Pali njira zambiri zothandizira mankhwala omwe alipo
Zaka makumi angapo zapitazo, taphunzira kuti sikuti khansa ya m'mawere ndi yofanana. Kuwonjezera pa kusiyana komwe kumawoneka pansi pa microscope, pali kusiyana pakati pa khansa iyi pamtundu wa maselo. Mukakhala ndi chiopsezo kapena opaleshoni mudzaphunzira ngati khansa yanu ya m'mawere ndi yesrogen receptor positive kapena progesterone receptor positive, komanso malo anu a HER2.
Ngati mwauzidwa kuti khansa yanu ya m'mawere ndi HER2 zabwino, kodi izi zikutanthauza chiyani? Ndi mankhwala ati omwe amagwira ntchito makamaka pamtundu uwu wa khansa ya m'mawere ndi mankhwala ena omwe angagwiritsidwe ntchito?
Mwachidule cha Chithandizo cha Chithandizo
Anthu omwe ali ndi khansa yapachifuwa ya HER2 akhoza kuchitidwa mofanana ndi anthu omwe ali ndi zotupa za HER2 m'njira zina. Mwachitsanzo, opaleshoni (mwina lumpectomy kapena mastectomy,) adjuvant chemotherapy, ndi / kapena mankhwala otchedwa hormonal therapy (ngati chotupacho ndi estrogen receptor positive) chingagwiritsidwe ntchito.
Zovuta zothandizira zokhudzana ndi matenda okwana HER2 zimagwiritsidwanso ntchito ndipo zimakhala ndi chiwopsezo cha kupulumuka kwa zotupa za H22. Njira zomwe mungasankhe pazochitika zoyambirira komanso matenda odwala matendawa zimakambidwa pansipa.
Momwe Mankhwala Akugwiritsidwira Ntchito
Pafupifupi anthu asanu kapena asanu ndi mmodzi omwe ali ndi kansa ya m'mawere adzakhala ndi zotupa zomwe ziri HER2 / neu zabwino. Izi zikutanthauza kuti maselo a khansa ya m'mawere ndi khansa yowonjezera m'magazi a HER2, zomwe zimabweretsa kuwonjezereka kwa mapuloteni a HER2.
Mapuloteniwa amagwira ntchito kuti ayendetse kukula kwa kansalu ya khansa.
HER2 khansa yabwino ya m'mawere imakhala yaukali kwambiri, ndipo zaka zoyambirira zinkakhala zovuta kwambiri. Mu 1998 mankhwala oyamba omwe akuwombera mwachindunji HER2 adavomerezedwa. Mankhwalawa ndi Herceptin (trastuzumab).
Kuchokera nthawi imeneyo HER2 zina zokhudzana ndi mankhwala zapezeka.
Perjeta (pertuzumab) ndi T-DM1 (trastuzumab emtansine) nawonso avomerezedwa.
Mu 2017, Nerlynx (neratinib) ya mankhwala inavomerezedwanso kuti anthu omwe ali ndi khansa yapachiyambi ya HER2-positive akutsata mankhwala ndi Herceptin. Pamene neratinib (tyrosine kinase inhibitor) inawonjezeredwa kuchipatala choyenera cha khansa ya m'mawere m'chaka cha 2016, mayeso omvera onse anali apamwamba kusiyana ndi anthu omwe anachiritsidwa ndi Herceptin kuphatikizapo mankhwala oyenera.
Tykerb (lapatinib) ndi tyrosine kinase inhibitor yomwe ingagwiritsidwe ntchito pambuyo pa mankhwala ndi Herceptin kapena mankhwala ena a HER2.
Kuchiza kwa Maphunziro Oyambirira
Chithandizo cha khansa ya m'mawere yoyamwitsa ya HER2 yoyambirira ndi yofanana ndi khansa ya m'mawere ya HER2, koma kawirikawiri imaphatikizaponso kugwiritsa ntchito mankhwala osokoneza bongo omwe ali ndi HER2 monga Herceptin.
Zosankha zikuphatikizapo:
- Kuchita Opaleshoni: Mwinanso amakhala ndi lumpectomy kapena mastectomy omwe amachititsa kuchotsa chotupacho. Ngati chotupacho ndi DCIS (siteji 0) kapena ngati ali ndi maonekedwe abwino (kuyesera kwa jini kuti azindikire kuti akhoza kubwereranso), mankhwala ena amafunikira. Pa zotupa zomwe ziri zazikulu, makamaka zomwe zili ndi ma lymph node , nthawi zambiri mankhwalawa amathandizidwa.
