Kodi Ndi Zabwino Kapena Zoipa Kuti Mukhale ndi Kachilombo Koyenera Kachiwerewere?
Ngati mwauzidwa kuti khansara yako ya m'mawere ndi HER2 zabwino, mwina muli ndi mafunso ambiri ponena za izi. Koma ngati muli ngati ena ambiri, funso lanu loyamba lingakhale lakuti, "Kodi ndi zabwino kapena zoipa kukhala HER2 zabwino?" Mwa kuyankhula kwina, kodi "ndibwino" ngati chotupa chanu chiri HER2 zabwino kapena HER2 chosasangalatsa?
Pamene tikuphunzira kuti khansara ya m'mawere si matenda amodzi koma matenda ambiri omwe amasiyana ndi maselo, izi ndi mafunso ofunikira.
Yankho lofulumira ndi lakuti HER2 positivity ikhoza kukhala yabwino komanso yoipa. Tiyeni tiwone momwe chikhalidwe cha HER2 chimakhudzira chirichonse chifukwa cha kupwetekedwa kwa chotupa, kupangira chithandizo chamankhwala, poika chiopsezo cha kubwereranso ndi kubwereza.
Kubwereza Kwachidule
Khansara ya pachifuwa si nthenda imodzi-kwenikweni, palibe khansa ziwiri zofanana-koma tsopano tili ndi kuthetsa ma khansawa m'magawo osiyana siyana kuchokera pa "malo obwera" a zotupa. Khansa ya m'mawere imasiyana m'mapuloteni omwe amapeza maselo, mapuloteni omwe amachititsa kukula kwa zotupa. Mapuloteniwa amakhala okhudzana ndi zosiyana siyana zomwe zimayambitsa matenda a khansa.
Anthu ambiri amadziwika ndi khansa ya m'mawere yotchedwa estrogen, imene estrogen imagwirizanitsa ndi kuchuluka kwa mapuloteniwa pa maselo a khansa ya m'mawere kuti atenge kukula kwa chotupacho.
Zomwe zimachitika ndi HER2 zabwino zoyamwitsa khansa zofanana, koma ndizosiyana mitundu yovomerezeka pamwamba pa kansera ya khansa yomwe imachititsa kukula ndi kufalikira kwa chotupacho.
Kuphatikiza pa maselo a estrogen pamwamba pa maselo (omwe amachititsa chidwi ndi estrogen ), pali HER2 receptors pamwamba pa maselo (omwe amathandizidwa ndi kukula kwa zinthu zopititsa patsogolo kukula).
HER2 jini (epidermal kukula factor receptor 2 kapena HER2 / neu) ndi jini (yomwe tonse tili nayo) yomwe imatulutsa mapuloteni omwe akukhudzana ndi kukula kwa maselo a m'mawere.
Amatchedwanso kuti ERBB2 gene ndipo ndi jini (protooncogene) yomwe imapezeka pa chromosome 17.
Zida za H22 zimapereka malangizo opanga mapuloteni a HER2. Mapuloteniwa amagwira ntchito ngati maselo a m'mawere. Pamene makope ambiri a HER2 alipo (chifukwa cha kuwonongeka kwa majini mu selo kapena kusintha kwa thupi) zimabweretsa kuwonjezereka kwakukulu (kapena "kudzikuza") kwa HER2.
Ndikofunika kuzindikira kuti maselo onse a m'mawere onse opatsirana khansa ndi osakanikirana-ali ndi receptors HER2 pamwamba pa selo. Kusiyanitsa ndiko kuti maselo a khansa ya khansa ya HER2 yabwino ali ndi nambala 40 mpaka 100 nambala iyi. Pamene zinthu zokula m'thupi zimamangiriza kumatenda awa, zimapangitsa kuti maselo a m'mawere apitirire.
Monga momwe tili ndi mankhwala omwe amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda (kapena kuchepetsa estrogen m'thupi) kuti tipeze khansa ya m'mawere yotchedwa estrogen, tili ndi mankhwala omwe amalepheretsa kulandira ma ARV pa HER2.
Pafupifupi 25 peresenti (15 mpaka 30 peresenti) ya khansa ya m'mawere ndi yabwino kwa HER2 (HER2 kufotokozera kwambiri).
