Kodi zotupa za Pancoast ndizosiyana bwanji ndi mitundu ina ya khansa ya m'mapapo monga zizindikiro, ndi chithandizo?
Matenda am'mimba ndi mapiritsi a m'mapapo omwe amayamba pamwamba pa mapiritsi a kumanja kapena kumanzere ndikuukira khoma la chifuwa. Amatchedwanso zotupa zopambana za sulcus . Ziphuphu zamtunduwu zimabwera ndi zizindikiro zapadera zomwe zimatchedwa "Pancoast syndrome," zomwe zimapweteka pamapewa ndi mkati mwa mkono ndi dzanja.
Matenda oopsa amatha kukhala pakati pa atatu ndi asanu peresenti ya khansa ya m'mapapo ndipo amasiyana ndi mitundu ina ya khansa yamapapo m'njira zambiri zofunika.
Matenda oopsa kwambiri ndi khansa ya m'mapapo yomwe ingakhale ikusowa kwa nthawi yaitali chifukwa chovutika kuona ziphuphuzi pa maphunziro a X-ray komanso chifukwa cha zizindikiro zawo zachilendo.
Zizindikiro
Zizindikiro za chotupa cha pancoast zimachokera ku kupanikizika kwa ziwalo (mitsempha) yomwe ili pafupi ndi kumtunda kwa mapapo pomwe khansa ilipo. Zizindikiro zapamwamba zimatchedwa matenda a Pancoast-Tobias ndipo zimaphatikizapo:
- Kupweteka kwa ululu ndi kupweteka nthawi zambiri kumawombera pansi mkono (makamaka gawo la mkati mwa mkono ndi mbali ya pinky ya dzanja.) Ululuwu nthawi zambiri ndi wovuta komanso wosalekeza. Ululu ukhoza kulowanso mu mphutsi kapena m'mapewa. ( Kupweteka kwa m'mimba kungakhale chizindikiro choyamba cha khansara yamapapo , makamaka kwa iwo omwe ali ndi zotupa za Pancoast.)
- Zofooka mu minofu ya manja .
- Kusinkhasinkha ndi kumangoganizira kwambiri sindiri dzanja, makamaka mphete ndi pinki.
- "Horner's syndrome " yomwe imaphatikizapo ptosis (khungu lopweteka) ndi anhidrosis (pamapeto pake sagwidwa thukuta pambali imodzi ya nkhope yomwe nthawi zambiri imayamba kutsogolo ndi thukuta kumbali imodzi) komanso miosis (wophunzira wa diso. )
Nthawi zina palinso kutupa kwa mkono wapamwamba chifukwa cha kukakamizidwa pa mitsempha ya subclavia (mitsempha yothamangira pansi pa collarbone).
Ngati muli ndi zizindikiro zilizonse zomwe zikuwonetsa chotupa cha Pancoast, lankhulani ndi dokotala wanu kapena mutenge kachiwiri. Zambiri mwa zotupazi zikusowa poyambirira chifukwa cha zizindikiro zawo zosiyana komanso chifukwa zimakhala zovuta kuziwona pa-x-ray.
Malo ndi Chilengedwe
Ziphuphu zam'mlengalenga zimachitika kumtunda kwa mapepala apamwamba kapena kumanzere (kumadera ozungulira) ndikuukira zigawo pafupi ndi dera lino. Izi zingaphatikizepo:
- Nthiti (nthawi zambiri nthiti 1 ndi 2) ndi vertebrae.
- Plexus ya brachial - gulu la mitsempha pafupi ndi mphepo.
- Mitsempha kapena mitsempha ya mitsempha pafupi ndi mapapo (pamwamba pake, mitsempha ya subclavia, mitsempha ya phrenic, mitsempha yowonongeka, ndi nthenda ya vagus.)
Tanthauzo la Zamankhwala / Anatomic ya Matenda a Pansi
Kwa iwo amene akufuna kufotokozera mozama za matenda a pancoast, American College of Chest Physicians amatanthawuza Matenda a Pansi monga mapapu a mapapu omwe amatha kugwidwa ndi ziwalo zina za pamwamba (m'mapapo) a chifuwa, kuphatikizapo nthiti zoyamba za thoracic , mitsempha ya m'munsi ya bronchial plexus, mndandanda wachifundo ndi kulengeza ziphuphu pafupi ndi pamwamba pa chifuwa kapena ziwiya za subclavia (zotengera za subclavia zikuphatikizapo mitsempha ndi mitsempha yomwe imayenda pansi pa collarbone kapena kuwombera.)
Zimayambitsa
Kusuta ndikumayambitsa khansa zambiri, koma n'kofunika kuzindikira kuti matenda a khansa yamapapo ndi yowonjezereka kwambiri kwa anthu omwe kale anali osuta kusiyana ndi anthu omwe akusuta. Zina mwazidzidzidzi za khansa ya m'mapapo zimaphatikizapo kutentha kwa radon , kusuta fodya, ndi kusagwira ntchito kwa mankhwala ndi zinthu zomwe zimadziwika kuti zimayambitsa khansa ya m'mapapo.
Kudziwa
Kuzindikira kwa zotupa za pancoast nthawi zambiri kumachepetsedwa pazifukwa ziwiri. Matendawa sakhala ndi zizindikiro za khansa yamapapu , monga kupuma pang'ono ndi kukhwima, ndipo nthawi zambiri anthu amawona dokotala wa opaleshoni wamatenda kapena wazamagulu kuti azindikire.
Zilonda zam'mimba zimakhala zovuta kuziwona pachifuwa x-ray chifukwa cha malo awo.
Kugwiritsidwa ntchito kwa CT ndi ma MRI nthawi zambiri zimagwiritsidwa ntchito - ndi MRI zofunika pamaso pa opaleshoni kuti ayang'anire kugwira ntchito. Chiwopsezo cha mapapu cha mtundu wina-kaya chotsegulira chifuwa cha biopsy (thoracotomy) kapena kupyolera mu chiwopsezo cha mitsempha pamwamba pa collarbone Mayesero ena, monga bronchoscopy akhoza kuchitanso.
Kusinthana
Kawirikawiri kumagwiritsidwa ntchito pothandizira PET scan / CT. Ambiri mwa khansayi ndi khansa ya m'magazi ya IIB yopanda khungu. Malinga ndi kafukufuku wa khansa ya TNM yamapapo , ambiri a iwo ndi T3 kapena T4.
Mtundu wa khansa ya mphutsi
Matenda a phokoso nthawi zambiri amakhala mtundu wa khansara yopanda makapu. Mwa izi, pafupifupi 2/3 ndi mapapu adenocarcinoma ndipo 1/3 ndi squamous cell carcinoma kapena lalikulu cell carcinoma. Popeza pali mankhwala ochiritsira omwe tsopano alipo pamapapo adenocarcinoma , ndipo tsopano chifukwa cha squamous cell carcinoma, ndikofunikira kuti muwonetsetse kuti muli ndi profini (genetic profiling) yomwe yachitidwa pamimba yanu.
Chithandizo
Njira zothandizira anthu omwe ali ndi zotupa za pancoast zimadalira kukula kwa chotupacho. Pakalipano, kwa omwe ali ndi siteji yoyamba ndikuyambitsa mapulumulo atatu, mankhwalawa ndi ophatikizapo mankhwala omwe amachititsa opaleshoni. Zosankha zikuphatikizapo:
Chemotherapy komanso mankhwala ochiritsira
Chithandizo cha chotupa cha Pancoast chimayamba ndi mankhwala a kansa yamapapu , kaya opaleshoni ingatheke kapena ayi. Chifukwa cha malo omwe angapangitse opaleshoni kukhala ovuta, cholinga chake ndi kuchepetsa chotupa mu kukula momwe zingathere pamaso pa opaleshoni. Kuwonjezera pamenepo, ambiri mwa zotupazi ndizo "zowonongeka" - ziphuphu zamtunduwu zomwe zimapezeka pa kuyesedwa kwa jini zomwe zothandizira zowonongeka zilipo. Ngati simunayambe kuyesedwa kwa jini, yomwe imatchedwanso kuti ma molecular profiling kapena profiling gene, lankhulani ndi dokotala wanu.
Opaleshoni
Opaleshoni ikhoza kuchitidwa pa zotupa za pancoast, koma kawirikawiri zimachitika pambuyo pa mankhwala otchedwa chemotherapy ndi / kapena chithandizo chowongolera kuphatikizapo mankhwala opatsirana pogwiritsa ntchito ma radiation kuti awononge matumbo. Katswiri wa opaleshoni ya opaleshoni yotchedwa Chemotherapy amachitcha kuti "mankhwala opatsirana pogwiritsa ntchito mankhwala." Kuchita opaleshoniyi kungakhale kovuta kwambiri, ndipo n'kofunika kupeza malo opatsirana khansa kumene madokotala ochita opaleshoni amadziwika ndi vutoli. Mosiyana ndi khansa zina zomwe zafalikira ku mafupa, anthu ena omwe ali ndi zotupa zapanyanja zomwe zasokoneza vertebrae amatha kuchiritsidwa bwino ndi opaleshoni. Pa opaleshoni, maselo amphongo pakati pa mapapo (otchedwa midastinal lymph nodes) amachotsedwanso.
