Ciwon Huhun Daji

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Ciwon Huhun Daji
Cancerous lung.jpg
Description (en) Fassara
Iri respiratory system cancer (en) Fassara, lung disease (en) Fassara, lung neoplasm (en) Fassara
disease (individual) (en) Fassara
Specialty (en) Fassara oncology (en) Fassara
pulmonology (en) Fassara
Sanadi tobacco smoking (en) Fassara, asbestosis (en) Fassara, passive smoking (en) Fassara, radon (en) Fassara, Gurbacewar Iska
smoking (en) Fassara
Symptoms and signs (en) Fassara chest pain (en) Fassara, tari, Tari jini, Rashin karfi, weight loss (en) Fassara, anorexia (en) Fassara, dyspnea (en) Fassara
wheeze (en) Fassara
Effect (en) Fassara death (en) Fassara
Physical examination (en) Fassara radiography (en) Fassara, computed tomography (en) Fassara, bronchoscopy (en) Fassara
biopsy (en) Fassara
Genetic association (en) Fassara CHEK2 (en) Fassara, TP63 (en) Fassara, BPTF (en) Fassara, VTI1A (en) Fassara, PHACTR2 (en) Fassara, LRFN2 (en) Fassara, RAD52 (en) Fassara, TERT (en) Fassara, MTMR3 (en) Fassara, GPC5 (en) Fassara, TGM5 (en) Fassara, CLPTM1L (en) Fassara, IL1RAP (en) Fassara da EGFR (en) Fassara
Identifier (en) Fassara
ICD-10-CM C34.2, C34.1 da C34.3
ICD-9-CM 162.3, 162.5, 162.8 da 162.4
ICD-10 C3333.-C3434.
ICD-9 162162
OMIM 211980, 608935, 612593, 614210 da 612571
DiseasesDB 7616
MedlinePlus 007194 da 007270
eMedicine 007194 da 007270
Disease Ontology ID DOID:1324
alamun Ciwon daji a nono

Ciwon huhun daji ciwo ne na qarin huhu ana danganta shi da girmar tantani mara magani na fale-falen nama ta huhu. Idan ba a nemo magani ba, wannan girmar zata yaɗu nisa da huhun ta hanyar metastasis zuwa fale-falen nama ko sassan jikin. Yawancin ciwon daji da ke faruwa a huhu ana ce da su ciwon huhun daji na farko, acrcinomas. Ainihin waɗannan ire-ire biyu sune; karamin-tantanin huhun carcinoma (SCLC) da mara-karamin-tantanin huhun carcinoma (NSCLC). [1]Yawan alamomin wannan ciwo sune; tari (da tarin jini), ramewa, kasawar numfashi da ciwon kirji.

Kaso bisa darin jama'a tamanin da biyar (85%) na matsalolin ciwon huhun daji ya nuna cewa shan taba na tsawon lokaci na kawo ciwon. Sa'annan 10-15 bisa dari (10-15%) matsalolin wannan ciwo ya samu ne ta rashin shan taba/sigari. Wadannan matsalolin na sa haduwa matsalar kayyade da watsawa zuwa rado gas, asbestos, da wasu hayakin kone-kone da wasu gurbacewar iska. Za a iya ganin ciwon huhun daji kamar ciwon kirji ne idan an yi hoto aka kuma hada duba da na'ura (CT). Gwajin ta bayyanu ta bayosfsi wanda kullum ana yinta bronchoscopy ko na'ura mai kwakwalwwa.

Rigakafin shi ne ta kiyaye hazarin kamuwa da ita, tare da shan hayaki da kuma gurvacewar iska. kula da wannan da sakamako na tsawon lokaci ya danganta ga irin ciwon huhun dajin, yanayinta (yadda ya ke yaxuwa), da kuma dukan lafiyar mutumin. 'yawancin matsalolin ba a iya magance su. Maganinsa na yau dakullum ya hada da fixa, da magangunan kimiya, da dauka hoton. Ana iya magance NSCLC da fixa wasu lokuta, sa'annan SCLC kuma qan ji magangunan kimiya da daukan hoton da sauri fiye da fixa.

File:Clatterbridge Cancer Centre, Liverpool . 2.jpg
Babban Asibitin kula da Ciwon daji dake Liverpool

A duniya gaba daya a shekara ta 2012, an same mutum miliyan daya da digo takwas (1.8 million) an gwada su da ciwon huhun daji, sa'annan mutum miliyan daya da digo shida sun mutu ta dalilin ciwon (1.6 million). Wannan ya zamma sanadiyyar mutuwa a maza na ciwon huhun daji gama gari da ya faru da na biyu cikin sanadiyyar mutuwar mata bayan ciwon-nono. 'yan shekaru saba'in ne an fi gwada su da wannan cutar. Mutane kashi sha bakwai da digo hudu cikin dari cikin Qasar Amurka an gwada su da wannan ciwon huhun daji, sun rayu da ciwon na shekaru biyar bayan gwajin, sa'annan sakamakon a Qaddarance a Qasashe masu tasowa.[2]

Alamomi Da Alamun Bayyana Cututtuka[gyara sashe | Gyara masomin]

Alamomi da alamun bayyanar cututtuka da zasu iya ba da shawarar ciwon daji na huhu sun haɗa da:[1] Alamun numfashi: tari, tari na jini, shaƙatawa, ko ƙarancin numfashi Alamomin tsarin: asarar nauyi, rauni, zazzabi, ko kullun farce Alamun saboda yawan ciwon daji na latsawa akan sifofin da ke kusa: ciwon kirji, ciwon kashi, toshewar vena cava, ko wahalar haɗiye Idan ciwon daji ya girma a cikin hanyoyin iska, yana iya toshe kwararar iska yana haifar da wahalar numfashi. Haka kuma toshewar na iya haifar da tarin sinadarai a bayan toshewar, da kuma kara hadarin kamuwa da ciwon huhu[1].[3] Yawancin alamomin ciwon daji na huhu (rashin ci, rage kiba, zazzabi, gajiya) ba su takamaimai ba.[3] A cikin mutane da yawa, ciwon daji ya riga ya yadu fiye da asalin wurin lokacin da suke da alamun bayyanar cututtuka da kuma neman magani.[20] Alamomin da ke ba da shawarar kasancewar cutar ƙanƙara sun haɗa da asarar nauyi, ciwon kashi, da alamun jijiya (ciwon kai, suma, jijjiga, ko raunin hannuwa).[1] Wuraren yaɗuwar gama gari sun haɗa da kwakwalwa, ƙashi, glanden adrenal, kishiyar huhu, hanta, pericardium, da koda.[20] Kimanin kashi 10% na mutanen da ke fama da ciwon huhu ba su da alamun bayyanar cututtuka a ganewar asali; Ana samun waɗannan ciwon daji bisa ga radiyon ƙirji na yau da kullun.[15] Dangane da nau'in ƙari, abubuwan ban mamaki na paraneoplastic - alamun da ba saboda kasancewar ciwon daji ba - na iya fara jawo hankali ga cutar.[21] A cikin ciwon huhu na huhu, waɗannan abubuwan mamaki na iya haɗawa da hypercalcemia, ciwo na hormone antidiuretic da bai dace ba (fitsarin da ba a saba da shi ba da jini mai narkewa), samar da ACTH na ectopic, ko ciwo na Lambert-Eaton myasthenic (rauni na tsoka saboda autoantibodies). Ciwon daji a saman huhu, wanda aka sani da ciwace-ciwacen Pancoast, na iya mamaye yankin yankin na tsarin juyayi mai juyayi, wanda ke haifar da ciwon Horner (faɗin fatar ido da ƙaramin ɗalibi a wancan gefen), da kuma lalata plexus na brachial[4]

Dalilai[gyara sashe | Gyara masomin]

Risk of death from lung cancer is strongly correlated with smoking.
Dangantaka tsakanin shan taba sigari kowane mutum (blue) da namijin huhu ciwon daji (dark yellow) a Amurka sama da karni.

Dalilai Dangantaka tsakanin shan taba sigari kowane mutum (blue) da namijin ciwon huhu na huhu (dark yellow) a Amurka sama da karni Haɗarin mutuwa daga ciwon huhu yana da alaƙa da shan taba.[5] Ciwon daji yana tasowa bayan lalacewar kwayoyin halitta ga DNA da canje-canje na epigenetic. Wadancan canje-canjen suna shafar ayyukan al'ada na tantanin halitta, gami da yaɗuwar tantanin halitta, tsarin mutuwar kwayar halitta (apoptosis), da gyaran DNA. Yayin da ƙarin lalacewa ke taruwa, haɗarin ciwon daji yana ƙaruwa.[22].[6]

