Yintoni i-Pancoast Tumors kwaye iphathwa njani?

Umxholo

• Iimpawu zepancoast tumor
• Oonobangela be-Pancoast tumor
• Isifo sePancoast sifunyanwa njani
• Unyango lwePancoast tumor
• Ukuqokelela
• Unyango
• Uncedo lwentlungu
• Amaxabiso okusinda kwiPancoast tumor
• Imbonakalo

Ushwankathelo

Ithumba lepancoast luhlobo olunqabileyo lomhlaza wemiphunga. Olu hlobo lwethumba lubekwe phezulu (phezulu) komphunga wasekunene okanye wasekhohlo. Njengoko ithumba likhula, indawo elikuyo liyenza ikwazi ukuhlasela imithambo-luvo ejikeleze imisipha, ii-lymph node, izihlunu ezihlangeneyo, iimbambo ezingaphezulu kunye ne-vertebrae ephezulu. Oku kubangela iintlungu eziqatha egxalabeni nasengalweni.

Ukuchongwa kwamathumba ePancoast kuhlala kulibaziseka, kuba ithumba alibonisi zimpawu zakudala zomhlaza wemiphunga, njengokukhohlela.

Izidumba zepancoast zikwabizwa ngokuba zizidumbu eziphezulu zesulcus. Iseti yazo yeempawu ibizwa ngokuba yiPancoast syndrome. Abantu abanesifo sethumba bajikeleze iminyaka engama-60 ubudala. Amadoda achaphazeleka kunabafazi.

Lo mhlaza ubizwa ngegama, ingcali ye-radiologist yasePhiladelphia eyaqala ichaza amathumba ngo-1924 nango-1932.

Iiseli ezincinci zomhlaza zePancoast tumors zezi:

• umhlaza wesisele esibuhlungu
• adenocarcinomas
• ezinkulu-cell carcinomas
• iiseli ezincinane zeselcinoma

Iimpawu zepancoast tumor

Intlungu ebukhali egxalabeni lolona phawu luqhelekileyo lwePancoast tumor kwizigaba zayo zokuqala.Ezinye iimpawu zixhomekeke kwiindawo apho i-tumor ihlasela ngokujikeleza kwesifuba (i-thoracic inlet).

Njengoko ithumba likhula, iintlungu zamahlombe ziba qatha kwaye zenze buthathaka. Ingaphuma iye kwi-armpit (axilla), igxalaba, kunye nethambo elidibanisa igxalaba nengalo (scapula).

Ngaphezulu kwamatyala ethumba ePancoast, ithumba lingena kumagumbi angasemva naphakathi okuvula kwesifuba. Intlungu inokuqaqamba:

• ezantsi kwengalo esecaleni lomzimba elandela i-ulnar nerve (imithambo-luvo eyehla ecaleni kwengalo yakho iye kwi-pinky, ime esihlahleni)
• entanyeni
• kwiimbambo eziphezulu
• womnatha womnatha ofikelela kwiimbambo, umnqonqo, kunye nasekhwapheni

Ezinye iimpawu zibandakanya:

• ukudumba kwengalo ephezulu
• ubuthathaka kwimisipha yesandla
• Ukuphulukana nobuchule besandla
• Ukuchitheka kwezihlunu zemisipha esandleni
• ukurhawuzelela okanye ukuba ndindisholo esandleni
• ukuqina kwesifuba
• ukudinwa
• ukuhla ukusinda

Zizonke ezi mpawu ziyaziwa njengePancoast syndrome.

Kubantu abane-Pancoast tumors, umhlaza uhlasela imithambo-luvo efikelela ebusweni. Oku kubizwa ngokuba yi-Claude-Bernard-Horner syndrome, okanye i-Horner's syndrome nje. Kwicala elichaphazelekayo, unokuba:

• ijwabu leso elichophileyo (i-blepharoptosis)
• ukungakwazi ukubila ngesiqhelo (anhidrosis)
• ukugungxula
• ukufuduka kwamehlo akho (enophthalmos)

Intlungu yesisu sePancoast sinzima kwaye sihlala sihleli. Ngokuqhelekileyo ayiphenduli kwiintlungu eziqhelekileyo ezithengiswayo. Intlungu ihleli nokuba uhleli, umile, okanye ulele.

