Umdlavuza we-Lung

Uyini umdlavuza wamaphaphu?

Umdlavuza wamaphaphu wuhlobo lomdlavuza oluqala emaphashini. Umdlavuza wamaphaphu uqala emaphashini futhi ungase udlulele kuma-lymph nodes noma kwezinye izitho zomzimba, njengobuchopho. Umdlavuza ovela kwezinye izitho nawo ungase udlulele emaphashini. Lapho amangqamuzana omdlavuza esakazeka esuka kwesinye isitho aye kwesinye, abizwa ngokuthi ama-metastases.

Wonke amaseli emzimbeni aqukethe okokusebenza kofuzo okubizwa nge-deoxyribonucleic acid (DNA). Njalo lapho ingqamuzana elivuthiwe lihlukana libe ngamaseli amabili amasha, i-DNA yalo iyaphindwa ncamashi. Amaseli angamakhophi weseli yoqobo, acishe afane ngayo yonke indlela. Ngale ndlela, imizimba yethu iyaqhubeka izigcwalisa. Amaseli amadala ayafa bese isizukulwane esilandelayo sithatha indawo yawo.

Umdlavuza uqala ngephutha, noma ngokuguquka kwezakhi zofuzo, kuyi-DNA yeseli. Ukuguqulwa kwe-DNA kungadalwa inqubo ejwayelekile yokuguga noma ngenxa yezimo zemvelo, ezifana nentuthu kagwayi, ukuphefumula ezintanjeni ze-asbestos, kanye nokuchayeka kugesi we-radon.

Abacwaningi bathole ukuthi kuthatha uchungechunge lwezinguquko ukwakha iseli lomdlavuza wamaphaphu. Ngaphambi kokuba abe nomdlavuza ngokuphelele, amaseli angaba precancerous, ngokuthi abe noshintsho oluthile kodwa asasebenza ngokujwayelekile njengamaseli wamaphaphu. Lapho ingqamuzana elinofuzo lihlukana, lidlulisela izakhi zalo zofuzo ezingajwayelekile emangqamuzaneni amabili amasha, abese ehlukana abe amangqamuzana amane anamaphutha ku-DNA yawo nokunye. Ngokuguquguquka okusha ngakunye, ingqamuzana lethishu yamaphaphu liyaguquka futhi lingase lingasebenzi kahle ekwenzeni umsebenzi walo njengengqamuzana lamaphaphu. Esigabeni sakamuva sesifo, amanye amangqamuzana angase ahambe kude nesimila sokuqala futhi aqale ukukhula kwezinye izingxenye zomzimba. Le nqubo ibizwa ngokuthi i-metastasis futhi amasayithi amasha akude abizwa ngokuthi ama-metastases.

I-Primary Versus Secondary Cancer Lung

Umdlavuza wamaphaphu oyinhloko uqala emaphashini. Amaseli omdlavuza angamangqamuzana amaphaphu angavamile. Kwesinye isikhathi, abantu bazoba nokuhamba komdlavuza usuka kwenye ingxenye yomzimba wabo noma u-metastasize uye emaphashini abo. Lokhu kubizwa ngokuthi umdlavuza wamaphaphu wesibili ngoba amaphaphu ayindawo yesibili uma kuqhathaniswa nendawo yokuqala yomdlavuza. Ngakho-ke, isibonelo, amangqamuzana omdlavuza webele aye emaphashini awawona umdlavuza wamaphaphu kodwa kunalokho umdlavuza webele we-metastatic futhi azodinga ukwelashwa okunqunyelwe umdlavuza webele kunomdlavuza wamaphaphu.

Izici zobungozi zomdlavuza wamaphaphu

Ingcuphe yinoma yini enyusa amathuba omuntu okuthola isifo esifana nomdlavuza. Umdlavuza ohlukile unezici ezahlukahlukene zobungozi. Ezinye izinto ezinobungozi, njengokubhema, zingashintshwa. Abanye, njengobudala bomuntu noma umlando womndeni, abakwazi ukuguqulwa.

Kodwa ukuba nengcuphe, noma ngisho nokumbalwa, akusho ukuthi uzosithola lesi sifo. Futhi abanye abantu abathola lesi sifo kungenzeka babe nezici ezimbalwa zobungozi noma bangazazi.

Izici eziningana zobungozi zingakwenza ube namathuba amaningi okuba nomdlavuza wamaphaphu. Lezi zinto zihlobene nengozi yomdlavuza wamaphaphu ngokujwayelekile. Kungenzeka ukuthi ezinye zazo zingase zingasebenzi kumdlavuza omncane wamaphaphu wamangqamuzana (SCLC).

Izici zobungozi ongazishintsha

Intuthu kagwayi

Ukubhema yiyona nto ehamba phambili ebangela umdlavuza wamaphaphu. Cishe ama-80% okufa komdlavuza wamaphaphu kucatshangwa ukuthi kubangelwa ukubhema futhi leli nani mhlawumbe liphakeme kakhulu ngomdlavuza omncane wamaphaphu wamangqamuzana (SCLC). Kuyinto engavamile kakhulu kumuntu ongakaze abheme ukuba abe ne-SCLC.

Ingozi yomdlavuza wamaphaphu wababhemayo iphindwe kaningi kunalabo abangabhemi. Uma uqhubeka ubhema futhi amaphakethe amaningi ngosuku ubhema, iba nkulu ingozi.

Ukubhema i-cigar nokubhema ipayipi cishe kungadala umdlavuza wamaphaphu njengokubhema ugwayi. Ukubhema osikilidi abanetiyela eliphansi noma “elula” kwandisa ingozi yomdlavuza wamaphaphu njengogwayi ojwayelekile. Ukubhema ugwayi we-menthol kungakhuphula ubungozi nakakhulu ngoba i-menthol ingavumela ababhemayo ukuthi bahogele ngokujulile.

