Gwaje-gwajen da kuma hanyoyin da za a bincikar cutar ciwon huhu
Sakamakon ganewar cutar ciwon huhu na iya farawa da rayukan rayukan kirji, amma tun da wannan gwajin zata iya rasa ciwon canji, likitan kirji na CT yayi, kuma a karshe an samu biopsy idan an samo nodule ko taro, ana bukata.
Kwayar ciwon huhu a lokuta da ake zargi da laifi bayan an gano wani abu mai banƙyama akan rayukan rayukan kirji don kimanta tari ko jin zafi. A lokacin wannan tsoratarwa, yana da amfani a san wasu hanyoyin da za'a iya bada shawara don gano idan mummunan abu ya zama marar kyau (wanda ba zai yiwu ba), ko m (cancerous).
Idan mummunan abu ya zama mummunan aiki, an cigaba da nazari don ganin ko ciwon daji ya yada ( metastasized ) zuwa wasu sassan jiki kuma ya gano yanayin cutar.
Lung Cancer Screening
Ga wadanda ba tare da bayyanar cututtuka ba, an riga an amince da binciken cutar kanjamau a farkon shekaru 55 zuwa 80, sun taba kyauta don akalla shekaru 30, da kuma shan taba ko kuma barin shan taba a cikin shekaru 15 da suka gabata. Yana da mahimmanci a lura, duk da haka, yin nazari yana nufin zama gwajin da aka yi ga waɗanda ba su da wata alama. Idan kana da wata alamar cututtuka na ciwon huhu na huhu, za a buƙatar wasu gwaje-gwaje, ciki har da cikakken CT scan.
Lung "Spots" da Sauran Bayanan
Kafin ka shiga ganewar asibiti na ciwon huhu, zaku iya jin dadin ku ta bayyanar cututtuka, da kuma duk wani mummunar da likitanku ya gani ko za ku gani akan x-ray ko CT scan. A matsayin mai dubawa mai sauri, A matsayin mai dubawa mai sauri, an yi la'akari da ƙwayar huhu a matsayin "tabo" a kan huhu wanda yake da 3 cm (inci da rabi) ko žasa a diamita.
Tsarin ruhu yana nufin wani mummunan abu wanda ya fi girma 3 cm a diamita. Hanya a kan huhu ko "kututtukan huhu" zai iya kasancewa mara kyau ko m. Kyakkyawan "inuwa" a kan x-ray na iya zama marar kyau ko m, ko kuma kawai maɓallin al'ada a cikin kirji.
Tarihi da Jiki
Lokacin da ake zargi da ciwon huhu na huhu, likita zai fara yin tarihi sosai da kuma jarrabawar jiki.
Anyi wannan ne don kimanta bayyanar cututtuka da kuma abubuwan haɗari ga ciwon huhu na huhu , da kuma neman duk wani alamomin jiki wanda ya nuna damuwa da cutar huhu . Wadannan zasu iya haɗawa da sautunan ƙwayoyin ƙwayar cuta, ƙaddarar ƙwayoyin lymph , rashin asarar rashin nauyi, ko cin kuɗin ƙwanƙwasa (ƙwallon ƙafa).
Laboratory and Radiology Studies
Za'a iya buƙatar wasu nau'o'in nazarin hotunan daban-daban, dangane da ƙayyadadden bayyanar cututtuka da bincike akan gwaji. Wadannan sun haɗa da:
Chest X-Ray
Kwancen rayukan kirji shine yawan gwajin farko da aka yi don kimanta duk wani damuwar da ta shafi tarihin hankali da ta jiki. Wannan yana iya nuna taro a cikin huhu ko kuma ƙara yawan ƙwayoyin lymph. Wani lokaci nau'in rayukan kirji na al'ada ne, kuma ana buƙatar gwaje-gwaje don neman cutar kanjamau. Ko da za a samo taro, waɗannan ba sau da yawa ne kuma ana buƙatar nazarin. Ya kamata a jaddada cewa rayukan rayukan kirji kadai bai isa ya yi sarauta akan ciwon huhu ba, kuma ana iya rasa ciwon daji tare da waɗannan gwaje-gwaje.
