Ingabe uzwa ubuhlungu emahlombe kanye nobuthakathaka bengalo? Kungaba yi-Pancoast Tumor!

Ingabe uzwa ubuhlungu obungachazeki ehlombe, ngezinye izikhathi ohlangothini lwentamo yakho, kanye nobuhlungu engalweni yakho, ukungazweli esandleni sakho? Ngezinye izikhathi singase sicabange ukuthi kumane nje kuyisihibe noma inzwa ecindezelwe. Kodwa-ke, lezi zimpawu ngezinye izikhathi zingaba uphawu lokuthile okungathi sína kakhulu. Yileso simo esizokhuluma ngaso namuhla, esibizwa ngokuthi i-Pancoast Tumor.

Kuyini i-Pancoast Tumor? Kalula nje...

Cabanga ngakho, isimila sasePancoast uhlobo lomdlavuza wamaphaphu . Kodwa kuyamangaza kancane. Sakheka phezulu emaphashini akho, ngaphezu kombambo wakho wokuqala. Ngokungafani neminye imidlavuza yamaphaphu, isimila sasePancoast asibangeli ukukhwehlela noma ubuhlungu besifuba . Esikhundleni salokho, abantu abanalesi simila bavame ukuzwa ubuhlungu obukhulu emahlombe kanye nobuthakathaka bengalo . Odokotela babiza lokhu kuhlanganiswa kwezimpawu ngokuthi "i-Pancoast syndrome." I-Pancoast syndrome ayibangeli izimpawu zomdlavuza wamaphaphu ojwayelekile, ngakho kungathatha isikhathi ukuthola lezi zimila. Ezimweni eziningi, ukuxilongwa okuqondile akwenziwa kuze kube yilapho umdlavuza ususakazekele ezinzwaneni nasemithanjeni yegazi eseduze. Izimila zasePancoast ziqanjwe ngodokotela we-radiologist owazichaza okokuqala ekuqaleni kwekhulu lama-20. Elinye igama lazo yi-superior sulcus tumor.

Ingabe zikhona izinhlobo zalokhu?

Yebo, kunezinhlobo eziningana zezimila zasePancoast. Eziyinhloko yilezi:

• Umdlavuza wamaphaphu ongewona amangqamuzana amancane - isibonelo, ama-adenocarcinoma kanye nama-squamous cell carcinoma.
• Umdlavuza wamaphaphu wamangqamuzana amancane.

Iningi lezimila zasePancoast uhlobo lomdlavuza olubizwa ngokuthi i-adenocarcinomas . Lezi zimila ziqala onqenqemeni lwendlela yakho yomoya kanye ne-alveoli (amasaka amancane omoya emaphashini akho), ikakhulukazi kumaseli ezindlala enza i-mucus.

Sivame kangakanani lesi simo?

Izimila zasePancoast azivamile kakhulu , zingaphansi kuka-5% wazo zonke izimila zamaphaphu.

Ziyini izimpawu zalokhu? Ake sibheke kabanzi!

I-brachial plexus yakho ithintwa yi-Pancoast tumor.Le nethiwekhi yezinzwa ingacindezelwa. Le nethiwekhi yezinzwa isuka esifubeni sakho esingaphezulu idlule entanyeni yakho iye ezingalweni zakho. Uma kusetshenziswa lokhu kucindezela, kungase kube nesethi ethile yezimpawu. Yingakho odokotela beyibiza ngokuthi i-Pancoast syndrome noma i-Pancoast-Tobias syndrome. Lezi zimpawu zenzeka ohlangothini olufanayo nolwesimila . Isibonelo, uma isimila sisephashini lakho langakwesokudla, izimpawu zizothinta nohlangothi lwesokudla lomzimba wakho. Izimpawu zesimila se-Pancoast zingafaka:

• Ubuhlungu obukhulu behlombe : Lokhu kungafaka phakathi ubuhlungu ehlombe lakho.
• Ubuhlungu obuphuma engalweni: Lobuhlungu bungase buphele esihlakaleni, ngaphezu nje komunwe omncane.
• Ubuthakathaka esandleni nasengalweni.
• Ubuhlungu bentamo.
• Ubuhlungu engxenyeni engenhla yezimbambo.
• Ukuvuvukala kwengalo engenhla.
• Ukulahlekelwa ikhono ezandleni naseminweni.
• Ukuqaqamba noma ukuba ndikindiki esandleni.
• Ukukhathala.
• Ukuqina kwesifuba.
• Ukwehlisa isisindo ngaphandle kwesizathu.