Shan taba[gyara sashe | Gyara masomin]

shan taba shine babban abin da ke haifar da cutar kansar huhu.[4] Hayakin taba sigari ya ƙunshi aƙalla sanannun ƙwayoyin cuta na 73, [23] gami da benzo [a] pyrene, [24] NNK, 1,3-butadiene, da isotope na rediyoaktif na polonium - polonium-210.[23]. A duk kasashen da suka ci gaba, kashi 90% na mutuwar cutar kansar huhu a maza da kashi 70% na mata a shekarar 2000 ana danganta su da shan taba.[7][25] Shan taba yana da kusan kashi 85% na cututtukan daji na huhu.[14] Vaping na iya zama abin haɗari ga kansar huhu, amma ƙasa da na sigari, kuma ƙarin bincike ya zama dole saboda tsawon lokacin da zai iya ɗauka don cutar kansar huhu bayan kamuwa da cututtukan carcinogens.[26][27] Shan taba mai wucewa - shakar hayaki daga shan taba wani - shine sanadin cutar kansar huhu ga masu shan taba. Ana iya bayyana mai shan taba a matsayin wanda ko dai yana zaune ko yana aiki tare da mai shan taba. Nazarin daga Amurka, [28] [29] [30] Birtaniya [31] da sauran ƙasashen Turai[32] sun nuna ci gaba da haɓaka haɗari tsakanin waɗanda ke fuskantar shan taba.[33] Haɗarin kamuwa da kansar huhu yana ƙaruwa da kashi 25-28%.[34] Binciken hayaki na gefe (babban abin da ke haifar da hayaki na biyu; a kusa da 85%) yana nuna cewa yana da haɗari fiye da hayaƙi na yau da kullun.[35] Hayakin marijuana ya ƙunshi yawancin ƙwayoyin cuta iri ɗaya kamar waɗanda aka samu a cikin hayaƙin taba, [36] amma tasirin shan wiwi akan haɗarin kansar huhu bai bayyana ba.[8][37][38] Binciken 2013 bai sami ƙarin haɗari daga haske zuwa amfani mai matsakaici ba.[39] Binciken da aka yi a shekara ta 2014 ya nuna cewa shan wiwi ya ninka haɗarin kansar huhu, kodayake cannabis yana cikin ƙasashe da yawa da aka haɗa da taba.][9]

Radon Gas[gyara sashe | Gyara masomin]

Radon iskar gas ce mara launi da wari da ke haifarwa ta hanyar karyewar radium na rediyoaktif, wanda kuma shine rubewar samfurin uranium, wanda ake samu a cikin ɓawon ƙasa. Samfuran ruɓar raɗaɗi suna haɗar da kwayoyin halitta, suna haifar da maye gurbi wanda wani lokaci ya zama cutar kansa. Radon shine na biyu-mafi yawan sanadin cutar kansar huhu a cikin Amurka, [41] yana haifar da mutuwar kusan 21,000 kowace shekara.[42] Haɗarin yana ƙaruwa 8-16% na kowane 100 Bq/m³ karuwa a cikin radon maida hankali.[[10]43] Matakan gas na Radon sun bambanta ta wurin zama da kuma abun da ke cikin ƙasa da duwatsu. Kusan ɗaya cikin gidaje 15 a Amurka yana da matakan radon sama da shawarar da aka ba da shawarar na 4 picocuries kowace lita (pCi/l) (148 Bq/m³).[44][11]

Asbestos[gyara sashe | Gyara masomin]

Asbestos na iya haifar da cututtukan huhu iri-iri kamar kansar huhu. Shan taba da kuma bayyanar da asbestos tare suna da tasirin haɗin gwiwa akan ci gaban ciwon huhu[12].[5] A cikin masu shan taba da ke aiki tare da asbestos, haɗarin ciwon daji na huhu yana ƙaruwa sau 45 idan aka kwatanta da yawan jama'a.[45]. Hakanan asbestos na iya haifar da ciwon daji na pleura, wanda ake kira mesothelioma - wanda a zahiri ya bambanta da kansar huhu.[46][13]

Gurbatacciyar Iska[gyara sashe | Gyara masomin]

Gurbacewar iskar gurbacewar iska a waje, musamman sinadarai da ake fitarwa daga kona man kaburbura, na kara kamuwa da cutar kansar huhu.[4] Fine particulates (PM2.5) da sulfate aerosols, waɗanda za a iya saki a cikin hayaki sharar hanya, suna da alaƙa da ɗan ƙara haɗari.[4][[14]47] Ga nitrogen dioxide, karuwar kashi 10 a kowace biliyan yana ƙara haɗarin cutar kansar huhu da kashi 14%.[48] An kiyasta gurɓacewar iska a waje yana haifar da kashi 1-2% na cututtukan daji na huhu.[4] Shaida ta asali tana goyan bayan ƙarin haɗarin cutar kansar huhu daga gurɓacewar iska a cikin gida dangane da ƙone itace, gawayi, taki, ko ragowar amfanin gona don dafawa da dumama.[49] Matan da hayaƙin kwal na cikin gida suna da kusan ninki biyu na haɗarin, [15]kuma yawancin abubuwan da ake samu na konewar ƙwayoyin cuta an san su ko kuma waɗanda ake zargi da cutar sankarau.[50] Wannan hadarin ya shafi kusan mutane biliyan 2.4 a duk duniya, [49] kuma an yi imanin yana haifar da kashi 1.5% na mutuwar cutar kansar huhu.[16]

Genetics[gyara sashe | Gyara masomin]

Kimanin kashi 8% na cututtukan daji na huhu suna faruwa ne ta hanyar abubuwan gado (genetic)[51]. A cikin dangin mutanen da aka gano suna da ciwon huhu na huhu, haɗarin yana ninka sau biyu, mai yiwuwa saboda haɗuwa da kwayoyin halitta.[52]. Polymorphisms akan chromosomes 5, 6, da 15 [17]an gano su kuma suna da alaƙa da haɗarin cutar kansar huhu.[53] Single-nucleotide polymorphisms na kwayoyin halittar nicotinic acetylcholine receptor (nAChR) - CHRNA5, CHRNA3, da CHRNB4 - suna daga cikin waɗanda ke da alaƙa da haɗarin ciwon huhu na huhu, da RGS17 - kwayar halitta mai daidaita siginar G-protein.[53] ] Sabbin nazarin kwayoyin halitta, sun gano 18 masu rauni loci suna samun ma'anar kwayar halitta. Wadannan loci suna nuna nau'in nau'in nau'i a cikin raunin kwayoyin halitta a cikin nau'o'in histological subtypes na ciwon huhu, sake gano masu karɓar nicotinic cholinergic, misali. CHRNA2.[18]

Sauran Abubuwan Da Ke Haifarwa[gyara sashe | Gyara masomin]

da wasu abubuwa da yawa, sana'o'i, da bayyanar muhalli an danganta su da cutar kansar huhu. Hukumar Bincike kan Ciwon daji ta Duniya ta bayyana cewa "isasshen shaida" ya kasance don nuna cewa waɗannan suna da ciwon daji a cikin huhu:[19] Wasu karafa (samar da aluminum, cadmium da cadmium mahadi, mahadi chromium (VI), mahadi na beryllium da beryllium mahadi. baƙin ƙarfe da karfe kafa, nickel mahadi, arsenic da inorganic arsenic mahadi, da kuma karkashin kasa hematite ma'adinai) Wasu kayayyakin na konewa (rashin cikakken konewa, kwal (a cikin gida hayaki daga gida kwal kona), kwal gasification, kwal-tar farar, coke samar, soot, da ingin dizal) Ionizing radiation (X-ray da gamma) Wasu gas masu guba (methyl ether (nau'in fasaha), da bis- (chloromethyl) ether, sulfur mustard, MOPP (vincristine-prednisone-nitrogen mustard-procarbazine cakuda) da hayaki. daga zanen) Samar da roba da ƙurar siliki na crystalline Ana ganin ƙananan haɓakar haɗarin cutar kansar huhu a cikin mutanen da ke fama da cutar sclerosis.[20]

Pathogenesis[gyara sashe | Gyara masomin]

Pathogenesis Duba kuma: Ciwon daji kamar sauran cututtukan daji, ciwon huhu yana farawa ne ta hanyar kunna ƙwayoyin cuta ko rashin kunna ƙwayoyin ƙwayoyin cuta na ƙari.[56] Carcinogens yana haifar da maye gurbi a cikin waɗannan kwayoyin halitta waɗanda ke haifar da haɓakar ciwon daji [57]. Maye gurbi a cikin K-ras proto-oncogene yana ba da gudummawa ga kusan 10-30% na adenocarcinomas na huhu.[58][59] Kusan kashi 4% na cututtukan huhu marasa ƙananan ƙwayoyin cuta sun haɗa da EML4-ALK tyrosine kinase fusion gene.[60] Canje-canje na Epigenetic kamar canjin DNA methylation, gyaran wutsiya na histone, ko tsarin microRNA na iya haifar da rashin kunna ƙwayoyin ƙwayoyin cuta masu hana ƙari.[61] Mahimmanci, ƙwayoyin cutar kansa suna haɓaka juriya ga danniya na oxidative, wanda ke ba su damar jurewa da haɓaka yanayin kumburi wanda ke hana ayyukan tsarin rigakafi da ƙari.[62][63]. Mai karɓar haɓakar haɓakar epidermal (EGFR) yana daidaita haɓakar ƙwayoyin sel, apoptosis, angiogenesis, da mamayewa.[58]. Maye gurbi da haɓaka EGFR sun zama ruwan dare a cikin NSCLC, kuma suna ba da tushen jiyya tare da masu hana EGFR. Her2/neu ba shi da yawa sosai.[58] Sauran kwayoyin halittar da ake yawan canzawa ko inganta su sun hada da c-MET, NKX2-1, LKB1, PIK3CA, da BRAF.[58] Ba a cika fahimtar layukan tantanin halitta ba.[1] Na'urar na iya haɗawa da ƙarancin kunna sel masu tushe. A cikin hanyoyin iska na kusa, ƙananan ƙwayoyin da ke bayyana keratin 5 sun fi kamuwa da cutar, yawanci suna haifar da squamous-cell huhu carcinoma. A cikin hanyoyin iska na tsakiya, sel mai tushe sun haɗa da ƙwayoyin kulab da ƙwayoyin neuroepithelial waɗanda ke bayyana furotin sirrin kulab. SCLC na iya samo asali daga waɗannan layin salula [64] ko ƙwayoyin neuroendocrine, [1] kuma yana iya bayyana CD44.[64]. Metastasis na ciwon huhu yana buƙatar canzawa daga epithelial zuwa nau'in cell mesenchymal. Wannan na iya faruwa ta hanyar kunna hanyoyin sigina kamar Akt/GSK3Beta, MEK-ERK, Fas, da Par6

