Umdlavuza wamangqamuzana ongewona omncane

Umdlavuza wamangqamuzana ongewona omncane uhlobo oluvame kakhulu lomdlavuza wamaphaphu. Imvamisa ikhula futhi isakazeke kancane kancane kunomdlavuza omncane wamaphaphu weseli.

Kunezinhlobo ezintathu ezivamile zomdlavuza wamaphaphu wamangqamuzana ongewona omncane (NSCLC):

• I-Adenocarcinomas ivame ukutholakala endaweni engaphandle yamaphaphu.
• Ama-squamous cell carcinomas ngokuvamile atholakala maphakathi nephaphu eduze kweshubhu lomoya (i-bronchus).
• Ama-carcinomas amangqamuzana amakhulu kungenzeka kunoma iyiphi ingxenye yamaphaphu.
• Kunezinhlobo eziningi ezingavamile zomdlavuza wamaphaphu obizwa nangokuthi awuncane.

Ukubhema kubangela amacala amaningi (cishe ama-90%) womdlavuza wamangqamuzana ongewona omncane. Ubungozi buncike kwinani likagwayi obhema usuku ngalunye nokuthi unesikhathi esingakanani ubhema. Ukuba seduze komusi ovela kwabanye abantu (intuthu kagwayi) futhi kukhulisa ingozi yokuba nomdlavuza wamaphaphu. Kodwa abanye abantu abangakaze babheme baba nomdlavuza wamaphaphu.

Ucwaningo lukhombisa ukuthi ukubhema insangu kungasiza ukukhula kwamangqamuzana omdlavuza. Kepha akukho ukuxhumana okuqondile phakathi kokubhema insangu nokukhulisa umdlavuza wamaphaphu.

Ukuchayeka njalo emazingeni aphezulu okungcoliswa komoya namanzi okuphuza anezinga eliphakeme le-arsenic kungakhuphula ingozi yokuba nomdlavuza wamaphaphu. Umlando wokwelashwa ngemisebe emaphashini nawo ungakhuphula ubungozi.

Ukusebenza noma ukuhlala eduze kwamakhemikhali noma izinto ezibangela umdlavuza nakho kungandisa ingozi yokuba nomdlavuza wamaphaphu. Amakhemikhali anjalo afaka:

• Ama-asbestosi
• URadon
  
• Amakhemikhali afana ne-uranium, i-beryllium, i-vinyl chloride, i-nickel chromates, imikhiqizo yamalahle, igesi yesinaphi, i-chloromethyl ethers, uphethiloli nedizili
• Ama-alloys athile, upende, izingulube, kanye nezinto zokubulala
• Imikhiqizo esebenzisa i-chloride ne-formaldehyde

Izimpawu zingafaka:

• Ubuhlungu besifuba
• Ukukhwehlela okungapheli
• Akhwehlele igazi
• Ukukhathala
• Ukuphelelwa isifiso sokudla
• Ukwehlisa isisindo ngaphandle kokuzama
• Ukuphelelwa umoya
• Ukuqhuma
• Ubuhlungu lapho busakazekela kwezinye izindawo zomzimba

Umdlavuza wamaphaphu wokuqala awunakubanga zimpawu.

Ezinye izimpawu ezingabangelwa yi-NSCLC, imvamisa ngezigaba ezedlule:

• Ubuhlungu bamathambo noma isisa
• Ijwabu lehla
• Ukubola noma ukushintsha kwezwi
• Ubuhlungu obuhlangene
• Izinkinga zesipikili
• Ukugwinya ubunzima
• Ukuvuvukala kobuso
• Ubuthakathaka
• Ubuhlungu behlombe noma ubuthakathaka

Lezi zimpawu zingabangelwa ezinye izimo, ezingathi sína kakhulu. Kubalulekile ukukhuluma nomhlinzeki wakho wezempilo uma unezimpawu.

Umhlinzeki uzokwenza ukuhlolwa ngokomzimba futhi abuze ngomlando wakho wezokwelapha. Uzobuzwa ukuthi uyabhema yini, futhi uma kunjalo, ubhema kangakanani nokuthi usunesikhathi esingakanani ubhema. Uzobuzwa futhi nangezinye izinto okungenzeka zikubeke engcupheni yokuba nomdlavuza wamaphaphu, njengokuchayeka kumakhemikhali athile.

