Kuyini i-Pancoast Tumors futhi iphathwa kanjani?

-Delile

• Izimpawu zesimila sePancoast
• Izimbangela zesimila sePancoast
• Sitholakala kanjani isimila sePancoast
• Ukwelashwa kwesimila sePancoast
• Isiteji
• Ukwelashwa
• Ukudambisa izinhlungu
• Amanani okusinda kwesimila sePancoast
• Umbono

Ukubuka konke

Isimila sePancoast siyindlela engajwayelekile yomdlavuza wamaphaphu. Lolu hlobo lwesimila lutholakala phezulu (phezulu) kwephaphu langakwesokudla noma kwesobunxele. Njengoba isimila sikhula, indawo esikuyo siyenza ikwazi ukuhlasela izinzwa, imisipha, ama-lymph node, izicubu ezixhumene nazo, izimbambo ezingaphezulu nama-vertebrae aphezulu. Lokhu kubangela ubuhlungu obukhulu ehlombe nasengalweni.

Ukuxilongwa kwezimila zePancoast kuvame ukubambezeleka, ngoba isimila asibonisi izimpawu zakudala zomdlavuza wamaphaphu, njengokukhwehlela.

Izimila zepancoast zaziwa nangokuthi izicubu eziphakeme ze-sulcus. Izimpawu zazo ezibizwa ngokuthi yi-Pancoast syndrome. Abantu abane-tumor qala cishe baneminyaka engama-60 ubudala. Abesilisa bayathinteka kunabesifazane.

Lo mdlavuza uqanjwe ngaye, udokotela oyi-radiologist wasePhiladelphia owaqala wachaza izicubu ngo-1924 nango-1932.

Ama-subtypes womdlavuza wamangqamuzana ePancoast yilawa:

• umdlavuza wamangqamuzana squamous
• adenocarcinomas
• ama-carcinomas amangqamuzana amakhulu
• ama-carcinomas amangqamuzana amancane

Izimpawu zesimila sePancoast

Ubuhlungu behlombe obukhali uphawu oluvame kakhulu lwesimila sePancoast kusaqala. Ezinye izimpawu zincike ezindaweni lapho isimila singena sizungeze ukuvulwa kwesifuba (i-thoracic inlet).

Njengoba isimila sikhula, ubuhlungu behlombe buba bukhulu kakhulu futhi buthakaze. Ingakhanya ibheke ekhwapheni (i-axilla), emgodleni wamahlombe, nasethanjeni elixhumanisa ihlombe nengalo (scapula).

Ezimweni ezingaphezu kwesimila sePancoast, isimila singena ezingxenyeni ezingemuva naphakathi kokuvulwa kwesifuba. Ubuhlungu bungakhipha:

• wehle engalweni ohlangothini lomzimba ulandela imizwa ye-ulnar (inzwa eyehla ohlangothini lwengalo yakho iye ngaku-pinky, ime esihlakaleni)
• entanyeni
• ezimbanjeni ezingenhla
• kwinethiwekhi yezinzwa efinyelela ezimbanjeni, emgogodleni nasekhwapheni

Ezinye izimpawu zifaka:

• ukuvuvukala kwengalo engenhla
• ubuthakathaka emisipheni yesandla
• ukulahleka kobuciko besandla
• ukumoshwa kwezicubu zemisipha esandleni
• ukuluma noma ukuba ndikindiki esandleni
• ukuqina kwesifuba
• ukukhathala
• ukuncipha komzimba

Zizonke lezi zimpawu zaziwa njenge-Pancoast syndrome.

Kubantu abanezicubu zePancoast, umdlavuza uhlasela izinzwa ezifinyelela ebusweni. Lokhu kubizwa ngokuthi yi-Claude-Bernard-Horner syndrome, noma nje i-Horner's syndrome. Ohlangothini oluthintekile, ungahle ube:

• ijwabu leso le-droopy (blepharoptosis)
• ukungakwazi ukujuluka ngokujwayelekile (anhidrosis)
• ukuqhuma
• ukufuduka kwenhlamvu yeso lakho (enophthalmos)

Ubuhlungu besimila sePancoast bukhulu futhi buhlala buhleli. Imvamisa ayiphenduli ekunciphiseni izinhlungu ezivamile ezithengiswayo. Ubuhlungu buhlala noma ngabe uhleli, umile, noma ulele phansi.

