He aha nā Tumo Pancoast a pehea e mālama ʻia ai?

Anter

• Nā ʻōuli o ka tumo Pancoast
• Nā kumu o ka tumo Pancoast
• Pehea e ʻike ʻia ai kahi tumo Pancoast
• Hoʻomaʻo no ka tumo Pancoast
• Ke hoʻokū nei
• Lapaʻau
• Hoʻomaha ʻeha
• Nā helu e ola ai no ka tumo Pancoast
• Outlook

Hōʻike Overview

ʻO kahi tumo Pancoast kahi ʻano laha ʻole o ka maʻi ʻaʻa maʻi. Aia kēia ʻano tumo ma ka piko o luna (apex) o ka akau a hema paha. Ke ulu nei ka tumo, hiki i kona wahi ke hoʻouka iā ia i nā ʻalolo a puni, nā mākala, nā pūnana lymph, nā mea hoʻopili, nā iwi ʻaoʻao o luna, a me nā iwi ʻaoʻao kiʻekiʻe. ʻO kēia ke kumu o ka ʻeha nui i ka poʻohiwi a me ka lima.

Hoʻolālā pinepine ka hōʻoia ʻana o nā tumo Pancoast, no ka mea ʻaʻole hōʻike ka tumo i nā ʻōuli kilika o ka maʻi ʻaʻai māmā, e like me ka maʻa.

ʻO nā tumo Pancoast kahi i ʻike ʻia ma ke ʻano he ʻoiʻoi sulcus tumors. Kāhea ʻia kā lākou mau hōʻailona kikoʻī ʻo Pancoast Syndrome. ʻO nā kānaka me ka pākī hoʻomaka ma kahi o 60 mau makahiki. Pili nā kāne ma mua o ka wahine.

Ua kapa ʻia kēia maʻi ʻaʻai, he radiologist Philadelphia nāna i wehewehe mua i nā tumors i 1924 a me 1932.

ʻO nā subtypes pūnana maʻi o nā tumo Pancoast:

• maʻi ʻaʻai maʻi squamous
• adenocarcinomas
• carcinomas nui pūnaewele
• carcinomas liʻiliʻi pūnaewele

Nā ʻōuli o ka tumo Pancoast

ʻO kaʻeha poʻohiwi ākea ka hōʻailona maʻamau o ka tumo Pancoast i kona wā mua.ʻO nā ʻōuli ʻē aʻe e pili ana i nā wahi a ka puʻupuʻu e hoʻouka ai a puni ka puka o ka umauma (ka puka komo thoracic).

Ke ulu nei ka tumo, ʻoi aku ka ʻeha o ka poʻohiwi a hoʻonāwaliwali hoʻi. Hiki iā ia ke hoʻomālamalama i ka ʻūlima (axilla), ka poʻohiwi, a me ka iwi e hoʻopili ana i ka poʻohiwi i ka lima (scapula).

I nā mea ʻoi aku ma mua o nā hihia tumo Pancoast, hoʻouka ka maʻi tumo i nā keʻena hope a waena o ka wehe ʻana o ka pahu. Hiki i ka ʻeha ke hoʻomālamalama:

• lalo ka lima ma ka ʻaoʻao o ke kino e ukali ana i ke aʻalolo ulnar (ʻo ke aʻalolo e holo ana i ka ʻaoʻao o kou lima i ka pinky, e kū ana ma ka pulimaʻu)
• i ka ʻāʻī
• i nā iwi ʻaoʻao luna
• i ka pūnaewele nerve e hōʻea i nā iwi ʻaoʻao, iwi kuamoʻo, a me ka ʻāpana lima

ʻO nā ʻōuli ʻē aʻe e like me:

• pehu ka luna o luna
• nāwaliwali i nā mākala lima
• lilo o ka dexterity lima
• ka hoʻonele ʻana i nāʻiʻo i ka lima
• ʻūlū a manamana paha i ka lima
• paʻa paʻa o ka umauma
• luhi
• Kaumaha emi

ʻO kēia mau hōʻailona i kapa ʻia ʻo Pancoast Syndrome.

