Ingabe Kuhle noma Okubi Ukuba Nayo I-HER2 I-Positive Cancer Breast?
Uma utshelwe ukuthi umdlavuza wakho webele u-HER2 omuhle, cishe unemibuzo eminingi mayelana nokuthi kusho ukuthini lokhu. Kodwa uma ufana nabanye abaningi, umbuzo wakho wokuqala ungaba, "Ingabe kuhle noma kubi ukuthi kube yi-HER2 enhle?" Ngamanye amazwi, "kungcono" uma isisu sakho singu-HER2 noma i-HER2 engalungile?
Njengoba sifunda ukuthi umdlavuza webele awusona isifo esisodwa kodwa kunezifo eziningi ezihlukile ezingeni lemangqamuzana, le mibandela ebalulekile.
Impendulo esheshayo yukuthi i-HER2 positivity ingaba kokubili okuhle nokubi. Ake sihlole ukuthi isimo se-HER2 sithinta kanjani konke ukuhlukumeza kwesisu, ukhetho lwezokwelapha, engozini yokuphindaphindiwe nokubikezela.
Ukubukeza Okufushane
Umdlavuza wesibeletho akusona isifo esisodwa-empeleni, akukho khansa ezimbili zifana-kodwa manje sinamandla okuphuza lezi zansana phansi zibe ngaphansi kwe-subtypes ezisekelwe "esimweni sokuthola" sezicubu. Amagciwane ebeletho ahluke kuma-proteins athola indawo yeseli, amaprotheni anesibopho sokukhula kwezidumbu. Lezi zinhlelo zamaprotheni zihlobene nokungafani okwehlukahlukana kwezakhi zofuzo zamangqamuzana omdlavuza.
Abantu abaningi bajwayele umdlavuza webele we- estrogen we-receptor-positive , lapho i-estrogen ibopha izinombolo ezikhudlwana zalezi zitholampilo ezingqamuzaneni zomdlavuza webele ukuze kukhuthazwe ukukhula kwesisu.
Okwenzeka nge-HER2 emdlavuza webele wesifuba esifanayo, kodwa uhlobo oluthile lwe-receptor ebusweni bomdlavuza wesifo somdlavuza obangela ukukhula nokusabalala kwesisu.
Ngaphezu kwama-estrogen receptors ebusweni bamangqamuzana (okuyinto evuselelwa yi-estrogen ), kune-receptors ye-HER2 ebusweni bamaseli (okukhuthazwa yizici zokukhula ukushayela ukukhula).
I-HER2 gene (i-epidermal growth factor receptor 2 noma i-HER2 / neu) isisindo (esisodwa sonke esinakho) esikhombisa amaprotheni ahilelekile ekukhuleni kwamaseli webele.
Kubizwa nangokuthi igciwane le-ERBB2 futhi isakhi (protooncogene) esitholakala ku-chromosome 17.
Izakhi ze-HER2 ziphethe imiyalo yokwenza amaprotheni ama-HER2. Lawa maprotheni asebenza njengama-receptors kumaseli asebele. Uma amakhophi amaningi wegciwane le-HER2 ekhona (ngenxa yomonakalo ekuphatheni kwezakhi zofuzo esitokisini noma ezishintshashintshayo) kubangelwa ukukhiqizwa ngokweqile (noma "ukucindezela") kwe-HER2.
Kubalulekile ukuqaphela ukuthi wonke amaseli webele-kokubili anomdlavuza nonancercerous-abe nama-receptors e-HER2 ebusweni beseli. Umehluko wukuthi ama-HER2 amangqamuzana omdlavuza webele webele anama-40 kuya kwangu-100 le namba. Uma izici zokukhula emzimbeni zibopha kulezi zitholampilo, kubangelwa ukugcwala kwamaseli webele.
Njengoba nje sinemithi ephazamisa i-estrogen receptor (noma ukunciphisa i-estrogen emzimbeni) ukuphatha umdlavuza webele we-estrogen we-receptor-positive, manje sinemithi ephazamisa ama-receptors e-HER2 kuma-cancer angamahle we-HER2.
Amaphesenti angaba ngu-25 (amaphesenti angu-15 kuya ku-30) wegazi lamabele ahle kakhulu ku-HER2 (HER2 ngokweqile kakhulu).
HER2 Isimo Esihle: Esihle Noma Esibi?
