Zizindikiro, Kuzindikira, ndi Kupita Patsogolo pa Chithandizo
Khansara ya m'magazi imadziwikiratu ku ubongo pafupifupi 40 peresenti ya milandu yomwe imakhala ndi metastasis. Metastasis ndi mankhwala omwe amagwiritsidwa ntchito kufotokoza khansara yomwe yafalikira kupitirira chilakolako choyambirira ku chipangizo chosiyana, chokhala kutali. Ndi khansara yamapapu, izi zimatengedwa gawo 4 la matendawa.
Mwachidule
Pamene metastases imachitika mwa anthu omwe ali ndi khansara yamapapo, kachilombo kachilendo kawiri sikanatengedwa kuti ndi "khansara ya ubongo" koma makamaka "khansa yamapapo ya m'mapapo ku ubongo" kapena "kansa ya m'mapapo ndi kansa ya metastases." Mosiyana ndi zimenezo, mawu akuti khansa ya ubongo imagwiritsidwa ntchito pa zotupa zomwe zimachokera mu ubongo monga choyambirira, osati chachiwiri, malignancy .
Mwa kuyankhula kwina, ngati mutatenga chitsanzo cha maselo a khansa mu ubongo iwo angakhale maselo a mapapu a khansa, osati maselo a ubongo a khansa.
N'zomvetsa chisoni kuti khansa ya m'mapapo ndi metastase ku ubongo imakhala yosauka kwambiri, koma izi zikusintha kwa anthu ena. Mosiyana ndi mankhwala ambiri a mankhwala a chemotherapy, ena mwa njira zatsopano zothandizira khansa ya m'mapapo amatha kulowa mkati mwazitsulo za ubongo ndipo zingathandize kuthana ndi mapiritsi a mapapo omwe afalikira ku ubongo. Palinso zosankha zatsopano zomwe zilipo kwa omwe ali ndi zochepa chabe ku ubongo (nthawi zina amatchedwa oligometastases). A
Kawirikawiri nthawi yopulumuka ndi ubongo metastases nthawi zambiri imakhala yosachepera chaka, koma pamene masitima okhaokha (oligometastases) amapezeka ndipo angathe kuchiritsidwa, oposa 60 peresenti ya anthu akhoza kupulumuka zaka ziwiri kapena kuposerapo.
Ngati muli ndi khansara yamapapu ndi metastases ya chiwindi, chithandizo chanu ndi mayeza angakhale osiyana kusiyana ndi wina yemwe ali ndi chikhalidwe chimodzimodzi chaka chimodzi kapena ziwiri zapitazo.
Ndikofunika kuphunzira zonse zomwe mungathe ndikukhala mtsogoleri wanu.
Zizindikiro
Matenda a ubongo amatha kuchitika ndi khansa yaing'ono ya m'mapapo ya m'mapapo kapena kansa yaing'ono ya m'mapapo . Kansera yaing'ono ya m'mapapo ya m'mapapo nthawi zambiri imakhala yovuta kufotokozera kumayambiriro oyambirira ndipo, motero, imafalikira ku ubongo musanagwiritse ntchito matenda.
Mankhwala a khansa omwe sali ang'ono angathenso kufalikira ku ubongo koma amatha kuchita zimenezi patapita nthawi matendawa atatha.
Zizindikiro zingasinthe malinga ndi mtundu wa khansa ya m'mapapo ndi kumene mu ubongo metastases zimachitika. Chokhumudwitsa, ambiri mwa anthu atatu alionse omwe ali ndi khansa yachiwiri ya ubongo sangakhale ndi zizindikiro zilizonse. Ngati zichitika, zimaphatikizapo:
- Mutu
- Kutopa
- Kutaya malire
- Nsowa ndi kusanza
- Kuvuta kuyenda
- Kutaya chiyanjano
- Mavuto a kulankhula
- Masomphenya amasintha, kuphatikizapo imfa ya masomphenya kapena masomphenya awiri
- Kufooka kwapadera (kumachitika mbali imodzi ya thupi)
- Kutaya kwaiwala
- Kusintha kwa umunthu
- Kugonjetsa
Kudziwa
Ngati dokotala akuganiza kuti khansa yanu yamapapu yafalikira mu ubongo wanu, iye adzayesa zojambula zojambula monga computed tomography (CT scan) yomwe imagwiritsa ntchito X-rays kuti ipange zithunzi zojambulidwa kapena kujambulira maginito (MRI) omwe amachitanso chimodzimodzi ndi mafunde amphamvu. Ngakhale kuti MRI imaonedwa kuti ndi yolondola, sizingagwiritsidwe ntchito kwa anthu okhala ndi zida zina zazitsulo (kuphatikizapo osakhala otetezeka pacemakers).
