Mukati
Kuongororwa kwegomarara remapapu kunofanirwa kukurumidza, kwakakwana uye kwakazara. Zvadaro zvinobvumira munhu kusarudzwa uye optimization yekurapa cancer. Kutenda kune hutsva hwekurapa, vamwe varwere vane mukana wekuwedzera hupenyu hwavo kwete nevashoma, asi nemwedzi yakati wandei. Kenza yemapapu inova chirwere chisingaperi.
Kenza yemapapu - kuongororwa
-Kuongororwa kwegomarara remapapu kunoda kubatanidzwa kwenyanzvi dzakawanda, kusiyana nemamwe magomarara emunhengo, senge gomarara rezamu kana melanoma, anoonekwa uye anorapwa zvakanyanya neoncologists. Gomarara remapapu rinosiyana zvakanyanya pano - anodaro Prof. Dr hab. n. med. Joanna Chorostowska-Wynimko, mukuru weDhipatimendi reGenetics uye Clinical Immunology yeInstitute of Tuberculosis uye Lung Diseases muWarsaw.
Kudyidzana kwenyanzvi dzakawanda kwakakosha zvikuru, nguva yakatsaurirwa kuongororwa uyezve kukodzera kurapwa kwakakosha. - Nekukurumidza chirwere chegomarara, nekukurumidza kufungidzira uye endoscopic diagnostics inoitwa, nekukurumidza iyo pathomorphological assessment uye inodiwa molecular test inoitwa, nekukurumidza isu tinogona kupa murwere kurapwa kwakanyanya. Not suboptimal, just optimal. Zvichienderana nedanho regomarara, tinogona kutsvaga kurapwa, senge padanho I-IIIA, kana mukenza yemapapu yakajairika. Panyaya yekufambira mberi kwenzvimbo, tinogona kushandisa kurapwa kwemuno kwakasanganiswa nehurongwa hwekurapa, senge radiochemotherapy, yakawedzerwa zvakanyanya ne immunotherapy, kana pakupedzisira systemic kurapwa yakatsaurirwa kuvarwere vane generalized cancer yemapapu, apa tariro ndiyo nzira itsva dzekurapa, kureva kuti molecularly yakanangana. kana immunocompetent zvinodhaka. Clinical oncologist, radiotherapist, chiremba anovhiya anofanira zvachose kutora chikamu muboka renyanzvi dzemarudzi akasiyana-siyana - mumamota emuchipfuva ndichiremba anovhiya wechipfuva - kazhinji zvakare chiremba wepulmonologist uye nyanzvi yekuongorora kufungidzira, kureva radiologist - anotsanangura Prof. Dr hab. n. med. Dariusz M. Kowalski kubva kuDhipatimendi reLung uye Thoracic Cancer yeNational Institute of Oncology-National Research Institute muWarsaw, mutungamiri wePolish Lung Cancer Group.
Prof. Chorostowska-Wynimko anoyeuchidza kuti varwere vazhinji vekenza yemapapu vane zvirwere zvekufema. -Ini handigone kufungidzira mamiriro ezvinhu apo sarudzo nezve yakanakisa oncological kurapwa kwemurwere akadaro inoitwa pasina kufunga nezvezvirwere zvemapapu zvinosangana. Izvi zvinodaro nekuti isu tichakodzera kurapwa kwekuvhiya murwere ane mapapu ane hutano kunze kwegomarara, uye murwere ane chirwere chisingaperi chekufema, senge pulmonary fibrosis kana chisingaperi chinodzivirira pulmonary chirwere (COPD). Ndokumbirawo muyeuke kuti mamiriro ese ari maviri ane njodzi ine chekuita nekenza yemapapu. Ikozvino, muzera redenda, tichave nevarwere vazhinji vane COVID-19 pulmonary complications - anodaro Prof. Chorostowska-Wynimko.
Nyanzvi dzinosimbisa kukosha kwezvakanaka, zvakakwana uye zvakakwana kuongororwa. - Sezvo nguva yakakosha zvakanyanya, kuongororwa kunofanirwa kuitwa nemazvo uye zvinobudirira, kureva munzvimbo dzakanaka dzinogona kunyatsoita zvishoma uye invasive diagnostics, kusanganisira kuunganidza yakaringana yezvakanaka biopsy zvinhu zvekuwedzera bvunzo, zvisinei nehunyanzvi hunoshandiswa. Nzvimbo yakadaro inofanirwa kuve yakabatana neiyo yakanaka pathomorphological uye molecular diagnostics centre. Zvinyorwa zvekutsvakurudza zvinofanira kuchengetedzwa zvakanaka uye kutumirwa pakarepo, izvo zvinobvumira kuongororwa kwakanaka maererano nehutachiona hwehutachiona, uyezve genetic maitiro. Nenzira yakanaka, nzvimbo yekuongorora inofanirwa kuve nechokwadi chekushanda panguva imwe chete yezvisarudzo zvebiomarker - anotenda Prof. Chorostowska-Wynimko.
