Kuwerengera Kuopsa kwa Khansa Yam'mimba - Kuwunika Kuvumbula Nodule

by Lynne Eldridge, MD; Yofotokozedwa ndi Grant Hughes, MD

Kodi Mankhwalawa Amapezeka Bwanji pa Kujambula Khungu la Khansa?

Pamene kansa ya m'mapapo yowononga mapapo imavumbulutsa nkhono, kodi mwayi ndi khansa yotani?

Kufika kwa kuyang'ana khansa yamapapo kumatha kupulumutsa miyoyo yambiri. Koma monga ndi mayesero ambiri, nthawi zambiri pamakhala "zonyenga" chinachake chimakayikira kuti kenako chimakhala chopanda pake. Kodi ndizotheka kuti nkhono yomwe imapezeka pa kuyang'ana ndi khansara ( yosautsa ) komanso nthawi zingati minofu imakhala yoipa (osati ya khansa?)

Choyamba, ndizofunikira kulankhula za zomwe zimatanthawuzidwa ndi kuyang'ana khansa yamapapo, komanso ziwerengero zingapo.

Kuwongolera Khansa Yam'mimba ndi Ziwerengero

Kwa nthawi yayitali, takhala tikuyembekeza kuyesa kuyesera khansa yamapapo. Ndipotu, tili ndi mamembala kuti tiwone khansa ya m'mawere, mapepala a pap kuti tiyang'ane khansara ya khola lachiberekero, ndi ma colonoscopies kuti tiyang'ane khansa yamtundu. Chifukwa chake ndi chophweka. Kawirikawiri (koma osati nthawi zonse) khansa amachiritsidwa kwambiri kumayambiriro kwa matendawa.

Izi ndi zoona kwa khansara yamapapo. Kuchuluka kwa anthu omwe ali ndi khansa ya mapapu yoyamba ndi pafupifupi 60 mpaka 80 peresenti. Izi zimachepetsera osachepera 10 peresenti kwa omwe amapezeka ndi gawo 4 la matendawa. Mwamwayi, anthu 40 pa anthu 100 alionse ali ndi khansa ya m'mapapo 4 (metastatic) yamapapu pa nthawi ya matenda. Gawo 4 limatanthauza kuti khansara yayamba kufalikira kumadera akutali kapena mapapo ena, ndipo kotero, sangathe kugwira ntchito . Kuwona kuti khansara yamapapo ndiyo yomwe imayambitsa imfa ya amuna ndi akazi ku United States yomwe ili vuto lalikulu.

Kodi Mpangidwe wa CT Ndi Wotani?

Koma kwa anthu ena, tsopano tili ndi mayeso owonetsera. Mayendedwe a Lungwe la National Lung Screening anapeza kuti kuyeza kwa CT (kuchepa kwa dozi CT) kunachepetsera chiŵerengero cha imfa kuchokera ku khansa ya m'mapapo ndi 20 peresenti pamene anthu ena ayesa kuyerekezera chaka chochepa cha CT . Izi zikuphatikizapo anthu omwe:

Ali pakati pa zaka 55 ndi 74
Khalani ndi mbiri ya zaka makumi atatu za phukusi la kusuta, ndipo
Pitirizani kusuta, kapena musiye zaka 15 zapitazo.

Powerengera manambala, anthu 6 peresenti yokha ndiwo amakumana ndi ndondomeko yowunikira, koma ndiyambe. Ndipo ndi chiyambi chimenecho pakubwera mavuto angapo. Pamene nthendayi ikuwonekera pa kuyang'ana - ndipo izi ndizofala - ndizotani kuti ndi khansara?

Choyamba, zimathandiza kumvetsetsa momwe zimawonekera kuti mupeze mayendedwe pamapulogalamu oyesera a CT. Kupeza cholakwika pa x-ray kapena CT ya chifuwa sikutanthauza khansara. Ndipotu, ndizotheka kukhala china chake - chinachake chimene simungazidziwe ndipo sichidzakuvutitsani ngati simunapangidwe.

Kodi Zidzakhala Zogwirizana Bwanji ndi Mankhwala Osokoneza Bongo Anthu Amene Anayang'aniratu Khansa Yam'mimba?