Cishe abantu abangu-50% abanezimila zasePancoast nabo banesifo esibizwa ngokuthi i-Horner's syndrome , esingabangela izimpawu ezifana nalezi:

• Ukuhlanza ubuso.
• Ijwabu leso eligobile (i-ptosis).
• Amajwabu amehlo aphendukela ngaphakathi (i-enophthalmos).
• Ukuntuleka kokujuluka (i-anhidrosis).

Yini ebangela lokhu? Yiziphi izinto ezibangela ingozi?

Izimbangela kanye nezici eziyingozi zezimila zasePancoast zifana nezinye izinhlobo zomdlavuza wamaphaphu. Izici eziyinhloko eziyingozi yilezi:

• Ukubhema .
• Ukuchayeka entuthwini ebhemayo.
• Ukuchayeka isikhathi eside ezintweni ezithile ezifana ne-asbestos, igesi ye-radon, kanye nezinsimbi ezisindayo.

Cabanga nje, ngokuzibeka engozini kulezi zinto, silimaza amaphaphu ethu ngokungazi. Ngakho-ke kubaluleke kakhulu ukuqaphela lokhu.

Lokhu kusabalala kanjani?

Umdlavuza usakazeka lapho amangqamuzana omdlavuza ehlukana nesimila sokuqala, ehamba ohlelweni lwakho lwegazi noma ohlelweni lwakho lwe-lymph, bese edala izimila ezintsha kwezinye izingxenye zomzimba wakho. Izimila zasePancoast zivame ukusakazeka zisuka engxenyeni engenhla yamaphaphu ziye ezindaweni ezilandelayo:

• Isifuba esingaphezulu.
• Kubheke phansi.
• Izimbambo zesifuba.
• Imithambo yegazi eseduze nezandla.

Lokhu kusabalala komdlavuza ezindaweni ezikude kubizwa ngokuthi i-metastasis .

Kutholakala kanjani lokhu?

Ezigabeni zokuqala, izimila zasePancoast azibonakali kalula ku-X-ray ejwayelekile yesifuba enobukhulu obubili. Yingakho kungaba nzima ukuzixilonga. Uma udokotela esola ukuthi unesimila sasePancoast ngokusekelwe ezimpawini zakho, angase ancome ezinye izivivinyo zokuxilonga, ezifana nalezi:

• Ezinye izivivinyo zezithombe.
• I-biopsy yenaliti.
• Ukuhlinzwa kwe-thoracoscopy okusizwa yividiyo (i-VATS).
• Ukuhlinzwa kwe-Thoracotomy.

Ukuhlolwa kwezithombe

Ubuchwepheshe obuthuthukisiwe bokuthwebula izithombe bungasiza udokotela wakho ukuthola isithombe esicacile samaphaphu akho. Angase a-ode ukuhlolwa okufana nalokhu:

• I-CT scan (CT - i-computed tomography scans).
• Ukuskena kwe-PET (ukuskena kwe-positron emission tomography).
• Ukuskena kwe-MRI (i-MRI - i-magnetic resonance imaging).

Lezi zinhlobo zokuskena zinganikeza ulwazi oluningi, njengobukhulu besimila, indawo yaso, nokuthi ngabe sisakazekele kwezinye izindawo.

I-biopsy yenaliti

Ku-biopsy yenaliti, udokotela uthatha isampula yoketshezi, izicubu, noma amaseli avela eqhubu elingavamile. Isampula ithunyelwa elabhorethri yezifo ukuze ihlolwe kabanzi. Yilapho kuphela lapho singazi khona ngokuqinisekile ukuthi umdlavuza nokuthi uluhlobo luni.