HER2 Mkhalidwe Wabwino: Zabwino Kapena Zoipa?
Kuti muyankhe bwino funsoli ngati ndi chinthu chabwino kapena chinthu choipa kukhala HER2 zabwino, ndikofunika kulankhula za kusiyana pakati pa zotupa zomwe ziri HER2 zabwino ndi zomwe ziri HER2 zoipa.
Yankho lofulumira ndi lakuti lingakhale labwino kapena loipa. Potsirizira pake, anthu ambiri amafuna kudziwa momwe kukhala ndi khansa yabwino ya bere ya HER2 yathandizira kupulumuka, komabe ngakhale ziŵerengerozo zingathe kusocheretsa popanda kumvetsa momwe kukhala HER2 zabwino kumakhudzira kukula kwa khansa.
Chitsanzo chofotokozera mfundoyi ndi cha khansa ya m'mawere kwa atsikana . Pafupipafupi, chiwerengero cha anthu omwe ali ndi kachilombo ka HIV ndi otsika kwa atsikana omwe ali ndi matendawa koma izi zingawonongeke. Kwa achinyamata, matendawa amapezeka nthawi zambiri. Kotero ngakhale kuti mtsikana wamng'ono akhoza kulekerera mankhwalawa bwino ndikukhala ndi moyo wabwino panthawi inayake, chiwerengero cha moyo ndi chochepa chifukwa cha masitepe apamwamba.
Yankho lofulumira la kukhala ndi khansa yabwino ya HER2 zabwino kapena zoipa ndikuti "zimadalira." Chifukwa chake tiyenera kuyang'ana njira zomwe H22 zikhoza kukhalira ndi khansara. Izi zikuphatikizapo:
- Mtundu wa anthu omwe ali ndi vutoli (mwachitsanzo, ausinkhu wa zaka)
- Gawo limene H22 khansa imapezeka, poyerekeza ndi zifuwa zoipa za HER2
- Kaya chotupacho ndi mlandira wa estrogen wabwino
- Njira zothandizira zilipo
- Kuopsa kwa kubwereza
- Chiwerengero cha kupulumuka kwathunthu
Ndikofunika kudziwa kuti nthawi ya H2 nthawi zina si yolondola ndipo ikhoza kusintha pambuyo pa kubwereza (onani m'munsimu).
Kusiyanitsa Kuopsya
Ngakhale pali zambiri zomwe zimachitika, anthu ena ndi ovuta kuposa ena kuti akhale ndi khansa yabwino ya HER2. Maphunziro awiri, kufufuza kwa LACE ndi PATHWAYS kufufuza, adayang'ana mu makhalidwe a anthu amene amakhala ovuta kapena osasangalatsa.
- Azimayi omwe ali ndi ziphuphu ndi kuwonongeka kwakukulu kwa HER2 ndi odwala otchedwa estrogen amakhala ochepa kwambiri, sangathe kugwiritsira ntchito mankhwala opangira mahomoni, ndipo amakhala ochepa kwambiri ku Asia kapena ku Spain.
- Matenda omwe ali abwino HER2 samaoneka ngati akuphatikiza ndi kumwa mowa kapena kusuta fodya, ndipo mosiyana ndi zotupa za estrogen zotenga thupi zolimbitsa thupi siziwoneka ngati zilibe mphamvu yoteteza matenda.
- Amuna omwe ali ndi khansa ya m'mawere ndi ocheperapo kusiyana ndi amayi kuti akhale ndi ziphuphu zabwino za HER2.
- N'zochititsa chidwi kuti zapezeka kuti ductal carcinoma in situ (DCIS) kapena mapiritsi 0 amtunduwu amakhala oposa HER2 kuposa ma cancer oyamwitsa, omwe ochita kafukufuku ena amakhulupirira kuti akugwirizana ndi chitukuko.
- Mitundu ina ya khansa ya m'mawere ikhoza kukhala yochepa kukhala HER2 zabwino. Mwachitsanzo, si zachilendo kwa khansa ya m'mawere ya mucinous (colloidal) , medullary carcinoma, kapena tubular carcinoma ya m'mawere kuti akhale HER2 abwino.
