Mhlawumbi uye wakuva malunga nomhlaza wesifuba we -estrogen-positive kunye nomhlaza webele we- HER positive . Kusenokwenzeka ukuba uye wakuva malunga nomhlaza wesibeleko wesithathu. Kodwa yintoni umhlaza wesifuba webele wesithathu?
Akuqhelekanga ukuba umdlavuza webele ube yi-estrogen receptor positive (ER +), i-progesterone receptor positive (PgR +), kunye ne-HER2 / neu positive (HER2 +).
Ziziphi iindlela zokuhlukumeza iintsholongwane ezithandekayo ezivela kwezinye iincinci zesifo somhlaza wesibeleko ngokubhekiselele kokubili ukuziphatha kwe-tumor kunye nezokwelapha ezisebenza kakuhle? Yiyiphi enye into omele uyayiyazi kwaye yintoni isilumkiso?
Inkcazo
Igama elithi "umhlaza wesibeleko sesifuba esithathu" aluqhelekanga kubantu abaninzi. Enyanisweni, abanye banokucinga ukuba yi-typo kunye nokuba sicinga ngentsholongwane yomhlaza wesithathu.
Oku kubangelwa ukuba uphando lwe-"kathathu oluhle" lomhlaza webele lubonakala lutsha kummandla, nangona izilonda ezintathu ezintle zibonakala ziyingcambu ekhethekileyo yomhlaza wesifuba. Ekuvavanyeni, ezi zicubu zifunyenwe zi-ER +, PgR +, kunye ne-HER2 / neu +.
Ngama-receptor omabili kunye ne-HER2 enomdlavuza wamabele, kukho iiprotheyini ezifumana umlenze phezu kweeseli zomhlaza zesifuba ezijongene nokuqhuba ukukhula komhlaza. Iiseli zesifuba eziqhelekileyo zine-estrogen kunye ne-HER2 receptors. Kwimeko yee-tumor-positive tumors, kukho inani elinyuka kakhulu lala ma-receptors.
Ukuguqulwa kwamanani okanye inani elongezelelweyo lejeni (ukukhulisa i-gene) kuphumela ekuveliseni ezinye zezi proteins.
Xa i- estrogen ibophelela kwi-estrogen receptors, ivuselela ukukhula kweseli. Nge-H22, yinto yokukhula ebopha kwi-receptor ukukhuthaza ukukhula. Kwii-HER2 zesalathisi zesifuba esifanelekileyo sebele, kukho amaxesha angama-100 amaninzi kula ma-receptors njengama-cell ejwayelekile asebele.
Nangona kusekho ukuphikisana ngaphezu komhlaza wesibeleko wesifuba esinesithathu esincinci, i-cancer ebonakalayo iyahluka ngokuphathelele kokuziphatha komhlaza kunye nokuphendula kwonyango. Ngokubanzi, izilonda ezintathu ezintle zithatha ukwenza izinto ezinjenge-receroor receptor ezilungileyo kunye ne-HER2 ezihlambulukanga, nakuba kukho ukufana phakathi kwesithathu somhlaza nomhlaza wesithathu .
I-Triple Positive vs. HER2 +
Amanomdla okubeleka ase-HER2 ayenokuthi ahluke kakhulu. Ngokuqhelekileyo, izicubu ezi-HER2 zenza ukuba zixhase, zinezinga elincinci lokusinda, kwaye ayisoloko isabela kwiyeza zonyango. I-HER2 i-tumors ezichanekileyo ezithe zafumana i-estrogen receptor (positive kathathu) nangona kunjalo, inokuziphatha ngokufana ne-estrogen receptor positive tumors kwaye inokuba yincinci ngaphezu kokuphendula kwi-hormonal treatment.
Ukuqonda umhlaza wesifuba esinezintathu ezintle ngokubanzi, kunokunceda ukujonga ezinye iintlukwano phakathi kwe-HER2 enhle kunye ne-HER2 yomhlaza wesifuba .
I-Triple Positive vs. ER +
Izidumbu ezinesithathu ezintle zivame ukuba zinobudlova kunokuba zingu-ER + yedwa. Ulwaphulo lwe-hormonal lungabonakali kakuhle, kwaye i-chemotherapy, ubuncinci kunye neengcambu zesantya, lingaba luncedo.
Amanqamu omncuba angama-triple-negative nawo anakho amathuba okuba ne-lymph nodes ezilungileyo kunezo zi-recerogen ezithe zodwa.
I-Triple Positive vs. Triple Negative
Ekubonweni kokuqala, kubonakala ngathi ukuhlaselwa kwesifo somhlaza wesibeleko sesithathu kuya kuba phezulu, kulandelwa ngamathumba anesifo se-estrogen kuphela okanye i-HER2 enhle, elandelwa ngamathumba anesithathu.