CT dubawa
A CT scan (kwamfuta tomography) shi ne akai-akai mataki na biyu ko dai don bi a kan wani mahaukaci gano rayukan kirji ko don kimanta bayyanar cututtuka a waɗanda suke da kwakwalwa na rayukan rayuka. Binciken CT ya ƙunshi jerin rayukan x da suka haifar da ra'ayi na uku na huhu.
Idan CT yana da mawuyacin hali, cutar sankarar ciwon huhu ta buƙatar tabbaci ta hanyar samfurin nama ta hanyar daya daga cikin hanyoyin da ke ƙasa.
MRI (yanayin haɓaka mai kwakwalwa)
Ga wasu mutane, MRI (hotunan haɓaka mai kwakwalwa) za a yi amfani dasu don kimanta yiwuwar cutar ciwon huhu. Wannan hanya tana amfani da magnetism kuma baya shafar radiation. Wasu mutane, irin su waɗanda suke da ƙarfin ƙarfe (masu sintiri, da dai sauransu) bazai da MRI ba. Kwararren za su tambayi tambayoyi don tabbatar da waɗannan ba a nan ba.
PET Scan
Binciken PET (tasirin haɓakaccen haɗari) yana amfani da kayan aikin rediyo don ƙirƙirar hotunan hoton uku na yanki na jiki.
Irin wannan tsari ya bambanta da wasu a cikin wannan yana fassara magungunan da ke ci gaba da girma. An yi amfani da ƙwayar rediyo mai zurfi a cikin jini, kuma an ba da lokaci da za a dauka ta hanyar kwayoyin halitta. Sel da suke ci gaba da girma suna karuwa fiye da sukari, kuma suna haskakawa a fina-finai. Ana gwaji gwajin tare da CT scan (PET / CT). Bugu da žari ga sauran hanyoyin, wasu masu bincike sun nuna cewa mai yiwuwa PET ta gano magungunan ciwon daji a baya, ko da ma kafin a gani su ta hanyar binciken sauran. Kwancen PET yana da amfani don bambanta tsakanin ciwace-ciwacen daji da ƙwayar cuta a cikin mutanen da suka kware a cikin huhu don kowane dalili.
Sputum Cytology
Bayan da ake zargi da cutar kanjamau bisa ga hoto, ana buƙatar samfurin nama don tabbatar da ganewar asali da kuma sanin irin ciwon daji. Cytology Sputum ita ce hanyar da ta fi dacewa ta yi, amma amfani da shi yana iyakancewa ga waƙar da ake yadawa a cikin hanyoyi. Sputum cytology ba koyaushe ba ne kuma zai iya rasa wasu kwayoyin cutar ciwon daji. Jarabawar ta fi amfana idan ya tabbata, amma ya ce kadan idan yayi mummunar.
Bronchoscopy
A cikin ƙwararren ƙwayar jiki , ƙwararren ƙwayar cuta ya sanya wani bututu a cikin hanyoyi don duba da kuma daukar samfurin ƙwayar. Ana amfani da wannan hanya lokacin da ake samun kututture a cikin manyan hanyoyi na iska kuma za'a iya kaiwa ta hanyar ikon. An ba marasa lafiya anesthesia yayin wannan hanya don rage rashin jin daɗi. A lokacin da aka gano dabbar jiki, za'a iya daukar kwayar cutar ta kowane ciwo ko sauran abubuwan da ke faruwa a cikin hanyoyi.
Endobronchial Duban dan tayi
Erasbronchial ultrasound ne mai inganci sabon ƙwayar maganin cutar kanjamau. Yayin da likitoci suka yi amfani da su, likitoci sunyi amfani da bincike na duban dan tayi a cikin jirgin sama don bincika huhu da yanki tsakanin huhu (mediastinum). Ga ciwace-ciwacen da ke kusa da filin jirgin sama, ana iya yin biopsy tare da wannan hoton.
