation, ndipo anapezeka kuti apititse patsogolo kupulumuka kwaulere.
Chifukwa chakuti zotsatira za mankhwala ndizosauka , National Cancer Institute imanena kuti anthu onse omwe ali ndi khansa ya m'mapapo 3 ya pamapapo ayenera kukhala oyenerera ku mayesero a zamankhwala - zomwe zimayesa njira zatsopano zothandizira khansa ya m'mapapo.
Kuthamangitsani
Zomwe zimakhalapo zaka zisanu ndi zisanu ndi zisanu ndi zitatu. Nthawi yopulumuka yapakatikati (nthawi yomwe odwala 50 peresenti ali amoyo ndipo 50 peresenti yafa) ali pafupi miyezi 13 ndikuchiritsidwa. Kumbukirani kuti ziŵerengerozi ndi nambala zomwe zinapezedwa pamaso pa mankhwala atsopano-monga mankhwala ena ochiritsira ndi immunotherapy-adavomerezedwa kuti azisamalira khansa ya m'mapapo.
Thandizo
Kafukufuku akusonyeza kuti kuphunzira zomwe mungathe pa khansara kumathandiza ndi zotsatira zake. Pali zambiri zowonjezera pa intaneti, komabe zingakhale zovuta kudziwa komwe mungapeze uthenga wabwino. Onani zotsatila izi kuti mudziwe zambiri zokhudza khansa . Chinthu chofunikira kwambiri chomwe mungachite ndicho kuphunzira kukhala wothandizira wanu pa chisamaliro chanu cha khansa . Chithandizo cha khansa ya m'mapapo chikusintha mofulumira, ndipo zingakhale zovuta ngakhale akatswiri a khansa ya m'mapapo kuti asamvetsetse kafukufuku wonsewo.
Njira yabwino yothandizira kupeza chithandizo ndi uthenga wabwino ndikutenga nawo gulu la chithandizo cha khansa ya m'mapapo kapena gulu lothandizira . Mungamve zochepa za magulu a khansa ya m'mapapo kusiyana ndi kunena, magulu a khansa ya m'mawere, koma zomwe maguluwa alibe zowerengera zomwe ali nazo mozama. Hashtag #LCSM imaimira khansa ya m'mapapo. Koposa zonse, musataye chiyembekezo. Matenda onse komanso kupulumuka kwa khansa ya m'mapapo yakula. Mu 2015 panali mankhwala ena atsopano omwe amavomereza khansara yamapapo kusiyana ndi kale lonse, ndipo mankhwala ena akuyesedwa mu mayesero a zamankhwala.
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. Kusinthidwa 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.
Faithi, A. ndi J. Brahmer. Chemotherapy pa khansa yapakhungu yopanda khansa yapakhungu. Masemina mu Opaleshoni ya Thoracic ndi Mafupa . 2008. 20 (3): 210-6.
National Cancer Institute. Mankhwala Osakaniza Amtundu Wambiri Wopanda Khansa (PDQ) - Health Professional Version. Kusinthidwa 07/07/16. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq#section/all