- Chikhalidwe cha H2 chikhoza kusiyana ndi zizindikiro za chibadwa cha khansa ya m'mawere. Mwachitsanzo, BRCA1 yokhudzana ndi khansa ya m'mawere imakhala yochepa kuti ikhale yabwino HER2.
Kuwona Koyesedwa ndi Kusintha Mkhalidwe
Nthawi zambiri timayankhula za HER2 monga ngati wakuda ndi woyera, koma sizinali choncho. Pali mitundu yosiyanasiyana ya kuyesa yomwe ingasinthe molondola. Palinso "mbali" zosiyana zokhudzana ndi chidziwitso. Mwachitsanzo, chotupa chingakhale 1+, 2+, kapena 3+. Ziphuphu zomwe "sizikhala zabwino" zingatchulidwe kuti zili ndi vuto lalikulu la HER2 osati kukhala HER2 zabwino.
Panopa tikulimbikitsidwa kuti amayi omwe ali ndi mtundu umodzi wa kuyezetsa ayambirenso, monga njira zina zoyesera sizolondola kuposa ena. Kubwezeretsa kumalimbikitsidwanso ngati mayeso akubwezedwa monga "borderline." Ndikofunikira kutchula kuti matendawa ndi osaphatikizapo; gawo limodzi la chifuwa cha m'mawere likhoza kukhala HER2 zabwino pamene gawo lina liri HER2 loipa.
Mkhalidwe HER2 ungasinthe, ndipo izi zasokoneza anthu ambiri. Chotupa chomwe poyamba chiri HER2 chotheka chingakhale chosachiritsika cha HER2 ngati chimasintha kapena chikufalikira. Chimodzimodzinso, chotupa chomwe poyamba chiri HER2 chosasintha chingakhale HER2 chokhazikika ngati chimatha. Chikhalidwe cha H2 chiyenera kubwerezedwa nthawi zonse potsatira kubwereza.
Kuthamanga
HER2 khansa yabwino ya m'mawere imakhala yowawa kwambiri kuposa minofu yoipa ya HER2.
Matenda a pachifuwa amapatsidwa chiwombankhanga pa nthawi ya matenda opatsirana pogwiritsa ntchito maonekedwe a maselo omwe ali pansi pa microscope. Mapuloteni ndi nambala yomwe imaperekedwa pofotokoza kukhumudwa kwa chotupa, ndi nambala yambiri yosautsa, ndipo zitatu mwazosautsa. Matenda okwana HER2 amakhala osowa kwambiri atatu. Ziphuphu zimenezi zimakula mofulumira kuposa matenda a m'munsi ndipo nthawi zambiri zimafalikira ku maselo am'mimba.
Pitani ku Lymph Nodes
Mankhwala a khansa ya HER2 amatha kufalikira ku maselo am'mimba. Momwemonso, siteji yomwe imapezeka payekha ingakhale yapamwamba kuposa ya matenda olakwika a HER2.
Chithandizo cha Kuchiza
Zisanayambe chithandizo cha mankhwala okhudzana ndi khansa yabwino ya HER2, monga Herceptin (trastuzumab) , njira yothandizira anthu omwe ali ndi khansa yabwino ya m'mawere sinali yabwino kwa iwo omwe ali ndi matenda oopsa a HER2.
Matenda omwe anawatsata kwa khansa ya khansa yabwino ya HER2 yawasintha, ndipo tsopano zotsatira za mankhwala ndizofanana ndi ziwalo za HER2 zoipa (ngakhale kuti matenda a HER2 amakhala aakulu). Malingana ndi National Cancer Institute, mankhwalawa asintha malingaliro a pulasitala I kupita ku gawo lachitatu HER2 yabwino khansa ya m'mawere kuchokera kuumphawi mpaka wabwino.
Herceptin amachepetsa chiopsezo cha kubwereranso ndipo amakula bwino zaka 10 zapulumuka kwa omwe ali ndi siteji I kupita ku matenda atatu omwe ali pafupi ndi 30 peresenti.
Komabe, pali vuto lalikulu la kubwerera m'mbuyo ndi ma metastasis ndi maonekedwe abwino a HER2, ndipo miyeso ya moyo ndi yochepa kuposa ya HER2 yolakwika koma zotupa za estrogen.
Anthu omwe ali ndi ziphuphu zabwino za H2 sangachitepo kanthu pa mankhwala a kansa ya m'mawere kusiyana ndi omwe ali oipa.
