Kodi khansara ya m'mapapo ndi yotani kwa akulu akulu omwe amawachiritsira ndipo kodi matendawa ndi ovuta kuposa a achinyamata? Kodi pali nthawi imene munthu wina wamkulu kwambiri kuti achitire opaleshoni kapena chemotherapy? Kodi khansa ya m'mapapo imasiyana bwanji ndi okalamba, mwachitsanzo, omwe ali ndi zaka zoposa 80?
Kansa Yam'mimba M'zolamba Zakale
Imodzi mwa nthano za khansa ya m'mapapo yakhala kuti akuluakulu alibe zoyenera za mankhwala a kansa yamapapo omwe achinyamata omwe ali ndi khansara yamapapo ali nawo.
Zikuwoneka kuti akuganiza kuti akuluakulu sangathe kulekerera zotsatira za mankhwala, kapena mankhwalawa ayenera "kutayidwa pansi."
Kodi maphunzirowa amatiuza chiyani? Ndipotu, timva kuti 50 ndi 30, ndipo 70 ndi 50.
Palibe ndondomeko yeniyeni yeniyeni yomwe imatanthauza "okalamba" kapena "okalamba" odwala khansa ya m'mapapo, koma maphunziro ambiri amawoneka kuti akugwiritsa ntchito kudulidwa kwa zaka 70. Ngati mutakhala mumsinkhu uwu, chonde werengani on. Tikupeza kuti nthawi yowerengera ndi yosafunika kwambiri kusiyana ndi zifukwa zina zodziwira yankho komanso kuthekera kupirira. Imakhalanso nthawi yosangalatsa kwambiri, monga mankhwala ambiri omwe amavomerezedwa kuti athe kupatsirana khansa ya m'mapapo, komanso omwe akuyesedwa m'mayesero a zachipatala, kaŵirikaŵiri amalekerera kusiyana ndi mankhwala a chibadwa.
Maphunziro ena amagwiritsa ntchito mawu oti "odwala okalamba" kuti afotokoze anthu omwe ali ndi zaka zoposa 80.
Ngakhale mu maphunziro omwe amagwiritsira ntchito mbadwo uno mmalo mwa zaka zofanana kwambiri 70 kuti afotokoze "akuluakulu" mukhoza kudabwa kuona momwe ambiri mwa anthuwa amalekerera chithandizo cha khansa ya m'mapapo.
Kodi Ndizogwirizana Bwanji ndi khansa ya m'mimba mu akuluakulu achikulire?
Pakalipano, anthu oposa 40 peresenti ya anthu omwe ali ndi khansa ya m'mapapo ali ndi zaka 70 kapena kuposa.
Mavuto Pogwiritsa Ntchito Nthawi Yakale Mu Kusankha Chithandizo
Pali mavuto awiri oyambirira pogwiritsira ntchito zaka zowerengera pofufuza za khansa ya m'mapapo. Poyamba, zapezeka kuti m'badwo wokha sulankhula zambiri za momwe wina angalekerere mankhwalawa. Machitidwe , chiyero cha "ubwino" ndikumakhala kosavuta kulosera momwe munthu angakhalire bwino. Madokotala akuyang'ana njira zina zodziwira momwe munthu angaperekere mankhwala, monga kuyeza kwapadera (CGA). Zida izi zikuyang'ana zizindikiro zoleza mtima kuti tidziwiratu kulekerera kuchipatala ndi kupulumuka ndikuphatikizapo:
- Mkhalidwe wa zakudya
- Kukhalapo kwa matenda ena
- Mzere wa ntchito
- Zochita za tsiku ndi tsiku (ADL)
- Thandizo la anthu
- Chikhalidwe cha kunyumba
Vuto lina loyang'ana zaka za nyengo ndilokuti sitidziwa zambiri. Mankhwala ambiri ndi mankhwala akhala akuphunziridwa m'mayesero a kachipatala kwa odwala achinyamata.
