Ziziphi izicubu ze-Pancoast kwaye zihluke njani kwezinye iindidi zomhlaza wamaphaphu ngokubhekiselele kwimpawu, kunye nonyango?
Iimvumi zepascoast zingumdlavuza wamaphaphu oqala phezulu kwiphaphu yomnene okanye ekhohlo kwaye ahlasele udonga lwesifuba. Kwakhona kuthiwa yi- tumor tumors tumors . Iimvumi ze-pancoast zivame ukuza kunye neempawu ezahlukileyo ezibizwa ngokuba yi "Pancoast syndrome," equlethwe intlungu ehlombe kunye nangaphakathi kwengalo nesandla.
Izidumbu ze-Pancoast zijongene phakathi kweesithathu kunye neetlanu zeepesenti zeemiphunga zamaphaphu kwaye zihluke kwezinye iintlobo zomhlaza wesifo somphunga kwiindlela ezininzi ezibalulekileyo.
Iimvumba zenyama zihlobo lomhlaza womphunga ongaphantsi kwexesha ngenxa yobunzima bokubona lezi zicubu kwi-x-ray izifundo kunye ngenxa yempawu zabo ezingavamile.
Iimpawu
Iimpawu zesifo se-Pancoast zibangelwa ukuxinwa kwezakhiwo (imiqobo) esecaleni kwiphondo eliphezulu apho umhlaza ukhona khona. Iimpawu zeklasi zibizwa ngokuba yi-Pancoast-Tobias syndrome kwaye ziquka:
- Iintlungu kunye neentlungu ziyaxhamla phantsi kwengalo (ngakumbi ingxenyeni yangaphakathi yengalo kunye nepinki e-pinky yesandla.) Le ntlungu ihlala ilukhuni kwaye ingapheli. Ubunzima buyakwazi ukugqithisa kwi-armpit okanye kwi-blade blade. ( Intlungu yesisu ingaba uphawu lokuqala lomhlaza wamaphaphu , ngokukodwa kulabo abaneengxaki zesifo sePancoast.)
- Ubuthathaka kwizihlunu zesandla .
- Ukulinganisa kunye neenkuthazo, andiyiyo isandla, ingakumbi iminwe kunye ne-pinky iminwe.
- "I-Horner's syndrome " equka iptosis (i-eophopiyo ye-droopy) i-anhidrosis (ukungabi naso kwesigqubuthelo kwelinye icala lobuso edlalwa ngaphambili ngokushushumbisa nokukhupha kwelinye icala lobuso) kunye ne-miosis (umfundi ongeyena. ) U
Ngamanye amaxesha kukho ukuvuvukala kwengalo engaphezulu ngenxa yengcinezelo kwi-subclavian vein (umtya ohamba phantsi kwe-collarbone).
Ukuba unayo nayiphi na impawu ebonisa ukuxhamla kwesifo se-pancoast, xela ugqirha okanye ufumane umbono wesibini. Uninzi lwala mathambo alulahleki okokuqala ngenxa yeempawu zabo ezizodwa kwaye kuba kunzima ukubona kuma-ray-ray.
Indawo kunye neAnatomy
Iintsholongwane zomhlaba zenzeke kwingxenyeni ephezulu yomphunga wesinxele okanye wesobunxele (ummandla we-apical) kwaye uhlasele izakhiwo kufuphi nale ndawo. Ezi ziquka:
- Iibhanki (ngokuqhelekileyo izibambo ze-1 neye-2) kunye ne-vertebrae.
- I-plexus ye-brachial - iqoqo leentsimbi ezisekufuphi.
- Imisipha okanye imilambo yegazi kufuphi nomphezulu wemiphunga (umzekelo, umzobo we-subclavian, i-nerve phrenic, i-laryngeal nererve, kunye ne-vagus nererve.)