Kuopsa Kowonongeka
HER2 khansa yabwino ya m'mawere imatha kubwereranso (kubwereranso) kenako HER2 khansa ya m'mawere. Kafukufuku apeza kuti m'mawa oyambirira a khansa (stage I ndi siteji II) nthawi ziwiri kapena zisanu zimakhala zowonjezereka kuposa ziwalo za HER2 zoipa. Ngakhale ang'onoang'ono HER2 zotupa zabwino (zosachepera 1 cm kapena theka la inchi m'mimba mwake) ndi ma lymph nodes omwe ali ndi chiopsezo chachikulu cha kubwereranso ndi zotupa zomwe ziri HER2 zoipa. Kuchiza ndi Herceptin kungachepetse ngoziyi ndi theka.
Chitsanzo cha kubwerera kwa khansa ya m'mawere chingakhalenso chosiyana. Ziphuphu zazing'ono zimakhalanso ndi chizoloŵezi chobwerezabwereza (mosiyana ndi kubwerera m'midzi kapena kumidzi) ngati ali HER2 abwino.
Metastasis
Kaya zotupa za HER2 zimakhala zochepa kwambiri kuposa zovuta zokhudzana ndi zotupa zimadalira malo a masewera a khansa ya m'mawere tikukambirana. Mavuto a metastases onse, makamaka a metastases a ubongo, amalingalira kuti akuwonjezeka, koma maphunziro ambiriwa amachitika asanagwiritsire ntchito Herceptin.
Maphunziro atangotulukira Herceptin (ndi zina zothandizidwa ndi HER2) adapeza kuti HER2 zabwino za khansa za m'mawere zimapitirira kukhala ndi chiwerengero chokwanira cha mitsempha ya ubongo. Mankhwalawa amatha kufalikira kumayambiriro kwa matendawa kupita ku maselo a mitsempha, mapapo, mafupa, mazira, ndi mazira a adrenal.
Mpata wa metastases ndi HER2 zotupa zabwino zingakhale zosiyana malingana ndi ngati chotupacho ndi mlingo wa estrogen wabwino. Vuto la ubongo, chiwindi, fupa , ndi mapapu a m'mapapo mu HER2 zabwino zotupa zimakhudzanso ngati chotupacho ndi mlingo wa estrogen wabwino kapena woipa.
Mavuto a metastases angadalenso ndi zinthu zomwe zimagwirizana. Mwachitsanzo, chiopsezo cha chiwindi cha chiwindi kuchokera ku khansa ya m'mawere n'chokwanira ndi zotupa za HER2 ngati anthu akusuta.
Khansa Yabwino Yoyamba ya Khansa
Pafupifupi 50 peresenti ya HER2 zabwino zotupa zimakhalanso estrogen receptor zabwino. Kafukufuku apeza kuti kugwirizanitsa kumeneku kungachititse kuti pakhale njira yosiyana yobwerezabwereza, koma kafukufuku owerengeka chabe adayang'ana makhalidwe ndi zotsatira za zotupa zabwino zitatu.
Matenda a khansa omwe amapezeka ndi estrogen receptor zabwino ndipo HER2 zoipa (luminal A) ali ndi mbiri yabwino kwambiri. Zomwe zili ndi estrogen receptor zabwino ndipo BER (binal) (B lumine) yabwino imakhala yovuta kwambiri, koma matendawa amakhalabe abwino kuposa anthu omwe ali ndi khansa ya m'mawere yosautsa kapena katatu.
Zolakwika pa Kutulukira
Zokambirana izi sizikanatha popanda kunena kuti nthawi zina khansara ya m'mawere imapezeka ngati HER2 zabwino kapena HER2. Mayesero omwe amapezeka kuti adziwe udindo wa HER2 sakhala opanda pake. Ndikofunika kufunsa wanu oncologist mayeso omwe adachitidwa ndipo ngati mukuyenera kubwezeretsedwa kapena ayi.