Binciken CT[gyara sashe | Gyara masomin]

CT scan showing a cancerous tumor in the left lung
Primary pulmonary sarcoma in an asymptomatic 72-year-old male

Binciken CT scan yana nuna ciwon daji a cikin huhu na hagu Sarcoma na farko na huhu a cikin wani namiji mai shekaru 72 mai asymptomatic Yin rediyon kirji (x-ray) yana ɗaya daga cikin matakan bincike na farko idan mutum ya ba da rahoton alamun da ke iya zama alamar huhu. ciwon daji. X-ray na iya bayyana wani bayyanannen taro, faɗaɗawar mediastinum (mai ba da shawarar yaduwa zuwa nodes na lymph a can), atelectasis (ruɗuwar huhu), ƙarfafawa ( ciwon huhu), ko zubar da jini.[14]. Ana yawan amfani da hoton ƙirji na ƙirji (CT) don ganewar asali kuma yana iya bayyana wani ɗimbin ƙirƙira wanda ke da nuni da cutar kansar huhu. Hakanan ana amfani da hoton CT don samar da ƙarin bayani game da nau'in cuta da girman cutar. Bronchoscopic ko CT-guided biopsy ana amfani da shi sau da yawa don yin samfurin ƙwayar cuta don histopathology.[15] Ciwon daji na huhu na iya bayyana sau da yawa azaman nodule na huhu guda ɗaya akan gidan rediyon ƙirji. Duk da haka, bambance-bambancen ganewar asali yana da fadi kuma wasu cututtuka da yawa kuma na iya ba da wannan bayyanar, ciki har da ciwon daji na metastatic, hamartomas, da granuloma masu kamuwa da cutar tarin fuka, histoplasmosis, ko coccidioidomycosis.[66]. Ciwon daji na huhu kuma yana iya zama abin ganowa ba zato ba tsammani, a matsayin nodule na huhu guda ɗaya akan radiyon ƙirji ko CT scan wanda aka yi saboda wani dalili maras alaƙa.[67] Mahimmin ganewar cutar kansar huhu ya dogara ne akan binciken tarihi na naman da ake tuhuma a cikin mahallin sifofin asibiti da na rediyo.[1][3]. Sharuɗɗa na aikin asibiti suna ba da shawarar takamaiman mitoci (tsakanin tazarar lokaci tsakanin gwaje-gwaje) don kula da nodule na huhu.[68] Ba a ba da shawarar yin amfani da hoton CT na tsawon lokaci ko akai-akai fiye da yadda aka nuna a cikin jagororin asibiti ba, saboda duk wani ƙarin sa ido yana fallasa mutane zuwa ƙarar radiation kuma yana da tsada.[68]

Taswirar Rarrabawa[gyara sashe | Gyara masomin]

Taswirar kek yana nuna abubuwan da suka faru na NSCLCs idan aka kwatanta da SCLCs da aka nuna a dama, tare da ɓangarorin masu shan sigari da marasa shan taba da aka nuna ga kowane nau'in.[21]
Ciwon daji na huhu da ya daidaita shekaru ta nau'in tarihi[22]
Histological type Incidence per 100,000 per year
All types 66.9
Adenocarcinoma 22.1
Squamous-cell carcinoma 14.4
Small-cell carcinoma 9.8

Taswirar Rarraba Pie wanda ke nuna abubuwan da suka faru na NSCLCs idan aka kwatanta da SCLCs da aka nuna a dama, tare da ɓangarorin masu shan taba da masu shan taba da aka nuna ga kowane nau'in[69] Daidaita yanayin ciwon huhu ta hanyar nau'in tarihin tarihi 66.9 Adenocarcinoma 22.1 Squamous-cell carcinoma 14.4 Karamin-cell carcinoma 9.8 An rarraba kansar huhu bisa ga nau'in tarihin tarihi.[3] Wannan rarrabuwa yana da mahimmanci don ƙayyade duka gudanarwa da tsinkayar sakamakon cutar. Ciwon daji na huhu shine carcinomas - malignancies da ke tasowa daga kwayoyin epithelial. An rarraba carcinomas na huhu ta hanyar girma da bayyanar mugayen ƙwayoyin cuta waɗanda masanin ilimin tarihi ya gani a ƙarƙashin na'urar hangen nesa. Don dalilai na warkewa, ana rarrabe manyan nau'ikan ma'auni ne da ake rarrabe su: carcinoma (NSCLC). Ciwon huhun da ba ƙaramin tantai ba Manyan nau'ikan nau'ikan NSCLC guda uku sune adenocarcinoma, squamous-cell carcinoma, da carcinoma babba-cell.[1] Nau'ukan da ba safai ba sun haɗa da adenocarcinoma na ciki na huhu.[71] Kusan kashi 40 cikin 100 na cututtukan daji na huhu sune adenocarcinomas, wanda yawanci ke fitowa daga nama na huhu.[3] Kodayake mafi yawan lokuta na adenocarcinoma suna da alaƙa da shan taba, kuma shine mafi yawan nau'in ciwon huhu na huhu a tsakanin mutanen da suka sha taba sigari kasa da 100 a rayuwarsu ("masu taba shan taba") [1] [72] da kuma masu shan taba tare da tsofaffi. tarihin shan taba.[1] Wani nau'i na adenocarcinoma, ciwon daji na bronchioloalveolar, ya fi kowa a cikin mata masu shan taba, kuma yana iya samun rayuwa mafi kyau na dogon lokaci.[73]. Squamous-cell carcinoma yana haifar da kusan kashi 30% na cututtukan huhu. Yawanci suna faruwa kusa da manyan hanyoyin iska. Ramin rami da mutuwar tantanin halitta yawanci ana samun su a tsakiyar ƙwayar cuta.[3] Kusan kashi 10 zuwa 15 cikin 100 na cututtukan daji na huhu sune carcinoma babba.[74] Ana kiran waɗannan suna saboda ƙwayoyin kansar suna da girma, tare da cytoplasm mai yawa, manyan tsakiya, da kuma nucleoli na fili.[3] Karamin-cell carcinoma huhu A cikin SCLC, sel sun ƙunshi ƙananan ƙwayoyin cuta na neurosecretory (vesicles dauke da hormones na neuroendocrine), waɗanda ke ba da wannan ƙwayar cuta ta endocrin ko ƙungiyar paraneoplastic syndrome.[75]. Yawancin lokuta suna tasowa a cikin manyan hanyoyin iska (na farko da na biyu).[15] Kimanin kashi 60-70% suna da cututtuka masu yawa (waɗanda ba za a iya yin niyya ba a cikin filin jiyya guda ɗaya) a lokacin gabatarwa.[1] Wasu manyan nau'ikan tarihin tarihi guda huɗu an san su, kodayake wasu cututtukan daji na iya ƙunsar haɗaɗɗun nau'ikan cututtukan daji na iya ƙunsar haɗuwa da nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan halitta daban-daban, [70] kamar carcinoma adenosquamous.[3] Nau'ukan da ba safai ba sun haɗa da ciwace-ciwacen daji, ciwon daji na ƙwayar cuta, da sarcomatoid carcinomas.[3]

Metastasis[gyara sashe | Gyara masomin]

Rubutun Napsin-A da TTF-1 na yau da kullun na rigakafi a cikin carcinoma na huhu na farko [23]
Histological type Napsin-A TTF-1
Squamous-cell carcinoma Negative Negative
Adenocarcinoma Positive Positive
Small-cell carcinoma Negative Positive

Metastasis Napsin-A da TTF-1 Immunostaining a Primary huhu Carcinoma[1] Nau'in Histological Napsin-A TTF-1 Squamous-cell carcinoma mara kyau Adenocarcinoma Kyawun Kyawun-cell carcinoma mara kyau. ciwace-ciwace daga sauran sassan jiki. Wadannan ciwace-ciwace ana kiransu metastases ko ciwace-ciwacen ciwace-ciwace. Mafi yawan bayyanar da x-ray na ƙirji shine kasancewar nodules da yawa a cikin ƙananan lobes.[76] Ciwon daji na huhu na farko kuma yakan yi ƙaura zuwa kwakwalwa, ƙasusuwa, hanta, da glandar adrenal.[3] Immunostination na biopsy yawanci yana taimakawa wajen tantance asalin asalin.[77] Kasancewar Napsin-A, TTF-1, CK7, da CK20 suna taimakawa tabbatar da nau'in ciwon daji na huhu. SCLC wanda ya samo asali daga ƙwayoyin neuroendocrine na iya bayyana CD56, kwayoyin adhesion cell cell, synaptophysin, ko chromogranin.[1].

