Ke ʻeha nei ʻoe i ka poʻohiwi a me ka nāwaliwali o ka lima? He Pancoast Tumor paha ia!

Ke ʻeha nei ʻoe i ka ʻeha poʻohiwi i wehewehe ʻole ʻia, i kekahi manawa ma ka ʻaoʻao o kou ʻāʻī, me ka ʻeha ma lalo o kou lima, ka mae ʻana o kou lima? I kekahi manawa manaʻo paha mākou he ʻeha wale nō ia a he aʻalolo i ʻoki ʻia paha. Eia nō naʻe, hiki i kēia mau hōʻailona ke hōʻailona o kahi mea ʻoi aku ka koʻikoʻi. ʻO ia ke kūlana a mākou e kamaʻilio ai i kēia lā, ʻo ia hoʻi ka Pancoast Tumor.

He aha ka Pancoast Tumor? I ka ʻōlelo maʻalahi...

E noʻonoʻo e pili ana i ia mea, he ʻano maʻi kanesa māmā ka puʻupuʻu Pancoast. Akā he mea ʻē iki ia. Hoʻokumu ʻia ia ma ka piko loa o kou mau māmā, ma luna pono o kou iwi ʻaoʻao mua. ʻAʻole e like me nā maʻi kanesa māmā ʻē aʻe, ʻaʻole hoʻoulu ka puʻupuʻu Pancoast i ka ʻū a i ʻole ka ʻeha umauma . Akā, ʻike pinepine ka poʻe me kēia puʻupuʻu i ka ʻeha nui o ka poʻohiwi a me ka nāwaliwali o ka lima . Kāhea nā kauka i kēia hui pū ʻana o nā hōʻailona "Pancoast syndrome." ʻAʻole hoʻoulu ka Pancoast syndrome i nā hōʻailona o nā maʻi kanesa māmā maʻamau, no laila hiki ke lōʻihi ka manawa e ʻike ai i kēia mau puʻupuʻu. I nā hihia he nui, ʻaʻole i hana ʻia kahi hōʻailona paʻa a hiki i ka laha ʻana o ke kanesa i nā aʻalolo a me nā kīʻaha koko kokoke. Ua kapa ʻia nā puʻupuʻu Pancoast ma hope o ka radiologist nāna i wehewehe mua iā lākou i ka hoʻomaka ʻana o ke kenekulia 20. ʻO kekahi inoa no lākou ʻo ka superior sulcus tumor.

Aia kekahi mau ʻano o kēia?

ʻAe, aia kekahi mau ʻano ʻano o nā puʻupuʻu Pancoast. ʻO nā mea nui:

• ʻO nā maʻi ʻaʻai māmā liʻiliʻi ʻole - no ka laʻana, adenocarcinomas a me nā carcinomas cell squamous.
• Nā maʻi ʻaʻai māmā liʻiliʻi.

ʻO ka hapa nui o nā puʻupuʻu Pancoast he ʻano maʻi kanesa i kapa ʻia ʻo adenocarcinomas . Hoʻomaka kēia mau maʻi kanesa ma ka ʻili o kou mau alaloa a me nā alveoli (nā ʻeke ea liʻiliʻi i loko o kou mau māmā), ʻoi aku hoʻi i loko o nā pūnaewele glandular e hana ana i ka mucus.

Pehea ka maʻamau o kēia ʻano?

He mea kākaʻikahi loa nā puʻupuʻu Pancoast, ʻoi aku ka liʻiliʻi ma mua o 5% o nā puʻupuʻu māmā āpau.

He aha nā hōʻailona o kēia? E nānā pono kākou!

