Ukujamelana ne-Adrenal Metastase evela kwiClay Cancer
Ukuba uye watshelwa ukuba umhlaza wakho wamaphaphu (okanye omnye umhlaza) usasazeke kwii-adrenal glands (i-adrenal metastases) unokuba udidekile. Ngokungafani nokusabalaliswa komhlaza kwezinye iindawo, ezifana nesibindi, ukusasazeka kwiintlanzi ze-adrenal akhulumi ngaso rhoqo. Oko kwathiwa, i-adrenal metastases ifana kakhulu nomhlaza womphunga. Ziphi izilonda ze-adrenal kwaye uthetha ntoni ukuba umhlaza wakho wamaphaphu usasazeka kule ndawo?
Funda ukuba kutheni i-metastase kwi-adrenal glands ingaba nokuhlaselwa okulungileyo kunezinye iindawo ze-metastases, ngakumbi xa zivela kwicala elinye lomzimba njengomhlaza.
Sibanzi
Iingqungquthela ze-adrenal zincinci ezincinci ezinobunxantathu ezifumaneka phezulu kweentliziyo nganye. Ezi zithobe ze-endocrine zinoxanduva lokuvimba ama-hormone, kuquka "i-hormone yoxinzelelo" njenge-cortisol, i-epinephrine (i-adrenaline) kunye ne-norepinephrin.
Iintsholongwane Ezichitha Kwii-Grenal Adlands
Phantse nawuphi na umhlaza ungasasazeka kwiingqungquthela ze-adrenal, kodwa ezinye izicubu zininzi kunokuba ezinye zilungele kule ndawo. Kwisifundo esithile, umdlavuza oqhelekileyo ojongene ne-adrenal metastases yayingumphunga (iipesenti ezingama-35) ezilandelwa ngumdlavuza wesisu (iipesenti ezili-14) umhlaza wesisu (iipesenti ezili-12) kunye nomhlaza wesibindi / i-bile duct (10%). Ezinye iisifo zomdlavuza eziqhelekileyo kule ndawo ziquka umhlaza wesifo, i-melanoma, umdlavuza webele, umdlavuza we-colon kunye ne-lymphoma.
Ukuba umhlaza wamaphaphu usasazeke kwiingqungquthela ze-adrenal, kuthathwa njengesigaba se-4 esingekho esincinci somhlaza wamaphaphu (okanye umgca wecala lomhlaza wesifo somnxeba). Kwixesha elidlulileyo, kwakungekho nto yokwenza umhlaza wamaphaphu wawunqunyiwe. Kwiminyaka yakutshanje, nangona kunjalo, kuye kwaphawulwa ukuba kwabanye abantu-ingakumbi abo abanesifo se-adrenal adrenal-utyando olunyanzelisayo lwe-metastasis kunokubangela ukuba baphile ixesha elide.
Njengoko kuxoxwe ngezantsi, ukuxeliswa kwe-adrenal metastases yomdlavuza wamaphaphu kunokuba ngcono kunokuba ukuxela kweminye imitha-masta - njengaleyo yesibindi, ingqondo kunye namathambo.
Isiganeko se-Adrenal Metastases
Ukufikelela kumaphesenti angama-40 abantu abanomdlavuza wamaphaphu baya kuhlakulela i-adrenal metastases ngexesha elithile, kwaye kwi-10 ekhulwini labantu abanomdlavuza wesifo samangqamu omncinci, isifo sisasazeka kuzo zombini izilonda ze-adrenal. Ezi zithintelo zikhona kwipesenti ezi-2 ukuya kwe-3 zabantu ngexesha lokuxilongwa, kwaye kwiimeko ezinqabileyo zibonakaliso lokuqala lomhlaza wamaphaphu.
Iimpawu
Uninzi lwexesha xa umdlavuza usasazeka kwiintlanzi ze-adrenal azikho naziphi iimpawu. Enyanisweni, kwisifundo esinye kuphela Iipesenti ezi-5 zabantu abane-adrenal metastases babenempawu. Abantu bahlala beqaphela kuphela ezi ziphumo ngenxa yee-radiology izifundo ezifana ne-CT scan, i-MRI, okanye i-PET scan.
Xa zikhona iimpawu, zingabandakanya:
- Intlungu ebuhlungu (kwindawo yangasemva).
- Intlungu zesisu.
- Ukuqhekeza kwisisu (isisu).