Staging[gyara sashe | Gyara masomin]

Matsayin kansar huhu Matsayin kansar huhu shine kimanta girman yaduwar cutar kansa daga asalinsa.[3] Yana daya daga cikin abubuwan da suka shafi duka tsinkaye da yuwuwar maganin kansar huhu.[1][3] Ƙimar matakan NSCLC tana amfani da rarrabuwar TNM (tumor, node, metastasis). Wannan ya dogara ne akan girman ƙwayar ƙwayar cuta ta farko, shigar kumburin lymph, da metastasis mai nisa.[1] Rarraba TNM a cikin ciwon huhu na huhu[78][79] T: Tumor Primary TX Duk wani daga cikin: Tumor na farko ba za a iya tantance ƙwayoyin Tumor da ke cikin sputum ko wankewar buroshi ba, amma ƙari ba a gani tare da hoto ko bronchoscopy T0 Babu wata shaida ta farko Tis Carcinoma a ciki Situ T1 Tumor kasa da ko daidai da 3 cm a fadin, kewaye da huhu ko visceral pleura, ba tare da mamayewa kusa da lobar bronchus T1mi Karamin invasive adenocarcinoma T1a Tumor kasa da ko daidai 1 cm a fadin T1b Tumor Girman fiye da 1 cm amma kasa da ko daidai da 2 cm a fadin T1c Girman Tumor fiye da 2 cm amma ƙasa da ko daidai da 3 cm a fadin T2 Duk wani na: Girman Tumor fiye da 3 cm amma ƙasa da ko daidai da 5 cm a fadin Sa hannun babban bronchus amma a'a. Ciwon huhu na visceral pleura Atelectasis / obstructive pneumonitis wanda ya shimfiɗa zuwa girman T2a Tumor fiye da 3 cm amma ƙasa da ko daidai da 4 cm a fadin T2b Tumor girma fiye da 4 cm amma kasa ko daidai da 5 cm a fadin T3 Duk wani: Girman Tumor fiye da 5 cm amma kasa da ko daidai da 7 cm a fadin mamayewa a cikin bangon kirji, jijiyar phrenic, ko parietal pericardium Rarrabe nodule nodule a cikin lobe guda T4 Duk wani: Girman Tumor fiye da 7 cm mamaye diaphragm, mediastinum, zuciya, manyan tasoshin. , trachea, carina, jijiyar laryngeal na yau da kullum, esophagus, ko vertebral jiki Rarrabe nodule nodule a cikin wani nau'i daban-daban na huhu guda N: Lymph nodes NX Ƙwayoyin lymph na yanki ba za a iya tantance su ba hilar lymph nodes N1a Metastasis zuwa guda N1 nodal tashar N1b Metastasis zuwa biyu ko fiye N1 nodal tashoshi N2 Metastasis zuwa ipsilateral mediastinal da / ko subcarinal lymph nodes N2a1 Metastasis zuwa daya N2 nodal tashar ba tare da shigar da N1 nodes N2a2 Metastasis zuwa N2 nodes daya N2a2. Tasha kuma aƙalla tashar nodal N1 N2b Metastasis zuwa biyu ko fiye N2 nodal tashoshi N3 Kowane na: Metastasis zuwa sikelin ko supraclavicular lymph nodes Metastasis zuwa contralateral hilar o r mediastinal lymph nodes M: Metastasis MX Metastasis mai nisa ba za a iya tantancewa ba M0 Babu metastasis mai nisa M1a Kowanne daga cikin: Rarrabe nodule nodule a cikin sauran huhu Tumor tare da pleural ko pericardial nodules M Pleural ko pericardial effusion M1b A guda metastasis wajen kirji M1c Biyu ko fiye. metastases a waje da ƙirji Ta amfani da bayanan TNM, an ba da rukuni, kama daga ciwon daji na asiri, ta matakai 0, IA (daya-A), IB, IIA, IIB, IIIA, IIIB, da IV (hudu). Wannan rukunin matakin yana taimakawa tare da zaɓin jiyya da ƙiyasin tsinkaya.[80] Rukunin mataki bisa ga TNM

Rikakafi Sashin Huhu Na Dan Adam[gyara sashe | Gyara masomin]

.Sashin giciye na huhu na ɗan adam: Yankin farin da ke cikin lobe na sama shine ciwon daji; wuraren baƙar fata suna canzawa saboda shan taba.

Rigakafi Sashin huhu na ɗan adam: Farin wurin da ke saman lobe shine ciwon daji; wuraren baƙar fata suna canzawa saboda shan taba. Rigakafin shan taba da daina shan sigari hanyoyi ne masu tasiri na rage haɗarin cutar kansar huhu.[24]

Haramcin shan taba[gyara sashe | Gyara masomin]

Haramcin shan taba Yayin da a yawancin ƙasashe an gano cutar sankarau da na cikin gida kuma an hana su, shan taba yana yaɗuwa. Kawar da shan taba sigari shine manufa ta farko a cikin rigakafin cutar kansar huhu, kuma daina shan taba wani muhimmin kayan kariya ne a cikin wannan tsari.[81] Harkokin siyasa don rage shan taba a wuraren jama'a kamar gidajen abinci da wuraren aiki ya zama ruwan dare a yawancin kasashen yammacin Turai.[82]. Bhutan ta sami cikakkiyar dokar hana shan taba tun 2005[83] yayin da Indiya ta gabatar da dokar hana shan taba a bainar jama'a a cikin Oktoba 2008.[84] Hukumar lafiya ta duniya ta yi kira ga gwamnatoci da su kafa dokar hana tallar taba domin hana matasa shan taba.[85] Sun kiyasta cewa irin wannan haramcin ya rage shan taba da kashi 16% a inda aka kafa.[85]

Bincike[gyara sashe | Gyara masomin]

Binciken cutar daji na huhu Binciken ciwon daji yana amfani da gwaje-gwajen likita don gano cututtuka a cikin manyan rukunin mutanen da ba su da alamun cutar.[86] Ga mutanen da ke da hatsarin kamuwa da cutar kansar huhu, tantancewar lissafi (CT) na iya gano cutar kansa kuma ya ba mutum zaɓi don amsa ta ta hanyar da za ta tsawaita rayuwa.[68][87] Wannan nau'i na tantancewa yana rage yiwuwar mutuwa daga cutar kansa ta huhu da cikakkiyar adadin 0.3% (kwatankwacin adadin 20%).[88][89]. Mutanen da ke da haɗari su ne masu shekaru 55-74 waɗanda suka sha kwatankwacin adadin sigari kowace rana tsawon shekaru 30 ciki har da lokaci a cikin shekaru 15 da suka gabata.[68] Binciken CT yana da alaƙa da babban adadin gwaje-gwaje na gaskiya na ƙarya, wanda zai iya haifar da jiyya maras buƙata.[90] Ga kowane ingantacciyar siffa mai kyau akwai kusan 19 na binciken karya.[89] Sauran abubuwan da ke damun sun haɗa da hasarar radiation[90] da farashin gwaji tare da bin diddigin.[68] Bincike bai samo wasu gwaje-gwaje guda biyu da ake da su ba - sputum cytology ko gwaje-gwajen rediyo na kirji (CXR) - don samun fa'ida.[87][91] Sojojin masu kariya na Amurka suna ba da shawarar neman bayan da aka yi ta amfani da low-lokacin da ke da shekara 55 da 80 har zuwa mutum bai yi shan sigari fiye da shekaru 15 ba. [ 92] Shawarar tasu ta keɓance waɗanda ke da wasu matsalolin kiwon lafiya waɗanda za su yi maganin kansar huhu idan ba a sami zaɓi ba.[92] Ma'aikatar Lafiya ta Ingila ta kasance a cikin 2014 tana sake nazarin shaidun tantancewar.

Sauran Dabarun Rigakafi[gyara sashe | Gyara masomin]

Sauran dabarun rigakafi Amfani da dogon lokaci na ƙarin bitamin A, [94] bitamin B, [94] bitamin D[94] ko bitamin E[94] baya rage haɗarin ciwon huhu. Kariyar bitamin C na iya rage haɗarin cutar kansar huhu.[95][96] Wasu binciken sun gano bitamin A, B, da E na iya kara haɗarin kamuwa da cutar kansar huhu ga waɗanda ke da tarihin shan taba.[94] Wasu nazarin sun ba da shawarar cewa mutanen da ke cin abinci tare da mafi yawan kayan lambu da 'ya'yan itace suna da ƙarancin haɗari, [30][97] amma wannan yana iya zama saboda rikicewa - tare da ƙananan haɗari a zahiri saboda haɗin 'ya'yan itace mai girma. da abincin kayan lambu tare da rage shan taba[98]. Yawancin bincike da yawa ba su nuna cikakkiyar alaƙa tsakanin abinci da haɗarin cutar kansar huhu ba, [1] [97] ko da yake meta-bincike wanda ke lissafin matsayin shan taba na iya nuna fa'ida daga abinci mai kyau.

Gabatarwa[gyara sashe | Gyara masomin]

Gudanarwa: Maganin cutar kansar huhu Jiyya ga kansar huhu ya dogara da takamaiman nau'in tantanin halitta na kansa, yadda ya yaɗu, da matsayin aikin mutum. Jiyya na yau da kullun sun haɗa da kulawar jin daɗi, [100] tiyata, chemotherapy, da maganin radiation.[1] Maganin da aka yi niyya na kansar huhu yana girma cikin mahimmanci ga ci gaban kansar huhu.[101] Bugu da kari, ana ba da shawarar daina shan taba da motsa jiki.[102][103]

Tiyata[gyara sashe | Gyara masomin]

Samfurin pneumonectomy wanda ke dauke da kwayar cutar sankara, wanda ake gani a matsayin farin wuri kusa da mashako.

