Khansa ya m'mimba ifalikire kumapula

Kusamalira Mankhwala a Lung Kuchokera ku Khansa ya M'mimba

Kodi zikutanthauzanji ngati kansa ya m'mawere ikufalitsa (metastasizes) m'mapapu anu? Kodi ndi zizindikiro ziti zomwe mungayembekezere, ndipo ndi mankhwala ati omwe alipo? Kaya mukudandaula kuti khansara yanu ingafalikire, kapena ngati mwaphunzira kuti ilipo, mwinamwake muli ndi mafunso ambiri. Ngakhale khansara ya m'mawere siimachiritsidwa, imachiritsidwa kwambiri, ndipo njira zatsopano zothandizira zowonjezera zakhala zikukula.

Tanthauzo

Mapapu ndiwachiwiri kwambiri komwe khansa ya m'mawere imafalikira pambuyo pa mafupa. Malo ena odziwika bwino a metastasis ndi chiwindi ndi ubongo, ngakhale khansara ya m'mawere ingafalikire pafupifupi gawo lililonse la thupi.

Khansara ya m'mawere imakula m'mapapu akadali khansa ya m'mawere. Ngati mutatenga chitsanzo cha maselo omwe amapezeka m'mapapu angakhale maselo a kansa ya m'mawere, osati maselo a khansa yamapapu. Anthu ena molakwika amatchula khansara yamapapu, koma m'malo mwake, amatchulidwa kuti "khansa ya m'mawere m'mapapo" kapena khansa ya m'mawere ndi mapiritsi a mapapo. "Zingathenso kutchedwa" khansa yachiwiri ya m'mawere . "

Maselo a khansa ya m'mimba akhoza kufalikira kudzera mu zotengera zamagulu kapena zamagazi. Popeza magazi onse amadutsa m'mapapo kuti atenge mpweya watsopano, n'zosadabwitsa kuti mapapu ndi malo omwe anthu ambiri amagwiritsa ntchito.

Ngakhale mapapu ammapapu ali ofanana, sizimagulu zonse za m'mapapo mwa amayi omwe ali ndi khansa ya m'mawere ndi metastases (onani m'munsimu), ndi kuyesedwa kochuluka ndipo kawirikawiri chidziwitso n'chofunika kuti zitsimikizire kuti zomwe zikuwoneka kuti zikugwedezeka sizinanso (monga khansara yamapapo kapena kutupa).

Chikoka ndi Makhalidwe

Phunziro limodzi lalikulu, la amayi omwe ali ndi khansa ya m'mawere, makumi asanu ndi limodzi ndi makumi asanu ndi atatu (36.4%) anali ndi masitimu a mapapu, ndipo 10,5 peresenti anali ndi mitsempha yamapapu yokha. Izi zikutanthauza kuti awiri mwa magawo atatu a amayi omwe amapanga mavitamini a m'mapapo ali ndi zigawo zina m'madera ena a thupi.

Anthu ena omwe ali ndi khansa ya m'mawere amatha kukhala ndi mavitamini a m'mapapo kusiyana ndi ena.

Ndithudi, anthu omwe ali ndi zaka zapamwamba kwambiri za khansa ya m'mawere oyambirira amakhala ndifupipafupi, ndipo izi ndi zoona kwa iwo omwe ali ndi mimba yapamwamba kwambiri. Nthawi yambiri pakati pa nthawi yoyamba ya khansa ya m'mawere yoyamba ikupezeka ndipo chitukuko cha masastases ndi mapepala 68.6 miyezi.

Mankhwala a metastases amawoneka bwino kwambiri mwa amayi kusiyana ndi amuna omwe ali ndi khansa ya m'mawere, ku Africa American vs Caucasians, komanso mwa omwe ali ndi zotupa zomwe ndi estrogen receptor zoipa ndi HER2 zabwino , onse omwe ali estrogen receptor ndi HER2 zabwino, ndi omwe ali ndi katatu khansa ya m'mawere.

