Kodi mukumva kupweteka kwa phewa ndi kufooka kwa mkono? Kungakhale khansa ya Pancoast!

Kodi mumamva kupweteka kwa phewa kosaneneka, nthawi zina m'mbali mwa khosi lanu, limodzi ndi ululu pansi pa mkono wanu, dzanzi m'dzanja lanu? Nthawi zina tingaganize kuti ndi kuvulala kapena kupsinjika kwa mitsempha. Komabe, zizindikiro izi nthawi zina zingakhale chizindikiro cha vuto lalikulu. Umenewo ndi vuto lomwe tikambirane lero, lomwe limatchedwa Pancoast Tumor.

Kodi Chotupa cha Pancoast n'chiyani? Mwachidule...

Taganizirani izi, chotupa cha Pancoast ndi mtundu wa khansa ya m'mapapo . Koma ndi chachilendo pang'ono. Chifukwa chimapangika pamwamba pa mapapu anu, pamwamba pa nthiti yanu yoyamba, pamwamba. Mosiyana ndi khansa zina za m'mapapo, chotupa cha Pancoast sichimayambitsa chifuwa kapena kupweteka pachifuwa . M'malo mwake, anthu omwe ali ndi chotupachi nthawi zambiri amamva kupweteka kwambiri kwa phewa ndi kufooka kwa mkono . Madokotala amatcha kuphatikiza kwa zizindikiro izi kuti "Pancoast syndrome." Pancoast syndrome siyambitsa zizindikiro za khansa ya m'mapapo yachizolowezi, kotero zingatenge nthawi kuti zizindikire zotupazi. Nthawi zambiri, matenda enieni sapezeka mpaka khansa itafalikira ku mitsempha yapafupi ndi mitsempha yamagazi. Zotupa za Pancoast zimatchedwa dzina la katswiri wa radiologist yemwe adazifotokoza koyamba kumayambiriro kwa zaka za m'ma 1900. Dzina lina la iwo ndi chotupa chapamwamba cha sulcus.

Kodi pali mitundu ya izi?

Inde, pali mitundu ingapo ya zotupa za Pancoast. Zoopsa kwambiri ndi izi:

• Khansa za m'mapapo zomwe si za maselo ang'onoang'ono - mwachitsanzo, adenocarcinomas ndi squamous cell carcinomas.
• Khansa ya m'mapapo ya maselo ang'onoang'ono.

Matenda ambiri a Pancoast ndi mtundu wa khansa wotchedwa adenocarcinomas . Khansa zimenezi zimayambira m'kati mwa njira zanu zopumira mpweya ndi alveoli (tizikwama tating'onoting'ono ta mpweya m'mapapu anu), makamaka m'maselo a glandular omwe amapanga ntchofu.

Kodi vutoli ndi lofala bwanji?

Matenda a m'mapapo a Pancoast ndi osowa kwambiri , ndipo ndi ochepera 5% ya matenda onse a m'mapapo.

Kodi zizindikiro za izi ndi ziti? Tiyeni tiwone bwino!

Plexus yanu ya brachial imakhudzidwa ndi chotupa cha Pancoast.Ulalo wa mitsempha uwu ukhoza kupanikizika. Ulalo wa mitsempha uwu umayambira pachifuwa chanu chapamwamba kudzera m'khosi mpaka m'manja mwanu. Kupanikizika kumeneku kukagwiritsidwa ntchito, zizindikiro zinazake zimatha kuchitika. Ndicho chifukwa chake madokotala amatcha Pancoast syndrome kapena Pancoast-Tobias syndrome. Zizindikirozi zimachitika mbali imodzi ndi chotupa . Mwachitsanzo, ngati chotupacho chili m'mapapo anu akumanja, zizindikirozo zimakhudzanso mbali yakumanja ya thupi lanu. Zizindikiro za chotupa cha Pancoast zingaphatikizepo:

