Iimpawu, isistim, iTranscription, kunye nePrognosis
Kuthetha ukuthini ukuba unomdlavuza wesifo somhlaza wesigaba 3 kwaye uhluke njani kwezinye izigaba? Ziziphi iingonyango ezinokuthi zinconywe kwaye yintoni omele uyazi ukuze ube ngummeli wakho kumnonophelo wakho womhlaza? Yiyiphi i-prognosis yale nqanaba kwaye yintoni oku kuguqulwa ngonyango olutsha?
Sibanzi
Umgangatho wesi-3 wesifo somhlaza wesifo samangcwaba esingekho encinci yinkalo ebanzi kunye neyohlukeneyo yamanomdla emiphunga ephazamisayo aphinda aphule ukuya kwisigaba 3A kunye nesigaba 3B .
I-Advanced Advanced vs. I-Stage Ephakamileyo 3 I-Cancer Cancer
Kulula ukuchaza ukuhlukahluka kwesigaba se-3 somdlavuza wamaphaphu ngokuphula yonke i-cancer yemiphunga ibe ngamacandelo amabini aphambili.
- Umdlavuza wamapopom Ezi zicubu azizange zisasaze kwiindawo ezikude zomzimba, kodwa zisasazeka kwii- lymph nodes kwicala elinye lomzimba njenge-tumor. Isigaba I ukuya kwinqanaba le-3A i-cancer yeemiphunga ibhekwa "isebenzayo" esithetha ukuba utyando linika ithuba lokunyanga.
- Umhlaza wamaphaphu ophezulu - Ngomdla wesifo somhlaza wesifo somdlavuza, isigaba se-3B somhlaza wesifo somdlavuza sithathwa njengomdlavuza omkhulu wamaphaphu . Ezi zicubu ziye zasasazeka kwinqanaba elinjalo lokuba ukuhlinzwa akunakwenzeka (ngaphandle kokuba, nangamanye amaxesha, emva kokonyango kunye ne-chemotherapy kunye nokunyanga kwamayeza.) Ezi zicubu "azinakwenzeka" kwaye akaqhelekanga, kodwa zonyango, kwaye ezininzi unyango yavunywa kwiminyaka yamuva.
Ukukhula
Amaphesenti angama-30 abantu abanomdlavuza womdlavuza wesigaba se-3 ngexesha lokuxilongwa, ukushiya ama-30 ekhulwini abantu abafunyaniswe kwisigaba sokuqala ( isigaba sokuqala okanye isigaba sesi-2 sesifo) kunye neepesenti ezingama-40 sele sele ziqhubele phambili kwisigaba 4 (imetastatic) yomhlaza womhlaza ixesha lokuxilongwa.
Ukucwangcisa
Umdlavuza wesifo somdlavuza uyisinyathelo esibalulekileyo ekukhetheni ukhetho olungcono lwezokwelapha, ngokukodwa ukwenza ukwahlula phakathi kwesigaba 3A kunye nesigaba 3B.
Isigaba se-3 somhlaza wesifo somdlavuza sichazwa kakuhle ngokuhlula izigaba ukuya kwisigaba 3A kunye nesigaba se-3B ngokwahlukileyo.
Isigaba 3A Umhlaza wemiphunga uquka izicubu ezinkulu kwaye zisasaza kwii-lymph nodes ezikufuphi, okanye iiswini zaso nawaphi na ubungakanani obuye basasazeka kwii-lymph nodes ezide zide kodwa zihlala kwicala elifanayo lomzimba njengomhlaza.
Isigaba 3B Umhlaza wesifo somdlavuza uchazwa njengengqamzana naluphi na ubukhulu obuye lwasasazeka kwii-lymph nodes okanye luye lwahlasela ezinye izakhiwo kwisifuba (njengentliziyo okanye isifo . kwisigxina esinyanisekileyo phakathi kweemigca ezithwala imiphunga) zatshintshwa ukusuka kwisigaba 3B ukuya kwisigaba 4 ngo-2009.
