Chirongwa cheGedhi 3 Chirwere cheLungi
Kana wakamboudzwa kuti une kenza yemapapu matatu, iwe unotya uye unotya. Izvi zvinorevei? Ndeapi rudzi rwemishonga inoshandiswa pamutsara uyu wekenza yemapapu? Uye, chii chinonzi chirevo?
Tisati tatanga kutaura pamusoro pechiitiko ichi chekenza zvakakosha kuona kuti kufambira mberi kwakakosha mune zvose kurapwa kwehupenyu hwemukati wekenza yemapapu emapapiro matatu kwakaitika mumakore mashoma apfuura.
Iwe unogona kuva nemhuri kana shamwari dzave nemukenza wekumapapu munguva yakapfuura kana kuti dzingaona vanhu vachipindura kwauri nechisviniro pavanonzwa uine kenza yemapapu matatu. Iwe unogona kuve nehanya nekuyeuchidza vadiwa vako kuti kurapwa kwakagadziridzwa uye kune nzira dzakawanda dzekurapa chirwere ichi chechirwere nemamwe nzira dzinowanikwa mumakiriniki ekuedza.
Tsanangudzo
Chikamu chechitatu chekenza yemukenza yemapapu isati yakakura uye yakasiyana-siyana yekenza yemukenza inowedzera kuputsika kusvika muchigadziko chechitatuA uye chigadziko che3B . Sezvo chikwata cheA 3A ne3B chakasiyana kwazvo uye chinowanzobatwa zvakasiyana zvakasiyana, ngatitsanangure izvi zvakasiyana.
- Nhanho 3AKenza yemapapu - Mutsara 3A makondomu emapapu anotorwa sekenza yepamaperembudzi yemapapu. Izvi ndezviremara zvisina kupararira kune nzvimbo dziri kure dzomuviri (hazvina kugadziriswa, asi dzakapararira kune lymph nodes pane imwe mubhokisi, asi kune rumwe rutivi rwemuviri sekenza. Nhanho 3A makondomu emapapu anogona kuonekwa achigoneka (akafanana nechitsauko 1 uye gweta 2 mapepa emarapu emapapu.)
- Nhanho 3B Muchirwere wemapapu - Pamwe nechitsauko chemukenza wemapapu emapapu, chirwere che3B yemukenza yemapapu inofungidzirwa kuva mhanza yemapapu akapfuura Izvozvo zvinouraya zvakapinda kana kupararira kune zvisikwa zvakapoteredza kusvika kune imwe nzvimbo yakadai sokuvhiya hazvibviri; kunyanya kwete pakutanga. Kunyange zvazvo zvirwere izvi hazviwanzopora, zvinoporesa uye zvirwere zvakasiyana-siyana zviripo. Nokufamba kwenguva, kenza yemapapu e3B inoderedzwa muhupamhi zvakaringana nechemotherapy uye mazairo anovhiyiwa-uye naizvozvo, mukana werapa-inogona kuitika.
Kuwanda
Vanenge makumi matatu kubva muzana yevanhu vane kenza yemapapu emapapu matatu panguva yekuongororwa. Vanenge 30 muzana yevanhu vanoongororwa pane imwe nguva yapfuura (danho 1 kana ganhuro 2) uye 40 muzana yevanhu vakatofambira mberi kusvika kumucheto wekenza yemapapu 4, iyo yakanyanya kufambira mberi yechirwere.
Staging
Kenza yepayipi yemapuranga ndeye danho rinokosha pakusarudza nzira dzakanakisisa dzokurapa, kunyanya kusiyanisa pakati pechitsauko 3A nechitatu chechitatuB.
- Nhanho 3AKenza yemapapu inosanganisira matumbo makuru uye akapararira kune lymph node dziri pedyo, kana zviputi zveupi upi zvahwo hwakapararira kune lymph nodes dziri kure asi asi kune rumwe rutivi rwemuviri sekenza.