Izimbangela zesimila sePancoast

Izimbangela zesimila sePancoast ziyefana nezinye zomdlavuza wamaphaphu. Lokhu kufaka phakathi:

• ukubhema
• ukuvezwa intuthu yesibili
• ukuvezwa isikhathi eside ezinsimbi ezisindayo, amakhemikhali, noma ukukhishwa kukadizili
• ukuvezwa isikhathi eside kuma-asbestos noma amazinga aphezulu we-radon

Ezimweni ezingavamile, i-Pancoast syndrome yezimpawu ingaba nezinye izimbangela, njengezinye izinhlobo zomdlavuza, ukutheleleka kwamagciwane noma ukhunta, noma isifo sofuba (TB) nezinye izifo.

Sitholakala kanjani isimila sePancoast

Ukuxilongwa kwesimila sePancoast kuyinselele futhi kuvame ukubambezeleka ngoba izimpawu zaso ziyefana nezesifo samathambo nezihlanganisi. Futhi, izicubu zePancoast azivamile futhi kungenzeka zingaziwa odokotela. Izimila zepancoast zakha kuphela wonke umdlavuza wamaphaphu.

Udokotela wakho uzokubuza ngezimpawu zakho, ukuthi zaqala nini, nokuthi zishintshile yini ngokuhamba kwesikhathi. Bazokwenza ukuhlolwa ngokomzimba noku-oda izivivinyo ukubheka isimila nanoma yikuphi ukusabalala komdlavuza. Uma kutholakala isimila, udokotela wakho angalawula izivivinyo ezengeziwe ukuthola isigaba sesimila.

Ukuhlolwa kungafaka:

• Ama-X-ray. Kwesinye isikhathi isimila ngenxa yesikhundla saso.
• Iskena se-CT. Isixazululo sayo esiphakeme singakhomba ukusabalala kwesimila ezindaweni eziseduze.
• Ukuskena kwe-MRI. Lokhu kuhlolwa kwe-imaging kungakhombisa ukusabalala kwesimila futhi kunikeze umhlahlandlela wokuhlinzwa.
• I-Mediastinoscopy. Ishubhu efakwe entanyeni ivumela udokotela ukuba athathe isampula lama-lymph node.
• Isidumbu. Ukususa izicubu ze-tumor ukuze kuhlolwe kubhekwa njengokuqinisekisa isigaba se-tumor nokunquma ukwelashwa.
• I-thoracoscopy esizwa ngevidiyo (VATS). Lokhu kuhlinzwa okuncane okungajwayelekile kuvumela ukufinyelela kwezicubu ukuze zihlaziywe.
• I-mini-thoracotomy. Le nqubo isebenzisa ukusikeka okuncane, futhi ukuthola izicubu zokuhlaziywa.
• Okunye ukuskena. Lokhu kungadingeka ukuhlola ukusabalala komdlavuza emathanjeni, ebuchosheni nakwezinye izindawo zomzimba.

Ukwelashwa kwesimila sePancoast

Yize ake abhekwa njengabulalayo, namuhla izimila zepancoast ziyelapheka, yize zingakalapheki.

Ukwelashwa kwesimila sePancoast kuncike ekutheni sitholakale kanjani kusenesikhathi, sisabalale kangakanani, izindawo ezithintekayo, nesimo sakho sempilo jikelele.

Isiteji

Isigaxa sePancoast “sihlelwe” ngendlela efanayo neminye imidlavuza yamaphaphu, kusetshenziswa izinombolo ezi-roman I kuya ku-IV nama-subtypes A noma B ukukhombisa ukuthi lesi sifo sihambe kanjani. Isiteji siyisiqondiso sokwelashwa okuthile ozokuthola.

Ngaphezu kwalokho, izicubu ze-Pancoast zihlukaniswa ngokwengeziwe ngezinombolo nezinombolo 1 kuya ku-4 ezibonisa ubunzima:

• U-T ukhomba ubukhulu nokusabalala kwesimila.
• U-N uchaza ukubandakanyeka kwe-lymph node.
• M kubhekiswa ekutheni ngabe amasayithi akude ahlaselwe yini (ama-metastases).

Iningi lamathumba ePancoast ahlukaniswa njenge-T3 noma i-T4, ngenxa yendawo akuyo. Izimila zihlukaniswa njenge-T3 uma zihlasela udonga lwesifuba noma izinzwa ezizwelayo. Ziyizicubu ze-T4 uma zihlasela ezinye izakhiwo, ezinjenge-vertebrae noma izinzwa ze-brachial.

Ngisho nezicubu zokuqala zePancoast zithathwa okungenani njenge-IIB, futhi ngenxa yendawo yazo.

Ukwelashwa

Ukwelashwa kwezimila zepancoast kuhlukahlukene futhi kufaka inhlanganisela yamakhemikhali, imisebe kanye nokuhlinzwa.

Izilonda zepancoast eziye zagcwala ezindaweni ezingaphezulu kwesifuba kungenzeka zingalungelwa ukuhlinzwa.