I-Oncologists isebenzisa inkqubo ye- TNM ukuchaza ngakumbi izigaba zomhlaza wemiphunga. Inkcazo elula yenkqubo ye-TNM ibandakanya:
T ibhekisela kwisayizi somzimba:
- I-T1 - I-tumor ingaphantsi kwe-3 cm (1 ½ intshi) ngobukhulu.
- I-T2 -I-tumor ingaphezu kwe-3 cm.
- I-T3 - I-tumor ingaba nayiphi na ubukhulu, kodwa isondele kwindlela yokuhamba ngomoya okanye isasazeka kwiindawo zendawo ezifana nodonga lwesifuba okanye isithsaba .
- I-T4 - I-tumor nayiphi na ubukhulu, kodwa ikhona kwindlela yokuhamba ngomoya okanye ihlasele izakhiwo zengingqi ezifana nentliziyo, okanye i-oopopus.
N ibhekisela kuma-lymph nodes:
- I-N0 - Akukho zikhundla ezichaphazelekayo.
- I-N1 - I-tumor isasazeke kwiindawo ezikufutshane kwicala elifanayo lomzimba.
- I-N2 - I-tumor isasazelele kwiindawo ezingaphezulu kude kodwa kwicala elinye lomzimba.
- I-N3 - Iiseli zentsholongwane zikhoyo kwi-lymph nodes ngaphesheya kwesifuba esivela kwi-tumor, okanye kwiindawo ezikufutshane ne-collarbone okanye imisipha yentamo.
M imela izifo ze-metastatic :
- M0 - Akukho mastases apha.
- I-M1 - I-tumor isasazekile (i-metastasized) kwenye imimandla yomzimba okanye enye imiphunga.
Ukusebenzisa i-TNM System, isigaba se-3A umdlavuza wamaphaphu uchazwa ngokuthi:
- I-T1N2M0 - I-tumor ingaphantsi kwe-3 cm ngobukhulu kwaye isasazeka kwii-lymph nodes kude kodwa ngaphandle kwelinye icala lomzimba njenge-tumor.
- I-T2N2M0 - I-tumor ikhulu kunama-3 cm kwaye isasazeka kwii-lymph node kude kodwa ngaphandle kwelinye icala lomzimba.
- I-T3N1M0 - I-tumor nayiphi na ubukhulu kodwa isondele kwindlela yomoya okanye isasaze kwindawo yangasese njengodonga lwesifuba okanye i-diaphragm, kwaye i-lymph nodes ezikufutshane zichaphazelekayo.
- I-T3N2M0 - I-tumor nayiphi na ubukhulu kodwa isondele kwindlela yokuhamba nomhlaba okanye isasazeka kwindawo yangasese njengodonga lwesifuba okanye i-diaphragm, kunye ne-lymph nodes ezide kude kodwa kwicala elifanayo lomzimba zichaphazelekayo.
Ukusebenzisa i-TNM System, isigaba 3B sichazwa ngokuthi:
- Naliphi na i-T, i-N3, i-M0- I-tumor yaluphi na ubukhulu obuye basasazeka kwi-lymph nodes ngaphesheya kwesifuba esivela kwi-tumor okanye kwiindawo ezikufutshane ne-collarbone okanye imisipha yeentamo, kodwa ayizange isasaze kwiindawo ezikude zomzimba.
- I-T4, nayiphina i- N, i-M0- I-tumor yaluphi na ubukhulu obukulo moya, okanye luye lwahlasela izakhiwo zengingqi ezifana nentliziyo okanye isifo. Amanqwanqwa angabandakanyeka okanye angabandakanyekanga, kwaye xa athe wathinteka, unokusondela kwisiqhumane okanye uhambe ngakumbi kwisifuba okanye entanyeni, kodwa isisu asizange sisasaze kwiindawo ezikude zomzimba.
Iimpawu
Isigaba se-3 impawu zomhlaza weemiphunga ziyahlukahluka ukususela kwinqanaba lesi-3 liquka uluhlu olubanzi lweekhensa. Iimpawu ezibangelwa ngumhlaza kwimiphunga efana nokukhwehlela okuqhubekayo , ukuphefumula okufutshane , kunye nezifo eziphindaphindiweyo ezifana ne-pneumonia okanye i-bronchitis, ziqhelekile.
