Izinhlobo zokuvivinya, ukuchithwa, kanye nezinguquko ekuhlolweni kwe-HER2
Uma uke waba ne-biopsy noma ukuhlinzeka ngomdlavuza wesifuba kungenzeka ukuthi uzwile ukuthi isisu sakho singu-HER2 esihle noma esingalungile. Uma ungazange uzwe, kufanele ucele i-oncologist yakho ngemiphumela yalolu vavanyo. Kubalulekile ukuqonda ukuhlola kwe-HER2 nemiphumela, ngisho noma isisu sakho singenayo i-HER2 engalungile.
Izinsisekelo ze-HER2 + Cancer
Ama-protein a-HER2 ayenzeka phezu kwamaseli webele, kungakhathaliseki ukuthi anomdlavuza noma evamile.
Isakhi (i-HER2 noma i-ERBB2 gene) sonke sithwale imiyalelo noma uhlelo lokukhiqiza la maprotheni. Iseli ngalinye liqukethe amakhophi amabili wegesi. Uma kukhona amakhophi engeziwe ale geyimu (UHER2 amplification) umphumela yinani eliphezulu le-HER2 receptors ebusweni beseli lesifuba (ukucindezeleka okukhulu kwe-HER2). Ngenkathi amaseli webele wejwayelekile anezigidi ezimbili zama-receptors, ama-HER2 amangqamuzana omdlavuza webele webele anezikhathi ezingaba ngu-100 lezi eziningi.
Ngokulula, lapho izici zokukhula emzimbeni zinamathele kulezi zamukeli ezengeziwe, libonisa ukuthi iseli lihlukanise futhi liphumela ekukhuleni okungaphandle kokulawula kwamangqamuzana esifuba esiwabiza ngomdlavuza.
Amaphesenti angama-25 abantu abanomdlavuza webele uzoba yi-HER2 enhle. Esikhathini esidlule, ukuba yi-HER2 positive kwakuhlotshaniswa nokuhlushwa okubi. Manje njengoba sibheke izindlela zokwelapha (ezifana ne- Herceptin (trastuzumab) ) etholakalayo, ezingaphazamisa lezi zitholampilo, ukuchazwa kwesifo somdlavuza webele we-HER2 kungcono kakhulu.
Kubaluleka kokuhlola
Kubalulekile ukuba nomphumela we-HER2 onembile ukuze uthole izinketho zokwelapha ezingcono kakhulu zomdlavuza webele we-HER2 omuhle . Lokhu kuhlanganisa ukhetho lwezokwelapha ezihlosiwe ezifana no-Herceptin (trastuzumab), i-Perjeta (pertuzumab), iTykerb (lapatinib), no-Nerlynx (neratinib).
Izinhlobo ezithile ze- chemotherapy yomdlavuza wesifuba osebenza kahle nazo zingahlukahluka nesimo se-HER2.
Isimo esinembile se-HER2 sibalulekile futhi ekwelapheni umdlavuza webele we-HER2 omuhle we-metastatic . I-pattern of metastases, kanye nokwelapha amasayithi ethize we-metastase, ingahluka ngokusekelwe ku-HER2 isimo.
Nini Ukuhlola
Wonke umuntu onoma yiluphi uhlobo lwe-invasive (infiltrating) umdlavuza webele kufanele abe ne-tumor yabo ihlolwe isimo se-HER2. Umdlavuza webele we-"invasive" uchazwa njenganoma yimuphi umdlavuza ongaphezu kwesigaba 0 noma i- carcinoma in situ . Zonke ezinye izigaba zesifo somdlavuza webele, kusukela esiteji I kuya esigabeni IV, kufanele zihlolwe isimo se-HER2 ngesikhathi sokuxilongwa futhi ngaphambi kokuqala ukwelashwa.
Izinhlobo Zemivivinyo
Kunezinhlobo ezahlukene zokuhlolwa ezingenziwa ngesisu ukuze kunqunywe ukuthi ngabe i-HER2 enhle noma cha. Lokhu kufaka:
- HER2 Immunohistochemistry (IHC) : I-IHC iyinani lezinombolo ze-HER2 amaprotheni receptors ebusweni bamaseli omdlavuza webele noma "ukucindezeleka kwe-HER2"
- In hybridation (ISH) : ISH isilinganiso senani lamakhophi we-HER2 kumakhalekhukhwini ngamunye wesifo somdlavuza webele noma "UHER2 ukukhulisa." Kunezinhlobo ezimbili ezihlukene zokuhlolwa kwe-ISH: i-fluorescence (i-FISH) nensimu ekhanyayo i-ISH.
Kukhona ukuphikisana ngokuthi yiziphi izinyathelo zokuhlola eziqondile kakhulu.
