Zviratidzo, Kutaura, Kurapa, uye Kurapa
Zvinorevei kana uine mukana wekenza yemapapu uye izvi zvakasiyana sei nezvimwe zvikamu? Ndezvipi zvirongwa zvinogona kukurudzirwa uye chii chaunofanira kuziva kuti iwe unogona kuva mutongi wako muchecheche rako? Ndezvipi zvinofananidzira zvemukati uyu uye izvi zvinochinja sei nemishonga mitsva?
Overview
Chikamu chechitatu chekenza yemukenza yemapapu isati yakakura uye yakasiyana-siyana yekenza yemukenza inowedzera kuputsika kusvika muchigadziko chechitatuA uye chigadziko che3B .
Locally Advanced vs. Advanced Stage 3 Mwoyo Mutsva
Zviri nyore kurondedzera kusiyana kwekenza yekenza yemapapu 3 kuburikidza nekuputsa mapepa ose emapapu emapapu mumakamuri maviri mazana.
- Locally yakagadzirwa nemukenza wemapapu - Stage 3A inonzi inofanirwa munzvimbo yepamapapu yemapapu. Izvozvi mapfupa haana kupararira kunzvimbo dziri kure dzomuviri, asi akapararira kune lymph nodes kune rumwe rutivi rwemuviri sechirwere. Nhanho I kuenda kune imwe nzvimbo 3A mapiritsi emukenza anonzi "anoshandiswa" zvinoreva kuti kuvhiyiwa kunopa mukana wekurapa.
- Kanzera yepamapapu yakapfurikidza - pamwe chete nechikamu chemukati wemukenza wemapapu, chirwere chemukati chemukenza wemapapu chinonzi mapapu chinotapukira . Izvi zvipembenene zvakapararira kusvika pachidimbu zvokuti chirwere hachibviri (kunze kwekuti, uye dzimwe nguva, mushure mekurapa ne chemotherapy uye remishonga inonzi radiation.) Izvi zvipembenene "hazvibviri" uye hazviwanzopora, asi zvinorapwa, uye mishonga mitsva yakave yakave yakagamuchirwa mumakore achangopfuura.
Kuwanda
Vanenge 30 muzana yevanhu vane kenza yemapapu emapapu matatu panguva yekuongororwa, vachisiya 30 kubva muzana yevanhu vakaonekwa pane imwe nguva yapfuura ( danho 1 kana shanho 2 chirwere) uye 40 muzana zvatove zvichifambira mberi kusvika panhete 4 (metastatic) kanha yemapapu pa nguva yekuongororwa.
Staging
Kenza yepayipi yemapuranga ndeye danho rinokosha pakusarudza nzira dzakanakisisa dzokurapa, kunyanya kusiyanisa pakati pechitsauko 3A nechitatu chechitatuB.
Chikamu chemukenza wemapapu wemapapu chinonyatsotsanangurwa nekuparadzanisa zvikamu kusvika muchigadziko 3A uye nhanho 3B zvakasiyana.
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 3 zviratidzo zvemukenza wemapapu zvinopesana kubvira padanho rechitatu rinosanganisira zvirwere zvakawanda zvekenza. Zviratidzo zvinokonzerwa nekenza mumapapu akadai sokukanganiswa kusingaperi , kufema kufema , uye kudzokorora zvirwere zvakadai sepneumonia kana bronchitis, zvinowanzoitika.
Kupararira kunzvimbo dzakadai sedanda rebhokisi uye diaphragm zvinogona kukonzera marwadzo mubhokisi, mbabvu, mapepa, uye kumashure. Mvumo iri pedyo ne-airways inogona kukonzera hemoptysis ( kukwira ropa ) uye kuputika . Apo bundu racho rinosanganisira nzvimbo dzakadai sedopu uye dzimwe dzimba dzechifukidzo, dysphagia (kunetseka kunomedza) uye kushaya simba kunogona kuitika. Nhamo kumusana, chifuva, uye mbabvu zvinowanzoitika kana ruzha rukuru ruripo, uye izvi zvinogona kukonzera kuwedzera kukurumidza kufema.
Zviratidzo zvechirwere zvakadai sekuneta uye kurasikirwa kwekurema kwechido kungangovepo zvakare.