Ukuhlinzwa kwe-thoracoscopy okusizwa ngevidiyo (VATS)

Phakathi nale nqubo, udokotela wenza ukusika okuncane esifubeni sakho bese efaka i-thoracoscope (ithubhu elincane elinekhamera encane kulo). Lokhu kumvumela ukuthi abheke ngaphakathi kwesifuba sakho futhi ahlole izimila noma ezinye izinkinga. Uma kutholakala ezinye, isampula yezicubu iyathathwa bese ithunyelwa elabhorethri ukuze ihlolwe.

Ukususwa kwesifuba

Kwezinye izimo, udokotela kungadingeka enze i-thoracotomy. Kulokhu, benza i-incision ohlangothini lwesokudla noma lwesobunxele lwesifuba sakho, phakathi kwezimbambo. Lokhu kubavumela ukuthi babone kahle iphaphu elithintekile futhi bathathe i-biopsy yanoma yiziphi izicubu ezingavamile. Ezimweni eziningi, bazosusa nesimila ngesikhathi esifanayo. Lokhu kuzokusindisa ekubeni uhlinzwe kaningi.

Ake sifunde ngesigaba salo mdlavuza.

Njengezinye izinhlobo zomdlavuza wamaphaphu, odokotela bahlukanisa izimila zasePancoast besebenzisa uhlelo lokulinganisa umdlavuza . Basebenzisa izinombolo zesiRoma (I, II, III, IV) kanye nezinhlobo ezincane (A, B) ukuchaza ukuthi isimila sithuthuke kangakanani nokuthi sisakazeke kangakanani. Kuma-tumor asePancoast, odokotela basebenzisa izinhlamvu T, N, M kanye nezinombolo 1, 2, 3, 4 ukukhombisa ubunzima besimo:

• Uhlamvu u-T lubhekisela kubukhulu besimila sakho nokuthi sisakazeke kangakanani.
• Uhlamvu u -N lubhekisela ekutheni umdlavuza ususakazekele yini kuma -lymph node akho.
• Uhlamvu M lubonisa ukuthi umdlavuza ususakazekele yini ezingxenyeni ezikude zomzimba (i-metastasis) .

Kukusiphi isigaba lapho izimila zasePancoast zivame ukutholakala khona?

Ngenxa yokuthi izimila zasePancoast kunzima ukuzibona ezigabeni zokuqala, eziningi zitholakala esigabeni se-T3 noma se-T4. I-T3 isho ukuthi umdlavuza ususakazekele odongeni lwesifuba sakho noma ezinzwaneni zakho ezizwelayo. I-T4 isho ukuthi umdlavuza ususakazekele kwezinye izakhiwo, njengemithambo yakho ye-brachial noma intambo yomgogodla. Lesi yisimo esibi kakhulu.

Iyini indlela yokwelapha?

Lokhu kuncike ekutheni isimila sikuphi nokuthi umdlavuza ususabalale kangakanani. Kunezindlela eziningana zokwelapha:

• Ukwelashwa nge-Chemoradiation kanye nokuhlinzwa.
• Ukwelashwa ngamakhemikhali kanye nokuhlinzwa.
• Ukwelashwa ngemisebe kanye nokwelashwa nge-immunotherapy.
• Ukwelashwa ngemisebe.
• Ukwelashwa okuqondiwe.

Ukwelashwa nge-Chemoradiation kanye nokuhlinzwa

Ukuhlinzwa kuyindlela engcono kakhulu yokwelapha noma nini lapho kungenzeka. Kodwa-ke, ngaphambi kokuhlinzwa, odokotela bangakunikeza i-chemoradiation - inhlanganisela ye-chemotherapy kanye ne-radiation therapy - ukuze kuncishiswe isimila. Ukuhlinzwa kokususa isimila sasePancoast kungaba nzima kakhulu. Ngokuvamile, udokotela ohlinzayo kuzodingeka asuse izimbambo zakho ezimbili eziphezulu. Kungase kudingeke futhi asuse umthambo omkhulu bese ewufaka endaweni yawo i-vascular graft - ithubhu yokwenziwa evumela igazi ukuthi ligeleze. Udokotela wakho ohlinzayo uzokuchazela konke lokhu ngaphambi kokuhlinzwa.