Chinthu china chogwiritsa ntchito kujambula ndi positron emission tomography (PET scan) yomwe imatha kusiyanitsa pakati pa maselo ofanana ndi maselo a metabolism ndi omwe amaoneka ngati oopsa (monga maselo a kansa).
Ngati chotupa chokayikira chikupezeka koma matendawa sichikudziwika, chikhoza kuyesedwa kuti chipeze zitsanzo za minofu kuti zitsimikizidwe.
Chithandizo
Chithandizo cha ubongo metastases chimadalira zifukwa zingapo kuphatikizapo kuchuluka kwa ubongo zomwe zikukhudzidwa ndi thanzi lanu lonse. Ngati ubongo wa metastases uli wochulukirapo, chithandizochi chimayang'anitsitsa kuthetsa zizindikiro ndi zovuta kuti zithe kukwaniritsa umoyo wa moyo. Ngati pali masastases angapo, mankhwala am'deralo kuthetsa metastases nthawi zambiri amathamangitsidwa.
Steroids monga Decadron (dexamethasone) ikhoza kugwiritsidwa ntchito kuthetsa ubongo uliwonse, pamene mankhwala osokoneza bongo (mankhwala osokoneza bongo) angachepetse chiwopsezo ndi kupweteka kwa kugwidwa.
Mankhwala ena akhoza kuthyoledwa kukhala mankhwala akuluakulu a khansa ya m'mapapo 4, mankhwala ochiritsa matenda a ubongo, komanso mankhwala ochiritsira oligometastases.
Mankhwala ambiri a khansara kulikonse komwe angakhalepo angaphatikizepo:
- Chemotherapy: Mankhwala ambiri okhudza mankhwala osokoneza bongo ndi othandiza kwambiri pakuthana ndi ubongo wa metastases chifukwa cha kupezeka kwa magazi-ubongo, kapangidwe ka kapillaries komwe kumateteza poizoni (kuphatikizapo chemotherapy mankhwala) kunja kwa ubongo. Chemotherapy ikhoza kuchepetsa kukula kwa zotupa m'mapapu ndipo zimachepetsa kufalikira kwa ubongo.
- Thandizo lothandizira: Mankhwala omwe amawunikira pa kusintha kwa EGFR, ALK rearrangements, ROS1 rearrangements ndi zina nthawi zina amatha kulowa mkati mwachinsinsi cha magazi. Zina mwa mankhwala atsopano zikuwoneka kuti ndi othandiza pakuchita choncho. Monga chemotherapy, mankhwalawa amatetezeranso chotupa chachikulu ndipo amalephera kufalikira ku ubongo.
- Immunotherapy : Ndiposachedwa kwambiri kuti mudziwe zambiri (mankhwala oyamba a khansa ya m'mapapo ya khansa yamapapu inavomerezedwa mu 2015) koma mankhwala atatu omwe amavomereza khansara yamapapu amasonyeza kuti angathe kuthetsa ubongo wa metastases. Kwa anthu ena, mankhwalawa adatsogolera kuwirikiza mavitamini ndi "yankho lokhazikika" kwa khansa yonse.
Mankhwala omwe amatsindika makamaka ubongo wa metastases koma okonzedwa kuti azichiza matenda ambiri:
- Katswiri wa ubongo wotchedwa radiotherapy: Ngati pali masewases angapo a ubongo alipo (malo opatsirana khansa amasiyana pakufotokozera izi ndi chiwerengero chawo chiposa zitatu kapena zazikulu kuposa 20), ubongo wonse wa ubongo wakhala ukulimbikitsidwa. Mafilimu onse a ubongo angakhale abwino kwa omwe ali ndi zizindikiro zokhudzana ndi ubongo wawo kapena omwe ali pangozi ya mavuto (monga stroke). Ikhoza kugwiritsidwanso ntchito pambuyo pa opaleshoni kuti kuchepetsa kufalikira kwa khansa. Ngakhale kuti sikunapangidwe kuti athe kuchiza khansa, pafupifupi 50 peresenti ya anthu omwe ali ndi ubongo wonse wa ubongo amazindikira kuti zizindikiro zikhoza kusintha. Zotsatira zoyipa zimatha kuphatikizapo kukumbukira kukumbukira (makamaka kukumbukira mawu), kutupa khungu, ndi kutopa. Ma Radiation oncologists nthawi zambiri amalimbikitsa mankhwala omwe amawoneka kuti amachepetsanso kusokonezeka kwa chidziwitso chokhudzana ndi mankhwalawa.
