Mayesero ndi Ndondomeko Zowunikira Khansa Yam'mimba
Matenda a khansa yamapapu angayambe ndi chifuwa cha x-ray, koma popeza mayesowa amatha kuphonya khansa yoyambirira, chifuwa chachikulu cha CT, ndipo pamapeto pake chimafunika ngati chifuwa kapena minofu chikupezeka.
Kawirikawiri khansa ya m'mimba imakayikira pambuyo poti malo osadziwika amapezeka pachifuwa cha x-ray kuti ayese kupweteka kwa chifuwa kapena chifuwa. Pa nthawi yoopsyayi, ndi zothandiza kudziwa njira zomwe zingakonzedwe kuti mudziwe ngati zachilendo ndizosaononga (osati khansa), kapena zoopsa (khansa).
Ngati kusalongosoka kuli kosautsa, kufufuza kwina kumachitika kuti tiwone ngati khansara yayamba kufalikira ( m'magazi ) m'madera ena mu thupi ndi kufotokoza ndondomeko ya matenda.
Kuwongolera Khansa Yam'mimba
Kwa omwe alibe zizindikiro, kuyezetsa khansa ya m'mapapo tsopano yavomerezedwa kuti ayambe kufufuza kwa anthu omwe ali pakati pa zaka zapakati pa 55 ndi 80, asuta fodya kwa zaka zosachepera 30, ndipo amasuta kapena kusiya kusuta fodya m'zaka 15 zapitazo. Ndikofunika kuzindikira kuti, kuyesera kuyesedwa kuti ikhale yeseso kwa omwe alibe zizindikiro. Ngati muli ndi zizindikiro za khansara yamapapo, mayeso ena, kuphatikizapo CT scan full.
Maungulo "Mawanga" ndi Mafotokozedwe Ena
Musanapite ku matenda a khansa ya m'mapapu, mumakhala mukudandaula ndi zizindikiro zanu, komanso kuti dokotala wina wawona kapena akudziwoneka kuti ndi wodabwitsa. Monga ndemanga yofulumira, Monga ndemanga yofulumira, chifuwa cha mapapo chimatengedwa ngati "malo" pamapapo omwe ali masentimita atatu (inchi ndi theka) kapena osachepera.
Mafupa amatanthauza chinthu chachilendo chomwe chili chachikulu kuposa masentimita atatu . Malo pamapapo kapena "mapapo a m'mapapo" angakhale oopsa kapena oopsa. "Mthunzi" pa x-ray ukhozanso kukhala wodetsa kapena wosasangalatsa, kapena kungowamba kumene mu chifuwa.
Mbiri ndi Thupi
Pamene khansa ya m'mapapo imakayikiridwa, dokotala adzayamba kuchita mbiri yake yonse ndikuyesa.
Izi zachitika pofufuza zizindikiro ndi zoopsa za khansa ya m'mapapo , ndi kuyang'ana zizindikiro zilizonse zomwe zimapangitsa kuti mapaipi apitirire . Izi zingaphatikizepo mapuloteni osapsa, mapuloteni owonjezera, kutaya kwadzidzidzi , kapena kugwiritsira ntchito zikhomo (zikhomo).
Maphunziro ndi Maphunziro a Zamankhwala
Zitsanzo zosiyanasiyana zojambula zojambula zingakhale zofunikira, malingana ndi zizindikiro zanu komanso zomwe mwapeza pa mayeso. Izi ziphatikizapo:
Chifuwa cha X Ray
Chifuwa cha x-ray nthawi zambiri amayesedwa pofuna kuyesa zodetsa nkhaŵa zokhudzana ndi mbiri yakale komanso zakuthupi. Izi zikhoza kusonyeza unyinji m'mapapu kapena mitsempha yowonjezera. Nthawi zina chifuwa cha x-ray ndi chachilendo, ndipo mayesero ena amafunika kuyang'ana khansara yamakono. Ngakhale misa ikupezeka, izi sizimakhala zosautsa nthawi zonse ndipo maphunziro ena amafunika. Tiyenera kugogomezera kuti chifuwa cha ray chokha sichikwanira kuletsa khansa ya m'mapapo, ndipo mayesero oyambirira akhoza kusoweka mosavuta ndi mayesero awa.
