Iimvavanyo kunye neenkqubo zokuSonga iCancer Cancer
Ukuxilongwa komdlavuza wamaphaphu kungaqala nge-x-ray esifubeni, kodwa ekubeni olu vavanyo lungahle luphuphe i-cancer ye-early, isifo se-CT scan, kwaye ekugqibeleni i-biopsy ukuba i-nodule okanye ubunzima bufunyenwe, kuyadingeka.
Umdlavuza womlenze uvame ukukhankanywa emva kokuba indawo engavumelekile ifunyenwe kwi-x-ray esifubeni eyenziwe ukuhlola intlungu yomkhuhlane okanye isifuba. Ngethuba lexesha eliyikrakrayo, kunceda ukwazi ezinye iinkqubo ezinokuthi zinconywe ukuba zifumanise ukuba ukungaqhelekanga kunobungozi (kungengomdlavuza), okanye unobungozi (umdlavuza).
Ukuba ukungaqhelekanga kuyingozi, uphando olongezelelweyo lwenziwe ukuze lubone ukuba umhlaza usasazeke ( unxibelelwano lweminye imimandla) kwezinye iindawo zomzimba kwaye ufunde isigaba sesifo.
Ukuhlolwa kweCarcer Lung
Kwalabo abangenayo impawu, ukuhlolwa komhlaza wamaphaphu ngoku kuvunyelwe ukufunyanwa kwangaphambili kubantu abaphakathi kweminyaka engama-55 no-80, baye bamtsha ubuncinane iminyaka engama-30 yepakethi, bamise okanye bayeke ukutshaya kwiminyaka eyi-15 edlulileyo. Kubalulekile ukuba uqaphele, nangona kunjalo, ukuba ukuphononongwa kuthethwa ukuba luvavanyo lwabantu abangenazo iimpawu. Ukuba unayo nayiphi na impawu yomdlavuza wamaphaphu, iimvavanyo ezongezelelweyo, kuquka ne-CT epheleleyo izakufuneka.
I-Lung "Amabala" kunye nezinye iinkcazo
Ngaphambi kokungena kwisifo somhlaza wamaphaphu, usenokuba uzive ukhululekile ngenxa yeempawu zakho, kwaye naluphi na uhlobo olugqithisileyo ugqirha obonayo okanye oluya kubona kwi x-ray okanye CT scan. Njengokuhlaziywa okukhawulezayo, Njengokuhlaziywa okukhawulezayo, i-nodule yamaphaphu ithathwa ngokuba "yindawo" empompo enesi-3 cm (intshi kunye nesiqingatha) okanye ngaphantsi ububanzi.
Ubunzima bomphunga bubhekisela kwisimo esingavamile esingaphezu kwe-3 cm ububanzi. Indawo kwindawo yomphunga okanye "umlenze wephunga" ingaba yinto embi okanye eyingozi. "Isithunzi" kwi-x-ray sinokuthi sinokuthi sinobungozi okanye siyingozi, okanye nje ukugqithwa kwezakhiwo eziqhelekileyo esifubeni.
Imbali kunye neMzimba
Xa umrhatsane wamaphaphu ukhunjulwa, ugqirha uya kuqala enze imbali epheleleyo kunye nokuhlolwa komzimba.
Oku kwenziwayo ukuvavanya iimpawu kunye nemingcipheko yomdlavuza wamaphaphu , kunye nokujonga nayiphina impawu ebonakalayo ebonisa ukukhangela kombhobho r. Ezi zibandakanya izandi ezingaqhelekanga zamapayipi, i- lymph nodes ekhulisiweyo, ukulahleka kwesisindo esingenasenzo, okanye i- clubbing yeeminwe (iminwe eminwe).