Intuthu kagwayi

Uma ungabhemi, ukuphefumula intuthu yabanye (okubizwa ngentuthu kagwayi noma intuthu kagwayi wendawo) kungakhuphula ingozi yokuba nomdlavuza wamaphaphu. Intuthu kagwayi kucatshangwa ukuthi ingadala ukufa kwabantu abangaphezu kuka-7,000 XNUMX ngonyaka ngenxa yomdlavuza wamaphaphu.

Ukuvezwa ku-radon

IRadon iyigesi enemisebe eyenzeka ngokwemvelo ebangelwa ukuwohloka kwe-uranium enhlabathini nasemadwaleni. Awukwazi ukubona, ukunambitha, noma ukuhogela. Ngokwe-US Environmental Protection Agency (EPA), i-radon iyimbangela yesibili ehamba phambili yomdlavuza wamaphaphu kuleli, futhi iyimbangela ehamba phambili kwabangabhemi.

Ngaphandle, kune-radon encane kakhulu okungenzeka ingabi yingozi. Kepha endlini, i-radon ingagxila kakhulu. Ukuyiphefumula kuveza amaphaphu akho kumanani amancane emisebe. Lokhu kungakhuphula ingozi yomuntu yokuba nomdlavuza wamaphaphu.

Amakhaya nezinye izakhiwo cishe kunoma iyiphi ingxenye ye-United States angaba namazinga aphezulu we-radon yasendlini (ikakhulukazi ezindlini ezingaphansi).

Ukuvezwa kwe-asbestos

Abantu abasebenza nge-asbestosi (njengezimayini, izigayo, izitshalo zendwangu, izindawo lapho kusetshenziswa khona ukwahlukanisa, kanye namagceke emikhumbi) banamathuba amaningi okubulawa ngumdlavuza wamaphaphu. Ubungozi bomdlavuza wamaphaphu bukhulu kakhulu kubasebenzi abavezwe kuma-asbestos nawo abhemayo. Akucaci ukuthi ukuvezwa kwezinga eliphansi noma lesikhashana ku-asbestos kungakhuphula ingozi yomdlavuza wamaphaphu.

Abantu abadalulwe eningi le-asbestos futhi banengozi enkulu yokuthuthukisa i-mesothelioma, uhlobo lomdlavuza oluqala ku-pleura (ulwelwesi oluzungeze amaphaphu). Ukuze uthole okwengeziwe ngalolu hlobo lomdlavuza, bheka iMalotlant Mesothelioma.

Eminyakeni yamuva nje, imithethonqubo kahulumeni inciphise kakhulu ukusetshenziswa kwama-asbestos emikhiqizweni yezentengiselwano neyezimboni. Kusekhona emakhaya amaningi nakwezinye izakhiwo ezindala, kepha akuvame ukubhekwa njengokulimaza inqobo nje uma kungakhishelwa emoyeni ngokonakala, ukudilizwa, noma ukulungiswa kabusha. Ukuthola eminye imininingwane, bheka i-Asbestos kanye ne-Cancer Risk.

Ukuchayeka kwamanye amanxusa abangela umdlavuza emsebenzini

Amanye ama-carcinogens (ama-agent abangela umdlavuza) atholakala kwezinye izindawo zokusebenza angakhuphula ingozi yomdlavuza wamaphaphu afaka:

• Ama-ores anemisebe njenge-uranium
• Amakhemikhali angenayo afana ne-arsenic, i-beryllium, i-cadmium, i-silica, i-vinyl chloride, ama-nickel compounds, ama-chromium compounds, imikhiqizo yamalahle, igesi yesinaphi, ne-chloromethyl ethers
• Ukukhipha udizili

Uhulumeni nezimboni bathathe izinyathelo eminyakeni edlule ukusiza ukuvikela abasebenzi kokuningi kwalokhu kudalulwa. Kepha izingozi zisekhona, ngakho-ke uma usebenza kulawa ma-ejenti, qaphela ukukhawulela ukuvezwa kwakho lapho kungenzeka khona.

Ukuthatha izithako ezithile zokudla

Ucwaningo olubheka indima engaba khona yezithasiselo zamavithamini ekwehliseni ingozi yomdlavuza wamaphaphu lube nemiphumela edumazayo. Eqinisweni, izifundo ezimbili ezinkulu zathola ukuthi ababhemayo abathatha izithako ze-beta carotene empeleni babenengozi eyengeziwe yomdlavuza wamaphaphu. Imiphumela yalezi zifundo ikhombisa ukuthi ababhemayo kufanele bagweme ukuthatha izithasiselo ze-beta carotene.

I-Arsenic emanzini okuphuza

Ucwaningo lwabantu ezingxenyeni eziseNingizimu-mpumalanga ye-Asia naseNingizimu Melika abanamazinga aphezulu e-arsenic emanzini abo okuphuza bathole ingozi ephezulu yomdlavuza wamaphaphu. Kuningi lalezi zifundo, amazinga e-arsenic emanzini ayephakeme kaningi kunalawo abonwa e-United States, ngisho nasezindaweni lapho amazinga e-arsenic angaphezulu kokujwayelekile. Kwabaningi baseMelika abasezinhlelweni zamanzi zomphakathi, amanzi okuphuza awawona umthombo omkhulu we-arsenic.