- Mankhwala ochizira: Ngati chotupa chimakhala ndi mchere wotchedwa estrogen , mankhwala opatsirana amadzimadzi amatchulidwa nthawi zambiri (kutsatira chemotherapy mwa iwo omwe ali ndi mankhwala a adjuvant chemotherapy). Kwa amayi oyambirira, chisankho choyamba kawirikawiri ndi tamoxifen, ndi aromatase inhibitors amalimbikitsa akazi omwe ali postmenopausal. Kuwonjezera apo, mankhwala osokoneza bongo ovari, ovarian ablation, kapena kawirikawiri, ovariectomy angalimbikitsidwe kwa amayi omwe ali ndi chikhalidwe choyamba kuti achepetse mayendedwe a estrogen ndikuloleza kugwiritsa ntchito aromatase inhibitors.
- Chemotherapy: Mogwirizana ndi siteji ya khansa ya m'mawere, kukula kwake, kaya kukhala ndi mitsempha ya mitsempha imakhalapo, ndipo kuyesera kwa jini, mankhwala a adjuvant chemotherapy angapangidwe. Izi kawirikawiri zimayamba pafupifupi mwezi umodzi pambuyo pa lumpectomy kapena mastectomy ndipo zachitika kwa nthawi ya miyezi inayi kapena isanu ndi umodzi.
- Mankhwalawa amathandiza kwambiri: Monga momwe tafotokozera pamwambapa, tsopano pali njira zingapo zothandizira odwala omwe ali ndi ma ARV, kuphatikizapo Herceptin (trastuzumab), Perjeta (pertuzumab), ndi T-DM1 (trastuzumab emtansine), ndi mankhwala ena omwe amawerengedwa muzipatala mayesero. Kawirikawiri, Herceptin amagwiritsidwa ntchito poyamba. Tykerb (lapatinib) ndi tyrosine kinase inhibitor yogwira ntchito za HER2 zabwino zotupa. Nelynx (neratinib), ina yotchedwa kinase inhibitor, idalandiridwa posachedwapa kuti ayambe kulandira khansa ya m'mawere yoyamwitsa ya HER2 yoyamba potsatira mankhwala ndi Herceptin.
- Mankhwala othandizira ma ARV: Kwa anthu amene amasankha lumpectomy, mankhwalawa amawalimbikitsa pakapita opaleshoni. Pa zotupa zomwe zili ndi zinayi zam'mimba zowonjezera, mankhwala opatsirana pogwiritsa ntchito mankhwalawa amatha kuganiziridwa. Ziphuphu ndi mankhwala amodzi kapena atatu omwe ali abwino kwambiri, ndipo ndi ofunika kulankhulana ndi odwala oncologist ndi ma radiation oncologist phindu la mankhwalawa.
- Zilonda zam'chipatala: Pali zovuta zambiri zachipatala zomwe zikuyang'anitsitsa kuyang'ana njira zosiyanasiyana zochizira, chemotherapy, komanso njira zamagetsi zothandizira, komanso kuyerekezera mitundu yosiyanasiyana ya mankhwala ndi ma ARV. Pali nthano zambiri zokhudzana ndi mayesero a zachipatala , komabe nthawi zina kuyezetsa kachipatala kumapereka chithandizo chabwino kwambiri cha mankhwala. Ndikofunika kulankhula ndi oncologist wanu za mayesero alionse omwe angakhale abwino kwa inu.
- Mankhwala osokoneza bongo: Posachedwapa, Kuwonjezera kwa mankhwala a bisphosphonate wakhala akuganiziridwa kumayambiriro kwa kansa ya m'mawere chifukwa cha kuchepetsa chiopsezo cha mitsempha ya mafupa m'tsogolomu. Lankhulani ndi oncologist wanu za izi.
Kuchiza kwa Maphunziro Otukula
Ndi khansa ya m'mawere ya metastatic (stage 4), njira zamakono zothandizira matendawa nthawi zambiri cholinga cha chithandizo. Mankhwala opanga opaleshoni ndi ma radiation amaonedwa ngati mankhwala am'derali ndipo samagwiritsidwa ntchito mobwerezabwereza kupatula zochepetsera (kuchepetsa kupweteka ndi / kapena kuteteza fractures).