• Kupweteka kwambiri kwa phewa : Izi zingaphatikizepo kupweteka kwa tsamba la phewa lanu.
• Ululu wotuluka m'dzanja: Ululuwu ukhoza kutha padzanja, pamwamba pa chala chaching'ono.
• Kufooka m'manja ndi m'manja.
• Kupweteka kwa khosi.
• Ululu m'mbali ya pamwamba pa nthiti.
• Kutupa kwa mkono wapamwamba.
• Kutaya luso m'manja ndi zala.
• Kumva dzanzi kapena kunjenjemera m'dzanja.
• Kutopa.
• Kulimba pachifuwa.
• Kuchepetsa thupi popanda chifukwa.

Pafupifupi 50% ya anthu omwe ali ndi zotupa za Pancoast amakhalanso ndi vuto lotchedwa Horner's syndrome , lomwe lingayambitse zizindikiro monga:

• Kutsuka nkhope.
• Chikope chofooka (ptosis).
• Zikope zotembenukira mkati (enophthalmos).
• Kusatuluka thukuta (anhidrosis).

Kodi n’chiyani chimayambitsa izi? Kodi zinthu zoopsa ndi ziti?

Zomwe zimayambitsa komanso zomwe zimayambitsa khansa ya Pancoast ndi zofanana ndi khansa zina za m'mapapo. Zinthu zazikulu zomwe zimayambitsa khansa ndi izi:

• Kusuta fodya .
• Kukhudzidwa ndi utsi wa munthu wina.
• Kukumana ndi zinthu zina monga asbestos, mpweya wa radon, ndi zitsulo zolemera kwa nthawi yayitali.

Tangoganizani, podziika pangozi pazinthu izi, tikuwononga mapapu athu mosadziwa. Choncho ndikofunikira kwambiri kusamala ndi izi.

Kodi izi zimafalikira bwanji?

Khansa imafalikira pamene maselo a khansa amachoka ku chotupa choyambirira, amayenda m'magazi anu kapena m'thupi lanu, ndikupanga zotupa zatsopano m'mbali zina za thupi lanu. Zotupa za Pancoast nthawi zambiri zimatha kufalikira kuchokera kumtunda kwa mapapo kupita kumalo otsatirawa:

• Chifuwa chapamwamba.
• Mozondoka.
• Nthiti za m'chifuwa.
• Mitsempha yamagazi yomwe ili pafupi ndi manja.

Kufalikira kwa khansa kumeneku kumalo akutali kumatchedwa metastasis .

Kodi izi zimazindikirika bwanji?

Poyamba, zotupa za Pancoast sizimaoneka mosavuta pa X-ray yokhazikika ya chifuwa cha mbali ziwiri. Ndicho chifukwa chake zingakhale zovuta kuzizindikira. Ngati dokotala akukayikira kuti muli ndi chotupa cha Pancoast kutengera zizindikiro zanu, angakulangizeni mayeso ena ozindikira, monga:

• Mayeso ena ojambula zithunzi.
• Kufufuza kwa singano.
• Opaleshoni ya thoracoscopy yothandizidwa ndi kanema (VATS).
• Opaleshoni ya Thoracotomy.

Mayeso ojambula zithunzi

Ukadaulo wapamwamba wojambula zithunzi ungathandize dokotala wanu kudziwa bwino mapapu anu. Iye angakupatseni mayeso monga awa:

• Kujambula kwa CT (CT - computed tomography scans).
• Kujambula kwa PET (positron emission tomography scans).
• Kujambula kwa MRI (MRI - kujambula kwa maginito).

Ma scan amtunduwu angapereke chidziwitso chambiri, monga kukula kwa chotupacho, komwe chili, komanso ngati chafalikira kumadera ena.

Kufufuza kwa singano

Pakujambula singano, dokotala amatenga chitsanzo cha madzi, minofu, kapena maselo kuchokera ku chotupa chosazolowereka. Kenako chitsanzocho chimatumizidwa ku labu ya matenda kuti akachiyesenso. Ndi pamenepa pomwe tingadziwe ngati ndi khansa komanso mtundu wake.

