Zizindikiro, Chithandizo ndi Kutupa
Matenda a khansa ya m'magazi (metastatic) ku chiwindi amavuta kwambiri. Pafupifupi 40 peresenti ya anthu omwe ali ndi khansara yamapapu ali ndi mitsempha kupita ku dera lakutali kwambiri. Kodi mungayang'ane chiyani ngati khansara yanu ya mapapu yatayika ku chiwindi?
Mwachidule
Khansa ya m'magazi yomwe yafalikira pachiwindi imatchedwa "khansa yamapapu yamapapo ku chiwindi" (mosiyana ndi khansa ya chiwindi ya chiwindi, yomwe ingatanthauze khansa yomwe inayamba pachiwindi ndi kufalikira ku dera lina la thupi).
Kwa anthu omwe ali ndi khansa ya m'mapapo yopanda maselo , kufalikira kwa khansara ku chiwindi kungawononge ngati khansara 4 . Ndi khansa yaing'ono yamapapu ya m'mapapo , idzakhala ngati malo ochezera .
Khansara ya m'magazi ikhoza kufalikira kumadera alionse a thupi, koma nthawi zambiri imafalikira ku chiwindi, maselo a m'mimba, ubongo, mafupa, ndi adrenal glands. Kawirikawiri khansa ya m'mapapo idzafalikira kumadera oposa thupi limodzi. Mwachitsanzo, kawirikawiri zimakhala ndi chiwindi cha chiwindi ndi metastases ya ubongo.
Tiyeni tiwone zizindikiro za matenda a chiwindi ndi momwe amachitira. Mwinanso mungafune kuphunzira za kayendetsedwe ka:
- Matenda a ubongo kuchokera ku khansa ya m'mapapo
- Matenda a metastases ochokera ku khansa ya m'mapapo
- Adrenal gland metastases kuchokera ku khansa ya m'mapapo
Zizindikiro
Ngati kansa ya m'mapapu yafalikira ku chiwindi, simungakhale ndi zizindikiro zilizonse. Ndipotu, kufalikira (metastasis) kawirikawiri kumapezeka pamene mayesero, monga scan scan kapena PET, amawunikira kuti adziwe kansa ya kansa yanu.
Ngati muli ndi zizindikiro, izi zingaphatikize kupweteka pansi pa nthiti kapena m'mimba mwanu pambali ya thupi lanu, ndi zizindikiro zambiri, monga kusowa kwa njala ndi nseru. Ngati muli ndi zotupa zambiri mu chiwindi kapena ngati metastasis ndi yayikulu mokwanira kuti izilepheretsa kuti mudye, mukhoza kuyamba kupweteka kwa khungu, khungu loyera la khungu lanu ndi mbali yoyera ya maso anu.
Metastase ya chiwindi imasokonezanso metabolism ya bile yomwe imayambitsa ma salt bile pakhungu. Izi zingabweretse kuyabwa kwakukulu ndi kokhumudwitsa.
Kudziwa
Mayesero omwe angapangidwe kuti apeze chiwindi cha chiwindi kuchokera ku khansa yamapapo ndi awa:
- CT scan ya mimba
- Mimba ya ultrasound
- MRI ya mimba
- PET kuyesa
Kusatsimikizika kwa Zotsatira za Chiwindi Ndizofala
Ndikofunika kuzindikira kuti zotsatira zosazolowereka zimakhala zachilendo pamene chiwindi chimayambira, ndipo nthawi zina zimakhala zovuta kudziwa ngati malo kapena mawanga pachiwindi ndi chifukwa cha kufalikira kwa khansara kapena chifukwa china. Ngati dokotala sakudziwa ngati chizoloŵezi cha chiwindi chanu chikugwirizana ndi khansara yanu, ndipo njira yothetsera imasiyana malinga ndi zotsatira zake, akhoza kuyambitsa chiwindi cha chiwindi kuti ayang'ane minofuyo kuti adziwe kuti mukudwala.
Zingakhale zokhumudwitsa ngati dokotala sakudziwa za zomwe zapezeka m'chiwindi chanu, ndipo izi zingakupangitseni kuda nkhawa ndi kusamalidwa kwanu. Zingakhale zothandiza kudziwa kuti izi ndi zachilendo komanso kuti pali zambiri zomwe zimachitika pakati pa "zachibadwa" zosaoneka bwino m'chiwindi ndi chiwindi cha chiwindi.
Chithandizo
Zakale, chithandizo cha kansa ya m'mapapo yomwe yafalikira pachiwindi inali yaikulu kwambiri, kutanthauza kuti cholinga cha chithandizo ndi kuthetsa zizindikiro kusiyana ndi kuyesa kuchiza matendawa.
Chemotherapy ingagwiritsidwe ntchito pochizira gawo lachinayi.
Chivomerezo cha mankhwala opatsirana onse (mankhwala omwe amachititsa kusintha kwa EGFR kusintha , ALK rearrangements , ndi ROS1 kukonzanso zina mwa ena) ndipo matendawa amayamba kusintha pulogalamuyo, ndipo nthawi zina, mankhwalawa angayambitse matenda a khansa ya m'mapapo nthawi yaitali .
Mankhwala opatsirana amapitirizabe kukhala njira yoyamba pamene ambiri a chiwindi amapezeka, koma omwe ali ndi miyeso yochepa-chinachake chimatchedwa "oligometastases" -kusintha.
Matenda a Mitastases
M'mbuyomu, ngati kamodzi kokha kameneka kanali pachiwindi, opaleshoni sikunkachitidwa kuti kuchotsa chotupacho, koma njira zatsopano zothandizira mazirazi zikukula pa izi.