CT scan
Kafukufuku wa CT (computerized tomography) kawirikawiri ndilo gawo lachiwiri lotsatira chifuwa chachilendo cha x-ray kupeza kapena kufufuza zizindikiro zovuta kwa iwo omwe ali ndi chifuwa cha x-ray. Kuyeza kwa CT kumaphatikizapo mndandanda wa x-rays zomwe zimapanga maonekedwe a mapaipi atatu.
Ngati CT ndi yachilendo, matenda a kansa ya m'mapapo akufunikanso kutsimikiziridwa pogwiritsa ntchito minofu imodzi mwa njira zotsatirazi.
MRI (kujambula kwa magnetic resonance)
Kwa anthu ena, kujambulidwa kwa MRI (magnetic resonance imaging) kudzagwiritsidwa ntchito pofufuza momwe mungathere ndi khansa ya m'mapapo. Njirayi imagwiritsira ntchito magnetism ndipo sichikuphatikizapo ma radiation. Anthu ena, monga omwe ali ndi zitsulo zopangira zitsulo (pacemakers, etc.) sayenera kukhala ndi MRI. Wogwira ntchitoyo adzafunsa mafunso kuti atsimikizire kuti palibe.
PET Scan
Kufufuza kwa PET (positron emission tomography) kumagwiritsa ntchito mafilimu opangira mafilimu kuti apange zithunzi zamitundu itatu za chigawo cha thupi.
Kansalu kameneka kamasiyana ndi ena chifukwa chimatanthauzira zotupa zomwe zikukula. Kagulu ka shuga ka radioactive kakaloledwa m'magazi, ndipo amapatsidwa nthawi yokwatulidwa ndi maselo. Maselo omwe akukula mofulumira amatenga shuga wambiri, ndikuwunika mafilimu. Kawirikawiri mayesowa ali ndi CT scan (PET / CT). Monga kuwonjezera pa njira zina, ochita kafukufuku ena amati PET kusinkhasinkha amatha kuzindikira matenda m'mbuyomu, ngakhale asanakhale akuwoneka mwa maphunziro ena. Kufufuza kwa PET kumathandizanso posiyanitsa pakati pa zotupa ndi minofu mu anthu omwe akusowa m'mapapo chifukwa cha chifukwa chilichonse.
Chiputu cha Cytology
Pambuyo pa khansa yamapapu imakayikiridwa pogwiritsa ntchito kujambula, chinyama cha minofu chiyenera kutsimikiziridwa kuti chimapezeka ndi kudziwa mtundu wa khansara. Puloteni ya cytology ndiyo njira yosavuta yochitira izi, koma kugwiritsa ntchito kwake kumangokhala kwa ziphuphu zomwe zimapitilira mumlengalenga. Mphungu ya cytology si nthawi zonse yolondola ndipo imatha kuphonya ma selo a khansa. Chiyesocho ndi chopindulitsa kwambiri pamene chitsimikizo, koma chimanena pang'ono ngati chiri cholakwika.
Bronchoscopy
Mu bronchoscopy , katswiri wamapapu amachititsa chubu kupita mumlengalenga kuti aganizire ndi kutenga chitsanzo cha chotupacho. Njirayi imagwiritsidwa ntchito pamene chotupacho chikupezeka mumtunda waukulu wa mpweya ndipo chikhoza kufika pamtunda. Odwala amapatsidwa anesthesia panthawiyi kuti kuchepetsa kuchepa. Pa bronchoscopy, chiwombankhanga chingatengedwe ndi chotupa chilichonse kapena zosaoneka zina zomwe zimawonekera mu airways.
