Iintlobo zoVavanyo, Ukuchaneka, kunye noTshintsho kwi-H22
Ukuba unayo i-biopsy okanye utyando lomhlaza wesisu usenokuba uvile ukuba i-tumor yakho i-H22 enhle okanye ayibi. Ukuba awuzange uve, kufuneka ucele oncologist yakho malunga neziphumo zolu vavanyo. Kubalulekile ukuqonda ukuhlolwa kwe-HER2 kunye neziphumo, nangona i-tumor yakho i-HER2 negative.
Isiseko seHER2 + Cancer
Iiprojekithi ze-HER2 zenzeka phezu kweeseli zebele, nokuba ngumhlaza okanye oqhelekileyo.
I-gene (i-HER2 okanye i-ERBB2 gene) sonke sithwala imiyalelo okanye iprogram yokuvelisa ezi proteins. Iseli nganye iqulethe iikopi ezimbini ze-gene. Xa kukho iikopi ezongezelelweyo zalo mzi (i-HER2 amplification) umphumo wenyusa inani le-HER2 receptors ephezulu kweseli yesifuba (i-HER2). Nangona iiseli zesifuba eziqhelekileyo zinezigidi ezizigidi zezi-receptors, ii-HER2 zesifo seengqambela zesifo somhlaza zifikelela kumawaka angama-100 ezi zininzi.
Ngokulula, xa izinto zokukhula emzimbeni zifakela kule miyalezo eyongezelelweyo, ibonisa iseli ukwahlula kwaye ibangele ukukhula kwangaphandle kokulawulwa kweeseli zebele ezibizwa ngokuba ngumhlaza.
Amaphesenti angama-25 abantu abanomhlaza wesibeleko baya kuba yi-HER2 enhle. Kwixesha elidlulileyo, ukufumana i-HER positive kwakunxulumene nesifo esilungileyo. Ngoku ukuba sijolise kwizonyango (ezifana ne- Herceptin (trastuzumab) ) ezikhoyo, ezinokuphazamisa ezi mphumela, ukuxeliswa komhlaza wesibeletho se-HER2 kungcono kakhulu.
Kubaluleka kovavanyo
Kubalulekile ukuba ube nesiphumo se-HER2 echanekileyo ukwenzela ukuba ufumane ezifanelekileyo iindlela zokonyango kwi-HER2 yomhlaza webele . Oku kubandakanya ukhetho lwezonyango ezijoliswe ku-Herceptin (trastuzumab), i-Perjeta (pertuzumab), iTykerb (lapatinib) kunye no-Nerlynx (neratinib).
Iintlobo ezithile ze- chemotherapy kumhlaza wesifuba osebenza ngokusemgangathweni zinokuhluka ngokuma kwe-HER2.
Ubume obuchanekileyo be-HER2 bubalulekile nakwonyango lwe-HER2 yesifo somhlaza webele . Umzekelo we-metastases, kunye nokunyangwa kweendawo ezithile zeemastastases, ziyahluka ngokusekelwe kwi-H2 status.
Xa Uvavanyo
Wonke umntu onalo naluphi uhlobo lwe-invasive (infiltrating) umdlavuza wesifuba kufuneka abe ne-tumor yabo ivavanywe ngesimo se-H22. Umdlavuza webele we-"invasive" uchazwa njengowuphi umhlaza ongaphaya kwinqanaba 0 okanye i- carcinoma . Zonke ezinye izigaba zomhlaza wesisu, ukusuka kwinqanaba lokuqala ukuya kwisigaba IV, kufuneka zihlolwe kwi-HER status ngexesha lokuxilongwa kwaye ngaphambi kokuba unyango luqale.
Iintlobo zezilingo
Kukho iintlobo ezahlukeneyo zeemvavanyo ezingenziwa kwi-tumor ukuze zichonge ukuba ingaba yi-HER2 efanelekileyo. Ezi ziquka:
- I-HER2 Immunohistochemistry (IHC) : IHC ngumlinganiselo wenani le-HER2 i-receptors kwi-cell cell cells okanye "HER2"
- In hybridation in situ (ISH) : ISH ngumlinganiselo wenani leekopi ze-HER2 kwisinye somhlaza wesibindi okanye "UHER2 amplification." Kukho iindlela ezimbini ezahlukeneyo zokuhlola i-ISH: i-fluorescence (i-FISH) kunye ne-ISH ebanzi.
