Gawo lachiwiri Khansa Yam'mimba - Tanthawuzo, Chithandizo, ndi Mafupa
Gawo 2 la khansa ya m'mapapo yopanda khansa imatchedwa " khansara ", ndiko kuti, iyo imatanthawuza chotupa chomwe chiripo m'mapapo ndipo chikhoza kufalikira ku maselo am'deralo, koma sinafalikire. Ziphuphu zomwe zafalikira kupyola izi zimatchedwa "khansa yapamwamba." Pafupifupi 30 peresenti ya khansa ya m'mapapo imapezeka pamene ali pa stade 1 kapena 2, ndipo zizindikirozo (zotsatira za nthawi yayitali) zimakhala bwino kwambiri kusiyana ndi mliri wa matendawa.
Kodi zimatsimikiziranji kuti khansara yamapapo ndi siteji yachiwiri (siteji yachiwiri), ndi momwe gawo ili la khansa ya m'mapapo imachiritsidwa?
Mwachidule
Kutsimikiza siteji ya khansa yamapapo ndikofunika kwambiri posankha chithandizo choyenera kwambiri.
Gawo lachiwiri lagawidwa mu magawo a IIA ndi IIB. Gawo IIA ndi IIB ligawidwa m'magawo awiri malingana ndi kukula kwa chotupacho, kumene chifuwacho chimapezeka, komanso ngati pali khansa m'matumbo.
Gawo IIA
(1) Khansa yafalikira ku maselo amphongo kumbali imodzi ya chifuwa monga chotupa. Mafupa a khansa ndi khansa ali mkati mwa mapapo kapena pafupi ndi bronchus , ndipo chimodzi kapena zingapo zotsatirazi ndi zoona:
- Chotupacho sichiri chachikulu kuposa masentimita asanu.
- Khansara yafalikira ku bronchus yaikulu ndipo ili ndi masentimita awiri pansipa pamene trachea ikuphatikizana ndi bronchus.
- Khansara yayamba kufalikira pamkati mwa nembanemba yomwe ili ndi mapapo.
- Gawo la mapapo lagwa kapena layamba pneumonitis (kutupa kwa mapapo) kumalo kumene trachea imayanjana ndi bronchus koma siimaphatikizapo mapapo.
kapena
(2) Khansa sinafalikire ku maselo a m'mimba ndipo chimodzi mwa zinthu zotsatirazi ndi zoona:
- Chotupacho chikukula kuposa masentimita asanu koma osaposa masentimita 7.
- Khansara yafalikira ku bronchus yaikulu ndipo ili ndi masentimita awiri pansipa pamene trachea ikuphatikizana ndi bronchus.
- Khansara yayamba kufalikira pamkati mwa nembanemba yomwe ili ndi mapapo.
- Gawo la mapapo lagwa kapena layamba pneumonitis (kutupa kwa mapapo) kumalo kumene trachea ikuphatikizana ndi bronchus koma sizimaphatikizapo mapapo onse; ndi
Gawo IIB
(1) Khansa yafalikira ku maselo am'mbali pafupi ndi mbali ya chifuwa ngati chotupa. Mafupa a khansa ndi khansa ali m'mapapo kapena pafupi ndi bronchus. Ndiponso, chimodzi kapena zambiri mwa zotsatirazi ndi zoona:
- Chotupacho chikukula kuposa masentimita asanu koma osaposa masentimita 7.
- Khansara yafalikira ku bronchus yaikulu ndipo ili ndi masentimita awiri pansi pa dera limene trachea ikuphatikizana ndi bronchus.
- Khansara yayamba kufalikira pamkati mwa nembanemba yomwe ili ndi mapapo.
- Gawo la mapapo lagwa ( atelectasis ) kapena linapangidwa pneumonitis (kutupa kwa mapapo) kumalo kumene trachea ikuphatikizana ndi bronchus.
kapena
(2) Khansa sinafalikire ku maselo a m'mimba ndipo chimodzi mwa zinthu zotsatirazi ndi zoona:
- Chotupacho n'choposa 7 centimita.
- Khansa yafalikira pamtundu waukulu wa bronchus (ndipo uli pansi pa masentimita awiri pafupi ndi malo pomwe trachea ikuphatikizana ndi bronchus koma siimaphatikizapo mphambano), khoma la chifuwa, chifuwa, kapena mitsempha yomwe imayendetsa chithunzithunzi.
- Khansara yafalikira ku memphane kuzungulira mtima ( pericardium ) kapena kuyala khoma la chifuwa.
- Pali chotupa chimodzi kapena zingapo zosiyana mumtundu umodzi wa mapapo.
Kusinthana
Oncologists amayankhula za magawo a khansa yamapapo yochokera ku chinachake chotchedwa TNM dongosolo . M'dongosolo lino, T imatanthawuza kukula kwa chotupacho, N imatanthawuza kukhudzidwa kwa mitsempha iliyonse ndi kumene ili, ndipo M amasonyeza ngati pali mitsempha yambiri , ndiko kufalikira kwa chotupa kumadera ena a thupi . Kugwiritsira ntchito TNM system, kansa ya mapapo 2 yamapapo ikufotokozedwa monga:
- 2A - T1A / 1BN1M0 - Kutanthauza kuti chotupacho n'chosachepera 3 cm (mainchesi 1½) kukula kwake, ndipo chafalikira ku maselo amkati omwe ali pafupi.