- Nhanho 3B Muchirwere wemapapu unotsanangurwa sechirwere chepasipo chero chipi zvacho chakapararira kune nhengo dzomukati dzakare kure kana kuti dzakapinda dzimwe nhengo dziri muchipfuva (zvakadai semwoyo kana nhengo). mukati mekudzivirirwa kwepakati pakati pematanda akaisa mapapu) akachinjwa kubva pachigadziko 3B kusvika padanho 4 muna 2009.
Oncologists vanoshandisa TNM system kuti iwedzere kutsanangura matanho emukenza wemapapu. Tsanangudzo yakajeka yeTMM system inosanganisira:
T inoreva chiremera chekukura:
- T1 - Tsvina iri pasi pe3 cm (1 ½ inches) muhukuru.
- T2 -Ichirwere chikuru kupfuura 3 cm.
- T3 - Chirwere chacho chinogona kuva chero chiyero, asi chiri pedyo nemugwagwa kana kuti chakapararira kune dzimwe nzvimbo dzakadai sedanda rechifupa kana diaphragm .
- T4 - Chirwere chacho chero chiyero, asi chiri mumugwagwa kana kuti chakasvibisa zvivako zvemunharaunda zvakadai semwoyo, kana kuti inophagus.
N inoreva lymph nodes:
- N0 - Hapana nodesiti inobatwa.
- N1 - Tsvina yakapararira kune node dziri pedyo kune rumwe rutivi rwemuviri.
- N2 - Chirwere ichi chakapararira kune nodes mberi zvakare asi kune rumwe rutivi rwemuviri.
- N3 - Masero eKenza anowanikwa mumakirinikodhi kune rumwe rutivi rwechifuva kubva mumhutu, kana mune nodhi pedyo nekollarbone kana mitsipa yemutsipa.
M inomirira chirwere chemasastatic :
- M0 - Hapana metastases aripo.
- M1 - Tsvina yakapararira (inoderedzwa) kune dzimwe nzvimbo dzomuviri kana mamwe mapapu.
Kushandisa TNM System, chirwere chemuti 3A yemukenza yemapapu chinotsanangurwa se:
- T1N2M0 - Chirwere chacho chiri pasi pe3 cm muhukuru uye chakapararira kune lymph nodes mberi kunze asi kune rumwe rutivi rwemuviri sechirwere.
- T2N2M0 - Chirwere ichi chikuru kupfuura 3 cm uye chakapararira kune lymph nodes mberi kunze asi kune rumwe rutivi rwemuviri.
- T3N1M0 - Chiremara chiri chero chiyero asi chiri pedyo nemugwagwa kana chakapararira kune imwe nzvimbo kufanana nedanda rebhokisi kana diaphragm, uye lymph nodes dziri pedyo dzinosangana.
- T3N2M0 - Chirwere chacho chiri chiyero asi chiri pedyo nemugwagwa kana kuti chapararira kune imwe nzvimbo yakadai sedombo rebhokisi kana diaphragm, uye lymph node dziri kure asi asi kune rumwe rutivi rwemuviri zvinoshandiswa.
Kushandisa TNM System, danho reB3B rinotsanangurwa se:
- Chero T, N3, M0 - Chirwere chemhando chero ipi zvayo yakapararira kune lymph nodes kune rumwe rutivi rwechifuva kubva mumarara kana kuti node pedyo nekorlarbone kana mitsipa yemutsipa, asi haina kupararira kune nzvimbo dziri kure dzomuviri.
- T4, Chero N, M0 - Chirwere chemhando chero ipi zvayo inenge iri mumhepo, kana kuti yakasvibisa zvivako zvemukati zvakadai semwoyo kana nheyo. Nodha dzinogona kunge dzisingabatanidzwi, uye kana dzichibatwa, dzinogona kunge dziri pedyo nechomuviri kana kuti dzichienderera mberi muchipfuva kana mumutsipa, asi chironda chisina kupararira kune nzvimbo dziri kure dzomuviri.