Zizindikiro

Pamene khansa ya m'mawere imayamba kufalikira kumapapo, sizingayambitse zizindikiro. Pamene zizindikiro zimapezeka, zimakhala ndi izi:

• Kupuma pang'ono (poyamba kungakhale kobisika, kokha ndi ntchito): Ichi ndicho chizindikiro choyamba choyamba
• Chifuwa chosatha
• Kupweteka kwa chifuwa, kapena kupweteka ndi kupuma kwakukulu ( kupweteka kwa chifuwa chofufumitsa )
• Matenda a chifuwa monga bronchitis kapena chibayo

Zizindikiro zina zingaphatikizepo kuthamanga, kukhumudwa, kukhetsa magazi, kutopa, ndi kutayika kosalemetsa .

Zizindikiro za Kusokonezeka Kwambiri

Pamene khansa ya m'mawere imafalikira ku pleura (kupuma kwa mapapu), madzi amadzimangira m'maganizo (pleural effusion) omwe angapangitse mapapo ndipo nthawi zina amachititsa kuti mpweya ukhale wofulumira.

Kuwombera kwachinyengo kumachitika pamene khansara ya m'mawere imafalikira kumapapo, koma ikhozanso kupezeka popanda mapapo a m'mapapu ngati khansara imafalikira ku mitsempha ya m'mimba mkati mwa mapaipi.

Kudziwa

Pali njira zingapo zomwe zingapezeke kuti mupeze matenda a m'mapapo.

• Chifuwa cha X-ray: Chifuwa cha x-ray nthawi zambiri chimayesedwa koyamba, koma sichikhoza kuphonya mankhwala ochepa kwambiri a khansa ya m'mapapo.
• Chifuwa chachikulu cha CT: Chifuwa cha CT chimatha kutenga mitsempha yomwe imakhala yaying'ono kwambiri kusiyana ndi yomwe imawonekera pa chigamulo cha x-ray, ndipo imatha kuwonetsa zovuta zonse.
• PET kuyesa: PET kuyesa ndiyeso yomwe imayang'ana malo okula mofulumira, ndipo ndiyeso yeniyeni yowonetsera metastases.

• MRI: Imatchedwanso magnetic resonance imaging imagwiritsidwa ntchito mobwerezabwereza, koma nthawi zina imathandiza.
• Bronchoscopy: bronchoscopy ndi chiyeso chomwe chimagwiritsira ntchito chubu chimaikidwa pakamwa ndikukwera mpaka ku bronchi. Zingakhale zothandiza pakutola zotupa pafupi ndi misewu yaikulu.

Chimake

Ngakhalenso mapangidwe ammapapu amatsutsidwa kwambiri pogwiritsa ntchito maphunziro a kujambula, chiwindi cha mapapo nthawi zambiri chimapangidwa. Izi ndi zofunika kwambiri pazifukwa ziwiri:

1. Sikuti mapapu onse amawombera akazi omwe ali ndi khansa ya m'mawere ndi metastases, ndipo kwenikweni, ambiri sali. Phunziro limodzi, mitsempha ya m'mapapo inafotokozedwa mwa amayi omwe anachiritsidwa ku khansa ya m'mawere oyambirira, 47 peresenti ya mitsempha ya mitsempha imayimilira ma breastastases. Mayi 40 peresenti ya mitsempha ya khansa ndi khansa yapakhungu yamapisozi (yomwe imakhala yambiri pamapapo mapapo a adenocarcinoma , mtundu wa khansara wamapapu wambiri mwa anthu osasuta), ndipo 13 peresenti anali oopsa (kutupa kapena chibayo).
2. Chifukwa cha kusagwirizana. Anthu akayamba kuchitidwa khansa ya m'mawere, adziphunzira ngati ali otchedwa estrogen receptor kapena HER2 zabwino. Izi zingasinthe. Khansa sizimangokhala maselo osasinthika a maselo, koma nthawi zonse amasintha kusintha kwatsopano ndikusintha maonekedwe awo. Phunziro lalikulu, 20 peresenti ya anthu omwe ali ndi kachilombo ka khansa yoyambirira ya mfuti inali yosiyana ndi momwe amachitira khansa ya m'mawere yomwe imatha kuchepa m'mapapo.

Zosankha zokhudzana ndi mapapu zimaphatikizapo chidziwitso cha singano (njira imene singano imayikidwa kudzera m'mapapo kuti mupeze minofu) kapena transbronchial biopsy (njira yofananamo koma kudzera mu khoma lachimake pa bronchoscopy) .