Kukho ukuphikisana malunga nawaphi amanyathelo okuvavanya afanelekileyo.
Abanye abaphandi bakholelwa ukuba i-FISH ISH ichanekile ngakumbi, kodwa i-IHC yenziwa ngokubanzi e-United States. Ekubeni le ndawo iyatshintsha ngokukhawuleza, kubalulekile ukuthetha ne-oncologist yakho malunga nokuvavanya okwenzileyo nokuba kutheni indlela ekhethekileyo ikhethwa.
Iziphumo zovavanyo
Ngokwezikhokelo ze-ASCO / CAP ze-2013, ukuba uvavanyo lwe-HER2 lubuya njengemida okanye ngokulinganayo, "ukuhlolwa kwe-reflex" (ukuqhuba ngokukhawuleza kolunye uvavanyo) kufuneka kwenziwe ngezinye iilinga. Ngokomzekelo, ukuba i-IHC yanikezela iziphumo ezisezantsi, i-ISH iya kwenziwa kwisampuli efanayo, kwaye ukuba i-ISH ingumda we-IHC, kufuneka iqhutywe ngaphambi kokuba iziphumo zichazwe.
Ngamanye amaxesha iziphumo zeemvavanyo ezahlukeneyo ze-HER2, umzekelo, zombini i-IHC kunye ne-FISH ISH iya kuba ngumda wonxweme, ongagqibekanga, okanye olinganayo. Okwamanje asikho izikhokelo eziqhelekileyo malunga nendlela yokuqhuba ukuba ngaba kunjalo, kwaye wena kunye ne-oncologist yakho kuya kufuneka ukuba nixoxe ngendlela yokuqhuba.
Ukulinganiselwa kwemilinganiselo
Ukongeza kokuba neziphumo zokuvavanya ezingenanto okanye ezingalunganga kodwa kunomda ongqamle okanye olinganayo, kukho ezinye iimingcele ekuhlolweni kwakhe. Ezi ziquka:
- Ukungalungi (iimpazamo): Naluphina uhlobo lwolu vavanyo lwebhubhoratri luhlala lufumana umngcipheko weziphene.
- Ukungaphumeleli ukuphinda ukuvavanywa ukuba umphumo ungumda we-endline, ungagqibekanga, okanye ulinganayo: Ukuba uvavanyo lubuya njengomda we-edgeline, kufuneka luphindwe kwakhona.
- Ubunzima bokuthi: Uhlobo lwe-tumor heterogeneity lutsha kwaye ludideka. Ekubeni iiseli zomhlaza zihlala zitshintsha, kunokuba neengxenye zesisu esivavanya i-HER2 enhle kunye nezinye iindawo ezivanya i-HER2 negative. Oku kulula ukuyiqonda xa siqaphela ukuba iintlobo ezahlukeneyo zesifo sinokuba nezintlu ezahlukeneyo zeseli phantsi kwe-microscope ngokunjalo.
- Utshintsho: Izibilini zingashintsha imeko ehlukile yeHER2.
Utshintsho kwi-HER2 Status
Sivame ukucinga ngeekresela njengesiqhelo sesisele esisodwa esilungileyo apho zonke iiseli zifana, kodwa oku akunjalo. Siyazi ukuba iiseli zomhlaza ziqhubeka nokuphuhlisa utshintsho olutsha kunye noshintsho. Inxalenye ezahlukeneyo zesisu esisodwa sinomdlavuza weempawu ezahlukeneyo (i-tumor heterogeneity) kwaye ezi zinguqu zinokuba zibonakala ngakumbi xa iqhuma iqhubeka, njengento yokuphindaphinda okanye isifo se-metastatic.
Akukhona kuphela isimo seHER2 esingatshintsha. I-Estrogen receptor (ER) kunye ne-progesterone receptor (PR) isimo sinokutshintsha xa i-tumor ibuyeka okanye idibeneyo, kwaye utshintsho kwiimeko zamukeli libizwa ngokuba "ukuxabana." I-tumor ingatshintsha ukusuka ekubeni yinto enokuthi ibe yinto engalunganga kwenye yalezi zifunyenwe, okanye ngokuchaseneyo, ekubeni yinto enobungozi.