Abanye abacwaningi bakholelwa ukuthi i-FISH ISH inembile kakhulu, kodwa i-IHC ivame kakhulu e-United States. Njengoba le ndawo ishintsha kakhulu kakhulu, kubalulekile ukukhuluma ne-oncologist yakho mayelana nokuhlolwa okwenzile nokuthi kungani le ndlela ethile ingase ikhethwe.
Imiphumela yokuhlola
Ngokwemihlahlandlela ka-ASCO / CAP ka-2013, uma ukuhlola kwe-HER2 kubuyela emuva njengomngcele we-borderline noma ngokulinganayo, "ukuhlolwa kwe-reflex" (okuqhubekayo kwesinye isilingo) kufanele kwenziwe ngezinye izindlela zokuhlola. Isibonelo, uma i-IHC inikeza imiphumela emingceleni, i-ISH kufanele yenziwe esikhwameni esifanayo, futhi uma i-ISH ingumngcele, i-IHC kufanele yenziwe ngaphambi kokuba imiphumela ibikwe.
Ngezinye izikhathi umphumela wezivivinyo ezahlukene ze-HER2, isibonelo, kokubili i-IHC kanye ne-FISH ISH kuyoba umngcele ongenamkhawulo, ongenqunyelwe, noma olinganayo. Okwamanje asikho imikhombandlela evamile yokuthi singaqhubeka kanjani uma kunjalo, futhi wena kanye ne-oncologist yakho kuzodingeka uxoxe ukuthi ungaqhubeka kanjani.
Ukulinganiselwa kokuhlola
Ngaphezu kokuba nemiphumela yokuhlola engekho emihle noma engalungile kodwa kunomkhawulo ophansi noma olinganayo, kunezinye ukulinganiselwa okungenzeka ku-HER ukuhlolwa. Lokhu kufaka:
- Ukungalungi (amaphutha): Kunoma yiluphi uhlobo lwe-laboratory test kuhlale kunengozi yamaphutha.
- Ukungaphumeleli ukuphinda ukuhlolwa uma umphumela ungumkhawulo-mhlaba, ungakapheli, noma u-equivocal: Uma ukuhlolwa kubuya njengemingcele, kumele kuphindwe.
- Ukuphazamiseka komzimba: Umqondo we-heterogeneity we-tumor ukhululekile futhi ungadideka. Njengoba amangqamuzana omdlavuza ashintsha njalo, kungase kube nezingxenye zesisu esihlola i-HER2 enhle nezinye izingxenye ezivivinya i-HER2 negative. Lokhu kulula ukuyiqonda uma siqaphela ukuthi izinhlobo ezahlukene zesifo singaba nezinhlobo ezahlukene zeseli ngaphansi kwe-microscope.
- Shintsha: I-Tumors ingashintsha isimo esihlukile se-HER2.
Izinguquko ku-HER2 Isimo
Sivame ukucabanga ngegciwane lesandulela ngculaza njengelungu le-cell errant lapho onke amangqamuzana afana khona, kepha lokhu akunjalo nje. Siyazi ukuthi amangqamuzana omdlavuza aqhubeka nokuthuthukisa ukushintshwa okusha kanye noshintsho. Izingxenye ezihlukene zesisindo esisodwa esisodwa singaba namagciwane omdlavuza anezici ezahlukene (i-tumor heterogeneity) futhi lezi zinguquko zingabonakala nakakhulu uma isisu sithuthuka, njenge-recurrence noma isifo se-metastatic.
Akuyona isimo se-HER2 kuphela esingashintsha. I-Estrogen receptor (ER) kanye nesimo se-progesterone receptor (PR) singashintsha lapho isimila siphindela noma sinciphisa umzimba, futhi lolu shintsho esimweni se-receptor sibhekwa ngokuthi "ukuhlukunyezwa." I-tumor ingashintsha kusukela ekubeni nomphumela omuhle kunomunye walawa ma-receptors, noma ngokuphambene, kusukela ekubeni nombi kuya omuhle.
Izidumbu zishintsha kangaki? Ithuba lokuhlukana phakathi kwe-tumor yangempela kanye ne-metastasis yokuqala noma yesibili (mhlawumbe kusuka emibi kuya emihle noma emihle kuya emibi) kanje:
- ER: amaphesenti angu-20.7
- I-PR: amaphesenti angu-40.7
- HER2: amaphesenti angu-19.6
Kulolu cwaningo, cishe amaphesenti angu-20 e-tumors ashintshe isimo kusuka ku-HER2 enhle ukuba anganaki noma angenzi kahle. Ukwazi ukuthi isisu sesishintshile kubaluleke kakhulu ekukhetheni izinketho ezinhle zokwelapha,
Ingabe kuhle noma kubi uma isimo se-HER2 se-receptor sishintsha? Uma nje kutholakala ushintsho (ngokwenza ukuhlolwa okuphindaphindiwe) ukuze ukwelashwa okungcono kunconywe, akubonakali ukuthi ushintsho esimweni se-receptor ludlala indima enkulu ekuchazeni. Kulezi zicubu zokucwaninga ezazingavumelani ne-HER2 (ezishintshe ukuthi zibe zihle noma zibi) zinezifuba ezifanayo kulezo zicubu ezingazange zishintshe isimo se-receptor ye-HER2.