Ua hoʻopilikia ʻia kou plexus brachial e kahi puʻupuʻu Pancoast.Hiki ke hoʻopaʻa ʻia kēia pūnaewele aʻalolo. Holo kēia pūnaewele aʻalolo mai kou umauma luna ma o kou ʻāʻī a i kou mau lima. Ke kau ʻia kēia kaomi, hiki ke loaʻa kahi hōʻailona kikoʻī. ʻO ia ke kumu i kapa ʻia ai e nā kauka he Pancoast syndrome a i ʻole Pancoast-Tobias syndrome. Loaʻa kēia mau hōʻailona ma ka ʻaoʻao like me ka puʻupuʻu . No ka laʻana, inā aia ka puʻupuʻu ma kou māmā ʻākau, e hoʻopilikia pū nā hōʻailona i ka ʻaoʻao ʻākau o kou kino. Hiki i nā hōʻailona o kahi puʻupuʻu Pancoast ke komo pū me:

• ʻEha nui o ka poʻohiwi : Hiki i kēia ke komo pū me ka ʻeha ma kou ʻūhā poʻohiwi.
• ʻEha e hohola ana i lalo o ka lima: Hiki ke pau kēia ʻeha ma ka pulima, ma luna pono o ka manamana lima liʻiliʻi.
• Ka nāwaliwali ma ka lima a me ka pūhaka.
• ʻEha ʻāʻī.
• ʻEha ma ka ʻaoʻao o luna o nā iwi ʻaoʻao.
• Ka pehu ʻana o ka lima luna.
• Ka nalowale o ke akamai ma nā lima a me nā manamana lima.
• ʻUʻumi a ʻāʻī paha i ka lima.
• Luhi.
• Paʻa ka umauma.
• Ka pohō kaumaha me ke kumu ʻole.

Ma kahi o 50% o ka poʻe me nā puʻupuʻu Pancoast e hoʻomohala pū i kahi maʻi i kapa ʻia ʻo Horner's syndrome , hiki ke hana i nā hōʻailona e like me:

• ʻUlaʻula o ka maka.
• Ka lihilihi ʻana o ka maka (ptosis).
• Ke huli nei nā lihilihi i loko (enophthalmos).
• ʻAʻohe hou ʻana (anhidrosis).

He aha ke kumu o kēia? He aha nā kumu pilikia?

Ua like nā kumu a me nā kumu pilikia no nā puʻupuʻu Pancoast me nā maʻi kanesa māmā ʻē aʻe. ʻO nā kumu pilikia nui:

• Puhipaka .
• Ka ʻike ʻia ʻana e ka uahi lua.
• ʻO ka hoʻopili lōʻihi ʻana i kekahi mau mea e like me ka asbestos, ke kinoea radon, a me nā metala kaumaha.

E noʻonoʻo wale, ma ka hōʻike ʻana iā mākou iho i kēia mau mea, ke hōʻino nei mākou i ko mākou mau māmā me ka ʻike ʻole. No laila he mea nui loa ia e makaʻala i kēia.

Pehea e laha ai kēia?

Hoʻolaha ka maʻi kanesa ke hemo nā hunaola kanesa mai ka puʻupuʻu mua, hele ma o kou ʻōnaehana koko a i ʻole ka ʻōnaehana lymph, a hana i nā puʻupuʻu hou ma nā wahi ʻē aʻe o kou kino. Hiki i nā puʻupuʻu Pancoast ke hoʻolaha pinepine mai ka ʻaoʻao o luna o nā māmā a i nā wahi aʻe:

• Umauma luna.
• I lalo ke poʻo.
• Nā iwi ʻaoʻao ʻūhā.
• ʻO nā kīʻaha koko kokoke loa i nā lima.

ʻO kēia laha ʻana o ke kanesa i nā wahi mamao aku ua kapa ʻia ʻo metastasis .

Pehea e ʻike ʻia ai kēia?

I nā pae mua, ʻaʻole ʻike maʻalahi ʻia nā puʻupuʻu Pancoast ma kahi X-ray umauma ʻelua-dimensional maʻamau. ʻO ia ke kumu e paʻakikī ai ke ʻike. Inā kānalua ke kauka i kahi puʻupuʻu Pancoast ma muli o kāu mau hōʻailona, ​​​​hiki iā lākou ke paipai i nā hoʻokolohua diagnostic ʻē aʻe, e like me:

• Nā hoʻokolohua kiʻi ʻē aʻe.
• ʻO ka biopsy nila.
• ʻO ke ʻoki thoracoscopy i kōkua ʻia e ke wikiō (VATS).
• ʻO ke ʻoki ʻana o ka thoracotomy.

