Kuzindikira Lung Adenocarcinoma

Zizindikiro ndi Kupita Patsogolo pa Chithandizo cha Khansa

Khwangwala la adenocarcinoma ndi mawonekedwe a khansara yamapapu yopanda makapu , omwe ndi khansa ya m'mapapo. Zachilombo zapangidwe za khansa zapang'onopang'ono zimawerengera 80 peresenti ya malungo a m'mapapo, ndipo mwa izi, pafupifupi 50 peresenti ndi adenocarcinomas.

Adenocarcinoma lero ndi khansa ya m'mapapo yofala kwambiri mwa amayi, Asiya, ndi anthu osakwanitsa zaka 45 . Mochititsa chidwi, zimakhala zovuta kuti anthu asakhale osuta fodya (mwina osuta fodya kapena osuta fodya) kuposa anthu omwe akusuta.

Ngakhale kuti chiwerengero cha amuna chikuchepa kwambiri ndipo chiwerengero cha amayi chikuchepa, chiwerengero chikupitirizabe kukula mwa amayi achichepere, osasamala, ndipo sitiri otsimikiza kuti chifukwa chiyani. Ambiri amakhulupirira kuti utsi , kusuta fodya , komanso kutulukira kwa radon m'nyumba ndizo zonse zomwe zimapangitsa.

Zizindikiro

Matenda a adenocarcinomas amayamba m'kati mwa mapaipi ndipo amatha kukhalapo nthawi yaitali kuti zizindikiro zisayambe. Pamene potsiriza amawoneka, zizindikiro nthawi zambiri siziwoneka bwino kuposa mitundu ina ya khansa ya m'mapapo, kuwonetsetsa ndi chifuwa chachikulu ndi mfuti yamagazi kokha pambuyo pake, magawo apamwamba kwambiri.

Chifukwa cha izi, zina mwazidziwikiratu, zizindikiro zoyambirira (monga kutopa, kupuma kwachinsinsi, kapena kupweteka kwa m'mbuyo ndi kupfuwa) zingaphonye kapena zimayesedwa ndi zifukwa zina. Zotsatira zake, matendawa amachedwa mochedwa, makamaka pakati pa achinyamata ndi osuta fodya omwe sanaganizirepo khansa ngati choopsya.

Kudziwa

Kafukufuku wa khansa amayamba kupezeka pamene zovuta zimawoneka pa X-ray, kawirikawiri ngati mawonekedwe osadziwika bwino . Ngakhale kudandaula, kupeza kumeneku kumapereka mwayi wodwalayo. Pafupifupi 25 peresenti ya khansa yamapapu yamapapu, chifuwa cha X-ray sichidzazindikira kuti palibenso vuto lililonse ndipo zimabweretsanso matenda omwe amapezeka.

Ngati mukuganiza kuti khansara ikuwoneka, zotsatira zina zingathe kugwiritsidwa ntchito, kuphatikizapo:

• Kuchuluka kwa tomato (CT scan) , kapangidwe ka chifuwa chomwe chingathe kuzindikira zochepa kwambiri kuposa chifuwa cha x-ray
• Maganizo opanga maginito (MRI) omwe amagwiritsa ntchito maginito kuti apange zithunzi
• Bronchoscopy , ndondomeko yomwe amatha kuloŵera mozungulira pamtima kuti aone bwinobwino njira yaikulu m'mapapo
• Positron emission tomography (PET kanema) yomwe ingaganizire zinthu zomwe zimayambitsa matenda osokoneza bongo, zomwe zingatheke ndi maselo a khansa

Mphuno yotchedwa scutum cytology , yomwe imapangidwira mchere wa saliva ndi ntchentche, imagwiritsidwanso ntchito koma sichinthu chofunikira kwambiri pozindikira khansa yoyambirira.

Malingana ndi zotsatira, dokotala wanu angafune kupeza minofu ya m'mapapo kuti atsimikizidwe kuti ali ndi matenda. Kuphatikiza pa zovuta zowonongeka zamapapo m'mapapo , kuyesedwa kwatsopano kwa magazi komwe kumatchedwa biopsy madzi kumatha kutsatira zovuta zapachibadwa za maselo a khansa yamapapo monga kusintha kwa EGFR.

Kufufuza kwa Genetic Profiling ndi PD-L1

Chimodzi mwa zinthu zopititsa patsogolo kwambiri ndikugwiritsa ntchito kuyesa kwa majini ku maselo a khansara. Pochita zimenezi, madokotala angasankhe mankhwala omwe angathe kuwongolera zosiyana siyana.

