Malangizo Anu Ozama Kwambiri a Squamous Cell Carcinoma M'mapula

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

Zizindikiro, Kusanthula, Kuchiza, ndi Kugonjetsedwa kwa Khansa Yambiri Yopangika Magulu

Squamous cell carcinoma m'mapapu ndi mtundu umodzi wa khansara yochepa ya maselo . Mankhwala osakaniza ang'onoang'ono a maselo amachititsa pafupifupi 80 peresenti ya khansa ya m'mapapo, ndipo mwa izi, pafupifupi 30 peresenti ndi squamous cell carcinomas.

Mwachidule

Squamous cell carcinoma imayamba m'zinthu zomwe zimayendera mpweya m'mapapo. Amatchedwanso epidermoid carcinoma.

Magulu ambiri a squamous cell amapapu ali pakati, nthawi zambiri mu bronchi yaikulu yomwe imagwirizana ndi trachea kumapapu.

Squamous cell carcinomas imalumikizana kwambiri ndi kusuta kusiyana ndi mitundu ina ya khansa yaing'ono yamapapu yambiri komanso yowonjezereka mwa amuna kuposa akazi. Amakonda kukhala akukula pang'onopang'ono, ndipo chifukwa cha malo awo nthawi zambiri amapezeka kale kusiyana ndi khansa ya m'mapapo ya mitundu ina. Chimake cha squamous cell carcinoma m'mapapu chachepa m'zaka zaposachedwapa, pamene khansa ina yamapapo, adenocarcinoma yakhala kuwonjezeka. Anthu ena amaganiza kuti kuwonjezera kwa mafayikiro kwa ndudu amalola utsi kuti ukhale wotsekemera kwambiri m'mapapu kumene adenocarcinomas amapezeka. Koma khansa imeneyi ikhoza kuchitika ngakhale kwa anthu omwe sanasute fodya.

Zotsatira

Maselo a squamous mapangidwe a kansa amagawidwa mowonjezereka mu 4 subtypes ndi zomwe amawoneka ngati pansi pa microscope ndi momwe amachitira.

Izi zikuphatikizapo:

Choyamba
Zakale
Chinsinsi
Pansi

Tikudziwa kuti pali kusiyana pakati pa subtypes koma akungodziwa momwe mtundu uliwonse ungayankhire mosiyana ndi mankhwala osiyanasiyana. Ambiri mwa mankhwalawa amamva mankhwala osachepera amodzi omwe amagwiritsidwa ntchito pogwiritsa ntchito mankhwala a chemotherapy. Chimodzimodzinso chingakhale khansara ya squamous cell cancer.

Mankhwalawa sagwirizana kwambiri ndi mankhwala omwe amagwiritsidwa ntchito kawirikawiri chifukwa amayamba kuchepa (ndipo chemotherapy nthawi zambiri imakhala yothandiza kwambiri pa khansa yofulumira kwambiri chifukwa imafuna kugawa maselo).

Zizindikiro

Zizindikiro ndi zizindikiro za khansa ya m'mapapo ndi chifuwa chosatha, kukakamira magazi, kupuma pang'ono, ndi kupuma. Popeza magulu a squamous cell carcinomas amakhala pafupi ndi maulendo akuluakulu, nthaŵi zambiri amachititsa zizindikiro kusiyana ndi mitundu ina ya khansa ya m'mapapo. Kuwonongedwa kwa mlengalenga kungayambitse matenda monga chibayo, kapena kugwa kwa gawo la mapapo ( atelectasis ), ndipo matenda opuma ngati chibayo angakhale chizindikiro choyamba kuti chinachake chili choipa.

Squamous cell carcinoma ndi chifukwa chofala kwambiri cha chinachake chomwe chimadziwika kuti matenda a Pancoast kapena matenda opambana a sulcus. Matenda a phokoso amayamba chifukwa cha khansa ya m'mapapo yomwe imayandikira pafupi ndi mapapo ndi kumenyana ndi malo pafupi, monga mitsempha. Zizindikiro zambiri zimaphatikizapo ululu wopweteka umene umatulutsa mkati mwa mkono, kufooka kapena kupwetekedwa m'manja, kuthamanga kapena kutukuta kumbali imodzi ya nkhope, ndi khungu lakuthwa (Horner's syndrome).