Ukuze uphendule kahle umbuzo wokuthi ngabe into enhle noma into embi ukuthi ibe yi-HER2 emihle, kubalulekile ukukhuluma ngokungafani phakathi kwezingculazi ezihle kakhulu ze-HER2 nalabo abangenayo i-HER2 engalungile.
Impendulo esheshayo yukuthi kungaba kuhle noma kubi. Ekugcineni, abantu abaningi bafuna ukwazi ukuthi umphumela wokuba nomdlavuza webele we-HER2 unempilo kangakanani, kodwa ngisho nalawo masibalo angadukisa ngaphandle kokuqonda ukuthi ukwenza i-HER2 emihle kuthinta kanjani ukukhula kwala makhamera.
Isibonelo sokufanekisa leli phuzu yilokho lomdlavuza webele emantombazaneni abasha . Ngokuvamile, amazinga okusinda aphansi kubantu besifazane abancane abanesifo kodwa lokhu kungase kudukise. Kubantu abasebasha, lesi sifo sivame ukutholakala ukuthi siyizigaba eziphambili kakhulu. Ngakho-ke nakuba owesifazane osemncane engase akwazi ukubekezelela ukwelashwa okungcono futhi abe nesilinganiso esingcono sokusinda esiteji esithile, izinga lokusinda jikelele liphansi ngenxa yezigaba eziphakeme lapho kutholakala khona.
Impendulo esheshayo yokuthi ngabe unomdlavuza webele we-HER2 omuhle noma omubi ukuthi "kuxhomeke." Ngakho-ke kudingeka sibheke izindlela lapho isimo se-HER2 singathinta umdlavuza. Lokhu kufaka:
- Uhlobo lwabantu abahlakulela lolu hlobo lwesisu (isibonelo, isilinganiso seminyaka)
- Isiteji lapho i-HER2 ye-Cancer itholakala khona, ngokumelene nama-HER2 amathumba amabi
- Kungakhathaliseki ukuthi i-tumor ibuye isrogen receptor enhle
- Izinketho zokwelashwa zitholakalayo
- Ingozi yokuphindaphinda
- Izinga lokusinda jikelele
Kubalulekile ukuqaphela ukuthi isimo se-HER2 ngezinye izikhathi singalungile futhi singashintsha ngemva kokuphindaphinda (bheka ngezansi).
Umehluko Emngciphekweni
Ngenkathi kuhamba kakhulu, abanye abantu baningi amathuba kunokuba abanye babe nomdlavuza webele we-HER2 omuhle. Ucwaningo olubili, ucwaningo lwe-LACE kanye nokucwaninga kwe-PATHWAYS, libuke ngezici zabantu abangahle babe yi-HER2 enhle noma engalungile.
- Abesifazane abanezinambuzane ngokucindezeleka ngokweqile kwe-HER2 kanye ne-estrogen receptor negative kungenzeka ukuthi bancane, kungenzeka ukuthi baye basebenzisa i-hormone substitution therapy, futhi kungenzeka ukuthi bangama-Asian noma amaSpanishi.
- Izicubu eziyi-HER2 positive azibonakali zihlotshaniswa nokudla noma ukubhema utshwala, futhi ngokungafani ne-estrogen receptor positive tumors umsebenzi ongokomzimba awubonakali unomthelela wokuvikela lesi sifo.
- Amadoda anomdlavuza wesifuba awuncane kakhulu kunabesifazane ukuba babe nezicubu ezihle ze-HER2.
- Ngokuthakazelisayo, kutholakale ukuthi i- ductal carcinoma in situ (DCIS) noma isithombeni se-0 esithombeni kungenzeka ukuba sibe ne-HER2 emihle kunezifo zomdlavuza webele, abanye abacwaningi bakholelwa ukuthi kuhlobene nenqubo yokuthuthukiswa kwezidumbu.
- Ezinye izinhlobo ze-khansa yebele zingase zibe ncane amathuba okuba yi-HER2 enhle. Isibonelo, akuvamile ukuthi umdlavuza webele we- mucinous (colloidal) webele , i- medullary carcinoma, noma i- carbulaoma ye-tubular yesifuba ibe yi-HER2 enhle.
- Isimo se-HER2 singashintsha ngezici zokufaka izakhi zofuzo zomdlavuza webele. Isibonelo, i-BRCA1 yomdlavuza wamabele ehlotshaniswayo ayinamathuba amancane okuba yi-HER2 enhle.
