Ngaba Kulungile okanye Kokubi Ukuba ne-HER2 I-Cancer Positive Cancer?
Ukuba uxelelwe ukuba umdlavuza wakho webele u-HER2 positive, mhlawumbi unemibuzo eminingi malunga noko oku kuthetha ntoni. Kodwa ukuba unjengezinye ezininzi, umbuzo wakho wokuqala unokuthi, "Ngaba kulungile okanye kukubi ukuba yi-H2 positive?" Ngamanye amazwi, "kungcono" ukuba i-tumor yakho i-H22 echanekileyo okanye i-HER2 engalunganga?
Njengoko sifunda ukuba umdlavuza wesifuba akusisinye isifo kodwa kunoko izifo ezininzi ezihlukileyo kumgangatho weey molecular, le mibuzo ibalulekileyo.
Impendulo esheshayo kukuba i-HER2 positivity inokubili ilungile kwaye imbi. Masihlole indlela isimo seHER2 sithintela ngayo yonke into evela kwintlungu, kwindlela yokwelashwa, engozini yokuphindaphinda nokuhlaselwa.
Uhlolo olufutshane
Umhlaza wesifuba awusisinye isifo-ngokuqinisekileyo, akukho zikhondla ezimbini zifana-kodwa ngoku sinakho ukukwazi ukuwaphula le khansela ukuya kwiincinci ezahlukeneyo ezisekelwe kwi "status receptor" yeesisu. Amanqamana omncuba ahluke kwiiprotheni zifunyenwe iseli, iiprotini ezijongene nokukhula kwezidumbu. Ezi proteins zihambelana nokungafani nakwezinye iimpawu zemizimba yeseli yomhlaza.
Abantu abaninzi bayayazi umdlavuza webele we -estrogen-receptor-positive , apho i-estrogen ibophezela kwinani elandisiweyo lala ma-receptors kumaseli omhlaza wesifuba ukukhuthaza ukukhula kwe-tumor.
Yintoni eyenzeka nge-HER2 ezinomdlavuza zesifuba esifanelekileyo, kodwa luhlobo oluthile lwe-receptor ebusweni benomhlaza weseli oqhuba ukukhula nokusabalala kwe-tumor.
Ukongeza kwi-esrogen receptors kwiindawo zeeseli ( ezikhuthazwa yi-estrogen ), zikhona i-HER2 receptors ephezulu zamaseli (ezikhuthazwa ngokubangela ukukhula ukuqhuba ukukhula).
Umgubo we-HER2 (i-epidermal growth factor receptor 2 okanye i-HER2 / neu) ngumgubo (enye sonke esinayo) ukuba ikhowudi yeeprotheni ezibandakanyeka ekukhuleni kweeseli zebele.
Ikwabizwa ngokuba yi-ERBB2 kwaye i-gene (protooncogene) ifunyenwe kwi-chromosome 17.
Iigeri zeHER2 zithwala imiyalelo yokwenza iiproteti ze-HER2. Ezi iiprotheni zisebenza njengama-receptors kwiiseli zebele. Xa kukho iikopi ezininzi ze-HER2 gene (ngenxa yomonakalo kwimpahla yezofuzo kwisitishi okanye utshintsho) kuphumela ekukhuliseni (okanye "ukugqithisa") kweHER2.
Kubalulekile ukuba uqaphele ukuba zonke iiseli zesifuba-zombini ezingumdlavuza kunye ezingenanto-zine-receptors ze-H32 phezu kweseli. Ukwahlukana kukuba i-HER2 yesifo seengqambela zesifo somhlaza sinamaxesha angama-40 ukuya ku-100 eli li nani. Xa izinto zokukhula emzimbeni zibophelela kula ma-receptors, kubangela ukugqithisa kweeseli zebele.
Njengokuba sinamachiza aphazamisa i-estrogen receptor (okanye ukunciphisa i-estrogen emzimbeni) ukunyanga umdlavuza webele we-estrogen, sinokufumana imithi ephazamisa i-HER2 receptors kwi-HER2 enomdlavuza webele.
Amaphesenti angama-25 (i-15 ukuya ku-30 ekhulwini) yeengxube zengxube zengxube zichanekile kwi-HER2 (i-HER2 yokugqithisa).
I-HER2 Imeko efanelekileyo: Enhle okanye eyiyo?
