Ingqwalasela yeSigaba 3 I-Cancer Cancer
Ukuba uye watshelwa ukuba unomdlavuza womdlavuza wesigaba 3, usenokwenzeka ukwesaba kwaye ukhathazekile. Ithetha ntoni le nto? Ziziphi iindlela zonyango ezisetyenziselwa le nqanaba lomhlaza wemiphunga? Kwaye, yintoni na isilumkiso?
Ngaphambi kokuba siqale ukuthetha ngalolu nqanaba lomhlaza kubalulekile ukuqaphela ukuba uphuhliso olubalulekileyo kwindlela yokunyanga kwinqanaba lokusinda kwisigaba 3 somhlaza wamaphaphu kwenzeke kwiminyaka embalwa edlulileyo.
Unokuba neentsapho okanye abahlobo abanomdlavuza wamaphaphu ngexesha elidlulileyo okanye banokwazi ukuba abantu baphendule kuwe ngokukrakra xa beva ukuba unomdlavuza womdlavuza wesigaba 3. Unokudinga ukukhumbuza ngokuthandana nabathandekayo bakho ukuba unyango luye lwaphucula kwaye kukho iindlela ezininzi zokuphatha le nqanaba yesifo ngeendlela ezongezelelweyo ezikhoyo kwizilingo zonyango.
Inkcazo
Umgangatho wesi-3 wesifo somhlaza wesifo samangcwaba esingekho encinci yinkalo ebanzi kunye neyohlukeneyo yamanomdla emiphunga ephazamisayo aphinda aphule ukuya kwisigaba 3A kunye nesigaba 3B . Ekubeni isigaba 3A ne-3B zihluke kakhulu kwaye zihlala ziphathwa ngokungafaniyo, machaze ezi zinto ngokwahlukileyo.
- Isigaba 3A Umhlaza wamaphaphu - Isigaba 3A iisomdlavuza zamaphaphu zithathwa njengeengcingo zamaphaphu eziphambili. Ezi ziimvumba ezingasasazekanga kwiindawo ezikude zomzimba (azizange zenze i-metastasized), kodwa ziye zasasaza kwi-lymph nodes kwindawo ethile esifubeni, kodwa kwicala elinye lomzimba njengomhlaza. Isigaba 3A isifo somdlavuza samaphaphu sinokuthathwa njengokusebenzayo (esifana nesigaba 1 kunye nesigaba 2 somdlavuza wamaphaphu.)
- Isigaba 3B Umhlaza wemiphunga - Kanye nesigaba somhlaza wesi-4 somhlaza , isigaba se-3B somhlaza wemiphunga uthathwa njengomhlaza wamaphaphu ophezulu . Ezi khansela ziye zangena okanye zazisasaza kwiisuncu eziseduze ukuya kwinqanaba elinjalo lokuba ukuhlinzwa akunakwenzeka; ubuncinane ekuqaleni. Nangona la ma-cancer aqhelekanga aphilisa, athatyathwa kakhulu kwaye uluhlu olubanzi lwezonyango lukhoyo. Ekuhambeni kwexesha, umhlaza we-3B wesifo somdlavuza unciphise ngobukhulu obaneleyo kunye ne-chemotherapy kunye ne-radiation enokuhlinzwa-kwaye ke, ithuba lokunyanga-linokuthi lenzeke.
Ukukhula
Phantse ama-30 ekhulwini abantu banomdlavuza wesifo somdlavuza kwimeko yesifo. Phantse ama-30 ekhulwini abantu bafunyaniswa kwisigaba sokuqala (isigaba soku-1 okanye isigaba 2) kunye nama-40 ekhulwini abantu sele beqhubekele phambili kwisigaba 4 somhlaza womphunga, isigaba esiphezulu sesifo.
Ukucwangcisa
Umdlavuza wesifo somdlavuza uyisinyathelo esibalulekileyo ekukhetheni ukhetho olungcono lwezokwelapha, ngokukodwa ukwenza ukwahlula phakathi kwesigaba 3A kunye nesigaba 3B.
- 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 somhlaza wesi-3 somdlavuza sisoloko sifunyenwe xa umntu ebona ugqirha wakhe ngolunye uhlobo lweempawu. Izimpawu zomhlaza zomphunga eziqhelekileyo kunye nesigaba somhlaza wesi-3 somhlaza ziquka:
- Ukukhwehlela okuqhubekayo
- Ukuqhawukelwa ngumphefumlo
- Ukuhlamba igazi
- Ukugubha
- Ukuphindaphinda izifo zokuphefumula ezifana ne-pneumonia okanye i-bronchitis.
