Mishonga uye Mafungiro Evanhu Kana Chirwere Chechirwere Chichipararira
Bone metastases kubva mumukenza wemapapu (kupararira kwemapapu emapapu kumapfupa) zvinowanzobatwa nekenza yemapapu, zvinokonzera 30 kusvika ku40 muzana yevanhu vane kenza yemapapu yakakura . Ichokwadi, sezvo kuponeswa kwemukenza wemapapu kuri kuwedzera, nhamba yevanhu vanogara nemasitosita emapfupa ari kuwedzerawo.
Mukuwedzera pakukonzera kurwadziwa kwakanyanya uye kusagadzikana, magetsi emasasa anogona kuguma nekuputsika kunovhiringidza mabasa ezuva nezuva nekuderedza hupenyu hwako.
Ndezvipi zviratidzo, kurapwa, uye kufungidzira kwemukenza wemapapu nemasitase emapfupa?
Overview
Kenza yemaperembudzi nemasitoshe emapfupa inoreva mishonga yemukenza yemapapu inopararira kune pfupa kuburikidza neropa kana kuti kuburikidza neLymphatics (midziyo inotakura masero ekurwisa zvirwere mumuviri). Cancer metastatic kusvika pfupa yakasiyana nekenza yemapfupa- makumbo anobva mumapfupa uye anoumbwa nemasero mashoma emasopa. Cancer metastatic kusvika pfupa yakaumbwa nemasero anotangira mukenza yepamusoro -mune iyi mamiriro, mapapu. Kana izvi zvichivhiringidza, unogona kudzidza zvakawanda pamusoro pekuti kanaya inopararira sei mumuviri .
Ndezvipi Zvisingaiti Zvinokonzera Kanzira Inopararira?
Kanza yemaperembudzi ndiyo chechitatu chinowanzosiyana nekenza yekupararira kumapfupa (mushure mekenza yepamu nekenza yeprotate), uye kana masitasita kusvika pfupa awanikwa pasina pachena, imwe hafu yenguva iyo inowirirana nekamupamu wekenza yemapapu. Mapfupa akawandisa kune mamwe mapepa emapapu anopararira anosanganisira:
- Iyo musana (kunyanya vertebrae mubhokisi uye pasi pemadzimai epamuviri)
- The pelvis
- Mafupa ekumusoro emakumbo netsoka (the humerus and femur)
Kanza yemaperembudzi yakasiyanawo neimwe yekuti inogona kupararira kumafupa mumaoko netsoka.
Zviratidzo
Marwadzo kazhinji chiratidzo chekutanga chemupapu wemapapu nemasitasti emapfupa.
Kutambudzika kunogona kutanga kunzwa sechisimba chinokwevera kana chinetso, asi zvishoma nezvishoma chinopera uye chinogona kuva chakanyanya. Apo pfupa metastases inosanganisira maoko nemakumbo, kurwadziwa kunowanzoipisisa nekufamba. Marwadzo anokonzerwa nokupararira kwemukenza wemapapu kumusana inowanzoipisisa usiku uye pashure pokuzorora pamubhedha.
Kana mapfupa emapfupa anosanganisira mutsara, kukanganiswa kwemutsipa wepelinha nokuda kwechirwere kunogona kukonzera marwadzo nekufamba uye kushaya simba kana kumira mumakumbo. Kana chirwere chepempa chinokonzera chakakomba mumucheto wepasi (cauda equina syndrome), kurwadziwa uye kushaya simba mumakumbo zvinogona kuitika pamwe nekurasikirwa kwemuviri kana chirwere chebasa. Ichi ndicho chirwere chekurapa, uye zviratidzo zvinogona kuva zvekusingaperi pasina kurapwa nokukurumidza.
Dzimwe nguva chiratidzo chekutanga chekenza yemapapu chakapararira kumapfupa chirwere (kuputika kwechirwere ) Mukugadzirisa uku, masero ekenza anotsiva hutachiona hwemapfupa ehutachiona, achiwonesa saka zvinowanzoputsa. Izvi zvinoputika zvinogona kuitika pasina chero chinhu chinokonzera kushungurudzika (kunyange kutenderera pamubhedha) uye panguva yezvinoitwa zvezuva nezuva.