Ukuhlolwa okungenziwa ukuthola umdlavuza wamaphaphu noma ukubona ukuthi kusakazekile kufaka:

• Ukuskena kwamathambo
• I-x-ray yesifuba
• Qedela ukubalwa kwegazi (CBC)
• I-CT scan yesifuba
• I-MRI yesifuba
• Ukuskena kwePositron emission tomography (PET)
• Ukuhlolwa kwesikhwehlela ukubheka amangqamuzana omdlavuza
• I-Thoracentesis (isampuli yokwakhiwa ketshezi elizungeze iphaphu)

Ezimweni eziningi, ucezu lwesicubu luyasuswa emaphashini akho ukuze luhlolwe ngesibonakhulu. Lokhu kubizwa ngokuthi yi-biopsy. Kunezindlela eziningana zokwenza lokhu:

• I-Bronchoscopy ihlangene ne-biopsy
• I-CT-scan-iqondise i-needle biopsy
• I-endoscopic esophageal ultrasound (EUS) ene-biopsy
• I-Mediastinoscopy ene-biopsy
• Vula i-biopsy yamaphaphu
• I-Pleural biopsy

Uma i-biopsy ikhombisa umdlavuza, kwenziwa ukuhlolwa okuningi kwe-imaging ukuthola isigaba somdlavuza. Isiteji sisho ukuthi sikhulu kangakanani isimila nokuthi sesisabalale kangakanani. I-NSCLC yehlukaniswe izigaba ezi-5:

• Isigaba 0 - Umdlavuza awusakazekanga ngaphesheya kwengaphakathi langaphakathi lephaphu.
• Isigaba I - Umdlavuza mncane futhi awusabalalanga kuma-lymph node.
• Isigaba II - Umdlavuza ususabalalele kwamanye ama-lymph node eduze kwesimila sokuqala.
• Isigaba III - Umdlavuza ususabalele ezicutshini eziseduze noma kuma-lymph node akude.
• Isigaba IV - Umdlavuza ususabalele kwezinye izitho zomzimba, njengamanye amaphaphu, ubuchopho, noma isibindi.

Kunezinhlobo eziningi zokwelashwa ze-NSCLC. Ukwelashwa kuya ngesigaba somdlavuza.

Ukuhlinzwa ukwelashwa okuvamile kwe-NSCLC okungasakazekanga ngaphesheya kwama-lymph node aseduze. Udokotela ohlinzayo angasusa:

• Elinye lama-lobes lamaphaphu (lobectomy)
• Ingxenye encane kuphela yamaphaphu (ukususwa kwesigaxa noma kwengxenye)
• Lonke iphaphu (i-pneumonectomy)

Abanye abantu badinga i-chemotherapy. I-Chemotherapy isebenzisa izidakamizwa ukubulala amangqamuzana omdlavuza nokuvimba amaseli amasha ukuthi angakhuli. Ukwelashwa kungenziwa ngezindlela ezilandelayo:

• Ukwelashwa ngamakhemikhali kukodwa kuvame ukusetshenziswa lapho umdlavuza ususabalele ngaphandle kwamaphaphu (isigaba IV).
• Kunganikezwa futhi ngaphambi kokuhlinzwa noma imisebe yokwenza lezo zindlela zisebenze kangcono. Lokhu kubizwa ngokuthi ukwelashwa kwe-neoadjuvant.
• Kunganikezwa ngemuva kokuhlinzwa ukubulala noma yimuphi umdlavuza osele. Lokhu kubizwa ngokuthi yi-adjuvant therapy.
• I-Chemotherapy ivame ukunikezwa ngomthambo (nge-IV). Noma, inganikezwa ngamaphilisi.

Ukulawula izimpawu nokuvimbela izinkinga ngesikhathi nangemva kwe-chemotherapy kuyingxenye ebalulekile yokunakekelwa.

I-Immunotherapy wuhlobo olusha ukwelashwa olunganikezwa lona uqobo noma nge-chemotherapy.

Ukwelashwa okuhlosiwe kungasetshenziswa ukwelapha i-NSCLC. Ukwelashwa okuqondisiwe kusebenzisa izidakamizwa zero ngaphakathi kokuqondiwe (ama-molecule) ngaphakathi noma kumaseli womdlavuza. Lezi zinhloso zibamba iqhaza ekutheni amangqamuzana omdlavuza akhula futhi aphile kanjani. Kusetshenziswa lezi zinhloso, umuthi ukhubaza amangqamuzana omdlavuza ukuze angakwazi ukusabalala.

Ukwelashwa ngemisebe kungasetshenziswa ngamakhemikhali uma ukuhlinzwa kungenzeki. Ukwelashwa ngemisebe isebenzisa ama-x-ray anamandla noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza. Imisebe ingasetshenziswa uku:

• Yelapha umdlavuza, kanye ne-chemotherapy, uma ukuhlinzwa kungenzeki
• Siza ukuqeda izimpawu ezibangelwa umdlavuza, njengezinkinga zokuphefumula nokuvuvukala
• Siza ukudambisa izinhlungu zomdlavuza lapho umdlavuza ususabalele emathanjeni

Ukulawula izimpawu ngesikhathi nangemva kwemisebe esifubeni kuyingxenye ebalulekile yokunakekelwa.

