Kuzindikira siteji ya kansa yanu yamapapu ndi imodzi mwa njira zofunika kwambiri zoyamba mutapezeka. Zingakhale zokhumudwitsa kuyembekezera panthawiyi, nthawi zambiri mayesero amalamulidwa. Nthawi zina sitingathe kuweruzidwa mozengereza mpaka patatha opaleshoni, koma nkofunika kuti kansa ya m'mapapo ikhale yolondola.
Kufunika kwa Mapangidwe a Khansa ya M'mimba
Pali zifukwa zingapo zomwe zimatanthawuzira malo a kansa yanu ya mapapo ndizofunikira.
Choyamba ndi chakuti kuwonetsa siteji ya khansa kumapereka chidziwitso chofunikira kuti mupange dongosolo la mankhwala. Kuphatikizidwa kungakuthandizeni kudziwa ngati ayi kapena ayi opaleshoni yanu ndi khansara yanu, ndipo ndizowawa bwanji kukhala ndi mankhwala ena. Phindu linanso la kusamalitsa mosamala ndikulingalira kuti mukuyang'ana. Ngakhale mankhwala opatsirana khansa akusintha ndipo ndizosatheka kudziwa momwe mungayankhire mankhwala anu, siteji yanu ya khansa ingakupatseni lingaliro la zomwe mungathe kuyembekezera.
Mayesero ndi Ndondomeko Zopangira Khansa ya M'magazi
Kafukufuku wochuluka amachitika pofuna kudziwa malo enieni a kansa ya m'mapapo. Maphunzirowa achitidwa kuti aone kukula kwa chifuwa chanu, ndipo ngati ndifalikira pati. Mayesero ojambula angapereke zambiri, koma chidziwitso chimakhala chofunikira kuti mudziwe mtundu wa khansara wamapapu yomwe muli nayo, komanso momwe ilili yapadera pa maselo. Mayesero ena angaphatikizepo:
Kafukufuku woganizira - CT scans ndi MRI scans zingathandize kufotokoza kukula kwa khansa ya m'mapapo ndi kufalikira kwake. Kugwiritsiridwa ntchito kwa PET kuyang'ana khansa ya m'mapapo kungawathandize kwambiri pakuzindikira ngati khansara yamapapu imatha kugwira ntchito kapena ayi.
Bronchoscopy - bronchoscopy ndi njira imene chida chowongolera chimayikidwa m'kamwa mwako ndi mu bronchi yanu kuti muwone momwe zimaonekera m'mapapu anu.
Izi zimathandiza madokotala kuona khansa pafupi ndi njira yanu yaikulu, komanso khansa yakuya m'mapapo kudzera mu njira yotchedwa endobronchial ultrasound.
Mediastinoscopy - A mediastinoscopy ndi ndondomeko yomwe nthawi zina amagwiritsidwa ntchito kuti muwonetsetse-ndi chidziwitso, ngati n'koyenera-dera lotchedwa mediastinum. Pakati pa mapapu anu ali ndi mtima, mimba, trachea, komanso ma lymph nodes ambiri. Kudziwa ngati khansara yanu yafalikira kapena ayi ku maseŵera a pakatiwa angathandize kwambiri pokonzekera chithandizo.
Mapulogalamu ozunguza mapulogalamu - Pambuyo pophunzira mapulogalamu, mapulogalamu ammapapu amafunika kuti azindikire mtundu weniweni wa kansa ya m'mapapo yomwe muli nayo komanso maonekedwe a maselo a chifuwa chanu. Chiwopsezo cha mapapu chikhoza kuchitika m'njira zingapo: Kudzera mu singano ya singano yomwe singano imayikidwa kudzera mu khoma la chifuwa mumapapo anu, biopsy yomwe imachitidwa pa bronchoscopy, kutsegula kwa mapapu otsegula (nthawi zambiri pa opaleshoni ya khansa yamapapo), kapena kanema -thandizidwe ophatikizira, omwe mumapanga chifuwa chanu ndipo mowonjezereka mumalowa kuti mupeze minofu. Posachedwapa mayesero otchedwa madzi akumwa amayamba kupezeka, omwe angapangitse makhalidwe ena a kansa yanu ndi mayeso a magazi.
Malipoti ochipatala - Nthaŵi zina siteji yolondola silingadziŵike mpaka mutatha opaleshoni, monga lobectomy, yapangidwa. Phunzirani momwe mungawerenge lipoti lanu la kansa ya m'mapapo .