Aikin tiyatar ciwon huhu na huhu samfurin pneumonectomy wanda ke ɗauke da ƙwayar ƙwayar ƙwayar cuta, ana gani a matsayin wuri mai farin kusa da bronchi Idan bincike ya tabbatar da NSCLC, ana tantance matakin don sanin ko cutar tana cikin gida kuma tana iya yin tiyata ko kuma idan ta yada zuwa ga. wurin da ba a iya warkewa ta hanyar tiyata. Za a iya amfani da CT scan da PET-CT, gwaje-gwajen da ba su da ƙarfi, don taimakawa wajen kawar da malignancy ko shigar da kumburin lymph na mediastinal.[1][104] Idan ana zargin shigar da kumburin lymph na mediastinal ta amfani da PET-CT, ana iya yin samfurin nodes (ta amfani da biopsy) don taimakawa tantancewa, gwajin PET-CT bai isa a yi amfani da shi kadai ba.[104] Dabarun da ake amfani da su don samun samfurin sun haɗa da buƙatun allura na transthoracic, buƙatun allurar transbronchial (tare da ko ba tare da duban dan tayi ba), endoscopic duban dan tayi tare da buƙatun allura, mediastinoscopy, da thoracoscopy.[105]. Ana amfani da gwajin jini da gwajin aikin huhu don tantance ko mutum ya isa aikin tiyata.[15] Idan gwaje-gwajen aikin huhu ya nuna rashin isasshen ajiyar numfashi, tiyata ba zai yiwu ba.[1] A mafi yawan lokuta na matakin farko na NSCLC, kawar da lobe na huhu (lobectomy) shine magani na zabi. A cikin mutanen da ba su dace da cikakken lobectomy ba, za a iya yin ƙaramin ɓarna na sublobar (ƙuƙwalwar fata). Duk da haka, ɓacin rai yana da haɗari mafi girma na sake dawowa fiye da lobectomy. Jiyya na aikin rediyoaktif na iodine a gefen ɓangarorin yanki na iya rage haɗarin sake dawowa. Da wuya, ana cire duk huhu (pneumonectomy) [106]. Bidiyo-taimakawa aikin tiyata na thoracoscopic (VATS) da VATS lobectomy suna amfani da hanya kaɗan ta mamaye aikin tiyatar ciwon huhu.[107] VATS lobectomy daidai yake da tasiri idan aka kwatanta da buɗaɗɗen lobectomy na al'ada, tare da ƙarancin rashin lafiya bayan tiyata.[108] A cikin SCLC, chemotherapy ko radiotherapy yawanci ana amfani da su, ko kuma wani lokacin duka biyu.[109] Koyaya, ana sake yin la'akari da rawar tiyata a cikin SCLC. Tiyata na iya inganta sakamako idan aka ƙara zuwa chemotherapy da radiation a farkon matakin SCLC.[110] Amfanin aikin tiyata na huhu na huhu (resection) ga mutanen da ke da mataki na I-IIA NSCLC ba a bayyana ba, amma shaidu masu rauni sun nuna cewa haɗin gwiwa na maganin ciwon huhu na huhu da kuma cire ƙwayoyin lymph na mediastinal (matsakaicin ƙwayar lymph node) na iya inganta rayuwa idan aka kwatanta da su. resection na huhu da samfurin mediastinal nodes (ba cikakkiyar rarrabawar kumburi ba).

Radiotherapy[gyara sashe | Gyara masomin]

Brachytherapy (radiyo na ciki) don ciwon huhu da ake bayarwa ta hanyar iska

Radiotherapy Brachytherapy (na cikin gida radiotherapy) don ciwon huhu da aka bayar ta hanyar iska Ana ba da Radiotherapy sau da yawa tare da chemotherapy, kuma ana iya amfani da shi da nufin warkarwa a cikin mutanen da ke da NSCLC waɗanda ba su cancanci yin tiyata ba.[112]. Wannan nau'i na babban aikin rediyo mai ƙarfi ana kiransa radical radiotherapy.[45] Gyaran wannan dabarar ita ce ci gaba da haɓaka haɓakar haɓakar rediyo (CHART), wanda ake ba da babban adadin maganin rediyo a cikin ɗan gajeren lokaci.[113]. Yin aikin rediyo yana nufin dabarar maganin rediyo na ba da madaidaicin adadin maganin rediyo wanda kwamfuta ke jagoranta.[114] Bayan tiyata (adjuvant) thoracic radiotherapy gabaɗaya ba a yi amfani da shi bayan tiyata-nufin tiyata don NSCLC.[115] Wasu mutanen da ke da kumburin kumburin lymph na mediastinal N2 na iya amfana daga aikin rediyo bayan tiyata.[116] Don abubuwan da za a iya warkewa na SCLC da aka yi da tiyata, ana ba da shawarar maganin rediyon ƙirji bayan tiyata.[3] Ba a san lokacin da ya dace na waɗannan hanyoyin kwantar da hankali ba (mafi kyawun lokacin da za a ba da maganin rediyo da chemotherapy don inganta rayuwa)[117]. Idan ciwon daji ya toshe wani ɗan gajeren sashe na bronchus, ana iya ba da brachytherapy (radiyo na gida) kai tsaye a cikin hanyar iska don buɗe hanyar. Idan aka kwatanta da rediyon katako na waje, brachytherapy yana ba da damar rage lokacin jiyya da rage tasirin radiation ga ma'aikatan kiwon lafiya.[118] Shaida don maganin brachytherapy, duk da haka, bai kai na na waje ba don maganin rediyo na waje.[119] Prophylactic cranial irradiation wani nau'i ne na radiotherapy zuwa kwakwalwa, wanda ake amfani dashi don rage haɗarin metastasis. Ana amfani da PCI a cikin SCLC.[45] A cikin ƙayyadaddun cututtuka, PCI yana ƙaruwa tsawon shekaru uku daga 15% zuwa 20%; A cikin manyan cututtuka, rayuwa na shekara guda yana ƙaruwa daga 13% zuwa 27% [120]. Ga mutanen da ke da NSCLC da ƙwayar ƙwayar cuta guda ɗaya, ba a bayyana ba idan tiyata ya fi tasiri fiye da aikin rediyo.[114] Ci gaban kwanan nan a cikin niyya da hoto sun haifar da haɓakar stereotactic radiation a cikin maganin ciwon huhu na farko. A cikin wannan nau'i na maganin rediyo, ana isar da allurai masu yawa a kan lokuta da yawa ta amfani da dabaru na niyya. Amfani da shi shine da farko a cikin marasa lafiya waɗanda ba masu neman aikin tiyata ba saboda cututtukan cututtuka.[121] Ga duka NSCLC da marasa lafiya na SCLC, ana iya amfani da ƙananan allurai na radiation zuwa ƙirji don sarrafa alamun (palliative radiotherapy).[122][123] Ba a nuna amfani da mafi girman allurai na rediyo don kula da jin daɗi don tsawaita rayuwa na.

Chemotherapy[gyara sashe | Gyara masomin]

Chemotherapy Tsarin chemotherapy ya dogara da nau'in ciwon daji.[3] SCLC, ko da ingantacciyar cuta ta farko, ana kula da ita da farko tare da chemotherapy da radiation.[124] A cikin SCLC, an fi amfani da cisplatin da etoposide.[125] Hakanan ana amfani da haɗe-haɗe tare da carboplatin, gemcitabine, paclitaxel, vinorelbine, topotecan, da irinotecan.[126] [127] A cikin ci gaba na NSCLC, chemotherapy yana inganta rayuwa kuma ana amfani dashi azaman jiyya na farko, muddin mutum ya isa maganin.[128] Yawanci, ana amfani da kwayoyi guda biyu, wanda ɗaya daga cikinsu yana da tushen platinum (ko dai cisplatin ko carboplatin). Sauran magungunan da aka saba amfani da su sune gemcitabine, paclitaxel, docetaxel, [129][130] pemetrexed, [131] etoposide ko vinorelbine.[130] Magunguna na tushen Platinum da haɗuwa waɗanda suka haɗa da maganin platinum ba su da alama sun fi fa'ida don tsawaita rayuwa idan aka kwatanta da sauran magungunan da ba platinum ba, kuma suna iya haifar da haɗarin haɗari mai haɗari, kamar tashin zuciya, amai, anemia, da thrombocytopenia, 132] musamman a cikin mutanen da suka haura shekaru 70.[133]. Shaidu ba su isa ba don sanin ko wace hanya ce ta chemotherapy ke da alaƙa da mafi ingancin rayuwa.[132] Har ila yau, babu shaidar da za ta iya tantance ko yin magani ga mutanen da ke da NSCLC a karo na biyu lokacin da zagaye na farko na chemotherapy bai yi nasara ba (chemotherapy na biyu) yana haifar da ƙarin fa'ida ko cutarwa.[134] Adjuvant chemotherapy yana nufin yin amfani da chemotherapy bayan aikin tiyata a fili don inganta sakamako. A cikin NSCLC, ana ɗaukar samfurori na nodes na lymph na kusa yayin tiyata don taimakawa tsarawa. Idan an tabbatar da cutar mataki-II ko -III, adjuvant chemotherapy (ciki har da ko a'a hada da radiotherapy bayan tiyata) yana inganta rayuwa da 4% a shekaru biyar.[135][136][137] Haɗin vinorelbine da cisplatin ya fi tasiri fiye da tsofaffin magunguna.[136] Adjuvant chemotherapy ga mutanen da ke da ciwon daji na IB yana da cece-kuce, saboda gwajin asibiti bai nuna fa'idar rayuwa a fili ba.[138] Chemotherapy kafin tiyata a cikin NSCLC wanda za'a iya cirewa ta hanyar tiyata na iya inganta sakamako.[139][140] Za a iya haɗa chemotherapy tare da kulawar jinya a cikin jiyya na NSCLC.[141] A cikin lamuran da suka ci gaba, maganin chemotherapy da ya dace yana inganta matsakaicin rayuwa akan kulawar tallafi kaɗai, da kuma inganta ingancin rayuwa.[141][142] Tare da isassun lafiyar jiki da ke kula da chemotherapy a lokacin maganin ciwon huhu na huhu yana ba da watanni 1.5 zuwa 3 na tsawaita rayuwa, taimako na bayyanar cututtuka, da inganta yanayin rayuwa, tare da kyakkyawan sakamako da aka gani tare da wakilai na zamani.[143][144] Ƙungiyar NSCLC Meta-Analyses Collaborative Group ta ba da shawarar idan mai karɓa yana so kuma zai iya jure wa jiyya, to ana iya la'akari da chemotherapy a cikin NSCLC mai ci gaba.