Lesi sifundo sathola ukuhlukunyezwa phakathi kwe-metastases yasekuqaleni kanye ne-metastasis yokuqala noma yesibili, kodwa ukuhlukunyezwa kungenzeka phakathi kwe-metastasis yokuqala neyesibili.
Phinda ukuhlola
Ngaphezu kokuhlolwa kwe-HER2 okumelwe kwenziwe kuwo wonke umuntu ngesikhathi sokuxilongwa, kunezimo lapho ukuhlolwa okumele kwenziwe khona. Lokhu kufaka:
- Ngesikhathi sokuphindaphinda , kungakhathaliseki ukuthi ukuphindaphindiwe kwendawo, kwesifunda, noma kwesimiso esifanayo.
- Uma umdlavuza wesifuba usakazeka futhi kunoma yiziphi izimpawu ezintsha.
- Uma wena ne-oncologist yakho ninomuzwa wokuthi ukuhlolwa kwe-HER2 okwenzile akukona okunembile njengokuhlolwa okusha.
I-misdiagnosis
Kwenzekani uma isimo sakho se-HER2 singenakunakwa? Uma isisu sakho singu-HER2 omuhle kodwa uthola umphumela omuhle we-HER2, ungase ungatholi ukwelashwa okungcono okusinda. Ngakolunye uhlangothi, uma isimo sakho se-HER2 singalungile ngempela kodwa uthola umphumela omuhle we-HER2, usengozini yokuvezwa kwemiphumela emibi yezokwelapha ezibhekiswe ku-HER2 ngenzuzo encane (nakuba abanye abantu abangenayo i-HER2 negative babe ne-tumors ephendule lezi zindlela ezithintekayo).
Izwi elivela
Ukuhlolwa kwe-HER2, kanye nokuhlolwa kwe-recerogen kanye ne-progesterone receptor, kufanele kwenziwe kuzo zonke izifo zomdlavuza zesifuba (esiteji sokuqala kuya esiteji IV) ngesikhathi sokuxilongwa futhi ngaphambi kokwelashwa kwenziwa (ngezinye izikhathi ngaphandle kokuzivocavoca).
Ukuhlolwa kufanele kuphinde kuphinde kubuyeke uma ngabe uvivinyo olubuyiselwe njengalokhu lungafinyeleleki, uma i-oncologist yakho izwa uhlobo oluhlukile lokuhlolwa lilunga kakhulu, noma uma umdlavuza wakho uphindela noma usakazeka. Isimo se-HER2 se-tumor singashintsha ngokuhamba kwesikhathi, ngisho nasezindaweni ezihlukene zesisu esisodwa.
Isimo se-HER2 esinembile sibalulekile ekukhetheni izinketho zokwelapha ezingcono kakhulu zomdlavuza wakho ngenkathi ukunciphisa imiphumela emibi yokwelapha okungencane amathuba okusebenza. Kukhona ukungqubuzana phakathi kokuhlolwa okuhle kakhulu kwe-HER2, futhi ukuhlolwa okusha futhi okuguquliwe kuhlolwa namuhla. Lokho kusho ukuthi kubalulekile ukubuza imibuzo futhi ube ngummeli wakho siqu ekunakekeleni umdlavuza wakho.
> Imithombo:
> Society of American of Clinical Oncology. Ukuzijwayeza kanye nezinkombandlela. Umdlavuza webele. Izincomo ze-Human Epidermal Growth Factor Receptor 2 Ukuhlolwa kwe-Breast Cancer Update. http://www.asco.org/practice-guidelines/quality-guidelines/guidelines/breast-cancer#/9751
> Lim, T., Lim, A., Thike, A., Tien, S., noP. Tan. Umthelela wokubuyekezwa kwe-2013 American Society of Clinical Oncology / College of American Pathologists Izincomo Zemihlahlandlela Yokuhlolwa Kwama-Human Epidermal Growth Factor Receptor 2 Ukuhlolwa KwamaGeni Ukusebenzisa i-Immunohistochemistry ne-Fluorescence In Hybridization for Breast Cancer. I-Archives of Pathology kanye neLab Medicine . 2016. 140 (2): 140-7.
> Ephansi, E., Khan, S., Kennedy, D., no R. Baughman. Ukuhlukaniswa kwe-Estrogen Receptor kanye ne-HER-2 / neu ku-Cancer yaseBesheni Kusukela kuLesion Primary ukuya ku-Site yokuqala neyesibili yeMetastatic. I-Cancer Medical (I-Dove Medical Press) . 2017. 5: 515-520.