Popeza kuti kuyang'ana kwa CT kuli kochepa, sitidziwa bwinobwino momwe ma thovu amodzi amachitira. Kafukufuku anapeza kuti pafupifupi 20 peresenti ya anthu (omwe anawonedwa motsatira ndondomeko zapamwamba) anali ndi nodule imodzi yomwe imafunikira kuyesedwa kwina. Apa ndikofunika kusiyanitsa pakati pa zomwe katswiri wa zamagetsi amatha kutcha misa ndi zomwe akuzitcha ngati nkhonya. Misa imatanthauzira chinthu chachilendo kuposa masentimita atatu (pafupifupi 1½ cm).

Mawu akuti nodule amagwiritsidwa ntchito pofotokoza zolakwika zosachepera 3 cm mu kukula.

Kodi Makhalidwe Abwino Ambiri Amapezeka Bwanji pa Kuwonetsa Khansa?

Kotero ngati mukumva foni yoopsya, yomwe dokotala wanu akunena kuti " tapeza mthunzi mukuyang'anitsitsa CT ," muyenera kukhala ndi nkhawa bwanji?

Mu mayeso a National Lung Cancer Screening, pakati pa 1 ndi 4 peresenti ya anthu ankafuna kuyesedwa kosavuta kuti atsatire CT scans. Mwa anthu amene anachitidwa opaleshoni, 25 peresenti ya mitsemphayi inakhala yonyansa.

Kuyang'ana izi mwanjira yina, Mu kafukufuku waposachedwapa ofufuza adawona anthu mu maphunziro awiri osiyana.

Mmodzi wa awa (Pan-American Early Detection of Lung Cancer Study (PanCan), 7008 mitsempha ya 7008 inapezeka pakati pa anthu 1871. Mwa awa 102 anali khansa. M'chigawo china (British Columbia Cancer Agency (BCCA), anapezeka mu 1090 anthu, ndipo 42 anali akuipitsa.

Kuphwanya manambala, izi zikufika pa 5.5 peresenti ya anthu mu phunziro limodzi ndipo 3.7 peresenti mu winayo amene anali ndi mitsempha yomwe inapezeka kuti ndi khansa.

Pa nthawiyi, ndizofunikira kudziwa kuti nambalayi - mwayi woti kachilombo ka khansa ndi khansa - ndi anthu odwala popanda zizindikiritso omwe akuyesedwa. Kukhala ndi kachilombo kosautsa kumakhala kosiyana kwa omwe ali ndi zizindikiro. Zingakhalenso zosiyana kwa iwo omwe ali ndi chifuwa cha pulmonary pa kufufuza koma samatsata ndondomeko zotchulidwa pamwambapa.

Kodi Nodule Mwinanso N'zotheka Kukhala Khansa Liti?

Poyang'ana maphunziro mpaka lero, mitsempha yamapulumu yomwe imapezeka pa kuyesera kwa CT inali yowopsa kwambiri ngati:

Iwo anali kumanzere kumtunda kapena kumtunda kwapamwamba, ndipo mosakayikira kukhala odetsa ngati anali mu lobes lamanzere kapena lamanzere, kapena pakatikati.
Panali zongoganizira za nodule (kutanthauza kuti mmalo mwa malo osalongosoka, anali ndi malo ochepa omwe amachokera ku chotupa,) kapena ngati malirewo anali osalongosoka kapena ovomerezeka.
Ngati iwo anali aakulu.
Ngati zinachitikira anthu akuluakulu kuposa achinyamata.
Ngati munthu ali ndi mbiri ya banja la khansa ya m'mapapo.
Ngati zinachitikira akazi nthawi zambiri kuposa amuna.
Ndi kukula kwakukulu kwa nodules.
Kwa anthu omwe ali ndi mbiri ya emphysema.
Mu anthu omwe ali ndi mitsempha yochepa.

Kuphatikiza apo:

Gawo lolimba limagwiritsidwa ntchito kwambiri kuti likhale khansa kusiyana ndi mitsempha yolimba.
Mitsempha yowonjezereka inali yowopsa kwambiri kuposa khansa yosalimba kapena mitsempha ndi maonekedwe a "galasi".