- Isifo esingenakwanela ( isifo sika-Addison ): Iimpawu zesifo se-Addison zingabandakanya ubuthathaka, uxinzelelo lwegazi oluphantsi (i-hypotension), ishukela ephantsi yegazi (u- hypoglycemia ), inqanaba le-sodium eliphantsi kwigazi (hyponatremia), kunye nezinga eliphezulu le-potassium ( hyperkalemia ).
Ukuxilongwa
Ukuba uneskripthi yokukhankanya kwi-adrenal metastases, awuyi kufuneka nayiphi na inkqubo yokuvavanya, ngakumbi ukuba unemastastases kwezinye iindawo zomzimba wakho. Kwezinye iimeko, ugqirha wakho unqwenela ukuqiniseka ukuba ubunzima kwi-adrenal gland yakho kubangelwa ngumhlaza wesifo se-metastatic, kwaye ucebisa i-biopsy ekhokelwa yi-CT.
Unyango
Unyango olucetyiswayo lwe-adrenal metastases luyahlukahluka kuxhomekeke kwizinto ezininzi. Kubantu bonke abantu abanenkxaso yokubaluleka kubalulekile. Kubantu abaneempawu ezinjenge-hemorrhage, unyango olunjenge-operesheni lunokuba luyimfuneko ukulawula iimpawu. Kwamanye abantu, unyango ngenjongo yokuphilisa umdlavuza unokwenzeka.
Unonophelo loNcedo: Ukuba okanye wena kunye nogqirha wakho unqumle ukuba unyango olongezelelweyo lomhlaza wakho okanye i-adrenal metastases, ukunyamekela iimpawu zakho kubaluleke kakhulu. Abantu abanomdla bafanelwe ulawulo olubuhlungu kunye nokulawula ezinye iimpawu ezihlobene nomhlaza.
Unyango lweMpawu: Njengoko kuphawuliwe ngasentla, i-adrenal metastases ayikho nto ibangela iimpawu. Ukuba i-metastasis iphuma (i-hemorrhaging) okanye isengozini enkulu yokukhupha, ukuhlinzwa ukuba kususwe i-tumor kunye ne-adrenal gland (adrenalectomy) inokucetyiswa. Ukuba i-metastasis ibangele ukungakwazi kakuhle, unyango lwe-steroids lungadingeka. Ukuba ubuhlungu buhlungu okanye ubuhlungu besisu buya kwenzeka, oku kufuneka kuphathwe.
Unyango lwe-Primary Primary and Other Metastases: Ukunyanga isigaba somhlaza wesi-4 somdlavuza kungabandakanya i-chemotherapy, imithi ejoliswe kuyo, i-immunotherapy, kunye / okanye unyango lwe-radiation. Abanye abantu bathatha inxaxheba kwiimvavanyo zonyango befunda iziyobisi ezintsha kunye neenkqubo. Ukongezwa kwezilwanyana ezijoliswe kuyo kunye ne-immunotherapy, zatshintshile ubuso bomdlavuza wamaphaphu ophezulu kubantu abaninzi kwiminyaka yamuva. Xa kukho ukuguqulwa kwezinto ezijoliswe kuzo, izidakamizwa ezijoliswe ngamanye amaxesha zivumele ii-odokotela ukuba baphathe isigaba somhlaza wesi-4 somdlavuza njengesifo esingapheliyo. Nangona ukuxhatshazwa kwenzeka kulezi ziyobisi ngexesha, kwezinye iimeko izizukulwana zesibini kwaye ngoku izidakamizwa zezizukulwana zesithathu ziyafumaneka xa kufanelekile. I-Immunotherapy, xa isebenza ngokufanelekileyo, ngamanye amaxesha iye yabangela "impendulo eqhubekayo," ephethe umhlaza wamaphaphu ukujonga ixesha elide. Ekubeni iyeza lokuqala kulolu hlobo lugunyaziwe kuphela ngo-2015, asikwazanga ukuba iirhafu esizibonayo ngamanye amaxesha ziya kuhlala, okanye ziphi iziphumo zesikhathi eside.
Unyango Ngomnqophiso oPhezulu: Kubantu abanesifo se-metastasis esingaqhelekanga, unyango lunokubangela ukuba uphile ixesha elide. Khetha ziquka:
- Ugqirha: zombini i-adrenalectomy evulekileyo kunye ne-laparoscopic (ukususwa kwe-adrenal gland) inokwenziwa ngenjongo yokhathalela abanye abantu.