Oko kungabonakali ukuba kunjalo kunye nezicubu ezinesabelo esinesithathu esinesibini ezinye iziganeko kunye nezo zimbande ezintathu. Nangona ezinye izigulane ezingekho mbini zenza izinto ezinjenge-ER + izicubu, ezinye zalezi zicubu zifana nezi zihlamba ezintathu ezingezintlu ezixhomekeke kulezi zicubu ezinobundlobongela, ezenzeka ngokusemncinci ubudala, ezinezinga eliphezulu le-tumor ekuxilongweni, kunye nokuba nethuba lokuphindaphinda bobabini basekuhlaleni, kwingingqi, kunye nemitha.
Ukukhula
Umdlavuza wesifuba esithathu unomdla. Kucingelwa ukuba malunga nama-20 ukuya kuma-25 ekhulwini lweengcingo zebele (i-15 ukuya kuma-30 ekhulwini kwezinye izifundo) zi-HER2 ezintle. Okuqhelekileyo, malunga nama-70 ekhulwini weengxube zebele zesifo se-estrogen isiphumo esihle, ininzi yale ndawo i-progesterone receptor.
Amagciwane angama-HER2 aphilileyo, malunga neepesenti ezingama-50 kunye ne-estrogen receptor efanelekileyo, nangona i-esrogen receptor ibinzana ingaba ngamanqanaba aphantsi. Ngokubanzi, malunga neepesenti ezili-10 zezidumbu, ngokunqunyulwa, kuthathwa njengento emithathu ebonakalayo, nangona uphando olubanzi olujongene ne-epidemiology ludlala. Ukongeza, isantya se-estrogen positivity iyahluka phakathi kwezi zicubu.
Indlela yokwelapha
Ziyiphi imithi yokwelashwa kwebele yombele esebenza kakuhle kumhlaza wesibeleko wesifuba kathathu?
Kubonakala ngathi izicubu ezinesistim e-estrogen kunye ne-HER2 enokuthi iphendule kabini kunye kunyango. Ngaba akufuneki unyango lwe-HER2 yesifo sengqondo somhlaza esichukumisa i-estrogen receptors eyongezelela ukugqithisa okungcono kunokuba unyango lwe-ER + okanye i-HER2 + i-tumors kuphela?
Ngokudabukisayo, oku akunjalo. Kwezinye izicubu, ukusebenzisa ezi zimbini zonyango ndawonye kungabangela ukugqithisa nokunyusa ingozi yemiphumo emibi. Kodwa nangona zimbini zonyango ziboniswa, azinako ukusebenza.
Izifundo ezijongene nokuqala kweengcambu zamabele ziye zafumana inzuzo encinci ukusuka kwiiprogram ezijoliswe ku-HER2 xa izinga lababini be-receptors liphezulu. Ezi ziimvumba eziziphatha ngokufana ne-ER + / HER2 neg (i-luminal A). Kodwa ukuchithwa kwee-hormonal ephuculweyo kuye kwaphawulwa kwakhona. Kutheni oku kungenjalo, kwaye kutheni kungabi ngempumelelo ngakumbi? Ukuqonda oku kufuneka sijonge "kwi-crosstalk" phakathi kwe-estrogen kunye ne-HER2 receptors.
HER2 / Estrogen Receptor Crosstalk
Amanqwelana anesithathu athobileyo angaziphatha ngokungafaniyo kunokuba alindeleke ngokusekelwe kwi-HER2 okanye kwi-estrogen receptor positivity yedwa kwaye inokuchaphazeleka ngobudlelwane phakathi kwala ma-receptors. Olu dlelwane phakathi kwama-receptors lubhekiselwa kubaphandi "njenge-crosstalk."
Ingqungquthela phakathi kwe-HER2 ne-ER ingasebenzisa ukubonisa ukunyanzeliswa kwe-hormonal. Ngamanye amazwi, unxibelelwano phakathi kwee-receptors (lithetha i-HER2 ne-ER) lunokubangela ukuba unyango olwenziwe lu-anti-estrogen lube lusebenze ngaphantsi kwezicathulo ezintle. Ngendlela efanayo, ukusetyenziswa kwe-receptor signaling (okuhlobene nokuba yi-ER +) kunokubangela ukunyanzeliswa kwiingcali ezijoliswe kwi-HER2. Oku kunokuchaza ukuhlukahluka kwiimpawu ezi-HER2 ezintle, ezinye zazo ziphendula kangcono kunabanye ku-HER2 ukuvimbela iziyobisi.
Kungenzeka ukuba le "ngqongqelo" echaza isizathu sokuba singaboni iimpendulo zonyango lwe-hormonal okanye i-HER2 ejoliswe kunyango esiyilindele.