Endobronchial Ultrasound
Endobronchial ultrasound ndi njira yatsopano yodziwira khansa ya m'mapapo. Pa bronchoscopy, madokotala amagwiritsa ntchito kafukufuku wa ultrasound pamtunda kuti apende mapepala ndi malo pakati pa mapapo (mediastinum). Kwa zotupa zomwe zili pafupi ndi mlengalenga, chiwopsezo chikhoza kupangidwa ndi chithunzithunzi ichi.
Chidutswa cha singano
Mu nthenda yabwino ya singano (FNA) biopsy, dokotala amalowetsa singano yopanda phokoso kudzera mu khoma la chifuwa, kawirikawiri amatsogoleredwa ndi kuyang'ana kwa CT, kuti atenge chitsanzo cha chotupacho. Izi zikhoza kuchitika chifukwa cha zotupa zomwe sizingatheke ndi bronchoscopy, makamaka zomwe ziri pafupi ndi palimodzi za mapapo.
Thoracentesis
Khansara ya m'mapapo ikakhudza mpweya wa mapapo, ikhoza kuyambitsa madziwa pakati pa mapapo ndi mapulogalamu a mapapo (pleura.) Ndi anesthesia am'deralo, singano yaikulu imalowetsedwa mu chifuwa chachikulu chomwe chimakhala chodziŵika cha madzi. (kochepa kuti ayese maselo a khansa, kupweteka kwachinyengo ) kapena kuchulukitsa kwa madzi (kuchuluka kwa kupweteka ndi / kapena kupuma pang'ono) kuchotsedwa.
Mediastinoscopy
Njira yamakono Njirayi imayendetsedwa mu chipinda chogwiritsira ntchito pansi pa anesthesia. Chiwerengerochi chimayikidwa pamwamba pa sternum (m'mafupa mafupa) m'deralo pakati pa mapapo ( mediastinum ) kuti atenge zitsanzo za minofu. Kufufuza kwa PET tsopano kumapereka zotsatira zomwezo zomwe mediastinoscopy inachita kale.
Kuyesera Kudziŵa Ngati Khansa Yam'mimba Yafalikira (Yophiphiritsira)
Khansa ya m'magazi imafalikira ku chiwindi , zilonda za adrenal, ubongo ndi mafupa. Mayesero ofanana ndi awa:
- CT yesani mimba: Kuti muyang'ane kufalitsa kwa chiwindi kapena adrenal glands
- MRI ya ubongo: Kuyang'ana metastases ku ubongo
- Kugwiritsira fupa : Kuyeza mafupa , makamaka kumbuyo, m'chiuno, ndi nthiti
- Kufufuza kwa PET: PET scan imatha kuyang'ana metastases kwenikweni kulikonse m'thupi, ndipo nthawi zina imatha m'malo ena mayeso monga fupa kapena CT sc scans.
Mayesero Ena Panthawi Yodziwa
Zowonjezereka zosayezetsa zoyezetsa nthawi zambiri zimachitika pamene matenda a kansa ya m'mapapo akuyambanso. Izi zingaphatikizepo:
- Maphunziro oyendera mapulaneti (PFTs): PFT yofufuza mapapu ndipo amatha kudziwa momwe chifuwacho chimayendetsera kupuma, ndipo nthawi zina, ngati ndibwino kuchita opaleshoni
- Kuyezetsa magazi: Kuyezetsa magazi kwina kumatha kuona kuti matenda a chiwombankhanga amayamba chifukwa cha matenda a m'mapapo, ndipo amatha kunena kuti kufalikira kwa chifuwa
Phokoso lokhalira
Ngati khansara yamapapu imaganiziridwa pa maphunziro a kujambula, chotsatira ndicho kukhala ndi mapulogalamu a mapapu kuti azindikire ngati matendawa ndi a khansa kapena kuti ali ndi khansa ya m'mapapo.