Uncedo lwezonyango / iAnatomic Inkcazo yePancoast Syndrome
Kulabo bafuna inkcazelo engakumbi ngokucacileyo ye-Pancoast syndrome, i-American College ye-Chest Physicians ichaza i-Pancoast syndrome njengeemiphunga zamaphaphu ezitshabalalisa naziphi na izakhiwo zesigxina (phezulu komphunga) wesifuba, kubandakanywa nezimbambo zokuqala ze-thoracic , iingcambu ezisezantsi ze-plexus ye-bronchial, intambo enobubele kunye ne-ganglion esondele kufuphi nesibhokhwe okanye iinqanawa ze-subclavia (iinqanawa ze-subclavian ziquka umthambo kunye ne-vein ehamba phantsi kwe-collarbone okanye i-clavicle.)
Izizathu
Ukubhema kukuxanduva lwamaninzi eekomhlaza, kodwa kubalulekile ukuba uqaphele ukuba ukuxilongwa komhlaza wemiphunga okwangoku kuninzi kakhulu kubantu ababeshushu bokuba bangabantu abashushu. Eminye imingcipheko yomdlavuza wamaphaphu ibandakanya ukuhlaselwa kwe-radon , ukutshaya umsi, kunye nokuchayeka emsebenzini kwiikhemikhali kunye nezinto eziyaziwayo ukuba zenze umdlavuza wamaphaphu.
Ukuxilongwa
Ukuxilongwa kwezicubu zePancoast ngokukhawuleza kubambezeleka ngenxa yezizathu ezibini. Ezi zicubu zingenakwenzeka ukuba zibe neempawu zomhlaza zomphunga , ezifana nokuphefumula nokuphefumula, kwaye abantu baqala ukubona ugqirha wezilonda okanye i-neurologist kwimpawu zabo.
Iimvumi ze-Pancoast nazo zinzima ukubona kwiifub-ray ngenxa yeendawo zazo.
Ukuhlanganiswa kwee-CT kunye nee-MRI zihlala zisetyenziswa-kunye ne-MRI ibalulekile ngaphambi kokuhlinzwa ukuba ubhekane nokubandakanyeka komdla. I- biopsy yemiphunga yendlela ethile-ingaba isifuba esivulekile se-cheopsy (thoracotomy) okanye nge-biopsy ye-lymph nodes ngasentla kwe-collarbone (i-biopsy supraclavicular) idlalwa rhoqo ukuze ixilongwe. Ezinye iimvavanyo, ezifana ne- bronchoscopy zenziwa kwakhona.
Ukucwangcisa
Isitrasi senziwa rhoqo nge-PET scan / CT. Uninzi lwala ma-khansa lusempilweni ye-IIB engekho encinci yesifo somhlaza wamaphaphu. Ngokusekelwe kwi- TNM yesifo somhlaza wesifo somdlavuza , ininzi yabo i-T3 okanye i-T4.
Uhlobo lwe-Cancer Lung
Iintsholongwane zomhlaba ziqhelekileyo zifana nomhlaza wesifo somhlaza wesifo somhlaza. Kulezi, malunga ne-2/3 yi-lung adenocarcinoma kunye ne-1/3 yi-squamous cell carcinoma okanye inkulu cell carcinoma. Ekubeni kunamanyathelo athile ajoliswe kuwo ngoku atholakala kwi- lung adenocarcinoma , kwaye ngoku i-squamous cell carcinoma ngokunjalo, kubaluleke kakhulu ukuba uqiniseke ukuba unesiprofayili se-gene (i-molecular profiling) eyenziwe kwi-tumor yakho.
Unyango
Izinyango zokwelapha kubantu abaneengcambu zePancoast zixhomekeke kubukhulu besisu. Okwangoku, kubabo bane-stage I ukuya kwisigaba se-III izigulane, unyango "oluhle" lubandakanya ukudibanisa kwe-chemotherapy kunye nolwaphulo lwe-radiation olulandelwa utyando. Khetha ziquka:
I-Chemotherapy kunye neengxaki zokwelapha
Unyango lweTancoast tumor ngokuqhelekileyo uqala ngomhlaza wemiphunga wamachiza , mhlawumbi okanye ukutyunjwa kuya kwenzeka. Ngenxa yendawo engenza ukuba utyando lube lukhuni, injongo kukunciphisa isisu ngobuninzi kangangoko kunokwenzeka ngaphambi kokuhlinzwa. Ukongezelela, ezininzi zala mathambo "ziguqulwe ngokutshintshiweyo" - ukungabikho kwemfuyo engafanelekiyo ekufunyenwe kuvavanyo lwemizimba ekhoyo. Ukuba awuzange ube nokuhlolwa kofuzo, ubizwa ngokuba yi-molecular profiling okanye ukuprofetwa kwemfuza, xela ugqirha wakho.
Ukuhlinzwa
Utyando luyakwazi ukuqhutyelwa kwimizimba ye-Pancoast, kodwa ngokuqhelekileyo lwenziwa emva kwe-chemotherapy kunye / okanye unyango olujoliswe kuyo kunye nokunyanga kwamayeza okuhlaziya izicubu. I-Chemotherapy ngaphambi kokuba utyando luthiwa "unyango lokunyanga." Oku kutyunjwa kunokuba nzima kakhulu, kwaye kubalulekile ukufumana isikhungo somhlaza apho oogqirha baqhelana nalo hlobo lwesisu. Ngokungafani namanye amachiza atshabalalisa amathambo, abanye abantu abanezikhumba zePancoast eziye zangena kwi-vertebrae zingaphathwa ngempumelelo ngokuhlinzwa. Ngexesha lokuhlinzwa, i-lymph nodes kwisifuba esiphakathi kwemiphunga (ebizwa ngokuthi i-mediastinal lymph nodes) ihlala isuswa kwakhona.
Ukunyanga kwamayeza
Ukuba unyango olujoliswe kunyango alunakwenzeka, unyango lwe-radiation lunokuthi luncedo njengonyango olusisigxina - elinye lusetyenziswe ekunciphiseni ubuhlungu kunye nezinye iimpawu. Ulwaphulo lwe-radiation lungasetyenziselwa kunye ne-chemotherapy ukuba "lihle" isisu ngaphambi kokuhlinzwa.
Unyango olujoliswe
Njengoko kuphawuliwe ngasentla, wonke umntu onomdlavuza wesifo somnxeba omncinci kunye nompheno we-adenocarcinoma kufuneka abe neprofayile ye-molecular eyenziwe kwi-tumor. Iimvavanyo zivunyiwe ngoku kwalabo abane- EGFR, utshintsho lwe- ALK, ukulungiswa kwe- ROS1 kunye nokunye, kunye nokunyango olongezelelweyo olufundiswa kwizilingo zonyango.
Immunotherapy
I-Immunotherapy yindlela entsha yokuthabatha umdlavuza wamaphaphu, kunye neyeza lokuqala ezivunyiwe kule nkalo ngo-2015. Nangona ingasebenzi kuwo wonke umntu, abanye abantu-nokuba nabo abanomhlaza womphunga wamaphambili-banokulawula ixesha elide kwisifo sabo ezi zonyango.
Uvavanyo lwezonyango
Izidumbu ze-pancoast aziqabile, kwaye izilingo zonyango ziyaqhubeka ukuphonononga unyango olutsha.
Prognosis
Ukuphucula okubonakalayo ekusindisweni kwee-Tumcoast tumors kuye kwafezwa kwiminyaka embalwa edlulileyo. Ngokuqhelekileyo, izicubu zePancoast zineziganeko ezingcono kunezo zicubu ezitholakala ngaphezulu kwimipopho, kwaye izinga lokusinda linokuba ngcono kunezinye iidrange kwisigaba esifanayo
Isilinganiso seminyaka emi-2 esasisindayo sifumaneka phakathi kwama-55 ekhulwini kunye nama-70 ekhulwini-aphezulu kakhulu kunamanye amachiza emiphunga emiphunga, kunye nalabo abanezitho zomzimba zePancoast ezingaphathwa unyango, isilinganiso seminyaka emi-5 sokusinda sasiphakathi kwama-50 no-77 pesenti.
Kubalulekile ukuba uqaphele ukuba ezi zindleko zokusinda zinokuba ziphakamileyo kakhulu ngoku, ekubeni iipilisi ezijoliswe kuzo ezintsha, kunye nezidakamizwa ze-immunotherapy ziye zavunywa njengoko ezi zifundo zigqityiwe.
