Iimpawu, unyango kunye nokuhlaziya
Ukusabalalisa umdlavuza womlenze (i-metastatic) kwisibindi kuxhaphake kakhulu. Phantse ama-40 ekhulwini labantu abanomdlavuza wamaphaphu baye bafumana umgama kwiindawo ezikude zomzimba ngexesha lokuxilongwa. Yintoni onokuyilindela ukuba umhlaza wakho wamaphaphu usasazeke kwisibindi sakho?
Sibanzi
Umdlavuza womlenze oye wasasazeka kwisibindi kuthiwa "umhlaza wesifo samathambo emasitini" (ngokuchasene nomdlavuza wesibindi, oya kubhekisela kumdlavuza owaqala kwisibindi waza wazeka kwenye indawo yomzimba).
Kubantu abanomdlavuza wamangqamu omncinci omncinci , ukusasazeka komhlaza kwisibindi kuya kufaka njengesigaba somhlaza wesi-4 . Ngomdlavuza omncinci wamangqamuzana omnxeba , uya kubalwa njengesigaba esiphezulu .
Umdlavuza womlenze ungasasazeka kunoma yimuphi ummandla womzimba, kodwa ngokuqhelekileyo usasazeka kwisibindi, i-lymph nodes, ingqondo, amathambo kunye neentlobo ze-adrenal. Ngokuqhelekileyo, umhlaza wamaphaphu uza kufakelwa kwindawo engaphezu komnye womzimba. Ngokomzekelo, kunokuqhelekileyo ukuba neesibini zesibindi kunye neengqondo zengqondo.
Makhe sijonge kwiimpawu zesifo seesibindi kunye nendlela eziphathwa ngayo. Unokuba nomdla ekufundeni malunga nokulawulwa kwe:
- I-Brain metastases esuka kumdlavuza wamaphaphu
- I-Bone metastases evela kumdlavuza wamaphaphu
- I-Adrenal gland i-metastases evela kumdlavuza wamaphaphu
Iimpawu
Ukuba umhlaza wakho wamaphaphu usasazeke kwisibindi sakho, unokungenayo nayiphi na impawu. Enyanisweni, ukusasazeka (i-metastasis) ifunyaniswa rhoqo xa uvavanyo, olufana ne- CT scan okanye i- PET scan lwenziwa ukwenzela ukuqwalasela isigaba somhlaza wakho.
Ukuba unayo impawu, ezi ziquka intlungu phantsi kwembambo zakho okanye esiswini sakho sokunene komzimba wakho, kunye neempawu eziqhelekileyo, ezifana nokulahlekelwa kwesidlo kunye nesicefe. Ukuba unesifo esininzi kwisibindi sakho okanye ukuba i-metastasis inkulu ngokwaneleyo ukuphazamisa i-ducts yakho ye-bile, unokuhlakulela i-jaundice, ukugqithisa okwesibhakabhaka kwesikhumba sakho kunye nenxalenye emhlophe yamehlo akho.
Ubungqina bezilwanyana ziphazamisa i-metabolism ye-bile eyenza ukwakha i-bile salts elukhumbeni. Oku kunokubangela ukuba kube nzima nokukhungatheka.
Ukuxilongwa
Iimvavanyo ezinokuthi zenzeke ukujonga i-metastases yesibindi ukusuka kumdlavuza wamaphaphu ziquka:
- I-CT scan yesisu
- Isisu se- abdominal
- MRI yesisu
- PET yokuhlola
Ukungaqiniseki kokufunyanwa kweebindi kuqhelekileyo
Kubalulekile ukuba uqaphele ukuba iziphumo ezingavamile ziqhelekileyo xa kukhishwa izibilini zesibindi, kwaye ngamanye amaxesha kunokuba nzima ukufumanisa ukuba indawo okanye izibindi esesibindi zibangelwa ukusasazeka komhlaza okanye esinye isizathu. Ukuba ugqirha wakho akaqinisekanga ukuba okanye ukungaqhelekanga kwisibindi sakho kuhambelana nomhlaza wakho, kwaye indlela yokwelapha iyahlukahluka kuxhomekeke kwimiphumo, unokuncoma isibindi se-biop ukuze ukhangele iisishu ukuba uqiniseke ukuba uyasifumana.