Ukuze uphendule ngokufanelekileyo umbuzo malunga nokuba yinto enhle okanye into embi ukuba yi-HER2 efanelekileyo, kubalulekile ukuthetha malunga nokwahlukana phakathi kwee-tumors ezi-HER2 ezintle kunye nezo zi-HER2 ezingalunganga.
Impendulo esheshayo kukuba ingaba yinto emihle okanye embi. Ekugqibeleni, abaninzi abantu bafuna ukwazi ukuba njani umphumo wokuba nomdlavuza webele weHER2 unomdla, kodwa ke loo manani angakhohlisa ngaphandle kokuqonda indlela ukufumana i-HER2 echaphazela ngayo ukukhula kwala ma-cancer.
Umzekelo wokubonisa le ngongoma yeso sifo somhlaza wesifuba kubasetyhini abaselula . Ngokubanzi, amazinga okusinda aphantsi kwabesetyhini abancinci besifo kodwa oku kungakhohlisa. Kubantu abancinci, esi sifo sivame ukufunyaniswa kwizigaba eziphambili. Ngoko nangona umfazi osemncinci angakwazi ukunyamezela unyango olungcono kwaye unomlinganiselo wokusinda kangcono kwisigaba esithile, isantya sokusinda sisonke siphezulu ngenxa yezigaba eziphezulu ekuxilongweni.
Impendulo esheshayo nokuba ngaba une-HER2 isifo esihle somhlaza wesifuba esihle okanye esibi kukuba "kuya kuxhomekeka." Ngoko ke kufuneka sijonge iindlela iindlela zeHER2 ezichaphazela ngayo umhlaza. Ezi ziquka:
- Udidi lwabantu abahlakulela lolu hlobo lwesifo (umzekelo, umyinge wexesha eliphakathi)
- Isigaba apho i-HER2 i-Cancer ifunyaniswa khona, ngokubhekiselele kwi-HER2 negative tumors
- Ingaba i-tumor ibuye i-estrogen receptor
- Izinyango zokwelapha ziyafumaneka
- Umngcipheko wokuphindaphinda
- Amanqanaba okusinda jikelele
Kubalulekile ukuba uqaphele ukuba imeko yeHER2 ngezinye iimeko ayilungile kwaye ingatshintsha emva kokuphindaphinda (jonga ngezantsi).
Ulwahluko kwiNgozi
Nangona kuninzi kakhulu, abanye abantu baninzi kunokuba abanye bafumane umdlavuza webele weHER2. Izifundo ezimbini, uphando lwe-LACE kunye ne-PATHWAYS yokufunda, sele zijonge kwiimpawu zabantu abangenako ukufumana i-H22 emihle okanye engalunganga.
- Abasetyhini abanemiphunga ngokugqithiseleyo kwe-HER2 kunye ne-estrogen receptor negative, banokuba bancinci kakhulu, abanako ukusetyenziswa kwe-hormone yonyango, kwaye banokuthi babe ngama-Asia okanye amaSpeyin.
- Izibilini ezi-HER2 ezintle azibonakali zidibene nokutywala utywala okanye ukutshaya, kwaye ngokungafani ne-estrogen receptor i-tumor imithwalo eyenziwa ngumzimba ayibonakali inokukhusela kwisifo.
- Amadoda anomhlaza wesibeleko abancinci kunokuba besifazane babe ne-HER2 ezihle zicubu.
- Kuyathakazelisa, kuye kwafunyanwa ukuba i- ductal carcinoma in situ (DCIS) okanye isigaba se-0 se-tumors sinokuthi sibe ne-H22 enomdla kunomdlavuza webele, apho abanye abaphandi bakholelwa ukuba kuhambelana nenkqubo yokuphucula i-tumor.
- Ezinye iindidi zeengcambu zebele ziba nzima ukuba zi-HER2 ezilungileyo. Umzekelo, akuqhelekanga umdlavuza webele (colloidal) webele , i- medullary carcinoma, okanye i - carbulaoma ye- tubular yebele ukuba ibe yi-H22 enhle.
- Imoji ye-H2 iyakwazi ukuhluka kunye nemeko yobungozi bemfuyo yomhlaza wesifuba. Ngokomzekelo, i-BRCA1 ehambelana nomdlavuza wamabele ayinakwenzeka ukuba ibe yiHER2 enhle.
