Zizindikiro, Zojambula, Zochiritsira, ndi Zamatenda
Kodi zikutanthauzanji ngati muli ndi kansa ya m'mapapo 3, ndipo izi zikusiyana bwanji ndi magawo ena? Kodi ndi mankhwala ati omwe angakonzedwenso ndi chiyani chomwe muyenera kudziwa kotero kuti mutha kukhala wothandizira anu pa chisamaliro chanu cha khansa? Kodi nchiyani chomwe chikugwiritsidwa ntchito pa siteji iyi ndi momwe izi zikusinthira ndi mankhwala atsopano?
Mwachidule
Khwerero 3 ya khansa ya m'mapapo yopanda mapapu ndi khansa yamapapu yambiri yomwe ikuphatikizidwira mu siteji 3A ndi siteji 3B .
Zomwe Zili Patsogolo Pafupi ndi Zotsatira Zowonjezera 3 Khansa Yam'mimba
Ndi kosavuta kufotokoza kusiyana kwa khansa ya khansa ya m'magazi 3 pochepetsa mapiritsi onse a mapapo m'magawo awiri.
- Khansara yamapapu yapakhungu - Gawo 3A imatengedwa kuti ndi khansa ya m'mapapo yakwathu. Matendawa sanafalikira kumadera akutali a thupi, koma afalikira ku maselo amodzi pambali imodzi ya thupi ngati chotupa. Gawo I kuti ndipite ku malo oyamba 3A khansa ya m'mapapo imatengedwa ngati "yogwiritsidwa ntchito" kutanthauza kuti opaleshoni imapereka chithandizo cha mankhwala.
- Khansara yamapapu yapamwamba - Pamodzi ndi kansa ya mapapo 4 yamapapu, siteji 3B khansa yamapapo imatengedwa kuti ndi khansa ya m'mapapo yapamwamba . Ziphuphuzi zafalikira pamlingo wotere kuti opaleshoni sizingatheke (kupatulapo, komanso nthawi zina, atachizidwa ndi chemotherapy ndi mankhwala a radiation.) Matendawa "sagwiritsidwa ntchito" ndipo kaŵirikaŵiri amachira, koma amachiritsidwa, ndipo mankhwala ambiri atsopano akhala yemvomerezeka m'zaka zaposachedwa.
Kukula
Pafupifupi 30 peresenti ya anthu ali ndi khansara ya m'mapapo 3 pamtundu wa matenda a kansa pa nthawi ya matenda, ndipo anthu 30 pa 100 aliwonse amapezeka pa sitepe yoyamba ( gawo 1 kapena gawo 2 la matenda) ndipo 40 peresenti atayamba kale kupita ku siteji 4 (khansa) yamatenda a m'mapapo . nthawi yofufuza.
Kusinthana
Maphunziro a khansa ya m'magazi ndi ofunika kwambiri posankha njira zabwino zothandizira, makamaka kusiyana pakati pa gawo 3A ndi siteji 3B.
Khansara ya m'magazi yachitatu ikufotokozedwa bwino posiyanitsa magawo mu siteji 3A ndi siteji 3B padera.
Gawo 3A Khansa yamapapo yamapiko imaphatikizapo zotupa zomwe ndi zazikulu ndipo zafalikira ku maselo oyandikana nawo pafupi, kapena zotupa za usinkhu uliwonse zomwe zafalitsidwa ku maselo omwe ali kutali koma komabe pambali imodzi ya thupi ngati khansara.
Gawo la 3B Khansa ya m'magazi imatanthawuza ngati chotupa cha kukula kwake kulikonse komwe kwafalikira kumatenda a kutali kwambiri kapena kuwononga ziwalo zina mu chifuwa (monga mtima kapena chifuwa ). Pakati pa mapepala omwe amapezeka m'mapapu) anasinthidwa kuchoka pa siteji 3B kupita ku stage 4 mu 2009.