Ukunemba kokuhlola nokuguquka esimweni
Sivame ukukhuluma ngesimo se-HER2 njengokungathi simnyama nomhlophe, kodwa lokho akusiyo njalo. Kunezinhlobo ezahlukene zokuhlolwa ezingahluka ngokuqondile. Kukhona futhi "amazinga" ahlukile wokuzimela. Isibonelo, isisu singaba yi-1+, 2+, noma i-3 +. Ama-Tumor "aphansi kakhulu" angase abizwe ngokuthi abe nokucindezeleka okukhulu kwe-HER2 kunokuba abe yi-HER2 enhle.
Manje kunconywa ukuthi abesifazane abanohlobo olulodwa lokuhlolwa babuyiselwa emuva, njengoba ezinye izindlela zokuhlola zinembile kunabanye. Ukuphinda kubuyiselwe kunconywa futhi uma ukuhlolwa kubuyiselwa njenge "umngcele." Kubalulekile futhi ukukhuluma nge-heterogeneity of tumors; enye ingxenye ye-tumor yebele ingaba i-HER2 emihle ngenkathi esinye isigaba si-HER2 negative.
Isimo se-HER2 singashintsha, futhi lokhu kudidekile kubantu abaningi. Isifo esivela ku-HER2 esihle singase sibe yi-HER2 negative uma siphindela noma sisakazeka. Ngokufanayo, i-tumor esekuqaleni i-HER2 negative ingaba i-HER2 emihle uma iphinda ibuye. Isimo se-HER2 kufanele siphenduwe ngaso sonke isikhathi ngemuva kokuphindaphindiwe.
Ukuguquka
I-HER2 imithi yesifo esihle sebele ivame ukuba namandla kunama-tumor HER2 angalungile.
Amathumba omzimba anikezwa ibanga lesikhumba ngesikhathi sokuxilongwa ngokusekelwe kwamaseli ngaphansi kwe-microscope. I-tumor grade yinombolo enikezwa ukuchaza ukuhlukumeza kwesisu, enombalwa womuntu onobudlova obuncane, kanti iningi lezintathu liyingozi kakhulu. I-HER2 i-tumor emihle cishe inamabanga amathathu. Lezi zicubu zivame ukukhula ngokushesha kunama-tumors ebangeni elingaphansi futhi kungenzeka ukuthi zisakaze kuma-lymph nodes.
Spread to Lymph Nodes
Ama-cancer webele we-HER2 angase afinyelele kuma-lymph nodes. Njengalokhu, isiteji esitholakalayo singase sibe ngaphezulu kunama-tumor HER2 angalungile.
Impendulo yokwelapha
Ngaphambi kokuthuthukiswa kwemithi ehlosiwe yomdlavuza webele we-HER2, njenge- Herceptin (trastuzumab) , impendulo yokwelashwa yabantu abane-cancer yabo yesifuba enhle ayifanele kulabo abanesifo esibi se-HER2.
Ukwelashwa okuhlosiwe kwe-HER2 umdlavuza webele we-HER2 ushintshile ukubikezela, futhi manje imiphumela yokwelapha ifana neze-HER2 izifo ezimbi (nakuba izicubu ze-HER2 zivame ukuba zinkulu). Ngokusho kweNational Cancer Institute, le mithi ishintshe ukubikezelwa kwesiteji I ukuya esigabeni sesithathu se-HER2 esifanele emdlalweni webele wesifuba kusuka empofu kuya omuhle.
I-Herceptin inciphisa ingozi yokuphindaphinda iphinde ithuthukise izinga lokusinda iminyaka engu-10 kulabo abanesiteji I kuya esigabeni sesifo se-III ngamaphesenti angaba ngu-30.
Kodwa-ke, kukhona ingozi enkulu yokuphindaphinda futhi i-metastasis ngesimo esihle se-HER2, futhi amazinga okusinda aphansi kakhulu kunama-tumor HER2 angalungile kodwa izidakamizwa ezitholwa yi-estrogen.
Abantu abane-tumor emihle ye-H32 bancane amathuba okuphendula isifo somdlavuza we-cancer wamabele kunabo abangalungile.
