Iimpawu kunye neNtuthuko kwiCreatcer Treatment
I-adenocarcinoma ye-Lung yindlela yokwenza umhlaza wesifo se-cell ummangci , ongowona hlobo oqhelekileyo ngumhlaza womphunga. I-akhawunti yamancinci yamangqamuzana amancinci angama-80 engama-lunge emiphunga yamapayipi, kwaye kwezi zi-50 ekhulwini zi-adenocarcinomas.
I-Adenocarcinoma namhlanje uhlobo oluqhelekileyo lomdlavuza wamaphaphu kwabasetyhini, abaseAsia kunye nabantu abangaphantsi kweminyaka engama-45 . Ngokuqinisekileyo, kunokwenzeka ukuba batshabalale abangabhemi (mhlawumbi ababhemayo okanye ababhemayo ngaphambili) kunabantu abangokutsha.
Nangona izinga liye lahla kumadoda kwaye lilinganisa nabasetyhini, amanani aqhubeka nokunyuka kwabasetyhini abancinci, kwaye abaqinisekanga ngokupheleleyo ukuba kutheni. Kukholelwa kakhulu ukuba i-genetics, umsi wesibambiso , kunye nokugqithiselwa kwi-radon ekhaya kukho konke okuchaphazelayo.
Iimpawu
I-adenocarcinomas i-lung iqala ngokuqala kwiifomas kufuphi nommandla ongaphandle wemiphunga kwaye inokuba khona ixesha elide ngaphambi kokuba iimpawu zivele. Xa ekugqibeleni zibonakala, imiqondiso ibonakala ingacacanga kunezinye iintlobo zomhlaza wemiphunga, kubonakaliswa ngumkhuhlane ongapheliyo kunye ne- sputum egazini kuphela emva kwezigaba eziphambili.
Ngenxa yoko, ezinye zeziganeko eziqhelekileyo, iimpawu zokuqala (ezifana nokukhathala, ukuphefumula okuphambanisayo, okanye intlungu ephezulu nangemva kwesifuba) kunokungaphuthelwa okanye kubangelwe kwezinye izizathu. Ngenxa yoko, ukuxilongwa kudla ngokukhawuleza, ngokukodwa phakathi kwabaselula nabangabhemi abangenakuze babecinge ngomhlaza njengengozi.
Ukuxilongwa
Umdlavuza womlenze uvame ukufunyanwa kuqala xa ukungabonakali kubonakala kwi-X-ray, ngokuqhelekileyo ngendlela yesithunzi esichaziweyo . Ngelixa lusizi, ukufumana ubuncinci kubonelela ithuba lokuxilongwa kwangaphambili. Kwimiba engama-25 ekhulwini lweengxaki zomhlaza wamaphaphu, i-X-ray isifuba ayifumananga nasiphi na isitenxo kwaye ibuyisele "ukuhlolwa" kwesiqhelo.
Ukuba umtsalane uyakrokrelwa, ezinye iisifo zokuxilonga ezingapheliyo zingasetyenziswa, kuquka:
- I-tomography e-Computing (scan scan) , iskripthi somfuyo esingafumanisa ukungaqhelekanga kangako kunesifo se-x-ray
- Umfanekiso we-magnontic resonance (MRI) osebenzisa izixhobo zamagnetic ukwenza imifanekiso
- I-bronchoscopy , inqubo apho i-flexible scope ifakwa kwi-throat ukuze kuhlolwe i-airways enkulu emiphakeni
- I-Positron emission tomography (i-PET scan) engabonakalisa iziganeko zokuxhatshazwa komzimba, ezinokuthi zenzeke ngamaseli omhlaza
I-sputum cytology , apho isampuli ye-salive ekhuhliweyo kunye ne-mucus ihlolwa, ingasetyenziselwa kodwa ibonwa njengeluncedo ekuhloleni umhlaza wokuqala.
Ngokuxhomekeke kwiziphumo, ugqirha wakho angathanda ukufumana isampula yamathambo emiphunga ukuqinisekisa ukuxilongwa. Ukongeza kwimiba ye-biopsies engapheliyo yamaphaphu amaninzi , uvavanyo olutsha lwegazi olubizwa ngokuba yi -biopsy yamanzi luyakwazi ukulandelelanisa okungafaniyo kwemfuyo yeseli yemiphunga efana ne-EGFR.
Ukuhlolwa kweGenestic and PD-L1
Enye yezinto eziqhubele phambili phambili ziye zasetyenziswa ukuhlolwa kofuzo kumaseli esifo somhlaza. Ngokwenza njalo, oogqirha banokukhetha ukhathalelo olukwazi ukujolisa ezo zimilo ezithile zofuzo.