Mayeso a Metastases
Kuwonjezera pa mayesero omwe anayesedwa kuti ayese kansa ya m'mapapo yokha, mayesero amachitidwa kuti ayang'ane mayendedwe a kansa ya m'mapapo. Malo ambiri omwe khansa ya m'mapapo imafalikira imaphatikizapo mafupa, ubongo, chiwindi, ndi glands za adrenal. Mayeserowa angaphatikizepo kupyolera m'mimba ya CT (kuyang'ana chiwindi ndi adrenal metastase), fupa la fupa (kufunafuna metastases), ndi ubongo wa CT kapena MRI scan (kuyang'ana ubongo metastases).
Khansara ya m'mapapo ya m'kati ya mitsempha imatha kufalikira ku fupa, ndipo nthawizina mafupa a mafupa amapangidwa pofuna kuyang'ana kufalikira.
TNM Staging
Kuti mumvetsetse siteji ya khansara yanu yamapapu ndizothandiza kuti mubwereze mwamsanga chinachake chomwe chimadziwika kuti "TNM staging". Ndalama ya TNM ndi njira yoyang'ana chotupa chanu poyesa kukula kwake komanso momwe ikufalikira. Mwinamwake mwawona izi pamakalata ndi makalata monga T2N2M0. Ndizosavuta kumvetsa izi kuposa momwe zikuwonekera. Makalata awa omwe muwawona awaphatikizapo:
T -T amaimira "chotupa" ndipo ndiyeso ya kukula kwa khansa yanu mu masentimita. Mwachitsanzo, khansa yomwe imakhala yolemera masentimita 1.5 idalembedwa "T1."
N - N imayimirira kuti ikhale ndi "node" yophatikizapo. N0 zikutanthawuza kuti khansayo siidafalikire ku maselo amodzi. N1 imatanthauza kuti khansara yafalikira ku maselo am'mimba pafupi ndi chotupa choyambirira. N2 zikutanthauza kuti chotupacho chafalikira ku mitsempha yam'mimba kwambiri kutali ndi chotupa chachikulu. N3 imatanthawuza ma selo amphongo ngakhale kutali kwambiri ndi chotupa kapena mbali ina ya thupi.
M - M amaimira kukhalapo kwa metastases. M1b amatanthauza kuti khansara yafalikira kumadera akutali a thupi. M1a zikutanthauza kuti khansara yayamba kufalikira kumapapo ena, kapena pakadutsa pakati pa zigawo zowonjezera m'mapapu (kupweteka kosautsa).
Kuphatikizira kwa TNM komweku, kumbali yake, kumayenderana ndi magawo angapo a nambala (magawo a nambala) a khansa ya m'mapapo.
Mitundu Yosiyanasiyana ya Khansa Yam'mimba
Pa khansa yamapapo yamapapo, mitundu yosiyanasiyana imakhala yosiyana kwambiri
Khansara yaing'ono ya m'mapapo ya m'magazi yathyoledwa mu magawo asanu: siteji 0 mpaka siteji IV, ndi magulu aang'ono omwe izi zikuchepa kwambiri. Kansera yaing'ono ya m'mapapo ya m'mapapo yathyoledwa mu magawo awiri okha: sitepe yochepa ndi siteji yambiri.
Maselo Osakwanira Aang'ono Omwe Amayambitsa Khansa
Khansara yaing'ono ya selo imasweka mpaka magawo asanu, kuyambira pa siteji 0 mpaka siteji IV. Gawo lililonse la magawowa likuphatikizidwanso m'malo ena. Tiyeni tiyang'ane pa ndondomeko iliyonseyi komanso njira zina zochiritsira.
Gawo 0 Khansara Yam'mimba
Kutulukira kwa siteji 0 kansa yaing'ono ya m'mapapo ya khansa ndi yosavuta, koma nthawi zambiri imakhala yowonjezereka tsopano pamene kansa ya m'mapapo ya TB ikuwonekera kwambiri. Kansera ya mapapo 0 yamapapo-komanso carcinoma in situ-khansara imakhala m'magawo angapo a maselo yomwe imayambira ndipo siifala kupyola m'mapapo. Ziphuphuzi zimakayikiridwa pogwiritsa ntchito kafukufuku wa sputum (cytology) koma khansayo sichikuwoneka pa maphunziro ojambula omwe tili nawo panopa. Popeza kuti zotupazo ndizochepa, zimapezeka poyesedwa ndipo nthawi zambiri zimakhala ndi zizindikiro.