Kucatshangelwa ukuba kusetyenziswe ukudibanisa kwe-HER2 yonyango (umzekelo, uHerceptin) kunye nonyango lwe-hormone (njengeTamoxifen okanye i-Faslodex (fulvestrant), nangona kunjalo, inokubuyisela enye ye-estrogen yokumelana ne-hormonal therapy.
Ukongezelela, i-regimens yomhlaza wesifuba yebele isebenze bhetele okanye iyingozi ngakumbi kwi-HER2 izifo ezintle. Kodwa ngelixa i-chemotherapy ingaba yinzuzo encinci kwizifo zesantya, zifumana inzuzo enamandla kwizifo zesifo se-metastatic.
I-Metastatic Triple Positive Cancer
Umdlavuza webele we-Metastatic kathathu unesifo esifanelekileyo udlalwa ngokwahlukileyo kwi- metastatic HER2 yomhlaza wesifuba esihle . Ngokungafani nezicathulo ezi-HER2 ezizimeleyo zodwa, kubonakala ngathi kuphila ngokucacileyo kwaye kubalulekile ukusebenzisa i-chemotherapy kunye ne-HER2 yokuthintela unyango. Oku kunokulandelwa ngonyango lwama-hormone (njenge-aromatase inhibitor).
Prognosis
Ekubeni zifundo ezimbalwa, kunzima ukuxela kwangaphambili ukuhlwayelwa kwesifo somhlaza wesibeleko sesithathu. Ukuziphatha nokuphendula ezininzi kwezi zicubu zifana nesifo se-estrogen kodwa i-HER2 negative tumors, iphakamisa i-prognosis. Oko kwathiwa, siye saqaphela ukuba kunokuba ne-crosstalk phakathi kwe-HER2 kunye ne-estrogen receptors ezikhokelela ekuchaseni kuzo zombini i-hormonal kunye ne-HER2 ejoliswe kunyango.
Kubonakala ukuba ukuxeliswa komzimba kungcono kubasetyhini abaneemathumba ezi-kathathu ezixhomekeke kwi-postmenopausal. Kuhlolisiso oluthile olulinganiswa nabasetyhini baseSpeyin kunye nabase-Asia, abaseAsia nabasePacific Islands bafunyanwa benesifo esiphantsi kunabamhlophe abamhlophe / abangengabemi baseSpeyinya abanezintathu ezinezifo ezintle.
ILizwi
Ingxabano ihlala ingaphezu kokuba isifo somhlaza wesifuba esisithathu sisisigxina esifanelekileyo sesifo, nangona kokubili ukuziphatha kwezi zicubu kunye nokuphendula kwonyango kubonakala kubonisa ukuba kunjalo. Ngokubanzi, ezi zicubu zivame "ukwenza" ezininzi njenge-receroor receptor, i-HER2 i-tumor tumors, kodwa kukho ukuhluka okubalulekileyo.
Kukho ukungaqiniseki ngenxa yendlela yokunyanga engcono kakhulu yezidumbu ezintathu, kwaye kubonakala ukuba kukho iissetyenzisi ezahlukeneyo ngokubhekiselele kwinqanaba le-ER kunye nokunye. Ukongezelela, kukho ukukhokelela phakathi kweentlobo ezahlukeneyo zokufumana iziphumo, ezinokubangela ukuphungulwa kwezilwanyana ezijoliswe kuhlobo olulodwa. Uphando olongezelelweyo lufunekayo ukujonga iimpendulo, kunye neendlela zokunciphisa umgca wokukhokelela.
Njengalo naluphi uhlobo okanye i-subtype yomhlaza wesifuba, kubalulekile ukuzifundisa ngesifo sakho. Buza imibuzo eninzi, funda indlela yokuphanda umhlaza wakho, kwaye ube ngummeli wakho ekunyamekeleni kwakho. Ukubandakanyeka kwingingqi yokuxhaswa ngumhlaza wesikhumba kunokuba luncedo gqitha, kuba le yintlupheko ekungayifumana kuphela inkxaso ekuhambeni kwakho kodwa ufunde ngeziphumo zakutshanje zonyango.
> Imithombo:
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> I-Schott, A. I-Adjuvant Trastuzumab Inzuzo kwizigulane ezixutywayo neCatrice-positive Breast Cancer. JAMA Oncology . 2016. 2 (8): 1047-8.
> Vici, P., Pizzuti, L., Natoli, C. et al. I-Cancer Positive Cancer Eyesithathu: I-Subtype? . Uphononongo lweZonyango . 2015. 41 (2): 69-76.
> Vici, P., Pizzuti, L., Sperduti, A. et al. "I-Triple Positive" I-Cancer yaseBrazil yasekuqaleni: I-Observational Multicenter I-Retrospective Analysis of Outcome. Oncotarget . 2016. 7 (14): 17932-17944.