Anthu omwe ali ndi squamous cell carcinoma amakhalanso ndi mlingo wokwanira wa calcium ( hypercalcemia ) umene ungabweretse minofu yofooka ndi mitsempha.

Matenda a hypercalcemia ndi chimodzi mwa zizindikiro za matenda a paranoplastic ndipo amayamba chifukwa chotupa chimbudzi chomwe chimatulutsa chiwerengero cha calcium m'magazi.

Kudziwa

Squamous cell carcinoma m'mapapu kawirikawiri amakayikiridwa pamene zosaoneka zimawoneka pa x-ray. Kuonjezera kwina kungaphatikizepo:

Chifuwa CT Scan
Chiputu cha Cytology . Popeza magulu a squamous cell carcinomas nthawi zambiri amathamanga panjira, pamakhala chitsanzo cha sitiroko nthawi zina amatha kudziwa maselo a khansa
Bronchoscopy
PET Scan . Kufufuza kwa PET ndi yesero "yogwira ntchito" lopangidwa pofuna kuyang'ana ziphuphu zomwe zikukula mwamphamvu ndipo nthawi zambiri zimayesedwa pofuna kuyang'ana umboni uliwonse wa kufalitsa (metastasis)

Endobronchial Ultrasound . An endobronchial ultrasound akugwiritsidwa ntchito pogwiritsa ntchito kafukufuku wapadera pa bronchoscopy.

Malingana ndi zotsatira, dokotala wanu nthawi zambiri amafuna kupeza minofu (mapulogalamu a m'mapapo ) kuti atsimikizidwe kuti ali ndi matenda komanso kuti ayesetse kuyesa kuti ayang'ane ngati kansa yanu yafalikira.

Kusinthana

Squamous cell carcinoma m'mapapu akuphwasulidwa mu magawo anayi :

Gawo 1 - Khansara imapezeka mkati mwa mapapo ndipo sinafalikira ku maselo amodzi
Gawo 2 - Khansara yayamba kufalikira kumapapo, kapena m'madera ena a bronchus
Gawo 3 - Khansara yayamba kufalikira ku minofu pafupi ndi mapapo
Gawo lachinayi - Khansara yafalikira (yowonongeka) ku mbali ina ya thupi, malo ambiri omwe amakhala mafupa, ubongo, chiwindi, kapena adrenal glands

Madokotala amagwiritsanso ntchito njira ina, yosokoneza kwambiri yosankha pa siteji ya khansa ya m'mapapo yotchedwa TNM staging . Izi zimayang'ana kukula kwa chotupa (chomwe chikuyimiridwa ndi T), kaya nthiti zimakhudzidwa, ndi zingati (zimayimiridwa ndi N), komanso ngati chotupacho chafalikira (m'magazi) m'madera a thupi kunja mapapu, kapena mapapo ena (akuyimiridwa ndi M). Mwachitsanzo, dokotala wanu akhoza kufotokoza khansa yanu yamapapu monga T3N2M0.

Zimayambitsa

Squamous cell carcinoma ya m'mapapo ndi mtundu wa khansara wamapapu yogwirizana kwambiri ndi kusuta , koma zifukwa zina zingathandizenso. Kuwonetseredwa kwa Radoni panyumba ndiwotsatira wachiwiri wa khansa ya m'mapapo. Zochita zapamwamba, monga dizilo ndi zina zambiri ndizofunikira zoopsa pakukula kwa khansa yapakhungu yamapapo.

Ma Genetics angathandizenso, ndipo ngozi ya khansa ya m'mapapo imakula kwa anthu omwe ali ndi achibale ena ndi matendawa.

Kuchiza

Malingana ndi siteji ya squamous cell carcinoma m'mapapu, chithandizochi chingaphatikizepo opaleshoni, chemotherapy, mankhwala opatsirana pogwiritsa ntchito mankhwala, mankhwala ochiritsira, immunotherapy, kapena kuphatikiza izi. Mayesero ambiri a zachipatala akuyang'ana kufunafuna njira zatsopano zothandizira khansara iyi ndikuthandizani kusankha njira zomwe zithandizira kwambiri.