Nemhaka yekuparara kwemapfupa, iyo inosunungura calcium, imwe yakakwirira ye calcium muropa (hypercalcemia) inogona kukonzera kuvhiringidzika, kushungurudza uye kunatswa, nyota, uye kushaya simba kwemisimba.
Matambudziko
Sezvakataurwa pamusoro apa, zvirwere zvepfupa zvinogona kukonzera mhando dzakawanda dzezviratidzo, dzakawanda dzinoderedza hupenyu hwevanhu vanorarama nekenza yemapapu.
- Marwadzo - Urombo hwakabatana nemapfupa emasasa anogona kunge akaoma, kuora mwoyo hupenyu hwehupenyu. Mukuwedzera, mishonga yekurapa marwadzo inogona kuita kuti uwedzere kuneta, pamwe nekuvhara.
- Mitsetse - Fractures ndeyechokwadi, inowanzorwadza, asi inoderedza hupenyu hwehupenyu zvakare. Yakabatana nekenza, yakaderera kufamba nekuda kwekuparara kunowedzera mukana wekudzidzira ropa clots uye pulmonary emboli .
- Mutsara Wemakumbo Kuomesa - Mukuwedzera pakukonzera zviratidzo, musana wechipfupa kushandiswa chirwere chinotyisa chinogona kukonzera kuora mwoyo uye kurasikirwa kwemuviri uye chekuita.
- Hypercalcemia - Mukuwedzera pakukonzera zviratidzo zviri pamusoro, hypercalcemia mune vanorwara nekenza ndeyekukurumidzira, uye kunogona kukonzera kusagadzikana kwemoyo mafungiro, kuora mwoyo, uye kunyange rufu. Zviratidzo zve hypercalcemia zvinogona kusanganisira kunyorera uye kurutsira, nyota yakawedzera, kuderera kunyura, musimba uye pamwe chete, kushaya simba, uye kuvhiringidzika.
- Mamwe majekiseni, Kuvhiya, uye Mishonga - Kana kurapwa kwemaawa, kurapwa kana mishonga inoshandiswa kurapa zvinetso zvemasitashu emapfupa, migumisiro yechipatara ichi inowedzerwa nemigumisiro yemishonga inoshandiswa pakurapa kenza pakutanga.
- Kusina Kurapa - Chimwe chinetso chisingawanzokosheswa, ndechekuti masasita emapfupa anganganisa kune dzimwe mishonga zvekenza. Nenzira iyi, skeletal zviitiko zvakakanganisika (zvakadai sezviputsi) zvinogona kuva chikamu chepakati inotyisa iyo kenza inokonzera dambudziko (somuenzaniso kuputsika) iyo inogonawo kuita chimwe chinhu chinogona kugadzirisa kushandiswa kwemishonga nekuvhiya kurapa kenza.
Kuziva
Miedzo inoshandiswa kutarisa mapfupa emasitini inogona kusanganisira:
- Bhana rinotarisa : Mafupa emapfupa anoshandiswa kashoma kuti aongorore mapfupa emasitema kupfuura kare, uye dzimwe nguva zvingava zvakaoma kusiyanisa kenza kune mamwe mapfupa.
- PET inoongorora : PET inoongorora inonyanya kunzwisisika pakuona mafupa emasitema , sezvavanotarisa nzvimbo dzekushanda kwemarara mumapfupa.
- MRI inoongorora
- CT inoongorora
Kurapa
Kurapa kwemapapu emapapu nematasisita emapfupa kunonyanya kupisa -kureva, zvinoreva kurega zviratidzo, asi kwete kurapa kenza. Chinangwa chikuru chekurapa ndechokuderedza marwadzo anokonzerwa nemasitosita uye kubata kana kudzivirira kuputika uye zvimwe zvinetso. Izvozvo zvakati, kune vanhu vane masastases mashomanene (chimwe chinhu chinonzi oligometastatic), vanachiremba vanogona kutarisa kurapa zviratidzo zvakashata netariro yekugara kwenguva refu (ona pasi apa).