Niyya Da Rigakafi[gyara sashe | Gyara masomin]

https://doi.org/10.3390/ph13110373
Babban makamai na magani na gwaji na asibiti na lokaci 3 da ke ba da rigakafi a cikin layi na farko don marasa lafiya tare da NSCLC https://doi.org/10.3390/ph13110373
https://doi.org/10.3390/ph13110373
Monoclonal rigakafi da aka yi amfani da su a cikin maganin NSCLC da tsarin aikin su https://doi.org/10.3390/ph13110373

An yi niyya da rigakafin rigakafi Akwai magunguna da yawa waɗanda ke kaiwa ga hanyoyin ƙwayoyin cuta a cikin cutar kansar huhu, musamman don maganin cututtukan da suka ci gaba. Erlotinib, gefitinib, da afatinib sun hana tyrosine kinase a mai karɓar haɓakar girma na epidermal (EGFR). Wadannan masu hana EGFR na iya taimakawa wajen jinkirta yaduwar kwayoyin cutar kansa ga mutanen da ke fama da ciwon huhu na EGFR M+ kuma suna iya inganta rayuwar mutum.[146] Ba a nuna masu hana EGFR don taimakawa mutane su rayu tsawon lokaci ba.[146] Ga mutanen da ke da maye gurbi na EGFR, jiyya tare da gefitinib na iya haifar da ingantacciyar rayuwa idan aka kwatanta da jiyya tare da chemotherapy.[147] Denosumab, maganin rigakafi na monoclonal wanda aka yi wa mai karɓar mai kunnawa na kappa-B ligand, na iya zama da amfani wajen maganin metastases na kashi.[148] https://doi.org/10.3390/ph13110373 Monoclonal antibodies amfani da maganin NSCLC da tsarin aikin su https://doi.org/10.3390/ph13110373 Immunotherapy za a iya amfani da su duka biyu SCLC da NSCLC.[149][150] ] Kwayoyin NSCLC da ke bayyana tsarin mutuwa-ligand 1 (PD-L1) na iya yin hulɗa tare da shirin mai karɓar mai karɓar mutuwa 1 (PD-1) wanda aka bayyana a saman kwayoyin T, kuma yana haifar da raguwar ƙwayar ƙwayar cuta ta hanyar tsarin rigakafi.[151]. Atezolizumab shine maganin rigakafi na monoclonal na PD-L1. Nivolumab da Pembrolizumab su ne antibodies na PD-1 monoclonal. Ipilimumab wani maganin rigakafi ne na monoclonal wanda ke da alhakin gina jiki mai haɗin gwiwar Cytotoxic T-lymphocyte 4 (CTLA-4) akan saman ƙwayoyin T. Bevacizumab wani maganin rigakafi ne na monoclonal wanda ke da alhakin haɓakar haɓakar jijiyoyi a cikin wurare dabam dabam, kuma yana aiki azaman mai hana angiogenesis.[151]. Yawancin gwaje-gwaje na asibiti na 3 da ke amfani da immunotherapy a cikin layi na farko don maganin NSCLC an buga su, ciki har da Pembrolizumab a cikin KEYNOTE-024, KEYNOTE-042, KEYNOTE-189 da KEYNOTE-407; Nivolumab da Ipilimumab a cikin CHECKMATE-227 da CHECKMATE 9LA; da Atezolizumab a cikin IMpower110, IMpower130 da IMpower150.[151] https://doi.org/10.3390/ph13110373 Babban makamai na magani na lokaci 3 gwaji na asibiti da ke ba da rigakafi a cikin layi na farko ga marasa lafiya tare da NSCLC bazai haifar da ingantacciyar rayuwa ga mutanen da ke da matakan I-III NSCLC ba.

Bronchoscopy[gyara sashe | Gyara masomin]

Bronchoscopy Ana iya ba da jiyya da yawa ta hanyar bronchoscopy don kula da toshewar iska ko zubar jini. Idan ci gaban ciwon daji ya toshe hanyar iska, zaɓuɓɓuka sun haɗa da m bronchoscopy, balloon bronchoplasty, stenting, da microdebridement.[153] Hoto na Laser ya ƙunshi isar da hasken laser a cikin hanyar iska ta hanyar bronchoscope don cire ƙwayar cuta mai toshewa.[154]

Kulawa D Jin Daɗi[gyara sashe | Gyara masomin]

Kulawar jin daɗi idan aka ƙara zuwa maganin kansa na yau da kullun yana amfanar mutane ko da har yanzu suna samun ilimin chemotherapy.[155] Waɗannan hanyoyin suna ba da damar ƙarin tattaunawa game da zaɓuɓɓukan magani kuma suna ba da damar isa ga yanke shawara da aka yi la'akari sosai[156][157]. Kulawa da jin daɗi na iya guje wa rashin amfani amma kulawa mai tsada ba kawai a ƙarshen rayuwa ba, har ma a duk tsawon lokacin rashin lafiya. Ga mutanen da ke da cututtukan da suka ci gaba, kulawar asibiti kuma na iya dacewa.

Hanyoyi Daba Na Cin Zarafi[gyara sashe | Gyara masomin]

Hanyoyin da ba na cin zarafi

Mafi kyawun sa baki don guje wa mutuwa daga cutar kansar huhu shine a daina shan taba; hatta mutanen da suka riga sun kamu da cutar sankara ta huhu ana kwadaitar da su daina shan taba[103]. Babu wata bayyananniyar shaida wacce shirin daina shan taba ya fi tasiri ga mutanen da aka gano suna da ciwon huhu.[103] Wasu rarraunan shaida sun nuna cewa wasu hanyoyin kulawa na tallafi (marasa haɗari) waɗanda ke mai da hankali kan jin daɗin rayuwa ga mutanen da ke fama da ciwon huhu na iya inganta ingancin rayuwa.[158] Matsaloli kamar masu bin aikin jinya, ilimin halin ɗan adam, ilimin halayyar ɗan adam, da shirye-shiryen ilimi na iya zama masu fa'ida, duk da haka, shaidar ba ta da ƙarfi (ana buƙatar ƙarin bincike).[158]. Nasiha na iya taimaka wa mutane su jimre da alamun motsin rai da suka shafi kansar huhu.[158] Reflexology na iya yin tasiri a cikin ɗan gajeren lokaci, duk da haka ana buƙatar ƙarin bincike.[158] Ba a sami wata shaida da ta nuna cewa ayyukan abinci mai gina jiki ko shirye-shiryen motsa jiki ga mutumin da ke fama da cutar kansar huhu yana haifar da ingantuwar rayuwar da ta dace ko kuma ta daɗe.[158] Horon motsa jiki na iya amfanar mutanen da ke da NSCLC waɗanda ke murmurewa daga tiyatar huhu.[159] Bugu da ƙari, horar da motsa jiki na iya amfanar mutanen da ke da NSCLC waɗanda suka sami maganin rediyo, chemotherapy, chemoradiotherapy, ko kula da jin dadi.[160] Horon motsa jiki kafin tiyatar ciwon huhu na iya inganta sakamako.[102] Ba a sani ba ko horon motsa jiki ko shirye-shiryen motsa jiki suna da amfani ga mutanen da suka sami ci gaba da ciwon huhu.[161][158] Abun da ke tushen gida a cikin keɓaɓɓen shirin gyaran jiki na iya zama da amfani don murmurewa.[160] Ba a sani ba idan gyaran gida (kafin tiyata) yana haifar da ƙarancin abubuwan da ba su da kyau ko lokacin asibiti.[160] Gyaran jiki tare da sashin gida na iya inganta farfadowa bayan jiyya da lafiyar huhu gaba ɗaya.