Njira yowonongekayi ndi yosawerengeka kwambiri kusiyana ndi njira zamakono zatsopano zomwe zakhala zikuyambitsa maselo abwino komanso osayenera, zomwe zimayambitsa zotsatira zoyipa komanso zosatsutsika.

Zotsatira zamakono zimalimbikitsa kuti anthu onse omwe ali ndipamwamba kapena metastatic lung adenocarcinoma ayesedwe mthupi ndipo ali ndi PD-L1 kuyesa kufotokoza kansa yawo.

Matenda apadera samapezeka kwa iwo omwe ali ndi kusintha kwa EGFR , ALK rearrangements , ndi rearrangements za ROS1 , koma BRAF, ERBB2, MET kusintha kwamasinthasintha ndi kukula, RET rearrangements, ndi zina. Kuwonjezera apo, mayesero a zachipatala akuyang'anitsitsa kuyang'ana kusintha kwakukulu ndi njira zochiritsira.

Kuyeza kwa PD-L1 kumachitika pofuna kudziwiratu kuti njira zitatu zowonongeka zowonongeka zomwe zimavomereza khansara yamapapo. Kukambirana za kuyesa kwa maselo ndi PD-L1 ndi chimodzi mwa zinthu zofunika kwambiri pamene mutangoyamba kupeza kuti muli ndi mapapu adenocarcinoma, chifukwa dera lino likusintha mofulumira. Mwachitsanzo, mankhwala oyamba a immunotherapy adavomerezedwa mu 2015.

Miyendo

Kamodzi kafukufuku wa kansa atatsimikiziridwa, adokotala adzayambitsa matendawa pogwiritsa ntchito mayeso osiyanasiyana. Cholinga cha kuyeza ndi kudziwa momwe khansara yapitira patsogolo, kaya yafalikira, ndipo ngati zilipo, zida zina zingagwiritsidwe ntchito. Kuphatikizira kumathandizira kulongosola chithandizo m'njira yoyenerera, osati kuyambitsa chiwonongeko kapena kuponderezana mkati ndi kuvulaza kwambiri kuposa zabwino.

Zigawo zinayi zikulongosoledwa monga:

• Gawo 0 : Khansara siidakalipo, koma m'malo mwake ndi carcinoma-in-situ .
• Khansara ya m'mapapo ya matsenga: Khansara ya m'magazi imakhala ngati ilipo ngati maselo a khansa amapezeka m'matope koma chotupa sichitha kupezeka m'mapapu pofufuza maphunziro.
• Gawo 1 : Khansara imapezeka kumidzi ndipo sinafalikira ku maselo amodzi. Iyi ndiyo gawo loyambirira la khansara yamapapo yamapapo.
• Gawo lachiwiri : Khansara yayamba kufalikira kumapiritsi, mapaipi, kapena mapiri akuluakulu.
• Gawo 3 : Khansara yayamba kufalikira minofu yoyandikana nayo. Gawo lachitatu lidasinthidwanso mu siteji 3A ndi siteji 3B yomwe nthawi zambiri imachiritsidwa mosiyana.
• Gawo lachinayi : Khansara yafalikira (yowonongeka) ku madera ena a thupi kapena pali kupwetekedwa kosautsa . Matenda a khansa amatha kufalikira ku mafupa, ubongo, chiwindi, ndi mazira a adrenal.

Mukamaphunzira za mankhwala omwe mungamve mukamamva za khansara yamapapo ikufotokozedwa mwa njira izi:

• Khansara ya m'mapapo oyambirira : Mawu oyambirira akugwiritsidwa ntchito pofotokoza khansa yamapapu yomwe ili gawo 1, siteji yachiwiri, ndi siteji 3A. Izi ndi zotupa zomwe zingathe kuchiritsidwa ndi opaleshoni.
• Khansara yamapapu yapamwamba: Mawu awa amagwiritsidwa ntchito nthawi zambiri pofotokoza khansa yomwe ili siteji 3A. Kuchita opaleshoni kungakhale kotheka, koma mankhwala opatsirana pogwiritsa ntchito chemotherapy ndi mankhwala opatsirana ndi mankhwala amafunika kuthana ndi vutoli.
• Khansara ya m'mapapo yapamwamba : Dzina la khansa yapakhungu yamapapu nthawi zambiri limagwiritsidwa ntchito pa siteji 3B ndi khansa yazitsulo 4, ndipo ndi siteji yomwe mankhwala osapaleshoni ndi abwino kwambiri.