Kurapa
Mushonga wepakati 3 menza yemapapu yemapapu ndiyo inonyanya kukakavara pamakwara ose emukenza emapapu, chikamu nokuti boka iri rakasiyana zvakasiyana. Pamusana pevarombo vashoma vanopona, National Cancer Institute inotaura kuti munhu wese ane chirwere chemukati wepamu 3 anofanira kuonekwa somunhu akakodzera kuongororwa kwepiriniki - zvidzidzo zvinongororwa mushonga mutsva kana kusanganiswa kwezvirwere zvekenza yemapapu.
Nhanho 3A Kurapa
Kune rimwe danho rega 3A yemapirisa emapapu, chirwere chinogona kuitwa kuti chibvise tumarara uye kazhinji kateverwa neAdjuvant chemotherapy (chemotherapy mushure mekuvhiyiwa). Kuvhiya kunopa mukana wekurapa asi hausi nguva dzose inogoneka nemakumbo ehuyu. Dambudziko rekupora kenza yemapapu uye rakanyanya kukwirira kune vanhu vane gweta 3A kenza yemapapu.
Kune avo vane utano hwakanaka, kusanganiswa kwekemotherapy kana chemotherapy uye remishonga inonzi radiation inowanzokurudzirwa. Kana vanhu vasingakwanisi kubvumira chemotherapy, therapy inogona kushandiswa yoga kuti iite zviratidzo zvakadai sekurwadziwa nekupererwa kwemhepo.
Ikozvino yakakurudzirwa kuti kufungidzira kwema molecular (kuongorora kwejeni) kuitirwe kune munhu wese ane chesi duku duku rekenza yemapapu, kunyanya 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 kwekufamba kwenguva, asi zvizvarwa zvinotevera zvinogamuchirwa uye zviri kuongororwa 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.
Zvine mishonga mishonga yemunyanzvi yemagetsi yakagamuchirwa 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) yakagamuchirwa muna February 2018 pakurapwa kwemaitiro emusana wemapapu asingakwanisike mushure mekemotherapy uye remishonga inonzi radiation. Kana yakashandiswa mune izvi, yakagadziridzwa kuchinja zvakanyanya kufambira mberi-kusina kusununguka.
Nhanho 3B Kurapwa
Nhanho 3B kanzira, kusiyana nesero 3A, haigoni kurapwa nekuvhiyiwa. Mune mamwe mazwi, haasviki-asi kwete asingatambudziki. Mishonga inogona kusanganisira chemotherapy, therapy rayation, inorapwa, uye immunotherapy sechikamu chechitatu 3A chirwere.
Mune zvimwe zviitiko, kushandiswa kwemakemikrasi uye remishonga inonzi radiation inokwanisa kuderedza ukuru hwechirwere kuitira kuti chirwere chinogoneka. Chemotherapy inoshandiswa nenzira iyi inonzi "neoadjuvant chemotherapy."
Kune vanhu vane chirwere chemukati wemapapu 3, kurapwa kunogona kushandiswa sekuchirapa ., Zvinoreva kuti kunyanya kwekurapa kunoderedza zviratidzo zvakadai sekurwadziwa nekupererwa kwemweya panzvimbo yekuedza kudzora kenza. Ichokwadi chave chichiwana kuti kurapa kwakanyanya kune vanhu vane kenza yemapapu kunogona kuwedzera kupona.
Prognosis
Zvose zvinokwana makore mashanu ekupona kwemutiro 3A kenza yemapapu ine 14 muzana, asi inogona kusiyana zvikuru. Kuve nemakore mashanu ekupukunyuka nechirongwa chemukondombera wemapapu 3B zvinosuruvarisa chete ne5 muzana. Zvakakosha kuchengetedza mupfungwa kuti idzi nhamba dzinotarisana nemabatiro anoita vanhu nekenza yemapapu munguva yakapfuura. Sezvo pave pane mishonga yakagamuchirwa yekurapwa kwemukenza wemapapu pakati pa2011 na2015 kupfuura makore makumi mana apfuura gore ra2011, nhamba idzi hadzina kutendeseka mukufungidzira kutarisira upenyu nhasi.
Kutsungirira uye Kutsigira
Zvidzidzo zvinoratidza kuti kudzidza zvese zvaunogona nezvekenza yako kunobatsira nemigumisiro. Bvunza mibvunzo. Itai kuti vadiwa venyu uye muvakurudzire kubvunza mibvunzo zvakare. Funga kubatana neboka rekutsigira . Dzidza nezvemakiriniki emakirini angave akafanirwa nemamiriro ako ezvinhu. Kudzidza nezvekenza yako uye kuburikidza nekurapa kunogona kutora nguva yakawanda. 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
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