Ingozi Yokuphindaphinda
I-HER2 umdlavuza wesifuba omuhle kungenzeka ukuthi ubuyele emuva (ubuyele) bese kuba nomdlavuza webele weHER2 omubi. Ucwaningo luye lwabona ukuthi amantombazane okuqala webele (isigaba I nesigaba II) ziphindwe izikhathi ezimbili kuya kwezingamakhulu amathuba okuphindaphinda kunama-tumor angama-HER2. Ngisho nezincane ezincane kakhulu ze-HER2 (ezingaphansi kwe-1 cm noma ingxenye engamamitha amayintshi ububanzi) ezinama-lymph nodes angenayo ingozi ephezulu kakhulu yokuphindaphinda isihlobo nezicubu ezingenayo i-HER2 negative. Ukwelashwa noHerceptin kunganciphisa ingozi ngesigamu.
Indlela yokuphindaphinda umdlavuza webele ingahluka futhi. Amathumba amancane nawo angaphinda abe nokuphindaphinda kwemetri (ngokungafani nokuphindaphinda kwendawo noma kwesifunda) uma be-HER2 positive.
I-Metastasis
Kungakhathaliseki ukuthi i-HER2 izifo ezinomzimba cishe zinomthelela omkhulu kunamahlumela amabi ancike kumasayithi we-metastases yomdlavuza webele esiwacabangayo . Ingozi ye-metastases jikelele, ikakhulukazi imetastases yobuchopho, kucatshangwa ukuthi yanda, kodwa izifundo eziningi zenziwa ngaphambi kokusetshenziswa okujwayelekile kwe-Herceptin.
Ucwaningo olwenziwe ngemuva kokusungulwa kwe-Herceptin (nezinye izifo ezithintekayo ze-HER2) zithole ukuthi i-HER2 emdlavuza webele isifuba iqhubeka nokuba nemiphumela ephakeme kakhulu ye-metastases yobuchopho. I-HER2 i-tumor emihle ijwayele ukusabalalisa kusenesikhathi lesi sifo ukuya kuma-lymph nodes, ama-lungs, umnkantso wamathambo, ama-ovari, nama-gland adrenal.
Amathuba we-metastases ne-HER2 amathumba amahle angase ahluke kuye ngokuthi ngabe isifo se-estrogen sinempilo yini noma cha. Ingozi yobuchopho, isibindi, amathambo kanye namaphasimase emaphaphu ku-HER2 izifo ezinomzimba nazo zithinteka ukuthi ngabe i-tumor is receptor istergen noma imbi.
Ingozi ye-metastase ingase ibuye ixhomeke ezintweni ezihambisanayo. Isibonelo, ingozi ye- metastase yesibindi esuka emdlalweni webele webele iphakeme nge-HER2 izifo ezinomzimba uma abantu bebhema.
I-Cancer Positive Breast Positive
Amaphesenti angaba ngu-50 we-HER2 amathumba amahle azophinde abe nesisitho se-receptor esihle. Ucwaningo luye lwabona ukuthi le nhlanganisela ingabangela iphethini ehlukile yokubuyela emuva, kodwa izifundo ezimbalwa kuphela zibuke izici kanye nomthelela wezicubu ezintathu ezinhle.
Amagciwane okubeletha angama-estrogen receptor ayenayo futhi i-HER2 engalungile (i-luminal A) ine-prognosis engcono kakhulu. Lokho okutholakala nge-estrogen receptor futhi i-HER positive (i-B-luminal) i-prognosis eyimpofu, kodwa ukubikezela kusalokhu kungcono kunabantu abanesifo somdlavuza wesifuba esingenayo kathathu noma esingama-estrogen.
Amaphutha ekutholeni
Le ngxoxo ngeke iphelele ngaphandle kokusho ukuthi ngezinye izikhathi umdlavuza webele usuhlolwe ngephutha njengo-HER2 positive noma i-HER2 negative. Ukuhlolwa okutholakala ekunqumeni isimo se-HER2 akuyona into engalungile. Kubalulekile ukubuza i-oncologist yakho ukuthi yikuphi ukuvivinywa okwenziwayo nokuthi ngabe kufanele yini ukubuyiswa noma cha.
Iphutha ekuxilongweni (i-misdiagnosis) lapho i-HER2 emihle isifo esitholakala ngengozi ingabangela umuntu anganikezwa ukwelashwa okuhlosiwe; ukwelashwa okungenza ngcono ukusinda. Yiqiniso, ukutholakala ukuthi unesifo esihle esingu-HER2 empeleni i-HER2 negative ingabangela ukusebenzisa imithi engasebenzi (nakuba ezinye izicubu ezimbi ze-HER2 ziye zaphendula ku-Herceptin).
