Kana uri kurarama nekenza yemukenza wemapapu 4 wako oncologist angangodaro akakurukura chinangwa chemishonga yawakapiwa. Asi isu tiri kudzidza kuti izvo vanhu vangatarisira kubva kune dzimwe nzira dzechirapa zvakasiyana kubva pane izvo zveoncologist dziri kutarisira. Chii chiri chokwadi pamusoro pemakemikari uye remishonga inopisa mazai emusana wekenza yemapapu 4 uye ndeapi mamwe maonero asina kunaka?
Tariro neTariro Yenhema uye Prognosis
Kune tariro yakawanda kune avo vane chirwere chemukati wemapapu 4 kupfuura kare. Zvakakosha kucherechedza zvakananga mberi kwekuti kufungidzira kwevanhu vane chirwere chemukati wemapapu 4 kunovandudzwa; mishonga mitsva iri kuwanikwa, uye kuponeswa kwehuwandu kuri kuwedzera. Kune vanhu vakawanda vanoonekwa se "nguva refu" vanopukunyuka pamusana wekenza yemapapu 4, uye nhamba iyo iri kuwedzera gore negore.
Izvozvo zvakati, maitiro emutambo wepaneti yemapapu 4 haasi izvo zvatinoda, uye dzimwe mishonga haiti kushanda pamwe chete nezvatinoda kuti vaite. Mukukurukurirana pamusoro pemishonga iyi, pane hutano hwakanaka pakati pekuisa tariro uye kupa tariro yechema.
Tariro yenhema pamusoro pemishonga inogona kushandiswa inogona kutungamirira vanhu kuti vawane zvirwere zvinorema zvakanyanya maererano nehupenyu hwehupenyu . Tariro yenhema inogonawo kuchengetedza vanhu kuti vasaite zvisarudzo zvakasiyana siyana zvekurapa izvo zvingashanda zviri nani. Tariro yechokwadi, zvakasiyana, inosanganisira kutendeseka kuongorora kana kurapa kwakakosha, asi nzira iyo iwe unogona kunzwa uine simba mukuita zvisarudzo zvehupenyu hwako.
Zvinangwa zveVarapi vs Zvirwere zvevarwere
Kusvikira munguva pfupi yapfuura takafungidzira kuti vanachiremba nevarwere vakanga vari kuenzana kwakafanana apo zvakauya kune zvinotarisirwa pamusoro pemutambo wekenza yemapapu emapapu. Zvimwe zvidzidzo zvishomanana, zvisinei, zvakaputsa kuvhuvhuta uku, pamwe nekuremekedza zvakatarirwa zvine chokuita nekhemotherapy uye remishonga inonzi radiation.
(Targeted therapies, immunotherapy, uye rumwe rudzi rwehutachiona hwemishonga ndeimwe nyaya uye ichakurukurwa zvakare pasi apa.) Ngationei zvataidzidza.
Chemotherapy Results vs Matarisiro
Mune chidzidzo che2012, vatsvakurudzi vakaronga kuti vaone kana kutarisira kwevarwere uye oncologist kwaive pamwe chete maererano nezvetarisiro zvine chokuita nechikwereti chemakemikari yepamuti 4 yemapapu emapapu . Zvigumisiro zvekudzidza zvakanga zvichishungurudza.
Muzvikamu zvose, 69 muzana yematanda emakirini emapapu emakumbo (uye 81 muzana yechitambo 4 varwere vanorwara nekenza) havana kunzwisisa kuti chemotherapy yakanga isingamboiti kurapa kenza yavo. Mune mamwe mazwi, ruzhinji rwevanhu ava vane mutsa wemapapu vaitakura tariro yechema kuti chemotherapy inogona kuporesa chirwere chavo.
Chimwe chidzidzo chakaitwa muna 2015 chakasimbisa kuti kusiyana kwezviitiko izvi kwakaramba kuchienderera mberi, mune izvo zvikamu zviviri kubva kune zvitatu zvevarwere vane chirwere chemukati 4 mapapu kana kenza yemukironi vakanga vasinganzwisisi kuti chemotherapy yakanga isingamboiti kurapa kenza yavo.