Ukuchaneka kovavanyo kunye noTshintsho kwiimeko
Sivame ukuthetha ngesimo seHER2 njengokungumnyama nomhlophe, kodwa akusoloko kunjalo. Kukho iindlela ezahlukeneyo zokuvavanya ezingafani ngokuchanekileyo. Kukho "amanqanaba" ahlukeneyo okuba nomoya. Umzekelo, i-tumor ingaba ngu-1+, i-2+, okanye i-3+. Izibilini "ezincinci" zingabhekiselwa ekubeni zineenkxalabo ezingaphezulu kwe-HER2 kunokuba zibe yi-HER2 positive.
Ngoku kuyacetyiswa ukuba abafazi abaye bafumana uhlobo olulodwa lokuvavanywa baphinde babuyiselwe, njengoko ezinye iindlela zokuvavanya zichanileyo kunabanye. Ukubuyiselwa kwakhona kuyacetyiswa ukuba uvavanyo lubuyiselwa "lube ngumda." Kwakhona kubalulekile ukukhankanya i-heterogeneity of tumors; enye inxalenye yesisu sesisu ingaba i-H3 positive ngelixa elinye icandelo li-HER2 libi.
Isimo se-H2 sinokutshintsha , kwaye oku kudidekile kubantu abaninzi. I-tumor eyokuqala i-HER2 positive ingaba yi-HER2 engalunganga ukuba iphinda iphinde iphinde isasaze. Ngokufanayo, i-tumor eyokuqala i-HER2 negative ingaba yi-HER2 ifanele ukuba iphinda ibuye. Imoji ye-H2 kufuneka ihlale iphindwa emva kokuphindaphinda.
Ukuguquka
I-HER2 isifuba sebele sesifuba sinomdla ngakumbi kunesifo se-HER2 esibi.
Izibilini zesisu zinikwe ibanga le-tumor ngexesha lokuxilongwa ngokubhekisele kubonakala beeseli phantsi kwe-microscope. Ibanga le-tumor liyinani elinikezwa ukuchaza ubugwenxa besifo, kunye nenani lomnye unobundlobongela, kwaye uninzi lwezinto ezintathu zinobudlova. I-HER2 i-tumors emihle inokuthi ibe ne-grade tumor yesithathu. Ezi zicubu zivame ukukhula ngokukhawuleza kunezo zicubu zebanga eliphantsi kwaye zinokwenzeka ukuba zisasazeka kwi-lymph nodes.
Sasaza kwiiLymph Nodes
I-HER2 i-cancer yebele iyakwazi ukusasazeka kwii-lymph nodes. Ngaloo ndlela, isigaba sokuxilongwa singaphakanyiswa ngaphezu kwe-HER2 ezihlambulukileyo.
Impendulo Yonyango
Ngaphambi kokuphuhliswa kwezilwanyana ezijoliswe kumdlavuza webele weHER2, njengeHerceptin (trastuzumab) , impendulo yonyango kubantu abanomdlavuza wesifuba wakhe wawungeyona into enhle kulabo abanesifo esibi se-HER2.
Ukwelashwa okujoliswe ku-HER2 umdlavuza webele we-HER2 utshintshe ukuxela, kwaye ngoku iziphumo zonyango zifana ne-HER2 ezihlambalazi ezimbi (nangona i-HER2 izikhumba ziba zikhulu). Ngokutsho kweNational Cancer Institute, la mayeza ayitshintshile isalathiso kwisigaba sam ukuya kwinqanaba lesi-III HER2 esifanelekileyo somhlaza wesifuba esiswini.
I-Herceptin inciphisa umngcipheko wokuphindaphinda kwaye uphucula izinga lokusinda iminyaka eli-10 kulabo abanesigaba sokuqala ukuya kwisigaba se-III kwisifo esingama-30 ekhulwini.
Noko ke, kukho umngcipheko omkhulu wokuphindaphinda kwakhona kunye ne-metastasis ngesimo esihle seHER2, kwaye izinga lokusinda lihle kakhulu kune-HER2 engalunganga kodwa i-tumoror-positive positive tumors.
Abantu abanama-tumor e-H2 positive abanako ukuphendula kwi- chemotherapy yomhlaza wesikhumba kunabanye ababi.