Sakamakon Hasashen Ciwon Daji Na Huhu[gyara sashe | Gyara masomin]

Sakamakon cutar kansar huhu bisa ga matakin asibiti[25]
Clinical stage Five-year survival (%)
Non-small-cell lung carcinoma Small-cell lung carcinoma
IA 50 38
IB 47 21
IIA 36 38
IIB 26 18
IIIA 19 13
IIIB 7 9
IV 2 1
Gabaɗaya rayuwa a cikin marasa lafiya na NSCLC da aka bi da su tare da ka'idoji waɗanda ke haɗa maganin rigakafi a cikin layin farko don ci gaba ko cuta mai haɓakawa. Nasser NJ, Gorenberg M, Agbarya A. Pharmaceuticals 2020, 13(11), 373; https://doi.org/10.3390/ph13110373

Sakamakon Hasashen a cikin ciwon daji na huhu bisa ga matakin asibiti[80] Matsayin asibiti Rayuwa na shekaru biyar (%) Carcinoma marasa ƙananan ƙwayoyin cuta IA 50 38 IB 47 21 IIA 36 38 IIB 26 18 IIIA 19 13 IIIB 9 IV 2 1 Daga cikin duk mutanen da ke da ciwon huhu a Amurka, kusan kashi 17% zuwa 20% suna rayuwa aƙalla shekaru biyar bayan ganewar asali.[162][2][163] A Ingila da Wales, tsakanin 2013 da 2017, an kiyasta tsawon shekaru biyar na rayuwa ga cutar kansar huhu a kashi 13.8%[164]. Sakamakon gabaɗaya ya fi muni a ƙasashe masu tasowa.[19] Sakamakon gano marigayi, matakin ciwon huhu yakan ci gaba a lokacin ganewar asali. A lokacin gabatarwa, kusan kashi ɗaya bisa uku na lokuta na NSCLC suna da cututtukan ƙwayar cuta, kuma 60-70% na SCLC suna da cututtuka masu yawa.[3] Rayuwa don ciwon huhu na huhu yana faɗuwa yayin da matakin gano cutar ya ƙara haɓaka; Bayanan Ingilishi sun nuna cewa kusan kashi 70% na marasa lafiya suna rayuwa aƙalla shekara guda idan aka gano su a farkon matakin, amma wannan ya faɗi zuwa 14% kawai ga waɗanda aka gano suna da cutar mafi girma (mataki IV).[165]. Abubuwan haɓakawa a cikin NSCLC sun haɗa da kasancewar alamun cututtukan huhu, girman ƙwayar ƙwayar cuta mai girma (> 3 cm), nau'in tantanin halitta mara kyau (histology), digiri na yaduwa (mataki) da metastases zuwa ƙwayoyin lymph da yawa, da mamayewar jijiyoyin jini. Ga mutanen da ke fama da rashin aiki, sakamakon ya fi muni a cikin waɗanda ke da rashin aikin yi da asarar nauyi fiye da 10%.[166] Abubuwan da ake iya ganowa a cikin ƙananan ciwon huhu na huhu sun haɗa da matsayi na aiki, jima'i na halitta, mataki na cututtuka, da kuma shiga cikin tsarin kulawa na tsakiya ko hanta a lokacin ganewar asali.[167]. Gabaɗaya rayuwa a cikin marasa lafiya na NSCLC da aka bi da su tare da ka'idoji waɗanda ke haɗa immunotherapy a cikin layin farko don ci gaba ko cuta mai haɓakawa. Nasser NJ, Gorenberg M, Agbarya A. Pharmaceuticals 2020, 13(11), 373; https://doi.org/10.3390/ph13110373 Ga NSCLC, ana samun mafi kyawun tsinkaya tare da cikakken aikin tiyata na mataki-IA, tare da rayuwa har zuwa 70% na shekaru biyar.[168]. Mutanen da ke da babban matakin SCLC suna da matsakaicin ƙimar rayuwa na shekaru biyar ƙasa da 1%. Matsakaicin lokacin rayuwa don ƙayyadaddun cututtuka shine watanni 20, tare da adadin rayuwa na shekaru biyar na 20%.[14] Hasashen marasa lafiya tare da NSCLC sun inganta sosai a cikin shekaru na ƙarshe tare da gabatarwar rigakafi.[151] Marasa lafiya tare da ƙari PDL-1 da aka bayyana sama da rabin ko fiye na ƙwayoyin ƙari sun sami matsakaicin rayuwa na tsawon watanni 30 tare da pembrolizumab.[169] An buga gwaje-gwaje masu yawa na lokaci 3 da ke ba da rigakafi a cikin layi na farko ga marasa lafiya da ciwon huhu marasa ƙananan ƙwayoyin cuta.[151] Bisa ga bayanan da Cibiyar Ciwon daji ta Ƙasa ta bayar, matsakaicin shekarun da aka gano game da ciwon huhu a Amurka shine shekaru 70, [170] kuma matsakaicin shekarun mutuwa shine shekaru 72.[171]. A Amurka, mutanen da ke da inshorar likita sun fi samun sakamako mai kyau.

Epidemiology[gyara sashe | Gyara masomin]

Trachea, bronchus, and lung cancers deaths per million persons in 2012
  0–7
  8–12
  13–32
  33–53
  54–81
  82–125
  126–286
  287–398
  399–527
  528–889
Ciwon daji na huhu, abin da ya faru, mace-mace, da rayuwa, Ingila 1971–2011

Epidemiology Trachea, Bronchus, da huhu na ciwon daji na mutuwar mutum miliyan a cikin 2012 0-7 8-12 13-32 33-53 54-81 82-125 126-286 287-398 399-527 528-889 kamuwa da cutar kansa. , da kuma tsira, Ingila 1971-2011 A duk duniya, ciwon huhu shine mafi yawan ciwon daji a tsakanin maza don cututtuka da mace-mace, kuma a cikin mata suna da na uku mafi girma (bayan ciwon nono da launin fata) da mace-mace na biyu (bayan ciwon nono). ). A cikin 2020, an sami sabbin maganganu miliyan 2.2 a duk duniya, kuma miliyan 1.8 sun mutu sakamakon cutar kansar huhu, wanda ke wakiltar kashi 18.0% na duk mutuwar daga cutar kansa. Mafi girman farashi shine a Micronesia, Polynesia, Turai, Asiya, Arewacin Amurka da Turai. Ƙididdiga a Afirka da Amurka ta Tsakiya sun yi ƙasa sosai.[6] Mutanen da ke da tarihin shan taba suna da haɗari mafi girma na kamuwa da cutar sankarar huhu, tare da haɗarin karuwa tare da tsawon lokacin shan taba. Abubuwan da suka faru a cikin maza sun tashi har zuwa tsakiyar 1980s, kuma sun ragu tun lokacin. A cikin mata, lamarin ya karu har zuwa karshen shekarun 1990, kuma tun daga lokacin ya tsaya tsayin daka.[3] Ga kowane sigari miliyan 3-4 da aka sha, cutar kansar huhu ɗaya na iya faruwa.[173] Tasirin "Babban Taba" yana taka muhimmiyar rawa wajen shan taba.[174] Matasan da ba sa shan taba suna ganin tallace-tallacen taba sun fi shan taba.[175] Ana ƙara gane rawar da shan taba sigari ke haifarwa a matsayin haɗarin cutar kansar huhu, [33] wanda ke haifar da sa baki na siyasa don rage bayyanar da marasa shan taba ga hayaƙin taba.[176] Daga shekarun 1960, adadin adenocarcinoma na huhu ya fara karuwa dangane da wasu nau'in kansar huhu, wani bangare saboda shigar da sigari mai tacewa. Amfani da tacewa yana cire manyan barbashi daga hayakin taba, don haka rage ajiya a manyan hanyoyin iska. Duk da haka, mai shan sigari dole ne ya zurfafa zurfi don karɓar adadin nicotine iri ɗaya, yana ƙaruwa da ɓarna a cikin ƙananan hanyoyin iska inda adenocarcinoma ke tasowa.[177]. Yawan adenocarcinoma na huhu yana ci gaba da karuwa.

Amurka[gyara sashe | Gyara masomin]

Amurka A cikin Amurka, baƙar fata maza da mata baƙar fata suna da babban abin da ya faru.[179][180] Hadarin rayuwa na kamuwa da cutar kansar huhu shine kashi 8% a cikin maza da kashi 6% a cikin mata.[1] Har ila yau, a cikin Amurka, tsofaffin soja suna da kashi 25-50% mafi girma na ciwon huhu na huhu da farko saboda yawan shan taba.[181] A lokacin yakin duniya na biyu da yakin Koriya, asbestos ma ya taka rawa, kuma Agent Orange na iya haifar da wasu matsaloli a lokacin yakin Vietnam.[182]

Birtaniya[gyara sashe | Gyara masomin]

Ciwon daji na huhu na United Kingdom shine ciwon daji na uku mafi yawan jama'a a cikin Burtaniya (47,968 mutane sun kamu da cutar a cikin 2017), [183] ​​kuma shine mafi yawan sanadin mutuwar ciwon daji (kusan mutane 34,600 sun mutu a cikin 2018).

Sauran Kasashe[gyara sashe | Gyara masomin]

Sauran kasashe a halin yanzu adadin kansar huhu ya ragu a kasashe masu tasowa.[185] Tare da karuwar shan taba a kasashe masu tasowa, ana sa ran adadin zai karu a cikin 'yan shekaru masu zuwa, musamman a China[186] da Indiya.