Nā hoʻokolohua kiʻi

Hiki i ka ʻenehana kiʻi kiʻekiʻe ke kōkua i kāu kauka e kiʻi i kahi kiʻi maopopo o kou mau māmā. Hiki iā ia ke kauoha i nā hoʻokolohua e like me kēia:

• ʻO ke kiʻi CT (CT - nā kiʻi tomography i helu ʻia).
• ʻO ke scan PET (nā scan tomography hoʻokuʻu positron).
• MRI scan (MRI - kiʻi hoʻohālikelike magnetic).

Hiki i kēia ʻano scan ke hāʻawi i ka ʻike he nui, e like me ka nui o ka puʻupuʻu, kona wahi, a inā ua pālahalaha aku i nā wahi ʻē aʻe.

ʻO ka biopsy nila

I loko o kahi biopsy nila, lawe ke kauka i kahi hāpana o ka wai, nā ʻiʻo, a i ʻole nā ​​​​​​kelepona mai kahi puʻupuʻu ʻē. A laila hoʻouna ʻia ka hāpana i kahi keʻena hoʻokolohua pathology no ka hoʻāʻo hou aku. Ma laila wale nō e hiki ai iā mākou ke ʻike maopopo inā he maʻi ʻaʻai ia a he aha ke ʻano.

ʻO ke ʻoki thoracoscopy i kōkua ʻia e ke wikiō (VATS)

I loko o kēia kaʻina hana, hana ke kauka i kahi ʻoki liʻiliʻi ma kou umauma a hoʻokomo i kahi thoracoscope (he ʻōmole lahilahi me kahi kāmela liʻiliʻi ma luna). ʻAe kēia iā ia e nānā i loko o kou lua umauma a nānā i nā puʻupuʻu a i ʻole nā ​​​​​​mea ʻē aʻe. Inā loaʻa kekahi, lawe ʻia kahi hāpana o ka ʻiʻo a hoʻouna ʻia i kahi keʻena hoʻokolohua no ka hoʻāʻo ʻana.

Ka hoʻopaʻa ʻana o ka ʻūhā

I kekahi mau hihia, pono paha ke kauka e hana i kahi thoracotomy. Ma kēia, hana lākou i kahi ʻoki ma ka ʻaoʻao ʻākau a hema paha o kou umauma, ma waena o nā iwi ʻaoʻao. ʻAe kēia iā lākou e ʻike maopopo i ka māmā i hoʻopilikia ʻia a lawe i kahi biopsy o kekahi ʻiʻo ʻē. I ka hapa nui o nā hihia, e wehe pū lākou i ka puʻupuʻu i ka manawa like. E hoʻopakele kēia iā ʻoe mai ka pono e hana i nā ʻokiʻoki he nui.

E aʻo kākou e pili ana i ke kahua o kēia maʻi ʻaʻai.

E like me nā ʻano maʻi ʻaʻai māmā ʻē aʻe, hoʻokaʻawale nā ​​kauka i nā puʻupuʻu Pancoast me ka hoʻohana ʻana i kahi ʻōnaehana hoʻonohonoho maʻi kanesa . Hoʻohana lākou i nā helu Roma (I, II, III, IV) a me nā subtypes (A, B) e wehewehe i ke ʻano o ka holomua o ka puʻupuʻu a me ka mamao o kona laha ʻana. No nā puʻupuʻu Pancoast, hoʻohana nā kauka i nā leka T, N, M a me nā helu 1, 2, 3, 4 e hōʻike i ke koʻikoʻi o ke kūlana:

• ʻO ka leka T e pili ana i ka nui o kou puʻupuʻu a me ka mamao o kona pālahalaha ʻana.
• ʻO ka leka N e pili ana inā ua pālahalaha ke kanesa i kou mau lymph nodes .
• Hōʻike ka leka M inā ua pālahalaha ke kanesa i nā ʻāpana mamao o ke kino (metastasis) .