Kurapa kwemafupa emasitasase zvakanyorwa pasi apa. Chinonyanya kukosha kuchengeta mupfungwa, zvisinei, ndechokuti chinangwa chekurapa chinofanira kunge chiri kubvisa marwadzo chero ipi zvayo kana kusagadzikana kwako. Zvidzidzo zvinotitaurira kuti rubatsiro rwakanaka rwekurwadziwa runokwanisika. Izvozvo zvakati, zvinhu zvishoma zvinogona kuita kuti izvi zviitike. Zvakakosha kune vanhu vane kenza kuti vaone kuti marwadzo ekurwadziwa, kana anoshandiswa seanorayirwa, haasati aita kuti uite zvinodhaka, uye iwe haugone kuderedza mukana wako wekurwadziwa mune ramangwana kana ukashandisa mishonga inorwadza iye zvino. Zvakakoshawo kuva iwe mumutevereri wako mukuchengetedzwa kwekenza uye kubvumira chiremba wako kuziva kana une marwadzo anokanganisa mararamiro ako ehupenyu.
Zvisarudzo zvekurapa zvinosanganisira zvose systemic (mumuviri wose) uye munharaunda (kutarisana nemasitasase emapfupa ndoga) machira. Ngatitarisei pane chimwe nechimwe chezvizvi zvakasiyana.
Systemic Treatment Options
Mishonga yakawanda yemukenza wemapapu emapapu, yakadai semakemikrapiro, anotarisirwa kurapwa, uye immunotherapy, inogona kuderedza mapfupa emapfupa. Yokutanga immunotherapy mishonga yemukenza wemapapu yakagamuchirwa muna 2015, uye iye zvino mishonga yakadai yakadai inowanikwa pamukenza wemapapu. Sekutsvaga kwakanaka, chidzidzo che 2018 chakawana kuti kuvapo kwefupa metastases kwaiva chirevo chekuzvimiririra icho Opdivo (nivolumab) inogona kunge yakakwanisa kenza.
Local Treatment Options
Pane hutano hwakawanda huripo hwekurapa masasisita emapfupa kuwedzera kune chero kurapwa kwauri kuitika kune kenza yako pachako. Aya maitiro anogona kushandiswa ari oga kana akabatanidzwa zvichienderana nekuoma kwemarwadzo ako uye zvinetso zvinogona kuitika. Zvimwe zvinosanganisira:
Mishonga yemarwadzo - Mishonga yose inopesana nekuvhiringidza uye narcotics, yakadai se morphine, inogona kushandiswa kudzora marwadzo kubva kumapfupa emapfupa. Apa pane mamwe mashoko pamusoro pekutarisira kurwadziwa kwekenza.
Radiation Therapy - Radiation ndiyo inoshandiswa kurapwa inoshandiswa kuderedza marwadzo, kudzivirira kuputika, uye kubvisa musana wechipinha kubva kumapfupa emapfupa. Vanhu vakawanda vanowana rubatsiro rwakanyanya rwehutachiona hwemishonga, uye kuvanhu vakawanda, miviri inogona kugadzirisa marwadzo avo zvachose.
Kuvhiya - Chirwere chinoshandiswa zvikuru kuti chigadzikane mapfupa kana zvikaputsika, kana kuti kudzivirira kuputsika mune pfupa rakaoma zvikuru nekenza (inopera kuputsika). Kuvhiya dzimwe nguva kunogona kushandiswa kana bundu iri riri kukonzera kuoma kukuru pamutsipa wepelinha, zvakadai ne cauda equina syndrome.
Tora inobata kurapwa kana kurapa -kuchinja- kurapa - Unogona kunzwa chiremba wako achitaura nezvefupa-kuchinja kurapwa . Aya maitirwo anosanganisira zvose kushandiswa kwe bisphosphates (inokurukurwa inotevera) uye kushandiswa kwe denosumab).
Bisphosphonates - Bisphosphonates mishonga yakashandiswa kurapa osteoporosis (masapfupa mashoma), asi inogonawo kubatsira kudzivirira kuputsika kwefupa kuvanhu vane mafupa metastases nemhaka yekenza. Mishonga inoshandiswa kuvanhu vane mutsa wemapapu inosanganisira Zometa (zoledronic acid) uye Prolia (denosumab.)
Iyi mishonga inonyatsochengeteka, muzviitiko zvisingashamisi inogona kukonzera chinetso chinonzi osteonecrosis chejaya (kuputsika kwefupa mumusere) uye kuora kwepvo. Inogona kushandiswa mushure mekunyanyisa kwemafupa emapfupa akaitika, kana kuti kudzivirira zvinetso pakutanga. Zometa naPralia vane rimwezve ruzivo rwekuva neanticancer properties. Zometa Zvose uye Prolia zvinopiwa semishonga inoratidzira (IV) masvondo matatu kusvika mana kune Zometa, kana masvondo maviri kusvika mana neProlia.