Zviratidzo
Chikamu chemukenza wemapapu wemapapu kazhinji chinowanzoonekwa kana munhu achiona chiremba ane rumwe rudzi rwezviratidzo. Zvinoratidza zvirwere zvepabonde zvemapapu nechitsauko 3 mutsa wemapapu unosanganisira
- Chirwere chinopfuurira
- Kupfupika kwemhepo
- Kuchema ropa
- Wheezing
- Yakadzokorora kupemha kwezvirwere zvakadai sepneumonia kana kuti bronchitis.
Kugurisa nekukanganisa ropa kunowanzoonekwa mumamoramu ari pedyo nemhepo huru yemakapu (the bronchi and bronchioles) asi kupfupika kwemweya kunonyanya kufanana nemakumbo ari mukati memapapupa. Tumhetu dzinowanikwa munzvimbo dzekunze dzemapapu pedyo nepapupa ( pleuray ) inogona kukonzera pleurisy , rudzi rwehutano hwakanyanya hunofuridza hwepfuva hunozara nekufema.
Sezvo dzakawanda zvekenza idzi dzakapararira kune imwe nzvimbo, vanhu vangave vane zviratidzo zvekutambudzika mumapfupa avo, mbambo, mapepa, kana kumashure. Apo bundu rinosanganisira nzvimbo dzakadai sedopu uye dzimwe dzimba dzechifukidzo, dysphagia (kunetseka kunomedza) uye kushaya simba kunogona kuitika.
Zviratidzo zvechirwere zvakadai sekuneta uye kurasikirwa kwekurema kwechido kungangovepo zvakare.
Mishonga
Mushonga wepakati 3 menza yemapapu yemapapu ndiyo inonyanya kukakavara pamakwara ose emukenza emapapu, chikamu nokuti boka iri rakasiyana zvakasiyana. I National Cancer Institute inorayira kuti ani naani ane kenza yemapapu emusero 3 anofunge kubatanidzwa muchirwere chechipatara, zvidzidzo zvinotarisa mishonga mitsva yekubatanidzwa kwerapa.
Chimwe chezvinhu zvakakosha zvikuru kuburikidza nekurapwa kwemukenza wemapapu, kunyanya asiri duku-kemukirini yemapapu yemapapu, ave kuwedzerwa kwezvirwere zvinotarisirwa. Ikozvino kune mishonga yakawanda inowanika inonyanya kutsvaga masero emukenza emapapu. Mukuwedzera, immunotherapy mishonga yakabvumirwa kuti, kana ichishanda, yakaguma nekugara kwenguva refu kwevamwe vanhu vane kunyange zvikamu zvepamusoro zvekenza yemapapu. Mishonga yekurapa inosanganisira:
Surgery
Kune rimwe danho rega 3A yemapupa emukenza, chirwere chemapapu chemapapu chinogona kuitwa kuitira kubvisa tumarara. Sezvo njodzi yekudzokorora yakanyanyisa kumusoro, izvi zvinowanzoteverwa ne adjuvant chemotherapy (chemotherapy mushure mekuvhiyiwa) kutarisa chero masero ekenza angangopararira kubva kumarara. Kune chikwata chechirwere chemapfupa 3B, chirwere hachiwanzo kurapa kwakanakisisa. Kune vamwe vanhu, zvisinei, chemotherapy (neoadadvant chemotherapy) inogona kuderedza ukuru hwechirwere kuitira kuti kuvhiyiwa zvigoneke.
Chemotherapy
Chemotherapy uye remishonga inonzi radiation zvose zvinowanzoshandiswa kurapa kenza yepente 3 yemapapu. Sezvakataurwa pamusoro apa, chemotherapy inogona kushandiswa mushure mekunge kana mushure mekuvhiyiwa kana inogona kushandiswa yoga kune avo vane kenza iyo isingagoni kurapwa nekuvhiyiwa. Chemotherapy inogonawo kusanganiswa nemamwe marapirwo emukenza wemapapu.
