Miedzo uye Nzira Dzokuona Kuongorora Mungozi
Kuongororwa kwemukenza wemapapu kunogona kutanga nebhokisi x-ray, asi kubva panguva iyi muedzo unogona kurasikirwa nekenza yekare, chifukidzo CT scan, uye pakupedzisira bhiopsy kana chidimbu kana kuti kuwanikwa kudiwa, inoda.
Kanza yemaperembudzi inowanzofungidzirwa mushure mekunge nzvimbo isina kuwanikwa inowanikwa pachifukidzo che-x-ray yakaongororwa kuongorora kuora kana kupfuva. Munguva ino inotyisa, zvinobatsira kuziva dzimwe nzira dzingave dzakakurudzirwa kuti uzive kana kusakoshesa kwakanaka (kwete kenza), kana kuipa (kenza).
Kana kusakanganiswa kwakaipa, zvimwe zvidzidzo zvinoitwa kuti zvione kana kenza yakapararira ( mastasized ) kune dzimwe nzvimbo mumuviri uye kuti uone danho rechirwere.
Lung Cancer Screening
Kune avo vasina zviratidzo, kuongorora kenza yemapapu ikozvino kwakagamuchirwa kuti vaonekwe kwekutanga kune vanhu vari pakati pemakore makumi mashanu nemakumi mashanu, vakasvuta kwemakore makumi matatu emakore-makumi matatu, uye vanosvuta kana kusiya kusvuta mumakore gumi apfuura. Zvakakosha kuziva, zvisinei, kuti kuongorora kunofanirwa kuve kuedzwa kune avo vasina zviratidzo. Kana iwe uine zviratidzo zvemukenza wemapapu, zvirwere zvakare, kusanganisira yakazara CT scan ichadiwa.
Mwenje "Mavara" uye Zvimwe Zvinotsanangurwa
Usati wapinda muhutano hwekenza yemapapu, unganzwa uchinetseka nezviratidzo zvako, uye chero upi zvausingazivi chiremba wako aona kana kuti achaona pa x-ray kana CT scan. Sekudzokororwa nokukurumidza, Sekudzokorora nokukurumidza, chironga chepapu chinoonekwa se "nzvimbo" pamapapu anenge masendimita matatu (inch nehafu) kana kuderera muhupamhi.
Chimiro chemapapu chinoreva kusakosha kunokosha kupfuura 3 cm muhupamhi. Pane imwe nzvimbo pamapapu kana kuti "chipembenene chepapu" inogona kunge yakaipa kana yakaipa. "Mvuri" pane x-ray inogonawo kuva yakaipa kana inonyangadza, kana kungovhiringidza zvivakwa zvakazara mubhokisi.
Nhoroondo uye Nyama
Kana mukenza wemapapu unofungidzirwa, chiremba achatanga kuita zvakakwana nhoroondo uye kuongorora muviri.
Izvi zvinoitwa kuti kuongorore zviratidzo uye ngozi kune mimwe yemukenza wemapapu , uye kutarisa chero zviratidzo zvepanyama zvinoratidza huputi r. Izvi zvinogona kusanganisira kusaputika kwemapapu mazwi, lymph node yakawedzerwa, kurasikirwa kwekushaya masimba, kana clubbing yeminwe (chubby fingernails).
Laboratory uye Radiology Studies
Zvimwe zvidzidzo zvakasiyana-siyana zvekufungidzira zvinogona kudiwa, zvichienderana nezviratidzo zvako zvakananga uye zvakawanikwa pakuongorora. Izvi zvinogona kusanganisira:
Bofu X-Ray
Bhokisi re x-ray rinowanzotanga kuongororwa kuti riongorore zvinetso zvose zvichibva munhoroondo yakanyatsocherechedza uye mumuviri. Izvi zvinogona kuratidza kuwanda mumapapu kana lymph nodes yakakura. Dzimwe nguva chikwata x-ray chinowanzoitika, uye mimwe miedzo inodiwa inotarisa kufungidzirwa kenza yemapapu. Kunyange kana uwandu hunowanikwa, izvi hazvisi nguva dzose kanzira uye zvimwe zvidzidzo zvinodiwa. Inofanira kusimbiswa kuti bhokisi x-raga roga harina kukwana kutonga kunze kwekenza yemapapu, uye mapepa okutanga anogona kushayikwa nyore nyore nemuedzo uyu.
CT scan
A CT scan (computerized tomography) inowanzoita danho rechipiri rokutevera pane chifukidzo chisina kujairika x-ray kuwana kana kuongorora zviratidzo zvinotambudza kune avo vane chikwata chemavara x-ray. CT kuongorora kunosanganisira mutsara we x-rays inoita 3-dimensional mapafu.
Kana iyo CT isingaenzaniswi, kuongororwa kwemukenza wemapapu kunoda hunovimbiso kuburikidza nemuenzaniso wezvisikwa neimwe yemitemo iri pasi apa.