Njira Zothandizira

Njira zochiritsira zidzasiyana malinga ndi zinthu zambiri, monga momwe zimakhalapo (osakwatiwa, owerengeka, kapena ambiri) komanso momwe aliri, kaya mapapu ndi malo okhawo a metastase kapena ngati metastases alipo m'madera ena komanso ( monga mafupa, chiwindi, kapena ubongo), ndi mankhwala ati omwe mwakhala nawo m'mbuyomo, momwe mumalandira mchere (izi zingasinthe), thanzi lanu lonse, ndi zina zambiri. Njira zochiritsira zidzadaliranso ndi zofuna zanu, ndipo mukulakalaka kukhala achiwawa.

Zosankha nthawi zambiri zimasweka m'magulu awiri:

• Mankhwala othandiza: Mankhwala othandiza ndi omwe amachititsa maselo a khansa ali paliponse m'thupi.
• Zochitika zapanyumba: Zochiritsira zakumunda zimagwiritsa ntchito maselo a khansa okha omwe ali mbali ya thupi, pakalipa, mapapo.

Zosankha Zochiza Matenda: Kusankha njira zothandizira kumadalira zifukwa zambiri. Ndikofunika kuzindikira kuti cholinga chachikulu cha mankhwala opatsirana khansa ya m'mawere n'chosiyana ndi khansa ya m'mawere oyambirira, ndipo izi zingachititse mantha ndi chisokonezo. Pokhala ndi khansa ya m'mawere oyambirira, nthawi zambiri mankhwala amawopsa, ndi cholinga chochiza matendawa. Khansara ya metastatic sichirachiritsidwa, ndipo cholinga cha mankhwala ndi kuchepetsa kukula kwa chotupacho ngati chithandizo chochepa ngati n'kotheka. Kugwiritsa ntchito nkhanza kwambiri sikusintha moyo, koma kumawonjezera kuchuluka kwa zotsatirapo ndi kuchepetsa umoyo wa moyo. Zosankha zikuphatikizapo:

• Chemotherapy: Pali mitundu yosiyanasiyana yambiri yomwe ilipo, kotero ngakhale mutakhala ndi chemotherapy musanayambe, pali zina zambiri.
• Thandizo la mahomoni: Kusankhidwa kwa mankhwala a mahomoni kumadalira ngati analigwiritsidwa ntchito kale kapena ayi, chifukwa chotupa chomwe chinakula ndi kufalikira ndi chithandizo chomwe munalandira (monga tamoxifen kapena chimodzi mwa aromatase inhibitors) ndi chotheka ku mankhwalawa.
• Thandizo lothandizira: HER2 zogwiritsidwa ntchito zothandizira zimagwiritsidwa ntchito kuti zithetse zilonda zabwino za HER2. Pali njira zingapo zothandizira ma ARV pa khansa ya m'mawere ya HER2 .
• Zilonda zam'chipatala: Kuphatikizana ndi magulu atsopano a mankhwala, mankhwala atsopano monga immunotherapy ndi PARP inhibitors akuyesedwa m'mayesero a zachipatala. Onetsetsani kuti mungalankhule ndi dokotala wanu za mayesero alionse omwe alipo, monga momwe chithandizo cha khansa yapamwamba chikuyendera mofulumira.

Local Treatment Options: Njira zakuchipatala zam'deralo zimangotengera mapepala okhaokha. Mankhwala am'deralo sagwiritsidwa ntchito kawirikawiri ngati pali ziwerengero zambiri za m'mapapo, makamaka pamene zimakhala ndi metastases ku zigawo zina za thupi. Komabe, pakakhala masastases ochepa okha, kulamulira kwanuko (monga kuchotsa opaleshoni) kungapangitse kukhala ndi moyo. Zosankha zikuphatikizapo:

• Mankhwala othandiza mafilimu: Njira yodziwika bwino yothandizira ma radiation yotchedwa stereotactic body radiation therapy ( SBRT ) imapereka miyezo yambiri ya mazira m'dera laling'ono (mosiyana ndi mmene imagwiritsiridwa ntchito ndi dzuwa pambuyo pa lumpectomy kapena mastectomy). Nthawi zina, izi ndi zofanana ndi kuchotsa opaleshoni ya metastasis.
• Opaleshoni: Opaleshoni yochotsa mitsempha imatchedwa metastasectomy , ndipo ikhoza kuganiziridwa ngati ilipo, kapena ndi masastases ochepa chabe. Mu kafukufuku wina wam'mbuyo, kupweteka kwa matenda a metastasectomy kwa anthu omwe anapatsidwa chisankho ichi. Njira yowonjezeka kwambiri yogwiritsidwa ntchito ndiyo mphete yothetsera .
• Kugwiritsa ntchito mankhwala osokoneza bongo (RFA): RFA sinaphunzire pa digiri imodzi, koma ingagwiritsidwe ntchito nthawi zina.