Ukwelashwa ngamakhemikhali kanye nokuhlinzwa

Kwezinye izimo, odokotela bangase batuse ukuhlinzwa kanye nokwelashwa ngamakhemikhali.– okungukuthi, kusetshenziswa inhlanganisela ye-chemotherapy kanye ne-immunotherapy. Nakuba i-chemotherapy ibulala amangqamuzana omdlavuza futhi yehlisa ukukhula kwesimila, i-immunotherapy ivuselela amasosha omzimba wakho ukuze asize ekulweni nomdlavuza.

Ukwelashwa nge-Chemoradiation kanye ne-immunotherapy

Ngezinye izikhathi, ukuhlinzwa akuyona inketho. Ezimweni ezinjalo, ithimba lakho lezokwelapha lingancoma inhlanganisela ye-chemoradiation kanye ne-immunotherapy.

Ukwelashwa ngemisebe

Uma ukuhlinzwa kungenzeki futhi umdlavuza ususakazekele kwezinye izingxenye zomzimba, udokotela wakho angase ancome ukwelashwa ngemisebe kuphela ukulawula ukukhula komdlavuza. Le ndlela yokunakekela esekelayo inganciphisa umdlavuza futhi inciphise izimpawu zakho.

Ukwelashwa okuqondiwe

Abanye abantu bayazuza ekwelashweni okuqondiwe . Lokhu kwelashwa kuhlose ukuguquka kwezakhi zofuzo okubangela ukuba amangqamuzana anempilo abe amangqamuzana omdlavuza. Ukuze athole ukuthi ungumuntu ofanele yini ukwelashwa okuqondiwe, udokotela uzohlola amangqamuzana akho omdlavuza ukuze abone ukuthi anama-receptor athile amaprotheni athile. Uma unemibuzo ngalokhu, khuluma nodokotela wakho.

Ingabe lokhu kungavinjelwa?

Nakuba izimila zasePancoast zingenakuvinjelwa ngokuphelele, kunezinto ongazenza ukuze unciphise ingozi yakho yokuthola lolu hlobo lomdlavuza:

• Gwema ukubhema neminye imikhiqizo kagwayi. Uma ubhema, khuluma nodokotela wakho ukuze akusize uyeke ukubhema.
• Gwema ukuchayeka entuthwini yomusi kaningi ngangokunokwenzeka.
• Qiniseka ukuthi indawo okuyo ayinawo amakhemikhali ayingozi njenge-asbestos .

Nakuba lezi zingase zibonakale zincane, zingaba nomthelela omkhulu empilweni yakho ngokuhamba kwesikhathi.

Ngaphezu kwalokho, uma othile emndenini wakho enomlando womdlavuza wamaphaphu, noma uma usengozini enkulu yokuba nomdlavuza wamaphaphu, kuwumqondo omuhle ukubuza udokotela wakho mayelana nokuhlolwa komdlavuza okuvimbelayo .

Yini ongayilindela uma unesimila sasePancoast?

Uma kutholakale ukuthi unesimila sasePancoast, udokotela wakho uzohlanganisa ithimba lokwelapha eliklanyelwe izidingo zakho ezithile. Ithimba lakho lokwelapha lingafaka:

• Odokotela abahlinzayo besifuba.
• Odokotela abahlinza izinzwa.
• Odokotela bezifo zomdlavuza , okungukuthi, odokotela bezifo zomdlavuza bezokwelapha, odokotela bezifo zomdlavuza abahlinzayo, kanye nodokotela bezifo zomdlavuza ngemisebe.

Ithimba lakho lezokwelapha lizoncoma ukwelashwa okusekelwe ngobukhulu besimila sasePancoast, indawo yaso, nokuthi umdlavuza ususakazekele kwezinye izindawo.