Oonobangela be-Pancoast tumor

Oonobangela bethumba lePancoast bayafana nabanye bomhlaza wemiphunga. Oku kubandakanya:

• ukutshaya
• ukubonakaliswa komsi wesibini
• ukubonakaliswa kwexesha elide kwizinyithi ezinzima, iikhemikhali, okanye ukukhutshwa kwedizili
• Ukuvezwa kwexesha elide kwi-asbestos okanye amanqanaba aphezulu eradon

Kwiimeko ezinqabileyo, isifo sePancoast sinokuba nezinye izizathu, ezinje ngomhlaza, usulelo lwebhaktiriya okanye lokungunda, okanye isifo sephepha (TB) kunye nezinye izifo.

Isifo sePancoast sifunyanwa njani

Ukuchongwa kwesifo sepancoast kunzima kwaye kuhlala kulibaziseka kuba iimpawu zayo ziyafana nezo zamathambo nezifo ezidibeneyo. Kwakhona, amathumba ePancoast anqabile kwaye anokungaqhelekanga koogqirha. Izidumba zepancoast zenza kuphela yonke imihlaza yomhlaza.

Ugqirha wakho uya kukubuza malunga neempawu zakho, ukuba ziqale nini, kwaye nokuba zitshintshile ngokuhamba kwexesha. Baza kuqhuba uvavanyo lomzimba kunye novavanyo lokujonga ukujonga ithumba kunye nakuphi na ukusasazeka komhlaza. Ukuba kubhaqwe ithumba, ugqirha unokuyalela uvavanyo olongezelelweyo ukumisela inqanaba lethumba.

Uvavanyo lunokubandakanya:

• X-reyi. Ngamanye amaxesha ithumba ngenxa yokuma kwalo.
• Ukuskena i-CT. Isisombululo sayo esiphakamileyo sinokuchonga ukusasazeka kwethumba kwiindawo ezikufuphi.
• Ukuskena iMRI. Olu vavanyo lwe-imaging lunokubonisa ukusasazeka kwethumba kwaye lubonelele ngesikhokelo sotyando.
• I-Mediastinoscopy. Umbhobho ofakwe entanyeni uvumela ugqirha ukuba athathe isampulu ye-lymph node.
• Uqhaqho. Ukususa izicwili zethumba kuvavanyo kuthathelwa ingqalelo ukuqinisekisa inqanaba lethumba kunye nokumisela unyango.
• I-thoracoscopy encediswa ngevidiyo (VATS). Olu tyando lungenelelayo oluncinci luvumela ukufikelela kwizicubu zohlalutyo.
• Mini-thoracotomy. Le nkqubo isebenzisa ukusikwa okuncinci, kunye nokufikelela kwizicubu zohlalutyo.
• Olunye uvavanyo. Oku kunokuba yimfuneko ukukhangela ukusasazeka komhlaza emathanjeni, kwingqondo nakwezinye iindawo zomzimba.

Unyango lwePancoast tumor

Nangona kwakukhe kwathiwa kuyabulala, namhlanje kuyenzeka ukuba izicubu zepancoast zinyangeke, kodwa ingekanyangeki.

Unyango lwethumba lePancoast luxhomekeke kwindlela esifunyenwe ngayo kwangoko, ukuba sele sisasazeke kangakanani, iindawo ezichaphazelekayo, kunye nemeko yempilo yakho ngokubanzi.

Ukuqokelela

Ithumba lepancoast "libekwe" ngendlela efanayo neminye imihlaza yomhlaza wamaphaphu, kusetyenziswa amanani aqhelekileyo e-I ukuya ku-IV kunye nee-subtypes A okanye B ukubonisa ukuba sihambele phambili kangakanani esi sifo. Isiteyiphu sisikhokelo sonyango oluthile oza kulifumana.

Ukongeza, amathumba ePancoast ahlelwa ngakumbi ngoonobumba kunye namanani 1 ukuya ku-4 abonisa ubukrakra:

• T ichaza ubungakanani nokusasazeka kwethumba.
• N ichaza ukubandakanyeka kwe-lymph node.
• M ibhekisa ekubeni iisayithi ezikude ziye zahlaselwa (i-metastases).

Uninzi lwamathumba ePancoast ahlelwa njenge-T3 okanye i-T4, ngenxa yendawo akuyo. Amathumba ahlelwa njenge-T3 ukuba ahlasela udonga lwesifuba okanye imithambo enovelwano. Zizo tum Tors ukuba bahlasela ezinye izakhiwo, ezinjengee-vertebrae okanye i-brachial nerves.

Nditsho ne-Pancoast yamathumba okuqala afunyenwe njenge-IIB ubuncinci, kwakhona ngenxa yendawo abakuyo.

Unyango

Unyango lwePancoast tumors luyahluka kwaye lubandakanya indibaniselwano yechemotherapy, radiation kunye notyando.