Izici zobungozi ongeke uzishintshe

Ukwelashwa kwemisebe yangaphambilini emaphashini

Abantu abake bathola ukwelashwa ngemisebe esifubeni ngenxa yeminye imidlavuza basengozini enkulu yomdlavuza wamaphaphu, ikakhulukazi uma bebhema. Izibonelo zifaka phakathi abantu abelashelwe isifo i-Hodgkin noma abesifazane abathola imisebe yesifuba ngemva kokuhlinzwa komdlavuza webele. Abesifazane abathola ukwelashwa ngemisebe ebeleni ngemva kwe-lumpectomy ababonakali benengozi ephakeme kunokulindelekile yomdlavuza wamaphaphu.

Ukungcoliswa komoya

Emadolobheni, ukungcoliswa komoya (ikakhulukazi eduze kwemigwaqo eshushumbiswe kakhulu) kubonakala kukhulisa ingozi yomdlavuza wamaphaphu kancane. Le ngozi incane kakhulu kunengozi edalwa ukubhema, kodwa abanye abacwaningi balinganisela ukuthi emhlabeni wonke cishe amaphesenti amahlanu (5%) abo bonke abantu ababulawa ngumdlavuza wamaphaphu angabangelwa ukungcoliswa komoya ngaphandle.

Umlando womuntu siqu noma womndeni womdlavuza wamaphaphu

Uma unomdlavuza wamaphaphu, unengozi enkulu yokuthola omunye umdlavuza wamaphaphu.

Abafowethu, odadewethu, kanye nezingane zabantu ababa nomdlavuza wamaphaphu bangaba nengozi ethe xaxa yomdlavuza wamaphaphu uqobo, ikakhulukazi uma isihlobo sitholakale sisencane. Akucaci ukuthi le ngozi ingabangwa kangakanani ngenxa yezakhi zofuzo ezabiwe phakathi kwamalungu omndeni nokuthi kungakanani okungatholakal kusuka ekuvezweni okwabiwe kwasekhaya (njengentuthu kagwayi noma i-radon).

Abaphenyi bathole ukuthi ufuzo lubonakala ludlala indima kweminye imindeni enomlando oqinile womdlavuza wamaphaphu.

Izici ezinemiphumela engaqinisekile noma engaqinisekisiwe engozini yomdlavuza wamaphaphu

Ukubhema insangu

Kunezizathu zokucabanga ukuthi ukubhema insangu kungakhuphula ingozi yomdlavuza wamaphaphu.

• Intuthu yensangu iqukethe itiyela nezinto eziningi ezibanga umdlavuza ezifanayo ezisentuthu kagwayi. (Itiyara iyinto enamathelayo, eqinile esala ngemuva kokusha, okucatshangwa ukuthi iqukethe iningi lezinto eziyingozi emsini.)
• Ugwayi wensangu (amalunga) ujwayele ukubhema kuze kube sekugcineni, lapho okuqukethwe itiyela kuphakeme kakhulu.
• Insangu ihogelwe kakhulu futhi intuthu ibanjwa emaphashini isikhathi eside, okunikeza noma yiziphi izinto ezibanga umdlavuza ithuba lokufaka emaphashini.
• Ngoba insangu isengavumelekile ezindaweni eziningi, kungahle kungenzeki ukulawula ukuthi iziphi ezinye izinto engahle iqukathe.

Labo abasebenzisa insangu bathambekele ekubhemeni osikilidi abambalwa bensangu ngosuku noma ngesonto kunenani likagwayi osetshenziswa ababhemayo. Inani elincane elibhemayo lizokwenza kube nzima ukubona umthelela engozini yomdlavuza wamaphaphu.

Kube nzima ukutadisha ukuthi ngabe kukhona ukuxhumana phakathi kwensangu nomdlavuza wamaphaphu ngoba insangu sekunesikhathi eside ingekho emthethweni ezindaweni eziningi, futhi akulula ukuqoqa imininingwane ngokusetshenziswa kwezidakamizwa ezingekho emthethweni. Futhi, ezifundweni ezibheke ukusetshenziswa kwensangu esikhathini esidlule kubantu ababenomdlavuza wamaphaphu, iningi lababhemayo babhema nogwayi. Lokhu kungenza kube nzima ukwazi ukuthi ingakanani ingozi eyandayo evela kugwayi nokuthi ingakanani engaba yinsangu. Ucwaningo oluningi luyadingeka ukuze wazi izingozi zomdlavuza ngokubhema insangu.

Ugwayi

Ama-e-cigarette awuhlobo lohlelo lokulethwa kwe-nicotine ngogesi. Aqukethe ugwayi kodwa i-Food and Drug Administration (FDA) iwahlukanisa njengemikhiqizo "kagwayi". Ama-cigarettes amasha sha futhi kudingeka ucwaningo olwengeziwe ukwazi ukuthi imiphumela emibi yesikhathi eside ingaba yini, kufaka phakathi ingozi yokuba nomdlavuza wamaphaphu.

I-Talc ne-talcum powder

I-Talc iyiminerali engohlobo lwayo lwemvelo ingaqukatha i-asbestos. Olunye ucwaningo luye lwasikisela ukuthi abavukuzi be-talc nabantu abasebenzisa izigayo ze-talc bangaba nengozi enkulu yomdlavuza wamaphaphu nezinye izifo zokuphefumula ngenxa yokuvezwa kwabo ku-talc grade grade. Kepha ezinye izifundo azitholanga ukwanda kwesilinganiso somdlavuza wamaphaphu.

I-Talcum powder yenziwa nge-talc. Ukusetshenziswa kwe-cosmetic talcum powder akutholakalanga ukwandisa ingozi yomdlavuza wamaphaphu.

Izinhlobo zomdlavuza wamaphaphu

Kunezinhlobo ezimbili zomdlavuza wamaphaphu futhi ziphathwa ngendlela ehluke kakhulu.