- I-SBRT: Ukuba ukuhlinzwa kungenakwenzeka, uphando lubonisa ukuba umzimba we-stereotactic radiotherapy (SBRT) unokusebenza kwaye uyanyamezela. I-SBRT ibandakanya ukusebenzisa umthamo ophezulu wemisebe kwindawo encinci, kwaye ngamanye amaxesha kuneziphumo ezifana nokuhlinzwa.
- I-Ablation Ucwaningo lwango-2018 lufumene ukuba, nangona ukusinda kwakumntu onobuhlwempu kulabo abanomdlavuza ongasetyenzana wamangqamuzana omnxeba owenza inkqubo ngaphandle kweminye iminye i-cancer, ukuxhaswa komfanekiso nge-cutter of adrenal metastases kunokwandisa ukusinda kwendawo yokungaqhubekiyo kwintlalo kunye nokuphila ngokubanzi. Kwisifundo, ukususela kwinqanaba le-tumor elidibanisiweyo) kwi-1, 3, kunye neminyaka emi-5 yayingu-82, 44, kunye ne-34 ekhulwini emva kwenkqubo.
Prognosis
Ngaphandle kwonyango, ukusinda komlambo emva kokuxilongwa kwe-adrenal metastases kwakuneenyanga ezintathu kuphela kwisifundo esinye. Oko kwathiwa, kwaye ngokungafani nemithambo eminye kwimimandla yomzimba, unyango lwale mizila kubantu abakhethiweyo abanomdlavuza wesifo samangqamu omncinci uye wabangela ukuhlala kwithuba elide. Ezi zibalo zokusinda zahlanganiswa phambi kokuba unyango olutsha olunjenge-immunotherapy, kunye neentlobo ezininzi zonyango esilujolise kuzo, zavunyelwa umhlaza wemiphunga.
Izifundo ezincinci ezinokuhlola unyango lwe-adrenal metastases zikhuthaze. Ngokomzekelo, kwelinye uphando lwezigulane ezingama-37, ukusinda ngokubanzi kwaba ngama-34 ekhulwini kulao gulane asebenze ukuhlinzwa, kodwa i-0 ekhulwini kulabo abangenalo utyando. Olunye uphando olutshanje lufumanise ukuba ukusinda kwangexesha elide kunokwenzeka kwi-25 ekhulwini yabathathi-nxaxheba abaye baphathwa nge-adrenal metastases.
Ngomdlavuza omncinci wamasipha omzimba , uphando lubonise ukuba, ngokungafani ne-metastases kwisibindi, ubuchopho, amathambo, kunye nesilumko, i-metastase kwi-adrenal gland yayingekho uphawu olungenakulungelelaniswa.
Kutheni Ubungqina Bokuba I-Prognosis Ilungelele kwi-Adrenal Metastases kunezinye i-Metastases?
Impendulo yombuzo malunga nokuba kutheni i-adrenal metastase i-prognosis engcono, ingaba yindlela umhlaza usasazeka ngayo ukuze ufike kwii-gland ze-adrenal. I-cancer iyasasazeka ngeendlela ezi-3 eziphambili. Omnye usekufuphi kwidumbu. Enye ikhona nge-lymphatics. Kwaye okwesithathu kusetyenziswa igazi. Xa umhlaza wesangena ungena kwigazi, uhambahamba kuwo wonke umzimba. (Abanye abaphandi bakholelwa ukuba umhlaza wemiphunga ungasasazeka ngokubanzi, okanye nge-airways.)
Kwisifundo esithile ekuvavanyeni ukusebenza kwe-adrenalectomy ngokusinda, kwafunyaniswa ukuba "ngesifo se-ipsilateral" -ukuthi, ukusasazeka komhlaza kwi-adrenal gland kwicala elifanayo lomzimba njengomdlavuza wamaphaphu-umlinganiselo weminyaka emihlanu ngama-83 ekhulwini. Ngokwahlukileyo, isilinganiso seminyaka emi-5 yokusindisa abantu abanokuthi "isifo sokuxhatshazwa" -imida yokuxhamla emacaleni omzimba ovela kumdlavuza wamaphaphu, izinga lokusinda iminyaka emi-5 kunye nokuhlinzwa kwakunzima.
Kucinga ukuba xa umdlavuza wamaphaphu usasazeka kwi-adrenal gland kwicala elifanayo lomzimba, lifikelela kwi-adrenal gland ngendlela ye-lymphatic system. Ngokwahlukileyo, xa i-adrenal gland kwicala eliphambene nomzimba lichaphazelekayo, mhlawumbi lihamba nge-bloodstream (ukusasazeka kwegazi) ukufika kwiingqungquthela ze-adrenal kunye nesiphumo asiyonto.