Opaleshoni ya thoracoscopy (VATS) (kanema yothandizidwa ndi thoracoscopy)

Pa nthawi imeneyi, dokotala amadula pang'ono pachifuwa panu ndipo amaika thoracoscope (chubu chopyapyala chokhala ndi kamera kakang'ono). Izi zimamuthandiza kuyang'ana mkati mwa chifuwa chanu ndikuwona ngati pali zotupa kapena zolakwika zina. Ngati zapezeka, minofu imatengedwa ndikutumizidwa ku labotale kuti ikayesedwe.

Chifuwa chochotsa mimba

Nthawi zina, dokotala angafunike kuchita opaleshoni ya thoracotomy. Pachifukwa ichi, amacheka mbali yakumanja kapena yakumanzere ya chifuwa chanu, pakati pa nthiti. Izi zimawathandiza kuwona bwino mapapu omwe akhudzidwa ndi kutenga biopsy ya minofu iliyonse yolakwika. Nthawi zambiri, amachotsanso chotupacho nthawi yomweyo. Izi zidzakuthandizani kuti musachite opaleshoni yambiri.

Tiyeni tiphunzire za momwe khansa iyi imafalikira.

Monga mitundu ina ya khansa ya m'mapapo, madokotala amagawa zotupa za Pancoast pogwiritsa ntchito njira yowerengera khansa . Amagwiritsa ntchito manambala achiroma (I, II, III, IV) ndi mitundu ina (A, B) pofotokoza momwe chotupacho chakulira komanso momwe chafalikira. Pa zotupa za Pancoast, madokotala amagwiritsa ntchito zilembo T, N, M ndi manambala 1, 2, 3, 4 posonyeza kuopsa kwa vutoli:

• Chilembo T chimatanthauza kukula kwa chotupa chanu komanso momwe chafalikira.
• Chilembo N chimatanthauza ngati khansa yafalikira ku ma lymph nodes anu.
• Chilembo M chimasonyeza ngati khansa yafalikira kumadera akutali a thupi (metastasis) .

Kodi zotupa za Pancoast zimapezeka nthawi zambiri pamlingo uti?

Popeza zotupa za Pancoast n'zovuta kuzizindikira kumayambiriro, zambiri zimapezeka pa siteji ya T3 kapena T4. T3 zikutanthauza kuti khansa yafalikira mpaka pakhoma la chifuwa chanu kapena mitsempha yanu ya sympathetic. T4 zikutanthauza kuti khansa yafalikira ku ziwalo zina, monga mitsempha yanu ya brachial kapena msana. Ili ndi vuto lalikulu kwambiri.

Kodi chithandizo chake ndi chiyani?

Izi zimadalira komwe chotupacho chili komanso momwe khansayo yafalikira. Pali njira zingapo zochiritsira:

• Kuchiza ndi opaleshoni ya khansa.
• Chemoimmunotherapy ndi opaleshoni.
• Chemoradiation ndi immunotherapy.
• Chithandizo cha radiation.
• Chithandizo cholunjika.

Kuchiza ndi opaleshoni ya khansa

Opaleshoni ndi njira yabwino kwambiri yochizira nthawi iliyonse yomwe ingatheke. Komabe, musanachite opaleshoni, madokotala angakupatseni mankhwala a chemoradiation — kuphatikiza mankhwala a chemotherapy ndi radiation — kuti muchepetse chotupacho. Opaleshoni yochotsa chotupa cha Pancoast ikhoza kukhala yovuta kwambiri. Nthawi zambiri, dokotala wa opaleshoni amafunika kuchotsa nthiti zanu ziwiri zapamwamba. Angafunikenso kuchotsa mtsempha waukulu ndikuwusintha ndi cholumikizira cha mitsempha — chubu chopangira chomwe chimalola magazi kuyenda. Dokotala wanu wa opaleshoni adzakufotokozerani zonsezi musanachite opaleshoni.