Ngati khansa ya m'mawere ya HER2 yabwino ya m'mawere ndi kansa ya pachifuwa ya khansa ya m'mawere, ndikofunika kuzindikira kuti udindo wa HER2 (komanso malo a recerogen receptor) angasinthe. Chidziwitso cha malo otchedwa metastasis ndi kubwereza maphunziro a receptor nthawi zambiri amalimbikitsidwa. Chotupa chomwe poyamba chinali HER2 chotheka chikhoza kukhala HER2 chosasinthika pa kubwereza komanso mosiyana.
Njira yoyamba yothandizira khansa yapachilombo ya HIV yodalirika idzadalira maphunziro awa. Kwa omwe ali HER positive, imodzi mwa njira zochizira za HER2 zimagwiritsidwa ntchito. Ngati chotupacho ndi kachilombo ka estrogen, kaya mankhwala opangira mahomoni, mankhwala a HER2, kapena onse awiri angaganizidwe. Chemotherapy ingagwiritsidwe ntchito kwa miyezi ingapo.
Ndikofunika kudziwa kuti cholinga chochizira khansa ya m'mawere ndi yosiyana kwambiri ndi kansa ya m'mawere, kuti ngati mankhwala ocheperako kuti athetse matendawa nthawi zambiri amalimbikitsa.
Ngati chotupa chakhala chikuchiritsidwa kale ndi Herceptin (trastuzumab) m'dongosolo la adjuvant, mutatha nthawi yopanda mankhwala (kuyesedwa kuchokera kumapeto a trastuzumab adjuvant) osapitirira miyezi isanu ndi umodzi chithandizo chotsatira chachiwiri ndi T-DM1 (ado -trastuzumab emtansine). Mwinanso, ngati chotupacho chakhala chikuchiritsidwa kale ndi Herceptin panthawi yomwe adjuvant ikuyendera, mutatha nthawi yopanda chithandizo kwa miyezi isanu ndi umodzi Perjeta (pertuzumab) kuphatikizapo trastuzumab ndi msonkho angagwiritsidwe ntchito.
Kwa odwala omwe amapita pambuyo pa trastuzumab ndi amisonkho mumalo osungirako zinthu, T-DM1 ndi kusankha kosankhidwa. Kwa odwala amene Herbethin sanawachitirepo kale, kuphatikizapo Herceptin komanso Perjeta kuphatikizapo msonkho ayenera kugwiritsidwa ntchito.
Ngati khansara yakula ngakhale kuti mankhwalawa akuyenda, kuphatikizapo Tykerb (lapatinib) ndi Xeloda (capecitabine) akhoza kuyesedwa. Mankhwala ena amachitiranso mankhwala.
HER2 khansa yabwino ya m'mawere imatha kufalikira ku ubongo ndi chiwindi kusiyana ndi zotupa za HER2 zoipa. Mwamwayi, Herceptin, ndipo mwinamwake Perjeta akuwoneka kuti akudutsa muchitetezo cha ubongo wa magazi ndi kuchepetsa kukula kwa ubongo metastases. Kwa anthu omwe ali ndi mitsempha ya mafupa, fupa losokoneza bongo monga bisphosphonates silingachepetse chiopsezo cha fractures koma limapanganso kupulumuka.
Zochiritsira Zogwirizana
Anthu ambiri amafunsa za kuthekera kwa njira zina zothandizira pamene akupezeka ndi khansa ya m'mawere. Pakalipano, palibe njira zina zothandizira zomwe zapezeka kuti zathandizira pochiza khansa ya m'mawere. M'malo mwake, anthu ena amene asankha chithandizochi kupatulapo mankhwala ochiritsira ataya mankhwala omwe asonyezedwa kuti ndi othandiza.
Koma nkofunika kuti musaponyedwe mwanayo pamodzi ndi madzi osambira. Pali njira zambiri zochiritsira za khansa zomwe zapezeka kuti zithandize anthu kuthana ndi zizindikiro za matenda ndi matenda a khansa, kuchokera ku kutopa ndi nkhawa mpaka kuzinyoza, phokoso la m'mimba , ndi zina zambiri. Zina mwa zochiritsira zomwe zaphunziridwa mwachindunji kwa amayi omwe ali ndi kansa ya m'mawere ndi yoga , kusinkhasinkha , kupatsira misala , ndi kuchitapo kanthu .