I loko o ka poʻe me nā tumo Pancoast, hoʻouka ka maʻi ʻaʻai i nā ʻāʻī a hiki i ka maka. Kapa ʻia kēia ʻo Claude-Bernard-Horner Syndrome, a i ʻole ʻo ka Horner's Syndrome maʻalahi. Ma ka ʻaoʻao i hoʻopilikia ʻia, loaʻa paha iā ʻoe:

• kahi lihilihi maka maka (blepharoptosis)
• hiki ʻole ke hou i ka hou (anhidrosis)
• ʻōpala
• hoʻoneʻe i kāu ʻōpeʻe (enophthalmos)

ʻO kaʻeha o kahi tumo Pancoast he koʻikoʻi a paʻa mau. ʻAʻole ia e pane maʻamau i nā mea hōʻeha ʻeha a ka poʻe maʻamau. Noho ka ʻeha inā ʻoe e noho, kū, a moe paha i lalo.

Nā kumu o ka tumo Pancoast

ʻO nā kumu o kahi tumo Pancoast e like me nā maʻi maʻi ʻē aʻe. Pākuʻi ʻia kēia mau mea:

• puhipaka
• kū i ka uahi lua
• ka lōʻihi o ke kū ʻana i nā metala kaumaha, nā kemika, a i ʻole ka pau ʻana o ka diesel
• ka wā lōʻihi i ka asbestos a i ʻole nā ​​pae kiʻekiʻe o radon

I nā hanana kakaikahi, he kumu ʻē aʻe paha kā ka Syndrome Pancoast o nā ʻōuli, e like me nā maʻi ʻino ʻē aʻe, nā maʻi koʻohune a fungal paha, a i ʻole tuberculosis (TB) a me nā maʻi ʻē aʻe.

Pehea e ʻike ʻia ai kahi tumo Pancoast

ʻIke ka hōʻoia o kahi tumo Pancoast paʻakikī a lohi hoʻi no ka mea like nā ʻōuli me nā iwi a me nā maʻi hui. Eia kekahi, ʻaʻohe laha nā tumo Pancoast a kamaʻāina paha ʻole i nā kauka. ʻO nā tumo Pancoast wale nō o nā maʻi ʻaʻai āpau.

E nīnau aku kāu kauka iā ʻoe e pili ana i kāu mau hōʻailona, ​​ke hoʻomaka lākou, a inā ua loli lākou i ka hala o ka manawa. E alakaʻi lākou i kahi hoʻokolohua kino a kauoha i nā hoʻokolohua e nānā no kahi tumo a me nā laha ʻana o ka maʻi ʻaʻai. Inā ʻike ʻia kahi tumo, kauoha paha kāu kauka i nā hoʻokolohua hou aku e hoʻoholo ai i ke kahua o ka tumo.

E komo pū paha nā hoʻāʻo:

• X-kukuna. I kekahi manawa ka tumo ma muli o kona kūlana.
• CT scan. Hiki i kāna hoʻonā kiʻekiʻe ke hoʻomaopopo i ka hoʻolaha ʻana o ka tumo i nā wahi kokoke.
• MRI hoʻoili. Hiki i kēia hoʻāʻo kiʻi ke hōʻike i ka hoʻolaha ʻana o ka tumo a hāʻawi i kahi alakaʻi no ke ʻoki.
• Mediastinoscopy. Hoʻokomo ʻia kahi paipu ma ka ʻāʻī i kahi kauka e lawe i kahi laʻana o nā lymph node.
• ʻO Biopsy. ʻO ka hemo ʻana i nā aʻa tumo no ka hoʻokolokolo ʻana e noʻonoʻo ʻia e hōʻoia i ka pae tumo a hoʻoholo i ka lāʻau.
• ʻO ka thoracoscopy kōkua kōkua wikiō (VATS). Hiki i kēia ʻoki hōʻemi iki ke komo i nā ʻaʻa no ke kālailai.
• Mini-thoracotomy. Hoʻohana kēia kaʻina hana i nā ʻoki liʻiliʻi, a me ke kiʻi ʻana i nā ʻaʻa no ke kālailai.
• Nā kaha ʻē aʻe. Pono paha kēia i mea e nānā ai no ka laha ʻana o ka maʻi ʻaʻai i nā iwi, ka lolo, a me nā wahi ʻē aʻe o ke kino.

