Mwinamwake mwamvapo za kansa ya m'mawere ya estrogen ndi khansa yabwino ya HER2 . Mwinamwake mwamvapo za khansa ya katatu yosamalitsa. Koma kodi kansa ya katatu yotetezeka ya m'mawere ndi yotani?
Si zachilendo kuti khansa ya m'mawere ikhale estrogen receptor positive (ER ++), progesterone receptor positive (PgR +), ndi HER2 / neu positive (HER2 +).
Kodi ma katemera oterewa amatupi osiyana bwanji ndi khansa ya m'mawere yokhudzana ndi khalidwe la chifuwacho ndi mankhwala omwe amagwira ntchito bwino? Ndi chiyani chinanso chimene muyenera kudziwa ndi chiyani chomwe chikugwiritsidwa ntchito?
Tanthauzo
Mawu akuti "khansa ya m'mawere yabwino" katatu sadziwika kwa anthu ambiri. Ndipotu, ena angaganize kuti ndi typo komanso kuti tikuganizira za khansa yachitatu yomwe imatulutsa mimba.
Izi ndi chifukwa chakuti kafukufuku wa khansa ya m'mawere ya "katatu yokha" imakhala yatsopano, ngakhale kuti zotupa zabwino katatu zikuwonekera kuti ndizosiyana kwambiri ndi khansa ya m'mawere. Poyesedwa, zotupazi zimapezeka kuti ndi ER, + PgR +, ndi HER2 / neu +.
Ndi mavitamini onse a estrojeni ndi HER2 zabwino za khansa ya m'mawere, pali mapuloteni othandizira pamwamba pa maselo a kansa ya m'mawere omwe ali ndi udindo woyendetsa kukula kwa khansa. Selo lachibadwa la maselo ali ndi estrogen ndi HER2 receptors. Pankhani ya zotupa zowonjezera, pali chiwerengero chokwanira cha mapulogalamu awa.
Kusintha kwa chiwerengero cha majini (gene amplification) kumapanga mapuloteni ambiri.
Pamene estrojeni imamangiriza kumtundu wa estrogen, imayambitsa kukula kwa selo. Ndi HER2, ndizikuluzikulu zomwe zimamangiriza kulandira mankhwala kuti zithandize kukula. Mu maselo a khansa abwino a HER2, pamakhala maulendo oposa 100 omwe amapezeka m'maselo oyamwa.
Ngakhale pakadakali kutsutsana pa kansa ya m'mawere yokhala ndi katatu yokhala yabwino kwambiri, ma khansawa amawoneka kuti amachita mosiyana ndi makhalidwe onse a khansa komanso yankho la mankhwala. Kwenikweni, zotupa zabwino zitatu zimakhala ngati monga estrogen receptor zabwino ndi HER2 zoipa zotupa, ngakhale pali kufanana pakati pa katatu wabwino ndi katatu kansa ya khansa ya m'mawere komanso.
Katatu Wokonda vs. HER2 +
Khansa ya m'mawere yomwe ili HER2 zabwino imasiyana kwambiri kuchokera kwa wina ndi mzake. Kawirikawiri, zotupa zomwe ziri HER2 zabwino zimakhala zaukali, zimakhala ndi zochepa zapulumuka, ndipo nthawi zambiri sichimayankha mankhwala opatsirana. HER2 zotupa zabwino zomwe ndi estrogen receptor zabwino (katatu zowonjezera), komabe zingathe kukhala ngati zotupa za estrogen ndipo zingakhale zosautsa pokhapokha pakuyankha mankhwala opatsirana.
Kuti mumvetse bwino kansa ya m'mawere yokhala ndi katatu mozama, zingakhale zothandiza kuyang'ana kusiyana pakati pa khansa yabwino ya HER2 ndi HER2 .
Katatu Wokonda vs. ER +
Ziphuphu zomwe zili ndi katatu zimakhala zoopsa kuposa zomwe ziri ER + zokha. Mankhwala osokoneza bongo sangakhale othandiza, ndipo mankhwala a chemotherapy, omwe ali ndi mapuloteni oyambirira, sangakhale othandiza.
Mankhwala a khansa atatu omwe ali ndi khansa amatha kukhala ndi ma lymph nodes abwino kuposa omwe ali estrogen receptor abwino okha.
Zitatu Zopindulitsa ndi Zing'onozing'ono Zitatu
Poyamba, zikuwoneka kuti chifuwa cha khansa ya m'mawere yokhala ndi katatu yokhala yabwino kwambiri, ikutsatidwa ndi zotupa zomwe ndi estrogen receptor zabwino kapena HER2 zabwino, zotsatila ndi zotupa zomwe zimakhala zolakwika katatu.
