Okuqukethwe
Ukuxilongwa komdlavuza wamaphaphu kufanele kusheshe, kuphelele futhi kuphelele. Khona-ke empeleni ivumela ukukhethwa komuntu ngamunye kanye nokwenza kahle kokwelashwa komdlavuza. Ngenxa yezindlela zokwelapha ezintsha, ezinye iziguli zinethuba lokwandisa ukuphila kwazo hhayi abambalwa, kodwa ngezinyanga ezimbalwa. Umdlavuza wamaphaphu uba yisifo esingelapheki.
Umdlavuza wamaphaphu - ukuxilongwa
- Ukuxilongwa komdlavuza wamaphaphu kudinga ukubandakanyeka kochwepheshe abaningi, ngokungafani nomdlavuza wezitho ezithile, njengomdlavuza webele noma i-melanoma, otholakala futhi welashwe ikakhulukazi odokotela be-oncologist. Umdlavuza wamaphaphu wehluka kakhulu lapha - kusho uProf. dr hab. n. med. Joanna Chorostowska-Wynimko, inhloko yoMnyango Wezakhi Zofuzo kanye Nezifo Zomzimba Zomtholampilo weSikhungo Sesifo Sofuba Nezifo Zamaphaphu e-Warsaw.
Ukubambisana kochwepheshe abaningi kubaluleke kakhulu, isikhathi esinikelwe ekuxilongeni bese kuthi ukufaneleka kokwelashwa sibaluleke kakhulu. - Uma umdlavuza utholakala ngokushesha, ngokushesha ukuthwebula izithombe kanye nokuxilongwa kwe-endoscopic kwenziwa, ngokushesha ukuhlolwa kwe-pathomorphological kanye nokuhlolwa kwamangqamuzana okudingekile, ngokushesha singanikeza isiguli ukwelashwa okufanele. Hhayi kahle kakhulu, ilungile nje. Ngokuya ngesigaba somdlavuza, singase sifune ikhambi, njengasesiteji I-IIIA, noma kumdlavuza wamaphaphu ojwayelekile. Endabeni yentuthuko yendawo, singasebenzisa ukwelashwa kwendawo okuhlanganiswe nokwelashwa okuhlelekile, okufana ne-radiochemotherapy, okuhambisana ngokugcwele ne-immunotherapy, noma ekugcineni ukwelashwa okuhlelekile okunikezelwe ezigulini ezinomdlavuza wamaphaphu ojwayelekile, lapha ithemba yizindlela zokwelapha ezintsha, okungukuthi okuhloswe nge-molecularly. noma izidakamizwa ezingenakuzivikela. I-Clinical oncologist, i-radiotherapist, udokotela ohlinzayo kufanele abambe iqhaza ngokuphelele eqenjini lochwepheshe abahlukahlukene - ezimila zesifuba kungudokotela ohlinzayo wesifuba - ezimweni eziningi futhi udokotela wamaphaphu kanye nochwepheshe ekuxilongweni kwezithombe, okungukuthi i-radiologist - kuchaza uProf. dr hab. n. med. U-Dariusz M. Kowalski ovela eMnyangweni we-Lung and Thoracic Cancer we-National Institute of Oncology-National Research Institute e-Warsaw, umongameli we-Polish Lung Cancer Group.
UProfesa Chorostowska-Wynimko ukhumbuza ukuthi iziguli eziningi ezinomdlavuza wamaphaphu zinezifo zokuphefumula ezihlala zikhona. - Angikwazi ukucabanga isimo lapho isinqumo mayelana nokwelashwa okuphelele kwe-oncological yesiguli esinjalo senziwa ngaphandle kokucabangela izifo zamaphaphu ezihambisanayo. Lokhu kungenxa yokuthi sizofanelekela ukwelashwa ngokuhlinzwa isiguli esinamaphaphu ngokuvamile anempilo ngaphandle komdlavuza, kanye nesiguli esinesifo sokuphefumula esingamahlalakhona, esifana ne-pulmonary fibrosis noma isifo esingamahlalakhona sokuvimbela amaphaphu (COPD). Sicela ukhumbule ukuthi zombili izimo ziyingozi enkulu yomdlavuza wamaphaphu. Manje, eminyakeni yobhubhane, sizoba neziguli eziningi ezinezinkinga zamaphaphu e-COVID-19 - kusho uProf. Chorostowska-Wynimko.