Kunokukhathazeka ukuba ugqirha wakho akaqinisekanga malunga nokufunyanwa kwintsholongwane yakho, kwaye oku kunokukwenza uzive uxhalabile kwaye ungaqiniseki ngokunyamekela kwakho. Kungenokuba luncedo ukwazi ukuba oku kuqhelekileyo kwaye kukho ukungqubuzana okukhulu phakathi kwesiqhelo "esingaqhelekanga" kwisibindi kunye nesifo seesibindi.
Unyango
Ngokomlando, unyango lomhlaza wemiphunga oye wasasazeka kwisibindi wawuthathaka kakhulu, oku kuthetha ukuba injongo yonyango ukukhupha iimpawu kunokuba uzame ukuphilisa eso sifo.
I-Chemotherapy ingasetyenziselwa ukuphatha isigaba 4 ngokubanzi.
Ukuvunyelwa kwezidakamizwa zonyango ezijoliswe kuzo (izilwanyana ezijolise kwiinguqulelo ze-EGFR , i- ALK rearrangements , kunye nokulungiswa kwakhona kwe-ROS1 kwabanye) kwaye i- immunotherapy iqalisa ukutshintsha loo mbono, kwaye kwezinye iimeko, le myeza ingakhokelela ekulawuleni ixesha elide lomhlaza wesifo semiphunga .
Unyango oluqhubekayo luqhubeka luyindlela eyona nto xa kukho izidumbu ezininzi zesibindi, kodwa kulabo abanama-metastase ambalwa-into ebizwa ngokuthi "i-oligometastase" -yatshintsha.
I-Metastases Eyona Ngonyango
Kwixesha elidlulileyo, ukuba kuphela i-metastasis enye ekhoyo kwisibindi, ukuhlinzwa kwakungaqhathaniswa ukuba kususwe isisu, kodwa iindlela zonyango zonyango olutsha ziphucula kulo.
Kulabo abane-oligometastases, ichazwe nje kuphela okanye "ezimbalwa" zezifo zesifo se-metastatic, ingakumbi abo banokuguqulwa kwezinto eziphathekayo kwi-profiling gene , ezimbini zibonakaliswe ukuphucula iziphumo kwi-subset ekhethiweyo yezigulane. Ezi ziquka:
- I-SBRT - I-radiotherapy yomzimba we-stereotactic (SBRT) yinkqubo apho inqanaba eliphezulu leyeza lonyango linikezelwa kwindawo encinci kunye neyona nto inethemba lokuphelisa i-metastases.
- I-SABR - I-radietratic acid ablative enye yindlela yokusebenzisa i-radiology esetyenziselwa ukuba "iblate" okanye ukutshabalalisa indawo encinane njengemetastasis.
Xa kuthelekiswa nokuhlinzwa, zombini le nkqubo (ebizwa ngokuba yi-metastasectomy) yingozi kakhulu kwaye ibe neerhafu eziphezulu zokulawula imitha. Ngeempembelelo ze-SBRT zangaphambili zibonise ukuphucula ubomi obuphakathi (ixesha apho isiqingatha sabantu siphila kwaye isiqingatha siphelile) kunye nama-25 ekhulwini kwixesha elide lokuhlala kwizigulane ezikhethiweyo. Uvavanyo lwezonyango luqhubeka ngakumbi luvavanya inzuzo ye-metastasectomy ye-oligometastases nomhlaza wesibindi, kwaye ukuguqulwa kweparadim kunyango le nzekayo.
Abantu abaneziphumo ezingcono kunye nolu hlobo lonyango kubandakanya abo banemizimba embalwa, abo apho umntu uphathwa ngayo kuyo yonke indawo eyaziwa ngumdlavuza, kunye nalabo abanamaxesha amaninzi angenazo izifo.