I-Chemotherapy ne-radiation yizinyathelo zokuqala ngaphambi kokuhlinzwa. Ngemuva kwalokho isimila siphinda sihlolwe ngenye i-CT scan noma okunye ukuhlolwa kwe-imaging. Ukuhlinzwa kwenzeka kahle emavikini amathathu kuya kwayisithupha ngemuva kokwelashwa ngamakhemikhali kanye nemisebe, ngaphambi kokuba noma yisiphi isibazi singaba endleleni yokuhlinzwa.

Kwezinye izinhlelo zokwelashwa, ukuhlinzwa kungalandelwa ezinye izindlela zokwelashwa ngemisebe ukubulala noma yimaphi amaseli omdlavuza asele.

Inhloso yokuhlinzwa ukususa ngokuphelele into enomdlavuza ezakhiweni ezihlasele. Lokhu akwenzeki ngaso sonke isikhathi, futhi lesi sifo singaphinda sibuye. Ucwaningo oluncane olwenziwe eMaryland luthole ukuthi lesi sifo siphinde sabuya kumaphesenti angama-50 alabo ababambe iqhaza abahlinzwa iPancoast tumor.

Intuthuko yezobuchwepheshe kumasu okuhlinza yenze ukuthi kube lula ukuhlinzeka ngezicubu ze-T4 Pancoast, kodwa umbono mubi kakhulu kunezinye izigaba zalesi sifo.

Ukudambisa izinhlungu

Ukuphumula kobuhlungu bamathumba wePancoast namuhla kubandakanya ukusetshenziswa okulawulwayo kwama-opioid abekwe ngudokotela. Kodwa-ke, lokhu kuza nemiphumela emibi engathandeki. Abanye abacwaningi baphikise ukubuyela kuzinyathelo zangaphambi kwe-opioid ezisebenza ngaphandle kwemiphumela emibi.

Imisebe nayo ingasetshenziselwa ukudambisa izinhlungu lapho ukuhlinzwa kungenzeki.

Ubuhlungu obukhulu ngamathumba wePancoast bungancishiswa ngenqubo yokuhlinza ekhubaza izinzwa eziqhuba izinhlungu emgogodleni. Lokhu kubizwa nge-cordotomy eqondiswa yi-CT, lapho i-CT scan isetshenziselwa ukuqondisa udokotela ohlinzayo.

Kwesinye isifundo, kulabo abane-Pancoast tumor babike ukuthuthuka okukhulu kobuhlungu ngale nqubo. I-cordotomy ngisho emasontweni okugcina wokuphila ingahlinzeka ukukhululeka kobuhlungu.

Okunye ukungenelela okungenzeka ukunciphisa izinhlungu zesimila sePancoast kufaka:

• i-decompression laminectomy (ukuhlinzwa okususa ingcindezi emithanjeni yomgogodla)
• i-phenol block (ukujova i-phenol ukuvimba izinzwa)
• ukukhuthazwa kwe-transdermal (usebenzisa amandla kagesi asezingeni eliphansi ngqo ebuchosheni)
• i-stellate ganglion block (ejova izinzwa emithanjeni entanyeni)

Amanani okusinda kwesimila sePancoast

Izinga lokusinda ngemuva kwe-chemotherapy, i-radiation, nokuhlinzwa kuyahlukahluka. Umbiko waseCleveland Clinic waphawula ukuthi isilinganiso sokusinda seminyaka emibili ngemuva kokuhlinzwa singamaphesenti angama-55 kuye kwangama-70. Izinga lokusinda leminyaka emihlanu lokuhlinzwa elasusa isimila sokuqala sePancoast lalingamaphesenti angama-54 laya kumaphesenti angama-77.

Umbono

Sekuyiminyaka eminingi izicubu zePancoast zithathwa njengezingelashwa. Ngenxa yendawo yesimila, kwakucatshangwa ukuthi ukuhlinzwa akunakwenzeka.

Emashumini eminyaka amuva nje, umbono wabantu abanezimila zePancoast usuthuthuke kakhulu. Izindlela ezintsha zokuhlinza zenze kwaba nokwenzeka ukuhlinza izicubu ezazibhekwa njengongasebenzi phambilini. Ukwelashwa okujwayelekile manje okubandakanya ukwelashwa ngamakhemikhali, imisebe, nokuhlinzwa kwandise amazinga okusinda.

Ukutholwa kokuqala kwesimila sePancoast kubalulekile ekunqumeni impumelelo yokwelashwa. Bheka udokotela wakho ngokushesha uma unezimpawu, bese uthatha izinyathelo zokukuvimbela njengokuyeka ukubhema uma ubhema.