Maganin daji ne
A cikin fata mai mahimmanci mai buƙata (FNA), likita ya saka wani allura mai zurfi a cikin bangon katako, yawanci jagorancin CT ne aka gani, don daukar samfurin ƙwayar cuta. Ana iya yin hakan akan ciwace-ciwacen da ba za a iya kaiwa ta hanyar bronchoscopy ba, musamman ma wadanda ke kusa da gefen huhu.
Tashin hankali
Yayin da ciwon huhu ya shafi kullun da zafin jiki, zai iya haifar da ruwa don ginawa a tsakanin huhu da kuma rufin huhu. (Tare da ƙwaƙwalwa.) Tare da anesthesia na gida, an saka allurar da aka fi girma a cikin ɓangaren kwakwalwa daga cikin ko wane nau'i na ruwa (ƙananan ƙwayar gwaji ga kwayoyin cutar ciwon daji, wani mummunan nau'in ruɓaɓɓen ƙwayar cuta ) ko kuma yanayin warkewar ruwa (adadin yawa don inganta ciwo da / ko gajeren numfashi) an cire.
Mediastinoscopy
A mediastinoscopy Wannan hanya an yi a cikin ɗakin aiki a ƙarƙashin ƙwayar cuta. An saka iyaka a saman sternum (ƙashi nono) a cikin yankin tsakanin huhu ( matsakaici ) don ɗaukar samfurori daga samfurorin lymph. A PET duba zai iya sau da yawa sau da yawa samar da wannan sakamakon da cewa mediastinoscopy yi a baya.
Jarraba don ƙayyade idan cutar kututture ta yadu (Metastasized)
Kwayar cutar huhu ta fi yawan yaduwa zuwa hanta , da ƙwayar daji, kwakwalwa da kasusuwa. Kasuwanni na yau da kullum sun hada da
- CT scan daga cikin ciki: Don bincika yada zuwa hanta ko giraguni
- MRI daga cikin kwakwalwa: Don neman samfurori ga kwakwalwa
- Bone scan : Don gwada metastases zuwa ƙasusuwa , musamman ma baya, kwatangwalo, da hamsin
- Bincike PET: Bincike na PET zai iya nemo matakan ganyayyaki da gaske a ko'ina cikin jiki, kuma a wasu lokutan za a maye gurbin wasu gwaje-gwaje a sama kamar ƙashi mai launi ko CT scans.
Wasu Gwaje-gwaje A lokacin Bincike
Ƙarin ƙarin gwaje-gwajen marasa kwaskwarima ana yin su akai-akai yayin ganewar asibiti na ciwon huhu. Wadannan zasu iya hada da:
- Gwajin aikin gwagwarmaya (PFTs): PFT gwajin gwajin gwagwarmaya kuma zai iya ƙayyade yawancin ƙwayar yana ciwo da numfashi, kuma wani lokacin, ko yana da lafiya don yin aikin tiyata
- Yin gwajin jini: Wasu gwaje-gwaje na jini na iya gano ƙwayoyin cututtukan halittu da cutar kututtuka suka haifar da su, kuma iya bayar da shawarar yaduwar ƙwayar cutar
Lung Biopsy
Idan ana jin dadin cutar kanjamau akan nazarin hoto, mataki na gaba shine a yi amfani da kwayar cutar kwayar halitta don sanin ko cutar ta kasance ko gaske ko kuma a'a, kuma don sanin irin cutar kanjamau.
Yawancin biopsies an yi akan samfurori na samfurori, amma biopsies na ruwa sune sabon hanyar da za su bi wasu mutanen da ke fama da ciwon huhu. An amince da shi a Yuni na shekarar 2016, za'a iya yin gwaje-gwajen ta hanyar zane mai sauƙi. A wannan lokacin, an yarda da su ne kawai don ganowa maye gurbin EGFR, amma ga kowa da kowa, sun kasance misali mai kyau na yadda cutar da cutar ta jijiyoyin inganta kowace shekara.