MRI (magnetic resonance imaging)
Kune vamwe vanhu, MRI (magnetic resonance imaging) inoshandiswa kuongororodza kuvepo kwekenza yemapapu. Iyi nzira inoshandisa magnetism uye haina kusanganisira mahara. Vamwe vanhu, vakadai sevaya vane midzi yesimbi (pacemakers, nezvimwewo) havafaniri kuva neMRI inotsvaga. Iyo nyanzvi ichabvunza mibvunzo kuti ione kuti idzi hadzisipo.
PET Scan
PET scan (positron emission tomography) inoshandisa masheya e-radioactive kuti iite mifananidzo yakave-3-dimensional yenharaunda yemuviri.
Iko rudzi rwekutsvaga rwakasiyana nemamwe mune kuti inotsanangura matumire ari kukura. Chimwe shuga cheashuga inokonzerwa nehudhiya inopindwa muropa, uye inopiwa nguva yekutorwa nemasero. Maseji ari kukura zvakasimba anotora shuga yakawanda, uye anopenya mumafirimu. Muedzo unowanzobatanidzwa neT CT scan (PET / CT). Sekuwedzera kune imwe nzira, vamwe vanotsvakurudza vanoti PET kuongorora kunogona kuona zvirwere kare, kunyange vasati vaoneka kuburikidza nedzimwe dzidzo. Kuongorora kwePET kunobatsirawo pakusiyanisa pakati pemakumbo nemaronda ekuvhara muvanhu vanopera mumapapu avo chero zvikonzero.
Sputum Cytology
Mushure memukenza wemapapu unofungidzirwa zvichibva pamagariro, muenzaniso wezvigunwe zvinotarisirwa kusimbisa kuongororwa uye kutsanangura rudzi rwekenza. Sputum cytology ndiyo nzira iri nyore yekuita izvi, asi kushandiswa kwayo kunogumira kune zviremara izvo zvinowedzera mumhepo. Sputum cytology haisi yakarurama nguva dzose uye inogona kukanganwa mamwe masero emukenza. Muedzo wacho unobatsira zvikuru kana uchiita zvakanaka, asi unotaura zvishoma kana usina kunaka.
Bronchoscopy
Mune maronchoscopy , nyanzvi yemapapu inopinza tubhu mumhepo inoenda kunofungidzira uye inotora sampu yechirwere. Iyi nzira inoshandiswa apo bundu racho rinowanikwa mumhepo huru uye rinokwanisa kusvika pamwero. Varwere vanopiwa anesthesia panguva iyi nzira yekuderedza kusagadzikana. Munguva yebronchoscopy, bhiopsy inogona kutorwa chero bundu chero ripi kana zvimwe zvisiri izvo zvinowanikwa mumhepo.
Endobronchial Ultrasound
Endobronchial ultrasound inzira inoshandiswa pakuongorora chirwere chemapapu. Munguva yegonchoscopy, vanachiremba vanoshandisa shanduro ye ultrasound mukati momugwagwa kuti vaongorore mapapu uye nzvimbo pakati pemapapu (mediastinum). Pamakumbo anenge ari pedyo nemhepo, bhaopsy inogona kuitwa nemufananidzo uyu.
Nyore Biopsy
Muchidimbu chinoshuva chinangwa (FNA) biopsy, chiremba anoisa chidimbu chisina kumira kuburikidza nechidziro chechifuva, kazhinji chinotungamirirwa neTV kuratidzira, kutora sampu yechirwere. Izvi zvinogona kuitwa nokuda kwemamota asingakwanisi kuwanikwa ne-bronchoscopy, kunyanya avo vari pedyo nechepakati pemapapu.
Thoracentesis
Kana kenza yemapapu inokonzera mhirizhonga yemapapu, inogona kukonzera kusvibiswa kuvaka pakati pemapapu nemapapu emvura (pleura.) Neanesthesia yemunharaunda, nhovo huru inopindirwa mukati mechipupuriro chinoshandiswa kubva kune iyo yekufungidzirwa kwehuwandu hwemvura (shoma shomanana kuongororwa nemasero emukenza, kuipa kwechirwere chisingaiti ) kana kuti kurapa kwechirwere (yakawanda kuwedzera marwadzo uye / kana kupererwa kwemweya) kubviswa.
Mediastinoscopy
A mediastinoscopy Iyi nzira inowanikwa muimba yekushandira pasi peanesthesia. Nharaunda inowanikwa pamusoro pe sternum (yepafupa pfupa) kupinda munharaunda pakati pemapapu ( mediastinum ) kutora samples kubva kumakirini. PET scan ikozvino inowanzopa migumisiro yakafanana iyo mediastinoscopy yakaita munguva yakapfuura.
Muedzo Wokuziva Kana Kanzura Yemawere Yakapararira (Inoshandiswa)
Kansa yemaperembudzi inowanzopararira kuchiropa , majozi adrenal, uropi nemapfupa. Miedzo yakajairika inosanganisira:
- CT kuongorora mimba: Kutarisa kuti yakapararira kuchiropa kana kudonsa glands
- MRI yehuropi: Kutsvaga metastases kuuropi
- Bhuta scan : Kuedza maitiro emasitema kumapfupa , kunyanya kumashure, mahudyu, uye nenyundo
- PET kuongorora: PET scan inogona kutarisa mastasisita chero ipi zvayo mumuviri, uye dzimwe nguva inogona kutora dzimwe mimwe miedzo iri pamusoro pese sepafupa kana CT scan.
Mimwe Miedzo Pakuziva
Zvimwe zvisina kuongorora zvirwere zvinowanzoitwa panguva yekuongororwa kwemukenza wemapapu pamwe chete. Izvi zvinogona kusanganisira:
- Pulmonary function tests (PFTs): PFTs inoongorora simba remapapu uye inogona kusarudza kuti yakaora sei inopesana nokufema, uye dzimwe nguva, kana yakachengeteka kuita chirwere
- Kuongororwa kweRopa: Mimwe miedzo yeropa inogona kuona kusagadzikana kwezvinhu zvakakonzerwa nekenza yemapapu, uye inogonawo kuratidza kupararira kwemarara
Mhembwe Nyuchi
Kana kenza yemapapu inofungidzirwa pane zvidzidzo zvekufungidzira, danho rinotevera nderekuva nemapapu emapapu akaitwa kuti aone kana kusakanganisika kwechokwadi kanomukenza, uye kuziva rudzi rwemapapu emapapu.
Zvizhinji zvebiopsies zvinowanikwa pamashizha emhando, asi mvura yakasvibirira inzira inofadza yekutevera vamwe vanhu vane kenza yemapapu. Yakagamuchirwa muna Gumiguru 2016, miedzo iyi inogona kuitwa kuburikidza neropa risina kutora. Panguva iyo, vanobvumirwa chete kuti vaone kuchinja kweEGFR, asi kune vose, ivo muenzaniso wakanaka wekuti kuongororwa uye kurapwa kwemukenza wemapapu kunovandudzika gore rose.
Apo mutanho wemapapu unopararira, zvakakosha ku "re-biopsy" mishonga, sezvo kanzura inogona kuchinja munguva, uye izvi zvingashandura iwe, iwewo, iwe uye chiremba wako kusarudza nzira dzakanakisisa dzokurapa.
Molecular Profiling / Gene Kuedzwa
Iko zvino inokurudzirwa kuti munhu wose ane kemukati kadiki isiri duku yemapapu, uye kunyanya mapapu adenocarcinoma, ane masayenzi ekufananidza akaitwa pachirwere chavo. Iyi kuongororwa kwechiini inotarisa kuchinja kwemasero emukenza kune mishonga inoshandiswa inowanikwa "inotarisa" mamiriro ezvinhu aya.
Izvi hazvisi kuchinja kwaunoberekerwa, uyewo haugoni kuzvipfuura kune vana vako. Iko kushanduka kunoitika mukushanda kwesero kuve nekenza uye iyo inofambisa kukura kwekenza.
Zvirongwa zvinotarirwa zvino zvakagamuchirwa kune vanhu vane mutsauko we EGFR , ALK rearrangements , ROS1 rearrangements , uye zvimwe zvishoma zvinoshanduka. Mukuwedzera, mamwe marapirwo ari kuwanikwa iye zvino mumakiriniki ekuedzwa .
PD-L1 Kuedza
Kubvira pakatanga kugadziriswa kwemukirini yemapapu muna 2015, mishonga mimwe mitatu yakawanikwa. Muedzo unonzi PD-L1 unogona kuitwa kuti uone huwandu hwekutaura kwaPD-L1 pamakero ako ekenza. PD-L1 ipuroteni inoratidzwa muhuwandu hwemamwe masero emukenza emapapu. Iyi protein inoita kuti iwedzere "mabheki" ezvirwere zvemuviri, zvichideredza kukwanisa kwayo kurwisa kenza masero. Mamwe masero emukenza akawana nzira dze "overexpress" puroteni iyi senzira yekuvanza kubva mumuviri wemuviri. Mishonga inozivikanwa se checkpoint inhibitors inoshanda nekuvhara chiito ichi uye inosunungura mabheki pachirwere chemuviri.
Isu hatizivi kuti kukosha kweP-L1 kuongorora kuchave kupi mukurapa kenza yemapapu. Zvose mapepa emapapu anonyanya kuisa PD-L1 uye avo vasingagoni kupindura mishonga iyi. Panguva ino yazvino inofungidzirwa kuti inogona kunge inobhadhara mari yekuita izvi, asi kuderedza kushandiswa kwemishonga iyi chete kune vanhu vane zviremera zvinorema PD-L1 zvinogona kuderedza nhamba yevanhu vanozobatsirwa nemishonga iyi.
> Sources:
> Aquiar, P., Perry, L., Penny-Dimr, J. et al. Migumisiro yePD-L1 Kuedzwa paKubhadhara-Kubudirira uye Kwemari Inoshandiswa neIndune-Check Inhibitor yeChipiri-Line Treatment yeNSCLC. Annals of Oncology . 2017 June 15. (Epub pamberi pekudhinda).
> National Institute of Health. Medline Plus: Lung Cancer. Yashandurwa 02/21/18. https://medlineplus.gov/lungcancer.html