ILizwi
Ukugxekwa nge-metastatic (isigaba 4) umhlaza wemiphunga akusiyo into esinokuyifisa. Oko kwathiwa, kuzo zonke iindawo zokudityaniswa kwezidumbu, i-adrenal metastases idla ngokugqithiseleyo (kwaye njengoko kuphawulwe, ukuxela kwangcono ngakumbi ukuba i-adrenal gland ibandakanyeka kwicala elifanayo lomzimba njengomhlaza wemiphunga). Ukongezelela, ukhetho lwamayeza kunye nemilinganiselo yokusinda komdlavuza wamapompo ephakamileyo ngokubanzi iphuculwe ngokukhawuleza, ingakumbi xa unyango olujoliswe ekuguquleni imfuyo okanye iziyobisi zonyango zingasetyenziselwa ukunyanga isisu.
Ukuba ufumene unyango wesigaba 4 somhlaza kunye ne-adrenal metastases, thatha ixesha lokufunda ngomhlaza wakho. Ukuthatha inxaxheba emphakathini womdlavuza wemiphunga kwi-intanethi kunceda kakhulu. Uphulo olutsha luphucula izinga lokusinda, kodwa unyango lomhlaza wamaphaphu litshintsha ngokukhawuleza kunzima ukuba nabani na ukuba bahlale phezulu kweziphumo zakutshanje. Ukuba uyazibuza ukuba ungayifumana njani abantu "abasemgangathweni" lophando lwemiphunga yemiphunga, ukusebenzisa i-hashtag #lcsm yomdlavuza wemiphunga yempilo yoluntu ayixabisekanga.
Unokunqwenela ukucinga ngombono wesibini kwenye yeyona nkampani enkulu yeCancercer Institute-izikhungo zomhlaza ezikhethiweyo, apho i-oncologists ekhethekileyo emdlavuza wamaphaphu banokufikelela kuphando olutsha kunye nezilingo zonyango ezikhoyo. Okona kubaluleke kakhulu, thabatha inxaxheba ekhuselekileyo kwaye ube ngummeli wakho . Sifunda ukuba ukuzimela (okanye nokuba nomhlobo okanye othandekayo onokuphanda izifo kwaye akukhuthaze), akugcini nje ekunciphiseni ukuxhalabisa kwaye kukunceda uzive ngakumbi ekulawuleni isifo sakho, kodwa kunokuphucula iziphumo ngokunjalo.
> Imithombo:
> Bastian, S. et al. Ukuxhatshazwa kokutshitshiswa kwe-Adrenal Metrenase eziPhezulu kwizigulane ezine-Cell-Non-Small Small Lung Cancer: I-One-Institution Experience and Review of the Literature. Onkologie . 2011. 34 (12): 665-70.
> Bazhenova, L. et al. I-Adrenal Metastases kwi-Lung Cancer: Impembelelo yezonyango zeMathematical Model. Umbhalo we-Thoracic Oncology . 2014. 9 (4): 442-6.
> Frenk, N., Daye, D., iTancali, K. et al. Ulawulo lwengingqi kunye nokuPhepha emva koMfanekiso-Ukukhokelwa nge-Percutaneous Ablation ye-Adrenal Metastase. I-Journal ye-Vascular ne-Interventional Radiology . 2018. 29 (2): 276-284.
> Hwang, E. et al. Iziphumo zokuxhaswa kweeNdawo zokuPhumela nokuKhuselwa koLuntu emva kwe-Adrenalectomy kwiCetomatic Metastatic: I-Retrospective Cohort Study Study. BMC Urology . 2014. 14:41.
> Nakazawa, K. et al. I-Metastase yeeMpawu eziPhezulu kunye nokuPhila kwiNcinci yeCancer Cancer. Iincwadi ze-Oncology . 2012. 4 (4): 617-620.
> Raz, D. et al. Iziphumo zezigulane ezine-Metastasis eziqhelekileyo ezivela kwi-Cell-Non-Small Cell Lung Cancer. Ama-Annal of Surgery Thoracic . 2011. 92 (5): 1788-92.
> Riiimaki, M. et al. Iindawo zeMetastatic kunye Nokusinda kwiCancer Cancer. Cancer Lung . 2014 uAgasti 2. uEpub ngaphambi kokuprinta.