Kuthamangitsani
Pambuyo pa HER2 chisanafike pa chithandizo chamankhwala, panalibe mankhwala enieni omwe amapezeka kuti ali ndi zotupa zabwino za HER2, ndipo awa ankaonedwa kuti ndi khansa yaukali. Koma pakubwera kwa chithandizo chamakono, izi zasintha.
Kafukufuku wa 2017 anapeza kuti amayi omwe ali ndi khansa yabwino ya mimba ya HER2 anali ndi moyo wapamwamba kusiyana ndi amayi omwe anali HER2 osasamala pamene mankhwalawa ndi Herceptin amagwiritsidwa ntchito. Mitengo yochepa kwambiri yopulumuka imakhala ya amayi omwe ali ndi khansa ya m'mawere itatu.
Kupeza Thandizo
Mwamwayi, kuwonjezeka kwadzidzidzi ndi ndalama za khansa ya m'mawere zakhala zikuchulukitsa zinthu zambiri kuti zithandize anthu kuthana ndi matendawa. Magulu othandizira ndi madera othandizira amapezeka kwa amayi omwe ali ndi khansara ya m'mawere, komanso omwe akulimbana ndi matenda a kansa ya mthupi. Madera a pa Intaneti komanso ngakhale magulu a Facebook a anthu omwe ali ndi khansa ya m'mawere ya H22 adasonkhana pamodzi pamene akukumana ndi mavuto awo.
Kuphatikizana ndi zochitika zamasewera ndizowathandiza kwambiri anthu ambiri omwe ali ndi matendawa. Ngati mumasankha kuchita nawo njirayi, khalani ndi mphindi kuti mudziwe momwe mungagawire ulendo wanu wa khansa pa Intaneti bwinobwino.
Intaneti ndi malo akulu ndipo nthawi zina zimakhala zovuta kupeza anthu omwe akukumana ndi ulendo wofanana ndi wanu. Kuti muyanjane ndi ena omwe akukhala nawo, kapena kuchiza khansa ya m'mawere, kugwiritsa ntchito hashtag #BCSM ndi othandiza kwambiri. BCSM imayimira khansa ya m'mawere.
Mawu Ochokera
M'mbuyomu, khansa ya m'mawere ya HER2 inkaonedwa kuti ndi chifuwa choopsa popanda mankhwala enieni omwe alipo. Zonsezi zinasintha mu 1998 ndi chivomerezo cha mankhwala oyambirira a HER2, Herceptin. Kuchokera nthawi imeneyo, mankhwala ena akhalapo kuphatikizapo Perjeta, T-DM1, lapatinib, ndipo posachedwapa neratinib, ndi mankhwala ena akuyesedwa mu mayesero a zamankhwala. Mankhwala ochiritsira omwe ali ndi HIV angathandize kuchepetsa chiopsezo cha khansa ya m'mawere yoyamwitsa ya HER2 komanso kuchepetsa kufala kwa khansa ya m'mawere ya HER2.
Kuphatikiza pa mankhwala ochiritsira a HER2, chithandizo cha khansa ya khansa ya HER2 imaphatikizapo mankhwala ochiza matenda a HER2 monga opaleshoni, mankhwala otchedwa hormonal therapy (ngati atagwiritsidwa ntchito), chemotherapy, mankhwala ochizira mazira, mankhwala enaake othetsera matenda, ndi kuthekera kwa mayesero ochipatala .
> Zotsatira:
> Chan, A., Kutaya, S., Holmes, F. et al. Neratinib Pambuyo pa Trastuzumab-Based Adjuvant Therapy kwa Odwala ndi HER2 Positive Cancer Cancer (ExteNET): Multicentre, Randomized, Double Blind, Placebo-Controlled Phase 3 Trial. Lancet Oncology . 17 (3): 367-77.
> Kast, K., Schoffer, O., Link, T. et al. Trastuzumab ndi Survival of Patients With Metastatic Breast Cancer. Archives of Gynecology and Obstetrics . 2017. 296 (2): 303-312.
> Park, J., Liu, M., Yee, D. ndi al. Kusintha Kwambiri kwa Neratinib mu Khansara Yam'mbuyo Yam'mbuyo. The New England Journal of Medicine . 2016. 375 (1): 11-22.