Kodi Nodule Yanga Ndi Chiyani Ngati Si Khansa?

Pali zifukwa zambiri zomwe zimayambitsa mitsempha yamatenda kuchokera ku matenda opatsirana ndi chifuwa chachikulu , ku mitsempha yothandizira matenda a nyamakazi, ndi zina zambiri. Nkhani yotsatira ikufotokoza zifukwa zingapo zowononga komanso zovulaza za mitsempha ya pulmonary .

Kuwerengera Ngozi

Koperative ya khansa yamapapu imapezeka kwa madokotala (ndi anthu) kuti awonetse kuti mwayi wotsekemera womwe ukupezeka pa kufufuza CT ndi woipa. Nodule Prediction Calculator inakhazikitsidwa pogwiritsa ntchito kafukufuku wa sayansi, koma anthu amachenjezedwa kuti sichilowetsa malangizo a dokotala kapena mankhwala. Anthu osayamika amafunsidwa kuti awerenge kuti akutsindika mfundo yofunika kwambiri: Sikuti zonsezi zimakhala ndi chiopsezo chachikulu ndi khansara, osati zonse zomwe zimayambitsa matendawa.

Kodi Mumachokera Kuti?

Ngati dokotala wanu akuganiza kuti muli ndi mitsempha yam'mimba kapena mitsempha, pali njira zingapo zomwe angapangire. Izi zidzadalira pa zinthu zingapo kuphatikizapo zoopsa zanu za khansa ya m'mapapo, maonekedwe a nodule, malo a nodule, ndi zokonda zanu. Zosankha zina zingaphatikizepo:

Pulogalamu ya PET
Bronchoscopy
Kuyembekezera kuyembekezera
Chiwopsezo (Pali njira zingapo zomwe mafunde angapangidwenso malinga ndi malo ake.)

_Zotsatira:

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_{Gould, M. et al.} _{Kuwunika kwa Anthu Omwe Ali ndi Mankhwala Osokoneza Bongo: Kodi Ndili Liti Labwino?} _{Kuzindikira ndi Kusamalira Khansa Yam'mimba, 3rd ed: American College of Chest Physicians Malangizo Othandizira Otsata Malingaliro Ochipatala.} _{Chifuwa .} _{143 (Suppl 5): e93S-120S.}

_{Grannis, F. Kuchepetsa Kuzindikira Kwambiri pa Kuyezetsa Khansa Kwambiri.} _{Journal of Oncology Opaleshoni .} _{2013 Aug 26. (Epub patsogolo pa kusindikiza).}

_{Greenberg, A. et al.} _{CT Scan Screening ya Khansa Yam'mimba: Zowopsa kwa Mazira ndi Malignancy Mgwirizano wa Mtauni Woopsa.} _{PLoS One .} _{2012. 7 (7): e39403.}

_{Lederlin, M. et al.} _{Njira Yogwirira Ntchito ya Pulmonary Nodule mu 2013.} _{Kujambula ndi Kujambula Kwapakati .} _{2013 Sep 11. (Epub patsogolo pa kusindikiza).}

_{Naidich, D. et al.} _{Zolinga za Management of Subsolid Zida Zam'madzi Zowonongeka pa CT: A Statement kuchokera ku Fleisher Society.} _{Zamankhwala .} _{2013. 266 (1): 304-17.}

_{McWilliams, A. et al.} _{Wopindula ndi Khansa mu Mitsempha Yoyendetsa Poyamba Yotengedwa ndi Kuwunika.} _{The New England Journal of Medicine .} _{2013. 369: 910-191.}

_{Gulu la Kafukufuku wa Kafukufuku wa Khansa Yadziko Lonse.} _{Kuchepetsa Matenda a Khansa Yamtundu wa Tomography Screening.} _{The New England Journal of Medicine .} _{2011. 365: 395-409}

_{Wahidi, M. et al.} _{Umboni Wothandizira Odwala Amene Ali ndi Mankhwala Osokoneza Bongo: Kodi Kodi Khansa Ili Ndi Liti ?: ACCP Malangizo Othandizira Omwe Amagwiritsa Ntchito Zipatala (Buku Lachiwiri).} _{Chifuwa .} _{2007. 132 (3 Suppl): 94S-107S.}