Ingozi yokuphindaphinda
I-HER2 isifo somhlaza wesifuba esihle kakhulu sinokubuyela kwakhona (ubuyele) emva kwe-HER2 yomhlaza wesifuba esingenayo. Izifundo ziye zafumanisa ukuba i-cancer yesifuba yokuqala (isigaba sam kunye nesigaba se-II) ziphindwe kabini ukuphindaphinda amahlanu ngaphezu kwe-HER2. Ncinane kakhulu i-HER2 i-tumors ezihle (ngaphantsi kwe-1 cm okanye i-intshi intshi ububanzi) kunye ne-lymph nodes ezibi zinomngcipheko ophezulu wokuphindaphinda ukuxhamla kwiimvumi ezingenayo i-HER2 engalunganga. Unyango kunye noHerceptin unokunciphisa umngcipheko ngesiqingatha.
Umzekelo wokuphindaphinda umdlavuza webele uyahluka . Iimvumi ezincinci nazo ziyakwazi ukuphindaphinda kwakhona (ngokuchasene nokuphindaphinda kwendawo okanye kwingingqi) ukuba ngaba yi-HER2 enhle.
Metastasis
Ukuba ingaba i-HER2 i-tumors ezichanekileyo zinokuthi zenze i-metastasize kunokuba izifo ezixhomekeke kwiindawo zesifo se-cancer esiswini esicinga ngazo. Umngcipheko weemastastases jikelele, ingakumbi i-metastases yengqondo, kucatshangelwa ukuba yanda, kodwa ezininzi zezifundo zenziwa ngaphambi kokusetyenziswa kweHerceptin.
Izifundo ezenziwe emva kokusungulwa kweHerceptin (kunye nezinye i-H3 ezijoliswe kwiipilisi) ziye zafumanisa ukuba i-HER2 ezinomdlavuza webele ziqhubeka ziba neziganeko eziphezulu zeengqondo ze-brain. I-HER2 izicubu ezintle zihlala zisasazeka kwixesha le sifo ukuya kuma-lymph node, iipomphu, umongo we-bone, i-ovaries, kunye ne-adrenal glands.
Ubuncwane bokuthi i-metastases ne-HER2 ezintle izihlamba ziyahlukahluka kuxhomekeke ekubeni ingaba i-tumoror is receptor. Umngcipheko weengqondo, isibindi, amathambo kunye nemiphunga yeemiphunga kwi-HER2 ezixubileyo zithinteka nokuba ngaba i-tumor is receptor okanye i-estrogen.
Umngcipheko we-metastase inokuxhomekeke kwiimeko ezinxulumene nazo. Ngokomzekelo, umngcipheko wesibindi sesifo esivela kumdlavuza webele uphezulu kunye ne-HER2 ezixubileyo ukuba abantu bayatshisa.
I-Cancer Positive Cancer
Phantse ama-50 ekhulwini le-HER2 efanelekileyo i-estrogen receptor. Izifundo ziye zafumanisa ukuba le nhlanganisela inokubangela umzekelo ohlukeneyo wokuphindaphinda, kodwa zifundo ezimbalwa kuphela ezijonge iimpawu kunye neempembelelo zezifo ezilitshumi ezilungileyo.
Amanomdla okubeleka esisifo se-estrogen kwaye i-HER2 engafanelekanga (i-luminal A) ineyona ndlela isisigxina. Labo abafumana i-estrogen receptor kwaye i-HER positive (i-Binal b) inobungqina obuthakathaka, kodwa ukugxekwa kusenokuba ngcono kunokuba abantu abane-receptor negative and receptor negative and HER2 over-expressing the cancer of the breast.
Iimpazamo kwiSifo
Le ngxoxo ayinakugqiba ngaphandle kokukhankanya ukuba ngamanye amaxesha umdlavuza webele ufumaniswa ngephutha njenge-HER2 enhle okanye i-HER2 engalunganga. Iimvavanyo ezifumanekayo zokumisela isimo se-H22 azikho nto. Kubalulekile ukubuza i-oncologist yakho ukuba uvavanyo luyenziwe kwaye ukuba awufanelekanga yini na okanye ungabuyiselanga.
Iphutha ekuxilongweni (i-misdiagnosis) apho i-HER2 enokuthi i-tumor emihle ifunyanwe ngengozi ingabangela ukuba umntu anganikezwa unyango olujoliswe kuyo; unyango olunokuphucula ubomi. Ewe, ukuba ufumanisa ukuba unesifo esihle esingu-HER2 okwenene i-HER2 negative ingakhokelela ekusebenziseni imishanguzo engasebenzi (nangona ezinye iimvumi ezingekho phantsi kwe-H3 ziphendule ku-Herceptin).