I ka pae hea e loaʻa pinepine ai nā puʻupuʻu Pancoast?

No ka mea, he paʻakikī ke ʻike ʻana i nā puʻupuʻu Pancoast i nā pae mua, ua ʻike ʻia ka hapa nui ma ke kahua T3 a i ʻole T4. ʻO ke ʻano o T3 ua pālahalaha ke kanesa i kou paia umauma a i ʻole kou mau aʻalolo sympathetic. ʻO ke ʻano o T4 ua pālahalaha ke kanesa i nā ʻano ʻē aʻe, e like me kou mau aʻalolo brachial a i ʻole ke kaula spinal. He ʻano koʻikoʻi kēia.

He aha ka lāʻau lapaʻau?

Aia kēia ma kahi o ka puʻupuʻu a me ka mamao o ka laha ʻana o ke kanesa. Aia kekahi mau koho lapaʻau:

• ʻO ke kemoradiation a me ke ʻoki kino.
• ʻO Chemoimmunotherapy a me ke ʻoki kino.
• ʻO Chemoradiation a me ka immunotherapy.
• Hoʻōla radiation.
• Lapaʻau i kuhikuhi ʻia.

ʻO ke kemoradiation a me ke ʻoki kino

ʻO ke ʻoki kino ka lāʻau lapaʻau maikaʻi loa i nā manawa āpau e hiki ai. Eia nō naʻe, ma mua o ke ʻoki kino, hāʻawi paha nā kauka iā ʻoe i ka chemoradiation - kahi hui pū ʻana o ka chemotherapy a me ka radiation therapy - e hoʻēmi i ka puʻupuʻu. Hiki ke paʻakikī iki ke ʻoki kino e wehe i kahi puʻupuʻu Pancoast. ʻO ka maʻamau, pono ke kauka ʻoki kino e wehe i kou mau iwi ʻaoʻao ʻelua o luna. Pono paha lākou e wehe i kahi aʻa nui a hoʻololi iā ia me kahi graft vascular - kahi paipu hana e ʻae ai i ke koko e kahe. E wehewehe kāu kauka ʻoki kino i kēia mau mea āpau iā ʻoe ma mua o ke ʻoki kino.

ʻO ke Chemoimmunotherapy a me ke ʻoki kino

I kekahi mau hihia, hiki i nā kauka ke ʻōlelo aku i ke ʻoki ʻana a me ka chemoimmunotherapy.- ʻo ia hoʻi, ka hui pū ʻana o ka chemotherapy a me ka immunotherapy - hoʻohana ʻia. ʻOiai ʻo ka chemotherapy e pepehi i nā hunaola kanesa a hoʻolohi i ka ulu ʻana o ka puʻupuʻu, hoʻoulu ka immunotherapy i kāu ʻōnaehana pale ponoʻī e kōkua i ke kaua ʻana i ka maʻi kanesa.

ʻO Chemoradiation a me ka immunotherapy

I kekahi manawa, ʻaʻole hiki ke hana ʻoki kino. I ia mau hihia, hiki i kāu hui lapaʻau ke paipai i ka hui pū ʻana o ka chemoradiation a me ka immunotherapy.

Hoʻōla radiation

Inā ʻaʻole hiki ke ʻoki ʻia a ua laha ke kanesa i nā ʻāpana ʻē aʻe o ke kino, hiki i kāu kauka ke ʻōlelo aku i ka radiation therapy wale nō e kāohi i ka ulu ʻana o ke kanesa. Hiki i kēia ʻano mālama kākoʻo ke hoʻēmi i ke kanesa a hōʻoluʻolu i kāu mau hōʻailona.