Njira zothandizira mankhwala a Metastasis ndi awa:
- Radiyo yotchedwa radiotherapy: Amadziwika kuti stereotactic radiosurgery kapena SBRT, uwu ndi mtundu wa mazira akuluakulu omwe amaperekedwa kumadera ena a ubongo. Popeza kuti mankhwalawa amawunikira, zotsatira zake zimakhala zochepa kwambiri ndipo zimapereka moyo wabwino kwambiri kusiyana ndi mankhwala onse a ubongo. Mtundu uwu wa radiotherapy nthawi zambiri umasungidwa kwa anthu omwe ali ndi ziwalo zitatu kapena zochepa, ngakhale kuti anthu ena athandizidwa ndi matendawa mpaka 20.
- Thandizo la Proton: Thandizo la Proton likugwiritsidwa ntchito mofanana ndi SBRT, ndipo likuchitidwa pofuna kuthetsa metastases omwe alipo.
- Opaleshoni: Opaleshoni imagwiritsidwa ntchito mocheperapo koma ikhoza kukhala njira ngati pali imodzi kapena ziwalo zina zomwe zimapezeka mosavuta, ndipo palibe zizindikiro za khansara kwinakwake. Kuchita opaleshoni kungaphatikizepo kuchotsedwa kwathunthu kwa chotupa kapena kuchotseratu pang'ono pofuna kuchepetsa zizindikiro. Mazira onse a ubongo amatsatira. Popeza maselo ang'onoang'ono amatha kukhala ndi radiotherapy okha, opaleshoni nthawi zambiri amachotsa khansa yaing'ono.
Ngati njira zosiyanasiyana zochiritsira zimakhala zosagwira ntchito, chisamaliro chochepetsera chingagwiritsidwe ntchito popereka mpumulo ndi kuchepetsa nkhawa zomwe zimagwiritsidwa ntchito ndi matenda opatsirana. Izi zingaphatikizepo kugwiritsa ntchito mankhwala opweteka, mankhwala okhudza thupi, ntchito zothandizira, kapena mankhwala othandizira kuti apititse patsogolo chitonthozo ndi kusintha umoyo wa moyo.
Mawu Ochokera
Matenda a ubongo chifukwa cha khansara yamapapo ingakhale yoopsa. Koma, mowopsya monga momwe zingakhalire, ndikofunika kukumbukira kuti palibe njira yothetsera khansa. Zimatha kusiyana pakati pa munthu ndi munthu, ndipo "kuyembekezera" kapena "kuyerekezera" kuyembekezera zomwe mukuwerenga sizikukhudzani inu nokha.
Ngati mukumana ndi metastases ya ubongo kuchokera ku khansa ya m'mapapo, gwiritsani ntchito ndi madokotala anu ndi okondedwa kuti mupange chisankho chodziwitsidwa mwachidziwitso cha chidziwitso. Kaŵirikaŵiri zimathandiza kupeza lingaliro lachiwiri pa malo akuluakulu a khansa omwe amadziwika kwambiri ndi khansa ya m'mapapo. Ngakhale ngati mankhwalawa ali ofanana, inu ndi banja lanu mukhoza kukhala otsimikiza kwambiri kuti muli mu njira yoyenera.
Ndikofunika kudzilola nokha kumverera zomwe mumamva ndi kufunafuna chithandizo kuti muthe kuyenda ulendo uno. Ingotenga sitepe imodzi panthawi.
> Zotsatira:
> Cohen, J., ndi H. Kluger. Imminotherapy Yodalirika kwa Chithandizo cha Mitsempha ya Ubongo. Malire a Oncology . 2016. 6:49.
> Jimenez, R., Alexander, B., Mahadevan, A. et al. Zotsatira za Njira Zosiyana Zolimbana ndi Mafilimu Omwe Amagwiritsidwa Ntchito Poyambitsa Mafuta Amayambitsa Mitsempha Yopangira Ubongo pa Zowonongeka za M'deralo ndi Poizoni. Kupita Patsogolo pa Mafilimu Achipangizo Chowombera . 2017. 2 (3): 391-397.
> Loganadane, G., Hendriks, L., Le Pechoux, C. et al. Ntchito Yamakono Yonse Yopereka Mankhwala Opaleshoni M'magulu Osakani Aang'ono Odwala Matenda a Khansa. Journal of Thoracic Oncology . 2017. 12 (10): 1467-1477.
> Zhu, Z., ndi Y. Chai. Kukana kwa Crizotinib Kugonjetsedwa ndi Ceritinib mu Cell ALK-Non-Small Cell Kugonjetsa Khansa Kupirira ndi ubongo Metastases: Nkhani Report. Medicine (Baltimore) . 2017. 96 (45): e8652.