Chithandizo cha khansa ya m'mapapo 0 - Chithandizo cha kusankha kwa khansa ya m'mapapo 0 ya opaleshoni ndi opaleshoni, ndi mtundu wa opaleshoni malinga ndi malo a khansa.
Kugonana kwa khansa ya m'mapapo 0 - Popeza khansa ya m'mapapo ya khansa, kapena kansa ya m'mimba , imatengedwa kuti si yowopsya, khansa imeneyi imayenera kukhala yathanzi ndi mankhwala.
Gawo I Yemwe Alibe Kagulu Kakang'ono ka Kansa Kwambiri (NSCLC)
Gawo I Khansara yamphongo yopanda mapapu imaphatikizapo zotupa zomwe zimakhala zovuta (magawo onse kupatulapo siteji 0 amaonedwa kuti ndi yovuta), koma omwe sanafalikire ku maselo amodzi. Mawu akuti "oopsa" akhoza kuwopsya, koma izi sizikutanthauza kuti khansara yayambitsa zida zilizonse kunja kwa mapapo. Izo zimangotanthauza kuti izo zafalikira kupyola pamwamba pa maselo okwera pamwamba pamaselo. Pafupifupi 15 peresenti ya anthu amapezeka pa malo awa. Ikuphatikizidwanso mpaka:
Gawo la khansa ya m'mapapo - Matendawa ndi osachepera 3cm (1.5 mainchesi) m'mimba mwake.
Khansara ya mapaipi ya Ib Ibwererezi ndi zazikulu kuposa 3cm muyeso.
Kuchiza kwa khansa ya m'mapapo ya m'magazi - Kuchita opaleshoni ya khansa ya m'magazi ndi mankhwala opangira khansa. Kwa anthu omwe ali ndi khansa ya m'mapapo ya m'mapapo koma sangathe kuchitidwa opaleshoni, kapena kwa omwe ali ndi ziwalo zomwe sitingathe kuzipeza ndi opaleshoni, thupi la stereotactic radiotherapy (SBRT) lingagwiritsidwe ntchito pochiza khansara. Ndi khansara ya mapapo, kupaleshoni ikhoza kukhala njira yokhayo yothandizira. Kwa khansa ya m'magazi ya Ib kapena anthu omwe ali ndi ziwawa, ovomerezeka amatha kulangiza mankhwala a adjuvant (chemotherapy omwe amagwiritsidwa ntchito pofuna kuthana ndi maselo ena a khansa omwe afalikira kupyola m'mapapu koma sangathe kudziwika pa masomphenya a kujambula.)
Kugonana kwa khansa ya m'mapapo ya khansa - Kufotokozera kwa khansa ya m'mapapo ya khansa ndibwino kwambiri, ndipo pafupifupi theka la anthu omwe amapezeka kuti ali ndi moyo zaka zisanu pambuyo pozindikira kuti ali ndi khansa. Matendawa ndi abwino kwambiri ngati khansa imapezeka panthawi yoyezetsa kansa ya m'mapapo.
Gawo lachiwiri Lopanda Khansa Yamtundu Wosakwanira
Gawo lachiwiri losagwiritsa ntchito maselo a khansa lamapiritsi ndi osiyana siyana. Mankhwalawa, omwe amawoneka kuti ndi "khansa yowonongeka," angakhale ang'ono koma atha kale kufalikira ku ma lymph nodes pafupi, kapena akhoza kukhala wamkulu kuposa khansa yoyamba. Ziphuphuzi zikhoza kuti zinayendetsa pamsewu kapena kumalo a mapapo (pleura).
Gawo lachiwiri la khansa ya m'mapapo - Ziphuphuzi nthawi zambiri zimakhala pakati pa 3 ndi 7cm ndipo zimafalikira ku minofu yapafupi.
Khwerero IIb ya khansa ya m'magazi - Mankhwalawa amapezeka pakati pa 5 ndi 7cm ndipo amafalitsidwa ku maselo amphongo oyandikana nawo, kapena samafalitsidwa ku maselo am'mimba koma amakhala aakulu (oposa 7cm).
Kuchiza kwa khansa ya m'kati ya II yamapapo - Chithandizo cha gawo lachiwirichi chimaphatikizapo kuphatikiza mankhwala ochiritsira. Opaleshoni ya khansa ya m'magazi (mankhwala am'derali) kawirikawiri imakhala imodzi ngati chotupacho chikugwiritsidwa ntchito. Mankhwala a mankhwala a adjuvant (mankhwala ochizira) amachitiranso bwino. Mankhwala ena angakonzedwe malinga ndi maonekedwe a maselo anu.