Hoʻōla i kuhikuhi ʻia

Loaʻa i kekahi poʻe ka pōmaikaʻi mai ka lāʻau lapaʻau i kuhikuhi ʻia . Kuhi kēia lāʻau lapaʻau i nā hoʻololi genetic e hoʻolilo i nā cell olakino e lilo i mau cell kanesa. No ka ʻike ʻana inā he moho maikaʻi ʻoe no ka lāʻau lapaʻau i kuhikuhi ʻia, e hoʻāʻo ke kauka i kāu mau cell kanesa e ʻike inā he mau mea loaʻa kikoʻī ko lākou no nā protein kikoʻī. Inā he mau nīnau kāu e pili ana i kēia, e kamaʻilio me kāu kauka.

Hiki ke pale ʻia kēia?

ʻOiai ʻaʻole hiki ke pale loa ʻia nā puʻupuʻu Pancoast, aia kekahi mau mea hiki iā ʻoe ke hana e hōʻemi i kou pilikia o ka hoʻomohala ʻana i kēia ʻano maʻi kanesa:

• E pale i ka puhipaka a me nā huahana paka ʻē aʻe. Inā ʻoe e puhipaka, e kamaʻilio me kāu kauka no ke kōkua e haʻalele.
• E pale i ka hoʻopili ʻana i ka uahi lua i ka hiki.
• E hōʻoia i ka ʻole o nā kemika ʻino e like me ka asbestos i kou wahi noho.

ʻOiai paha he mau mea liʻiliʻi kēia, hiki iā lākou ke hoʻopilikia nui i kou olakino i ka wā lōʻihi.

Eia kekahi, inā he moʻolelo ko kekahi o kou ʻohana no ka maʻi kanesa o ka māmā, a inā he kiʻekiʻe kou pilikia o ka loaʻa ʻana o ka maʻi kanesa o ka māmā, he mea maikaʻi ke nīnau i kāu kauka e pili ana i nā nānā ʻana i ka maʻi kanesa pale .

He aha kāu e manaʻo ai inā loaʻa iā ʻoe kahi maʻi puʻupuʻu Pancoast?

Inā ua ʻike ʻia ʻoe me kahi puʻupuʻu Pancoast, e hoʻonohonoho kāu kauka i kahi hui lapaʻau i kūpono i kāu mau pono kikoʻī. Hiki i kāu hui lapaʻau ke komo pū me:

• Nā kauka ʻokiʻoki umauma.
• Nā kauka ʻokiʻoki lolo.
• ʻO nā kauka maʻi kanesa , ʻo ia hoʻi, nā kauka maʻi kanesa lapaʻau, nā kauka maʻi kanesa ʻokiʻoki, a me nā kauka maʻi kanesa radiation.

E ʻōlelo aku kāu hui lapaʻau i ka lāʻau lapaʻau e pili ana i ka nui o ka puʻupuʻu Pancoast, kona wahi, a inā ua pālahalaha ke kanesa i nā wahi ʻē aʻe.

Pehea ka wikiwiki o ka ulu ʻana o kēia mau nati?

ʻO ka hapa nui o ka manawa, ulu mālie nā puʻupuʻu Pancoast. Eia naʻe, he mea kākaʻikahi loa, hiki i kahi puʻupuʻu ke ulu wikiwiki loa. E nānā mau kāu kauka i ka ulu ʻana o ka puʻupuʻu ma mua, i ka wā, a ma hope o ka mālama ʻana.

He aha ka manaʻolana ola?