Oncologists amagwiritsa ntchito njira ya TNM kufotokozera magawo a kansa ya m'mapapo. Malongosoledwe ophweka a TNM dongosolo akuphatikizapo:
T amatanthauza kukula kwa chotupa:
- T1 - Chotupacho sichichepera masentimita atatu mu kukula.
- T2 -Thusa imaposa 3 cm.
- T3 - Chotupacho chingakhale kukula konse, koma chiri pafupi ndi msewu wa pamsewu kapena kufalikira kumadera omwe akukhala ngati khoma la chifuwa kapena diaphragm .
- T4 - Chotupacho ndi kukula kwake, koma kuli panjira kapena kulimbana ndi zigawo zapansi monga mtima, kapena chiwonongeko.
N amatanthauza maselo:
- N0 - Palibe malo omwe amakhudzidwa.
- N1 - Chotupacho chafalikira kumadera oyandikana nawo mbali imodzi ya thupi.
- N2 - Chotupacho chafalikira ku nodes patsogolo koma pambali imodzi ya thupi.
- N3 - Maselo a khansa ali pamagulu a mitsempha kumbali ina ya chifuwa kuchokera ku chotupa, kapena m'madera pafupi ndi collarbone kapena minofu ya m'khosi.
M amaimira matenda oopsa :
- M0 - Palibe metastases alipo.
- M1 - Kutupa kwafalikira (kuchepetsedwa) kumadera ena a thupi kapena mapapo ena.
Pogwiritsa ntchito TNM System, siteji ya 3A khansa ya m'mapapo ikufotokozedwa monga:
- T1N2M0 - Chotupacho n'chosachepera 3 masentimita mu kukula ndipo chafalikira ku maselo amphamvu kwambiri kutali koma pambali imodzi ya thupi ngati chotupa.
- T2N2M0 - Chotupacho n'choposa 3 cm ndipo chikufalikira kumalo amphamvu kwambiri koma pambali imodzi ya thupi.
- T3N1M0 - Chotupacho ndi kukula kwake koma chili pafupi ndi pandege kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndipo ma lymph nodes omwe ali pafupi amakhudzidwa.
- T3N2M0 - Chotupacho ndi kukula kwake koma chili pafupi ndi pandege kapena kufalikira kwina kumalo ngati khoma la chifuwa kapena diaphragm, ndipo maselo omwe ali kutali koma pambali imodzi ya thupi amakhudzidwa.
Kugwiritsa ntchito TNM System, siteji 3B ikufotokozedwa monga:
- Matenda onse T, N3, M0 - Chotupa cha kukula kulikonse komwe kwafalikira ku maselo amphongo kumbali ina ya chifuwa kuchokera ku chotupa kapena nodes pafupi ndi collarbone kapena mitsempha ya mitsempha, koma sinafalikira kumadera akutali a thupi.
- T4, iliyonse N, M0 - Chotupa cha kukula kulikonse kumene kuli pa airways, kapena chasokoneza zipangizo zapakhomo monga mtima kapena malo. Node ikhoza kukhala yosagwiritsidwa ntchito, kapena ikagwidwa, ikhoza kukhala pafupi ndi chotupa kapena kupitilira mu chifuwa kapena khosi, koma chotupacho sichinafalikire kumadera akutali a thupi.
Zizindikiro
Zizindikiro za khansa ya m'mapapo 3 zimakhala zosiyana kuyambira pa siteji 3 zikuphatikizapo khansa zambiri. Zizindikiro chifukwa cha khansa m'mapapu monga chifuwa chokhazikika , kupuma pang'ono , ndi matenda obwerezabwereza monga chibayo kapena bronchitis, ndizofala.
Kufalikira kumadera ngati khoma la chifuwa ndi diaphragm kungabweretse kupweteka mu chifuwa, nthiti, mapewa, ndi kumbuyo.Zomwe zili pafupi ndi maulendo a airways zingayambitse hemoptysis ( kuthamanga magazi ) ndi kuwomba . Pamene chotupacho chimaphatikizapo malo monga chiwindi ndi ziwalo zina za chifuwa, dysphagia (kuvutika kumeza) ndi mantha akhoza kuchitika. Kupweteka kumbuyo, chifuwa, ndi nthiti ndizofala ngati phokoso lamakono likupezeka, ndipo izi zingapangitse kupuma pang'ono.