Chemoimmunotherapy ndi opaleshoni

Nthawi zina, madokotala angakulangizeni opaleshoni ndi mankhwala a chemoimmunotherapy.– kutanthauza kuti, kuphatikiza mankhwala a chemotherapy ndi immunotherapy – kumagwiritsidwa ntchito. Ngakhale kuti mankhwala a chemotherapy amapha maselo a khansa ndikuchepetsa kukula kwa chotupa, mankhwala a immunotherapy amalimbikitsa chitetezo cha mthupi lanu kuti chithandize kulimbana ndi khansa.

Chemoradiation ndi immunotherapy

Nthawi zina opaleshoni si njira ina. Pazochitika zotere, gulu lanu lachipatala lingakulangizeni kuphatikiza mankhwala a chemoradiation ndi immunotherapy.

Chithandizo cha radiation

Ngati opaleshoni siingatheke ndipo khansa yafalikira mbali zina za thupi, dokotala wanu angakulangizeni chithandizo cha radiation chokha kuti muchepetse kukula kwa khansa. Njira yothandizirayi ingathandize kuchepetsa khansa ndikuchepetsa zizindikiro zanu.

Chithandizo cholunjika

Anthu ena amapindula ndi chithandizo cholunjika . Chithandizochi chimayang'ana kusintha kwa majini komwe kumapangitsa maselo athanzi kukhala maselo a khansa. Kuti adziwe ngati ndinu woyenera kulandira chithandizo cholunjika, dokotala adzayesa maselo anu a khansa kuti awone ngati ali ndi ma receptors enieni a mapuloteni enaake. Ngati muli ndi mafunso okhudza izi, lankhulani ndi dokotala wanu.

Kodi izi zingapewedwe?

Ngakhale kuti zotupa za Pancoast sizingathe kupewedwa kotheratu, pali zinthu zomwe mungachite kuti muchepetse chiopsezo chanu chokhala ndi khansa yamtunduwu:

• Pewani kusuta fodya ndi zinthu zina zosuta. Ngati mukusuta, funsani dokotala wanu kuti akuthandizeni kusiya kusuta.
• Pewani kusuta fodya wa munthu wina momwe mungathere.
• Onetsetsani kuti malo anu alibe mankhwala owopsa monga asbestos .

Ngakhale kuti izi zingawoneke ngati zazing'ono, zitha kukhala ndi zotsatirapo zazikulu pa thanzi lanu pakapita nthawi.

Kuphatikiza apo, ngati wina m'banja mwanu ali ndi mbiri ya khansa ya m'mapapo, kapena ngati muli ndi chiopsezo chachikulu chotenga khansa ya m'mapapo, ndi bwino kufunsa dokotala wanu za kuyezetsa khansa yoteteza .

Kodi mungayembekezere chiyani ngati muli ndi chotupa cha Pancoast?

Ngati mwapezeka ndi chotupa cha Pancoast, dokotala wanu adzapanga gulu lothandizira lomwe likugwirizana ndi zosowa zanu. Gulu lanu lothandizira likhoza kuphatikizapo:

• Madokotala a opaleshoni ya chifuwa.
• Madokotala a opaleshoni ya ubongo.
• Akatswiri a khansa , kutanthauza madokotala a khansa, akatswiri a khansa ya opaleshoni, ndi akatswiri a khansa ya radiation.

Gulu lanu lachipatala lidzakulangizani chithandizo kutengera kukula kwa chotupa cha Pancoast, komwe chili, komanso ngati khansayo yafalikira kumadera ena.

Kodi mtedza uwu umakula mofulumira bwanji?

Nthawi zambiri, zotupa za Pancoast zimakula pang'onopang'ono . Komabe, nthawi zambiri, chotupa chimakula mofulumira kwambiri. Dokotala wanu nthawi zonse amawunika kukula kwa chotupacho asanayambe, panthawi yake, komanso atalandira chithandizo.

