Unyango kunye nePrognosis xa I-Cancer yandala isasazeka
I-Boneastast ye- Boneastases yomdlavuza wamaphaphu (ukusasazeka komdlavuza wamaphaphu kumathambo) aqhelekanga ngomhlaza wemiphunga, echaphazela abantu abangama-30 ukuya kuma-40 ekhulwini labantu abanomdlavuza omkhulu wamaphaphu . Enyanisweni, njengoko izinga lokusinda lomdlavuza wamaphaphu landa, inani labantu abahlala kunye neethambo zesifo se-boneastas landa.
Ukongezelela ekubangela intlungu eninzi kunye nokungahambi kakuhle, i-boneastases yamathambo ingabangela ukuphazamiseka okuphazamisa imisebenzi yansuku zonke nokunciphisa umgangatho wobomi.
Ziziphi iimpawu, unyango, kunye nesifo sengqondo somhlaza wamaphaphu kunye nesifo se-boneastas?
Sibanzi
Umdlavuza womlenze kunye namathambo e-boneastase kubhekisela kumaseli omhlaza wamaphaphu atsalela kwithambo okanye ngegazi okanye nge-lymphatics (iinqanawa ezithwala amangqamuzana okulwa nosuleleka emzimbeni). I-cancer ye-metastatic kuya kwithambo iyahluke kunomdlavuza wesifuba -amakhwenkwe aphuma emathanjeni kwaye akhiwa ngamaseli amathambo angavamile. I-cancer ye-metastatic kuya kwithambo yenziwe ngamaseli aphuma kumdlavuza oyintloko- kulo mzekelo, imiphunga. Ukuba oku kudideka, ungafunda ngakumbi malunga nomdlavuza usasazeka ngomzimba .
Ziziphi Iimpawu Zomdlavuza Wengqumbo?
Umhlaza womlenze nguye uhlobo lwesithathu oluqhelekileyo lomhlaza ukusasazeka kwamathambo (emva komhlaza wesifuba nomdlavuza wesibeletho), kwaye xa i-metastases ithambo itholakala ngaphandle komthombo ocacileyo, isiqingatha sexesha sichaphazeleka nomdlavuza wamaphaphu. Amathambo aqhelekileyo apho umhlaza wamaphaphu usasazeka khona:
- Umgudu (ikakhulukazi i-vertebrae kwisifuba nakwezinye izicathulo eziphantsi)
- I-pelvis
- Amathambo aphezulu eengalo nasemlenzeni (i-humerus ne-femur)
Umdlavuza womlenze uphawuleza ukuba ungasasazeka kumathambo ezandleni nasezinyaweni.
Iimpawu
Ubunzima ngokuqhelekileyo uphawu lokuqala lomhlaza wamaphaphu kunye neethambo zesifo.
Intlungu inokuqala ivakale njenge-muscle idonsa okanye ingxaki, kodwa iyancipha kwaye iyakhula. Xa i-boneastas i-boneast iquka iingalo nemilenze, intlungu idla ngokubi ngokunyakaza. Ubuhlungu ngenxa yokusasazeka komhlaza wemiphunga emgodini zihlala zibi kakhulu ebusuku kwaye emva kokuphumla ebhedini.
Ukuba amathambo e-boneastases aquka umgudu, ukunyanzelwa komthambo womgudu ngenxa yesisu kudala intlungu ngokuhamba nobuthathaka okanye ukubetha emilenzeni. Ukuba ubunzima bomgudu bunzima kwi-spine ephantsi (cauda equina syndrome), intlungu kunye nobuthakathaka emilenzeni inokwenzeka kunye nokulahlekelwa kwesilwanyana okanye isisu. Le ngxaki yongxamisekileyo yonyango, kwaye iimpawu zinokuhlala zisesigxina ngaphandle kokunyanga okukhawuleza.
Ngamanye amaxesha uphawu lokuqala lokuba umdlavuza wamaphaphu usasazeke kwithambo yintluko ( ukuphulwa komzimba ) Kulo mqathango, amangqamuzana omhlaza wesibeleko afaka isiswini samathambo esiqhelekileyo, asenza buthathaka ukuze kube lula ukuphula. Ezi ziqhekeza zingenzeka ngaphandle kokuphazamiseka okukhulu (kwanokugqithisa ebhedeni) kunye nemisebenzi yemihla ngemihla.
Ngenxa yokuphuka kwethambo, ekhupha i-calcium, inqanaba eliphakamileyo le-calcium egazini (hypercalcemia) lingabangela ukudideka, isisonguluko kunye nokuhlanza, ukoma, kunye nobuthakathaka be-muscle.
Iingxaki
Njengoko kuphawuliwe ngasentla, i-boneastases yamathambo ingabangela iintlobo ezininzi zeempawu, ezininzi zazo ezinciphisa umgangatho wobomi kubantu abaphila nomhlaza wemiphunga.
- Ubuhlungu - Ubuhlungu obuhambelana namathambo e-boneastases bunokuba bunzima kakhulu, buyingozi kwimpilo. Ukongezelela, amayeza okunyanga intlungu angabangela ukhathala okungaphezulu, kunye nokuqhawuka.
- Iifractures - Iifractures, ngokuqinisekileyo, zihlala zibuhlungu, kodwa zinciphisa umgangatho wobomi ngokunjalo. Ukudibaniswa nomhlaza, ukuhla kwehla ngenxa yokuphuka kwandisa umngcipheko wokuphuhlisa igazi kunye ne-pulmonary emboli .
- Ukugqithiswa kwe-Spinal Cord Ukunyanzeliswa - Ukongezelela ekubangela iimpawu, ukunyanzeliswa komthambo wentambo yongxamiseko yonyango engabangela ukukhubazeka kunye nokulahleka kwesilonda kunye nokulawulwa kwesisu.
- I-hypercalcemia - Ukongezelela ekubangela iimpawu ezingentla, ukuxhamla kwegazi kumagulane esifo somhlaza kungxamisekileyo, kwaye kunokubangela iziqhelo zentliziyo ezingavamile, ukuphazamiseka, kunye nokufa. Iimpawu ze-hypercalcemia zingabandakanya isicupunu kunye nokuhlanza, ukoma ukwanda, ukunciphisa ukuvuthwa, ukunyuka kwemizimba kunye nokudibanisa, ubuthathaka kunye nokudideka.
- Izaphulo ezongezelelweyo, Utyando, kunye neMithi - Ukuba unyango lwamayeza, unyango okanye amayeza asetyenziswa ukuphatha iingxaki zethambo zesifo, iziphumo zonyango zifakwe kwimiphumo emibi yonyango olusetyenziselwa ukunyanga umdlavuza kuqala.
- Iingxaki ezilahlekileyo - Enye inkathazo engavumelekanga ukuba yintoni, indlela i-boneastas i-boneastases ingayiphatha ngayo ezinye izifo zomhlaza. Ngale ndlela, iziganeko ezinxulumene nezifo (ezifana nezizahlukileyo) zinokuba yinxalenye yecangca eliyingozi apho umdlavuza ubangelwa ingxaki (umzekelo ukuphuka) okubangela into ekunciphiseni ukusetyenziswa kwemichiza kunye nokuhlinzwa ukuba uphathe umhlaza.
Ukuxilongwa
Iimvavanyo ezisetyenziselwa ukukhangela amathambo e-metastases zingabandakanya:
- I-Bone scans : Izicatshulwa ze- Bone zisetyenziselwa ukuba zijonge amathambo amaninzi kunexesha elidlulileyo, kwaye ngamanye amaxesha kunokuba nzima ukuhlukanisa umdlavuza kwezinye iimeko zethambo.
- I-PET ihlola : I-PET i-scans ibuhlungu kakhulu ekufumaneni i-boneastases yamathambo , njengoko ikhangele iindawo zokukhula kwe-tumor kwi-bone.
- I-MRI ihlola
- CT scans
Unyango
Unyango lomdlavuza wamaphaphu kunye ne-boneast metasasethi ngokuyinhloko i- palastative- oko kukuthi, kuthethwa ukukhupha iimpawu, kodwa kungaphilanga umdlavuza. Injongo ephambili yonyango kukunciphisa intlungu ebangelwa yimastastas kunye nokunyanga okanye ukuthintela iintambo kunye nezinye iingxaki. Oko kwathiwa, kubantu abanemizimba embalwa kuphela (into ebizwa ngokuba yi-oligometastatic), oogqirha banokuqwalasela ukuphatha i-metastases ngokugqithiseleyo nethemba lokuphila ixesha elide (jonga ngezantsi).
Izinyango zokwelapha zethambo zesithinteli zibhalwe ngezantsi. Okubaluleke kakhulu ukugcina engqondweni, nangona kunjalo, kukuba injongo yonyango kufuneka ukuba ikhuphe intlungu okanye ukungahambi kakuhle. Izifundo zisitshilo ukuba uncedo oluhle luncedo. Oko kwathiwa, izinto ezimbalwa zinokuqiniseka ukuba oku kwenzekayo. Kubalulekile ukuba abantu abanomdla ukuba baqonde ukuba imilenze yeentlungu, xa isetyenziswe njengoko iyalathwayo, ayikho nto ibangela ukuba utywala, kwaye awuyi kunciphisa ithuba lakho lokufumana intlungu ezayo xa usebenzisa iiyeza zentlungu ngoku. Kwakhona kubalulekile ukuba ngummeli wakho ekunyamekelweni komhlaza kwaye uvumele ugqirha wakho wazi ukuba unayo intlungu ephazamisa umgangatho wobomi.
Izinketho zokonyango ziquka zombini inkqubo (kuwo wonke umzimba) nakwendawo (ekujonganeni namathambo esisodwa kuphela). Makhe sijonge nganye kwezi zinto ngokwahlukileyo.
Izinketho Zonyango
Iingonyango eziqhelekileyo zomhlaza wesifo seemiphunga, ezifana ne-chemotherapy, iilrapies ezijoliswe kuyo, kunye ne-immunotherapy, zinganciphisa i-boneastases yeethambo. Isidakamizwa sokuqala se-immunotherapy yomdlavuza wamaphaphu savunywa ngo-2015, kwaye ngoku izidakamizwa ezine zifumaneka ngomhlaza wemiphunga. Njengokufumanisa okulungileyo, u-2018 uphando lubone ukuba ubukho beetastimase zethambo lwaluyimpembelelo ezizimeleyo ukuba i-Opdivo (nivolumab) inokusebenza ngomhlaza.
Izinketho zonyango lwasekhaya
Kukho iindlela ezininzi ezifumanekayo ekuphatheni amathambo e-boneastase ngaphezu kwonyango olwenzelwayo ngumhlaza wakho ngokwawo. Ezi zonyango zingasetyenziselwa zodwa okanye zidibeneyo ngokuxhomekeka kubuhlungu beentlungu zakho kunye neengxaki ezinokuthi zenzeke. Khetha ziquka:
Amachiza ezinhlungu - zombini amayeza anxamnye nokuvuvukala kunye neengqungquthela, ezifana ne-morphine, isenokusetyenziswa ukulawula intlungu kwi-metastases ye-bone. Nolwazi olungakumbi malunga nokulawula intlungu ngenxa yomhlaza.
Uphulo lwe- Radiation I-Radiation yonyango oluqhelekileyo elisetyenziselwa ukunciphisa intlungu, ukuthintela i-fractures, kunye nokunciphisa intambo yomgudu wokuxinwa kwi-bone metasase. Uninzi lwabantu lufumana uncedo olukhulu lweentlungu kwi-radiation therapy, kwaye kubantu abaninzi, ukukhanya kweemitha kunokunciphisa intlungu yabo ngokupheleleyo.
Ugqirha - Ukuhlinzwa kusetshenziselwa ngokuyinhloko ukuzinzisa amathambo xa bephuka, okanye ukuthintela ukuphuka kwithambo ebenobuthakathaka kakhulu ngumhlaza (ukuphambuka kwexesha elizayo). Ngamanye amaxesha ukuhlinzwa kungasetyenziswa ukuba i-tumor ibangela uxinzelelo olunzulu kumgca wesipelini, njenge-cauda equina syndrome.
I-Bone ijolise imithi okanye imithi yokuguqula amathambo - Unokuva ugqirha wakho uthetha malunga neengonyama zokuguqula amathambo . Ezi zonyango ziquka zombini ukusetyenziswa kwe-bisphosphates (echazwe ngokulandelayo) kunye nokusetyenziswa kwe-denosumab).
I-Bisphosphonates - i-Bisphosphonates yimichiza eye isetyenziselwa ukunyanga i-osteoporosis (amathambo amancinci), kodwa inokunceda ukunqanda ukuphuka kwethambo kubantu abaneethambo zesifo ngenxa yesifo somhlaza. Imithi esetyenziswa ngabantu abaneomhlaza wemiphunga iquka i-Zometa (zoledronic acid) kunye neProlia (denosumab.)
Ezi zonyango zikhuselekile, kwiimeko ezinqabileyo zingabangela ingxaki ebizwa ngokuba yi- osteonecrosis yomhlathi (ukuphuka kwethambo emhlathini) kunye nokulimala kwezintso. Zingasetyenziselwa emva kokuxhamla kweethambo zesifo se-boneastases zenzekile, okanye ukukhusela ingxaki kwindawo yokuqala. I-Zometa kunye neProtelia inomnye umvuzo wokuba iipropati ze-antiticancer. Zometa kunye neProlia zinikwe njengezonyango ezinqabileyo (IV) nganye kwiiveki ezintathu ukuya kwezine kwiZometa, okanye kwiiveki ezimbini ukuya kwezine kunye neProlia.
I-Denosumab - iDenosumab ngumntu ochasene nomntu oye wasetyenziswa ngempumelelo ethile kubantu abaneengxube zebele kunye neengqungquthela ezazisasaza amathambo. Kuze kube ngoku kucinga ukuba kunokunciphisa iingxaki, ezifana neziqhekeza, ezinxulumene nomhlaza womphunga oye wasasazeka amathambo. Kuye kucatshangelwa ukuba inokuthi ibe nempembelelo emdlalweni ngokwawo kuba inempahla yokulwa nesisu. I-Denosumab inikezwa njenge-injection subcuticular (nje ngaphantsi kwesikhumba) nganye kwiiveki ezine.
I-Radionuclide Treatment - unyango lwe-Radionuclide yindlela yokwelapha i-boneast metastase eye yasetyenziswa ngokuyinhloko kwi-prostate kunye neengcingo zebele. Ukuphononongwa kwezilingo ezimbalwa ezenziwe kwangomhla zifumene ukuba olu unyango lubangele ukukhululeka kwentlungu engama-75 ekhulwini labantu abanomdlavuza wamaphaphu beqala emva kweeveki ezintlanu emva kokunyanga kwaye bahlala kwiinyanga ezintandathu. Kuthemba ukuba izifundo ezikhulu ziya kuhlola ukusetyenziswa kwendlela ngelixa elizayo.
Uvavanyo lwezonyango - ukuhlolwa kwezonyango kuyaqhubeka ukukhangela iindlela ezingcono zokuphatha i-metastases yamathambo ngenxa yomhlaza.
Ezinye unyango - Abaphandi bajonga iindlela zokuphelisa iintlungu zethambo ngenxa yomhlaza wesifo se-metastatic, kunye nokwenza i- acupuncture inokubambelela isithembiso xa isetyenziswe ngokubhekiselele kwezinye ezi zonyango.
Unyango lweSigodi kunye ne-Oligometastase
Njengoko kuphawuliwe ngasentla, kwiimeko ezinqabileyo kubantu abanesifo esisodwa okanye nje kuphela samathambo esifo esivela kumdlavuza wamaphaphu, unyango lwe-radiation stereotactic ( SBRT ) lunokuqwalaselwa . Ngaloo ndlela oku kuye kwenziwa ngokukodwa kubantu abaneempawu ezixhatshaziweyo okanye ezimbalwa kwiingqondo okanye esibindi.
Prognosis
Ukusinda komlambo- oko kukuthi, isixa sexesha emva kokuba iipesenti ezingama-50 zabantu ziphila kwaye ama-50 eepesenti adlulile-ngokudabukisayo zingaphantsi kweenyanga ezintandathu kubantu abaneethambo ezisuka kumdlavuza wamaphaphu. Ukusinda kuninzi kunabesifazana , abo bane- adenocarcinoma , abantu abane-boneast metas, kunye nabanye abangenayo i-fractures. Oko kwathiwa, abanye abantu baye basinda kwaye benza kakuhle kwiminyaka emininzi emva kokuxilongwa komhlaza wamaphaphu kunye netastases yeethambo.
ILizwi Elivela Kwi-Bone Metastases Kwi-Cancer Lung
Ukufunda ukuba unamathambo omzimba wesifo somhlaza wamaphaphu uyabuhlungu. Kuthetha ukuba umhlaza wakho usiteji sesi-4 (i-metastatic) kwaye awusayi kunyanga. Ukongezelela, i-boneastases yamathambo ingaba buhlungu kakhulu kwaye inokuchaphazela ukwazi kwakho ukuhamba. Oko kwathiwa, unyango luya kuphucula. Unyango lomhlaza wesifo se-metastatic, njenge-chemotherapy, unyango olujoliswe kuyo, kunye ne-immunotherapy kunokunceda namathambo e-metastases ngokunjalo. Ukongezelela, i-boneastases yamathambo ingaphathwa kwiindawo ezikhethwe njengezonyango ezichithwa ngamathambo (ezinokuthi zineempembelelo zesifo somhlaza) kunye neyeza zonyango. Nangona i-prognosis ihluphekile ngokubanzi, abanye abantu baye baphila iminyaka emininzi ngeethambo zesifo somdlavuza wemiphunga.
> Imithombo:
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> Zacho, H., Karthigaseu, N., Fonager, R., noL. Petersen. Unyango kunye nama-radionuclides afuna amathambo e-boneastases ezibuhlungu kwizigulane zomhlaza wemiphunga: ukuhlolwa ngokufanelekileyo. Ukuncediswa kweBMJ kunye neNkathazo yokuPhatha . 2016 Jan 27. (Epub ngaphambi kokuprinta).