Denosumab - Denosumab munhu anopesana nevanhu akashandiswa pamwe nekubudirira kwevanhu vane mazamu uye maitiro eukenza akapararira kumapfupa. Kusvika ikozvino inofungidzirwa kuti inogona kuderedza zvinetso, zvakadai sezviputsi, zvine chokuita nekenza yemapapu yakapararira kumapfupa. Inofungidzirwawo kuti inogona kuva nemigumisiro kune kenza pachayo sezvo inorwisa-tumarara zvinhu. Denosumab inopiwa sejasi re subcuticular (iri pasi peganda) mavhiki mana.
Radionuclide Treatment - Radionuclide kurapwa inzira yekurapa masasisita emapfupa ayo akamboshandiswa kunyanya kweprostate uye nekenza yemazamu. Kuongororwa kwemuedzo mashomanana akaitwa kusvikira nhasi wakawana kuti kurapwa uku kwakaguma mukururwa kunorwadza kwe75 muzana yevanhu vane chirwere chemapapu kutanga kwevhiki imwe kusvika kune mashanu shure kwekurapwa nekugara kusvika kumwedzi mitanhatu. Zvinotarisirwa kuti zvidzidzo zvakakura zvichaongorora kushandiswa kweiyo nzira munguva yemberi iri mberi.
Mishonga yemakiriniki - Clinical trials inoramba ichitarisa nzira dzakanakisisa dzokurapa masastases emasasa nekuda kwekenza.
Zvimwe Mishonga Inorapwa - Vanotsvakurudza vari kutarisa nzira dzinobatanidza dzekurapa marwadzo emapfupa nekuda kwekenza yemastastas, uye kugadzirisa muviri kunogona kuita chivimbiso pachinoshandiswa mukuwedzera kune dzimwe mishonga.
Kurapa Kwevamwe Voga uye Oligometastases
Sezvakataurwa pamusoro apa, muzviitiko zvisingashamisi kune vanhu vane imwechete kana mashoma masastases mapfupa kubva kune chirwere chemapapu, stereotactic rayation therapy ( SBRT ) inogona kufungwa. Kusvika ikozvino izvi zvakaitwa zvikurukuru kune vanhu vane maitiro mashoma kana mashoma kuuropi kana chiropa.
Prognosis
Kupona kwemuviri -kureva, nguva yakatevera iyo 50 muzana yevanhu vapenyu uye 50 muzana yakapfuura-inosuruvarisa pasi pemwedzi mitanhatu kune vanhu vane mafupa emasitema kubva mukenza yemapapu. Kupona kwakanyanya kune vakadzi , avo vane adenocarcinoma , vanhu vane imwe chete yemasitasis bone, uye vanhu vasina zviputsi. Izvozvo zvakati, vamwe vanhu vakapona uye vakaita zvakanaka kwemakore mazhinji mushure mekuongororwa kwekenza yemapapu nematasisita emapfupa.
Shoko Rinobva Pfupa Matetasifesi Kubva muLung Cancer
Kudzidza kuti une mapfupa emasitema kubva mumukenza wemapapu unoshungurudza. Icho chinoreva kuti kenza yako isero 4 (metastatic) uye haichagone kurapwa. Mukuwedzera, bone metastases inogona kurwadza uye inokanganisa kukwanisa kwako kuenderera mberi. Izvozvo zvakati, kurapwa kuri kuwedzera. Kurapa kwekenza yemasitraine, yakadai sedhemotherapy, inotarisirwa kurapwa, uye immunotherapy inogona kubatsira nemapfupa emasitema zvakare. Mukuwedzera, mapfupa emapfupa anokwanisa kurapwa munharaunda nemasarudzo akadai se bone-modifying drugs (izvo zvinogona kunge zvinopesana nekenza zvinokonzera) uye remishonga inonzi radiation. Kunyange zvazvo kufungidzira kwakashata zvakakwana, vamwe vanhu vakagara makore mazhinji nemapfupa emapfupa emukenza wemapapu.
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