Iimpawu, ukuxilongwa, unyango, kunye nokuxhamla kwe-Squamous Cell Lung Cancer
I-Squamous cell carcinoma yemiphunga yindlela enye yomhlaza wesifo somhlaza wesininzi . I-akhawunti ye-cancer yamaphaphu engekho encinci malunga neepesenti ezingama-80 zamanomdlavuza emiphunga, kwaye ezo, malunga neepesenti ezingama-30 zi- squamous cell carcinomas.
Sibanzi
I-Squamous cell carcinoma iqala kwizicubu ezihamba kumaphepha emoyeni kwimiphunga. Kubizwa nangokuthi yi-epidermoid carcinoma.
Ininzi i-squamous cell carcinomas yamaphaphu iphakathi, ngokuqhelekileyo kwi- bronchi enkulu ejoyina i- trachea kumphunga.
I-Squamous cell carcinomas zixhamle ngakumbi ngokubhema kunezinye iindidi zeekliniki ezingamancinci zamaphaphu kwaye zixhaphake kakhulu kumadoda kunabesifazane. Bavame ukukhula ngokukhawuleza, kwaye ngenxa yeendawo zabo bahlala befumaneka ngaphaya kwezinye iindlela zomhlaza wemiphunga. Isiganeko se-squamous cell carcinoma yemiphunga sele sinciphile kwiminyaka yamuva nje, kanti enye uhlobo lomhlaza wemiphunga, i- adenocarcinoma ukwanda. Kucingelwa ngabanye ukuba ukongezwa kwezihlunu kwiisigarethi kuvumela umsi wokungcoliswa ngokugqithiseleyo kwimiphunga apho i-adenocarcinomas ihlala ithatha khona. Le ncenza, nangona kunjalo, ikhona nakubantu abangazange bavume.
Iincinci
Amagciwane e-squamous cell ephazamisa amachiza ayahlukana ngokuphindaphindiweyo ngama-subtypes angama-4 ngento ekhangeleka ngayo phantsi kwe-microscope nendlela abaziphatha ngayo.
Ezi ziquka:
- Eyokuqala
- Zasendulo
- Imfihlo
- Basal
Siyazi ukuba kukho ukungafani okukhoyo phakathi kwala ma-subtypes kodwa bafunda nje ngendlela uhlobo ngalunye lungaphendula ngayo ezahlukeneyo iziyobisi. Uninzi lwama-subtypes liphendula ubuncinane enye yezilwanyana zamachiza asebenzisa i-chemotherapy. Ikhefu lingaba ngumdlavuza we-squamous cell cell.
Le ngqungquthela ayixhasi kakhulu kwiiyobisi zamachiza e-khemotherapy esetyenziswa ngokuqhelekileyo kuba ithambe ukukhula ngokukhawuleza (kunye ne-chemotherapy kaninzi isebenza ngokuthe ngqo kumagciwane okukhula ngokukhawuleza kuba ijolise ukwahlula iiseli).
Iimpawu
Izimpawu eziqhelekileyo kunye neempawu zomhlaza wemiphunga ziquka ukukhwehlela okuqhubekayo, ukukhwehlela igazi, ukuphefumula okufutshane, nokuphefumula. Ekubeni i-squamous cell carcinomas zivame ukuba zikufuphi kwindlela ehamba phambili, zivame ukudala iimpawu ngaphambi kwezinye iindlela zomhlaza wemiphunga. Ukuvalwa kwendlela yokuhamba ngomoya kungakhokelela kwiintsholongwane ezifana ne-pneumonia, okanye ukuwa kweengxenye zemiphunga ( atelectasis ), kwaye ukusuleleka kokuphefumula okunjenge-pneumonia kunokube ngumqondiso wokuqala wokuba into ethile iyinto engalungile.
I-Squamous cell carcinoma yinto ebangela kakhulu into eyaziwa ngokuba yi- Pancoast syndrome okanye i-sulcus syndrome. I-pancoast syndrome ibangelwa ngamanqamana emiphunga aqala kufuphi nomphezulu wamaphaphu kwaye ahlasele izakhiwo ezikufuphi, ezinjengeentsimbi. Iimpawu zisoloko ziquka intlungu yeentlungu ezityhahla ngaphakathi kweengalo, ubuthathaka okanye iintlungu ezandleni, ukucubungula okanye ukujuluka kwelinye icala lobuso, kunye nesifo sejwabu (i-Horner's syndrome).