Zizindikiro zowopsa za khansa monga kutopa komanso kutaya kwadzidzidzi kungakhalepo.
Chithandizo
Chithandizo cha khansa ya m'mapapo 3 ya pamapapo ndizovuta kwambiri pamagulu onse a khansara wamapapo, makamaka chifukwa gululi ndi losiyana kwambiri. Chifukwa cha kupulumuka kosauka, National Cancer Institute imanena kuti aliyense amene ali ndi kansa ya m'mapapo 3 ya pamapapo ayenera kuonedwa kuti ndi woyenera pa zochitika zachipatala - maphunziro omwe amafufuza mankhwala atsopano kapena kuphatikiza kwa mankhwala a kansa ya m'mapapo.
Gawo 3A Chithandizo
Kwa kagawo kake ka khansa ya 3A, opaleshoni ikhoza kuchitidwa kuti achotse chotupacho ndipo nthawi zambiri amatsatira mankhwala a adjuvant chemotherapy (chemotherapy pambuyo pa opaleshoni). Opaleshoni imapereka mpata wochiritsidwa koma nthawizonse sizingatheke ndi zotupa za kukula uku. Kuopsa kwa matenda a khansa ya m'mapapo ndi kotheka kwa anthu omwe ali ndi kansa ya 3A kansa ya m'mapapo.
Kwa anthu omwe ali ndi thanzi labwino, kuphatikizapo mankhwala a chemotherapy kapena chemotherapy ndi mankhwala opatsirana pogwiritsa ntchito ma radiation nthawi zambiri amalimbikitsidwa. Ngati anthu sangathe kulekerera mankhwala a chemotherapy, mankhwalawa akhoza kugwiritsidwa ntchito pokhapokha kuti athe kupweteka monga kupweteka ndi kupuma pang'ono.
Panopa tikulimbikitsidwa kuti majekesitomu (kuyesera kwa jini) achite kwa aliyense yemwe ali ndi khansa ya m'mapapo yopanda makapu , makamaka mapapu adenocarcinoma . Mankhwala avomerezedwa kwa anthu omwe ali ndi kusintha kwa chisendetsero monga kusintha kwa EGFR , ALK rearrangements , ndi rearrangements za ROS1 , ndipo izi zothandizidwa nthawi zina zimatha kulamulira bwino matendawa. Kutsutsana kawirikawiri kumawonekera pakapita nthawi, koma mankhwala am'badwo wotsatira amavomerezedwa ndi kuyesedwa mu mayesero a zamakono pamene izi zikuchitika. Kwa omwe ali ndi squamous cell carcinoma m'mapapu , anti-EGFR antibodies angagwiritsidwe ntchito. Mayesero am'zipatala akuphunziranso mankhwala omwe amayang'ana kusintha kwa chibadwa cha khansa ya m'mapapo.
Mankhwala anayi atsopano ogwiritsidwa ntchito m'thupi amavomerezedwa mu 2015 kuti athetse khansa ya m'mapapo. Mankhwalawa amathandiza kwambiri kuti mphamvu zathu zoteteza mthupi zimenyane ndi khansa. Ngakhale kuti sagwira ntchito kwa aliyense, anthu ena atha kukhala ndi matenda a khansa yawo kwa nthawi yaitali. Imfinzi (durvalumab) makamaka inavomerezedwa mu February 2018 kuti ayambe kusamalidwa ndi khansa ya m'mapapo ya m'magazi itatu pambuyo pake. Pogwiritsidwa ntchito pazomwezi, zinapezeka kuti zimasintha kwambiri kupulumuka kwapakati pazomwekupita.