La mantongomane akhula ngokushesha kangakanani?

Esikhathini esiningi, izimila zasePancoast zikhula kancane . Kodwa-ke, akuvamile kakhulu, isimila singakhula ngokushesha. Udokotela wakho uzoqapha ukukhula kwesimila njalo ngaphambi, ngesikhathi, nangemva kokwelashwa.

Iyini isikhathi sokuphila?

Eminyakeni embalwa edlule, intuthuko kwezobuchwepheshe iholele ekwandeni kancane kancane kwenani labantu abaphulukiswa izimila zasePancoast. Kodwa kusekuningi okufanele kufundwe ngalesi sifo. Izinga lokusinda iminyaka emihlanu kubantu abanezimila zasePancoast ezisesigabeni sokuqala, ezingelashwa ngokuhlinzwa liphakathi kuka-30% no-50% . Lokho kusho ukuthi cishe ingxenye yabantu abatholakale benezimila zasePancoast ezisesigabeni sokuqala basaphila eminyakeni emihlanu ngemva kokuxilongwa. Kodwa kubalulekile ukukhumbula: Lawa mazinga okusinda ayizilinganiso nje. Abakutsheli ukuthi uzophila isikhathi esingakanani noma ukuthi ukwelashwa okuthile kuzokusebenzela kahle kangakanani. Khuluma nodokotela wakho ukuze uqonde ukuthi lo mdlavuza ukuthinta kanjani.

Kufanele ufune nini iseluleko sezokwelapha?

Uma unesihlungu esinzima samahlombe, ubuhlungu bengalo, ubuthakathaka bengalo, noma ezinye izimpawu zesimila sasePancoast, kufanele ubonane nodokotela ngokushesha. Ukutholwa kusenesikhathi kubalulekile.

Yimiphi imibuzo okufanele uyibuze udokotela?

Uma wena noma othandekayo wakho kutholakala ukuthi unesifo somdlavuza ePancoast, ungase ufune ukubuza udokotela wakho le mibuzo:

• Ikuphi ithumba?
• Ingabe isakazekele ezicutshini ezizungezile?
• Ingabe isisabalale ezingxenyeni ezikude zomzimba?
• Nginasiphi isigaba somdlavuza?
• Yiziphi izindlela zokwelapha enginazo?
• Ngizokwazi yini ukusebenza ngesikhathi sokwelashwa?
• Kuvame ukuthatha isikhathi esingakanani ukwelashwa?
• Unjani umbono wami?

Ingabe lesi yisifo se-Pancoast noma i-nerve ecindezelwe?

Abanye abantu abanezimila zasePancoast bathi izimpawu zabo ziqale ngomuzwa "wokucinana kwemizwa" . Uma unalolu hlobo lobuhlungu futhi luhlala isikhathi esingaphezu kwamasonto amabili, yazisa udokotela. Kungase kungabi yinto evamile.

Umyalezo Wokugcina Wokuya Nasekhaya

Izimila zasePancoast ziqala engxenyeni engenhla yamaphaphu akho. Zihlukile kwezinye izinhlobo zezimila zamaphaphu ngoba kunzima ukuzibona ezigabeni zokuqala. Ukuthola ukuthi unesimila sasePancoast kungaba yinto edidayo kakhulu. Kungaba nzima ukuhlela ukuthi yini ozoyenza ngokulandelayo.

Kodwa khumbula, udokotela wakho ukhona ukuzokusiza. Mcele ulwazi olwengeziwe ngesimo sakho esithile. Uma ungakwazi, joyina iqembu lokusekelana, kungaba mathupha noma ku-inthanethi. Ukukhuluma nabanye abadlula ezintweni ezifanayo odlula kuzo kungaba yinzuzo enkulu empilweni yakho yengqondo, ngokomzwelo nangokomoya. Ungalokothi uhlupheke wedwa.

 Ithumba lasePancoast, umdlavuza wamaphaphu, ubuhlungu behlombe, izimpawu zomdlavuza, ukwelashwa komdlavuza, umdlavuza wamaphaphu, ubuhlungu behlombe