Radiation Therapy
Sezvambotaurwa, chirwere chemazuva ano chinowanzoshandiswa pamwe chete nemakemikirini ekurapa nzvimbo dzinobatanidzwa nekeroti yemukenza wemapapu 3 iyo isingagoni kuvhiyiwa chirwere. Kurapa kwechirwere kunogonawo kushanda pakubata nezvinetso zvine chokuita nesero 3 yemukenza yemapapu, zvakadai sekudziviswa kwemhepo neyemarara.
Targeted Therapy
Munhu wose ane kamudiki kadiki kemapapu yemapapu anofanira kunge ane kufungidzirwa kwema molecular (kuongorora kwejeni) yakaitwa pamarara. kunyanya avo vane mapapu adenocarcinoma . Mishonga yakagamuchirwa kune vanhu vane kuchinja kwekufambisa kufambisa sekuchinja kweEGFR , ALK rearrangements , uye reRrang1 rearrangements , uye izvi zvinoshandiswa kurapa dzimwe nguva zvinogona kuita kuti zvirwere zvakanaka. Kurwisana kunowanzowedzera munguva, asi misi inotevera mishonga inogamuchirwa uye iri kuedzwa mumakiriniki ekuedzwa apo izvi zvinoitika. Kune avo vane squamous cell carcinoma yemapapu , anti-EGFR an antibodies angashandiswa. Mishonga yemakiriniki arikudzidzawo mishonga inotarisa mamwe maitiro ekuchinja mumukenza wemapapu.
Immunotherapy
Zvine mishonga mishonga yemunyanzvi yemagetsi yakagamuchirwa kubva muna 2015 kuitira kurapwa kwekenza yemapapu. Iyi mishonga inoshanda nekunyanya kusimbisa kukwanisa kwezvirwere zvedu zvekuzvidzivirira kurwisa kenza. Kunyange zvazvo vasingashandisi munhu wose, vamwe vanhu vakagadziriswa kwenguva refu kwenguva refu vasina kurwara zvirwere zvekenza yavo. Imfinzi (durvalumab), kunyanya, yakagamuchirwa muna February 2018 pakurapwa kwemaitiro emakenza emapapu asingagoneki mushure mekurapwa nekemotherapy uye mahara. Yakawanikwa muna 2017 kuti ivandudze zvakanyanya kufambira mberi-kusununguka kwevanhu ava vane chirwere chetatu.
Makore ekurarama
Vanhu vazhinji vanoshamisika nezvekufananidzira kwekenza yavo, asi zvakakosha kutaura zvinhu zvishomanana pamusoro pekuti zvinotarisirwa kuti zviitiko zvehupenyu zvinorevei maererano nechitsauko 3 chirwere.
Kune zvakawanda zvinoshandiswa zvinogona kukanganisa kutarisira kweupenyu nemukenza wemapapu. Zvimwe zveizvi zvinosanganisira zera rako, zvepabonde, nzvimbo yemarara yako, maitiro ehutachiona hwako, hutano hwako hukuru panguva yekuongororwa, uye mararamiro aunogamuchira.
Zvinokosha zvakare kutaura shoko kana maviri pamusoro pezviverengero. Nhamba dzinotitaurira kuti "chiyero" munhu achaitei nehosha, asi hapana munhu "akaenzana." Mukuwedzera, matanho ari, nekushoko, yekare. Apo patinotaura pamusoro pemakore mashanu ekupukunyuka kwechirwere kubva pane chirwere, tiri kutaura nezvevanhu vakakurudzirwa zvakaonekwa makore mashanu akapfuura. Sezvo paive nemamwe madhiragi anogamuchirwa nemukenza wemapapu pakati pe2011 ne2017 kupfuura ainge agamuchirwa mukati memakore makumi mana akapfuura, nhamba idzi dzingasave dzakakosha.