Abantu abathile abane-squamous cell carcinoma nabo banakho amathuba okufumana i-calcium ephezulu ( hypercalcemia ) engabangela ubuthathaka bemisipha kunye neenkampu.
I-hypercalcemia yenye yeempawu ze- paraneoplastic syndrome kwaye ibangelwa isisu esiyimfihlo ye-hormone ephakamisa izinga le-calcium egazini.
Ukuxilongwa
I-Squamous cell carcinoma yemiphunga idlalwa ngokukhawuleza xa ukungaqhelekanga kubonakala kwi-x-ray. Ukuphonononga kwakhona kungaquka:
- ICape CT Scan
- Sputum Cytology . Ekubeni i-squamous cell carcinomas ihlala ihamba kwindlela yokuhamba, i-sampuli ye-sputum ingayibona ngamanye amaxesha isifo somhlaza
- Bronchoscopy
- PET scan . Uvavanyo lwe-PET luvavanyo "olusebenzayo" olwenzelwe ukujonga izilwanyana ezikhulayo kwaye ngokuqhelekileyo zenziwa ukuba zikhangele naziphi na ubungqina bokusasazeka (i-metastasis)
- Endobronchial Ultrasound . I-endobronchial ultrasound yenziwe ngokusebenzisa ipowuni ekhethekileyo ngexesha le-bronchoscopy.
Ngokuxhomekeke kwiziphumo, ugqirha wakho uya kufuna ukufumana isampula yeesishu (i- lung biopsy ) ukuqinisekisa ukuxilongwa kwaye uya kulandelela iimvavanyo ezongezelelweyo ukujonga ukuba umhlaza wakho usasazeke.
Ukucwangcisa
I-squamous cell carcinoma yamaphaphu idilizwe kwiinqanaba ezine:
- Isigaba 1 - Umhlaza uphakathi kwipomphu kwaye awusasazeka nakweyiphi i-lymph nodes
- Isigaba sesi-2 - Umhlaza usasazeke kwii-lymph nodes okanye umgca wemiphunga, okanye kwindawo ethile ye-bronchus
- Isigaba sesi-3 - Umhlaza usasazeke kwiimpawu ezisondele kwimipuphu
- Isigaba sesi-4 - Umhlaza usasazekile (umgangatho wesinye) kwenye inxalenye yomzimba, iindawo eziqhelekileyo zibe ngamathambo, ubuchopho, isibindi, okanye izilonda
Oogqirha basebenzisa enye indlela, indlela edidekayo yokugqiba kwisiganeko somhlaza wemiphunga obizwa ngokuba yi- TNM . Kule nto bajonga ubukhulu be-tumor (emele i-T), nokuba iindawo ezichaphazelekayo zichaphazelekayo, phi na ngaphi (ezimelelwe ngu-N), nokuba ingaba isifo seqhenqa (okanye sisetyenzisiweyo) kwimimandla yomzimba ngaphandle yemiphunga, okanye kwenye imiphunga (emele iM.). Umzekelo, ugqirha wakho unokuchaza umhlaza wakho wemiphunga njengeT3N2M0.
Izizathu
I-squamous cell carcinoma yomphunga uhlobo lomhlaza wesifo somphunga unxulumene kakhulu nokutshaya , kodwa ezinye izizathu zinganceda. Ukuboniswa kweRadon kwikhaya yimbangela yesibini ebangela umdlavuza wamaphaphu. Ukunyanzeliswa komsebenzi, okufana ne-diesel fuel kunye nezinye izinto eziyimingcipheko ebalulekileyo ekuphuhliseni umhlaza wesifo somhlaza wamaphaphu.
I-Genetics inokudlala indima ngokunjalo, kwaye umngcipheko womhlaza wamaphaphu unyuka kubantu abanamalungu entsapho nesifo.
Unyango
Ngokuxhomekeke kwinqanaba le-squamous cell carcinoma yemiphunga, unyango lunokubandakanya ukuhlinzwa, i-chemotherapy, unyango lwe-radiation, unyango olujoliswe kuyo, ukuxilongwa kwe-immunotherapy, okanye ukudibanisa kwezi zinto. Uninzi lwezilingo zekliniki ziyaqhubeka zifuna iindlela ezintsha zokuphatha lo mhlaza kwaye ukuncedisa ukuba zeziphi unyango olusebenzayo.