Kuchiza kwa Pleural Effusions

Zomwe zimapangidwira zimatha kukhala zowonongeka, pomwe zimakhala zowonjezereka m'malo ozizira chifukwa cha kutupa, kapena zovulaza ( zowopsya ) zomwe ziri ndi maselo a kansa.

Gawo loyamba lachiritso kawirikawiri ndi thoracentesis, ndondomeko yomwe singano imayikidwa kupyolera mu khoma lachifuwa kuti imachotse nyemba. Ngati kuphulika kwakukulu, chifuwa cha chifuwa chiyenera kuikidwa kuti chichotse madzi.

Tsoka ilo, ngakhale ngati madzi akuchotsedwa kuchoka pamtambo wambiri, nthawi zambiri amawonjezeranso. Ngati izi zikuchitika pali zosankha zambiri. Nthawi zina zimakhala zowonjezera kuti madzi amatha kuyamwa mosalekeza (anthu amatha kupita kunyumba ndikutha kukhetsa madziwo). Njira ina ndi pleurodesis . Mwa njirayi, mankhwala osokoneza bongo (talc) amaikidwa pakati pa nembanemba zomwe zimawapangitsa kuti aziwombera pamodzi kuti madzi asadziwe. Pa milandu yovuta, pleura ingafunike kuchotsedwa ( pleurectomy ).

Kusamalira Zizindikiro

Kuphunzira kuti muli ndi khansa ya m'mawere ikuwopsya, ndipo anthu ambiri amadzifunsa ngati angavutike. Mwamwayi, pali njira zambiri zogwiritsira ntchito zizindikiro zowopsa za m'mapapo.

• Ululu: Mapapu pawokha alibe mapeto a mitsempha omwe amawonekeratu kupweteka, koma kukhumudwa kwachitsulo chodandaula kuchokera ku chiwonongeko sikungakhale kovuta kwambiri. Pali zambiri zomwe mungachite kuti musamavutike. Anthu ena amadwala mankhwala opweteka, poopa kuti sangakhale ndi zosankha m'tsogolomu ngati ululu ukupitirirabe. Izi siziri choncho, ndipo ndizofunika kuti umoyo wanu ukhale ndi ululu wabwino.
• Kupuma pang'ono: Pali miyeso yambiri yomwe ingathandize ndi mpweya wochepa. Ngati muli ndi spasms mu airways, inhaler ingagwiritsidwe ntchito. Steroids amagwiritsidwa ntchito mwachindunji kapena mwachangu ndi othandiza kwambiri. Morphine ukhoza kukhala othandiza kwambiri kuchepetsa chizindikiro cha mpweya wochepa komanso nkhawa zomwe zimagwirizana. Oxygen sizothandiza kwambiri koma ndizochonso.
• Kudandaula: Kawirikawiri, mankhwala osokoneza bongo, ngakhale pang'ono ting'ono, amatha kutuza chifuwa chokhumudwitsa. Njira zowonongeka, monga kupewa kupuma mpweya woziziritsa, kuthamanga pamene mukuyenda, kupewa kusokoneza chilengedwe monga utsi ndi zowawa kumathandiza anthu ena. Supuni ya tiyi ya uchi ingathandizenso kuchepetsa chifuwa.
• Kupewa kwa kayendedwe ka ndege : Nthawi zina zimapangika m'mapapu akukula mumlengalenga. Izi zikhoza kuchititsa kuti mpweya ukhale wochepa, komanso kuonjezera chiwopsezo cha chibayo choyamba kupitirira kuperewera. Mphungu ikhoza kukhazikitsidwa kuti mphepo ikhale yotseguka. Palinso zina zomwe mungasankhe, monga mankhwala ochizira.