- 2A - T2AN1M0 - Chotupacho n'choposa 3 cm, koma osachepera 5 masentimita, kukula kwake, kapena khansara yafalikira ku bronchus yaikulu ndipo pafupifupi 2 masentimita pansi pa carina, kapena khansara yakulalika mpweya; ndipo lafalikira ku maselo amphongo apafupi.
- 2B - T2N1M0 - Chotupachi n'choposa 3 cm, koma masentimita osachepera 7, kukula kwake, ndipo chafalikira ku maselo am'deralo.
- 2B-T3N0M0 - Chotupacho n'choposa 7 masentimita kukula kwake ndipo sichifalikira ku maselo, koma ali paulendo wamtunda kapena kufalikira kumadera omwe ali ngati khoma la chifuwa kapena diaphragm.
Molecular Profiling
Chinthu chimodzi chaposachedwapa cha chithandizo cha khansa ya m'mapapo ndikumatha kuchita zina mwa khansa mwa "kuwunikira" kusintha kwa chifuwacho. Kuphatikizana ndi kufotokoza chotupa chochokera ku kukula kwake komanso momwe zikufalikira, akatswiri ofufuza zamagetsi tsopano akugwiritsa ntchito mayeso a majini (khansa yopanga maselo) kwa khansara yamapapu kuti apitirize "kudzipangira yekha" matendawa. Mpaka posachedwa, kuyesedwa kunkaperekedwa makamaka kwa anthu omwe ali ndi magawo apamwamba kwambiri a matendawa, koma popita patsogolo, ndiye kuti omwe ali ndi siteji yachiwiri, makamaka anthu omwe ali ndi mapapo adenocarcinoma , kuyesa kumeneku kudzakhala kozolowereka.
Zizindikiro
Zomwe zimachitika pa siteji 2 khansa ya m'mapapo ndi chifuwa chokhazikika , kukhetsa magazi (hemoptysis), kupuma pang'ono , kupweteka mu chifuwa kapena kumbuyo , kapena matenda obwerezabwereza monga chibayo kapena bronchitis. Popeza khansara ya m'mapapo 2 ya m'mapapo siinayambe kufalikira (kupitirira) kupyola m'mapapo, zizindikiro monga kutaya thupi kosayembekezereka ndi kutopa sizodziwikiratu kusiyana ndi magawo apamwamba kwambiri.
Chithandizo
Chithandizo cha chithandizo cha khansa ya m'mapapo 2 ya khansa nthawi zambiri chimaphatikizapo mankhwala othandizira. Izi zikuphatikizapo:
- Opaleshoni: Opaleshoni ndi chithandizo cha kusankha kwa khansa ya m'mapapo ya pamapepala 2, imapereka chithandizo chachikulu kwambiri cha mankhwala pa gawo ili la matenda. Pali mitundu itatu yaikulu ya opaleshoni ya khansa ya m'mapapo yomwe imapangidwa ku khansara yamapapo, ndipo kusankha njira yomwe ili yabwino kumadalira kumene chifuwa chanu chiripo ndi dziko lanu lonse. M'zaka zaposachedwapa njira yochepa yopaleshoni yochitidwa opaleshoni yotchedwa video-assisted opera opaleshoni (VATS) yapezeka. Ndi njirayi, mbali ya mapapo ingachotsedwe kudzera muzithunzi zochepa mu khoma la chifuwa. Kungakhale kwanzeru kuganizira lingaliro lachiwiri pakusankha opaleshoni ya khansa ya m'mapapo . Kafukufuku amasonyeza kuti anthu omwe ali ndi njirazi zochitidwa kuchipatala chomwe chikuchita opaleshoni yaikuluyi amakhala ndi zotsatira zabwino.
- Chemotherapy: Ambiri mwa odwala oncologists amalimbikitsa mankhwala a adjuvant pambuyo pa opaleshoni) kwa omwe akuchitidwa opaleshoni ya kansa ya mapapo 2. Lingaliro la mtundu uwu wa chemotherapy ndi "kuyeretsa" maselo aliwonse a khansara omwe angafalikire kupyola m'mapapu (osokonezeka) koma sanawonekere pa mayesero aliwonse ojambula. Malingana ndi malo a chotupa chanu, ena oncologists akhoza m'malo mwa neoadjuvant chemotherapy-chemotherapy operekedwa opaleshoni isanayambe kuti athe kuchepetsa kukula kwa chotupa ndi kuchotsa chotupacho mosavuta.