Izi sizikuwoneka ngati zili choncho ndi zotupa zomwe ndizogawidwa bwino katatu ndi zina zomwe zimakhala zolakwika. Ngakhale ziwalo zina zitatu zowonongeka zimakhala ngati zotupa za ER, zina mwa zotupazi zimagwirizanitsa ndi zotupa zitatu zomwe zimachokera pamatendawa akukwiyitsa, zikuchitika ali aang'ono, kukhala ndi chifuwa chachikulu pamatenda, komanso kukhala ndi mwayi waukulu onse a m'deralo, m'deralo, ndi pamtunda.
Kukula
Kansara katatu yabwino ya m'mawere ndi yachilendo. Zikuganiza kuti pafupifupi 20 mpaka 25 peresenti ya khansa ya m'mawere (15 mpaka 30 peresenti mu maphunziro ena) ndi HER2 abwino. Zowonjezereka, pafupifupi 70 peresenti ya khansa ya m'mawere ndi yotchedwa estrogen receptor zabwino, zambiri mwazikhala progesterone receptor zabwino.
Za khansa zomwe ziri HER2 zabwino, pafupi 50 peresenti ndi estrogen receptor zabwino, ngakhale mayendedwe a estrogen amakhala ochepa. Zonsezi, pafupifupi 10 peresenti ya zotupa zingatheke, pochepetsedwa, kuwerengedwa ngati katatu, ngakhale kwakukulukulu kafukufuku kuyang'ana matendawa akusowa. Komanso, mlingo wa estrogen positivity ukhoza kusiyana pakati pa zotupazi.
Chithandizo Chakumayendedwe
Kodi mankhwala opatsirana khansa a m'mawere amathandiza bwanji khansa ya m'mawere yokha itatu?
Zikuwoneka kuti zotupa zomwe zimapezeka ndi estrogen receptor ndi HER2 zabwino zingayankhe kawiri komanso mankhwala. Kodi mankhwala sayenera kudwala khansa ya m'mawere ya HER2 yomwe imakhudzanso zotchedwa estrogen zowonjezereka kuposa mankhwala a ER + kapena HER2 + zotupa zokha?
N'zomvetsa chisoni kuti izi siziri choncho. Kwa zotupa zina, kugwiritsa ntchito mankhwala awiriwa pamodzi kungayambitse kupweteka kwambiri ndipo kumaonjezera chiopsezo cha zotsatirapo. Koma ngakhale pamene chithandizo chonse chikuwonetsedwa, sichigwira ntchito.
Kafukufuku akuyang'ana kumayambiriro a khansa akupeza phindu lochepa mwa mankhwala ochiritsira a HER2 pamene mlingo wa mapepala onse awiri ndi oposa. Izi ndi zotupa zomwe zimakhala ngati ER + / HER2 (luminal A) zotupa. Koma kuchepetsa mphamvu ya mankhwala ochizira amadziŵikanso. Nchifukwa chiyani izi sizinali choncho, ndipo nchifukwa chiyani izo sizikhala zogwira mtima kwambiri? Kuti timvetse izi tiyenera kuyang'ana pa "crosstalk" pakati pa estrogen ndi HER2 receptors.
HER2 / Estrogen Receptor Crosstalk
Khansa yomwe ili ndi katatu yokha ingasinthe mosiyana ndi momwe ingaganizire pogwiritsa ntchito HER2 kapena estrogen receptor positivity yokha ndipo ingakhudzidwe ndi mgwirizano pakati pa mapepalawa. Kuyanjana pakati pa mapulogalamuwa amatchulidwa ndi ochita kafukufuku monga "mtanda."
Mtsinje pakati pa HER2 ndi ER ungagwiritse ntchito kuwonetsa kusamvana kwa mahomoni. Mwa kuyankhula kwina, kuyankhulana pakati pa receptors (kunena HER2 ndi ER) kungapangitse mankhwala oletsa anti-estrogen kukhala opanda mphamvu mu zotupa zabwino zitatu. Mofananamo, kutsegulidwa kwa chizindikiro cha reception (chogwirizana ndi kukhala ER +) kungayambitse kukana mankhwala okhudza HER2. Izi zikhoza kufotokoza zina mwa kusiyana kwa zotupa za HER2 zabwino, zina zomwe zimachita bwino kuposa ena ku HER2 kuletsa mankhwala.
Zikhoza kukhala "msewu" womwe ukufotokozera chifukwa chake sitikuwona mayankho a mankhwala otchedwa hormonal treatment kapena HER2 omwe tifuna kuyembekezera.
Zimagwiritsidwa ntchito pogwiritsa ntchito mankhwala a HER2 (mwachitsanzo, Herceptin) ndi mankhwala otchedwa hormonal therapy (monga Tamoxifen kapena Faslodex (fulvestrant), komabe, akhoza kubwezeretsanso mankhwala enaake otchedwa estrogen.