Opaleshoni

Kuchita opaleshoni ya khansa ya m'mimba kungakhale kotheka kwa squamous cell carcinoma. Pokhala ndi siteji 1A kansa yamagazi ya m'mapapo ya maselo, opaleshoni yokhayo ikhoza kukhala yowiritsa. Kuchita opaleshoni kungathenso kulingalira kwa omwe ali ndi siteji 1B, siteji yachiwiri, ndi kansa ya 3A kansa ya m'mapapo, kawirikawiri pamodzi ndi mankhwala a chemotherapy ndi mankhwala omwe amachititsa mazira. Nthawi zina, chotupacho sichitha kugwira ntchito koma chingachepetse kukula ndi chemotherapy ndi / kapena mankhwala othandizidwa ndi dzuwa kuti athe kuchitidwa opaleshoni. Pamene chemotherapy yachitidwa kuti kuchepetsa kukula kwa chotupa chisanachitike opaleshoni imatchedwa "neoadjuvant chemotherapy." Posachedwapa, zakhala zikuwonetseredwa pogwiritsira ntchito immunotherapy kuchepetsa chotupa chosatheka kugwira ntchito kuti opaleshoni ichitike.

Chemotherapy

Chemotherapy ingagwiritsidwe ntchito yokha, pothandizidwa ndi mankhwala opatsirana ndi dzuwa, kapena asanayambe kapena atachita opaleshoni ya khansara yamapapo. Squamous cell carcinoma m'mapapu amasiyana kwambiri ndi khansa ya m'mapapo monga adenocarcinoma ndi mankhwala a chemotherapy. Mankhwala omwe amagwiritsidwa ntchito kale monga khansa ndi Platinol (cisplatin) ndi Gemzar (gemcitabine). Kwa omwe amavomereza chithandizo, kupitiriza ( kusamalira ) ndi Tarceva (erlotinib) kapena Alimta (pemetrexed) angagwiritsidwe ntchito.

Mankhwala Opanga Mafuta

Mankhwalawa angagwiritsidwe ntchito pochiza khansa kapena kuchepetsa zizindikiro zokhudzana ndi kufalikira kwa khansa. Mazira angaperekedwe kunja, kapena mkati mwake ( brachytherapy ) yomwe zipangizo zamagetsi zimaperekedwa kumalo enieni a mapapo pamene bronchoscopy.

Thandizo Lolinga

Mwinamwake mwamvapo za kugwiritsa ntchito mankhwala opatsirana pofuna kuthandizira kusintha kwa EGFR m'mapapo adenocarcinoma. EGFR, kapena epidermal kukula factor receptor, ndi mapuloteni omwe amaphatikizapo kuyendetsa kukula kwa khansa. Squamous cell carcinoma m'mapapu angathenso kuthandizidwa pogwiritsa ntchito njira ya EGFR, koma mwa njira yosiyana.

M'malo molimbana ndi kusintha kwa EGFR, anti-EGFR antibodies ndi gulu la mankhwala ogwiritsidwa ntchito kuti amangirire ku EGFR kunja kwa maselo a khansa. Pamene EGFR imamangidwa, njira yowonetsera yomwe imauza selo kukula imaletsedwa. Mapulogalamu (necitumumab) adavomerezedwa mu 2015 kuti agwiritse ntchito limodzi ndi chemotherapy kwa khansa yapakhungu ya squamous. Zilonda zamakono zikuyesa mankhwala ena, monga afatinib ndi zina zothandizira khansa yapakhungu yamapapo.

Immunotherapy

Mankhwala osokoneza bongo anavomerezedwa kuti athe kuchiritsidwa ndi khansa ya m'mapapo mu 2015, ndipo mankhwalawa akuphatikizidwa mu mayesero a zamankhwala.

Mu 2015, chithandizo choyamba cha immunotherapy chinavomerezedwa kwa anthu omwe ali ndi matendawa. Opdivo (nivolumab) mankhwala ndi mawonekedwe a immunotherapy omwe, mophweka kwambiri, amachititsa thupi lathu kuteteza thupi lathu kuteteza maselo a khansa.

Kuti mumvetse momwe mankhwalawa amagwirira ntchito, zingathandize kulingalira za chitetezo chanu cha mthupi monga galimoto. "Maburashi" amayang'aniridwa ndi mapuloteni otchedwa PD-1. Opdivo mu fanizoli amaletsa kuletsa PD-1-mabasi-kulola chitetezo cha mthupi kuti chilimbana ndi khansara popanda kusokoneza-kwenikweni, kuchotsa mabaki pamoto. Chithandizochi panopa chikuvomerezedwa kwa anthu omwe ali ndi khansa ya m'mapapo yosaoneka yaing'ono yomwe imakhala ndi khansa yomwe khansa yapita patsogolo kapena pambuyo pake. (Platinum-based chemotherapy amatanthauza mankhwala a chemotherapy monga Platinol (cisplatin) kapena Paraplatin (carboplatin)).