Le ndlela ejoliswe kuyo ingaphantsi kancinci kunezo zonyango zonyango ngaphambili ezahlaselwa ngokubanzi kwiiseli ezinobungozi kunye neziphilileyo, ezibangelwa yimiphumo emibi kwaye ingenakuxolisa.
Izikhokelo zamanje zincoma ukuba bonke abantu abane-advanced adenocarcinoma ephakamileyo okanye i- metastatic behlolwe i-gene and test PD-L1 ukuze bahlolisise umhlaza wabo othile.
Iinkatho ezithile zonyango azifumanekanga kuphela kubabenokuguqulwa kwe-EGFR , ukulungiswa kwe-ALK kunye nokulungiswa kwe-ROS1 , kodwa i-BRAF, i-ERBB2, i-MET iinguqulelo zentshukumo kunye nokukhulisa, ukulungiswa kwe-RET kunye nokunye. Ukongezelela, iimvavanyo zeklinikhi zijongene nokujonga utshintsho olongezelelweyo kunye neengxaki zokwelapha.
Uvavanyo lwe-PD-L1 lwenziwe ukuze kuqikelele ukusebenza kakuhle kwezi ziyobisi ezi-immunotherapy ngoku zivunyiwe ngumhlaza wemiphunga. Ukuxoxa ngokuvavanywa kwamathambo kunye novavanyo lwe-PD-L1 ngenye yezinyathelo ezibalulekileyo xa uqala ukufumanisa ukuba uphezulu lwe-lung adenocarcinoma, njengoko le ndawo iyatshintsha ngokukhawuleza. Ngokomzekelo, isilwanyana sokuqala se-immunotherapy savunywa ngo-2015.
Amanqanaba
Xa ukuxilongwa komhlaza kuqinisekisiweyo, ugqirha uya kubeka isifo esekelwe kwinqanaba leemvavanyo eziqhelekileyo. Injongo yesigxina kukujonga ukuba umkhwa oqhubele phambili kangakanani, nokuba usasazeka, kwaye kuthi, ukuba kukho nawuphi na amanye amathambo angabandakanyeka. Isalathisi sinceda ukunyanga unyango ngendlela efanelekileyo, kungabikho ukugula okanye ukungena kunye nokubangela ingozi ngaphezu kokulungileyo.
Amanqanaba amane ahlelwa njengalandelayo:
- Isigaba se-0 : Umhlaza awuyikho ingozi, kodwa kunokuba i- carcinoma-in-situ .
- Umhlaza wesifo somdlavuza: Umhlaza wemiphunga wamagciwane uyabonwa ukuba ukhona ukuba umhlaza wentsholongwane ufunyenwe kwi-sputum kodwa i-tumor ayifumaneki kwimiphunga ngokufunda i-imaging.
- Isigaba sokuqala : Umhlaza ulapha kwaye awuzange usasaze nakweyiphi i-lymph nodes. Esi sihlandlo sokuqala "somhlaza" wesifo somhlaza.
- Isigaba sesi-2 : Umhlaza usasazeke kwi-lymph nodes, umgca wemiphophu, okanye iindlu eziphambili zemiphunga.
- Isigaba sesi-3 : Umhlaza usasazeke kwiisisi ezikufutshane. Isigaba sesi-3 saphinda siphulwe kwisigaba se-3A kunye nesigaba se-3B esoloko siphathwa ngokungafaniyo.
- Isigaba sesi-4 : Umhlaza usasazekile (ulungelelaniso) kwezinye iindawo zomzimba okanye kukho ukuchithwa okubi kakubi . Umdlavuza womlenze udibanisa ngokusasazeka amathambo, ubuchopho, isibindi, kunye neengqungquthela ze-adrenal.
Xa ufunda malunga neendlela zokonyango unokuva ngomhlaza wemiphunga uchazwa ngenye yeendlela ezilandelayo:
- Umhlaza wesifo somhlaza wamandulo: Ixesha elidlulileyo lisetyenziselwa ukuchaza i-cancer yeemiphunga eziphambili 1, isigaba 2, kunye nesigaba 3A. Ezi ziimvumba ezinokuphilisa nokuhlinzwa.
- Umdlavuza wamaphaphu ophakathi: Eli gama lisetyenziswe ngokubanzi ekuchazeni iidrari ezisegabeni 3A. Ukuhlinzwa kungenzeka, kodwa unyango oluxhasayo kunye ne-chemotherapy kunye neyeza zonyango ngokuqhelekileyo kufuneka ukuba zilawulwe i-tumor.