Ukutshaya nokukhwehlela igazi kuqhelekileyo kwiimvumba ezikufutshane nomoya omkhulu wemipuphu (i- bronchi ne-bronchioles) kanti ukuphefumula okufutshane kufaneka kunye nezicubu eziphantsi kwimiphunga. Izidumbu ezifumaneka kwimimandla engaphandle yemiphunga ecaleni kwempuphu (i- pleura ) ingabangela i- pleurisy , uhlobo oluqhelekileyo olubuhlungu besifuba esiswini olubuhlungu ngokuphefumla.
Ekubeni ezininzi zala makhansela asasazeka kwindawo, abantu banokuba neempawu zentlungu esifubeni sabo, iimbambo, amahlombe, okanye umva. Xa i-tumor iquka indawo ezifana ne-esophagus kunye nezinye izakhiwo zesifuba, i-dysphagia (ubunzima bokugwinya) kunye nokwenyuka kunokwenzeka.
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. I-National Cancer Institute incoma ukuba nabani na abane-stage 3 umdlavuza wemiphunga bacinga ukuthatha inxaxheba kwilingo leklinikhi, uphando olulingisa unyango olutsha lwamanyathelo enyango.
Enye yezinto eziphambili kakhulu kunyango lomhlaza wamaphaphu, ngokukodwa umhlaza wesifo somhlaza wamangqamuzana, kuye kwaba ukongeza kwimiba ejoliswe kuyo. Kukho iindlela ezininzi zokwelapha ezifumanekayo ezijolise ngqo kumaseli omhlaza wamaphaphu. Ukongezelela, izidakamizwa ze-immunotherapy ziye zavunywa ukuba, xa zisebenza kakuhle, ziye zaphumela ekuphumeni kwexesha elide kwabanye abantu abanezigaba eziphambili zomhlaza wamaphaphu. Izinyango zokwelapha ziquka:
Ukuhlinzwa
Kwinqanaba le-3A lomdlavuza wamaphaphu, ukuhlinzwa komdlavuza wamaphaphu kunokwenziwa ukuze kususwe isisu. Ekubeni umngcipheko wokuphindaphinda uphezulu, oku kulandelwa yi-acrovant chemotherapy (i-chemotherapy emva kokutyunjwa) ukujongana nayiphi na iseli yomhlaza ongasasazeka kwi-tumor. Kwinqanaba le-3B lomhlaza wegazi, ukuhlinzwa akuqhelekanga unyango olungcono. Kwabanye abantu, nangona kunjalo, i-chemotherapy (i-neoadjuvant chemotherapy) inokunciphisa ubungakanani besisu ukuze utyando lube lunokwenzeka.
Chemotherapy
I-Chemotherapy kunye neyeza zonyango ziqhelekileyo zisetyenziselwa ukunyanga isigaba se-3 somdlavuza wamaphaphu. Njengoko kuphawuliwe ngasentla, i-chemotherapy ingasetyenziselwa ngaphambi okanye emva kokuhlinzwa okanye ingasetyenziselwa yodwa kulabo abanomdlavuza ongenakuze baphathwe ngokuhlinzwa. I-Chemotherapy inokudibaniswa nezinye iindlela zokwelapha umdlavuza wamaphaphu.
Utyando lweyeza
Njengoko kuphawuliwe ngasentla, unyango lwe-radiation luvame ukusetyenziswa kunye ne-chemotherapy ukuphatha iziganeko ezibandakanyeka kumgca wesi-3 somhlaza womphunga ongenakukwazi ukuphathwa ngonyango. Ulwaphulo lwe-radiation lungaphumelela ekujonganeni neengxaki ezinxulumene nesigaba somhlaza wesi-3 semiphunga, njengomqobo wokukhutshwa kwe-airways ngesisu.
Unyango olujoliswe
Wonke umntu onomdlavuza wesifo somnxeba ongeyomncinci kufuneka abe neprofayile yee-molecular (ukuhlolwa kofuzo) okwenziwe kwi-tumor. ngakumbi abo abane- 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 ngexesha, kodwa iilwimi ezizayo ziza kuvunywa kwaye zivavanywa kwizilingo zeclini xa kwenzeka. Kwalabo abane- squamous cell carcinoma yemiphunga , i-anti-EGFR antibodies ingasetyenziswa. Uvavanyo lwezonyango luye lwafunda imichiza ejongene nolunye utshintsho lomzimba kumdlavuza wamaphaphu.
Immunotherapy
Izidakamizwa ezine ezintsha ze- immunotherapy ziye zavunywa ukusuka 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), ngokukodwa, yavunywa ngoFebruwari 2018 ukwenzela unyango lwegciwane elingenakusebenza elingummdlavuza wamaphaphu emva kokuba unyango lwe-chemotherapy kunye ne-radiation. Kufunyenwe ngo-2017 ukuphucula ngokuphawulekayo ukuqhubekeka kokungena-nxaxheba kwala bantu abaneganga lesi-3.
