Kungenzeka ukuthi uzwile ngesifo somdlavuza webele we- estrogen kanye nomdlavuza webele we- HER2 omuhle . Kungenzeka ukuthi uke wezwa ngomdlavuza wesifuba wesithathu. Kodwa yini umdlavuza wesifuba wezintathu omuhle?
Akuvamile ukuba umdlavuza webele ube nesitholampilo se-estrogen (ER +), i-progesterone receptor positive (PgR +), ne-HER2 / neu positive (HER2 +).
Lezi zingane zomzimba ezinezifo zomdlavuza zihluke kanjani kwamanye ama-subtypes wesifo somdlavuza webele ngokubili kokuziphatha kwe-tumor kanye nokwelashwa okusebenza kahle? Yini enye okufanele uyenze nokuthi yikuphi ukubikezela?
Incazelo
Igama elithi "umdlavuza wesifuba kathathu omuhle" alujwayele abantu abaningi. Eqinisweni, abanye bangase bacabange ukuthi yi-typo nokuthi sicabanga ngempela ngomdlavuza webele wesithathu.
Lokhu kungenxa yokuthi ucwaningo lwe-"kathathu elihle" lomdlavuza webele lusemusha endaweni yesehlakalo, yize noma izicubu ezintathu ezibonakalayo zibonakala ziyingxenye ehlukile yomdlavuza webele. Ekuvivinyweni, lezi zitholampilo zitholakala njenge-ER +, PgR +, ne-HER2 / neu +.
Ngama-receptor womabili we-estrogen nama-cancer webele we-HER2, kunamaprotheni ama-receptors ebusweni bamangqamuzana omdlavuza wesifuba obhekene nokushayela ukukhula komdlavuza. Amaseli webele wejwayelekile ane-recerores ye-estrogen ne-HER2. Endabeni yezicubu ezinemitholampilo, kunenani elikhuphuke kakhulu lala ma-receptors.
Ukuguqulwa komzimba noma inani elikhulayo lezakhi zofuzo (i-gene amplification) kubangela ukukhiqizwa kwamaprotheni amaningi.
Uma i- estrogen ibophezela kuma-receptors e-estrogen, ivuselela ukukhula kweseli. Nge-HER2, yizici zokukhula ezibophezela ekutholeni ukukhula. Ku-HER2 amangqamuzana omdlavuza webele webele, kunamaphesenti angama-100 amaningi kulawa ma-receptors njengama-cell ejwayelekile webele.
Ngenkathi kusekhona impikiswano mayelana nomdlavuza wesibeletho wesifuba kathathu oyingqayizivele, lezi zomshukela zibonakala zenza ngendlela ehlukile mayelana nokuziphatha komdlavuza kanye nempendulo yokwelapha. Ngokuvamile, izicubu ezintathu ezinomzimba zithandwa kakhulu njenge-estrogen receptor ne-HER2 negative tumors, yize kukhona ukufana phakathi komdlavuza webele wesithathu omuhle futhi kathathu omubi .
I-Triple Positive vs. HER2 +
Amakhansela omzimba ayenayo i-HER2 positive angahluka kakhulu kunomunye nomunye. Ngokuvamile, izicubu eziyi-HER2 zithokozela kakhulu, zinezinga eliphansi lokusinda, futhi ngokuvamile aziphenduli ukwelashwa kwama-hormone. I-HER2 izifo ezinomsoco ezitholakala nge-estrogen receptor positive (kathathu positive) noma kunjalo, zingase ziphathe ngendlela efana ne-estrogen receptor positive tumors futhi zingase zibe nolaka ngaphezu kokuphendula ukwelashwa kwama-hormone.
Ukuze uzwisise umdlavuza wesifuba we-triple omuhle ngokujulile, kungase kube usizo ukubheka umehluko phakathi kwe-HER2 enhle ne-HER2 yomdlavuza wesifuba omubi .
I-Triple Positive vs. ER +
Izicubu ezinomthelela kathathu zivame ukwedlula ukwedlula lezo eziyi-ER + kuphela. Ukwelashwa kwama-hormonal kungase kungasebenzi kangako, futhi i-chemotherapy, okungenani ngamathumba okuqala, angase asebenze kangako.
Amakhansela amathumba amathumba angama-triple nawo angamathuba amaningi okuba nama-lymph nodes amahle kunalawo ase-estrogen receptor ayenayo yedwa.
I-Triple Positive vs. Triple Negative
Ekuboneni kokuqala, kubonakala sengathi ukuchazwa kwesifo somdlavuza webele wesithathu kungcono kakhulu, kulandelwa izicubu ezitholakala kuphela nge-estrogen receptor noma i-HER2 enhle, kulandelwa izicubu ezingezansi ezintathu.