ILebhu neeRidiology Studies
Izifundo ezahlukeneyo zokucinga zingafuneka, kuxhomekeke kwiimpawu zakho ezithile kunye nokufunyaniswa kuviwo. Ezi ziquka:
X-Ray
I-x-ray isifuba sivame ukuhlolwa kokuqala ukwenzela ukuvavanya nayiphi na inkxalabo esekelwe kwimbali echanekileyo nangokwenyama. Oku kungabonisa ubunzima kwimiphunga okanye i-lymph node. Ngamanye amaxesha i-x-ray isifuba iyinto eqhelekileyo, kwaye iimvavanyo ezongezelelweyo zifuneka zikhangele umkhanyo okhankanywe ngumhlaza wamaphaphu. Nangona u bunzima bufunyanwa, ezi zihlale zingumhlaza kwaye zifunyenwe ezinye izifundo. Kufuneka kugxininiswe ukuba i-x-ray yesifuba yedwa ayaneleyo ukulawula umdlavuza wamaphaphu, kwaye i-cancer ye-early cancers can easily miss out with these tests.
CT scan
I-CT scan (i-computerized tomography) ngokuqhelekileyo isinyathelo sesibini ukulandelelana ngesifuba esingaqhelekanga x-ray ukufumana okanye ukuvavanya iimpawu ezinzima kwii-x-ray esifubeni esifanayo. Ukutshekisha kwe-CT kubandakanya uchungechunge lwe-x-ray eyenza umboniso we-3-dimensional yemiphunga.
Ukuba i-CT ayiqhelekanga, ukuxilongwa komhlaza wemiphunga kusadinga ukuqinisekiswa ngokusebenzisa isampula yeethambo ngenye yeenkqubo ezi ngezantsi.
I-MRI (imagery magnetic imaging)
Kwabanye abantu, i-MRI (i-magnetic imagination resonance) iya kusetyenziswa ukuhlola umlinganiselo womhlaza wemiphunga. Le nkqubo isebenzisa i-magnetism kwaye ayibandakanyi imitha. Abanye abantu, njengalezo ezinezitshixo zetsimbi (abenzi be-pacemaker, njl.) Akufanele babe ne-MRI. Iingcali ziya kubuza imibuzo ukuqinisekisa ukuba azikho.
PET scan
I- PET yokuhlola (positron emission tomography) isebenzisa izinto ezinokuthi zenze i-radioactive ukudala imifanekiso emibala emithathu yommandla womzimba.
Olu hlobo lokuskena luhluke kwabanye kuba luchaza izihlamba ezikhula ngokukhawuleza. Inani elincinci le-sugaractive ishijithali ijojowe kwigazi, kwaye inikwe ithuba lokunyulwa ngamaseli. Iiseli ezikhula ngokukhawuleza zithatha ushukela ophezulu, kwaye zikhanyise kwiifilimu. Uvavanyo luvame ukuhlanganiswa ne-CT scan (PET / CT). Njengoko kwongezwa kwezinye iinkqubo, abanye abaphandi bacetyisa ukuba ukukhangela kwe-PET kungafumanisa izigulane ngaphambili, nangaphambi kokuba zibonwe ngokwazo ngezinye izifundo. I-PET i-scans iyanceda ekuhlukaniseni phakathi kwezicubu kunye nezicubu ezinqabileyo kubantu abaye banqanda emiphakeni yabo nasiphi isizathu.
Sputum Cytology
Emva kokuba umdlavuza wamaphaphu ukhunjulwe ngokusekelwe kwi-imaging, isampula yamathambo kuyadingeka ukuqinisekisa ukuxilongwa kunye nokuchonga uhlobo lomhlaza. I-sputum cytology yindlela elula kakhulu yokwenza oku, kodwa ukusetyenziswa kwayo kugqityiweyo kulawo mathambo aqhubekayo kwi-airways. I-sputum cytology ayisoloko ichanekile kwaye ilahleke ezinye iiseli zomhlaza. Uvavanyo luyinzuzo kakhulu xa luhle, kodwa luthi luncinci ukuba lubi.
Bronchoscopy
Kwi- bronchoscopy , ingcali yempuphu ifaka ityhubhu kwi-airways ukujonga ngolu hlobo kwaye ithathe isampuli yesisu. Le nkqubo isetyenziswe xa i-tumor ifumaneka kwi-airways enkulu kwaye ifikeleleke kwindawo. Izigulane zinikezwa i-anesthesia ngexesha le nkqubo ukwenzela ukunciphisa ukungazinzi. Ngexesha le-bronchoscopy, i-biopsy inokuthi ithathwe nayiphi na isisu okanye ezinye izinto ezingaqhelekanga ezibonakalayo kwi-airways.