Izindlela zokwelapha ezilandelayo zisetshenziselwa ukuqeda izimpawu ezibangelwa yi-NSCLC:

• Ukwelashwa nge-Laser - Isigaxa esincane sokukhanya okusha futhi sibulala amangqamuzana omdlavuza.
• Ukwelashwa kwe-Photodynamic - Isebenzisa isibani ukuze kusebenze umuthi emzimbeni, obulala amangqamuzana omdlavuza.

Unganciphisa ukucindezela kokugula ngokujoyina iqembu lokusekela. Ukwabelana nabanye abanokuhlangenwe nakho okuvamile nezinkinga kungakusiza ungazizwa uwedwa.

Umbono uyehluka. Imvamisa, i-NSCLC ikhula kancane. Kwezinye izimo, ingakhula futhi isakaze ngokushesha futhi ibangele ukufa ngokushesha. Umdlavuza ungadlulela nakwezinye izingxenye zomzimba, kufaka phakathi ithambo, isibindi, amathumbu amancane nobuchopho.

I-Chemotherapy ikhonjisiwe ukwelula impilo nokuthuthukisa ikhwalithi yempilo kwabanye abantu abane-stage IV NSCLC.

Izinga lokwelashwa lihlobene nesigaba sesifo nokuthi uyakwazi yini ukuhlinzwa.

• Umdlavuza weSigaba I no-II unamazinga aphezulu okusinda nokwelashwa.
• Umdlavuza weSigaba III ungalapheka kwezinye izimo.
• Umdlavuza weSigaba IV obuyile ucishe ungalapheki. Izinhloso zokwelashwa ukunweba nokwenza ngcono ikhwalithi yempilo.

Shayela umhlinzeki wakho uma unezimpawu zomdlavuza wamaphaphu, ikakhulukazi uma ubhema.

Uma ubhema, manje isikhathi sokuyeka. Uma unenkinga yokuyeka, khuluma nomhlinzeki wakho. Kunezindlela eziningi zokukusiza uyeke, kusuka emaqenjini okusekela kuya emithini kadokotela. Futhi, zama ukugwema intuthu kagwayi.

Uma uneminyaka engaphezu kwengu-55 ubudala futhi ubhema noma ujwayele ukubhema eminyakeni eyishumi edlule, khuluma nomhlinzeki wakho mayelana nokuhlolelwa umdlavuza wamaphaphu. Ukuze uhlolwe, udinga ukuhlolwa kwe-CT kwesifuba.

Umdlavuza - amaphaphu - iseli elingeyona elincane; Umdlavuza wamangqamuzana ongewona omncane; NSCLC; Adenocarcinoma - amaphaphu; I-squamous cell carcinoma - amaphaphu; I-cell carcinoma enkulu - amaphaphu

• Imisebe yesifuba - ukukhishwa
• Ukuhlinzwa kwamaphaphu - ukukhipha

• Amaphaphu
• Intuthu kagwayi nomdlavuza wamaphaphu

Araujo LH, Uphondo L, Merritt RE, Shilo K, Xu-Welliver M, Carbone DP. Umdlavuza wamaphaphu: umdlavuza wamaphaphu ongelona elincane nomdlavuza omncane wamaphaphu wamangqamuzana. Ku: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, abahleli. I-Abeloff’s Clinical Oncology. Umhlaka 6. IPhiladelphia, PA: Elsevier; 2020: isahluko 69.

I-Ettinger DS, i-Wood DE, i-Aggarwal C, et al. Imininingwane yemihlahlandlela ye-NCCN: umdlavuza wamaphaphu weseli ongeyona omncane, inguqulo 1.2020. UJ Natl Compr Canc Netw. 2019; 17 (12): 1464-1472. I-PMID: 31805526. pubmed.ncbi.nlm.nih.gov/31805526/.

Iwebhusayithi yeNational Cancer Institute. Ukwelashwa komdlavuza wamangqamuzana ongewona omncane (PDQ) - inguqulo yezobuchwepheshe yezempilo. www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq. Kubuyekezwe ngoMeyi 7, 2020. Kufinyelelwe ngoJulayi 13, 2020.

USilvestri GA, uPastis NJ, uTanner NT, uJett JR. Izici zomtholampilo zomdlavuza wamaphaphu. Ku: Broaddus VC, Mason RJ, Ernst JD, et al, abakwa-eds. Incwadi kaMurray neNadel Yemithi Yokuphefumula. Umhlaka 6. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 53.