Izinto ozilindile emhlabane
Abantu abaninzi bayazibuza ngokuchazwa kwesifo somhlaza wabo, kodwa kubalulekile ukusho izinto ezimbalwa malunga nokuba imilinganiselo yezinto zokuphila zithetha ntoni malunga nesigaba se-3.
Kukho iinguqu ezininzi ezinokuchaphazela ixesha lokuphila nomdlavuza wamaphaphu. Ezinye zazo zibandakanya ubudala bakho, ubulili bakho, indawo yecala lakho, i-molecular profile of your tumor, impilo yakho jikelele ngexesha lokuxilongwa, nendlela ophendula ngayo unyango olulwamkelayo.
Kwakhona kubalulekile ukuthetha igama okanye ezimbini malunga namanani. Izibalo zisitshela indlela umntu "oqhelekileyo" oya kwenza ngayo ngesifo, kodwa akukho mntu "ophakathi." Ukongezelela, iifomati zikho, ngcaciso, endala. Xa sithetha ngomlinganiselo wokusinda kweminyaka emi-5 kwisifo, sibhekisela kwindlela abantu abaye bafumanisa ngayo ubuncinane ubuncinane iminyaka emi-5 edlulileyo. Ekubeni kuninzi izidakamizwa ezivunyiweyo zomhlaza wamaphaphu phakathi kuka-2011 no-2017 kunokuba zivunyiwe kwiminyaka engama-40 edlulileyo, la manani ayinakunceda kakhulu.
Oko kwathiwa, ixesha lokuphila lobomi kumgangatho wesithathu umhlaza wesifo somhlaza wamangqamuzana (ixesha apho iipesenti ezingama-50 ezigulane zisaphila kwaye iipesenti ezingama-50 zidlulile) zijikeleze iinyanga ezili-15 kwisigaba se-3 somhlaza wemiphunga. Umlinganiselo weminyaka emihlanu-ukususela kwipesenti zabantu abalindelwe ukuba baphile iminyaka emi-5 emva kokuxilongwa kwesigaba somhlaza wesi-3 somdlavuza-ngokudabukisayo nje kuphela kweepesenti eziyi-14 kwinqanaba le-3A kunye neepesenti ezingama-5 kwisigaba 3B.
Njengengxelo yokugqibela, lixesha lokugxotha ezinye zeengcamango malunga nezilingo zeklinikhi . Iingcamango zabantu ngabantu beehagu zeginea zinezizathu ezithile kwixesha elidlulileyo, njengoko amaninzi amachiza aqale ahlolwe kubantu abanolwazi oluncinane malunga nendlela ababeza kusebenza ngayo. Oku kuye kwatshintsha kakhulu. Ngoku, uninzi lwemishanguzo yomhlaza oluthatywayo luye lwacwangciswa ngokucokisekileyo ukujongana neethagethi ezithile kwiimisele zamanqindi okanye iindima ezithile ezenziwa ngamajoni omzimba wokulwa nomdlavuza. Kuye kwaguqulwa kwinqanaba apho izilingo zokuqala ze- 1-izilingo zokuqala zonyango apho iyeza elitsha livavanywa ngabantu-kungekhona kuphela okukhuselekileyo kodwa ngokuqhelekileyo yindlela yokugcina isifo eso. Okukuphela kwendlela yokuhlala.
ILizwi
Uphononongo lubonisa ukuba ukufunda oko unokukwazi ngomhlaza wakho kunceda kwisiphumo. Buza imibuzo. Yibandakanye nabathandekayo bakho kwaye ubakhuthaze ukuba babuze imibuzo. Cinga ukujoyina iqela leenkxaso kunye / okanye udibanise nommangaliso womdlavuza wemiphunga emaphasini. Kwiminyaka yakutshanje lo mphakathi uphumelele kwaye uya kwamkelwa ngeengalo ezivulekileyo.
Funda malunga nezilingo zamachiza ezinokuthi zilungele imeko ethile. Enyanisweni, kwi-Twitter, kukho i-Twitter ingxoxo zonke iiveki apho izigulane, abagxininisi, abaphandi, kunye ne-oncologists bonke badibanisa ukuxoxa ngophando olutsha kunye nokulungelelanisa okubanzi malunga neengxaki eziphathelene nomhlaza wemiphunga. Ukuze ufumane uluntu, sebenzisa i-hashtag "LCSM" emele umdlavuza woluntu lomdlavuza.
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:
> 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.
> Boffa, D., Fernandez, F., Kim, S. et al. I-Clinical Stage IIIA-Clinical N2 I-Cancer Lung Cancer kwi-Society of the Thoracic Surgeons Database. Ama-Annal of Surgery Thoracic. Ngo-2017 Meyi 17. (Epub ngaphambi kokuprinta).
> INational Cancer Institute. Ukwelashwa kweNtsholongwane yeNtsholongwane yeeLungile (PDQ) - I-Health Professional Version. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq.