Umdlavuza wamaphaphu kubadala abadala baphathwa njani kwaye ngaba ukuhlaselwa kwesifo kunokugqithisa kunokuba abantu abancinci? Ngaba kukho ixesha xa umntu ekhulile kakhulu ukuba atyathwe okanye aphethwe yi-chemotherapy? Ziziphi iindlela umhlaza wemiphunga ohlukileyo kubantu abadala, umzekelo, abo bangaphezu kweminyaka eyi-80?
Umhlaza weLung kuBadala abadala
Enye yeengcamango zomdlavuza wemiphunga kukuba abantu asebekhulile abanalo ukhetho lwemiphunga yomhlaza wamaphaphu abantu abadala abasemdlavuza wesifo.
Kubonakala kubonakala ukuba abantu abadala abadala abakwazi ukunyamezela imiphumo emibi yonyango, okanye ukuba unyango kufuneka "lutywe phantsi."
Ziyintoni na ezi zifundo? Emva koko, siva ukuba i-50 yi-30 entsha, kwaye i-70 ngu-50 entsha.
Ayikho inkcazo ecacileyo yintoni ubudala ebonisa ukuba "abadala asebekhulile" okanye "abadala" abanomdlavuza wemiphunga, kodwa izifundo ezininzi zibonakala zisetyenziselwa ukucima iminyaka yobudala engama-70. Nceda ufunde . Sifumana ukuba iminyaka yokulandelana ibaluleke kakhulu kunezinye iimeko ekuqaliseni impendulo kunye nokukwazi ukunyamezela unyango. Kwakhona lixesha elinomdla kakhulu, uninzi lwezonyango ezivunyiweyo eziye zavunywa ukuba unyango lwemiphunga yemiphunga, kunye nezo vavanywa kwizilingo zonyango, zihlala zilula ukunyamezela kunokhemotherapy yendalo.
Ezinye izifundo zisebenzisa igama elithi "izigulane ezisebekhulile" ukuchaza abo bangaphezu kweminyaka eyi-80.
Ngaphandle kwezifundo ezisetyenziswe kule minyaka kunokuba iminyaka engama-70 echazwe ngokucacileyo "abadala asebekhulile" unokumangaliswa ukwazi ukuba baninzi aba bantu banokunyamezela unyango lomhlaza wemiphunga.
Ziyayifana Kangakanani Ngomhlaza We-Lung Kwi-Older Adult?
Ngexesha langoku, abangaphezu kwama-40 ekhulwini abantu abanomdlavuza womphunga baneminyaka engama-70 okanye ngaphezulu.
Iingxaki Ngokusebenzisa Ixesha lexesha lexesha ekukhetheni unyango
Kukho ubunzima bobunzima bokuqala ngokusebenzisa iminyaka yobudala ekuqwalaseleni unyango lomhlaza wamaphaphu. Okokuqala, kufunyenwe ukuba iminyaka yobudala ayithethi kakhulu malunga nendlela umntu oya kunyamezela ngayo le mpiliso. Isimo sokusebenza , imilinganiselo "yentlalo-ntle" yindawo ephosakeleyo ekuqikeleleni ukuba umntu uza kwenza njani. Oogqirha bajonga ezinye iindlela zokuqaphela indlela umntu anokunyamezela ngayo unyango, njengoluhlolo olunzulu lwe-griatric (CGA). Ezi zixhobo zijonge iimpawu zesigulane ukuze ziqikelele ukunyamezela unyango kunye nokuphila kwaye zibandakanya:
- Izondlo
- Ubukho bezinye iimeko zonyango
- Izinga lomsebenzi
- Umsebenzi wokuphila kwansuku zonke (i-ADL)
- Inkxaso yoluntu
- Indawo yasekhaya
Enye ingxaki ejongene neminyaka yokulandelana kwexesha kukuba asikwazi into eninzi. Uninzi lweziyobisi kunye nophando luye lwafundiswa kwizilingo zeclini kwizigulane eziselula.
Ixesha elingakanani elinokuchaphazela unyango lwe-Lung Cancer
Kubalulekile ukuba ukhombe okokuqala ukuba iminyaka ayinciphisi iindleko zonyango, kodwa unyango alukwazi ukunyanzeliswa kubantu abadala abadala. Ukuvumelana ngokubanzi kubonakala ngathi ukuba iminyaka yobudala kuphela ayifanele icacise ukuba zeziphi unyango ezinokuthi zisebenzise umhlaza wemiphunga.
Oko kwathiwa, kukho izizathu ezininzi zokubangela ukuba ezinye izigulane ezigugile zingenako ukunyamezela unyango kunye nezigulane ezincinci.
- Izigulane ezindala zivame ukuba neemeko zonyango ezikhoyo kunye (izidlobongela) kunezigulane ezincinci. Imbali yesifo senhliziyo, umzekelo, unokunciphisa ukusebenzisa ezinye iziyobisi zamakhemikhali. Ngokufanayo, iimeko ezinciphisa umsebenzi wamaphaphu, njenge-emphysema, ingenza umhlaza wesifo somdlavuza ongaphantsi.
- Izigulane eziguga zinokuthi ziye zinciphisa umsebenzi weentso okanye umsebenzi wesibindi, kwaye ezininzi iziyobisi ezisetyenziselwa ukunyanga umdlavuza zicutshungulwa ngezintso okanye isibindi.
- Izigulane ezindala zihlala zinobunzima obuncinci obunzima, obangela ukunyamezela ukulahlekelwa kwesisindo kunye nokunyanga ezithile, kwaye kubekho mngcipheko we- cachexia .
- Izigulane ezindala zihlala zinezintlu ezincinci zengxoworha, ziphakamisa umngcipheko weengxaki ezinxulumene nokunciphisa umongo we-bone of chemotherapy .
Ukubikezela ukuba i-Age iyakuthinta njani unyango
Izigulane ezigugile zisengozini yokubambisana ngenxa yokwesaba ngokunyamezela ukunyamezela iminyaka, kunye nefuthe ngenxa yonyango olungaphezulu. Kubalulekile xa ukhetha unyango ukugcina izinto ezimbini engqondweni: qwalasela umphumo, kwaye uqwalasele izilindelo zakho njengesigulane.
Unyango kubantu abadala
Ukujonga iinketho zonyango, eli nqaku liza kuphazamisa izigaba zomhlaza wamaphaphu ukuya kwinqanaba lomhlaza wesifo somdlavuza, umhlaza womphunga wamaphondo, kunye nesigaba se-4 (metastatic) yomhlaza wamaphaphu . Nangona kunqabile abantu abanomdlavuza omncinci wamangqamuzana omnxeba baphelelwa unyango, i-chemotherapy yisoloko yonyango lokuqala.
Kuye kwaba nombono oqhelekileyo phakathi kwabanye uluntu ukuba abantu abangaphantsi kweminyaka ethile bengayi kufuna ukunyanga, kwaye kunokuba babe "nokunyamekela" kuphela, kodwa oku kubonakala kungenjalo. Xa bebuzwa malunga nokuhlinzwa kwelinye uphando, iipesenti ezingama-50 zezigulane ezisebekhulile zibeka phambili phambili ekusindeni kunokuba zikhutshwe ngempawu.
Umhlaza weLung Cancer kwi-Older Adult
- Ukunyamezela nokunyamekela - Nangona kubonakala ngathi uvakalelwa phakathi koluntu ukuba utyando lomdlavuza wamaphaphu luya kuba yingozi kwizigulane ezisebekhulile, izifundo azixhasi. Enyanisweni, akukho mmahluko oqhubekayo wokusinda phakathi kwezigulane ezindala kunye nezigulane ezincinci eziye zahlinzwa ngenxa yesifo somhlaza wesifo somhlaza. Ngaphezulu, amazinga aphezulu okuhlinzwa ahambelana nemilinganiselo ephezulu yokusinda kwizigulane ezisebekhulile.
- Iintlobo zeeNgqungquthela ze-Lung Cancer - Nangona kubonakala ngathi inzuzo yokusindisa izigulane ezidlulileyo eziye zahlinzwa ngenxa yesifo somhlaza wamaphaphu, kungekhona zonke iintlobo zokuhlinzwa komhlaza wamaphaphu . Uphononongo olujongene nokuthengiswa kwemida okanye i- lobectomy njengonyango baye bafumanisa ukuba abantu abadala abadala bayakwazi ukunyamezela ukuhlinzwa ngokufanelekileyo. Noko ke, izifundo zifumene ukufa okuphezulu (izinga lokufa) kubantu abadala abadala abafumana i- pneumonectomy (ukususwa kompompo wonke,) nangona kubalulekile ukusho ukuba ezi zifundo zinika iinkcukacha, kwaye kwezinye iimeko, ugqirha unokucinga ukuba umntu omdala ziya kuzuza kule nkqubo. I-VATS (incedisi ye-thoracoscopic encediswa ngevidiyo) yindlela encinci yokususa i-lobe okanye inxalenye ye-lobe kwaye inokuzikhethela kakuhle kwizigulane ezikhethiweyo (le nkqubo ayisoloko inokwenzeka.Ukufundisisa ngo-2018 kwakhona kwaqinisekisa ukuba abantu abadala (ngaphezulu abaneminyaka engama-80) bavame ukunyamezela utyando lweemiphunga zamaphaphu kunye nabantu abadala, kodwa bafumanisa ukuba i-componentectomies (i-resege rection) ihambelana neziphumo ezingcono.
- I-SBRT / I-Radiofrequency Ablation Ablation - Kubantu abanomdlavuza wamaphaphu ongaphambili ongenakwenzeka okanye xa umntu engafuni ukuhlinzwa, ngezinye izikhathi i- radiotherapy yomzimba (SBRT) okanye i-radiation frequency irlation ingasetyenziswa ukuzama ukuphilisa umhlaza wamaphaphu. Inqanaba lokusinda kubantu abadala asebekhulile nge-SBRT lingaphantsi kokuhlinzwa kodwa lubhetele kunokuba lube luncedo oluxhasayo kuphela. I-radiation pneumonitis (ukuvuvukala kwemiphunga ebangelwa yimisebe) iqhelekileyo kwizigulane ezisekudala kule nkqubo kodwa ngokuqhelekileyo zonyango.
- Ukubuyiselwa kwePulmonary - Ukulungiswa kwepulmonary ngaphambi okanye emva kokuhlinzwa komdlavuza wamaphaphu kunokuba luncedo kubantu beminyaka yonke, kodwa ngakumbi kubantu abadala.
I-Cancer Advanced Lung Cancer kwiziguli ezigugile
Ubudala bodwa abuyinto yokuchasana (isizathu sokuba ungenzi) ngokususwa komhlaza wemiphunga (resection) kunye ne-acrovant chemotherapy (i-chemotherapy eyenzelwe ukukrazula umzimba wamaseli e-micrometastases-umdlavuza onokuba khona kodwa kakhulu kakhulu ukuba angabonwa kwiimvavanyo zengqondo .) Kwizigulane ezindala ezinegca 1 , isigaba sesi-2 , kunye nesigaba se-3A somhlaza wesifo somhlaza , utyando lunokuqwalaselwa (jonga ngasentla ngaphantsi komdlavuza wesifo somdlavuza ngokuphathelele ukuhlinzwa).
Ukongeza kwindlela yokuhlinzwa, i-chemotherapy adjuvant ihlala iphakanyiswa kubantu abanomdlavuza wamapapu ophezulu. Kukho ubungqina obuncinane bokuthi i-chemotherapy ene-adjuvant kwisigaba sesi-2 okanye isigaba se-3A somhlaza wesifo somdlavuza singaphucula ukuphila kwizigulane ezikhethiweyo ezikhethiweyo. Uvavanyo, nangona kunjalo, alufumananga ukuba i-radiation post-operative inefuthe elibi kweli qela. (Kwakhona, kubalulekile ukuchaza ukuba ezi zibalo, kwaye kukho izizathu ezifanelekileyo ukuba ugqirha uza kunconywa unyango lwe-radiation.)
I-Advanced okanye iMetastatic (Isigaba se-4) I-Cancer ye-Lung kwi-Older Adult
Ukususela kumgca wesi-4 umhlaza wemiphunga ngenkcazo isasaze ngaphaya kwamaphaphu, utyando aluqhelekanga.
Kubantu abanomphunga adenocarcinoma , kunye nabantu abangazange bavume naluphi na uhlobo lomhlaza womphuphu, ukuhlaziya i-molecular (ukuhlolwa kofuzo) ukujonga ukuguquka kwezinto eziphathekayo kubaluleke kakhulu. Kubantu abanokuguqulwa kwe-EGFR , i-ALK rearrangement ( umhlaza wesibeletho we-ALK ) okanye ukulungiswa kwakhona kwe- ROS1 , iithayibhile ezijoliswe kuzo zingaphucula ukuqhubekeka kokungabikho kokuqhubekayo, kunye nemiphumo emibi yale miyeza idla ngokugqithiseleyo kwaye ingaphantsi kunezidakamizwa zemveli zendalo.
I-Chemotherapy ngokuqhelekileyo iyona nto ingundoqo yokunyanga kwinqanaba lomhlaza wesifo somhlaza wesine, kwaye kunye nezigulane ezincinci, ukudibanisa ezimbini izidakamizwa ze-chemotherapy kuvame ukucetyiswa. Uninzi lwezigulane ezindala aziphilwanga ngekhemotherapy, kodwa kukho inzuzo ecacileyo yokuphila kwabo banako ukunyamezela iziphumo ezibi. Ukongezelela, ukusebenzisa umxube weyeza ezimbini kunokubangela ukwanda okukhulu kokusinda kunokusebenzisa esinye isichemotherapy kuphela.
Immunotherapy
Isidakamizwa sokuqala se- immunotherapy yomdlavuza wamaphaphu savunywa ngo-2015 kwaye abanye bafundiswa kwizilingo zonyango I-Immunotherapy imithi ingacingwa nje ngokulula nje njengezilwanyana ezibuyisela kwaye zisebenzise amandla ethu omzimba wokulwa nomdlavuza. La mayeza awasebenzeli wonke umntu onomdlavuza wamaphaphu, athathe ixesha lokuba aqale ukusebenza, kodwa xa usebenza ngokufanelekileyo, ngamanye amaxesha ungabangela ukulawula ixesha elide leemodemokrasi eziphambili zamaphaphu. Zivame ukunyamezela ngokulula ukuba izidakamizwa zemveli zengqondo kunye.
Ukuba ungumdala omdala onomhlaza we-Lung
Ukuba uneminyaka engaphezu kwe-70 okanye i-80 nomdlavuza wamaphaphu, gcinani engqondweni ukuba ubudala "usebenze" kwaye "uzive" mhlawumbi kubaluleke ngaphezu kwexesha ozalise ngalo kwiirekhodi zakho zonyango. Ngethuba elifanayo, ootitshala bezonyango abangakwaziyo kunye nokwaziyo wena unokujonga ukuba iminyaka ebhaliweyo kwitshati ibaluleke kakhulu. Konke okufuneka basebenze nabo.
Oko kuthetha ntoni, ngakumbi phakathi kweengcali eziqhelekileyo ukuba abadala abadala abakwazi ukunyamezela imiphumo emibi yonyango, kukuba kufuneka uhlakulele ubudlelwane obuhle kunye nogqirha wakho. Qinisekisa ukuba uyazi ukuba uneminyaka engama-85 ubudala kodwa uzive ngakumbi uneminyaka engama-70. Siyavuya ngokuba siphila kwixesha xa unyango lomhlaza luba lukhulu ngakumbi, kwaye ukungafani phakathi kwezigulane kuhlonishwa. Oko kwathiwa, ukuthatha ixesha lokufunda ukuba ube ngummeli wakho ekunyamekelweni komhlaza uya kukunceda uhambe nemingeni yokuphila nomhlaza kunye nokunyanga komhlaza, kodwa ungadlala indima kwisiphumo sakho.
> Imithombo:
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> IiChambers, A., Routledge, T., Pilling, J. kunye noMnu Scarci. Kwizigulane ezisebekhulile nomhlaza wemiphunga ukuhlaziywa ngokuchanekileyo ngokuchanekileyo, ukufa nokuphila komgangatho wobomi? . I-Interactive Cardiovascular and Thoracic Surgery . 2010. 10 (6): 1015-21.
> Davidoff, A., Tang, M., Seal, B. noM M. Edelman. I-Chemotherapy kunye noNcedo lokuPhepha kwiZifo ezikhulile ezineziThuthi ezingeNcinci. Umbhalo we-Clinical Oncology . 2010. 28 (13): 2191-2197.
> Gaira, A. ad A. Jatoi. I-Can-Small-Cell Cell Cancer Ngamayeza asebekhulile: Iingxoxo zoNyango lweZonyango. Umbhalo we-Clinical Oncology . Ishicilelwe kwi-intanethi ngaphambi kokushicilela uJulayi 28, 2014
> Gridelli, C. et al. Unyango lwabaguli abakhulileyo kunye ne-Cell-Non-Small Small Cell Lung Cancer: Iziphumo zeNgqungquthela yePhaneli yamaZwe wamazwe ngamazwe e-Italian Association of Thoracic Oncology. Cancer Lung Cancer . 2015 uMar 7. (Epub ngaphambi kokuprinta)
> Maione, P. et al. Ukunyanga umhlaza ongasetyenzana wesifo somhlaza kumaphepha asebekhulile. Uphuhliso lwezonyango kwi-Medical Oncology . 2010. 2 (4): 251-260.
> I-Quiox, E. Izicwangciso ze-pharmacotherapeutic ezifanelekileyo kwizigulane ezisebekhulile ezineemfuyo ezincinci zesifo somhlaza wamaphaphu. Iziyobisi kunye nokuguga . 2011. 28 (11): 885-94.
> Rivera, C. et al. Ulawulo lokuphanda kunye neziphumo zezigulane ezisebekhulile kunye nomhlaza wesifo somhlaza wamangcwaba omncinci. Esifubeni . 2011. 140 (4): 874-80.
> Stamenovic, D., Messerschmidt, A., kunye noT. Schneider. Ukugqithwa kwee-Lung Tumors kwi-Elderly: Isifundo seKhuphiswano seCandelo eliPhezulu kwiCandelo eliPhezulu (iminyaka engaphezu kwe-80) ekuPhakanyisweni kweeNkathazo ngokusebenzisa uModeli wokuThengiswa koMngcipheko. International Journal of Surgery . 2018. 52: 141-148.