Lokho kubonakala kungenjalo futhi izicubu ezinesabelo esinesithathu esinezici ezinye zezici ezingezansi. Ngenkathi ezinye izicubu ezintathu ezimbi zenza okuningi njengezicubu ze-ER +, ezinye zalezi zicubu zifana nezicubu ezintathu ezingezansi ezisekelwe kulezi zicubu ezinomfutho, ezenzeka ngesikhathi esincane, zibe nezinga eliphakeme le-tumor ekuxilongweni, futhi zibe nethuba lokuphindaphinda kokubili endaweni yangakini, esifundeni, nangokwemvelo.
Ukuvama
Umdlavuza webele wesithathu omuhle awuvamile. Kucatshangwa ukuthi cishe amaphesenti angama-20 kuya kwangu-25 emdlavuza webele (amaphesenti angu-15 kuya kwangu-30 kwezinye izifundo) yi-HER2 enhle. Okuvamile, cishe amaphesenti angama-70 emdlavuza webele anemitholampilo ye-estrogen, iningi lalo liyi-progesterone receptor enhle.
Amagciwane angama-HER2 amahle, azungeze amaphesenti angu-50 anemitholampilo ye-estrogen enhle, nakuba inkulumo ye-estrogen ye-receptor ingaba ngamazinga aphansi. Ngokuvamile, cishe amaphesenti angu-10 e-tumor angase ahlolwe njengemiphumela emihle, kodwa ukukhululeka okubhekene nalezi zinkinga. Ngaphezu kwalokho, izinga le-estrogen positivity lihlukahluka phakathi kwalezi zicubu.
Ukwelashwa Okusondelayo
Imiphi imithi yokwelapha umdlavuza webele isasebenza kangcono emdlalweni wesithathu webele wesifuba?
Kubonakala sengathi izicubu zombili izidakamizwa ze-estrogen kanye ne-HER2 positive zizophendula kabili kanye nokwelapha. Akufanele yini ukwelashwa kwe-HER2 umdlavuza webele we-HER2 ophinde uthinte ama-estrogen receptors engeza ukubikezela okungcono kunokwelashwa kwe-ER + noma i-HER2 + izicubu kuphela?
Ngokudabukisayo, akunjalo. Kwezinye izicubu, ukusebenzisa lezi zindlela ezimbili zokwelapha ndawonye kungabangela ukwedlula ngokweqile futhi kwandise ingozi yemiphumela emibi. Kodwa ngisho noma kokubili ukwelashwa kuboniswa, akusebenzi kahle.
Izifundo ezibheke phambili ezincelweni zomdlavuza zesikhumba ziye zathola inzuzo encane ezivela ku-HER2 zokwelashwa ezibhekiswe lapho izinga lazo zombili receptors liphakeme. Lezi izifo eziziphatha ngendlela efana ne-ER + / HER2 neg (luminal A) izicubu. Kodwa ukuphazamiseka kokunciphisa kwezidakamizwa ze-hormonal kuye kwaphawulwa futhi. Kungani lokhu kungenjalo, futhi kungani bekungeke kuphumelele nakakhulu? Ukuze siqonde lokhu kufanele sibheke "i-crosstalk" phakathi kwe-estrogen ne-HER2 receptors.
I-HER2 / Estrogen Receptor Crosstalk
Amakhansela anemiphumela emihle angase aphathe ngendlela ehlukile kunalokho engalindelwe ngokusekelwe ku-HER2 noma i-estrogen receptor positivity yedwa futhi ingathinteka ubuhlobo phakathi kwalezi zamukeli. Lokhu kuhlangana phakathi kwe-receptors kubhekiswa ngabacwaningi ngokuthi "i-crosstalk."
I-crosstalk phakathi kuka-HER2 no-ER ingasebenza ukukhombisa ukumelana kwe-hormonal. Ngamanye amazwi, ukukhulumisana phakathi kwe-receptors (kusho i-HER2 no-ER) kungabangela ukwelashwa kwama-anti-estrogen ukuba kungasebenzi kahle emathunjini amahle amathathu. Ngendlela efanayo, ukusetshenziselwa ukuphawula kwe-estrogen receptor (okuhlobene nokuba yi-ER +) kungabangela ukumelana nemithi yokwelashwa e-HER2. Lokhu kungase kuchaze ukuhlukahluka kwezifo eziphephile ze-HER2, ezinye zazo eziphendula kangcono kunabanye ku-HER2 izivimbela izidakamizwa.
Kungenzeka kube le "crosstalk" echaza ukuthi kungani singaboni izimpendulo zokwelashwa kwe-hormone noma ukwelashwa okuhlosiwe kwe-HER2 esingayilindela.