Kuchokera nthawi imeneyo, mankhwala ena awiri a immunotherapy avomerezedwa, Keytruda (pembrolizumab), ndi Tecentriq (atezolizumab).

Kuthamangitsani

Musanayankhe funsoli "Kodi chiwerengero cha khansa yapakhungu yoopsa kwambiri ndi chiyani?" Ndikofunika kulankhula za nambala yomwe ikufotokoza kuchuluka kwa moyo. Choyamba, aliyense ali wosiyana. Ziwerengero zimatiuza kuti "kawirikawiri" njira kapena kupulumuka ndi chiyani, koma satiuza kanthu kalikonse ka anthu ena enieni. Zinthu zambiri zingasokoneze chiwerengero cha khansa ya m'mapapo ya khansa kuphatikizapo msinkhu wanu wa matenda, kugonana kwanu, chikhalidwe chanu chonse, ndi momwe mumachitira ndi mankhwala.

Ndizothandiza kukumbukira kuti ziwerengero zimakhazikitsidwa pazomwe zili ndi zaka zingapo. Pamene mankhwala atsopano amapezeka, ziwerengerozi sizingaganizire molondola zomwe zikuchitika lero. Mwachitsanzo, zaka zisanu zomwe zapulumuka khansa ya m'mapapo inafotokozedwa mu 2018 zimachokera kwa anthu amene anapezeka m'chaka cha 2013 ndi kale. Popeza kuti mankhwala ambiri okhudza squamous cell carcinoma m'mapapu amavomerezedwa pambuyo pa 2013, ziwerengero sizisonyeza momwe munthu angachitire lero.

Pa nthawi yomweyo, pakhala pali mankhwala atsopano omwe amavomerezedwa kuti azisamalidwa ndi kansa ya m'mapapo m'zaka zisanu zapitazo, kuposa zaka 40 zapitazo. Mwachitsanzo, mankhwala a mankhwala osokoneza bongo sankapezeka pamene anthu a maphunzirowa adapezeka. Zomwe zikutanthawuza ndizomwe ziwerengero zokhudzana ndi kupulumuka zomwe zikuchitika panopa sizilephera kuganizira momwe wina adzayembekezere kuchita pa njira iliyonse yothandizira.

Pali chiyembekezo chochuluka kwa omwe ali ndi khansara yamapapo lero, koma mwatsoka, mawerengero omwe mungawerenge sangakhale othandiza kumvetsa chiyembekezo.

Matenda osaphatikizapo maselo osaphatikizapo maselo a khungu amatha kusiyana ndi msinkhu , ndipo amakhala ndi zaka makumi asanu (50 kapena kuposa) omwe ali ndi siteji yoyamba, koma awiri kapena 4 peresenti ndi stage 4. Chiwerengero cha zaka zisanu zapakati pa khansa yamapapo ndi zomvetsa chisoni zokha pa 18 peresenti. Kachiwiri ndikofunika kuzindikira kuti chiwerengero cha mitengoyi sichisonyeza kusintha kwa mankhwala atsopano ndi njira zomwe zilipo tsopano.

Kuyeza Matenda Anu

Pamene mukuyang'ana pa chithunzithunzi ndizofunikira kuzindikira kuti magulu onse a khansa yamapiritsi sangakhale ofanana. Ndipotu, ngati pali anthu 300 omwe ali ndi squamous cell lung carcinoma m'chipinda, amakhala ndi khansa yapadera 300. Khansara yanu ikhoza kukhala ndi maselo omwe amawonjezera kapena kuchepa. (Oncologist wanu akhoza kukambirana zina mwa izi ndi inu). Kuonjezera apo, kafufuzidwe ndikuyang'ana njira zina zowonetsera momwe thupi la squamous cell carcinoma limagwiritsira ntchito pofufuza zomwe zimachitika ngati maselo otupa omwe amapezeka pa madzi akumwa ndi zina.

Kulimbana

Matenda a squamous cell carcinoma m'mapapo ndi owopsya ndipo mumamva kuti muli nokha. Mawu oti "kumatengera mudzi" sakanakhala oyenera kuposa pamene akulankhula za khansa ya m'mapapo. Yesetsani ndipo mulole (gawo limenelo nthawizina ndilo fungulo) okondedwa anu kuti akuthandizeni.