Chemotherapy, iyo inoshandiswa kuvanhu vane chirwere chepaneti yemapapu 4 inogona kuwedzera kupona. Vanhu vanorapwa nemishonga iyi vanogara, paavhareji, vhiki shomanana kana mwedzi mishomanana kwenguva refu. Chemotherapy inogonawo kushandiswa sechirwere chinotapira, kuderedza zviratidzo zvakadai sekupererwa kwemhepo.
Asi chemotherapy inongowanzokonzera mushonga wemukenza wemapapu.
Radiation Therapy
Sezvakaita chemotherapy, zvinoratidzika kuti vanhu vazhinji vane maonero asina kunaka pamusoro pekubatsira kwemaawa ekurapa kwepaneti yemapapu 4 emapapu . Mune chidzidzo che2012, zvakawanikwa kuti 64 muzana yevanhu havana kuziva kuti kupisa kwemaawa kwakanga kusingagoni kuporesa kenza yavo.
Kushandiswa kwemishonga inonzi Radiation, sezvinonzi chemotherapy, inogona kuwedzera hupenyu, kana kubatsira nezviratidzo zvekenza, asi inongowanzoitika mukuguma kwenguva refu. Kusiyana nechemotherapy, zvisinei, kupisa kwezuva kunogona kubatsira zvikuru pakurapa kubuda ropa kana kuvhiringidzika kwemhepo nekuda kwekenza yemapapu, kana kurapa mafupa emasitema anogona kukonzera kurwadziwa kana kuputika.
Kune rumwe rudzi rwemishonga inonzi radiation iyo dzimwe nguva inoshandiswa netariro dzekugara kwenguva yakareba pakati pevaya vane chirwere chepamuti 4 yemapapu emapapu. Kana munhu ane imwechete kana kuti mashoma mashomanana kuuropi , somuenzaniso, stereotactic body radiotherapy (SBRT) inozivikanwawo seCyberKnife, dzimwe nguva yakaguma nekutonga kwenguva refu kwechirwere.
The Impact of False Hope
Zvave zvichikakavadzana pane dzimwe nguva kuti kuva netariro yenhema nekenza zviri nani kudarika tariro. Asi kana pavakabvunzwa, zvinoita sekuti vazhinji vevanhu vangasada kupiwa tariro yechema. Tariro yenhema inoramba vanhu mukana wekuita zvizere zvisarudzo zvavo kana kuva vatsigiri vavo pachavo mukutarisira kwavo. Pane zvikonzero zviviri zvinopesana nei tariro iyi yenhema ingakanganisa vanhu vanorarama nekenza yemapapu yakakura .
Chimwe chikonzero ndechokuti tariro yenhema inopa vanhu vanoda kuita zvose zvinobvira kuti vararame chirwere chavo kunyengera kuti izvi zvatoitika. Isu tine mishonga iye zvino kuwedzera chemotherapy, chirwere, uye remishonga inonzi radiation iyo inogona kupa tariro yakawanda kana mukana mukuru wekupona kune vamwe vanhu. Sezvo mamwe emishonga iyi mitsva ichangobva kugamuchirwa kana inongowanikwa mumakiriniki. Sezvo mamwe emishonga iyi mitsva ichangobva kugamuchirwa kana inongowanikwa mumakiriniki ekutambudza, kutakura tariro yechokwadi kuti chemotherapy inogona kuva mushonga inogona kudzivirira vanhu kubva pakutsvaga zvisarudzo zvinowanzosangana nezvinodiwa.
Chimwe chikonzero, zvisinei, ndechokuti munhu angapa kuzvirapa izvo zvinoderedza hupenyu hwavo hwekufunga kuti zvichawedzera huwandu kana izvo zvisingaiti. Nenzira iyi, tariro yenhema inoramba vanhu sarudzo yekusarudza zvakatendeka kuti vangada sei kupedza mazuva avo ekupedzisira.
Murwere / Chiremba Kutaurirana
Kutarisa kukanganisa pakati pezvinotarisirwa pakati pevarwere uye vanachiremba ungafunga kuti kukurukurirana kwaiva dambudziko. Pane kudaro, zvisinei, zvakaonekwa kuti varwere vati ivo vane hukama hwakanaka nevanachiremba vavo vainyanya kutakura tariro yemanyepo yokuti chemotherapy inogona kunge ichirapa. Kunyange zvazvo zvikonzero izvi zvisingazivikanwi, zvingadaro kuti oncologists vanotya kuti kugovana chokwadi nezve chemotherapy kunogona kubvisa tariro.
