Ukuba uhlala nomgca wesi-4 umhlaza wamaphaphu i- oncologist yakho inokuxubusha ngenjongo yonyango olunikezelweyo. Sekunjalo sifunda ukuba izinto abantu abanokuzilindela kwezinye iindidi zonyango ziyahluka kwizinto ezilindeleke. Iyintoni inyaniso malunga ne-chemotherapy kunye neyeza zokwelapha imitha kwisigaba somhlaza wesi-4 somdlavuza kwaye ziphi ezinye iingcamango ezingalunganga?
Ithemba kunye nethemba lobuxoki kunye nokuhlaziya
Kukho ithemba elingakumbi kulabo abanomdlavuza wesifo somdlavuza kwinqanaba elidlulileyo kunexesha elidlulileyo. Kubalulekile ukuba uqaphele phambili phambi kokuba ukuhlwayelwa kwabantu abanomdla wesifo somhlaza womphunga kumgangatho wesine; Uphulo olutsha luyafumaneka, kwaye izinga lokusinda liya kuphucula. Kukho abantu abaninzi ababhekanyiswa ngokuthi "ixesha elide" abasinde kwisigaba 4 somhlaza wamaphaphu, kwaye elo nani landa ngonyaka.
Oko kwathiwa, ukunyanzeliswa kwesigaba somhlaza wesi-4 somdlavuza akusikho into esinokuyifisa, kwaye ezinye iindlela zonyango azisebenzi njengoko sifuna ukuba nazo. Ekuxubusha ngezi zonyango, kukho ukulungelelanisa phakathi kokugxilisa ithemba kunye nokunikela ithemba lobuxoki.
Ithemba lobuxoki malunga nokukhethwa kwonyango kunokukhokelela abantu ukuba bafumane unyango olunzima kakhulu ngokubhekiselele kumgangatho wobomi . Ithemba elingamanga linokuthi abantu bafune ukukhetha iindlela ezahlukeneyo zonyango ezingasebenza kangcono. Ithemba lokwenene, ngokuchaseneyo, lithetha ngokunyaniseka ukuba unyango lufanelekile, kodwa indlela onokuziva ngayo unikwe amandla ekwenzeni izigqibo zobomi bakho.
Iinjongo zoogqirha kunye nokulindela izigulane
Kuze kube kutshanje sasiyicinga ukuba oogqirha kunye nezigulane babenomyinge ofanayo xa bekulindelwe malunga nesigaba se-4 somhlaza wesifo somhlaza. Noko ke, izifundo ezimbalwa, zithe zaphula le bhobho, ubuncinci ngokubhekiselele kwizilindelwe eziphathelene ne-chemotherapy kunye neyeza.
(Iithapi ezijoliswe kuyo, i-immunotherapy, kunye noluhlobo oluthile lonyango lomlilo lenye ibali kwaye kuya kuxutyushwa ngaphaya kwezantsi.) Masiqwalasele oko sikufundileyo.
I-Chemotherapy Results vs Ukulindela
Ngophando luka-2012, abaphandi baphakamisa ukuba babone ukuba ukulindela kwezigulane kunye ne-oncologists kwintsebenziswano ngokumalunga nokulindela okuhlobene ne- chemotherapy kwisigaba somhlaza wesi-4 somhlaza . Iziphumo zophando zazingxangqa.
Kulo lonke, iipesenti ezingama-69 zesigaba se-4 somhlaza wesifo somhlaza (kunye neepesenti ezingama-81 zesigaba 4 izigulane zesifo somhlaza) asizange siqonde ukuba i-chemotherapy yayingekho yonke into yokuphilisa umdlavuza wabo. Ngamanye amazwi, uninzi lwabantu abanomdlavuza wamaphaphu babethwala ithemba eliyonyaniso lokuba i-chemotherapy inokuphilisa isifo sabo.
Olunye uphando olwenziwayo ngo-2015 luqinisekisile ukuba ukungafani okulindelweyo kwaqhubeka, ngaloo ndlela i-2-thirds yezigulane ezineesigaba 4 somphunga okanye umhlaza wekolon akazange aqonde ukuba i-chemotherapy yayingekho yonke into yokunyanga umhlaza wabo.
I-Chemotherapy, xa isetyenziselwa abantu abane-stage 4 umhlaza womphunga unokwandisa ubomi. Abantu baphathwa ngalezi zi yobisi, ngokuqhelekileyo, iiveki ezimbalwa okanye iinyanga ezimbalwa. I-Chemotherapy ingasetyenziselwa nje njengonyango oluthile, ukunciphisa iimpawu ezifana nokuphefumula okufutshane.