Ndeipi basa reiyo pathologist
Pasina kuongororwa kwepathomorphological kana cytological, kureva kuongorora kuvepo kwemasero egomarara, murwere haakwanise kuwana chero kurapwa. - Iyo pathomorphologist inofanirwa kusiyanisa kana isu tiri kubata neasina diki cell cancer cancer (NSCLC) kana diki cell cancer (DRP), nekuti manejimendi evarwere anoenderana nazvo. Kana zvave kutozivikanwa kuti iyi NSCLC, chiremba wepathologist anofanira kuona kuti chii chinonzi subtype - glandular, sero guru, squamous kana imwe yeimwe, nokuti zvinonyanya kukosha kuraira nhevedzano yekuongorora kwema molecular, kunyanya mumhando yevasiri. -gomarara resquamous, kuitira kuti ukwanise kurapwa kwakanangwa molecular - inoyeuchidza Prof. Kowalski.
Panguva imwecheteyo, kuendeswa kwezvinhu kune pathologist kunofanira kuendeswa kune yakazara molecular diagnostics inovhara zvose biomarkers inoratidzwa nechirongwa chemishonga, migumisiro yaro inodiwa kusarudza pamusoro pekurapa kwakakwana kwemurwere. - Zvinoitika kuti murwere anongoendeswa kune mamwe maedzo emolecular. Maitiro aya haana kururama. Diagnostics inoitwa nenzira iyi kashoma kuita kuti zvikwanise kusarudza nzira yekurapa murwere zvakanaka. Pane mamiriro ezvinhu apo nhanho dzega dzemamolecular diagnostics dzinobvumirwa munzvimbo dzakasiyana. Nekuda kweizvozvo, tishu kana cytological zvinhu zviri kutenderera kuPoland, uye nguva iri kupera. Varwere havana nguva, havafanirwe kumirira - maalarm Prof. Chorostowska-Wynimko.
- Zvichakadaro, kurapwa kutsva, kwakasarudzwa zvakakodzera, kunobvumira murwere ane kenza yemapapu kuti ave chirwere chisingaperi uye kumutsaurira kwete mwedzi mishoma yehupenyu, asi kunyange makore akawanda - anowedzera Prof. Kowalski.
- Tarisa njodzi yako yekuva negomarara. Zviedze iwe pachako! Tenga tsvakiridzo yevakadzi nevarume
Varwere vese vanofanirwa kuongororwa zvizere here?
Haasi murwere wese anofanirwa kuenda kune yakazara pani yemamorekuru bvunzo. Inotarirwa nerudzi rwegomarara. -Mune-non-squamous carcinoma, kunyanya adenocarcinoma, varwere vose vakakodzera kurapwa kwepalliative vanofanira kuongororwa zvakakwana ma molecular, nokuti mune iyi murwere wehuwandu hwehutachiona hwema molecular disorders (EGFR mutations, ROS1 uye ALK gene rearrangements) inoitika zvakanyanya kakawanda kupfuura mune dzimwe kenza yemapapu. . Kune rumwe rutivi, kuongororwa kweiyo ligand yemhando ye1 programmed death receptor, kureva PD-L1, inofanira kuitwa mumatambudziko ose eNSCLC - anodaro Prof. Kowalski.
Chemoimmunotherapy iri nani pane chemotherapy chete
Pakutanga kwa2021, varwere vane ese NSCLC subtypes vakapihwa mukana wekugamuchira immunocompetent kurapwa, zvisinei nechiyero chePD-L1 protein kutaura. Pembrolizumab inogona kushandiswa kunyangwe PD-L1 kutaura kuri <50%. - mumamiriro ezvinhu akadaro, pamwe chete nechemotherapy nekushandiswa kweplatinum compounds uye yechitatu-chizvarwa cytostatic compounds yakasarudzwa maererano nekenza subtype.
-Kuita kwakadai kuri nani pane yakazvimirira chemotherapy - misiyano yehurefu hwekupona inosvika kunyange 12 mwedzi uchifarira chemoimmunotherapy - anodaro prof. Kowalski. Izvi zvinoreva kuti varwere vanorapwa nemishonga yakasanganiswa vanorarama avhareji yemwedzi makumi maviri nemiviri, uye varwere vanogamuchira chemotherapy chete kweinopfuura mwedzi gumi chete. Kune varwere avo, nekuda kwechemoimmunotherapy, vanorarama kunyange makore akati wandei kubva pakushandiswa kwayo.
Kurapa kwakadaro kunowanikwa mumutsara wekutanga wekurapa apo kuvhiyiwa uye chemoradiotherapy haigoni kushandiswa kune varwere vane chirwere chepamusoro, kureva kure kure metastases. Mamiriro ezvinhu akadzama akaiswa muChirongwa cheDrug reBazi reHutano chekurapa kenza yemapapu (chirongwa B.6). Maererano nefungidziro, 25-35 muzana ndivo vanoda chemoimmunotherapy. varwere vane nhanho IV NSCLC.
Nekuda kwekuwedzera kweiyo immunocompetent drug kuchemotherapy, varwere vanopindura zvirinani pakurapwa kwechirwere chegomarara pane vanhu vanongowana chemotherapy. Zvakakosha, mushure mekupera kwekemotherapy, immunotherapy sekuenderera mberi kwemishonga yekubatanidza inoshandiswa pane imwe nzvimbo yekunze. Izvi zvinoreva kuti murwere haafanire kuiswa muchipatara pese paanopihwa. Zvinonyatsovandudza hupenyu hwake.
Chinyorwa chakagadzirwa sechikamu chemushandirapamwe "Hupenyu Hurefu neCancer", yakaitwa neiyo portal www.pacjentilekarz.pl.
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