Endobronchial Ultrasound
I-endobronchial ultrasound yindlela entsha yokufumana umhlaza wemiphunga. Ngethuba le-bronchoscopy, oogqirha basebenzisa iprojekiti ye-ultrasound ngaphakathi kwendlela yokuhlola iipapu kunye nommandla phakathi kwemiphunga (mediastinum). Kwiimvumi eziseduze ne-airways, i-biopsy inokwenziwa ngolu hlobo.
Inal biopsy
Kwisipilisi esifanelekileyo senaliti (FNA) ye-biopsy, ugqirha ufaka isaliti esingenalutho ngodonga lwesifuba, ngokuqhelekileyo ekhokelwa yi-CT ukujonga, ukuba athathe isampuli yesisu. Oku kungenziwa kwiimvumi ezingenakufikelelwa yi-bronchoscopy, ingakumbi ezo zisondele kwimida yemiphunga.
ITraracentesis
Xa umdlavuza wamaphaphu uphazamisa umda weemiphunga, kunokubangela ukuba umbane ube nokwakhiwa phakathi kwemiphunga kunye nemiphunga yamapayipi (i-pleura.) Nge-anesthhesia yendawo, inaliti enkulu inokufakwa kwisigxina esilungileyo esivela kuyo ukuba ingakanani i-diagnostic amount of fluid (imali encinci ukuvavanya iiseli zomhlaza, ukutshatyalaliswa okukrakra komlomo ) okanye umlinganiselo wokwelapha (umlinganiselo omkhulu ukuphucula intlungu kunye / okanye ukuphefumla okufutshane) ususwe.
Mediastinoscopy
I- mediastinoscopy Le nqubo yenziwa kwigumbi lokusebenza phantsi kwe-anesthesia jikelele. Ubume bufakwe ngaphaya kwe-sternum (ithambo lesifuba) kummandla phakathi kwemiphunga ( i-mediastinum ) ukuthatha iisampuli zamathambo kwi-lymph nodes. Uvavanyo lwe-PET ngoku luhlala lubonelela ngeziphumo ezifanayo ukuba i-mediastinoscopy yenze ntoni ngaphambili.
Uvavanyo lokuQinisekisa ukuba umdlavuza weLung Uye usasazeka (iMastastised)
Umdlavuza womlenze uhlala usasazeka kwisibindi , iiglands ze-adrenal, ingqondo kunye namathambo. Uvavanyo oluqhelekileyo lubandakanya:
- I-CT scan yesisu: Ukujonga ukuba usasazeka kwisibindi okanye i-adrenal glands
- I-MRI yengqondo: Ukukhangela i- metastase ebuchosheni
- Ukukhangela kwe- Bone : Ukuvavanya ama- metastase amathambo , ingakumbi emva, emagqabini, nakubhonkco
- Ukukhangela kwe-PET: Iskripthi se-PET singakhangela i-metastases ngokubhekiselele kuyo nayiphi na indawo emzimbeni, kwaye ngamanye amaxesha ungatshintsha ezinye iimvavanyo ezinjenge-scan scan okanye i-CT scans.
Ezinye iimvavanyo ngexesha loxilongo
Uvavanyo olongezelelweyo olungenakuxilongwa luvame ukuqhutywa ngexesha lokuxilongwa komhlaza wemiphunga. Ezi ziquka:
- Uvavanyo lwemiqathango ye- Pulmonary (PFTs): Uvavanyo lwe-PFT uvavanyo lwamandla emiphunga kwaye lunokumisela ukuba i-tumor iphazamise kangakanani ukuphefumula, kwaye ngamanye amaxesha, nokuba lukhuselekile ukwenza utyando
- Ukuhlolwa kwegazi: Iimvavanyo ezithile zegazi ziyakwazi ukubona ukungaqhelekanga kwezinto eziphilayo ezibangelwa ngamanomdla emiphunga emiphunga, kwaye kunokubonisa ukuba ukusabalala kwe-tumor
I-Biopsy Lung
Ukuba umdlavuza wamaphaphu ukhunjulwa kwizifundo zokucinga, isinyathelo esilandelayo kukuba kwenziwe i-biopsy yamaphaphu ukuqinisekisa ukuba ingaba ngumhlaza wesiqhelo okanye awukho umhlaza womhlaza.