Targeted Therapies
Munhu wese ane chikwata chechina chekenza yemapapu chemapapu haafaniri kuva nehuwandu hwekuyera (kuongorora maitiro) imwe yemakumbo avo. Kune avo vane EGFR mutations , ALK rearrangements , ROS1 rearrangements , kana zvimwe zviitiko, zvakananga kurapwa kunogona kuita kuti kutarisana kwekenza yavo kupfuura izvo zvingatarisirwa ne chemotherapy.
Kunyange zvazvo kanzura inowanzova isinganzwisisiki nemishonga iyi munguva (inowanzokomberedza gore asi dzimwe nguva makore akawanda), imwe (yechipiri kana yechitatu yechizvarwa) mishonga inogona kunge yava yerudzo. Semuenzaniso, EGFR yakanaka yepamapu tumoror iyo inotungamirirwa kwenguva pfupi paTarceva (erlotinib) asi inoita kusagadzikana, inogona kuva nehanya nemutambo wechizvarwa chechitatu. Nenzira iyi, mutanho wemapapu, mapepa emapfupa emapfupa akasiyana-siyana, ari kuswedera pedyo nekurapa sechirwere chisingagumi: kwete kupora, asi kunodzora kwenguva yakawanda.
Immunotherapy
Muna 2015, maviri emishonga ekudzivirira immunotherapy akagamuchirwa kuitira kurapwa kwekenza yemapapu. Immunotherapy inoshanda nekushandisa mazano ezvirongwa zvedu zvekudzivirira zvirwere zvekenza. Kunyange zvazvo vanhu vakawanda vasingabvunzi pamishonga iyi, avo vanopindura vanogona dzimwe nguva kuwana nguva yakareba yekudzora kenza yavo. Mune mamwe mazwi, vanhu vanopindura mishonga iyi, yakadai seClétruda (pembrolizumab) kana Opdivo (nivolumab) vanogona kurarama kwenguva yakareba kudarika yavanenge vachitarisira kurarama kana vakarapwa nekemotherapy kana kuti remishonga inonzi radiation chete.
Kukurukurirana Nekuguma kweHupenyu Care
Kunze kwekugona kushandisa mushonga mutsva unogona kuva wakakosha kupfuura chemotherapy, takaona kuti chemotherapy kana remishonga inonzi radiation-kana mumwe munhu ari kushandisa marapa aya achitarisira kuti angaporesa mapfupa avo epamusoro-mapfupa-anogona kuderedza mukana wekutaurirana nekuvimbika avo oncologist pamusoro pekuguma-kwe--upenyu-nyaya.
Tirikudzidzira kuti kuchengetedza kwepamusoro (kunyatsotarisa kunogona kushandiswa kunyange kana mumwe munhu anotarisirwa kuporeswa) kwete chete kunowedzera hupenyu hwevanhu vane kenza yemapapu yakakura, asi inogona kuwedzera kupona. Kuchengetwa kwekuchengetedza maitiro kune imwe nzira yekuchengetedza, uye zvinosuruvarisa, vanhu vakawanda vanosarudza kutarisira izvi chete munguva pfupi iri muchirwere chavo uye vanoda kuti vainge vamboita kare nekuda kwekutsigirwa kunouya nechisarudzo ichi.
Kunobva:
Chen, A., Cronin, A., Mavhiki, J. et al. Zvatinotarisira nezvekubudirira kweRadioation Therapy pakati pevarwere vanoremekedzwa neLung Cancer. Nyaya yeCliniki Oncology . 2013. 31 (21): 2730-5.
Mack, J., Walling, A., Dy, S. et al. Mwoyo Murefu iyo Chemotherapy inogona kuve yakarongedza uye Kuchengetwa Inogamuchirwa Pakuguma kweUpenyu pakati pevarwere vane Mastasty Mungu uye Colorectal Cancer. Cancer . 2015. 121 (11): 1891-7.
Mavhiki, J., Catalano, P., Cronin, A. uye al. Varwere 'Vanotarisira nezve Migumisiro yeKemotherapy yeAkancer Cancer. The New England Journal of Medicine . 2012. 367: 1616-1625.