- Umhlaza wamaphaphu ophakamileyo: Ixesha elibhekiselele kumdlavuza wamapompo lisetyenziswa rhoqo kwisigaba 3B kunye nesigaba se-4 kanomdla, kwaye isigaba apho unyango olungaphelelanga luyona nto ingcono.
Izinyango Zonyango
Ngokuxhomekeke kwisigaba sesifo, unyango lunokuquka omnye okanye udibaniso lwezi zilandelayo:
- Ugqirha unokunikezwa kwiinqanaba zokuqala, nokuba wedwa okanye uhamba kunye ne-chemotherapy kunye / okanye unyango lwe-radiation.
- I-Chemotherapy ingasetyenziselwa yedwa, ngokubambisana neyeza zonyango, okanye ngaphambi okanye emva kokuhlinzwa.
- Iipilisi ezijoliswe kuzo ziyimithi eyenzelwe ukuhlaselwa ngokutshintshwa kwemfuza ethile. Basebenza ngokuqaphela iiprotheyini ezithile kwiiseli zomhlaza kunye nokuvimbela amandla eseli ukuphindaphinda. Izinketho ziquka iTarceva (erlotinib), i-Iressa (gefitinib), i-Gilotrif (afatinib), i-Xalkori (crizotinib), iZykadia (ceritinib), iAlectinib (alecnensa) kunye ne-Tagrisso (osimertinib).
- Ukunyangwa kwamayeza kunokusetyenziswa okanye ukunyanga umdlavuza okanye ukulawula iimpawu kulabo abanomdlavuza we-metastatic. Iifom zonyango ezijoliswe ngakumbi, ezaziwa ngokuba yi- radiotherapy yomzimba (stereotactic body radiotherapy (SBRT) , okanye unyango lweproton lungasetyenziselwa iintsholongwane ezincinci apho ukuhlinzwa kungenakufikelela.
- I-Immunotherapy yindlela yokonyango ejolise ekusebenziseni umzimba womzimba ukulwa nomhlaza. Izinketho zangoku ziquka i-Opdivo (nivolumab), i-Keytruda (pembrolizumab), ne-Tecentriq (i-atezolizumab).
ILizwi
Ngenxa yokuba iimpawu zokuqala zemiphunga ye-adenocarcinoma zihlala zilukhuni ukuzibona, isilinganiso seminyaka emihlanu yokusinda sisithuba sama- 18 ekhulwini. Kwabo bafunyanwe kwiimigangatho yokuqala, umbono ubaluleke kakhulu.
Oko oku kuphawulekayo kuyimfuneko yokwazisa ngokubanzi malunga neempawu ezingekho mbecala okanye ezinobungozi bomdlavuza wemiphunga. Ngokwabo, iimpawu ziba lula ukuphosakela. Ngokubambisana, banokubangela ifulegi ebomvu engakhokelela kokubili ukuxilongwa kwangaphambili nangaphambili, unyango olusebenzayo.
Unyango lwe-lung adenocarcinoma luphucula ngokukhawuleza kwaye iqondo lokuphila liphucuka ngokunjalo. Kwezinye iimeko, izidumbu eziphezulu zingagcinwa zikhangele ixesha elide kunye neendlela ezijoliswe kuzo. Kwipesenti encinci yabantu, unyango lwe-immunotherapy luye lwaphumela "kwimpendulo ehlala njalo" esithetha ukuba oogqirha baqaphele ukuba unokuphiliswa. Ngobunzima bokufumana izilwanyana, kunceda kakhulu ukufumana i-oncologist ejongene nomdlavuza wamaphaphu. Kubaluleke kakhulu ukuba ube ngummeli wakho kumnonophelo wakho womhlaza .
> Imithombo:
> I-American Cancer Society. "I-Cancer Cancer (I-Cell Non-Small.) I-Cell-Non-Small Small Lung Cancer Survival Rates ngeSigaba." Atlanta, Georgia; hlaziywa ngoMeyi 16, 2016.
> Chalela, R., Curull, V., Enriquez, C. et al. I-Adenocarcinoma ye-Lung: Ukusuka kwi-Molecular Basis ukuya kwi-Genome-Ulwaphulo oluPhathwayo kunye ne-Immunotherapy. I-Journal yeTagracic Diseases . 2017. 9 (7): 2142-2158.
> DiBardino, D., Sagi, A., uElvin, J. et al. Ukuzaliswa kunye neNkonzo yeZliniki zeSizukulwane esilandelayo Ukulandelelana kwezigulane ezikhethwe nge-Lung Adenocarcinoma. Cancer Lung Cancer . 2016. 17 (6): 517-522.e3.
> Sholl, L. I-Molecular Diagnostics yeSifo seLung eKliniki. Uphando lweLung Cancer Research . 2017. 6 (5): 560-569.