Nangona kunjalo i-chemotherapy kuphela ayiphumelelanga kwiphulo lomhlaza wemiphunga.
Utyando lweyeza
Njengoko i-chemotherapy, kubonakala ukuba abaninzi abantu baneengcamango ezingalunganga malunga nokunyangwa kwamayeza emzimbeni wesigaba somhlaza wesi-4 . Ngophando luka-2012, kwafunyanwa ukuba amaphesenti angama-64 abantu abazange baqaphele ukuba imisebe yayingenakuphulukisa umhlaza wabo.
Ulwaphulo lwe-radiation, njengokhemotherapy, lunokwandisa ubomi, okanye luncedo ngeempawu zomhlaza, kodwa luba negalelo elifutshane kwixesha elide lokuphila. Ngokuchasene ne-chemotherapy, nangona kunjalo, imisebe inokuba luncedo kakhulu ekulawuleni ukuphuma okanye ukuphazamiseka kwendlela yokuhamba nomoya ngenxa yomdlavuza wamaphaphu, okanye unyango lwesifo se-boneastas esingabangela intlungu okanye i-fractures.
Kukho uhlobo olulodwa lonyango lwamayeza olwalusetyenziswa ngamanye amaxesha nethemba lokuphila kwangexesha elide phakathi kwabo bane-stage 4 yomhlaza wamaphaphu. Ukuba umntu unelinye okanye iinguqu ezimbalwa kwiingqondo , umzekelo, i- radiotherapy yomzimba (stereotactic body radiotherapy) (i-SBRT) yaziwa nangokuthi yi-CyberKnife, ngamanye amaxesha ibangele ukulawula ixesha elide lesi sifo.
Impembelelo YeThemba Lamanga
Kuye kwaxutyushwa ngamanye amaxesha ukuba unethemba lokwenene ngomhlaza lungcono kunekho ithemba. Nangona kunjalo xa bebuzwa, kubonakala ngathi uninzi lwabantu alufuni kunikwa ithemba lobuxoki. Ithemba lamanga liphika abantu ithuba lokuzicwangcisa ngokwabo izigqibo okanye babe ngabameli babo ekunyamekeleni kwabo. Kukho izizathu ezibini ezichasene ukuba kutheni le nethemba lobuxoki linokulimaza abantu abaphila nomhlaza wamaphaphu .
Esinye isizathu kukuba ithemba lobuxoki linikeza abantu abafuna ukwenza konke okusemandleni ukunyanga isifo sabo ukuba kuyenziwe kakade. Sinoo unyango ngoku kongeza kwi-chemotherapy, ukuhlinzwa, kunye neyeza zokwenza imitha ezinokuthi zinikeze ithemba elininzi okanye amathuba amakhulu okusinda kwabanye abantu. Ekubeni ezinye zezo zonyango zonyango ziye zavunywa ngokutsha okanye ziyafumaneka kuphela kwiimvavanyo zeclini. Ekubeni ezinye zezo zonyango zonyango zivunyiwe nje kuphela okanye ziyafumaneka kuphela kwiimvavanyo zeclini, zithwele ithemba lobuxoki lokuba i-chemotherapy ibe yonyango inokuthintela abantu ukuba bafune ukukhetha izinto ezinokuthi banokuhlangabezana nazo.
Isizathu esithile, nangona kunjalo, ukuba umntu unokuthi azinikele kunyango oluye linciphisa umgangatho wobomi becinga ukuba liya kwandisa ubungakanani xa kungenakwenzeka. Ngaloo ndlela, ithemba lobuxoki liphika abantu abakhethiweyo ukuba bakhethe ngokunyanisekileyo ukuba bangathanda ukuchitha iintsuku zabo zokugqibela.
Umonde / Ugqirha noNxibelelwano
Ukujonga ukungafani phakathi kokulindela phakathi kwezigulane kunye noogqirha unokucinga ukuba ukunxibelelana kwakuyingxaki. Kunoko, nangona kunjalo, kwafunyaniswa ukuba izigulana ezathi zinobudlelwane obuhle kunye noogqirha babo zazikwazi ukuphatha ithemba lobuxoki lokuba i-chemotherapy ingaba yonyango. Nangona izizathu zalo zingaziwa, kunokwenzeka ukuba i-oncologists iyika ukuba ukwabelana ngenyaniso ngekhemotherapy kunokususa ithemba.