Mitundu yambiri yamagulu imagwiritsidwa ntchito pazithunzithunzi za minofu, koma zinyama zamadzi ndi njira yatsopano yosangalatsa yotsatirira anthu ena ndi khansara yamapapo. Yavomerezedwa mu June wa 2016, mayeserowa angathe kupyolera mwa kujambulidwa kwa magazi. Panthawiyi, amavomerezedwa kuti azindikire kusintha kwa EGFR, koma kwa aliyense, ndi chitsanzo chabwino cha momwe matenda ndi khansa ya m'mapapo ikuyendera chaka chilichonse.
Khansara yamapapu ikafalikira, ndikofunikira kuti mukhale ndi kachilombo kaye, monga khansa ingasinthe pakapita nthawi, ndipo kusintha kumeneku kungakuthandizeni inu ndi dokotala wanu kusankha zosankha zabwino.
Mapulogalamu ofotokoza / Kuyeza kwa Gene
Panopa tikulimbikitsidwa kuti aliyense amene ali ndi khansa yapakhungu yopanda mapapu, komanso makamaka mapapu adenocarcinoma, ali ndi ma profoni a maselo omwe amachititsa chifuwa chawo. Kuyezetsa kwa majeremusi kumafuna kusintha kwa maselo a khansa omwe mankhwala omwe alipo omwe "akuwongolera" kusintha kumeneku.
Izi sizikusinthika kumene mumabadwa nazo, ndipo simungathe kuzifikitsa kwa ana anu. Zimasinthasintha zomwe zimachitika panthawi ya selo kukhala khansara komanso "kuyendetsa" kukula kwa khansara.
Masiku ano mankhwala ochiritsidwa amavomerezedwa kwa anthu okhala ndi kusintha kwa EGFR , ALK rearrangements , rearrangements ya ROS1 , ndi zina kusintha zina. Kuonjezera apo, mankhwala ena akuwerengedwera m'mayesero a kachipatala .
Kuyesa PD-L1
Popeza mankhwala oyamba a immunotherapy adavomerezedwa kuti athe kuchiza khansa ya m'mapapo mu 2015, mankhwala ena atatu akhalapo. Chitsanzo chotchedwa PD-L1 chikhoza kuchitidwa kuti mudziwe kuti peresenti ya mawu a PD-L1 pa maselo anu a kansa. PD-L1 ndi mapuloteni omwe amafotokozedwa mochuluka pa maselo ena a khansa yamapapo. Mapuloteniwa amathandiza kuti "mavitamini" a chitetezo cha mthupi athandizidwe, kuchepetsa mphamvu zake zothana ndi maselo a khansa. Maselo ena a khansa apeza njira zowonjezera "overexpress" mapuloteni awa ngati njira yobisala ku chitetezo cha mthupi. Mankhwala omwe amadziwika ngati checkpoint inhibitors amagwira ntchito poletsa zimenezi ndipo makamaka amatulutsa mavitamini pa chitetezo cha mthupi.
Sitikudziwa kuti kufunika kwa PD-L1 kuyesedwa kotani ndi khansa yamapapo. Matenda awiri a khansa omwe amachititsa kuti PD-L1 ndi omwe sangathe kuyankha mankhwalawa. Pakalipano timaganiza kuti zingakhale zodula kuti tichite mayesowa, koma kuchepetsa kugwiritsa ntchito mankhwalawa kwa anthu omwe ali ndi ziphuphu zomwe zimapangitsa PD-L1 kuchepetsa chiwerengero cha anthu omwe angapindule ndi mankhwalawa.
> Zotsatira:
> Aquiar, P., Perry, L., Penny-Dimr, J. et al. Zotsatira za kuyesa kwa PD-L1 pa mtengo wogwira ndi zotsatira zachuma za ma chitetezo cha Immune Pogwiritsa Ntchito Mphamvu za Mthupi za NSCLC. Annals of Oncology . 2017 June 15. (Epub patsogolo pa kusindikiza).
> National Institute of Health. Medline Plus: Khansa Yam'mimba. Kusinthidwa 02/21/18. https://medlineplus.gov/lungcancer.html