Prognosis
Umdlavuza womlenze oye wasasazeka kwisibindi, ngokudabukisayo, unobungozi obunzima. Ukusinda komphakathi kubantu abahlala necandelo 4 elingekho encinci yeseli (imetastatic) yomhlaza wamaphaphu iphela malunga neenyanga ezisibhozo, nangona kukho ithemba lokuba inani elitsha elisekelwe kubantu kunye neendlela ezincinci zesibindi eziphathwe ngayo ngeendlela ezintsha zokushisa i-radiation ziza kubangela ukusinda okuphezulu. Ixesha lokuphila eliqhelekileyo labantu abanomlinganiselo omncinci weseli (imetastatic) umhlaza wamaphaphu unyanga ezimbini ukuya kwezine ngaphandle kokunyanga kunye neenyanga ezintandathu ukuya kunyango.
Inkxaso
Kunokuba nzima ukuba ufunde ukuba umdlavuza wakho uye wafa. Kwaye phezu kwentlungu yakho, kukho izinto ezilikhulu oziva ukuba ufuna ukuzenza. Okokuqala, gcinani engqondweni ukuba unyango lomhlaza wamaphaphu uphucula-nangona zigaba eziphambili. Ukuba uvakalelwa kakuhle kwaye unemigodi embalwa kuphela, xela ugqirha wakho malunga nokunyango olukhoyo ngoku. Zininzi unyango olutsha, kodwa ngelishwa, ezi ziguquka ngokukhawuleza kangangokuba kunzima ukuba nabani na ukuba bahlale behamba phambili.
I-National Cancer Institute incoma ukuba abantu abanomdlavuza wamapopayi ophezulu baphathe inxaxheba kwilingo lonyango. Kungaba nzima kakhulu ukuzama ukuzisebenzisa ezi zinto, kodwa unombulelo wemibutho emikhulu yomdlavuza wamaphaphu esebenzisene kunye ukubonelela ngenkonzo yokulinganisa isifo somhlaza wamaphaphu wamahhala, apho umhambi onokukuncedisa ukufanisa umdlavuza wakho wamaphaphu kunye nezilingo zamakliniki ezikhoyo naphi na emhlabeni.
Xa umhlaza awukwazi ukuphiliswa okanye ubomi obanzi, kusekho iindlela ezininzi zokugcina abantu bekhululekile ngokwaneleyo ukuze banandipha iintsuku zabo zokugqibela nabathandekayo. Khangela ezi ngcebiso zokujongana nomhlaza wesigulo.
> Imithombo:
> Bergsma, D. et al. Indima yokuguqula i-Radiotherapy ekuPhilweni kwe-Oligometastatic NSCLC. Ukuphononongwa kweNgcali kwi-Antiticancer Therapy . 2015. 15 (12): 1459-71.
> Guerrero, E., noM.Ahmed. Indima ye-Sterotactic Ablative Radiotherapy (SBRT) kuLawulo lwe-Oligometastatic Non-Small Cell Lung Cancer. Cancer Lung . 2016. 92: 22-8.
> I-Rusthoven, C., Yeh, N., noL. Gaspar. Ukwelashwa kwamayeza omzimba kwi-Oligometastatic engekho encinci yeSeli yeLung Cancer: iTheory and Practice. Iphephandaba leMhlaza . 2015. 21 (5): 404-12.
> Salama, J., noS S. Schild. Ukunyanga kwamayeza omzimba kwi-Oligometastatic Non-Small Cell Lung Cancer. Ukuhlaziywa kweCarter Metastasis . 2015. 34 (2): 183-93.
> Ueda, J. et al. Ukuqhawulwa kokutshitshiswa kwe-Self-metastatic Liver Tumor ephuma kwi-Lung Cancer: I-Series Series. Hepatogastroenterology . 2012. Ithenda: 10.5753 / hge12000. (Epub ngaphambi kokuprintwa).