Kucatshangwa ukuthi ukusebenzisa inhlanganisela yokwelashwa kwe-HER2 (isibonelo, i-Herceptin) kanye nokwelashwa kwama-hormone (njenge-Tamoxifen noma i-Faslodex (fulvestrant), noma kunjalo, ingabuyisa enye ye-estrogen ukumelana nokuthola ukwelashwa kwe-hormonal.
Ngaphezu kwalokho, ezinye izifo zomdlavuza webelevuza zesikhumba zisebenza kangcono noma zimbi kakhulu ezifweni eziphilayo ze-HER2. Kodwa ngenkathi i-chemotherapy ingahle ibe nenzuzo encane ngezifo zakuqala, isuke inenzuzo enamandla kwizifo zemetastatic.
I-Metastatic Triple Positive Cancer
Umdlavuza wesifuba we-metastatic kathathu omuhle uvame ukwelashwa ngokuhlukile kumdlavuza webele we-HER2 omuhle we-metastatic . Ngokungafani nama-tumor angama-HER2 aphilile yedwa, kubonakala sengathi kunenzuzo ephilayo ecacile yokusebenzisa i-chemotherapy kanye ne-HER2 yokwelapha ukuvimbela. Lokhu kungalandelwa yi-hormonal therapy (njenge-inhibitor ye-aromatase).
Isibikezelo
Njengoba kunezifundo ezimbalwa, kunzima ukubikezela ukuchazwa kwesifo somdlavuza wesifuba kathathu. Ukuziphatha nempendulo eminingi yalezi zicubu zifana nesifo se-estrogen kodwa se-HER2 engalungile, okuphakamisa ukubikezela okuhle. Lokho kusho, sesibonile ukuthi kungase kube khona umgwaqo phakathi kwe-HER2 ne-estrogen receptors eholela ekuphikisweni kokunakekelwa kokubili kwe-hormonal ne-HER2.
Kubonakala sengathi ukubikezelwa kungcono kangcono kwabesifazane abanezinhlamba ezintathu ezise-postmenopausal. Kwesinye isifundo sokuqhathanisa abesifazane besibindi baseSpain nabase-Asia, abatholakala e-Asia nase-Pacific Islander banesifo esiphansi kunabesifazane abamhlophe / abangewona amaSpanishi abanezinhlamba ezintathu ezinhle.
Izwi elivela
Ukuphikisana kugcina ukuthi ngabe umdlavuza wesifuba kathathu unesifo esiyingqayizivele sesifo, nakuba kokubili ukuziphatha kwalezi zicubu kanye nempendulo yokwelashwa kubonakala kubonisa ukuthi kunjalo. Ngokuvamile, lezi zicubu zivama "ukwenza" kakhulu njenge-receroor estrogen, ama-tumor HER2 aphikisayo, kodwa kukhona ukuhluka okuphawulekayo.
Kukhona ukungaqiniseki mayelana nendlela yokwelashwa engcono kakhulu yezinhlamba ezinhle ezintathu, futhi kubonakala sengathi kunezinsetjenziswa ezihlukeneko ngokususelwa ekungenikeni kwe-ER nokunye. Ngaphezu kwalokho, kunesidingo esikhulu phakathi kwezinhlobo ezahlukene ze-receptors, ezingabangela impendulo eyancipha emithini ekhomba uhlobo olulodwa. Ucwaningo olwengeziwe luyadingeka ukuze libheke izimpendulo, kanye nezindlela zokunciphisa umgwaqo oholela ekumenikeleni.
Njenganoma yiluphi uhlobo noma uhlobo lwesifo somdlavuza webele, kubalulekile ukuzifundisa ngesifo sakho. Buza imibuzo eminingi, ufunde ukucwaninga umdlavuza wakho, futhi ube ngummeli wakho ekunakekeleni kwakho. Ukubandakanyeka emphakathini wokusekela umdlavuza webele kungaba usizo kakhulu, ngoba lokhu kuyisisetshenziswa esingayitholi nje ukusekelwa ohambweni lwakho kodwa ukufunda ngezinzuzo zakamuva zokwelashwa.
> Imithombo:
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> Inzuzo ye-Schott, A. Adjuvant Trastuzumab ezigulwini ezibonwa ne-Cancer-positive Breast Cancer. I-JAMA Oncology . 2016. 2 (8): 1047-8.
> Vici, P., Pizzuti, L., Natoli, C. et al. I-Cancer Positive Breast Positive: A Subtype Subtype? . Ukubuyekezwa kweCanscer Treatment . 2015. 41 (2): 69-76.
> Vici, P., Pizzuti, L., Sperduti, A. et al. "I-Cancer Early Breast" Ebonakalayo Enhle: Ukuhlolwa Okubheka Umphumela Wokubheka Okubalulekile. I-Oncotarget . 2016. 7 (14): 17932-17944.