Kuthamangitsani

Malingaliro a moyo pambuyo poti matenda a metastases a m'mapapo amapezeka kuchokera ku khansa ya m'mawere si zomwe tingafune, koma zikuwongolera. Kuchuluka kwa moyo wapakati (nthawi yomwe theka la anthu ali ndi moyo ndi theka lafa) inali miyezi 21, mu phunziro limodzi, ndi 15.5 peresenti ya anthu akuchita bwino pambuyo pa zaka zitatu.

Nthendayi imakhala yotsika kwambiri ngati metastases ikhoza kuchotsedwa kapena kuchiritsidwa ndi SBRT, opaleshoni (metastasectomy), kapena RFA. Tilibe maphunziro omwe amatsimikizira izi, koma kafukufuku wa 2018 mpaka lero anapeza kuti zaka 5 zomwe zimachitika pakati pa amayi omwe ali ndi matenda a m'mapapo ndi omwe anali ndi 46 peresenti. Kwa iwo omwe anali ndi matenda a metastasectomy, makamaka, kupulumuka kwapakati kwapakati kunawonjezeka mpaka miyezi 103.

Zonsezi, zikuwoneka kuti ndizobwino kwa amayi omwe ali ndi zotupa zomwe zimapezeka ndi estrogen receptor ndi HER2 zabwino, omwe ali ndi inshuwalansi ya zachipatala, ndi omwe ali okwatirana.

Mawu Ochokera

Ngati mwauzidwa kuti mutha kukhala ndi masewera ammapapu pamayesero a masewero musanayambe khansa ya m'mawere m'mbuyomo, nkofunika kukhala ndi chiwopsezo. Mu maphunziro, theka, ndi mpaka atatu-magawo anai a mitsempha ya m'mapapo atapezeka kuti asakhale khansara ya m'mawere.

Zosankha zamankhwala zowonongeka ndi zam'deralo zilipo, ndipo ngati muli ovomerezeka ku zithandizo zam'dera lanu monga kuchotsa opaleshoni ya metastases, kapena SBRT, ndizopulumuka. Palinso mayesero angapo am'chipatala poyesa njira zatsopano zowonjezera zowonjezera zomwe zingapangitse kukhala ndi moyo m'tsogolomu.

Ngati mwangophunzira kuti muli ndi khansa ya metastatic, pitani kwa anzanu. Funsani mafunso ambiri ndipo khalani ovomerezeka anu mu chisamaliro chanu. Ngakhale pamene sitingathe kupulumuka kwa nthawi yayitali, zizindikiro zimatha kuyang'aniridwa kuti zikupangitseni kukhala ndi moyo wabwino kwambiri mukakhala ndi khansa ya metastatic.

> Zotsatira:

> Berman, A., Thukral, A., Hwang, W., Solin, L., ndi N. Vapiwala. Zochitika ndi Zitsanzo za Metastases Yambiri kwa Odwala Amene Ali ndi Matenda Oyamba Kumayamwitsa Kachiwerewere pambuyo pa Breast Conservation Surgery. Khansa ya m'mimba ya khansa . 2013. 13 (2): 88-94.

> Jin, X., ndi P. Mu. Kuwunikira Canast Metastasis. Khansa ya m'mawere (Auckland) . 2015. 9 (Suppl 1): 23-34.

> Matsuura, K., Itamoto, T., Noma, M. et al. Kufunika kwa Mphungu Yam'mimba Chifukwa cha Kuzindikira Kwambiri kwa Mankhwala Okhazikika M'matenda a Khansa ya m'mawere. Maselo ndi Ochipatala Oncology . 2018. 8 (2): 250-256.

> Chiguduli M., Love S. (2018) Udindo wa Opaleshoni mu Lung Metastases kuchokera ku khansa ya m'mawere. Mu: Wyld L., Markopoulos C., Leidenius M., Senkus-Konefka E. (eds) Chithandizo cha khansa ya m'mimba kwa Ochita opaleshoni. Springer, Cham.

> Xiao, W., Zheng, S., Liu, P. et al. Zowopsa ndi Zopulumuka kwa Odwala ndi Khansa ya M'bwere ndi Mayungidwe a Mitsempha: Phunziro Lochokera kwa Anthu. Cancer Medicine . 2018 Feb 23. (Epub patsogolo pa kusindikiza).