Umdlavuza wamangqamuzana ongewona omncane (NSCLC)

Cishe u-80% kuya ku-85% womdlavuza wamaphaphu yi-NSCLC. Izinhlobo ezincane eziyinhloko ze-NSCLC yi-adenocarcinoma, i-squamous cell carcinoma, kanye ne-cell carcinoma enkulu. Lezi zinhlobo ezincane, eziqala ezinhlotsheni ezihlukene zamaseli wamaphaphu ahlanganiswe ndawonye njenge-NSCLC ngoba ukwelashwa kwawo kanye nokubikezela (umbono) kuvame ukufana.

I-Adenocarcinoma: I-Adenocarcinomas iqala kumaseli angavame ukukhipha izinto ezinjenge-mucus.

Lolu hlobo lomdlavuza wamaphaphu lwenzeka ikakhulukazi kwababhemayo bamanje noma bangaphambili, kodwa futhi luhlobo oluvame kakhulu lomdlavuza wamaphaphu obonwa kwabangabhemi. Kuvame kakhulu kwabesifazane kunakubesilisa, futhi kungenzeka ukuthi kwenzeke kubantu abasha kunezinye izinhlobo zomdlavuza wamaphaphu.

I-Adenocarcinoma ivame ukutholakala ezingxenyeni ezingaphandle zamaphaphu futhi kungenzeka ukuthi itholakale ngaphambi kokuba isabalale.

Abantu abanohlobo lwe-adenocarcinoma olubizwa nge-adenocarcinoma in situ (ngaphambili elalibizwa nge-bronchioloalveolar carcinoma) bavame ukuba nombono ongcono kunalabo abanezinye izinhlobo zomdlavuza wamaphaphu.

I-squamous cell carcinoma: Ama-squamous cell carcinomas aqala kumaseli angama-squamous, angamaseli ayizicaba aqonde ngaphakathi kwemigwaqo yomoya emaphashini. Zivame ukuxhunyaniswa nomlando wokubhema futhi zivame ukutholakala engxenyeni emaphakathi yamaphaphu, eduze kwomoya omkhulu (bronchus).

Iseli enkulu (engahlukanisiwe) i-carcinoma: I-cell cell carcinoma enkulu ingavela kunoma iyiphi ingxenye yamaphaphu. Kuvame ukukhula nokusabalalisa ngokushesha, okungenza kube nzima ukwelapha. I-subtype enkulu ye-cell carcinoma, eyaziwa njenge-cell enkulu I-neuroendocrine carcinoma, umdlavuza okhula ngokushesha ofana kakhulu nomdlavuza omncane wamangqamuzana wamaphaphu.

Amanye ama-subtypes: Amanye ama-subtypes ambalwa we-NSCLC, afana ne-adenosquamous carcinoma ne-sarcomatoid carcinoma, ajwayelekile kakhulu.

Umdlavuza omncane wamaphaphu wamangqamuzana (SCLC)

Cishe i-10% kuya ku-15% yawo wonke umdlavuza wamaphaphu yi-SCLC futhi kwesinye isikhathi ibizwa nge-oat cell cancer.

Lolu hlobo lomdlavuza wamaphaphu luvame ukukhula futhi lusakazeke ngokushesha kune-NSCLC. Cishe u-70% wabantu abane-SCLC bazoba nomdlavuza osuvele usabalele ngesikhathi bexilongwa. Njengoba lo mdlavuza ukhula ngokushesha, uvame ukusabela kahle ekwelapheni ngamakhemikhali kanye nokwelashwa ngemisebe. Ngeshwa, kubantu abaningi, umdlavuza uzobuya ngesikhathi esithile.

Ezinye izinhlobo zamathumba emaphaphu

Kanye nezinhlobo eziyinhloko zomdlavuza wamaphaphu, ezinye izicubu zingenzeka emaphashini.

Izicubu ze-Lung carcinoid: Izimila ze-Carcinoid ze-akhawunti yamaphaphu ngaphansi kwama-5% wezicubu zamaphaphu. Iningi lazo likhula kancane. Ukuze uthole ulwazi olwengeziwe mayelana nalezi zimila, bheka I-Lung Carcinoid Tumor.

Ezinye izicubu zamaphaphu: Ezinye izinhlobo zomdlavuza wamaphaphu njenge-adenoid cystic carcinomas, i-lymphomas, ne-sarcomas, kanye nezicubu zamaphaphu ezinobungozi ezinjenge-hamartomas azivamile. Lezi ziphathwa ngokuhlukile kunomdlavuza wamaphaphu ovame kakhulu futhi akukhulunywa ngazo lapha.

Umdlavuza osakazekela emaphashini: Umdlavuza oqala kwezinye izitho (njengesifuba, amanyikwe, izinso, noma isikhumba) kwesinye isikhathi ungasakazeka (metastasize) uye emaphashini, kepha lokhu akuwona umdlavuza wamaphaphu. Isibonelo, umdlavuza oqala ebeleni bese usabalalela emaphashini usengumdlavuza webele, hhayi umdlavuza wamaphaphu. Ukwelashwa komdlavuza we-metastatic emaphashini kusekelwe lapho iqale khona (indawo yokuqala yomdlavuza).

Izimpawu zomdlavuza wamaphaphu

Umdlavuza wamaphaphu ngokuvamile awubangeli zimpawu nezimpawu ezigabeni zawo zokuqala. Izimpawu nezimpawu zomdlavuza wamaphaphu zivame ukwenzeka kuphela lapho isifo sesithuthukile.

Izimpawu nezimpawu zomdlavuza wamaphaphu zingafaka:

• Ukukhwehlela okusha okungapheli
• Ukukhwehlela igazi, noma inani elincane
• Ukuphelelwa umoya
• ubuhlungu besifuba
• Ukuthuthumela
• Ukwehlisa isisindo ngaphandle kokuzama
• Ubuhlungu be-Bone
• bekhanda

Uma umdlavuza wokuqala wamaphaphu usakazekile, umuntu angazizwa izimpawu kwezinye izindawo emzimbeni. Izindawo ezivamile zokusabalalisa umdlavuza wamaphaphu zifaka ezinye izingxenye zamaphaphu, ama-lymph node, amathambo, ubuchopho, isibindi kanye nezindlala ze-adrenal.