Kwa omwe ali ndi oligometastases, omwe amatchulidwa ngati "mawanga" amodzi okha a matenda a metastatic, makamaka omwe ali ndi vuto lothandizira kusintha kwa majini , njira ziwiri zoyambira ma radiwe zakhala zikuwonetsedwa kuti zithetsedwe pamasewero a odwala. Izi zikuphatikizapo:
- SBRT - Thupi la radiotherapy (Stereotactic body radiotherapy) ndi njira yomwe mliri wamatenda amawunikira kumadera ang'onoang'ono komanso omwe ali ndi chiyembekezo chochotseratu metastases.
- SABR - Miyendo yotchedwa abelative radiation yowonjezereka ndi njira ina yamagetsi yotchedwa "ablate" kapena kuwononga dera laling'ono monga masastasis.
Poyerekeza ndi opaleshoni, njira zonsezi (zomwe zimatchedwa metastasectomy) ndizochepa kwambiri ndipo zimakhala ndi mphamvu zowonongeka. Ndi zotsatira za SBRT zoyambirira zawonetsa kupulumuka kwapakatikati kwabwino (nthawi yomwe theka la anthu ali moyo ndi theka lafa) ndipo pafupifupi 25 peresenti ya moyo wautali mwa odwala osankhidwa mosamala. Zilonda zamakono zikupitirizabe kupenda phindu la masewasectomy kwa oligometastases ndi khansara ya chiwindi, ndipo kusintha kwapadera pa chithandizo cha chikhalidwe ichi chikuchitika.
Anthu omwe ali ndi zotsatira zabwino ndi mankhwalawa amaphatikizapo anthu omwe ali ndi zochepetsetsa zochepa, zomwe munthu amachiritsidwa ndi malo onse omwe amadziwika ndi khansa, komanso omwe ali ndi nthawi yayitali yopanda matenda.
Kuthamangitsani
Khansara ya m'mimba yomwe yafalikira pachiwindi, n'zomvetsa chisoni kuti imakhala ndi vuto lopweteka kwambiri. Kupulumuka kwapakati kwa anthu omwe amakhala ndi kansa yaching'ono ya maselo (metastatic) yamapapo ya pafupi ndi miyezi isanu ndi itatu, ngakhale pali chiyembekezo chakuti ziwerengero zatsopano zogwirizana ndi anthu ndi zochepa zomwe zimayambitsidwa ndi chiwindi zogwiritsidwa ntchito ndi njira zamakono zowonongeka zimadzetsa kupulumuka kwapamwamba. Kawirikawiri nthawi ya moyo ya anthu omwe ali ndi kansa yapamtunda (metastatic) khansa ya m'mapapo ndi miyezi iwiri kapena inayi yopanda chithandizo ndi miyezi isanu ndi umodzi pachaka ndi mankhwala.
Thandizo
Zingakhale zomvetsa chisoni kuti mudziwe kuti khansara yanu yayamba. Ndipo pamwamba pa chisoni chanu, nthawi zambiri mumakhala ndi zinthu zana zomwe mukuganiza kuti muyenera kuchita. Poyamba, kumbukirani kuti mankhwala opatsirana khansa ya m'mapapo akukwera-ngakhale pazitsamba zakutsogolo kwambiri. Ngati mukumva bwino ndikukhala ndi zochepa chabe, kambiranani ndi dokotala wanu za mankhwala omwe alipo tsopano. Pali mankhwala ambiri atsopano, koma mwatsoka, izi zikusintha mofulumira kwambiri moti zimakhala zovuta kuti aliyense asazindikire zomwe zikuchitika.
Nyuzipepala ya National Cancer Institute imalimbikitsa kuti anthu omwe ali ndi khansara yamapapu yakuya amalingalire kutenga mbali mu mayesero a zachipatala. Zitha kukhala zovuta kwambiri kuyesa kuyenda izi, koma zikondwerero zambiri za magulu a khansa yamapapu zagwira ntchito pamodzi kuti zithe kuyesa kuyerekezera khansa yamapapu yowononga mapapu , komwe woyendetsa sitima angathandize kuthana ndi khansara yanu yamapapo ndi mayesero a kachipatala kulikonse mdziko lapansi.
Pamene khansara sichichiritsidwa kapena kukhala ndi moyo, palinso njira zambiri zopezera anthu kukhala osangalala kuti asangalale ndi masiku awo otsiriza ndi okondedwa awo. Onani njira izi zothana ndi khansa yomaliza.
> Zotsatira:
> Bergsma, D. et al. Ntchito Yosintha ya Radiotherapy mu Chithandizo cha Oligometastatic NSCLC. Kufufuza kwa Akatswiri mu Mankhwala Opangira Anticancer . 2015. 15 (12): 1459-71.
> Guerrero, E., ndi M.Ahmed. Udindo wa Sterotactic Wopambana Radiotherapy (SBRT) mu Utsogoleri wa Oligometastatic Non-Small Cell Lung Cancer. Khansa Yam'mimba . 2016. 92: 22-8.
> Rusthoven, C., Yeh, N., ndi L. Gaspar. Thandizo la ma ARV kwa Oligometastatic Non-Small Cell Lung Cancer Lung: Theory and Practice. Khansa Journal . 2015. 21 (5): 404-12.
> Salama, J., ndi S. Schild. Thandizo la Ma Radiation kwa Oligometastatic Non-Small Cell Lung Cancer. Kanema Metastasis Review . 2015. 34 (2): 183-93.
> Ueda, J. et al. Kutsutsidwa kwa Opaleshoni Yopangidwa ndi Wodwala Metastatic Chiwindi Tumor Yachokera ku Khansa ya M'mimba: A Case Series. Hepatogastroenterology . 2012. doi: 10.5753 / hge12000. (Epub patsogolo pa kusindikiza).