Ochwepheshe bagcizelela ukubaluleka kokuxilonga okuhle, okuphelele nokuphelele. - Njengoba isikhathi sibaluleke kakhulu, ukuxilonga kufanele kwenziwe ngokuphumelelayo nangempumelelo, okungukuthi ezikhungweni ezinhle ezingenza ngokuphumelelayo ukuxilonga okuncane nokuhlaselayo, okuhlanganisa ukuqoqa inani elifanele lezinto ezinhle ze-biopsy ukuze kuhlolwe okwengeziwe, kungakhathaliseki ukuthi iyiphi inqubo esetshenzisiwe. Isikhungo esinjalo kufanele sixhunywe ngokusebenza nesikhungo esihle sokuxilonga i-pathomorphological and molecular diagnostics. Izinto zocwaningo kufanele zivikeleke kahle futhi zidluliselwe phambili ngokushesha, okuvumela ukuhlolwa okuhle mayelana nokuxilongwa kwe-pathomorphological, bese kuba nezici zofuzo. Ngokufanelekile, isikhungo sokuxilonga kufanele siqinisekise ukusebenza ngesikhathi esisodwa kokunqunywa kwe-biomarker - ukholelwa ukuthi uProf. Chorostowska-Wynimko.
Iyini indima ye-pathologist
Ngaphandle kokuhlolwa kwe-pathomorphological noma cytological, okungukuthi ukuxilonga ukuba khona kwamangqamuzana omdlavuza, isiguli asikwazi ukufaneleka ukuthola noma yikuphi ukwelashwa. - Isazi se-pathomorphologist kumele sihlukanise ukuthi sibhekene nomdlavuza wamaphaphu ongewona omncane (NSCLC) noma umdlavuza omncane wamangqamuzana (DRP), ngoba ukuphathwa kweziguli kuncike kuwo. Uma sekuvele kwaziwa ukuthi lena yi-NSCLC, udokotela wezifo kufanele anqume ukuthi i-subtype iyini - i-glaular, ingqamuzana elikhulu, i-squamous noma enye enye, ngoba kudingekile ngokuphelele uku-oda uchungechunge lokuhlolwa kwamangqamuzana, ikakhulukazi ohlotsheni lwe-non -umdlavuza we-squamous, ukuze ufanelekele ukwelashwa okuhlosiwe kwamangqamuzana - kukhumbuza u-prof. Kowalski.
Ngesikhathi esifanayo, ukudluliselwa kwezinto ku-pathologist kufanele kuhanjiswe ekuxilongweni kwamangqamuzana okuphelele okuhlanganisa zonke izimpawu ze-biomarker ezikhonjiswe uhlelo lwezidakamizwa, imiphumela edingekayo ukuze kunqunywe ukwelashwa okufanele kwesiguli. - Kwenzeka ukuthi isiguli sithunyelwe kuphela ekuhlolweni kwamangqamuzana athile. Lokhu kuziphatha akufanelekile. Ukuxilonga okwenziwa ngale ndlela akuvamile ukwenza kube nokwenzeka ukunquma indlela yokwelapha isiguli kahle. Kunezimo lapho izigaba zokuxilongwa kwamangqamuzana zitholwa ezikhungweni ezihlukene. Ngenxa yalokho, izicubu noma i-cytological material izungeza ePoland, futhi isikhathi siyahamba. Iziguli azinaso isikhathi, akufanele zilinde - ama-alamu prof. I-Chorostowska-Wynimko.
- Phakathi naleso sikhathi, ukwelashwa okusha, okukhethwe ngokufanele, kuvumela isiguli esinomdlavuza wamaphaphu ukuba sibe yisifo esingelapheki futhi simnike hhayi izinyanga ezimbalwa zokuphila, kodwa ngisho neminyaka eminingana - kunezela uProf Kowalski.
- Hlola ubungozi bakho bokuba nomdlavuza. Zihlole! Thenga iphakethe locwaningo labesifazane nabesilisa
Ingabe zonke iziguli kufanele zixilongwe ngokugcwele?
Akuzona zonke iziguli ezidinga ukuhlolwa okuphelele kwamangqamuzana. Kunqunywa uhlobo lomdlavuza. - Ku-non-squamous carcinoma, ikakhulukazi i-adenocarcinoma, zonke iziguli ezifanelekela ukwelashwa kwe-palliative kufanele zihlolwe ngokuphelele ngamangqamuzana, ngoba kulokhu ukuphazamiseka kwamangqamuzana esiguli (ukuguqulwa kwe-EGFR, i-ROS1 kanye nokuhlelwa kabusha kwezakhi zofuzo ze-ALK) kwenzeka kaningi kakhulu kunezinye izinhlobo zomdlavuza wamaphaphu. . Ngakolunye uhlangothi, ukuhlolwa kwe-ligand yohlobo lwe-1 ye-death receptor, okungukuthi i-PD-L1, kufanele yenziwe kuzo zonke izimo ze-NSCLC - kusho uProf. Kowalski.