Ukufingqa Kwezinselele
Lesi sihloko sibukeze umehluko omkhulu phakathi kwama-cancer webele we-HER2 anemiphumela emihle ne-HER2, nokuthi ukuthi lokho kungezwani kungathinta kanjani ukuphawula.
I-HER2 emdlavuza webele wesifuba uma kuqhathaniswa nama-tumor e-receptor-positive ajwayele ukuba:
- Ulaka olwedlulele (abe nebanga eliphakeme le-tumor)
- Kutholakala kwabesifazane abasebasha (nomdlavuza webele emantombazaneni abasha bavame ukutholakala ngezigaba eziphambili kakhulu)
- Cishe cishe kungenzeka ukuthi uphendule ukwelashwa manje ukuthi izifo ezithintekayo ze-HER2 zikhona
- Kungenzeka ukuthi ubuyekeze / buyele emuva
- Kungenzeka ukuthi kufinyeleleke, okungenani kumasayithi afana nobuchopho
Lezi zicubu zibuye zibe nesimo esithile esimpofu (nakuba ama-agent amasha avunyelwe, eyodwa ngo-2017, futhi asazi ukuthi lokhu kuzothinta kanjani ukubikezela.)
Kukhona okungafani nakakhulu kulezi zithole futhi kudingeka sikhumbule ukuthi wonke umuntu, nayo yonke imdlavuza yesifuba, ihlukile.
Izwi elivela
Ngenkathi jikelele ukuchazwa kwe-HER2 izifo ezivame ukuma kancane kunomsoco kunalabo abathola i-estrogen receptor positive kepha i-HER2 engalungile, ukwemukelwa okubanzi kwemithi yokwelashwa kwe-HER2 kwenza umehluko kumazinga okusinda kanye nengozi yokuphindaphinda.
Njengoba izindlela zokwelapha ze-HER2 zishaya endaweni entsha, futhi ukwelashwa okusha okuvuthiwe kuye kwavunyelwa ngo-2017 yedwa, izibalo azikho ngempela eziwusizo. Uma uhlala nomdlavuza webele we-HER2, iqiniso lokuthi impendulo yokwelashwa manje ema-tumor amahle a-HER2 afana ne-estrogen receptor positive tumors iyakhuthaza.
Ngayo yonke inguquko eqhubekayo ekwelapheni, futhi ngemithi eqhubekayo ehlolwe ekuvivinyweni kwemitholampilo, kubaluleke kakhulu kunanini ngaphambili ukuthi uthathe indima enkulu ekwelapheni kwakho. Thatha isikhashana ubuyekeze amanye amathiphu wokuthi ungaba kanjani ummeli wakho ekunakekelweni komdlavuza wakho .
> Imithombo:
> Ellingiord-Dale, M., Vos, L., Hjerkind, K., Hjartaker, A. et al. Utshwala, Umsebenzi Wokwenyama, Ukubhema Ne-Breast Cancer Subtypes Esifundweni Esiyinhloko Esihlambulukile-Ukulawulwa Kwesikhwama Esivela Esikhathini SeNorway Breast Cancer Screening Program. I-Epidemiology ye-Cancer Epidemiology Biomarkers and Prevention . 2017 Septhemba 6. (i-Epub ngaphambi kokuphrinta).
> National Cancer Institute. Indaba Yokuthola: Isixhumanisi se-Genetic Link ku-Breast Cancer Spurs Development of New Treatments. https://www.cancer.gov/research/progress/discovery/HER2
> Parise, C., no-V. Caggiano. Ukusinda Kwesifo Sebele Isisu Esichazwe yi-ER / PR / HER2 Subtypes kanye Nokuhlukaniswa Okungokwemvelo Ngokusho Kwezingcingo zeBanga ne-Immunohistochemical Biomarkers. Umagazini we-Cancer Epidemiology . 2014. 469251: 1-11.
> Schettini, F., Buono, G., Cardalesi, C. et al. I-Acceptor Hormone / I-Human Epidermal Growth Factor Receptor 2-I-Cancer Breast Breast Positive: Where We Are Now and Where We Are Going. Ukubuyekezwa kweCanscer Treatment . 2016. 46: 20-6.