Izvozvo zvakati, tarisiro yehupenyu hwemukati yechitsauko chechirwere chemapapu chemapapu matatu (kwete iyo duku yemapapu emapapu) (nguva iyo 50 muzana yevarwere vari vapenyu uye 50 muzana vapfuura) inenge mwedzi gumi nemashanu yeganda remukati wemapapu matatu. Izvi zvinokonzerwa nemakore mashanu-iyo inenge yevanhu vanotarisirwa kuva vapenyu makore mashanu mushure mekuongororwa kwemukati wekenza yemapapu matatu-zvinosuruvarisa chete 14 muzana yechitambo 3A uye nepamusoro pe5 kubva muzana pamusangano weBeji 3B.
Semashoko ekupedzisira, inguva yekudzivisa dzimwe dzenhema pamusoro pemakiriniki emakiriniki . Pfungwa yevanhu vari guinea yenguruve yaiva nedzimwe nheyo munguva yakapfuura, sezvo mishonga yakawanda yakatanga kuedzwa kuvanhu vane ruzivo rudiki rwekuti vangashanda sei. Izvi zvakachinja zvikuru. Iye zvino, mishonga yemukenza mutsva inodzidziswa yakanyatsogadziriswa kugadzirisa zvinangwa zvemasero emishonga kana mamwe mabasa ayo masimba ezvirwere anowedzera mukurwisa kenza. Yakashanduka kusvika pane imwe nzvimbo iyo yeruzhinji 1 miedzo - miedzo yekurapa yekutanga iyo mushonga mutsva unoongororwa nevanhu-kwete chete chete yakachengetedzeka asi inowanzo ndiyo chete nzira yekuchengetedza chirwere chacho. Choga choga chokuramba uchirarama.
Shoko Rinobva
Zvidzidzo zvinoratidza kuti kudzidza zvese zvaunogona nezvekenza yako kunobatsira nemigumisiro. Bvunza mibvunzo. Itai kuti vadiwa venyu uye muvakurudzire kubvunza mibvunzo zvakare. Funga kubatana neboka rekusimbisa uye / kana kuungana nechishamiso chemapapu emukenza yemukenza paIndaneti. Mumakore achangopfuura iyi nharaunda iyi yakabudirira uye iwe uchagamuchirwa nemaoko akazaruka.
Dzidza nezvemakiriniki emakirini angave akafanirwa nemamiriro ako ezvinhu. Zvechokwadi, pane Twitter, kune tweet chat imwe neimwe vhiki umo vatano, vatarisiri, vatsvakurudzi, uye oncologists vose vanobatana pamwe kuti vataure nezvekutsvakurudza kwakapfuura uyewo urongwa hwakawanda hwezvinhu zvine chokuita nekenza yemapapu. Kuti uwane mharaunda, shandisa hashtag "LCSM" iyo inomirira kenza yemapapu social media.
Kumbira uye kubvumira vadiwa vako neshamwari kuti vabatsire uye kukukurudzirai parwendo rwenyu. Usarasikirwa netarisiro-kunyange kana tariro iyoyo ichingova yakasununguka sezvinobvira iwe uchifarira kushamwaridzana neshamwari dzako.
> Sources:
> Antonia, S., Villegas, A., Daniel, D. et al. Durvalumab Mushure meKomoradiotherapy muGweta III Ndisina-Small-Cell Lung Cancer. The New England Journal of Medicine . 2017. 377: 1919-1929.
> Boffa, D., Fernandez, F., Kim, S. et al. Kukurukurwa Kutungamirirwa neMishonga Inonzi Clinical Stage IIIA-Clinical N2 Lung Cancer muThe Society of Thoracic Surgeons Database. Annals of Thoracic Surgery. 2017 May 17. (Epub mberi kwechinyorwa).
> National Cancer Institute. Non-Small Cell Lung Cancer Treatment (PDQ) - Health Professional Version. https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq.