Ko mutanho wemapapu muvanhu vakwegura vakuru vanorapwa uye chii chinonzi chirevo chakaipa kupfuura chevaduku? Pane imwe nguva here kana mumwe munhu akwegura zvekuvhiya kana chemotherapy? Munzira dzipi mutsa wemapapu wakasiyana kune vakwegura, somuenzaniso, avo vanopfuura makore makumi masere?
Chirwere chechirwere muVakuru Vakuru
Imwe yenhema yemapapu emapapu ndeyekuti vakuru vakwegura havakwanisi kusarudzwa nekenza yemapapu emapapu izvo vechidiki vane kenza yemapapu vane.
Ikoko kunoratidzika kunge kune pfungwa yakawanda yokuti vakuru vakwegura havakwanise kuregerera migumisiro yechirwere chekurapa, kana kuti kurapwa kunofanirwa kunge "kunoderedzwa pasi."
Ndezvipi zvidzidzo zvinotiudza? Pashure pezvose, tiri kunzwa kuti 50 ndiyo itsva 30, uye 70 ndiyo itsva 50.
Icho hachisi tsanangudzo chaiyo yezera ripi rinoreva "vakwegura" kana kuti "vakwegura" varwere vane kenza yemapapu, asi zvidzidzo zvakawanda zvinoita kuti zvishandise kugurwa kwemakore makumi manomwe. Kana iwe ukaitika uri muboka remakore aya, ndapota verenga on. Tiri kuwana kuti nguva yezvakaitika nguva isiri yakakosha kudarika zvimwe zvikonzero mukugadzirisa mhinduro uye kukwanisa kutsungirira kurapwa. Iyo inguvawo nguva inofadza zvikuru, sezvakawanda zvekurapa kunokonzera kugadziriswa kuri kubvumirwa kwekurapwa kwekenza yemapapu, pamwe chete nevaya vari kuedzwa mumakiriniki ekuedza, zvinowanzo nyore nyore kushivirira kupfuura tsika dzekemikirini.
Dzimwe dzidzo dzinoshandisa izwi rokuti "varwere vakwegura" kutsanangura avo vanopfuura makore makumi masere.
Kunyangwe mune zvidzidzo zvinoshandisa zera iri panzvimbo yezera rinowanzofananidza makore 70 kurondedzera "vakwegura" unogona kushamisika kuziva kuti vazhinji vevanhu ava vanogona sei kutsungirira kurapwa kwekenza yemapapu.
Ndezvipi Zvakafanana Nechirwere Chekenza muVakuru Vakuru?
Parizvino, nguva inopfuura 40 kubva muzana yevanhu vanorwara nekenza yemapapu vane makore makumi manomwe kana kupfuura.
Matambudziko Nokushandisa Nguva Yezvakaitika Pakusarudza Zvokurapa
Kune matambudziko maviri ekutanga kuburikidza nekushandisa nguva yezvakaitika pakuongorora mishonga yekenza yemapapu. Kutanga kubva, zvakawanikwa kuti zera roga haritauri zvakawanda pamusoro pekuti mumwe munhu achabvumira sei kurapwa uku. Chimiro chekuita , chiyero che "hukama hwakanaka" uyewo pane urombo mukufungidzira kuti munhu achaita sei zvakanaka. Vanachiremba vari kutarisa kune dzimwe nzira yekutsanangurira kuti munhu achabvumira sei kurapwa, zvakadai sezvenhepfenyuro yegeriatric assessment (CGA). Zvishandiso izvi zvinotarisa zvirwere zvehutano kuitira kufanotaura kubvumira kurapwa uye kupona uye kunosanganisira:
- Nutritional status
- Kuvapo kweimwe zvirwere
- Chiitiko chepamusoro
- Basa rekugara kwezuva nezuva (ADL's)
- Social support
- Mhuka yakasikwa
Imwe dambudziko rekutarisa nguva yezviitiko ndeyekuti isu hatizivi izvo zvakawanda. Zvizhinji zvinodhaka uye mishonga zvakadzidzwa mumakiriniki ekuedzwa kwevaduku vaduku.
Zera Rinogona Kuita Sei Kuchengetedzwa Kwekenza Kurapa
Zvakakosha kutanga kutarisa kuti zera harisi kuderedza zvigaro zvekurapa, asi kurapwa kunogona kusakanganisika kune vamwe vakwegura. Iyo kubvumirana kwekare kunoratidzika zvakare kuti iyo yezera iri yoga haifaniri kutaurira kuti zvipi zvirwere zvinogona kana kuti hazvigone kushandiswa pamukenza wemapapu.
Izvozvo zvakati, pane zvikonzero zvakasiyana siyana nei vamwe vakwegura vakwegura vasingagoni kubvumira kurapa pamwe nevarwere vaduku.
- Vakuru vakura vanowanzova nehuwandu hwehutano hwehutano huripo (co-morbidities) kupfuura vaduku vaduku. Nhoroondo yezvirwere zvepfungwa, somuenzaniso, inogona kuderedza kushandiswa kwemamwe chemotherapy mishonga. Saizvozvowo, mamiriro ezvinhu anoita kuti mapapu ashande, zvakadai se emphysema, anogona kuita chirwere chemapapu emapapu zvishoma zvakakwana.
- Vakwegura vanowanzove vakaderera zvepfungwa kana chiropa basa, uye mishonga yakawanda inoshandiswa kurapa kenza inonatswa kuburikidza neitsvo kana chiropa.
- Varwere vakwegura vanowanzova nemuviri mashoma mashoma, zvichiita kuti vasapindire kuregererwa kwemaviri nemamwe marapirwo, uyezve vari pangozi ye cachexia .
- Vakuru vakwegura vanowanzova nechepfupa remakore, kuchengetedza njodzi yezvinetso zvine chokuita nekuneta marora kuderedza chemotherapy .
Kufanotaura Kwenguva Ipi Ichaita Kurapa
Vakuru vakwegura vari panjodzi yekudzivirirwa pamusana pekutya pamusoro pekuregererwa kwemazera ane makore, uye chepfu inokonzerwa nekurapa. Zvinokosha pakusarudza kurapwa kuchengetedza zvinhu zviviri mupfungwa: funga zvakaguma, uye funga zvaunotarisira semurwere.
Mishonga muVakuru Vakuru
Kutarisa nzira dzokurapa, chikamu chino chichapedza matanho emumapapu emapapu mumusana wemapapu epakutanga, kenza yemapapu yemunzvimbo ino, uye chirwere chechina (metastatic) yemukenza yemapapu . Kunyange zvazvo zvisingawanzo vanhu vane kenza yemukiramu yemapapu vaduku vachida kurapwa, chemotherapy inowanzotanga kurapwa.
Pakave nemafungiro akawanda pakati pevamwe vanhu kuti vanhu vanopfuura kwezera rimwe havadi kutsvaka utsinye, uye vangadai vane "kutsigira" chete, asi izvi hazviiti sezviri. Apo pavakabvunzwa nezvekuvhiyiwa mune imwe chidzidzo, 50 muzana yevakwegura vakwegura vakaisa chinonyanya kukosha pane kupona kupfuura pane kuponeswa kwechiratidzo.
Mavambo Ekutanga Lung Cancer muVakuru Vakuru
- Kucherechedza Kutsungirira Nokupukunyuka - Kunyange apo panoita seine manzwiro pakati pevanhu kuti kuvhiyiwa kwemukenza wemapapu kungava nengozi kuvarwere vakwegura, zvidzidzo hazvibatsiri izvi. Muzvokwadi, hapasi kurarama kusingapfuuri kwepakati pakati pevarwere vakwegura nevarwere vaduku vanovhiyiwa kwekenza isiri duku yemapapu emapapu. Pamusoro peizvi, mazinga epamusoro ekuvhiya anokonzerwa nemazinga akakwirira ekupona kwevatana vakwegura vane kenza yemapapu ekutanga.
- Mhando dzeLung Cancer Surgery - Nepo kune inoratidzika kuva kubatsirwa kwevarwere vakwegura vanovhiyiwa kwekenza yemapapu epakutanga, kwete marudzi ose ekuvhiyiwa kwekenza yemapapu ndeyechete . Zvidzidzo zvinotarisa wedge resection kana lobectomy semishonga zvakawana kuti vakawanda vakwegura vanogona kubvumira kurapwa zvakanaka. Zvimwe zvidzidzo zvakawana kufa kwepamusoro kwevanhu vakuru vakagamuchira pneumonectomy (kubviswa kwemapapu ose,) kunyange zvazvo zvakakosha kutaura kuti zvidzidzo izvi zvinopa nhamba, uye mune dzimwe nguva, chiremba anokwanisa kufunga nezvekukwegura ichabatsirwa nemutemo uyu. VATS (mavhidhiyo-anobatsira chirwere chetachiracoscopic) inzira inopedzisira isingaiti yekubvisa chirebe kana chikamu cherube uye inogona kuva sarudzo yakanaka muvarwere vakasarudzwa (iyi nzira haisi nguva dzose inogona kuitika.Ukudzidza 2018 zvakare kwakatsigira kuti vanhu vakuru (pamusoro pe ava nemakore makumi masere nemakumi matatu) vanowanzomirira kuvhiyiwa kwemamapu emapapu uyewo vaduku vaduku, asi vakawana kuti segmentectomies (wedge resection) yakabatana nemigumisiro yakanaka.
- SBRT / Radiofrequency Ablation - Kune vanhu vane kenza yemapapu yekutanga iyo isingagoneki kana kana mumwe munhu asingadi kubuda kuburikidza nekuvhiyiwa, dzimwe nguva stereotactic body radiotherapy (SBRT) kana kuti raftrequency ablation ingashandiswa kuedza nekurapa kenza yemapapu. Kupona kwevanhu vakuru vakwegura neSBRT kune zvishoma kudarika nekuvhiyiwa asi zviri nani pane zvaizove nekusimbisa kutarisira chete. Radiation pneumonitis (kuputira kwemapapu anokonzerwa nemirasiyo) inowanzoonekwa nevarwere vakwegura vane chirongwa ichi asi kazhinji vanochirapa.
- Kuvandudza Pulmonary - Kuvandudzwa kwepulmonary mushure mekunge kana mushure mekuvhiyiwa kwekenza yemapapu kunogona kubatsira kune vanhu vezera rose, asi zvikurukuru kune vakwegura.
Locally Advanced Lung Cancer muVakuru Vakwegura
Zera rega harisi kupindirana (kurega kusaita) nekubviswa kwekenza yemapapu (resection) uye adjuvant chemotherapy (chemotherapy yakagadzirirwa kubvisa muviri we micrometastases-kenza yemasera inogona kuvapo asi ishoma kuduku kuonekwa pamifananidzo yekufungidzira .) Kuvatana vakwegura vane chirongwa chekutanga , chigamba chechipiri , uye chirwere chechitatu 3A kenza yemapapu , chirwere chinogona kufungidzirwa (ona pamusoro pekutanga muchengeti wemapapu emapapu maererano nekuvhiyiwa).
Kunze kwekuvhiyiwa, adjuvant chemotherapy inowanzokurudzirwa kune vanhu vane kenza yemapapu inowanikwa munzvimbo ino. Pane huwandu hunoratidza kuti adjuvant chemotherapy yechando chechikamu chechipiri kana chetatu 3A kenza yemapapu inogona kuwedzera kuponesa mukunyatsosarudzwa vakwegura. Zvidzidzo, zvisinei, hazvina kuwana kuti post-operative mazai ezuva ane zvakakosha muboka iri. (Zvakare, zvakakosha kutaura kuti izvi ndezvenhamba, uye pangave nezvikonzero zvakanaka chiremba angakurudzira kurapwa kwemazuva.)
Yakafambira mberi kana yeMetastatic (Mutsara wechina) Chirwere chemuviri muVakuru Vakuru
Sezvo chikwata chemukenza wemapapu wemapapu nechinangwa chapararira kupfuura mapapu, chirwere hachiwanzokurudzirwa.
Kune vanhu vane mapapu adenocarcinoma , uye vanhu vasina kumbobvira vatsva nemhando ipi zvayo yemukenza wemapapu, kufungidzirwa kwema molecular (maitiro ekuberekwa kwemajini) kutsvaga kurapwa kwemajini kunokosha zvikuru. Kune vanhu vane mutsauko weEGFR, rearrangement yeAlk ( kenza yemapapu emuAlk-positive ) kana kuti rearrangement yeROS1 , zvinotarisirwa kunogona kuwedzera kukura-kusununguka-kusununguka, nemigumisiro yemishonga iyi inowanzova yakaoma uye inopfuvura pane tsika dzechigadzirwa chemhemotherapy.
Chemotherapy inowanzotangira mushonga wekurapa kwepaneti yekenza yemapapu 4, uye nevarwere vaduku, kusanganiswa kwemaviri chemotherapy mishonga kunowanzokurudzirwa. Vakawanda varwere vakwegura havasi kurapwa nekemotherapy, asi kune hupenyu hwakanaka hunobatsira kune avo vanogona kushivirira migumisiro yemigumisiro. Mukuwedzera, kushandisa mishonga yemishonga mbiri kunogona kukonzera kukura kwakanyanya kune kushandiswa kwechimwe chemotherapy mishonga chete.
Immunotherapy
Yokutanga immunotherapy mishonga yemukenza yemapapu yakagamuchirwa muna 2015 uye vamwe vari kuongororwa mumakiriniki emirwere Immunotherapy mishonga inogona kufungidzirwa kusinganzwisisiki semishonga inodzorera uye inoita kuti simba redu rekudzivirira zvirwere rekudzivirira kenza riite. Iyi mishonga haishande kune munhu wose ane kenza yemapapu, tora nguva yekutanga kushanda, asi kana ichishanda, dzimwe nguva inogona kuguma nekugadzirisa kwenguva refu yepamusoro pekenza yemaperembudzi. Vanowanzoremeswa nyore nyore kuti mishonga yemakemikrasi pamwe chete.
Kana Uri Mukwegura Mukuru Aine Chirwere Chemuviri
Kana iwe uri pamusoro pemakore makumi manomwe kana makumi matatu nemukenza wemapapu, gara uchiyeuka kuti makore "iwe" unoita "uye" kunzwa "zvichida zvakanyanya kukosha kupfuura makore aunozadza marenda ako ezvehutano. Panguva imwe chete, vashandi vezvokurapa vasina kukuziva iwe uye iwe unoziva iwe pachako ungatarisa makore akanyorwa pane chati yako seinokosha zvikuru. Ndizvo zvose zvavanofanira kushanda nazvo.
Izvi zvinorevei, kunyanya pakati pezvinyorwa zvinowanzoitwa zvekare kuti vanhu vakwegura havagoni kutsungirira mimwe migumisiro yechirwere, ndeyekuti unofanira kukudziridza ukama hwakanaka hwekushanda nachiremba wako. Iva nechokwadi kuti anoziva kuti iwe unogona kuva nemakore makumi mashanu nemashanu asi unonzwa zvakafanana newe uri makumi manomwe. Tinofara kuti tiri kurarama panguva iyo kurapa kwekenza kwava kunyanya kufanana nevamwe, uye kusiyana pakati pevarwere kuri kukudzwa. Izvozvo zvakati, kutora nguva yekudzidza kuve iwe mumutevereri wako mukuchengetwa kwekenza kuchakubatsira iwe kutarisana nematambudziko ekurarama nekenza uye kurapwa kwekenza zviri nani, asi zvinogona kutotora chikamu mumigumisiro yako.
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