Izimpawu zomdlavuza wamaphaphu ezingenzeka kwenye indawo emzimbeni:

• Ukulahlekelwa kwesifiso sokudla noma isisindo esingachazwanga
• Ukonakala kwemisipha (okwaziwa nangokuthi i-cachexia)
• Ukukhathala
• Ukuphathwa yikhanda, ithambo noma ubuhlungu bamalunga
• Ukuphuka kwamathambo akuhlobene nokulimala ngengozi
• Izimpawu ze-Neurological, njengokuhamba okungazinzile noma ukulahleka kwememori
• Intamo noma ukuvuvukala kobuso
• Ubuthakathaka obujwayelekile
• ukopha
• Ama-clots egazi

Ukuxilongwa komdlavuza wamaphaphu

Uma umdlavuza wamaphaphu usolwa ngenxa yenqubo yokuhlola (i-CT, i-MRI noma i-PET scan), kufanele kuhlolwe ucezu oluncane lwamaphaphu ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza. Ebizwa ngokuthi yi-biopsy, le nqubo ingenziwa ngezindlela ezahlukene. Kwezinye izimo, udokotela udlulisa inaliti esikhunjeni angene emaphashini ukuze asuse isiqeshana esincane sezicubu; le nqubo ivame ukubizwa ngokuthi yi-needle biopsy.

Kwezinye izimo, i-biopsy ingenziwa ngesikhathi se-bronchoscopy. Ngesiguli esingaphansi kokulaliswa, udokotela ufaka ishubhu elincane ngomlomo noma ngamakhala nasemaphashini. Ishubhu, enekhamera elikhanyayo, elincane nethuluzi lokuhlinza ekugcineni, livumela udokotela ukuthi abone ngaphakathi kwephaphu futhi asuse isampula lesicubu esincane.

Muva nje, i-FDA ivume i-biopsy yokuqala yoketshezi yomdlavuza wamaphaphu esebenzisa i-DNA yamahhala ezintantayo egazini ukuze ihlaziywe. Amathumba achitha le nto ye-DNA egazini njengoba amaseli angaphakathi kwawo efa. I-DNA iyaqoqwa iphinde ihlaziywe ivumela odokotela ukuthi bathole "isithombe" sokushintshwa kwezakhi zofuzo nokunye okungahambi kahle okuholela ekukhuleni kwesimila. Ama-biopsies we-Liquid ahlinzeka ngezinzuzo ezithile ezibalulekile, ngoba azihlaseli, azibizi, zinikeza imiphumela efike ngesikhathi futhi ziyaphindeka kalula.

Uma amangqamuzana omdlavuza etholakala kusampula lezicubu, kungenziwa ukuhlolwa kofuzo. Ukuhlolwa kwezakhi zofuzo, okungabuye kubhekiswe kukho ngokuthi “ukufakwa kwamangqamuzana noma ukuguqulwa kwezakhi,” kuvumela odokotela ukuba babheke ngaphakathi kwamangqamuzana ama-tumor ukuthola izakhi zofuzo noma izinguquko okungenzeka ukuthi zibangele umdlavuza. Lokhu kuhlolwa kusiza udokotela ukuthi akhe uhlelo lokwelashwa kwesiguli.

Odokotela bezifo (odokotela abakhomba izifo ngokufunda amaseli nezicubu ngaphansi kwesibonakhulu) kanye nezazi zofuzo (ososayensi abanokuqeqeshwa okukhethekile ekutadisheni izakhi zofuzo) banganikeza udokotela wakho ulwazi aludingayo ukuze enze ukwelashwa okuzosebenza kakhulu. Lezi zingcweti zinganquma izici ezihlukile zomdlavuza ngamunye wamaphaphu: uhlobo lwesimila (i-NSCLC noma i-SCLC, isibonelo); ihambe ibanga elingakanani (isigaba sayo); kanye nokuguquka kwezakhi zofuzo (ukuguquka kwezakhi zofuzo) okubanga noma “kuqhube” umdlavuza.

Njengoba ukubaluleka kokuqonda izici zofuzo zeseli lephaphu sekukhuphukile, odokotela bezifo nama-pulmonologists bakhuthaza ukuthi kwenziwe ukuhlolwa kwe-reflex. Ukuhlolwa kwe-Reflex kuhilela ukwenza ukuhlolwa kokuguqulwa komdlavuza wamaphaphu okwenzekayo noma abashayeli ngasikhathi sinye lapho kwenziwa ukuhlolwa kokuxilongwa, kungakhathalekile ukuthi isiguli sinesitofu sini.

Izigaba zomdlavuza wamaphaphu

Isigaba I: Umdlavuza utholakala kuphela emaphashini futhi awusabalalanga kunoma yiziphi izakhi zomzimba.

Isigaba II: Umdlavuza usephashini nakuma-lymph node aseduze.

Isigaba III: Umdlavuza utholakala emaphashini nakuma-lymph node maphakathi nesifuba, nawo achazwa njengesifo esithuthuke kakhulu endaweni. Isigaba III sinama-subtypes amabili:

• Uma umdlavuza usabalele kuphela kuma-lymph node ohlangothini olufanayo lwesifuba lapho umdlavuza uqale khona, ubizwa ngokuthi isigaba IIIA.
• Uma umdlavuza ususabalele kuma-lymph node kolunye uhlangothi lwesifuba, noma ngaphezulu kwethambo lekhola, ubizwa ngokuthi isigaba IIIB.