Cholakwika pakudziwa (matenda osokoneza bongo) momwe kachilombo ka HER2 kamene kamasokonekera mwadzidzidzi kukhala koipa kungapangitse munthu kuti asaperekedwe mankhwala; mankhwala omwe angathe kupulumuka. Inde, poyesedwa ndi matenda a HER2 omwe alidi HER2 wosayenerera angapangitse kugwiritsa ntchito mankhwala omwe sagwira ntchito (ngakhale zina zotere za HER2 zakhala zikuyankha Herceptin).
Chidule cha Kusiyana
Nkhaniyi inafotokoza kusiyana kwakukulu pakati pa khansa zabwino za HER2 zabwino ndi HER2, komanso momwe kusiyana kumeneku kungakhudze matenda.
HER2 khansa yabwino ya m'mawere poyerekeza ndi zotupa zotchedwa estrogen zowalandira mpweya zimakhala:
- Zowonjezereka (kukhala ndi digiri yapamwamba kwambiri)
- Amapezeka kwa atsikana achichepere (ndi khansa ya m'mawere kwa atsikana amayamba kupezeka muzigawo zowonjezereka)
- Momwemonso amatha kuchitapo kanthu pakamwa pakali pano kuti HER2 imakhudza mankhwala opezeka
- Zingakhale zobwerezabwereza / kubwerera
- Zowonjezereka zowonongeka, makamaka pa malo monga ubongo
Ziphuphuzi zimakhalanso zovuta kwambiri (ngakhale kuti mawotchi atsopano avomerezedwa, chimodzimodzi mu 2017, ndipo sitikudziwa momwe izi zidzakhudzira matenda.)
Pali zowonjezera pazopezazi ndipo tikuyenera kukumbukira kuti munthu aliyense, komanso khansa ya m'mawere, ndi yapadera.
Mawu Ochokera
Ngakhale kuti zizindikiro za HER2 zabwino zotupa zimakhala zosauka kwambiri kusiyana ndi zomwe zimapezeka ndi estrogen receptor zabwino koma HER2 zoipa, kufalitsa kulandira mankhwala a HER2 kumapangitsa kusiyana pakati pa miyeso ya moyo ndi chiopsezo cha kubwereza.
Popeza kuti mankhwala a HER2 ndi atsopano, ndipo madokotala atsopano amavomerezedwa mu 2017 okha, ziwerengero sizothandiza kwenikweni. Ngati mukukhala ndi khansa yabwino ya HER2, chifukwa chakuti mapepala othandizira mankhwalawa mu HER2 zabwino zotupa zofanana ndi zotupa zotchedwa estrogen zimakhala zolimbikitsa.
Ndi kusintha komwe kumachitika pa chithandizo, ndipo ndi mankhwala ena omwe akuwerengedwera m'mayesero a kachipatala, ndikofunika kwambiri kusiyana ndi kale lonse kuti mutenge nawo mbali pa chithandizo chanu. Tengani kamphindi kuti muwerenge mfundo zina za momwe mungakhalire mutetezi anu pa chisamaliro chanu cha khansa .
> Zotsatira:
> Ellingiord-Dale, M., Vos, L., Hjerkind, K., Hjartaker, A. et al. Mowa, Ntchito Yathupi, Kusuta ndi Khansa ya M'bwere Zomwe Zili M'kati Mwachidziwitso Chachikulu Chakudya Chakudya Chochokera Kuchipatala cha ku Canada Choyesa Khansa ya Breast. Khansa Epidemiology Zida ndi Kupewa . 2017 Sep 6. (Epub patsogolo pa kusindikiza).
> National Cancer Institute. Nkhani Yopeza: Genetic Link ya HER2 ku Cancer Spurs Development of New Treatments. https://www.cancer.gov/research/progress/discovery/HER2
> Parise, C., ndi V. Caggiano. Kupulumutsidwa kwa khansa ya m'mawere Kutanthauzidwa ndi ER / PR / HER2 Subtypes ndi Kufufuza Mwapadera Malinga ndi Tumor Grade ndi Immunohistochemical Biomarkers. Journal of Cancer Epidemiology . 2014. 469251: 1-11.
> Schettini, F., Buono, G., Cardalesi, C. et al. Cholera cha Hormone / Chilombo cha Edzi Chokulirakulira kwa Anthu Cholandira Khansa Yachiberekero 2: Momwe Tiliri Tsopano ndi Kumene Tikupita. Ndemanga za Chithandizo cha Khansa . 2016. 46: 20-6.