Gawo 3B Chithandizo
Gawo 3B khansa, mosiyana ndi siteji 3A, sangathe kuchitidwa opaleshoni. Mwa kuyankhula kwina, iwo sangathe kugwira ntchito -koma osati osatetezedwa. Mankhwalawa angaphatikizepo mankhwala a chemotherapy, mankhwala a radiation, mankhwala ochiritsira, ndi matenda a immunotherapy monga matenda a sitepe 3A.
Nthaŵi zina, kugwiritsa ntchito mankhwala a chemotherapy ndi mankhwala omwe amachititsa kuti tizilombo tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda timatha kuchepetsa kukula kwa chotupa kotero kuti opaleshoni ikhoza kutheka. Chemotherapy amagwiritsidwa ntchito m'njira imeneyi amatchedwa "neoadjuvant chemotherapy."
Kwa anthu omwe ali ndi kansa ya m'mapapo 3, mankhwala amatha kugwiritsidwa ntchito ngati mankhwala opatsirana , kutanthauza kuti cholinga cha mankhwala ndikutulutsa zizindikiro monga kupweteka ndi kupuma pang'ono m'malo moyesera kuthetsa khansa. Zapezeka kuti mankhwala othandiza anthu omwe ali ndi khansara yamapapu angathe kupulumuka.
Kuthamangitsani
Kansera ya mapaipi ya mapawa 3A ya zaka zisanu ndi zisanu ndi zisanu ndi ziwiri, koma imatha kusintha mosiyanasiyana. Kuchuluka kwa zaka zisanu ndipakati pa siteji ya 3B khansa ya m'mapapo ili ndichisoni pafupifupi 5 peresenti. Ndikoyenera kukumbukira kuti ziwerengero izi zimagwirizana ndi momwe anthu amachitira ndi khansa ya m'mapapo m'mbuyomo. Popeza pali mankhwala ambiri omwe amavomerezedwa kuti azitha kuchiza khansa ya m'mapapo pakati pa 2011 ndi 2015 kusiyana ndi zaka makumi anayi zisanafike chaka cha 2011, ziwerengerozi ndi zosakhulupirika poyerekezera ndi chiyembekezo cha moyo masiku ano.
Kulimbana ndi Kuthandizidwa
Kafukufuku akusonyeza kuti kuphunzira zomwe mungathe pa khansara kumathandiza ndi zotsatira zake. Funsani mafunso. Phatikizani okondedwa anu ndikuwalimbikitsa kuti afunse mafunso. Ganizirani kulowetsa gulu lothandizira . Phunzirani za mayesero a zachipatala zomwe zingakhale zoyenera pazochitika zanu. Kuphunzira za khansara yanu ndi kuchipatala kungatenge nthawi yambiri. Funsani ndi kulola okondedwa anu ndi abwenzi kukuthandizani ndikukulimbikitsani ulendo wanu. Musataye chiyembekezo-ngakhale kuti chiyembekezo chimenecho chikhale chosangalatsa monga momwe mungathere mukakhala ndi anzanu.
Zotsatira
American Cancer Society. Khansa Yam'mimba (Cell Osati Small .
Komiti Yovomerezeka ya ku America ya Khansa. Khansara ya Khansa. Gulu lachisanu ndi chiwiri.
> Antonia, S., Villegas, A., Daniel, D. et al. Durvalumab Pambuyo pa Chemoradiotherapy mu Gawo III Lopanda Matenda Osakaniza Amtundu Wambiri. The New England Journal of Medicine . 2017. 377: 1919-1929.
Edge, S. et al (Eds). Buku la AJCC la Kukhazikitsa Khansa. Gulu lachisanu ndi chiwiri. Springer. New York, NY. 2010.
Faithi, A. ndi J. Brahmer. Chemotherapy pa khansa yapakhungu yopanda khansa yapakhungu. Masemina mu Opaleshoni ya Thoracic ndi Mafupa . 2008. 20 (3): 210-6.
National Cancer Institute. Mankhwala Osakaniza Amtundu Wambiri Wopanda Khansa (PDQ) - Health Professional Version.