Ukuhlinzwa
Ukuhlinzwa ngomhlaza womlenze kunokwenzeka nge-squamous cell carcinoma. Ngesigaba 1A umdlavuza we-squamous cell lung, umdlalo wedwa unokuba unyango. Unokuphinda uhlolwe ngabafundi abane-stage 1B, isigaba II, kunye nesigaba se-3A somhlaza wesifo somdlavuza, ngokuqhelekileyo kuhlanganiswe ne-chemotherapy kunye neyeza. Ngamanye amaxesha, i-tumor ingenakho ukusebenza kodwa ingancishiswa ngobukhulu kunye ne-chemotherapy kunye / okanye unyango lwe-radiation ukwenzela ukuba utyando lunokwenzeka. Xa i-chemotherapy eyenziwe ukunciphisa ubukhulu be-tumor ngaphambi kokuhlinzwa kuthiwa "yi-neoadjuvant chemotherapy." Kungekudala, impumelelo iboniswe ekusebenziseni i-immunotherapy ukunciphisa isisu esingenakusebenza ngokukhululeka ukwenzela ukuba utyando lwenziwa.
Chemotherapy
I-Chemotherapy ingasetyenziselwa yedwa, ngokubambisana ne-radiation therapy, okanye ngaphambi okanye emva kokuhlinzwa kwimihlaza yemiphunga. I-Squamous cell carcinoma yemiphunga iphendula ngendlela eyahlukileyo kunezinye iidrakthi zamaphaphu ezifana ne-adenocarcinoma kwiyeza zamakhemikhali. Amachiza aqhelekileyo asetyenzisiweyo ekuqaleni kwalolu hlobo lomhlaza aquka iPlatinol (cisplatin) kunye neGemzar (gemcitabine). Kulabo basabela kwonyango, ukuqhubekeka ( unyango lwamayeza ) kunye neTarceva (erlotinib) okanye i-Alimta (pemetrexed) isenokusetyenziswa.
Utyando lweyeza
Utyando lwe-Radiation lungasetyenziselwa ukunyanga umdlavuza okanye ukulawula iimpawu ezinxulumene nokusasazeka komhlaza. I-radiation inganikwa ngaphandle, okanye ngaphakathi (i- brachytherapy ) apho izinto ezinokusasazwayo zihanjiswa kwindawo echanekileyo yemiphunga ngexesha le-bronchoscopy.
Unyango olujoliswe
Usenokuba uvile malunga nokusetyenziswa kwezilwanyana ezijoliswe ekujoliseni ukuguquka kwe-EGFR kwi-lung adenocarcinoma. I-EGFR, okanye i-epidermal growth factor receptor, iprotheni ebandakanyekayo ekuqhubeni ukukhula komhlaza. I-squamous cell carcinoma yemiphunga ingaphathwa kwakhona ngokujolisa kwi-EGFR indlela, kodwa ngeendlela ezahlukeneyo.
Esikhundleni sokujoliswa kweenguquzelo ze-EGFR, iintsholongwane ze-EGFR zincinci yezilwanyana ezisetyenziselwa ukubopha kwi-EGFR ngaphandle kweeseli zomhlaza. Xa i-EGFR iboshwe njalo, indlela yokumisela eyenza ukuba iseli ikhule iyanqanyulwa. I-Portrazza (necitumumab) yavunywa ngo-2015 ukuba isebenzise kunye ne-chemotherapy kwi-cancer esele ye-cell squamous. Izilingo zonyango zivavanya ezinye iziyobisi, ezifana ne-afatinib kunye nokunye kunyango lwe-squamous cell cell cancer.
Immunotherapy
Izidakamizwa ze- immunotherapy zavunywa kuqala ukuba zonyango lomhlaza wamaphaphu ngo-2015, kwaye ngoku ukuhlanganiswa kwezi nkunkuma kufundiswa kwizilingo zonyango.
Ngo-2015, unyango lokuqala lwe-immunotherapy lwavunyelwa abantu abaneli sifo. Amachiza i- Opdivo (nivolumab) yindlela yokuzikhusela i-immunotherapy, elula kakhulu, ikhulisa amandla ethu omzimba omzimba wokulwa namaseli omhlaza.
Ukuqonda indlela aba basebenzayo ngayo izidakamizwa, kunokukunceda ukucinga ngesistim sakho somzimba njengemoto. "Iibhuleki" zilawulwa yiprotheyini ebizwa ngokuthi iPD-1. I-Opdivo kulo mzekeliso isebenza ukuvimba ii-PD-1-iibhuleki-ezivumela i-immune system ukuba ilwa nomhlaza ngaphandle kokuphazamiseka-inqobo, ukuthatha iibhuleki emotweni. Unyango okwangoku ivunyiwe kubantu abanomdlavuza we-metastatic squamous ongekho omncinci umhlaza wabo uphumelele ngexesha okanye emva kwe-staticum based based chemotherapy. (I-chemotherapy esekelwe kwiPlatinum ibhekisela kwi-regimen ye-chemotherapy kuquka nePlatinol (cisplatin) okanye iParaplatin (carboplatin)).