Mmene Zakale Zingakhudzire Kuchiza Khansa Kwambiri
Ndikofunika koyamba kunena kuti zaka sizingachepetse phindu la chithandizo, koma chithandizo sichingakhale cholekerera kwa achikulire ena. Chigwirizano chonse chikuwoneka ngati kuti zaka zokha siziyenera kulamula kuti mankhwala amatha kapena sangagwiritsidwe ntchito pa khansa ya m'mapapo.
Izi zinati, pali zifukwa zingapo zomwe odwala ena okalamba sangalolere mankhwala komanso odwala omwe ali odwala.
- Odwala okalamba amakhala ndi vuto lachilombo (co-morbidities) kusiyana ndi odwala. Mbiri ya matenda a mtima, mwachitsanzo, ikhoza kuchepetsa kugwiritsa ntchito mankhwala enaake a chemotherapy. Chimodzimodzinso, mikhalidwe yomwe imachepetsa mapapu, monga emphysema, ingapangitse opaleshoni ya khansa ya m'mapapo kuchepa.
- Odwala okalamba amakhala otsika kwambiri pampingo kapena chiwindi, ndipo mankhwala ambiri omwe amagwiritsidwa ntchito pochiza khansa amatsukidwa kudzera mu impso kapena chiwindi.
- Odwala achikulire nthawi zambiri amakhala ndi thupi lochepa kwambiri, lopangitsa kuti asapitirize kuchepetsa kulemera kwa mankhwala enaake, ndipo amakhala oopsa kwambiri.
- Odwala achikulire nthawi zambiri amakhala ndi mafupa ang'onoang'ono a mafupa, omwe amachititsa kuti zikhale zovuta zokhudzana ndi kupweteka kwa mafuta m'thupi .
Kulosera Zomwe Zidzachitikire Chithandizo
Odwala okalamba ali pangozi chifukwa cha mantha chifukwa cha kulekerera kwa zaka, komanso poizoni chifukwa cha chithandizo chamankhwala. Ndikofunika posankha chithandizo kuti musunge zinthu ziwiri m'malingaliro: ganizirani zotsatira, ndipo ganizirani zomwe mukuyembekezera monga wodwala.
Kuchiza kwa Okalamba Achikulire
Kuwona njira zothandizira mankhwala, nkhaniyi idzayambitsa magawo a kansa ya m'mapapo m'matenda a khansa yamapapo, khansa ya m'mapapo yapamtunda, ndi kansa ya 4 ya metastatic yamapapo . Ngakhale kawirikawiri anthu omwe ali ndi khansa yaing'ono ya m'mapapo amatha kupaleshoni, mankhwala a chemotherapy nthawi zambiri ndiwo mankhwala oyamba.
Anthu ambiri amalingalira kuti anthu opitirira msinkhu wina sangakonde kuchita nkhanza, ndipo m'malo mwake amakhala ndi "chisamaliro chothandizira" kokha, koma izi sizikuwoneka choncho. Pofunsidwa za opaleshoni mu phunziro limodzi, 50 peresenti ya odwala okalamba anaika patsogolo kwambiri kupulumuka kusiyana ndi kupumula kwa zizindikiro.
Maphunziro oyambirira a khansa ya khansa ya akuluakulu
- Kupirira Kupirira ndi Kupulumuka - Pamene zikuoneka kuti kumverera pakati pa anthu kuti opaleshoni ya khansara yamapapo ingakhale yoopsa kwa okalamba, maphunziro sagwirizana ndi izi. Ndipotu, palibe kusiyana komwe kumachitika pakati pa odwala achikulire ndi odwala omwe akuchitidwa opaleshoni ya khansa ya m'mapapo yopanda maselo. Pamwamba pa izi, ma opaleshoni apamwamba akugwirizanitsidwa ndi miyezo yapamwamba yopulumuka kwa okalamba omwe ali ndi khansa yamapapo oyambirira.