Tarihi[gyara sashe | Gyara masomin]

Tarihi Ciwon daji na huhu ya kasance ba a sani ba kafin zuwan shan taba; Ba a ma gane ta a matsayin cuta dabam ba sai 1761.[188] An kara yin bayanin fannoni daban-daban na kansar huhu a cikin 1810.[189]. Ciwon daji na huhu yana da kashi 1 cikin 100 ne kawai na duk cututtukan da aka gani a lokacin autopsy a 1878, amma sun haura zuwa 10-15% a farkon shekarun 1900.[190]. Rahoton shari'a a cikin littattafan likitanci ya ƙidaya 374 kawai a duniya a cikin 1912, [191] amma nazarin binciken gawarwakin ya nuna cewa cutar sankarar huhu ta karu daga 0.3% a cikin 1852 zuwa 5.66% a 1952.[192]. A cikin Jamus a cikin 1929, likita Fritz Lickint ya gane alaƙar da ke tsakanin shan taba da kansar huhu, [190] wanda ya haifar da yaƙin yaƙi da shan taba.[193] Nazarin Likitoci na Biritaniya, wanda aka buga a cikin 1950s, shine tabbataccen shaidar annoba ta farko ta alaƙa tsakanin ciwon huhu da shan taba.[194] Sakamakon haka, a cikin 1964, babban Likitan Amurka ya ba da shawarar masu shan taba su daina shan taba[195]. An fara gane alaƙa da iskar radon tsakanin masu hakar ma'adinai a tsaunin Ore kusa da Schneeberg, Saxony. Ana hakar azurfa a can tun shekara ta 1470, kuma wadannan ma'adinan suna da wadatar Uranium, tare da radium da radon gas.[196] Masu hakar ma'adinai sun sami rashin daidaituwar adadin cututtukan huhu, daga ƙarshe an gane su da kansar huhu a cikin 1870s.[197]. Duk da wannan binciken, an ci gaba da hakar ma'adinan har zuwa shekarun 1950, saboda bukatar USSR ta neman uranium.[196] An tabbatar da Radon a matsayin sanadin cutar kansar huhu a cikin shekarun 1960.[198]. An yi nasarar farko na pneumonectomy na ciwon huhu a cikin 1933.[199]. An yi amfani da maganin radiyo mai cutarwa tun daga shekarun 1940.[200]. Radical radiotherapy, da farko da aka yi amfani da shi a cikin 1950s, ƙoƙari ne na yin amfani da allurai masu girma na radiation a cikin marasa lafiya masu ciwon huhu na farko, amma waɗanda ba su dace da tiyata ba.[201] A cikin 1997, ana ganin CHART azaman haɓakawa akan tsarin rediyo na al'ada.[202] Tare da SCLC, yunƙurin farko a cikin 1960s a resection [203] da radical radiotherapy [204] ba su yi nasara ba. A cikin shekarun 1970s, an sami nasarar samar da tsarin maganin chemotherapy.

Umarnin Bincike[gyara sashe | Gyara masomin]

Umarnin bincike Ana ci gaba da neman sabbin zaɓuɓɓukan magani. Yawancin gwaje-gwaje na asibiti da suka haɗa da aikin rediyo, tiyata, masu hana EGFR, masu hana microtubule da immunotherapy suna gudana a halin yanzu.[206] Umarnin bincike don maganin ciwon huhu na huhu sun haɗa da immunotherapy, [207] [208] wanda ke ƙarfafa tsarin garkuwar jiki don kai hari ga ƙwayoyin tumo, epigenetics, da sabon haɗin chemotherapy da radiotherapy, duka a kan kansu kuma tare. Yawancin waɗannan sabbin jiyya suna aiki ta hanyar toshe wuraren bincike na rigakafi, suna ɓata ikon kansa na guje wa tsarin garkuwar jiki.[207][208] Ipilimumab yana toshe sigina ta hanyar mai karɓa akan ƙwayoyin T da aka sani da CTLA-4, wanda ke lalata tsarin rigakafi. Hukumar Abinci da Magunguna ta Amurka ta amince da ita don maganin cutar sankarau, kuma tana fuskantar gwaji na asibiti na NSCLC da SCLC.[207] Sauran jiyya na immunotherapy suna tsoma baki tare da ɗaure furotin da aka tsara na mutuwar kwayar halitta 1 (PD-1) tare da ligand PD-1 ligand 1 (PD-L1), kuma an yarda da su azaman jiyya na farko- da na gaba-gaba don ɓangarori daban-daban na cututtukan huhu. [208] Yin sigina ta hanyar PD-1 yana hana ƙwayoyin T. Wasu ƙwayoyin kansa suna bayyana suna amfani da wannan ta hanyar bayyana PD-L1 don kashe ƙwayoyin T waɗanda zasu iya gane su a matsayin barazana. Monoclonal rigakafi da ke niyya duka PD-1 da PD-L1, irin su pembrolizumab, nivolumab, [65] atezolizumab, da durvalumab[208] a halin yanzu suna cikin gwaji na asibiti don maganin ciwon huhu.[207][208] Epigenetics shine nazarin ƙananan gyare-gyaren kwayoyin halitta - ko "tags" - waɗanda ke ɗaure ga DNA kuma suna canza matakan bayyanar kwayoyin halitta. Yin niyya ga waɗannan alamun da kwayoyi na iya kashe ƙwayoyin cutar kansa. Binciken farko-farko a cikin NSCLC ta amfani da kwayoyi da ke nufin gyare-gyaren epigenetic ya nuna cewa toshe fiye da ɗaya daga cikin waɗannan alamun zai iya kashe kwayoyin cutar kansa tare da ƙananan sakamako masu illa.[209] Nazarin ya kuma nuna cewa ba wa mutane waɗannan magungunan kafin daidaitaccen magani na iya inganta tasirinsa. Ana gudanar da gwaje-gwaje na asibiti don tantance yadda waɗannan magungunan ke kashe ƙwayoyin cutar kansar huhu a cikin mutane.[209] Magunguna da yawa waɗanda ke da alaƙa da hanyoyin epigenetic suna cikin haɓakawa. Histone deacetylase inhibitors a cikin ci gaba sun haɗa da valproic acid, vorinostat, belinostat, panobinostat, entinostat, da romidepsin. Masu hana DNA methyltransferase a cikin haɓakawa sun haɗa da decitabine, azacytidine, da hydralazine.[61] Aikin TRACERx yana duban yadda NSCLC ke tasowa da haɓakawa, da kuma yadda waɗannan ciwace-ciwacen suka zama masu jure wa jiyya.[210] Aikin zai duba samfuran ƙari daga mutane 850 masu NSCLC a matakai daban-daban ciki har da ganewar asali, bayan jiyya na farko, bayan magani, da sake dawowa.[211]. Ta hanyar nazarin samfurori a wurare daban-daban na ci gaban ƙwayar cuta, masu binciken suna fatan gano canje-canjen da ke haifar da ci gaban ƙwayar cuta da juriya ga jiyya. Sakamakon wannan aikin zai taimaka wa masana kimiyya da likitoci su sami kyakkyawar fahimta game da NSCLC da yiwuwar haifar da ci gaba da sababbin magungunan cutar.[210]. Don cututtukan daji na huhu waɗanda ke haɓaka juriya ga mai karɓar haɓakar haɓakar epidermal (EGFR) da anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors, sabbin magunguna suna cikin haɓakawa. Masu hana EGFR sun haɗa da erlotinib, gefitinib, afatinib da icotinib (na ƙarshe yana samuwa a China kawai).[146] Madadin hanyar sigina, c-Met, na iya hana tivantinib da onartuzumab. Sabbin masu hana ALK sun haɗa da crizotinib da ceritinib.[212] Idan hanyar MAPK/ERK ta shiga, mai hana BRAF kinase dabrafenib da MAPK/MEK inhibitor trametinib na iya zama da amfani.[213] An bincika hanyar PI3K azaman manufa don maganin ciwon huhu. Mafi kyawun dabarun tunkarar wannan tafarki kamar hanawa ɗaya ko fiye da membobi na aji I PI3Ks ne, tare da hana wannan hanyar tare da wasu kamar MEK[214]. Kwayoyin ciwon daji na huhu galibi suna jure wa na al'ada.

Manazarta[gyara sashe | Gyara masomin]

  1. http://seer.cancer.gov/statfacts/html/lungb.html
  2. https://doi.org/10.1016%2Fj.gaceta.2021.04.001
  3. https://doi.org/10.3322%2Fcaac.21660
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577
  5. http://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq
  6. https://archive.org/details/lungcancer0000falk
  7. https://archive.org/details/lungcancer0000falk/page/3
  8. https://www.ncbi.nlm.nih.gov/books/NBK44324/
  9. http://monographs.iarc.fr/ENG/Monographs/vol83/mono83.pdf
  10. http://www.merck.com/mmpe/sec05/ch062/ch062b.html#sec05-ch062-ch062b-1405
  11. http://www.cancer.gov/types/lung/patient/lung-prevention-pdq#section/_12
  12. https://pubmed.ncbi.nlm.nih.gov/29790681/
  13. https://books.google.com/books?id=HaErOupWnO0C&pg=PA193
  14. https://archive.org/details/ajcccancerstagin0000unse
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868710
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479369
  17. http://www.ctsu.ox.ac.uk/~tobacco/
  18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220510
  19. https://doi.org/10.1016%2Fj.lungcan.2020.12.030
  20. http://www.druglibrary.org/schaffer/tobacco/caets/ets-main.htm
  21. Smokers defined as current or former smokers of more than 1 year of duration. See image page in Commons for percentages in numbers. Reference: Table 2 Archived 10 Satumba 2017 at the Wayback Machine in: Kenfield SA, Wei EK, Stampfer MJ, Rosner BA, Colditz GA (June 2008). "Comparison of aspects of smoking among the four histological types of lung cancer". Tobacco Control. 17 (3): 198–204. doi:10.1136/tc.2007.022582. PMC 3044470. PMID 18390646.
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  24. Dela Cruz CS, Tanoue LT, Matthay RA (December 2011). "Lung cancer: epidemiology, etiology, and prevention". Clinics in Chest Medicine. 32 (4): 605–44. doi:10.1016/j.ccm.2011.09.001. PMC 3864624. PMID 22054876.
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