Lokacin da ciwon daji ya yadu, yana da muhimmanci ga nama "re-biopsy", kamar yadda cututtuka na iya canjawa a lokaci, kuma waɗannan canje-canjen zasu iya taimaka maka da likitanka don zaɓar mafi kyawun zabin magani.
Masana ilimin kwayoyin halitta / Gene Testing
Yanzu an bayar da shawarar cewa kowa da kowa tare da ciwon huhu na ƙananan ƙwayoyin cuta, kuma musamman adenocarcinoma na huhu, suna da labarun kwayoyin da aka aikata a kan ciwon su. Wannan jarrabawar jigilar kwayoyin yana neman maye gurbi a cikin kwayoyin cutar ciwon daji wanda za'a iya samun magungunan ƙwayoyi waɗanda suke "ƙaddamar" waɗannan maye gurbin.
Wadannan ba maye gurbin da aka haife ku ba, kuma baka iya ba da su ga 'ya'yanku. Su ne maye gurbin da ke faruwa a yayin da kwayar halitta ta zama abin ƙyama kuma wanda "kullun" ya ci gaba da ciwon daji.
An riga an amince da jiyya da aka tsara don mutanen da suka maye gurbin EGFR , gyaran gyaran ALK, gyaran ROS1 , da wasu wasu maye gurbin. Bugu da ƙari, an yi nazari a wasu gwaje-gwaje na asibiti .
PD-L1 Gwaji
Tun lokacin da aka yarda da maganin rigakafin rigakafi na farko da ya dace don maganin cutar kanjamau a shekara ta 2015, 3 ƙarin magunguna sun zama samuwa. Ana iya yin gwaji da aka kira PD-L1 don ƙayyade kashi na faɗar PD-L1 a kan kwayoyin cutar Kanada. PD-L1 shine furotin da aka bayyana a mafi yawa a kan wasu kwayoyin cutar kanjamau. Wannan furotin yana taimakawa wajen bunkasa "ƙuƙwalwa" na tsarin na rigakafi, rage ikonsa na yaki da kwayar cutar ciwon daji. Wasu kwayoyin ciwon daji sun gano hanyoyin da za su "ɓoyewa" wannan furotin a matsayin hanyar ɓoyewa daga tsarin rigakafi. Magunguna da aka sani da masu hana masu zanga-zanga sunyi aiki ta hanyar hana wannan aikin kuma suna sake watsar da ƙuƙwalwar a kan tsarin da ba a rigakafi ba.
Har yanzu ba mu san yadda muhimmancin gwajin PD-L1 zai kasance a maganin ciwon huhu ba. Dukkan ciwon daji guda biyu wadanda kwayoyin cutar PD-L1 da wadanda basu iya amsa wadannan kwayoyi ba. A halin yanzu yana tunanin cewa yana iya zama mai tasiri don yin waɗannan gwaje-gwaje, amma iyakance amfani da wadannan kwayoyi kawai ga mutanen da ke da ciwon sukari da cewa PD-L1 mafi wuya zai iya rage yawan mutanen da zasu amfana daga waɗannan kwayoyi.
> Sources:
> Aquiar, P., Perry, L., Penny-Dimr, J. et al. Hanya na PD-L1 Gwaji akan Ƙimar-Kwarewa da Harkokin Tattalin Arziki na Ƙwararrun Masu Gano Maɗaukaki na Lafiya don Ra'ayin Na biyu na NSCLC. Annals na Oncology . 2017 Yuni 15. (Epub gaba da bugu).
> Cibiyar Nazarin Lafiya ta kasa. Medline Plus: Ciwon daji na huhu. Updated 02/21/18. https://medlineplus.gov/lungcancer.html