Kodi nthawi yoyembekezera moyo ndi yotani?

M'zaka zingapo zapitazi, kupita patsogolo kwa ukadaulo kwapangitsa kuti chiwerengero cha anthu omwe amachiritsidwa ku zotupa za Pancoast chiwonjezeke pang'onopang'ono. Koma pali zambiri zoti mudziwe zokhudza matendawa. Chiwerengero cha anthu omwe ali ndi zotupa za Pancoast zomwe zimachiritsidwa msanga komanso zomwe zimatheka opaleshoni chili pakati pa 30% ndi 50% . Izi zikutanthauza kuti pafupifupi theka la anthu omwe amapezeka ndi zotupa za Pancoast zomwe zimayambika msanga amakhalabe ndi moyo zaka zisanu kuchokera pamene adapezeka ndi matendawa. Koma ndikofunikira kukumbukira: Chiwerengero cha anthu omwe apulumuka ndi kungoyerekeza chabe. Sakukuuzani nthawi yeniyeni yomwe mudzakhala ndi moyo kapena momwe chithandizo china chingakuthandizireni. Lankhulani ndi dokotala wanu kuti mumvetse bwino momwe khansa iyi imakukhudzirani.

Kodi muyenera kufunsa upangiri wa dokotala liti?

Ngati muli ndi ululu waukulu wa phewa, kupweteka kwa mkono, kufooka kwa mkono, kapena zizindikiro zina za chotupa cha Pancoast, muyenera kuwona dokotala nthawi yomweyo. Kuzindikira msanga ndikofunikira.

Ndi mafunso ati omwe muyenera kufunsa dokotala?

Ngati inu kapena wokondedwa wanu mwapezeka ndi chotupa cha Pancoast, mungafune kufunsa dokotala wanu mafunso awa:

• Kodi chotupa chili kuti?
• Kodi yafalikira ku minofu yozungulira?
• Kodi yafalikira kumadera akutali a thupi?
• Kodi ndili ndi khansa ya gawo liti?
• Kodi ndi njira ziti zochiritsira zomwe ndili nazo?
• Kodi ndidzatha kugwira ntchito panthawi ya chithandizo?
• Kodi chithandizo nthawi zambiri chimatenga nthawi yayitali bwanji?
• Kodi maganizo anga ali bwanji?

Kodi ichi ndi chotupa cha Pancoast kapena mitsempha yopindika?

Anthu ena omwe ali ndi zotupa za Pancoast amati zizindikiro zawo zimayamba ndi kumva "kupsinjika kwa mitsempha" . Ngati muli ndi ululu wamtunduwu ndipo umakhalapo kwa milungu yoposa iwiri, dziwitsani dokotala. Mwina sizingakhale zachilendo.

Uthenga Womaliza Wopita Nawo Kunyumba

Matenda a Pancoast amayamba kumtunda kwa mapapu anu. Amasiyana ndi mitundu ina ya matenda a m'mapapo chifukwa ndi ovuta kuwazindikira pachiyambi. Kudziwa kuti muli ndi matenda a Pancoast kungakhale kovuta kwambiri. Zingakhale zovuta kukonzekera zomwe mungachite kenako.

Koma kumbukirani kuti dokotala wanu alipo kuti akuthandizeni. Mufunseni kuti akuuzeni zambiri zokhudza vuto lanu. Ngati mungathe, lowani nawo gulu lothandizira, kaya pamasom'pamaso kapena pa intaneti. Kulankhula ndi ena omwe akukumana ndi zinthu zomwezo zomwe mukukumana nazo kungakuthandizeni kwambiri pa thanzi lanu la maganizo, lamaganizo, komanso lauzimu. Musavutike nokha.

 Chotupa cha Pancoast, khansa ya m'mapapo, kupweteka kwa phewa, zizindikiro za khansa, chithandizo cha khansa, khansa ya m'mapapo, kupweteka kwa phewa