- Mankhwala Opatsirana Ndi Mafupa Osagwiritsidwa Ntchito: Mankhwala osokoneza bongo samagwiritsidwa ntchito ndi khansa ya m'mapapo 2, koma ndi mwayi kwa iwo omwe sangathe kuchitidwa opaleshoni chifukwa cha vutoli kapena khansa ya m'mapapo . Pachifukwa ichi, ma radiation nthawi zina amatha kuchiza. Njira zina monga chithandizo cha proton choyendetsera ntchito zikuyang'aniratu kuti adziwe matendawa.
Mayesero Amakono
Malinga ndi National Cancer Institute, anthu omwe ali ndi khansa ya m'mapapo ayenera kulingalira nawo mbali pa mayesero a zamankhwala . Zambiri zapita patsogolo pakuchiza khansa ya m'mapapo, ndipo pakati pa chaka cha 2011 ndi 2015, panali mankhwala atsopano ovomerezeka ndi khansa ya m'mapapo kuposa zaka 40 zisanafike 2011.
Mayesero ambiri a kachipatala akuyambira pa kansa ya mapapo 2 ya mapapo kuyang'ana njira zochepetsera zopaleshoni, njira zatsopano zamagetsi, ndi mankhwala atsopano monga chithandizo chochiritsira ndi chithandizo chamankhwala pa gawo ili la matenda.
Kuopsa Kowonongeka
Kawiri kawiri kawiri kawiri (m'deralo kapena m'madera ena a thupi) khansara yamapapo yamaphunziro (siteji 1 ndi siteji 2) ili pakati pa 20 ndi 50 peresenti. Ngati khansara yamapapu imayambiranso, njira zina zowonjezera zimapezeka kuchipatala. Izi zingaphatikizepo ma radiation kapena opanda mankhwala, kapena imodzi mwa mankhwala ochiritsidwa kapena mankhwala omwe amagwiritsidwa ntchito m'mayesero ambiri. Phunzirani zambiri za kusintha kwa khansa yamapapo .
Chiwerengero cha Survival
Kachilombo ka zaka zisanu ndi zisanu ndi zisanu ndi zitatu (30) pamsinkhu wa khansa ya m'mapapo ya sepulo yopanda mapira. Nthawi zina, nambala iyi nthawi zina imasiyana , malingana ndi chotupa chanu komanso thanzi lanu lonse. Kumbukirani kuti ziwerengero zokhudzana ndi kupulumuka kawirikawiri zimakhala zaka zingapo, ndipo mankhwala atsopano omwe avomerezedwa sangakhalepo pamene ziwerengerozo zinalembedwa.
Kulimbana
Kafukufuku akusonyeza kuti kuphunzira za matenda anu kungakuthandizeni. Funsani mafunso. Phunzirani za mayesero a zachipatala zomwe zingakhale zoyenera kwa inu. Ngati mwatengedwa kumene ndi khansara yamapapo , tengani kamphindi kuti mupume ndi kuganizira mosamala za momwe mulili panopo. Zosankha zambiri ndi khansara yamapapo sizowonjezereka, ndipo nthawi zambiri mumatenga nthawi pang'ono kuti muone bwinobwino zomwe mukuchita.
Mwanjira zina, mukhoza kumverera ngati mutangotaya moyo wanu, koma pali zinthu zina zomwe mungadzipangire nokha zomwe zingakuthandizeni kuti mukhale ndi khansa ya m'mapapo.
Kukhala ndi khansa kungatenge mudzi. Lolani anthu kuti akuthandizeni. Ino si nthawi yokhala "yamphamvu," ndipo khansa ikhoza kukhala yotopetsa ngakhale ndi thandizo. Ngati ndi wokondedwa wanu yemwe watengedwa ndi khansa, onani nkhani iyi, " Pamene wokondedwa wanu ali ndi khansara yamapapo. "
Ngakhale mutakhala ndi chithandizo chachikondi cha banja ndi abwenzi, kukhala ndi khansa kungakhale kosungulumwa. Yang'anani kumagulu othandizira m'dera lanu komanso pa intaneti . Pali khansa yabwino yamapapu pa intaneti komwe anthu ambiri omwe ali ndi kansa ya m'mapapo amapeza chithandizo, pomwe panthawi imodzimodzi akuphunzira za posachedwapa za khansa ya m'mapapo.
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 01/13/16. https://cancerstaging.org/references-tools/quickreferences/Documents/LungMedium.pdf
Edge, S. et al (Eds). Buku la AJCC la Kukhazikitsa Khansa. Gulu lachisanu ndi chiwiri. Springer. New York, NY. 2010.
Hotta, K. et al. Udindo wa mankhwala a adjuvant chemotherapy kwa odwala omwe ali ndi kansa ya m'mapapo ya m'mapapo yowonongeka: kuyambiranso ndi meta-zofufuza za mayesero olamuliridwa mosavuta. Journal of Clinical Oncology . 2004. 22 (19): 3850-7.
Kelsey, C. et al. Kubwereza kwanuko kumayambiriro koyamba kwa NSCLC: salvage ndi zotheka ndi mankhwala opatsirana. Khansa . 2006. 12 (4): 283-8.