- Mitundu ya Opaleshoni ya Khansa Yam'mimba - Pamene zikuwoneka kuti kupulumuka kwa okalamba omwe amatha kupaleshoni kwa khansa yamapapo oyambirira, sikuti mitundu yonse ya opaleshoni ya kansa ya m'mapapo ndi yofanana. Kafukufuku akuyang'ana mphero resection kapena lobectomy monga mankhwala apeza kuti ambiri achikulire amatha kupirira opaleshoniyo bwino. Komabe, kafukufuku akupeza kuti anthu ambiri okalamba amalandira pneumonectomy (kuchotsedwa kwa mapapo onse), ngakhale kuti ndikofunika kunena kuti maphunzirowa amapereka ziwerengero, ndipo nthawi zina dokotala angaganize munthu wamkulu adzapindula ndi njirayi. VATS (opaleshoni ya opaleshoni ya opaleshoni) ndi njira yochepa yochotsera osowa kapena mbali ya lobe ndipo ingakhale kusankha bwino kwa odwala osankhidwa (njirayi sizingatheke.Phunziro la 2018 linatsimikiziranso kuti achikulire (pa ali ndi zaka 80) amalekerera opaleshoni ya zotupa za m'mapapo komanso achinyamata akuluakulu, koma adapeza kuti gawo limodzi limagwirizanitsa ndi zotsatira zabwino.
- SBRT / Radiofrequency Ablation - Kwa anthu omwe ali ndi kansa ya m'mapapo ya m'mapapo yomwe sangathe kugwira ntchito kapena ngati wina sakufuna kupyola opaleshoni, nthawi zina zimakhala zogwiritsidwa ntchito poyerekeza ndi matenda a radiotherapy (SBRT) kapena kuperewera kwa dzuwa . Kusunga kwa okalamba achikulire omwe ali ndi SBRT ndizochepa kusiyana ndi opaleshoni koma bwino kuposa momwe zingakhalire ndi chithandizo chothandizira chokha. Mazira a pneumonitis (kutupa kwa mapapo chifukwa cha mazira) ndi ofala kwa okalamba omwe ali ndi njirayi koma nthawi zambiri amatha kuchiritsidwa.
- Kukonzekera Kwazitsulo - Kukonzekera kwa ukhondo pamaso kapena pambuyo pa opaleshoni ya khansa yamapapu ingakhale yopindulitsa kwa anthu a misinkhu yonse, koma makamaka okalamba.
Khansa Yopangika Kwambiri Pamalo Odwala Okalamba
Zaka zokha sizotsutsana (chifukwa chosafunika kuchita) kuchotsedwa kwa khansa yamapapo (resection) ndi adjuvant chemotherapy (chemotherapy yokonzera thupi la micrometastases-maselo a kansa omwe angakhalepo koma osakhala ochepa kuti asawoneke pazithunzi zojambula Kwa okalamba omwe ali ndi gawo 1 , siteji yachiwiri , ndi siteji ya 3A khansa yamapapo , opaleshoni ingaganizidwe (onani pamwambapa pamatenda oyambirira a kansa yamapapo pankhani ya opaleshoni).
Kuphatikiza pa opaleshoni, mankhwala a adjuvant chemotherapy nthawi zambiri amalimbikitsidwa kwa anthu omwe ali ndi khansara yamapapu yakumeneko. Pali umboni wochuluka wosonyeza kuti mankhwala a adjuvant pa stage 2 kapena siteji ya 3A ya kansa ya m'mapapo ingawathandize kupulumuka odwala achikulire osankhidwa bwino. Komabe, kafukufuku sanapeze kuti ma radiation apambuyo amathandiza kwambiri gululi. (Apanso, nkofunika kunena kuti izi ndi ziwerengero, ndipo pakhoza kukhala zifukwa zomveka dokotala angapatsire mankhwala othandizira ma ARV.)