I nā makahiki i hala iho nei, ua alakaʻi ka holomua o ka ʻenehana i ka piʻi mālie ʻana o ka nui o ka poʻe i ho'ōla ʻia mai nā puʻupuʻu Pancoast. Akā, nui nō nā mea e aʻo ai e pili ana i kēia maʻi. ʻO ka helu ola ʻelima makahiki no ka poʻe me nā puʻupuʻu Pancoast i ke kahua mua, hiki ke mālama ʻia ma ke ʻoki ʻana, aia ma waena o 30% a me 50% . ʻO ia hoʻi, ma kahi o ka hapalua o ka poʻe i ʻike ʻia me nā puʻupuʻu Pancoast i ke kahua mua e ola mau ana i ʻelima mau makahiki ma hope o ka ʻike ʻana. Akā, he mea nui e hoʻomanaʻo: He mau kuhi wale nō kēia mau helu ola. ʻAʻole lākou e haʻi pololei iā ʻoe i ka lōʻihi o kou ola ʻana a i ʻole pehea ka maikaʻi o kahi lāʻau lapaʻau iā ʻoe. E kamaʻilio me kāu kauka e hoʻomaopopo pono i ke ʻano o ka hopena o kēia maʻi kanesa iā ʻoe.

Āhea ʻoe e ʻimi ai i ke aʻo lapaʻau?

Inā loaʻa iā ʻoe ka ʻeha nui o ka poʻohiwi, ka ʻeha o ka lima, ka nāwaliwali o ka lima, a i ʻole nā ​​hōʻailona ʻē aʻe o kahi puʻupuʻu Pancoast, pono ʻoe e ʻike koke i ke kauka. He mea nui ka ʻike mua ʻana.

He aha nā nīnau āu e nīnau ai i ke kauka?

Inā ʻike ʻia ʻoe a i ʻole kahi mea aloha me kahi maʻi puʻupuʻu Pancoast, makemake paha ʻoe e nīnau i kāu kauka i kēia mau nīnau:

• Aia i hea ka puʻupuʻu?
• Ua laha anei i nā ʻiʻo a puni?
• Ua laha anei i nā wahi mamao o ke kino?
• He aha ke kahua o ka maʻi kanesa i loaʻa iaʻu?
• He aha nā koho lapaʻau e loaʻa iaʻu?
• E hiki anei iaʻu ke hana i ka wā o ka mālama ʻana?
• ʻEhia ka lōʻihi o ka mālama ʻana?
• Pehea koʻu manaʻo?

He puʻupuʻu Pancoast anei kēia a he aʻalolo ʻiʻo paha?

Wahi a kekahi poʻe me nā puʻupuʻu Pancoast ua hoʻomaka kā lākou mau hōʻailona me ka manaʻo "pinched nerve" . Inā loaʻa iā ʻoe kēia ʻano ʻeha a mau ia no ʻelua pule, e hoʻomaopopo i ke kauka. ʻAʻole paha he mea maʻamau.

Leka Hoʻihoʻi Hope Loa

Hoʻomaka nā puʻupuʻu Pancoast ma ka ʻaoʻao o luna o kou mau māmā. He ʻokoʻa lākou mai nā ʻano puʻupuʻu māmā ʻē aʻe no ka mea he paʻakikī ke ʻike i nā pae mua. ʻO ka ʻike ʻana he puʻupuʻu Pancoast kou hiki ke lilo i mea huikau loa. Hiki ke hoʻoluhi i ka hoʻolālā ʻana i ka mea e hana ai ma hope.

Akā e hoʻomanaʻo, aia kāu kauka ma laila e kōkua iā ʻoe. E noi iā ia no ka ʻike hou aku e pili ana i kou kūlana kikoʻī. Inā hiki iā ʻoe, e hui pū me kahi hui kākoʻo, ma ke kino a i ʻole ma ka pūnaewele. ʻO ke kamaʻilio ʻana me nā poʻe ʻē aʻe e hele nei i nā mea like āu e hele nei he mea maikaʻi loa ia no kou olakino noʻonoʻo, naʻau, a me ka ʻuhane. Mai ʻeha hoʻokahi.

 ʻO ka puʻupuʻu Pancoast, ka maʻi kanesa māmā, ʻeha poʻohiwi, nā hōʻailona kanesa, ka mālama ʻana i ka maʻi kanesa, ka maʻi kanesa māmā, ʻeha poʻohiwi