Kutsekula kwa gawo la II kansa yamapapo - Ngakhale opaleshoni nthawi zambiri ikupambana, pakati pa 20 ndi 50 peresenti ya zotupazi zimabwerera. Ngakhale atabwereranso, komabe mankhwala amapezeka. Gawo lachiwiri lazaka zisanu zapakati pa gawo lachiwirili ndi pafupifupi 30 peresenti koma likuwonjezeka ndivomerezedwa ndi mankhwala atsopano.
Gawo lachitatu Lomwe Silikulu laling'ono la khansa yowonongeka
Khwerero lachitatu Khansara yamapapu yopanda mapapu imaphatikizapo gulu losiyanasiyana la khansa. Kwenikweni, kansa yachitatu ya khansa ya m'mapapo imatchulidwa kuti "khansa ya m'mapapo" kumayambiriro pomwe kansa ya kansa yaing'onoting'ono yamapapu yochepa imatchulidwa kuti "yopambana". Gawo lachitatu lagonjetsedwa:
Khwerero IIIa kansa yaing'ono ya mapapu ya khansa - Awa khansa amakhala aakulu ndipo afalikira ku maselo amphongo afupi (N!) Kapena ang'onoang'ono ndipo afalikira kumapiri aatali (N2.) Angathenso kutumizidwa ku mapapo " apamwamba " khansa.
Khwerero IIIb osati khansa yapakhungu ya mapapu ya m'mapapo - Awa khansa akhoza kukhala amtundu uliwonse, koma afalikira kumalo amphamvu kwambiri (N2) kapena nyumba pafupi ndi mapapo monga mtima kapena malo.
Kuchiza kwa khansa ya m'magazi yachitatu - Njira zothandizira katemera wa IIIa ndi IIIb za khansa ndizosiyana kwambiri. Kwa kansalu yachitatu ya khansa yamapapo, opaleshoni ikhoza kuchitidwa ndi "cholinga chochizira" -medical lingo chomwe chimatanthauza cholinga chochiza khansara. Izi zimachitika nthawi zonse pamodzi ndi mankhwala a chemotherapy ndi mankhwala odzola .
Mosiyana ndi zimenezi, mankhwala opatsirana khansa a IIIb amatha kufanana ndi omwe amachititsa khansa ya IV, ndipo amachitidwa kuti apange zizindikiro kapena kupititsa patsogolo moyo, koma sangathe kuchiza khansa. Nthawi zambiri amachiritsidwa pogwiritsa ntchito mankhwala omwe amachititsa mankhwala komanso mankhwala. Nthawi zina, mankhwala omwe amachititsa mankhwalawa amachepetsa kukula kwa chotupa cha IIIb, kotero kuti opaleshoni ikhoza kuchitidwa patapita nthawi. Kuyeza majekeseni ndi kofunika kwambiri pa zotupa pamsinkhu uwu, popeza mankhwala opatsirana angakhale amodzi mwa mankhwala opatsirana bwino (onani kansa ya kansa ya IV.)
Kugonjetsa kwa khansa ya m'mapapo ya khansa yachitatu - Kutsegula kwa gawo la IIIa ndi IIIb mapiritsi a khansa ndi osiyana kwambiri. Mosiyana ndi zaka zisanu ndi zisanu zomwe zimachitika pa gawo lachitatu, gawo lopulumuka IIIb liri pafupi 5 peresenti. Monga taonera poyamba, ziŵerengerozi sizikuganizira za mankhwala atsopano omwe alipo tsopano ndi khansara yamapapo.
Mgwirizano wa Vuto lachinayi lopanda khansa
Khwerero IV yosakhala yaing'ono ya kansa yamapapu yamapapo ndi kansa yapamwamba kwambiri ya khansa ya m'mapapo yopanda maselo. Ngakhale zili choncho, pafupifupi 40 peresenti ya anthu ali ndi sitiroko ya matenda a IV pa nthawi ya matenda. Ziphuphuzi zafalikira kwa ziwalo zina za thupi, ku mapiko ena, kapena mpaka pakati pa mapepala omwe amalowa m'mapapu.