Zapamwamba kapena Metastatic (Gawo 4) Khansa Yam'mimba mu Okalamba Achikulire
Popeza khansara ya mapapo 4 yamagazi ndi tanthauzo lafalikira kupyola m'mapapu, opaleshoni nthawi zambiri sangalimbikitsidwa.
Kwa anthu omwe ali ndi mapapu adenocarcinoma , ndi anthu omwe sanasute ndi khansa yamapapo yamtundu uliwonse, kufotokozera maselo (kuyesa kwa majini) kuyang'ana kusinthika kwa majini ochiritsira n'kofunika kwambiri. Kwa anthu omwe ali ndi kusintha kwa EGFR , rearrangement ya ALK ( khansa ya m'mapapo ya ALK ) kapena rearrangement ya ROS1 , njira zochiritsira zomwe zingathandizidwe zingapangitse kupulumuka kwapanda phindu, ndipo zotsatira za mankhwalawa nthawi zambiri zimakhala zochepa komanso zochepa kusiyana ndi mankhwala a mankhwala amtundu wa mankhwala.
Chemotherapy kawirikawiri ndi mankhwala opatsirana a kansa ya pakhungu 4, ndipo ndi odwala aang'ono, kuphatikizapo mankhwala awiri a chemotherapy nthawi zambiri amalangizidwa. Odwala ambiri okalamba samachiritsidwa ndi chemotherapy, komabe pamakhala phindu lopulumuka kwa omwe angathe kulekerera zotsatira zake. Kuphatikiza apo, kugwiritsa ntchito mankhwala awiri kungapangitse kukhala ndi mavuto aakulu kuposa kugwiritsa ntchito mankhwala osokoneza bongo okha.
Immunotherapy
Mankhwala oyamba a khansa ya m'mapapo ya khansa ya m'mapapo adavomerezedwa mu 2015 ndipo ena akuphunziridwa m'mayesero a zachipatala. Mankhwala a Immunotherapy angaganizidwe mophweka ngati mankhwala omwe amabwezeretsanso kuti chitetezo chathu cha chitetezo cha mthupi chiteteze khansa. Mankhwalawa samagwira ntchito kwa aliyense ali ndi khansara yamapapu, amatenga nthawi kuti ayambe kugwira ntchito, koma ngati athandiza, nthawi zina amatha kulamulira nthawi yaitali ngakhale khansa yapakhungu yamapapu. Kawirikawiri amalekerera mosavuta mankhwala omwe amachititsa kuti mankhwalawa asamalidwe.
Ngati Ndinu Munthu Wakukalamba Amene Ali ndi Khansa Yam'mimba
Ngati muli ndi zaka zoposa 70 kapena 80 ndi khansara yamapapo, kumbukirani kuti zaka zomwe mumachita "ndi" kumva "ndizofunika kwambiri kuposa zaka zomwe mumazilemba pa zolemba zanu zachipatala. Pa nthawi yomweyi, akatswiri azachipatala omwe sakudziwa inu komanso momwe mumadziwira nokha angawone zaka zomwe zalembedwera pazithunzi zanu ngati zofunika kwambiri. Ndizo zonse zomwe akuyenera kuyanjana nazo.
Izi zikutanthawuza, makamaka pakati pa nthano zomwe anthu achikulire sangathe kulekerera zotsatira za mankhwala, ndikuti muyenera kukhala ndi ubale wabwino ndi dokotala wanu. Onetsetsani kuti akudziwa kuti mwina muli ndi zaka 85 koma mumamva ngati muli ndi zaka 70. Tikuyamikira kuti tikukhala mu nthawi yomwe mankhwala a khansa akukhala ofanana kwambiri, komanso kusiyana pakati pa odwala akulemekezedwa. Izi zimati, kutenga nthawi yophunzira kukhala mtsogoleri wanu pa khansa yanu kumakuthandizani kuthana ndi mavuto omwe mukukumana nawo ndi khansa komanso mankhwala a khansa bwino, komabe zingakhale ndi gawo pa zotsatira zanu.
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