Isishwankathelo soMbahluko
Eli nqaku liqwalasele ukuhlukana kwee-HER2 ezichanekileyo kunye ne-HER2 ezingenayo i-cancer yebele.
I-HER2 ezinomdlavuza zesifuba esifanelekileyo xa kuthelekiswa neesmorm-receptor-positive tumors ziba:
- Unobundlobongela obuninzi (unobumba obuphezulu be-tumor)
- Kufunyanwe kubasetyhini abaselula (kunye nomhlaza wesifuba kubasetyhini abaselula bavame ukufunyaniswa kwisigaba esiphezulu ngakumbi)
- Ngokulinganayo ngokusemandleni ukuphendula unyango ngoku ukuba i-H2 ijoliswe kwiipilisi ezikhoyo
- Kunokwenzeka ukuba ubuyele kwakhona / kwakhona
- Kunokwenzeka ukuba ulungelelanise, ubuncinci kwiziza ezinjengeengqondo
Ezi zicubu zibuye zenzeke kakuhle (nangona i-agents zangaphambili zivunyiwe, enye ngowama-2017, kwaye asiyazi ukuba oku kuya kuthintela njani ukuhlaziya.)
Kukho ngokungafaniyo kwezi ziphumo kwaye kufuneka sihlale sikhumbula ukuba wonke umntu, kunye nomhlaza ngamnye webele, uhlukile.
ILizwi
Nangona ngokubanzi ukugxekwa kwee-HER2 ezinomsoco ezintle ziba nzima kakhulu kunokuba zifumana i-estrogen receptor positive kodwa i-HER2 engalunganga, ukwamkelwa kwe-HER2 kwandiswe ngokubanzi okwenza ukuba kubekho ulwahlulo kwimilinganiselo yokuphila kunye nomngcipheko wokuphindaphinda.
Ekubeni i-HER2 yonyango iyingqungquthela kummandla, kwaye ezininzi unyango olutsha luye lwavunywa ngo-2017 yedwa, iifomati azikho into enentsingiselo. Ukuba uhlala nomdlavuza webele weHER2, ukuba impendulo kwonyango ngoku kwi-HER2 izifo ezintle ezilingana ne-estrogen receptor ezikhuphayo izikhumba zikhuthaza.
Ngazo zonke iinguqu ezenzeka kunyango, kwaye kunye nemichiza eyongezelelweyo efundiswa kwizilingo zonyango, kubaluleke kunanini ngaphambili ukuba uthathe inxaxheba ebalulekileyo kunyango lwakho. Thatha isikhashana ukuphonononga ezinye iingcebiso malunga nendlela yokuba ngummeli wakho kumnonophelo wakho womhlaza .
> Imithombo:
> Ellingiord-Dale, M., Vos, L., Hjerkind, K., Hjartaker, A. et al. Utywala, Umsebenzi oPhezulu, UkuSaza kunye neCanscer Subtypes kwiSifundo esikhulu sokuLawula iNtlu-mveliso esivela kwiNkqubo yeCancer Screening Screening yaseNorway. I-Epidemiology ye-Cancer Biomarkers kunye nokukhusela . 2017 Septemba 6. (Epub ngaphambi kokuprinta).
> INational Cancer Institute. Ibali lokufumanisa: I-HER2 ye-Genetic Link kwi-Cancer yaBestile ikhuthaza ukuThuthukiswa kweeNtsholongwane ezintsha. https://www.cancer.gov/research/progress/discovery/HER2
> Phakamisa, C., no-V. Caggiano. Ukusinda kweCarcer Breast Ukuchazwa ngu-ER / PR / HER2 I-Subtypes kunye nokuHlulwa koNgcoliso ngokweSigqeba seBanga kunye ne-Immunohistochemical Biomarkers. Umbhalo weCarcer Epidemiology . 2014. 469251: 1-11.
> Schettini, F., Buono, G., Cardalesi, C. et al. I-Hormone Receptor / i-Human Epidermal Growth Factor I-Receptor 2-I-Cancer Breast Breast: Where Where Are We Now and Where We Are. Uphononongo lweZonyango . 2016. 46: 20-6.