Kuchiza kwa khansa ya m'magazi ya m'kati ya IV - Ngakhale khansara ya mapiritsi a m'kati ya IV sichikuchiritsika, mankhwala opangidwa kuti athe kuchepetsa moyo ndi kuchepetsa zizindikiro zakula bwino kwambiri zaka zingapo zapitazi. Popeza khansara ya mapiritsi a m'kati mwake-yomwe imatchedwanso khansa ya m'mapapo ya mitsempha-imakhala ndi khansa kupitirira m'mapapu, opaleshoni sizimachitika. Mankhwala omwe amagwiritsidwa ntchito angaphatikizepo:
- Chemotherapy
- Zotsatira zochiritsira - Zopereka zilipo kwa anthu omwe amabereka ziwalo zosiyana siyana monga kusintha kwa ma genetic, kusintha kwa kusintha kwa EGFR, ALK rearrangements , ndi rearrangements za ROS1 , ndi mankhwala ena omwe akuphunziridwa m'mayesero a zamankhwala. Lumikizani wanu oncologist kuti mndandanda wa kusintha kwasinthidwe.
- Immunotherapy - Mankhwala awiri a immunotherapy tsopano avomerezedwa kwa anthu omwe ali ndi kansa ya m'mapapo. Ngakhale mankhwalawa sagwira ntchito kwa aliyense, kwa anthu ena iwo akhala akupulumuka kwa nthawi yaitali ngakhale kwa omwe ali ndi magawo apamwamba kwambiri a matenda.
Kugonana kwa khansa ya m'mapapo ya khansa ya IV - Kutsekula kwa gawo la khansa ya m'mapapo ya IV imakhala ikukula. Ngakhale kuti zaka zisanu zokha zapulumuka zimakhalapo 1 mpaka 2 peresenti, izi zikusintha ndi kuvomerezedwa kwatsopano kwa mankhwala atsopano, onse omwe amachiritsidwa, ndi chithandizo cha immunotherapy, kuti athetse matendawa.
Maselo aang'ono a khansa ya m'mimba
Monga taonera kale, khansara ya m'mapapo ya m'mapapo yathyoledwa mu magawo awiri okha, kansalu yochepa ya khansa yamapapo ya m'mapapo ndi kansalu kakang'ono ka khansa yamapapu ya m'mapapo . Mankhwalawa amagawidwa m'magulu atha kudziwa ngati khansayo ikhoza kuchiritsidwa pogwiritsa ntchito munda umodzi wa dzuwa kapena ayi.
Kamodzi Kokha Kamera Kamene Kamene Kamayambitsa Matenda
Pafupifupi gawo limodzi mwa magawo atatu aliwonse a anthu amapezeka kuti ali ndi kansa ya m'mapapo ya khansa, yomwe imatchedwa khansa ya m'mapapo yochepa. Ziphuphuzi zilipo m'mapapu amodzi okha, koma zikhoza kufalikira ku minofu.
Kuchiza kwa khansa yaing'ono ya khansa yaing'ono - Nthawi zambiri, opaleshoni ya khansa yaing'ono yamapapo ya m'mapapo ndiyotheka, koma chithandizochi nthawi zambiri chimagwirizanitsa ndi mankhwala a chemotherapy komanso mankhwala ochizira.
Kugonana kwa khansa ya m'mapapo ya m'mapapo yochepa - Kukula kwa khansa ya m'mapapo yochepa kumakhala zaka zisanu zapakati pa 30% mpaka 40 peresenti. Ndizapamwamba pamene zotupazi zimapezeka kwambiri kwambiri komanso pamene opaleshoni ikhoza kuchitidwa.
Matenda Ochepa Kwambiri Amayi Amtundu Wambiri
Pafupifupi theka la magawo atatu pa anthu atatu aliwonse omwe amapezeka ndi kansara yaing'ono ya m'mapapo ali ndi matenda aakulu. Mankhwalawa akhoza kupezeka m'mapapo awiri onse, ndipo nthawi zambiri amatha kufalikira ku zigawo zina za thupi, ngakhale pa nthawi ya matenda. Amakonda kufalikira ku ubongo.
Kuchiza kwa khansa ya m'mapapo ya m'mapapo - Ngakhale khansa yaing'ono ya m'mapapo ya m'mapapo imakhala khansara yowopsya, nthawi zambiri imayankha bwino kuphatikizapo mankhwala a chemotherapy ndi mankhwala omwe amawathandiza.