Iipilithi ezijoliswe
Wonke umntu onomgangatho wesine umhlaza wesifo somhlaza wamangqamuzana kufuneka abe neengqungquthela zeeselulu (ukuhlolwa kofuzo) esinye sezicuba zabo. Kwalabo abane- EGFR utshintsho , i- ALK rearrangements , i- ROS1 zokulungiswa kwakhona , okanye ezinye iinguqulelo, imithi ejoliswe kuyo ingabangela ukulawulwa komhlaza wabo ngaphezu kwezinto ezinokulindela nge-chemotherapy.
Nangona iintsholongwane zivame ukuxhatshazwa kwezi ziyobisi ngexesha (ngokuphindaphindiweyo kunyaka kodwa ngamanye amaxesha emininzi iminyaka), omnye (isibini okanye yesithathu isiyeza) unokukhetha. Umzekelo, i-EGFR emihle yemiphunga yomphunga elawulwa ngethuba elithile kwiTarceva (erlotinib) kodwa iqhubeka nokunyanzeliswa, inokuthi iyanamdla kumachiza wesizukulwana sesithathu. Ngaloo ndlela, umhlaza wamaphaphu, ubuncinane be-cancer yamaphaphu kunye nokutshintshana okutshintshileyo, usondela ekubeni uphathwe njengesifo esingapheliyo: awuphilwanga, kodwa ulawulwa ixesha elibalulekileyo.
Immunotherapy
Ngo-2015, izidakamizwa ezimbini ezintsha ze- immunotherapy zavunywa ukunyangwa komhlaza wemiphunga. I-Immunotherapy isebenza ngokusebenzisa imigaqo yamasosha ethu omzimba ukulwa namaseli omhlaza. Nangona abantu abaninzi bengaphenduli kulezi yobisi, abo baphendulayo ngamanye amaxesha bafumana ukulawula ixesha elide lomhlaza wabo. Ngamanye amazwi, abantu abaphendule kula mayeza, njenge-Keytruda (pembrolizumab) okanye i-Opdivo (nivolumab) banokuhlala ixesha elide kunokuba babekulindele ukuba baphile xa bephathwa nge-chemotherapy okanye unyango lwamayeza kuphela.
Iingxoxo malunga neNkcazo yoLondolozo loBomi
Ngaphandle kwindlela yokusebenzisa unyango olutsha olunokuba lusebenza ngakumbi kunokhemotherapy, saphawula ukuba i-chemotherapy okanye unyango lwe-radiation-ukuba umntu usebenzisa le zonyango elindele ukuba bangaphilisa umhlaza wabo wamaphaphu-unokunciphisa ithuba lokuthetha ngokunyanisekileyo kunye yabo ye-oncologist malunga nemiba yokuphela kwempilo.
Sifunda ukuba ukunyamekela (ukunyamekela ngentsholongwane kungasetyenziswa nangona umntu ulindeleke ukuba aphiliswe) kungekhona nje ukuphucula umgangatho wobomi kubantu abanomdlavuza wamapopayi, kodwa unokwandisa ukusinda kanye. Ukunakekelwa kwe-Hospice yindlela enye yokunyamekela, kwaye ngokudabukisayo, abaninzi abantu bakhetha ukunyamekela kuphela kwisifo sabo kwaye banqwenela ukuba benze njalo ngaphambili ngenxa yenkxaso ezayo nolu khetho.
Umthombo:
UKen, A., uCronin, A., iiveki, J. et al. Ukulindela malunga nokuPhathwa kweeNyango zonyango phakathi kwezigulane ezine-Cancer Incomeable Cancer. Umbhalo we-Clinical Oncology . 2013. 31 (21): 2730-5.
Mack, J., Walling, A., Dy, S. et al. Iimfundiso ezibekezelayo ukuba i-Chemotherapy ingaba yiNkcazo kunye neNkathalo efunyenwe ekupheleni koBomi phakathi kwezigulane ezineMigodi yeMetastatic kunye neColorectal Cancer. Cancer . 2015. 121 (11): 1891-7.
Iiveki, J., Catalano, P., Cronin, A. et al. Izilwanyana ezilindelweyo malunga neempembelelo zeKhemotherapy kwi-Cancer Advanced. I-New England Journal of Medicine . 2012. 367: 1616-1625.