Ukususela ngelo xesha, ezinye izidakamizwa ze-immunotherapy ziye zavunywa, i-Keytruda (pembrolizumab) kunye neTecentriq (i-atezolizumab).
Prognosis
Ngaphambi kokuba uphendule umbuzo othi "yintoni umgqomo wesifo somhlaza wesifo somhlaza wamaphaphu?" Kubalulekile ukuthetha malunga nawaphi amanani achaza izinga lokusinda. Okokuqala, wonke umntu uhlukile. Izibalo zitshilo ukuba yintoni inkambo "ephakathi" okanye ukusinda, kodwa abayitshiyo nantoni na ngabantu abathile. Zininzi izinto ezinokuchaphazela ukugxekwa kwesifo somhlaza wesifo somhlaza wesifo somdlavuza kuquka iminyaka yobudala ekuxilongweni, ngesondo sakho, imeko yempilweni yakho jikelele kunye nendlela osabela ngayo kunyango.
Kwakhona kunceda ukugcina engqondweni ukuba iinkcukacha zisekelwe kwingcaciso eneminyaka emininzi ubudala. Njengoko unyango olutsha luyafumaneka, la manani awanakubonakalisa ngokuchanekileyo oko kuthethwa kwakho namhlanje. Ngokomzekelo, izinga leminyaka emihlanu lokusinda komdlavuza wamaphaphu libikwe ngo-2018 lusekelwe kubantu abafumene unyango ngo-2013 nangaphambili. Ngenxa yokuba unyango oluninzi lwe-squamous cell carcinoma yomphunga lwavunywa kuphela emva ko-2013, inani lamanani alisoloko libonisa indlela umntu oza kwenza ngayo namhlanje.
Ngelo xesha, kukho iindlela ezintsha zonyango ezivunyiweyo zonyango lomhlaza wamaphaphu kwiminyaka emi-5 edluleyo, kuneminyaka engama-40 ngaphambili. Ngokomzekelo, i-drug Portrazza ayifumanekanga xa abantu bezo zifundo befunyaniswa. Oko kuthetha ukuthini ukuba amazinga okusinda okwangoku awanakho ukuqwalasela ukuba umntu uza kulindela ukuba enze njani nakwezinye zezi zonyango.
Kukho ithemba elininzi kulabo bafumene umdlavuza wamaphaphu namhlanje, kodwa ngelishwa, iifomanani oza kuzifunda akunakunceda ekuqondeni eli themba.
Amanqanaba okuphila komhlaza wesifo somhlaza wamapompo ahlukeneyo ahlukeneyo kunye nesigaba , ngokusinda kweminyaka emihlanu kwiminyaka engama-50 (okanye ngaphezulu) ngesigaba se-1 kwisifo, kodwa kuphela iipesenti ezimbini ukuya kwezine kunye nesigaba sesi-4. Umlinganiselo weminyaka emihlanu wokusinda komdlavuza wamaphaphu ubuhlungu nje ngeepesenti ezingama-18 kuphela. Kwakhona kubalulekile ukuqaphela ukuba amanqaku kula maxabiso awakubonakali uphuculo kunye neziyobisi ezintsha kunye neenkqubo ezikhoyo ngoku.
Ukuqikelela ukuxhamla kwakho
Xa ukhangela ukuhlaziya kubalulekile ukuba uqaphele ukuba zonke iintsholongwane zomhlaza zesifo samaphaphu azifani. Enyanisweni, ukuba kukho abantu abangama-300 abanesifo se-squamous cell lung carcinoma egumbini, babeza kuba nama-cancer ekhethekileyo angama-300. Umhlaza wakho unokuba neempawu zee-molecular eziza kunyuka okanye zinciphise ukuhlaselwa kwakho. (I-oncologist yakho ingathetha ezinye zezi zinto kunye nawe). Ukongezelela, uphando lufuna ezinye iindlela zokuqikelela ukuxeliswa komntu othile we-squamous cell carcinoma ngokusekelwe kwiziphumo ezifana nokujikeleza iisilini ze-tumor ezifumaneka kwi- biopsy yamanzi kunye nokunye.