Isigaba IV: Lesi yisigaba esithuthuke kakhulu somdlavuza wamaphaphu, futhi sichazwa futhi njengesifo esithuthukile. Yilapho-ke umdlavuza ususabalalele kuwo womabili amaphaphu, uketshezi olusendaweni ezungeze amaphaphu, noma kolunye uhlangothi lomzimba, njengesibindi noma ezinye izitho.

Ukwelashwa komdlavuza wamaphaphu

Ukuhlinzwa, imisebe, i-chemotherapy, ukwelashwa okuhlosiwe kanye ne-immunotherapy —Kuyedwa noma kuhlangene — kusetshenziselwa ukwelapha umdlavuza wamaphaphu. Ngayinye yalezi zinhlobo zokwelashwa zingadala imiphumela emibi eyehlukene.

Ukuhlinzwa

Iningi lomdlavuza wamaphaphu weseli ongewona omncane welashwa ngokuhlinzwa ukuze kususwe isimila. Ngale nqubo, udokotela ohlinzayo ususa i-lobe, noma isigaba, sephaphu eliqukethe isimila.

Abanye odokotela abahlinzayo basebenzisa i-video-assisted thoracoscopic surgery (VATS). Ngale nqubo, udokotela ohlinzayo usika, noma asike, isifuba esincane afake ishubhu elibizwa ngokuthi i-thoracoscope. I-thoracoscope inekhamera elula nekhamera encane exhunywe kwi-video monitor ukuze udokotela ohlinzayo abone ngaphakathi esifubeni. I-lobe lobe ingasuswa esikhaleni, ngaphandle kokwenza imbobo enkulu esifubeni.

I-Chemotherapy Nemisebe

Kubantu abanezicubu zamaphaphu zeseli ezingezincane ezingasuswa ngokuhlinzwa, ubufakazi buveza ukuthi ukwelashwa ngamakhemikhali ngemuva kokuhlinzwa, okwaziwa nge- “adjuvant chemotherapy,” kungasiza ekuvimbeleni umdlavuza ukuthi ungabuyi. Lokhu kuyiqiniso ikakhulukazi ezigulini ezinesifo sesigaba II no-IIIA. Kusasele imibuzo maqondana nokuthi i-adjuvant chemotherapy isebenza kwezinye iziguli nokuthi zizuza kangakanani.

Kubantu abanomdlavuza wamaphaphu wesigaba III ongakwazi ukususwa ngokuhlinzwa, odokotela bavame ukuncoma i-chemotherapy ngokuhlangana nokwelashwa kwemisebe okucacile (okuphezulu). Esigabeni somdlavuza wamaphaphu wesigaba IV, i-chemotherapy ngokuvamile iyindlela yokwelashwa eyinhloko. Ezigulini zesigaba IV, imisebe isetshenziswa kuphela ekunciphiseni izimpawu.

Uhlelo lokwelashwa ngamakhemikhali lomdlavuza wamaphaphu luvame ukuba nenhlanganisela yezidakamizwa. Phakathi kwezidakamizwa ezisetshenziswa kakhulu kubalwa i-cisplatin (Platinol) noma i-carboplatin (Paraplatin) kanye ne-docetaxel (Taxotere), i-gemcitabine (Gemzar), i-paclitaxel (i-Taxol nezinye), i-vinorelbine (i-Navelbine nezinye), noma i-pemetrexed (i-Alimta).

Kunezikhathi lapho lokhu kwelashwa kungahle kungasebenzi. Noma, ngemuva kokuba le mithi isebenze isikhashana, umdlavuza wamaphaphu ungabuya. Ezimweni ezinjalo, odokotela bavame ukunikeza inkambo yesibili yokwelashwa kwezidakamizwa okubizwa ngokuthi i-chemotherapy yomugqa wesibili.

Muva nje, umqondo wokwelashwa ngamakhemikhali wesondlo uhlolwe ezivivinyweni zomtholampilo, kungaba njengokushintshela komunye umuthi ngaphambi kokuba umdlavuza uqhubeke; noma ukuqhubeka nomuthi owodwa osetshenziswe ekuqaleni isikhathi eside. Womabili lawa masu akhombise okuhle ezigulini ezikhethiwe.

I-Chemotherapy Ngaphambi Kokunye Ukwelashwa (Ukwelashwa kwe-Neoadjuvant)

Ukuthola i-chemotherapy ngaphambi kwemisebe noma ukuhlinzwa kungasiza abantu abanomdlavuza wamaphaphu ngokunciphisa isimila ngokwanele ukwenza kube lula ukusikhipha ngokuhlinzwa, kwandise ukusebenza kwemisebe futhi kubhubhise amangqamuzana omdlavuza afihliwe ngesikhathi sokuqala.

Uma isimila singanciphi nge-chemotherapy, umuthi ungamiswa khona manjalo, uvumele udokotela ukuthi azame ukwelashwa okuhlukile. Ngaphezu kwalokho, ucwaningo lukhombisa ukuthi abantu abanomdlavuza wamaphaphu bakwazi kakhulu ukubhekana nemiphumela emibi yokwelashwa ngamakhemikhali lapho inikezwa ngaphambi kokuhlinzwa.

Kwesinye isikhathi, isikhathi esifushane sokwelashwa ngomuthi sinciphisa isimila ngaphambi kokuhlinzwa. Uma kunjalo, ukwelashwa okuqhubekayo ngomuthi ofanayo ngemuva kokuhlinzwa kungenzeka kusizise isiguli. Ngoba ochwepheshe abaningi bomdlavuza wamaphaphu emhlabeni wonke banikeza i-chemotherapy ezigulini zabo ngaphambi kokuhlinzwa, iziguli kufanele zikhulume nodokotela wazo.

Ukwelashwa Okuhlosiwe

Enye yezinto ezijabulisa kakhulu emithini yomdlavuza wamaphaphu ukwethulwa kwemithi ehlosiwe. Ngokungafani nemithi yokwelapha ngamakhemikhali, engakwazi ukwehlukanisa phakathi kwamaseli ajwayelekile namaseli womdlavuza, izindlela zokwelashwa eziqondisiwe zenzelwe ngqo ukuhlasela amangqamuzana omdlavuza ngokunamathisela noma ukuvimba izinhloso ezivela ezindaweni zalawo maseli. Abantu abanomdlavuza wamaphaphu osezingeni eliphezulu onama-biomarker athile wamangqamuzana bangathola ukwelashwa ngomuthi oqondisiwe kuphela noma ngokuhlanganiswa ne-chemotherapy. Lezi zindlela zokwelashwa komdlavuza wamaphaphu zifaka:

U-Erlotinib (Tarceva nabanye). Ukwelashwa okubhekiswe kukho okubizwa nge-erlotinib kukhonjisiwe ukuthi kuzuzise abanye abantu ngomdlavuza wamaphaphu weseli ongewona omncane. Lo muthi uvimba uhlobo oluthile lwe-receptor ebusweni beseli-i-epidermal growth factor receptor (EGFR). Abamukeli abanjenge-EGFR basebenza njengezicabha ngokuvumela izinto ngokuthi zingakhuthaza iseli lomdlavuza ukuthi likhule futhi lisabalale. Amaseli omdlavuza wamaphaphu anokuguquka ku-EGFR kungenzeka aphendule ekwelashweni nge-erlotinib esikhundleni se-chemotherapy. Ezigulini ezitholile ukwelashwa ngamakhemikhali, futhi ezidinga ukwelashwa okwengeziwe, i-erlotinib ingasetshenziswa ngisho nangaphandle kokuba khona kwenguquko.

I-Afatinib (Gilotrif). Ngo-2013, i-FDA yavuma i-afatinib ekwelashweni kokuqala kwe-metastatic NSCLC ezigulini ezinokuguqulwa noma ukususwa okufanayo kwezakhi zofuzo njengalezo ezingelashwa ngempumelelo nge-erlotinib.

I-Gefitinib (Iressa). Ngo-2015, i-FDA yavuma i-gefitinib yokwelashwa komugqa wokuqala kweziguli ezine-NSCLC ezinamathumba anezinhlobo ezithile zokuguqulwa kwezakhi zofuzo ze-EGFR, njengoba kutholakala ukuhlolwa okuvunyelwe yi-FDA.

I-Bevacizumab (Avastin). Njengezicubu ezijwayelekile, izicubu zidinga ukunikezwa kwegazi ukuze ziphile. Imithambo yegazi ikhula ngezindlela eziningana. Enye indlela iwukuba khona kwento ebizwa nge-vascular endothelial growth factor (VEGF). Le nto ikhuthaza imithambo yegazi ukuthi ingene kwizicubu iphinde inikeze umoya-mpilo, amaminerali, kanye nezinye izakhamzimba ukondla isimila. Lapho izimila zisakazeka emzimbeni wonke, zikhipha i-VEGF ukudala imithambo yegazi emisha.

IBevacizumab isebenza ngokumisa i-VEGF ekuvuseleleni ukukhula kwemithambo yegazi emisha. (Ngoba izicubu ezijwayelekile zinokutholakala kwegazi okuqinisekisiwe, azithinteki ngumuthi.) Lapho kuhlanganiswa ne-chemotherapy, i-bevacizumab ikhonjisiwe ukuthi ithuthukise ukusinda kubantu abanezinhlobo ezithile zomdlavuza ongewona omncane wamaphaphu, njenge-adenocarcinoma ne-cell cell carcinoma .

I-Crizotinib (Xalkori). Ukwelashwa okukhombise izinzuzo kubantu abanomdlavuza wamaphaphu weselula ongeyona omncane othuthukile abane-ALK gene mutation. I-Crizotinib isebenza ngokuvimba i-ALK nokumisa ukukhula kwesimila.

I-Ceritinib (Zykadia). Lokhu kwavunyelwa ngo-2014 kubantu abanomdlavuza wamaphaphu we-ALK-positive ongakwazi ukubekezelela i-crizotinib noma umdlavuza wakhe oqhubeka ukhula ngenkathi elashwa nge-crizotinib.

Ngoba izakhi zofuzo zamangqamuzana omdlavuza zingashintsha, ezinye izicubu zingamelana nokwelashwa okuhlosiwe. Imithi yokuhlangabezana nalezi zinselelo iyafundwa manje ezivivinyweni zokwelashwa, okuvame ukuhlinzeka ngezindlela ezibalulekile zokwelashwa kubantu abanomdlavuza wamaphaphu.

immunotherapy

I-Immunotherapy isanda kuvela njengenketho entsha yokwelashwa komdlavuza othile wamaphaphu. Ngenkathi noma yikuphi ukwelashwa komdlavuza kungadala imiphumela emibi, i-immunotherapy ngokuvamile ibekezelelwa kahle; lokhu ngokwengxenye kungenxa yendlela yokusebenza kwayo.

Amasosha ethu omzimba asebenza njalo ukusigcina siphilile. Iyabona futhi ilwe nobungozi, njengokutheleleka, amagciwane, namaseli omdlavuza akhulayo. Ngokuvamile, i-immunotherapy isebenzisa amasosha ethu omzimba njengokwelashwa komdlavuza.