Kuonjezera apo, mankhwala ena a khansa ya m'mawere amawoneka bwino kapena oipitsitsa kwa ziwalo za HER2 zabwino. Koma pamene chemotherapy ikhoza kukhala yopindula kwambiri ndi matenda oyambirira, imakhala yopindulitsa kwambiri m'thupi la matenda.
Katemera Wachitatu Wosakaniza Khansa
Kachilombo ka kansa ka katatu kamene kamatulutsa kansa kaŵirikaŵiri kamasamalidwa mosiyana ndi khansa yabwino ya bere ya HER2 yabwino . Mosiyana ndi zotupa zomwe ziri HER2 zabwino zokha, zikuwoneka kuti zimakhala zopindulitsa ndi zopindulitsa kupulumuka pogwiritsira ntchito chemotherapy pamodzi ndi HER2 mankhwala oletsa. Izi zikhoza kutsatiridwa ndi mankhwala a hormonal (monga aromatase inhibitor).
Kuthamangitsani
Popeza pali maphunziro owerengeka, ndi kovuta kufotokozera zizindikiro za khansa ya m'mawere yokhala ndi katatu. Makhalidwe ndi mayankho a zotupa zambiri ndi ofanana ndi estrogen zabwino koma matenda a HER2 osayenerera, akuwonetsa kuti akuwonetsa bwino. Izi zati, tawona kuti pangakhale chingwe pakati pa HER2 ndi maselo a estrogen omwe amachititsa kutsutsana kwa mahomoni onse ndi HER2 omwe amawathandiza.
Zikuwoneka kuti zizindikirozi zikhoza kukhala zabwino kwa amayi omwe ali ndi zotupa zitatu zomwe zimakhala ndi postmenopausal. Mu kafukufuku wina woyerekeza akazi achikasu kupita kwa anthu a ku Spain ndi a ku Asiya, anthu a ku Asia ndi Pacific akupezeka kuti ali ndi anthu ochepa kwambiri kuposa akazi omwe ali achizungu kapena osawerengeka omwe ali ndi zotupa zitatu.
Mawu Ochokera
Kutsutsana kumapitirirabe ngati kansa ya katatu yokondweretsa khansa ndi kachilombo kakang'ono ka matendawa, ngakhale khalidwe lonse la zotupa komanso momwe akuyankhira mankhwala zikuwoneka kuti zikusonyeza izi. Zonsezi, zotupazi zimakhala "kuchita" mofanana ndi zotchedwa estrogen receptor zabwino, zilonda za HER2 zoipa, koma pali kusiyana kwakukulu.
Pali kusatsimikizika pa njira yabwino yothandizira katemera wabwino katatu, ndipo zikuwoneka kuti pali magawo osiyanasiyana osiyana siyana malinga ndi kuchuluka kwa mawu a ER ndi zina. Kuonjezera apo, mwinamwake pali chotsutsana pakati pa mitundu yosiyanasiyana ya mapulogalamu, omwe angabweretse kuyankha kochepa kwa mankhwala omwe akuwongolera mtundu umodzi. Kafufuzidwe kafukufuku amafunika kuti ayang'ane mayankho, komanso njira zothandizira kuchepetsa vutoli.
Monga ndi mtundu uliwonse kapena kachigawo kakang'ono ka khansa ya m'mawere, nkofunika kudziphunzitsa nokha za matenda anu. Funsani mafunso ambiri, phunzirani momwe mungagwiritsire ntchito kansa yanu, ndipo khalani ovomerezeka anu mu chisamaliro chanu. Kukhala nawo m'dera lothandizira khansa ya m'mawere lingakhale lothandiza kwambiri, chifukwa ichi ndi chithandizo chomwe sichingopeza chithandizo pokhapokha ngati mutaphunzira za zowonjezereka zomwe mwapeza kuchipatala.
> Zotsatira:
> Negi, P., Kingsley, P., Jain, K. et al. Kupulumuka kwa katatu kosagwirizana ndi katatu Kachilombo ka khansa ya m'mawere: Kuyerekeza ndi kusiyana. Asia Pacific Journal Yopewera Khansa . 2016. 17 (8): 3911-6.
> Schott, A. Adjuvant Trastuzumab Pindulitsani mwa Odwala Odziwika Ndi Khansa Yabwino Yambiri Yopweteka. JAMA Oncology . 2016. 2 (8): 1047-8.
> Vici, P., Pizzuti, L., Natoli, C. et al. Khansa Yabwino Yoyamba ya Khansa: Kodi Ndiyo Yosiyana Kwambiri? . Ndemanga za Chithandizo cha Khansa . 2015. 41 (2): 69-76.
> Vici, P., Pizzuti, L., Sperduti, A. et al. "Khansa Yoyamba" Yoyamba Yam'mbuyo: Chidziwitso Chodziwika Chotsatira Chotsatira. Oncotarget . 2016. 7 (14): 17932-17944.