Ukujamelana
Ukuxilongwa kwe-squamous cell carcinoma yemiphunga kuyatshitshisa kwaye unokuziva uwedwa. Ibinzana elithi "kuthatha idolophana" alizange lilungele ngakumbi kunokuba lithetha ngomhlaza wemiphunga. Fumana kwaye uvumele (loo nxalenye ngamanye amaxesha uyintloko) abathandekayo bakho ukukuxhasa.
Thatha ixesha lokufunda ngomhlaza wakho. Izifundo zisitshela ukuba abantu abaqondayo kangcono umhlaza wabo abanakuvakalelwa kuphela amandla, kodwa ngolwazi ngamanye amaxesha unokwenza umehluko kwimpilo. Qaphela ukuba unokufumana iqela lokuxhasa abantu abanomdlavuza wamaphaphu kwindawo yakho, okanye uthathe ixesha lokuxhuma kunye nomdlavuza omangalisayo wamaphaphu kwi-intanethi.
Aba bantu abayikukwamukela kuphela kwaye bakuxhase kodwa bangaba ngumthombo omkhulu wolwazi olutsha kunye nophando ngokunjalo. Khangela imibutho yomdlavuza yemiphunga efana neLUNGevity, i-American Lung Association Lung Force, kunye ne-Lung Cancer Alliance. Xa sifuna abanye ngomdlavuza wamaphaphu kumajelo asekuhlaleni, i-hashtag yi-#LCSM emele umdlavuza womdlavuza woluntu. Ukuba uneminyaka engama-50 ubudala, qiniseka ukuba uhlolisise iSiseko seCancer Cancer Lung Cancer Lungiso, inhlangano ethatha umdla okhethekileyo kumdlavuza wamaphaphu kubantu abadala .
Uninzi lwazo zonke, yiba ngummeli wakho kumnonophelo wakho womhlaza . Ukonyangwa komdlavuza wamaphaphu kuguquka ngokukhawuleza, kwaye abantu baqhubeka bebizwa ukuba babe yingxenye esebenzayo yeqela labo lonyango. Enyanisweni, baninzi abasindileyo abasaphilayo abaphila nje kuba bafunda kwaye babenzela ukunyamekela kwabo. Ekubeni kunzima u-oncologist jikelele ukuba ahlale engathandabuzekiyo utshintsho olukhawulezayo kunyango, abaninzi abasinda kumdlavuza wamaphaphu bancoma ukuba bafumane umbono wesibini kwenye yeyona nkampani enkulu kwiCancer Cancer-izikhungo zomhlaza ezikhethiweyo ezineengcali zomhlaza wamaphaphu.
Ukuba Umntu Othandayo Unomdlavuza Wesifo Sengculaza
Ukujamelana nomdlavuza wamaphaphu kumntu othandekayo kunokuba ngumngeni. Akukuphela nje ukujongene noko umthandayo ovela kwinqanaba lakho, kodwa ingqiqo yokunganakunceda inokuba yintliziyo. Unokuqinisekiswa ukuba abaninzi abantu abanakuqonda ukuba basabela njani xa umthandayo enomdlavuza wamaphaphu. Ukubuza malunga nezindlela ezithile onokukunceda ngazo, kunokuba uthi "ndibize ukuba undifuna," yindlela ongayichazela ngayo kwaye unciphise umthwalo wabo. Thatha umzuzwana ufunde malunga nento ethanda ukuhlala nomdlavuza wamaphaphu kunye nendlela onokumxhasa ngayo umthandayo ngomhlaza .
> Imithombo
- > Kawai, K., Saito, Y., Demura, R. Inkcazo yePlmonous Squamous Cell Cell Carcinoma Yonyango ngoKhuselwa ngokuSebenza kwangaphambili kwe-Immune Checkpoint Inhibitor. Cancer Cancer . 2018 Feb 8. (Epub ngaphambi kokuprinta).
- > INational Cancer Institute. Ukwelashwa kweNtsholongwane yeNtsholongwane yeeLungile (PDQ) - I-Health Professional Version. Ukuhlaziywa 02/01/18. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq
- > Shum, E., Wang, F., Kim, S., Perez-Soler, R., noH. Cheng. Uphando lwezoPhando lwe-Squamous Cell Lung Cancer: Ukususela kwizifundo zezilwanyana ukuya kwiiNqanaba II zesiGaba. Iingcamango zengcali kwiiDrams . 2017. 26 (4): 415-426./
- > Thakur, M., no A. Wozniak. Ukujonga kwi-Necitumumab kwonyango ye-Cell-Non-Small Cell Lung Carcinoma. Cancer Lung . 2017. 8: 13-19.