Chikamu II Chirwere Chechirwere - Tsanangudzo, Zvirwere, uye Zvirwere
Chikamu chechipiri chisiri chediki chekenza yemapapu yemapapu chinorondedzerwa se " kenza yemunharaunda ," ndiko kuti, iyo inoreva chiremara chiripo mumapapu uye chingave chakapararira kune lymph node dzomunharaunda, asi haina kupararira mberi. Mishonga yakapararira mberi kwezvinhu izvi inonzi "yepamusoro yekenza." Inenge 30 muzana yemakondomu emapapu inowanikwa kana iri pachitsauko 1 kana 2, uye kusarudzwa (kwenguva yakareba mugumisiro) kunonyanya kuve nani pane zvikamu zvekare zvechirwere.
Izvo zvakagadziriswa sei kuti mupenza wemapapu uri danho repiri (danho repiri), uye kuti chirwere ichi chekenza yemapapu chinorapwa sei?
Overview
Kusarudza danho remukenza wemapapu zvakakosha mukusarudza kurapa kwakakodzera.
Chikamu II chakakamurwa kuva zvikamu IIA neIIB. Chikamu IIA neIIB chimwe nechimwe chakaparadzaniswa kuva zvikamu zviviri zvichienderana nekukura kwechirwere, apo chiremera chinowanikwa, uye kana kune kenza mumakirini.
Stage IIA
(1) Kanzera yakapararira kune lymph nodes kune rumwe rutivi rwechipfuva sechirwere. I-lymph nodes nekenza iri mukati memapapu kana pedyo ne- bronchus , uye chimwe kana zvinotevera zvinotevera ndezvechokwadi:
- Dumbu racho harina kukura kupfuura masentimita mashanu.
- Kanzira yakapararira kune yakakura bronchus uye inenge 2 cm masikati pasi apa apo trachea inosangana ne bronchus.
- Kanzira yakapararira kune mukati-kati memakumbo akavhara mapapu.
- Chikamu chemapapu chakanyura kana kuti chakatanga pneumonitis (kuputika kwemapapu) munharaunda iyo trachea inosangana ne bronchus asi haina kusanganisira mapapu.
kana
(2) Kanzera haina kupararira kune lymph nodes uye chimwe kana zvimwe zvinotevera ndezvechokwadi:
- Dumbu racho rakakura kudarika masendimita mashanu asi harina kupfuura masentimita manomwe.
- Kanzira yakapararira kune yakakura bronchus uye inenge 2 cm masikati pasi apa apo trachea inosangana ne bronchus.
- Kanzira yakapararira kune mukati-kati memakumbo akavhara mapapu.
- Chikamu chemapapu chakanyura kana kuti chakatanga pneumonitis (kuputika kwemapapu) munharaunda iyo trachea inosangana ne bronchus asi haina kusanganisira mapapu ose; and
Nhanho IIB
(1) Kanzera yakapararira kune lymph nodes iri pedyo nechechi chimwe chebhokisi sechiremera. I-lymph nodes nekenza iri mumapapu kana pedyo ne-bronchus. Uyezve, chimwe kana zvimwe zvinotevera ndezvechokwadi:
- Dumbu racho rakakura kudarika masendimita mashanu asi harina kupfuura masentimita manomwe.
- Kanzira yakapararira kune yakakura bronchus uye inenge masendimita maviri pasi apa munzvimbo iyo trachea inosangana ne bronchus.
- Kanzira yakapararira kune mukati-kati memakumbo akavhara mapapu.
- Chikamu chemapapu chakanyangarika ( atelectasis ) kana kuti yakagadzirwa pneumonitis (kuputika kwemapapu) munzvimbo iyo trachea inosangana ne bronchus.
kana
(2) Kanzera haina kupararira kune lymph nodes uye chimwe kana zvimwe zvinotevera ndezvechokwadi:
- Dumbu racho rakakura kudarika 7 masentimita.
- Kanzera yakapararira kune yakakura bronchus (uye iri pasi pemasendimita maviri pedyo nenzvimbo iyo trachea inosangana nebronchus asi haisati yambobatanidza nharaunda yacho), rusvingo rwechifuva, diaphragm, kana mutsara unodzora chidimbu.
- Kanzira yakapararira kune membrane yakakomberedza mwoyo ( pericardium ) kana kuvhara rusvingo rwechifuva.
- Ikoko kune imwe kana kupfuura yakaparadzana yakabatana mulobe imwechete yemapapu.
Staging
Oncologists vakataura nezvezvikamu zvemukenza wemapapu zvakabva kune chimwe chinonzi TNM system . Munyika iyi, T inoreva hukuru hwechirwere, N inoreva kusabatanidzwa kwemakiromodhi chero ipi zvayo uye pavanenge varipo, uye M inoratidza kana kune zvipi zvese zvinoshandiswa, izvo zvinoreva kupararira kwechiremera kune dzimwe nzvimbo dzomuviri . Uchishandisa TNM system, chirwere chemukati wemapapu 2 chinotsanangurwa se:
- 2A - T1A / 1BN1M0 - Ichitaura kuti chironda chacho chinopfuura masendimita matatu (1 ½ inches) muhukuru, uye chakapararira kune lymph nodes iri pedyo.
- 2A - T2AN1M0 - Chirwere ichi chikuru kupfuura 3 cm, asi pasi pe5 cm, muhukuru, kana kenza yakapararira kune yakanyanya bronchus uye inenge 2 cm pasi pe carina, kana kenza yakapararira kusvika pakamuri mpapu; uye yakapararira kune lymph nodes iri pedyo.
- 2B - T2N1M0 - Dumbu racho rinopfuura 3 cm, asi pasi pe7 cm, muhukuru, uye yakapararira kune lymph nodes.
- 2B-T3N0M0 - Dumbu racho rinopfuura 7 cm muhukuru uye harina kupararira kune lymph nodes, asi iri mumugwagwa kana kuti yakapararira kune dzimwe nzvimbo dzakadai sedanda rebhokisi kana diaphragm.
Molecular Profiling
Chimwe chekufambira mberi kwemukweremu wemapapu emapapu kwakange kuri kukwanisa kurapa mamwe emararamiro aya neku "tarisa" kuchinja kwemuviri. Izvo pamwe nekuratidzwa kwechirwere chinokonzerwa nekukura uye kuti yakakura zvakakura sei, oncologists ikozvino vachishandisa maitiro ekuongorora maitiro (molecular profiling) yemukenza wemapapu kuti awedzere "kuchinja" kuongorora. Kusvikira munguva pfupi yapfuura, kuongororwa kwaive kwakachengeterwa zvikuru kune vanhu vane zvikamu zvepamusoro zvechirwere, asi nekufambira mberi mukurapa, zvichida kuti avo vane chirwere chechirwere chechipiri, kunyanya vanhu vane mapapu adenocarcinoma , kuedza uku kuchava tsika.
Zviratidzo
Zviratidzo zvinowanzoitika pakugadzirisa 2 mutsa wemapapu ndeyekukanganiswa kusingaperi , kukonzera ropa (hemoptysis), kupererwa kwepfufu , kurwadziwa mubhokisi kana kumashure , kana kuti zvirwere zvakapetwa zvakadai sepneumonia kana bronchitis. Sezvo chirwere chepamuviri chemapapu chemapapu hachina kuisa mararamiro (kupararira) kunze kwemapapu, zviratidzo zvakadai sokurasikirwa kwekurema uye kusaneta hazviwanzovi kudarika pane zvidzidzo zvepamusoro.
Kurapa
Mishonga yekurapa yemutambo wekenza yemapapu kazhinji inowanzobatanidza kusanganiswa kwerapi. Izvi zvinosanganisira:
- Kuvhiya: Kuvhiya ndiko kurapwa kwesarudzo pamusana wekenza yemukenza wemapapu, inopa mukana mukuru kwazvo wekurapa panguva ino yechirwere. Kune 3 mhando mikuru yemapapu emapapu emapapu inowanikwa kumukenza wemapapu, uye kusarudza nzira ipi inonyanya kunakira kubva painosuruvara yako uye huwandu hwehutano hwako. Mumakore achangopfuura, maitiro mashoma ekuvhiya anonzi chirongwa chevhidhiyo (assisted thoracoscopic surgery) (VATS) chakawanikwa. Nechirongwa ichi, chikamu chemapapu chinogona kubviswa kuburikidza nekukwanisa kudukura mudombo. Zvinogona kuchenjera kufunga nezvechipiri pfungwa paunosarudza chirwere chemapapu chemapapu . Zvidzidzo zvinoratidza kuti vanhu vane maitiro aya anoitwa muzvipatara zvinowanzoita mavhivhi aya ane zvibereko zviri nani.
- Chemotherapy: Most oncologists vanokurudzira adjuvant chemotherapy (chemotherapy pashure pokuvhiyiwa) kune avo vanovhiyiwa nokuda kwekenza 2 yemukenza yemapapu. Izwi rine rudzi urwu rwemakemikirini ndeye "kuchenesa" chero masero emukenza angangopararira kunze kwemapapu (emastasized) asi haasati aoneka pane zvipi zvese zvekufungidzira. Zvichienderana nechinzvimbo chechirwere chako, vamwe oncologists vanogona kunge vaine neoadjuvant chemotherapy-chemotherapy inopiwa vasati vambovhiyiwa kuti kuderedze ukuru hwechirwere uye kuti kubvisa chiremara chiri nyore.
- Radiation Therapy for Inoperable Tumors: Radiation therapy haisi inowanzoshandiswa nechitsauko 2 chekenza yemapapu asi inosarudzwa kune avo vasingakwanisi kuvhiyiwa nemhaka yekuti chiremara chiriko kana kuti hutano hwemapapu husingagoneki . Mumamiriro ezvinhu aya, mashizha anogona dzimwe nguva anogadzira mushonga. Mamwe maitiro akadai seproton british therapy ari kuongororwa pachirwere chechipiri.