Ngo-Mashi 2015, i-FDA ivume i-immunotherapy nivolumab (Opdivo) yokwelashwa kwe-NSCLC ye-metastatic squamous engazange iphathwe ngempumelelo nge-chemotherapy. INivolumab isebenza ngokuthikameza “ukubopha” kwamangqamuzana okwaziwa ngePD-1 okuvimba amasosha omzimba ekuhlaseleni izicubu.

Ngo-2016, i-FDA yagunyaza i-immunotherapy entsha ebizwa nge-pembrolizumab (Keytruda) yokwelashwa kwe-NSCLC ethuthukisiwe njengokwelashwa kokuqala. Umsebenzi wayo wokwelapha ufana nowe-nivolumab. Iziguli zihlolelwa iphrotheni eyaziwa ngokuthi i-PDL-1 futhi uma inani elanele likhonjwa, zingase zifanelekele lokhu kwelashwa.

Izindlela ezingeziwe zokwelashwa kwe-immunotherapy yomdlavuza wamaphaphu zibonise isithembiso ekuhlolweni kokuqala kwemitholampilo futhi manje sezithuthukile esigabeni sekwephuzile. Ukwelashwa kwe-NSCLC kuthuthuke kakhulu; kodwa-ke, kunezindlela eziningi zokwelashwa okuncike ekuzivikeleni komzimba kwe-SCLC nakho okuthuthukayo emtholampilo. Lezi zindlela zokwelashwa ziwela kuzo izigaba ezine eziyinhloko:

• Amasosha omzimba angama-monoclonal ngamamolekyu akhiqizwa ilebhu abhekise kuma-antigen athile we-tumor (into amasosha omzimba ayibona ingeyangaphandle noma iyingozi).
• Izivimbeli zokuhlola khomba ama-molecule asebenza njengokuhlola kanye nezilinganiso ekulawulweni kwezimpendulo zomzimba.
• Imishanguzo yokwelapha ukukhomba ama-antigen ahlanganyelwe noma aqondene nesimila.
• Ukudluliswa kwe-T-cell okwamukelwayo indlela lapho amaseli ama-T (uhlobo lweseli elimhlophe) asuswa esigulini, aguqulwe izakhi zofuzo noma elashwa ngamakhemikhali ukuthuthukisa umsebenzi wawo, aphinde angeniswe esigulini ngenhloso yokwenza ngcono ukuphendula kwama-immune system .

Ukwelashwa kwe-CAR T-Cell ne-Natural Killer (NK) Ukwelashwa kwamaseli ngezinye zezindlela zokwelashwa ezintsha zokwelashwa komdlavuza wamaphaphu.

Ungavinjelwa kanjani umdlavuza wamaphaphu?

Ayikho indlela eqinisekile yokuvimbela umdlavuza wamaphaphu, kepha unganciphisa ubungozi bakho uma:

• Ungabhemi. Uma ungakaze ubheme, ungaqali. Khuluma nezingane zakho ngokungabhemi ukuze ziqonde ukuthi zingasigwema kanjani lesi sici esiyingozi somdlavuza wamaphaphu. Qala izingxoxo ngezingozi zokubhema nezingane zakho kusenesikhathi ukuze zazi ukuthi zingasabela kanjani ekucindezelweni ontanga.
• Yeka ukubhema. Yeka ukubhema manje. Ukuyeka kunciphisa amathuba okuba nomdlavuza wamaphaphu, ngisho noma usubheme iminyaka. Khuluma nodokotela wakho mayelana namasu kanye nezinsiza zokuyeka ukubhema ezingakusiza ukuba uyeke. Izinketho zifaka imikhiqizo yokubuyisela i-nicotine, imithi, namaqembu okusekela.
• Gwema ugwayi kagwayi. Uma uhlala noma usebenza nomuntu obhemayo, mnxuse ukuba ayeke. Okungenani, mcele ukuthi abheme ngaphandle. Gwema izindawo lapho abantu bebhema khona, njengamabha nezindawo zokudlela, futhi ufune izinketho zokungabhemi.
• Hlola ikhaya lakho nge-radon. Yenza ukuthi amazinga e-radon asekhaya lakho ahlolwe, ikakhulukazi uma uhlala endaweni lapho i-radon yaziwa njengenkinga. Amazinga aphezulu e-radon angalungiswa ukwenza ikhaya lakho liphephe. Ngemininingwane ngokuhlolwa kwe-radon, thinta umnyango wezempilo wangakini noma isahluko sendawo se-American Lung Association.
• Gwema ama-carcinogen emsebenzini. Thatha izinyathelo zokuzivikela ekuvezweni amakhemikhali anobuthi emsebenzini. Landela izinyathelo zomqashi wakho. Isibonelo, uma unikezwa isifihla-buso sobuso ukuze uvikeleke, ngaso sonke isikhathi yigqoke. Buza udokotela wakho ukuthi yini enye ongayenza ukuze uzivikele emsebenzini. Ingozi yakho yokulimala kwamaphaphu kusuka kuma-carcinogens asemsebenzini iyanda uma ubhema.
• Yidla ukudla okugcwele izithelo nemifino. Khetha ukudla okunempilo ngezithelo nemifino ehlukahlukene. Imithombo yokudla yamavithamini nezakhamzimba ingcono kakhulu. Gwema ukuthatha imithamo emikhulu yamavithamini efomini lamaphilisi, ngoba angaba yingozi. Isibonelo, abacwaningi abanethemba lokunciphisa ubungozi bomdlavuza wamaphaphu kubantu ababhemayo abasindayo babanikeza izithasiselo ze-beta carotene. Imiphumela ikhombise ukuthi izithasiselo zenyuse ubungozi bomdlavuza kubantu ababhemayo.
• Vivinya izinsuku eziningi zeviki. Uma ungazivocavoci njalo, qala kancane. Zama ukuzivocavoca izinsuku eziningi zesonto.