Hoʻomaʻo no ka tumo Pancoast

ʻOiai manaʻo ʻia he mea make, i kēia lā ʻo Pancoast tumors ke mālama ʻia, ʻoiai ʻaʻole hiki ke curable.

ʻO ka mālama ʻana i kahi tumo Pancoast ma muli o ka wanaʻao ua ʻike ʻia, pehea ka laha ʻana, nā wahi e pili ana, a me kou kūlana olakino olakino.

Ke hoʻokū nei

Hoʻohui ʻia kahi tumo Pancoast ma kahi ʻano like me nā maʻi ʻaʻai ʻē aʻe, e hoʻohana ana i nā helu romana I a i IV a me nā subtypes A a i ʻole B e hōʻike ai i ka holomua o ka maʻi. ʻO ke kau ʻana he alakaʻi no ka hana pilikino e loaʻa iā ʻoe.

Hoʻohui ʻia, hoʻokaʻawale hou ʻia nā tumo Pancoast me nā leka a me nā helu 1 a 4 e hōʻike ana i ka ʻoʻoleʻa:

• Hoʻonohonoho ʻo T i ka nui a hoʻolaha ʻia o ka tumo.
• N wehewehe i ke komo ʻana o ka pona lymph.
• Pili ʻo M inā paha ua hoʻouka ʻia nā pūnaewele mamao (metastases).

Hoʻokaʻawale ʻia ka hapa nui o nā tumo Pancoast ma ke ʻano he T3 a i ʻole T4, ma muli o ko lākou wahi. Hoʻokaʻawale ʻia nā tumors me T3 inā komo lākou i ka paia o ka umauma a i ʻole nā ​​ʻalalā aloha. He mau tumo T4 lākou ke lele lākou i nā hale ʻē aʻe, e like me ka vertebrae a i ʻole nā ​​ʻalalā brachial.

ʻOiai ʻo nā tumo mua loa o Pancoast i ʻike ʻia e hoʻonohonoho ʻia ma kahi o IIB, ma muli o ko lākou wahi.

Lapaʻau

Lapaʻau ka hoʻomaʻamaʻa no nā tumo Pancoast a pili i ka hui pū ʻana o ka chemotherapy, radiation, a me ke ʻoki kino.

ʻO nā tumo Pancoast i metastasized i nā wahi ma ʻō aku o ka umauma ʻaʻole paha he moho no ke ʻoki.

ʻO Chemotherapy a me radiation ka pae mua ma mua o ke kaha. A laila loiloi hou ʻia ka tumo me kahi CT scan ʻē aʻe a i ʻole nā ​​hōʻike kiʻi ʻē aʻe. Hana kūpono ʻia ke kaha ʻekolu a ʻeono paha pule ma hope o ka chemotherapy a me ka radiation, ma mua o ka loaʻa ʻana o kahi scarring i ke ala o ke ʻoki.

I kekahi mau hoʻolālā lapaʻau, e ukali ʻia ke kahakaha e nā lāʻau hoʻomaluna hou e pepehi i nā hunaola maʻi ʻē aʻe.

ʻO ka pahuhopu o ke ʻoki ʻo ia ke hoʻopau loa i nā mea maʻi ʻaʻai mai nā kūkulu āna i hoʻouka ai. ʻAʻole hiki kēia i nā manawa a pau, a piʻi hou paha ka maʻi. Ua ʻike ʻia kahi noiʻi liʻiliʻi i hana ʻia ma Maryland ua hoʻi hou ka maʻi ma 50 pākēneka o kēlā mau poʻe i komo i loaʻa i kahi ʻoki tumoast Pancoast.