Njira Zothandizira

Malinga ndi gawo la matenda, mankhwala angaphatikizepo chimodzi kapena kuphatikizapo zotsatirazi:

• Opaleshoni angaperekedwe pachiyambi, kaya ali yekha kapena amaphatikizidwa ndi mankhwala a chemotherapy ndi / kapena mankhwala.
• Chemotherapy ingagwiritsidwe ntchito yokha, kuphatikizapo mankhwala opatsirana ndi dzuwa, kapena asanayambe kapena opaleshoni.
• Njira zochiritsira ndizo mankhwala omwe amachititsa kuti asinthe zamoyo zina. Amagwira ntchito pozindikira mapuloteni enieni pa maselo a khansa ndi kuteteza mphamvu ya selo kuti ikhale yowonjezera. Zosankha ndi monga Tarceva (erlotinib), Iressa (gefitinib), Gilotrif (afatinib), Xalkori (crizotinib), Zykadia (ceritinib), Alectinib (alecnensa), ndi Tagrisso (osimertinib).
• Mankhwalawa angagwiritsidwe ntchito pochiza khansa kapena kuchepetsa zizindikiro kwa anthu omwe ali ndi khansa ya metastatic. Njira zina zochiritsira, zomwe zimatchedwa stereotactic body radiotherapy (SBRT) , kapena mankhwala a proton angagwiritsidwe ntchito kwa khansa zing'onozing'ono zomwe opaleshoni sangathe kuzifikira.
• Immunotherapy ndi mtundu wa mankhwala omwe cholinga chawo chimagwiritsa ntchito chitetezo cha mthupi kuti chiteteze khansa. Zosankha zamakono ndi Opdivo (nivolumab), Keytruda (pembrolizumab), ndi Tecentriq (atezolizumab).

Mawu Ochokera

Chifukwa chakuti zizindikiro zoyambirira za m'mapapo adenocarcinoma nthawi zambiri zimakhala zosavuta kuziwona, pafupifupi zaka zisanu ndi zisanu zomwe zimakhala ndi moyo zimakhala pafupifupi 18 peresenti. Kwa omwe amapezeka pamayambiriro oyambirira, malingalirowo ndi odalirika kwambiri.

Zomwe izi zikuwunikira ndizofunikira kuzindikiritsa kwambiri za zizindikiro zosaoneka kapena zachilendo za khansa ya m'mapapo. Kwaokha, zizindikiro zingakhale zophweka mosavuta. Pamodzi, akhoza kuyambitsa mbendera yofiira yomwe imatsogolera kuchipatala choyamba komanso kuchipatala.

Mankhwala a mapapu adenocarcinoma akukwera mwamsanga ndipo mitengo ya moyo imakula bwino. Nthawi zina, ngakhale zotupa zowonjezereka zingathe kusungidwa kwa nthawi yaitali ndi mankhwala okhudzidwa. Kwa chiwerengero chochepa cha anthu, mankhwala opatsirana pogonana athandiza "kuchitapo kanthu" motanthawuza kuti madokotala amadzifunsa mosamala kuti akhoza kuchiritsidwa. Ndi zovuta za zofufuza za maselo, ndi zothandiza kwambiri kupeza katswiri wodziwa za matenda a khansa amene amadziwika bwino ndi khansa ya m'mapapo. Ndikofunika kwambiri kuti ukhale wothandizira pawekha .

> Zotsatira:

> American Cancer Society. "Khansa Yam'mimba (Cell Osati Small). Atlanta, Georgia; zasinthidwa pa May 16, 2016.

> Chalela, R., Curull, V., Enriquez, C. et al. Mphuno ya Adenocarcinoma: Kuchokera ku Molecular Basis kupita ku Gome-Guided Therapy ndi Immunotherapy. Journal of Thoracic Diseases . 2017. 9 (7): 2142-2158.

> DiBardino, D., Sagi, A., Elvin, J. et al. Kupereka ndi Kachipangizo Ntchito ya Mbadwo Wotsatira Ukulingalira Odwala Omwe Ali ndi Matenda Aakulu a Adenocarcinoma. Khansara Yam'mimba Yamakono . 2016. 17 (6): 517-522.e3.

> Sholl, L. Molecular Diagnostics ya khansa ya m'mimba mu chipatala. Kafukufuku Wofufuza za Khansa Yamasulidwe . 2017. 6 (5): 560-569.