Izidumba zepancoast eziye zagcwala kwimimandla engaphaya kwesifuba ayinakuba ngabagqatswa botyando.

I-Chemotherapy kunye ne-radiation ngamanyathelo okuqala ngaphambi kotyando. Emva koko ithumba liphinda livavanywe ngolunye uvavanyo lwe-CT okanye olunye uvavanyo lokucinga. Utyando lwenzeka ngokufanelekileyo kwiiveki ezintathu ukuya kwezintandathu emva kwonyango lomchiza kunye nemitha, ngaphambi kokuba kukho nasiphi na isikrelemnqa esinokuthi sifike kwindlela yotyando.

Kwezinye izicwangciso zonyango, utyando lunokulandelwa ngonyango lokongezwa kwemitha ukubulala nayiphi na iseli yomhlaza eseleyo.

Injongo yoqhaqho kukususa ngokupheleleyo izinto ezinomhlaza kwizakhiwo ezihlaseleyo. Oku akusoloko kunokwenzeka, kwaye isifo sinokuphinda sibuye. Isifundo esincinci esenziwe eMaryland sifumanise ukuba esi sifo siphinde sabuya kwiipesenti ezingama-50 zabo bathathi-nxaxheba babe noqhaqho lwePancoast tumor.

Inkqubela phambili kwezobuchwephesha kubuchwephesha botyando kuye kwenza ukuba kube lula ukwenza utyando kwi-T4 Pancoast tumors, kodwa umbono mbi kakhulu kunamanye amanqanaba esi sifo.

Uncedo lwentlungu

Ukuthomalalisa iintlungu kwiPancoast tumors namhlanje kubandakanya ukusetyenziswa okulawulwayo kweeopioid ezimiselwe ngugqirha. Nangona kunjalo, oku kuza neziphumo ebezingalindelekanga. Abanye abaphandi bathi ukubuyela kumanyathelo e-opioid asebenzayo ngaphandle kweziphumo ebezingalindelekanga.

Imitha ingasetyenziselwa ukunciphisa iintlungu xa utyando lungenakwenzeka.

Intlungu ebukhali ene-Pancoast tumors inokuncitshiswa ngenkqubo yotyando ekhubaza iintlungu eziqhuba iintlungu kwithambo lomqolo. Oku kubizwa ngokuba yi-CT-ekhokelwa yi-cordotomy, apho kusetyenziswa i-CT scan ukukhokela ugqirha wotyando.

Kwisifundo esinye, kwabo bane-Pancoast tumor baxele ukuphuculwa kweentlungu kunye nale nkqubo. I-cordotomy nakwiiveki zokugqibela zobomi inokubonelela ngesiqabu sentlungu.

Olunye ungenelelo olunokwenzeka ukunciphisa iintlungu zepancoast tumor zibandakanya:

• Ukunciphisa i-laminectomy (utyando olususa uxinzelelo kwimithambo-luvo yomqolo)
• i-phenol block (inaliti ye-phenol ukuthintela imithambo)
• Ukhuthazo lwe-transdermal (usebenzisa inqanaba elisezantsi ngokuthe ngqo lombane kwingqondo)
• I-stellate ganglion block (inaliti ye-anesthetic kwiimbilini ezisentanyeni)

Amaxabiso okusinda kwiPancoast tumor

Amaxabiso okusinda emva kwechemotherapy, radiation, kunye notyando ziyahluka. Ingxelo yeklinikhi yaseCleveland iqaphele iminyaka emibini yokusinda emva kotyando njengama-55 ukuya kuma-70 epesenti. Inqanaba lokusinda kweminyaka emi-5 yotyando olususe ithumba lasePancoast lasekuqaleni lalingama-54% ukuya kuma-77 eepesenti.

Imbonakalo

Kwiminyaka emininzi, i-Pancoast tumors yathathelwa ingqalelo njengenganyangekiyo. Ngenxa yendawo yethumba, kwakucingwa ukuba utyando alunakwenzeka.

Kumashumi eminyaka akutshanje, imbonakalo yabantu abanePancoast tumors iphuculwe kakhulu. Iindlela ezintsha zotyando zenze ukuba kwenzeke ukuba kusebenze amathumba ngaphambili awayejongwa njengangasebenziyo. Unyango olusemgangathweni ngoku olubandakanya i-chemotherapy, i-radiation, kunye notyando lonyuse amazinga okusinda.

Ukufunyanwa kwangoko kwesifo sepancoast kubalulekile ekumiseleni impumelelo kunyango. Yiya kugqirha ngoko nangoko xa unempawu, kwaye uthathe amanyathelo othintelo njengokuyeka ukutshaya xa utshaya.