Ukusa kwiindawo ezinjengodonga lwesifuba kunye nesigxobhozo kunokubangela intlungu kwisifuba, iimbambo, amahlombe, nangemuva. Iziphakamiso ezikufutshane nomoya womoya zingabangela i-hemoptysis ( ukukhwehlela igazi ) kunye nokujikeleza . Xa i-tumor iquka indawo ezifana ne-esophagus kunye nezinye izakhiwo zesifuba, i-dysphagia (ubunzima bokugwinya) kunye nokwenyuka kunokwenzeka. Ubuhlungu kwimva, isifuba, kunye nezimbambo ziqhelekile ukuba kukho ukuxhatshazwa kwesigxina, kwaye oku kuya kubangela ukwanda kokuphefumula.
Iimpawu eziqhelekileyo zomhlaza ezifana nokukhathala kunye nokulahlekelwa kwesisindo esingenakuzenzela kungakho.
Unyango
Ukonyango kwinqanaba lomdlavuza wemiphunga lommangalo luyinkxalabo yezo zonke izigaba zomhlaza wamaphaphu, ngenxa yokuba eli qela lihluke kakhulu. Ngenxa yesantya sokusinda, i-National Cancer Institute ithi wonke umntu onomdlavuza wesifo somhlaza wesigaba 3 kufuneka acingwe njengomviwa kwizonyango zonyango - uphando olucwangcisa unyango olutsha okanye ukudibanisa unyango lomhlaza wamaphaphu.
Isigaba 3A unyango
Kwinqanaba le-3A lamanqamu emiphunga, ukuhlinzwa kungenziwa ukuze kususwe i-tumor kwaye ngokuqhelekileyo kulandelwe i- adjuvant chemotherapy (i-chemotherapy emva kokuhlinzwa). Ugqirha unikeza ithuba lokunyanga kodwa akusoloko kunokwenzeka ngeesisu zobukhulu. Umngcipheko wokuphindaphinda umdlavuza wamaphaphu uphakamileyo kakhulu kubantu abaneganga le-3A yomhlaza wamaphaphu.
Kwalawo aphilileyo, ukudibanisa i- chemotherapy okanye i-chemotherapy kunye neyeza zonyango zivame ukucetyiswa. Ukuba abantu abakwazi ukunyamezela i-chemotherapy, unyango lwe-radiation lungasetyenziselwa yedwa ukunyanga iimpawu ezifana nentlungu nokuphefumula okufutshane.
Ngoku kuyacetyiswa ukuba ukuhlaziywa kwe-molecular (ukuhlolwa kofuzo) kwenzelwe wonke umntu onomdlavuza wesifo somnxeba ongeyomncinci, ngokukodwa umphunga we-lungen adenocarcinoma . Amayeza avunyelwe abantu abaneentshukumo zokuguqulwa komqhubi ezifana nokuguquka kwe- EGFR , ukulungiswa kwe-ALK kunye nokulungiswa kwe-ROS1 , kwaye ezi zijoliswe kuluhlu zibangelwa ukulawulwa kakuhle kwesi sifo. Ukuchasana kudla ngokuphindaphindiweyo kwexesha, kodwa iyeza ezilandelayo ziza kuvunywa kwaye zivavanyelwa kwizilingo zonyango xa kwenzeka. Kwalabo abane- squamous cell carcinoma yemiphunga , i-anti-EGFR antibodies ingasetyenziswa. Uvavanyo lwezonyango luye lwafunda imichiza ejongene nolunye utshintsho lomzimba kumdlavuza wamaphaphu.
Izidakamizwa ezintsha ezine ezine- immunotherapy ziye zavunywa ngo-2015 kunyango lomhlaza wemiphunga. Ezi zonyango zisebenza ngokuphucula amandla ethu omzimba wokulwa nomdlavuza. Ngoxa bengabasebenzi kuwo wonke umntu, abanye abantu baye bafumana ukulawulwa kwemithi yesigulo esingahlali ixesha elide. Imfinzi (durvalumab) ngokukhethekileyo yavunywa ngoFebruwari 2018 ukunyanga kwe-stage engasebenziyo yomdlavuza wemiphunga emva kwe-chemotherapy kunye neyeza. Xa zisetyenziswe kulolu hlobo, kwafunyanwa ekuphuculeni ngokukhululeka ukuqhubekeka kokusasazeka.