Tengani nthawi yoti mudziwe za khansa yanu. Zofufuza zimatiuza kuti anthu omwe amamvetsa bwino khansa yawo samangomva kuti ali ndi mphamvu zambiri, koma chidziwitso chimenecho nthawi zina chingapangitse kusintha kwa moyo. Onani ngati mungapeze gulu lothandizira anthu omwe ali ndi kansa ya m'mapapo m'mudzi mwanu, kapena mutenge nthawi yolumikizana ndi kansa yamapapu yabwino kwambiri pa intaneti.

Anthu awa sadzakulandirani inu ndikukuthandizani koma akhoza kukhala chitsimikizo chachikulu cha zatsopano komanso kufufuza. Onani mabungwe a khansa yamapapo monga LUNGevity, American Lung Association Lung Force, ndi Lung Cancer Alliance. Pofunafuna ena ndi khansara yamapapu pazochitika zamasewera, hashtag ndi #LCSM yomwe imayimira khansa ya m'mapapo. Ngati muli ndi zaka 50, onetsetsani kuti onani Bonnie J. Addario Lung Cancer Foundation, bungwe lomwe limakonda kwambiri khansa ya m'mapapo kwa achinyamata .

Koposa zonse, khalani woyimira nokha pa chisamaliro chanu cha khansa . Chithandizo cha khansa yamapapo chikusintha mofulumira, ndipo anthu akuyitanidwa kuti akhale mbali yogwira ntchito ya gulu lawo lachipatala. Ndipotu, pali opulumuka ambiri omwe ali amoyo omwe ali ndi moyo chifukwa adziphunzitsa okha ndipo anali ochirikiza chisamaliro chawo. Popeza zimakhala zovuta kwa akatswiri ambiri a zachuma kuti asamangoganizira za kusintha kwakukulu kwa chithandizo, opulumuka ambiri a khansa ya m'mapapo akulangiza kupeza kachiwiri lingaliro pa chimodzi mwa zikuluzikulu za National Cancer Institute-malo opatsirana khansa omwe ali ndi akatswiri a khansa ya m'mapapo.

Ngati Wokondedwa Wanu Ali ndi Magulu Osaopsa Kwambiri

Kulimbana ndi khansa ya m'mapapo kwa wokondedwa kungakhale kovuta. Sikuti mukukumana ndi zomwe wokondedwa wanu akuchokera, koma lingaliro la kusowa thandizo lingakhale lopweteketsa mtima. Mukhoza kutsimikiziridwa kuti anthu ambiri sadziwa momwe angachitire pamene wokondedwa ali ndi khansa ya m'mapapo. Kufunsa njira zenizeni zomwe mungathandizire, m'malo moti "mundiimbire ine ngati mukufuna ine," ndi njira yomwe mungasonyezere kusamalira kwanu ndikuchepetsa zolemetsa zawo. Tengani kamphindi kuti mudziwe zomwe zimakonda kukhala ndi khansara yamapapo ndi momwe mungathandizire wokondedwa ndi khansa .

> Zosowa

> Kawai, K., Saito, Y., Demura, R. Mlandu wa Carcinoma Wachilendo Wowonongeka Wowonongeka Mwa Kugonjetsedwa Kupyolera Muyeso Wopanga Opaleshoni wa Immune Checkpoint Inhibitor. Khansa ya Thoracic . 2018 Feb 8. (Epub patsogolo pa kusindikiza).
> National Cancer Institute. Mankhwala Osakaniza Amtundu Wambiri Wopanda Khansa (PDQ) - Health Professional Version. Kusinthidwa 02/01/18. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq
> Shum, E., Wang, F., Kim, S., Perez-Soler, R., ndi H. Cheng. Thandizo la Opaleshoni ya Cell Squamous Cancer Lung: Kuchokera ku Maphunziro a Zanyama mpaka Kuyesedwa Kwachiwiri. Malingaliro a Akatswiri pa Mankhwala Osokoneza Bongo . 2017. 26 (4): 415-426./
> Thakur, M., ndi A. Wozniak. Zomwe zimachitika pa Necitumumab mu Chithandizo cha Osakhala Small Cell Lung Carcinoma. Khansa Yam'mimba . 2017. 8: 13-19.