Kugonana kwa khansa ya m'mapapo ya m'mapapo - Kukula kwa khansa yaing'ono ya sepine yazaka zisanu ndi zisanu ndi zisanu ndi ziwiri, koma zikuyembekezeredwa kuti izi zidzasintha. Ngakhale kuti zinkaoneka kuti palibe chitukuko chomwe chinapangidwira pa chithandizo cha khansa yaing'ono ya khansa kwa zaka makumi angapo izi zikusintha tsopano. Mayesero ambiri a zachipatala akupitiriza kuyesa zotsatilazi zomwe zingapite patsogolo.
Kodi Gawo la Khansa Yam'mimba Idzasintha?
Siteji yomwe mumapatsidwa kwa khansa yanu yamapapu ingasinthe pakapita nthawi, makamaka pamene mayesero ena akuwonetsa zatsopano. Izi zikuti, siteji ya kansa yanu nthawi zambiri imaimira malo omwe amadziwika. Mwachitsanzo, ngakhale kuti mwachita opaleshoni ya khansa ya m'magazi ya IIIa ndipo panopa mulibe umboni wa khansa, kansa yanu ikanatchedwa siteji IIIa (ngakhale izi zikuphatikizapo ndondomeko monga NED, yomwe siyimira umboni wa matenda.)
Si zachilendo kuti sitepe ya khansa ya m'mapapo ikhale yowonjezera pamene chidziwitso chatsopano chikupezeka. Mwachitsanzo, ngati mutadziwika kale mutayamba kuwona kuti maselo am'mimba amakhudzidwa pa PET. Ngati khansara ikhoza kubwerera, siteji ikhoza kuwonjezeka. Mwachitsanzo, ngati khansa ya m'magazi yachigawo ya II imayambiranso ndipo pali umboni wakuti yapitirira kufalikira ku mafupa, tsopano iyenera kuonedwa ngati khansa ya m'magazi ya sevenda la IV.
Khwerero Lanu Pambuyo pa Kansa Yanu Yapangidwe Loyamba
Mukakhala ndi dokotala wanu nthawi yoyenera, mukhoza kuyamba kukambirana za khansa ya m'mapapo . Ino ndi nthawi imene anthu ambiri amaganizira momwe angasankhire malo abwino ochizira khansa ya m'mapapo Ndi nthawi yomwe mungakonde kutsatira lingaliro lachiwiri la khansa yanu yamapapu. Ndikofunika kumvetsa kuti kupeza lingaliro lachiwiri sikudzakhumudwitse dokotala amene mwamuwona, ndipo kwenikweni, kupeza lingaliro lachiwiri likuyembekezeredwa. Malingalirowa angakupatseni njira zosiyanasiyana zochiritsira, kapena mmalo mwake, angangokulimbikitsani kuti mukhale ndi chidaliro cha mankhwala omwe mumasankha. Kumbukirani kuti pali zifukwa zambiri kuwonjezera pa siteji yomwe imapita kukasankha mankhwala abwino kwambiri.
Mawu Ochokera
Ndikofunika kumvetsetsa kuti aliyense ali wosiyana. Palibe magawo atatu a khansa omwe ali ofanana, ndipo aliyense amayankha mosiyana ndi mankhwala.
Sizingatheke kudandaula kuti mankhwalawa-komanso chiwerengero cha kupulumuka-khansa ya m'mapapo ikukula. Kumbukirani kuti ziŵerengero zilizonse zomwe mumawerenga zokhudza momwe mulili ndi zaka zingapo. Ngakhale kuti manambalawa angakupangitseni mozama za momwe anthu amawerengera, samatiuza zambiri za momwe mungayankhire payekha. Ndipo pakuganizira kuti panali mankhwala atsopano a kansa ya m'mapapo yomwe inavomerezedwa pakati pa 2011 ndi 2015 kusiyana ndi zaka 40 zisanafike 2011, izi sizingakhale zothandiza.
Tengani nthawi yophunzira momwe mungapezere uthenga wabwino wa khansa pa intaneti . Lolani achibale anu ndi abwenzi anu kukuthandizeni paulendo wanu. Mfundo yakuti mukuwerengera izi zikusonyeza kuti mwachitapo kanthu kuti mutenge nawo mbali. Phunzirani momwe mungakhalire mutetezi wanu mu chisamaliro chanu. Iwo amene akupulumuka ndikukhala ndi khansa ya m'mapapo adzakuwuzani kuti zimapanga kusiyana kwakukulu. Ndipo palibe amene ali ndi chidwi choposa omwe amakhala ndi matendawa.
Zotsatira:
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