Ukuba Ufumene I-Diagnosed
Ekubeni iimvumba zePancoast aziqhelekanga, kwaye ekubeni utyando lugqabileyo, kubalulekile ukuba ucinge ngoluvo lwe sibini ukuba ufumene ukuba unesifo se-Pancoast. Izifundo zisitshela ukuba ukufunda ngokusemandleni akho ngomhlaza wakho akusikuncedi nje ukuba uzive ulawulwa ngakumbi kodwa kunokukunceda nesiphumo sakho. Hlola ezi ngcebiso malunga nento omele uyenze xa usanda kuxilongwa , kwakunye nendlela yokuphanda umdlavuza wakho kwi-intanethi .
Ukuba ngummeli wakho kumnonophelo wakho womhlaza uye wenza umehluko kubantu abaninzi, kwaye ngokweNational Cancer Institute, abantu abanomdlavuza wamaphaphu kufuneka baqwalasele ukhetho lwezilingo zeklinikhi.
Usenokuba uvile ngakumbi ngomhlaza webele kunye neebhanki, kodwa umdlavuza womphakathi wamaphaphu usebenza kwaye uncedisa kakhulu. Nangona awunjalo uhlobo lomntu othanda amaqela enkxaso okanye amajelo asekuhlaleni, cinga ukuxhuma nabanye abaphila ngesifo esifanayo.
Kwaye, ukuba ngumthandi wakho oye wafumanisa ukuba ukhona, kufuneka ufunde malunga nento omele uyenze xa umthandayo enomdlavuza wamaphaphu .
> Imithombo:
> Caronia, F., Fiorelli, A., Ruffini, E. et al. Uhlalutyo olulinganisiweyo lwe-Pancoast tumor resection eyenziwa nge-video-assisted thoracic surgery versus standard approaches. I-Interactive Cardiovascular and Thoracic Surgery . 2014. 19 (3): 426-35.
> Abacebisi, J., iTronc, F., kunye neD Fortin. Ukulawulwa kwezidumbu ezibandakanya udonga lwesifuba kuquka iisifo ze-pancoast kunye nezicubu ezihlasela umlenze. Iiklinikhi zeeTraphic Surgery . 2013. 23 (3): 313-25.
> Foroulis, C., Zaraogoulidis, P., Darwiche, K. et al. I-Superior sulcus (Pancoast) i-tumors: ubungqina obukhoyo kwi-diagnostic and treatment. Umbhalo Wezifo Zesifo . 2013. 5 iSiza 4: S342-58.
> Nikolaos, P., Vasilios, L., Efstratios, K. et al. Iindlela zokwelapha zeengxaki zePancoast. Umbhalo Wezifo Zesifo . 2014. 6 I-Suppl 1: S180-93.
> Ozmen, O., Yilmaz, Ul, Dadali, Y. et al. Ukusetyenziswa kwe-FDG PET / CT kwizigulane ngee-Pancoast Tumors: Ingaba kukho nawuphi na umrhumo wokuLawula abaPhezulu? . I-Cancer Biotherapy & Radiopharmaceuticals . 2015. 30 (8): 359-67.
> Panagopoulos, N., Leivaditis, V., Koletsis, E. et al. Iimpawu zesifo se-pancoast: iimpawu kunye nokuhlolwa kwangaphambili. Umbhalo Wezifo Zesifo . 6 I-Suppl 1: S108-15.
> White, H., White, B., iBethel, C., noA. Arroliga. I-pancoast's syndrome eyesiqulatho kwizinto eziphathekayo ezithintekayo: into engekho yesiqhelo. I-American Journal yeSayensi yezoNyango . 2011. 341 (4): 333-6.
> Zarogoulidis, K., Porpodis, K., Domvri, K., Eleftheriadou, E., Ioannidou, D., kunye noP. Zarogoulidis. Ukuchonga nokuPhatha i-Pancoast Tumors. Ukuphononongwa kweNgcali kwiMicrothelo yokuphefumula . 2016. 10 (12): 1255-1258.