Isigaba 3B unyango
Isigaba se-3B kanomdlavuza, ngokungafani nesigaba se-3A, asikwazi ukuphathwa ngokuhlinzwa. Ngamanye amazwi, ayinakusebenza- kodwa ayinasifo. Unyango lunokubandakanya i-chemotherapy, unyango lwe-radiation, unyango olujoliswe kuyo, kunye ne-immunotherapy njengesiqendu se-3A.
Kwezinye iimeko, ukusebenzisa i-chemotherapy kunye neyeza zonyango ziyakwazi ukunciphisa ubungakanani besifo ukuze utyando lwenziwe. I-Chemotherapy esetyenziswe ngale ndlela ibizwa ngokuthi "i-neoadjuvant chemotherapy."
Kubantu abanomdlavuza wemiphunga yesigaba 3, unyango lungasetyenziselwa nje unyango oluthile , olubhekiselele ukuba ugxininiso lwonyango lunciphisa iimpawu ezinjengeentlungu nokuphefumula kokuphefumula kunokuzama ukulawula umhlaza. Ngokwenene kufunyenwe ukuba unyango olusisigxina kubantu abanomdlavuza wamaphaphu kunokuphucula ukuphila.
Prognosis
Umlinganiselo wonyaka wesi-5 wokusinda kwinqanaba le-3A lomhlaza wemiphunga li-14 ekhulwini, kodwa lingahluka ngokubanzi. Umlinganiselo we-5B wesigaba se-3B somhlaza wesifo somdlavuza unesihlungu kuphela malunga neepesenti ezingama-5 Kubalulekile ukukhumbula ukuba ezi manani zisekelwe kwindlela abantu abazenza ngayo ngomhlaza wamaphaphu esikhathini esidlulileyo. Ekubeni kubekho amayeza amaninzi avunyelwe unyango lomhlaza wamaphaphu phakathi kuka-2011 no-2015 kunokuba kukho kwiminyaka emine ngaphambi komhla ka-2011, ezi zibalo zinokuthenjwa ngokungathembeki ekuqikeleleni ukulindela ubomi namhlanje.
Ukunyamezela kunye nenkxaso
Uphononongo lubonisa ukuba ukufunda oko unokukwazi ngomhlaza wakho kunceda kwisiphumo. Buza imibuzo. Yibandakanye nabathandekayo bakho kwaye ubakhuthaze ukuba babuze imibuzo. Cinga ukujoyina iqela lokuxhasa . Funda malunga nezilingo zamachiza ezinokuthi zilungele imeko ethile. Ukufunda ngomhlaza wakho kunye nokwenza unyango kunokuthatha ixesha elininzi. Cela kwaye uvumele abathandekayo bakho nabahlobo ukuba bancede kwaye bakhuthaze uhambo lwakho. Ungalilahli ithemba-nangona elo themba liza kuba likhululekile njengoko linokuba lunandipha inkampani yabathandekayo bakho.
Imithombo
American Cancer Society. I-Cancer Cancer (I-Cell-Non-Small Small.) I -Cell-Non-Small Small Cell Lung Cancer Survival Rates .
IKomidi eliManyeneyo yaseMerika kwiCancer. I-Cancer Stage. I-7 Edition.
> Antonia, S., Villegas, A., Daniel, D. et al. I-Durvalumab Emva kweKomoradiotherapy kwiSigaba se-3 esingenanto esincinci. I-New England Journal of Medicine . 2017. 377: 1919-1929.
Edge, S. et al (Eds.). Umqulu we-AJCC weScanscer Staging Manual. I-7 Edition. Springer. ENew York, NY. 2010.
Faithi, A. noJ. Brahmer. I-Chemotherapy kwisifo esingekho esincinci somhlaza wesifo somhlaza. Iimviwo kwiiTrracic and Cardiovascular Surgery . 2008. 20 (3): 210-6.
National Cancer Institute. Ukwelashwa kweNtsholongwane yeNtsholongwane yeeLungile (PDQ) - I-Health Professional Version.