Uninzi lwe-biopsi luyenziwa kwiisampuli zamathambo, kodwa i-biopsies yamanzi yindlela entsha enomdla wokulandela abanye abantu abanomdlavuza wemiphunga. Kuyavunyelwa ngoJuni ka-2016, ezi mvavanyo zenziwa ngegazi elilula. Ngelo xesha, bavunywa kuphela ukuba bafumane utshintsho lwe-EGFR, kodwa kubo bonke, ngumzekelo omhle wendlela ukuxilongwa kunye nokunyangwa komhlaza wemiphunga kuphucula unyaka ngamnye.
Xa umhlaza wamaphaphu usasazeka, kubalulekile ukuba "i-biopsy" izicubu, njengoko iidlers zingatshintsha ngexesha, kwaye ezi ngenguqu zinokukunceda wena kunye nodokotela wakho ukhethe okukhethwa kukho unyango olungcono.
UkuLinganiswa kweMelecular / Testing Gene
Ngoku kuyacetyiswa ukuba wonke umntu onomdlavuza wesifo samangqamu omncinci, kwaye ngokukodwa imiphunga ye-lungen adarocarcinoma, inokuprofiliswa kwe- molecular eyenziwe kwi-tumor. Olu vavanyo lofuzo lujonge utshintsho kumaseli omhlaza apho amachiza athile afumanekayo "atyekele" ezo zinguqulelo.
Ezi zinto azitshintshi ozalelwe ngazo, kwaye awukwazi ukuzidlulisela kubantwana bakho. Zizitshintsho ezenzeka kwinkqubo yeseli eba ngumhlaza kwaye "ukuqhuba" ukukhula komhlaza.
Iipilisi ezijoliswe ngoku zivunyiwe kubantu abanokuguqulwa kwe-EGFR , ukulungiswa kwe-ALK, ukulungiswa kweROS1 kunye nezinye izinto ezincinane. Ukongezelela, ezinye iindlela zonyango ziqhutyelwa ukuvavanywa kwizilingo zonyango .
I-PD-L1 Uvavanyo
Ukususela ekubeni isicatshulwa sokuqala se-immunotherapy savunywa ukunyanga umhlaza wemiphunga ngo-2015, amayeza enesithathu afumanekile. Uvavanyo oluthiwa ngu-PD-L1 lunokwenziwa ukuba lunikwe ipesenti ye-PD-L1 kumaseli omhlaza wakho. I-PD-L1 yiprotheyini eboniswa ngamanani amaninzi kumaseli omhlaza wesifo somhlaza. Le protein isebenza ukuphucula "iibhuleki" zesistim somzimba, ukunciphisa amandla okulwa namaseli omhlaza. Ezinye iiseli zomhlaza ziye zathola iindlela zokuthi "zigqithise kakhulu" le protheni njengendlela yokufihla kwi-immune system. Amachiza eyaziwa ngokuba yi-checkpoint inhibitors asebenza ngokukhusela le ntshukumo kwaye ngokukhululekileyo akhulula ama-brake kwi-immune system.
Sisazi ukuba kubaluleke kangakanani ukuhlolwa kwe-PD-L1 kunyango lomhlaza wemiphunga. Zomibini zomdlavuza wamaphaphu ezithintela iPD-L1 kunye nabangenako ukuphendula kula mayeza. Ngexesha langoku kucatshangelwa ukuba kungabi neendleko zokwenza ezi mvavanyo, kodwa ukunciphisa ukusetyenziswa kwezi zonyango kuphela kubantu abaneemvumi ezithintela i-PD-L1 ekunciphiseni inani elinokunciphisa inani labantu abaya kuzuza kula mayeza.
> Imithombo:
> Aquiar, P., Perry, L., Penny-Dimr, J. et al. Umphumo we-PD-L1 Ukuvavanya kwi-Cost-Effectiveness and Impact of Immune Checkpoint Inhibitors kwi-Second-Line Treatment ye-NSCLC. Amanqaku e-Oncology . 2017 Juni 15. (Epub ngaphambi kokuprinta).
> ISiko leSizwe lezeMpilo. I-Medline Plus: I-Lung Cancer. Ukuhlaziywa 02/21/18. https://medlineplus.gov/lungcancer.html