Kuchiza ma ARV
Ngati mankhwala osachiritsika sangatheke, mankhwalawa akhoza kukhala othandiza monga mankhwala opatsirana - omwe amachititsa kuchepetsa ululu ndi zizindikiro zina. Mankhwalawa angagwiritsidwenso ntchito pamodzi ndi mankhwala a chemotherapy kuti "aswe" chotupa asanachitidwe opaleshoni.
Kuchiza mankhwala
Monga tafotokozera pamwambapa, aliyense yemwe ali ndi kansalu yopanda khansa yapakhungu ndi makamaka mapapu adenocarcinoma ayenera kukhala ndi mafilimu opangidwa pa chotupa chawo. Mankhwala amavomerezedwa kwa iwo omwe ali ndi kusintha kwa EGFR , ALK rearrangements , ROS1 rearrangements , ndi zina, ndi mankhwala ena omwe akuphunziridwa mu mayesero a zachipatala.
Immunotherapy
Immunotherapy ndi njira yatsopano yosamalira khansa ya m'mapapo, ndi mankhwala oyamba omwe amavomerezedwa mu 2015. Ngakhale kuti siigwira ntchito kwa aliyense, anthu ena-ngakhale omwe ali ndi kansa ya m'mapapo yapamwamba-akhala akuyang'anira matenda awo nthawi yayitali mankhwalawa.
Zovuta zachipatala
Ziphuphu zosaoneka bwino ndizosawerengeka, ndipo mayesero a zachipatala akuyesa kufufuza mankhwala atsopano.
Kuthamangitsani
Kukula kwakukulu kwa kupulumuka kwa zotupa za pancoast kwakhala kwakwaniritsidwa m'zaka makumi angapo apitayo. Kawirikawiri, zotupa za pancoast zimakhala bwino kwambiri kusiyana ndi zotupa zomwe zimapezeka kwambiri m'mapapu, ndipo kupulumuka kungakhale kosavuta kuposa khansa ina panthawi yomweyi
Zomwe zimakhalapo kwa zaka ziwiri zinapezeka kuti zili pakati pa 55 peresenti ndi 70 peresenti-zapamwamba kwambiri kuposa khansa zina zamapapu, komanso za omwe ali ndi ziwalo zapancoast zomwe zingathe kuchitidwa opaleshoni, zaka zisanu ndi zisanu zapakati pa moyo ndi pakati pa 50 ndi 77 peresenti.
Ndikofunika kudziwa kuti ziwopsezozi zikhoza kukhala zapamwamba kwambiri tsopano, popeza mankhwala ochiritsidwa atsopano, komanso mankhwala osokoneza bongo, avomereza kuti maphunzirowa atsirizidwa.
Ngati Mwadziwidwa
Popeza zotupa za Pancoast si zachilendo, ndipo popeza opaleshoni ndi yowopsya, ndikofunikira kulingalira kupeza lingaliro lachiwiri ngati mwapezeka kuti muli ndi chotupa cha Pancoast. Kafukufuku amatiuza kuti kuphunzira mwatchutchutchu kansalu yanu sikukungokuthandizani kuti muzimva bwino koma kungakuthandizeni ndi zotsatira zanu. Onani malingaliro awa pa zomwe mungachite mukangoyamba kumene kupeza , komanso momwe mungagwiritsire ntchito kanema yanu pa intaneti .
Kukhala wothandizira nokha pa chisamaliro chanu cha khansa kwasintha kusiyana kwa anthu ambiri, ndipo malinga ndi National Cancer Institute, anthu omwe ali ndi khansara yamapapu ayenera kuganizira momwe angayankhire mayesero.
Mwinamwake mwamvapo zambiri zokhudza khansa ya m'mawere ndi zibiso pinki, koma kansa ya m'mapapo imakhala yogwira ntchito komanso yothandizira kwambiri. Ngakhale simunali mtundu wa munthu amene amakonda magulu othandizira kapena zosangalatsa, onaninso kugwirizana ndi ena omwe ali ndi matenda omwewo.
Ndipo, ngati ali wokondedwa wanu yemwe amapezeka kuti ali mmalo mwake, muyenera kuphunzira zomwe muyenera kuchita pamene wokondedwa wanu ali ndi kansa ya m'mapapo .
> Zotsatira:
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