I-Chemoimmunotherapy ingcono kune-chemotherapy yodwa
Ekuqaleni kuka-2021, iziguli ezinawo wonke ama-subtypes e-NSCLC zanikezwa ithuba lokuthola ukwelashwa okungasebenzi kahle, kungakhathalekile ukuthi iliphi izinga le-PD-L1 protein expression. I-Pembrolizumab ingasetshenziswa ngisho nalapho inkulumo ye-PD-L1 ingu-<50%. - esimweni esinjalo, ngokuhlanganiswa ne-chemotherapy kanye nokusetshenziswa kwe-platinum compounds kanye nezinhlanganisela ze-cytostatic zesizukulwane sesithathu ezikhethiwe ngokusho kwe-subtype yomdlavuza.
- Inqubo enjalo ingcono impela kunokwelashwa ngamakhemikhali okuzimele - umehluko wobude bokuphila ufinyelela ngisho nezinyanga eziyi-12 uvuna i-chemoimmunotherapy - kusho u-prof. Kowalski. Lokhu kusho ukuthi iziguli ezelashwa ngenhlanganisela yokwelapha ziphila isilinganiso esiyizinyanga ezingama-22, kanti iziguli ezithola i-chemotherapy zizodwa nje ngaphezudlwana kwezinyanga eziyi-10. Kuneziguli okuthi, ngenxa ye-chemoimmunotherapy, ziphile ngisho neminyaka eminingana kusukela ekusetshenzisweni kwayo.
Ukwelapha okunjalo kuyatholakala emgqeni wokuqala wokwelashwa lapho ukuhlinzwa kanye ne-chemotherapytherapy ingakwazi ukusetshenziswa ezigulini ezinesifo esithuthukile, okungukuthi ama-metastases akude. Izimo ezinemininingwane zibekwe Ohlelweni Lwezidakamizwa Lomnyango Wezempilo ukuze zelashwe umdlavuza wamaphaphu (uhlelo B.6). Ngokwezilinganiso, amaphesenti angama-25-35 abantu abakhethelwe i-chemoimmunotherapy. iziguli ezinesigaba IV NSCLC.
Ngenxa yokwengezwa komuthi ovikela umzimba ku-chemotherapy, iziguli zisabela kangcono kakhulu ekwelashweni okulwa nomdlavuza kunabantu abathola i-chemotherapy kuphela. Okubalulekile, ngemva kokuphela kokwelashwa ngamakhemikhali, i-immunotherapy njengokuqhubeka kokwelashwa okuhlangene isetshenziswa esigulini esingalalisiwe. Lokhu kusho ukuthi isiguli asikho isidingo sokuthi silaliswe esibhedlela njalo uma siyithola. Nakanjani kuthuthukisa izinga lempilo yakhe.
Lesi sihloko sakhiwe njengengxenye yomkhankaso othi "Longer Life With Cancer", owenziwe yi-portal www.pacjentilekarz.pl.
Lokhu kungase kube nentshisekelo kuwe:
- Inobuthi njenge-asbestos. Ungadla kangakanani ukuze ungazilimazi?
- Amacala omdlavuza ayakhula. Isibalo sabashonile siyakhula nasePoland
- Ukuxilongwa okunjalo kuyashaqisa. Yini okufanele ngiyazi ngomdlavuza wamaphaphu?
Okuqukethwe kuwebhusayithi ye-medTvoiLokony kuhloswe ngayo ukuthuthukisa, hhayi esikhundleni, ukuxhumana phakathi komsebenzisi Wewebhusayithi nodokotela wabo. Isizindalwazi senzelwe izinjongo zokwazisa kanye nezokufundisa kuphela. Ngaphambi kokulandela ulwazi olukhethekile, ikakhulukazi izeluleko zezokwelapha, eziqukethwe kuWebhusayithi yethu, kufanele uthintane nodokotela. Umlawuli akanazo imiphumela ebangelwa ukusetshenziswa kolwazi oluqukethwe kuWebhusayithi. Ingabe udinga ukubonisana nodokotela noma incwadi kadokotela? Iya ku-halodoctor.pl, lapho uzothola khona usizo lwe-inthanethi - ngokushesha, ngokuphepha futhi ngaphandle kokushiya ikhaya lakho.