ʻO ka holomua ʻenehana i nā ʻenehana ʻoki lāʻau i hiki ai ke hana i ke kahakaha ma nā tumo T4 Pancoast, akā ʻoi aku ka maikaʻi o ka nānā ma mua o nā pae ʻē aʻe o ka maʻi.

Hoʻomaha ʻeha

ʻO ke kōkua ʻeha no nā tumo Pancoast i kēia lā e pili ana i ka hoʻohana ʻana o opioids i kuhikuhi ʻia e ke kauka. Eia nō naʻe, hele mai kēia me nā hopena ʻaoʻao makemake ʻole ʻia. Ua hoʻopaʻapaʻa kekahi mau mea noiʻi no ka hoʻi ʻana i nā hana pre-opioid i kūpono me ka ʻole o nā hopena ʻaoʻao.

Hiki paha ke hoʻohana i ka uila e hoʻomaha ai i ka ʻeha ke hiki ʻole ke ʻoki.

Hiki ke hoʻomāmā ʻia ka ʻehaʻeha me nā tumo Pancoast me kahi kaʻina ʻoki e hiki ʻole ai i nā ʻalalā ʻehaʻeha i loko o ka iwi kuamoo. Kāhea ʻia kēia he cordotomy alakaʻi ʻia CT, kahi e hoʻohana ʻia ai kahi CT scan e alakaʻi ai i ke kauka.

I hoʻokahi o nā noi ʻana, ʻo kēlā me nā tumo Pancoast i hōʻike i ka hoʻomaikaʻi ʻeha nui me kēia kaʻina hana. ʻO kahi cordotomy a i loko o nā pule hope o ke ola e hāʻawi i ka hoʻomaha ʻeha.

Nā hana kūpono e hiki ai ke hōʻoluʻolu i ka ʻeha tumo Pancoast me:

• decompression laminectomy (ʻoki e hoʻopau i ke kaomi ma nā aʻa kuamoʻo)
• palaka phenol (e hoʻokomo ana i ka phenol e ālai i nā aʻalolo)
• hoʻonāukiuki transdermal (e hoʻohana ana i ke au uila pololei haʻahaʻa haʻahaʻa ma ka lolo)
• stellate ganglion block (e hoʻokomo ana i ka anesthetic i loko o nā ʻāʻī i ka ʻāʻī)

Nā helu e ola ai no ka tumo Pancoast

ʻOkoʻa ke ola ma hope o ka chemotherapy, radiation, a me ke kaha ʻana. Ua hōʻike ʻia kahi hōʻike ʻo Cleveland Clinic i ka nui o ke ola ma hope o ʻelua mau makahiki ma hope o ke kaha ʻana ma ke ʻano he 55 a 70 pakeneka. ʻO ka helu ola 5 mau makahiki no nā ʻoki ʻana i lawe aku i ka tumo Pancoast kumu he 54 pakeneka a 77 pakeneka.

Outlook

No nā makahiki he nui, ua manaʻo ʻia nā tumo Pancoast hiki ʻole ke mālama ʻia. Ma muli o kahi o ka puʻupuʻu, ua manaʻo ʻia ʻaʻole hiki ke ʻoki kino.

I nā makahiki i hala aku nei, ua hoʻomaikaʻi nui ʻia ka nānā no ka poʻe me nā tumo Pancoast. ʻO nā ʻenehana ʻoki lāʻau hou i hiki ke hana i nā tumors i manaʻo ʻia ʻaʻole hiki ke hoʻohana ʻia. ʻO ka hoʻomaʻamaʻa maʻamau e pili ana i ka chemotherapy, radiation, a me ke kaha ʻana ua hoʻonui i nā helu ola.

ʻO ka ʻike mua ʻana i kahi tumo Pancoast he mea nui i ka hoʻoholo ʻana i ka kūleʻa o ka lapaʻau. E ʻike koke i kāu kauka inā loaʻa kāu mau ʻōuli, a hana i nā mea e pale ai e like me ka haʻalele ʻana i ka puhipaka inā puhipaka ʻoe.