Clinical Trials
Maererano neNational Cancer Institute, vanhu vane chirwere chemapapu vanofanira kufunga nezvekubatanidzwa mumakirinikirini . Kufambira mberi kwakawanda pakurapa mupenza wemapapu kwakagadzirwa, uye panguva iyo pakati pa2011 na2015, kwaiva nemishonga mitsva yakagamuchirwa nekenza yemapapu kupfuura mumakore makumi mana asati apfuura 2011.
Makiriniki mazhinji emakiriniki ari kuenderera mberi nechikwata chemukenza wemapapu chemapapu achicherechedza nzira dzisina kuvhiringidzika dzokuvhiya, nzira itsva dzehutachiona, uye mishonga mitsva yakadai seyakananga kurapwa uye immunotherapy nokuda kwechikamu ichi chechirwere.
Dambudziko rekudzokazve
Kuwanda kwehuwandu hwezvekudzoka (kunyanya munharaunda kana mune dzimwe nzvimbo dzomuviri) yemukenza wemapapu munharaunda (danho 1 uye gadziriro 2) iri pakati pe20 ne50 muzana. Kana kenza yemapapu ichidzoka, zvimwe zvinoshandiswa zviripo pakurapa. Izvi zvinogona kusanganisira mazai eine kana asina chemotherapy, kana chimwe chezvitsva zvinorapwa nemishonga kana immunotherapy mishonga iri kuongororwa mumakirini akawanda emakiriniki. Dzidza zvakawanda pamusoro pemarapirwo emapapu ekudzoka zvakare .
Survival Rate
Zvose zvinokwana makore mashanu ekupukunyuka zvinenge makumi matatu kubva muzana pamutambo wechikamu chechipiri kwete chediki chemapapu emapapu. Mune mamiriro ega ega, nhamba iyi dzimwe nguva inogona kusiyanisa , zvichienderana nehutachiona yako uye hutano hwako huse. Ramba uchifunga kuti nhamba dzekupona dzinowanzova nemakore akawanda, uye mushonga mutsva wakagamuchirwa ungadai usina kuwanikwa apo iyo nhamba yakanyorwa.
Kutsungirira
Zvidzidzo zvinoratidza kuti kudzidza pamusoro peswere chako kunogona kuvandudza zvawakaguma. Bvunza mibvunzo. Dzidza nezvemakiriniki ekuedzwa izvo zvingave zvakakodzera kwauri. Kana iwe uchangobva kuongororwa nemukenza wemapapu , tora nguva yekufema uye fungisisa zvakananga pamusoro pemamiriro ako ezvinhu. Zvisarudzo zvakawanda nemukenza wemapapu hazvikurumidzi, uye iwe unogona kazhinji kutora nguva shoma kuti uongorore zvizere matanho ako anotevera.
Mune dzimwe nzira, unganzwa sokuti wakangorasikirwa nehupenyu hwehupenyu hwako, asi kune zvimwe zvaungaita iwe pachako izvo zvinotowedzera kubudirira nekurwara nekenza yemapapu.
Kurarama nekenza kunogona kutora musha. Rega vanhu kuti vakubatsire. Ino haisi nguva yekuve "yakasimba," uye kenza inogona kutyisa kunyange nekubatsira. Kana iri mudiwa wako uyo akawanikwa ane kenza, ona chinyorwa ichi, " Apo mudiwa wako ane kenza yemapapu. "
Kunyange kana iwe uine rubatsiro rukuru rwemhuri neshamwari, kurarama nekenza kunogona kunge kuri kusurukirwa. Tarisa mumapoka ekutsigira munharaunda yako uye paIndaneti . Kune mhara yakanaka yemukenza yemapapu paIndaneti umo vanhu vakawanda vane kenza yemapapu vanowana rubatsiro, panguva imwechete vachidzidza nezvekufambira mberi kwemukenza wemapapu.
Sources:
American Cancer Society. Cancer Chokwadi uye Zvikamu 2014 . Atlanta: American Cancer Society; 2014. http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf
American Cancer Society. Chirwere Chechirwere (Chero Isina-Small Cell. Yapindurwa 02/08/16. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-survival-rates
American Joint Committee yeCancer. Lung Cancer Staging. 7th Edition. Yakasvika 01/13/16. https://cancerstaging.org/references-tools/quickreferences/Documents/LungMedium.pdf
Edge, S. et al (Eds.). AJCC Cancer Staging Manual. 7th Edition. Springer. New York, NY. 2010.
Hotta, K. et al. Basa rekudzivirira chemotherapy mune varwere vane kenza yemukenza yemapapu isina kubhadhara: kuongororwa nekuita meta-kuongororwa kwemiedzo yakasarudzwa yakaitwa. Nyaya yeCliniki Oncology . 2004. 22 (19): 3850-7.
Kelsey, C. uye al. Kudzokorora kwemukati mushure mekutanga kushandiswa kweNSCLC: kuchengetedza kunogona kuve nekurapa kwemaawa. Cancer . 2006 (12): 283-8.