Zingaphi iisondo ziguquka rhoqo? Ithuba lokungahambelani phakathi kwe-tumor yokuqala kunye ne-metastasis yokuqala okanye yesibini (mhlawumbi ukusuka kumbi ukuya kwi-positive okanye esuka kumbi ukuya kumbi) yile ndlela ilandelayo:
- I-ER: 20.7 pesenti
- PR: 40.7 ekhulwini
- HER2: i-19.6 pesenti
Kule sifundo, malunga neepesenti ezingama-20 zezidumbu zatshintsha isimo ukusuka kwi-H22 enokungalunganga okanye okungekho nto. Ukwazi ukuba i-tumor ishintshile ibaluleke kakhulu ekukhetheni ukhetho olungcono lwempilo,
Ngaba kulungile okanye kubi ukuba isimo se-HER2 samukeli sitshintshile? Nangona nje utshintsho lufunyenwe (ngokwenza ukuphinda ukuvavanya) ukwenzela ukuba unyango olungcono lunokucetyiswa, alubonakali ukuba utshintsho kwimeko ye-receptor ludlala indima enkulu ekugxekeni. Kule zicubu zezifundo ezingahambelani ne-HER2 (ezitshintshile ukuba zibe zilungileyo okanye zibi) zinezifuba ezifanayo kwezi zicubu ezingazange zitshintshe isimo se-receptor ye-HER2.
Olu pho nonongo lufumene ukuxabana phakathi kwe-metastases yasekuqaleni kunye ne-metastasis yokuqala okanye yesibini, kodwa ukuxabana kungenzeka phakathi kwe-metastasis yokuqala kunye nesibini.
Phinda Uvavanyo
Ukongeza kokuhlolwa kwe-HER2 okufuneka kwenziwe kuwo wonke umntu ngexesha lokuxilongwa, kukho imeko apho uvavanyo kufuneka luphindwe kwakhona. Ezi ziquka:
- Ngethuba lokuphindaphinda , nokuba ngaba yindawo yokuhlala, ingingqi okanye imetastatic.
- Ukuba umhlaza wesifuba usasazeka kunye naluphi na umonakalo omtsha.
- Ukuba wena kunye ne-oncologist yakho uvakalelwa kukuba uvavanyo lwe-HER2 owenzile aluchanekanga njengoluvavanyo olutsha.
I-Misdiagnosis
Yintoni eyenzekayo xa isimo sakho se-HER2 singakhange sichazwe? Ukuba i-tumor yakho i-HER2 enenjongo kodwa ufumana umphumo ongekho u-HER2, awukwazi ukufumana ukuphucula ukuphucula izifo. Ngakolunye uhlangothi, ukuba isimo sakho se-HER2 sibi kakhulu kodwa ufumana isiphumo esihle se-HER2, ubeka umngcipheko kwimiphumo emibi yezilwanyana ezijoliswe ku-HER2 ngenzuzo encinci (nangona abanye abantu abangenayo i-HER2 negative beba neempendulo kwezi zonyango).
ILizwi
Ukuhlolwa kwe-HER2, kunye nokuhlolwa kwe-esrogen kunye ne-progesterone receptor, kufuneka kwenziwe kwinto yonke engabonakaliyo (isigaba sam ukuya kwinqanaba IV) kwiisondo zomhlaza ngexesha lokuxilongwa kwaye phambi kokuba naluphi na unyango lwenziwe (kunye nexesha eliqhelekileyo lokugqitywa ngokugqithisileyo).
Uvavanyo kufuneka luphindwe kwakhona xa unokuvavanywa okubuyiselwayo, ukuba i-oncologist yakho ivakalelwa uhlobo oluthile lokuvavanya luchanileyo, okanye ukuba umhlaza wakho uphinde usasaze. Isimo se-HER2 se-tumor sinokutshintsha ngokuhamba kwexesha, kwimihlaba eyahlukileyo yesisu esisodwa.
Ubume obuchanekileyo be-HER2 bubalulekile ekukhetheni ukhetho olungcono lwempilo yomhlaza wakho ngeli xesha ukunciphisa imiphumo emibi yonyango olunokwenzeka ukuba luncedo. Kukho ukuphikisana kwiimvavanyo ezingcono kwi-HER2, kwaye iimvavanyo ezintsha kunye nezinguqu zijongwa namhlanje. Yintoni oku kuthetha ukuba kubalulekile ukubuza imibuzo kwaye ube ngummeli wakho kumnonophelo wakho womhlaza.
> Imithombo:
> I-American Society of Clinic Oncology. UkuSebenza kunye nezikhokelo. Umhlaza webele. Iziphakamiso ze-Human Epidermal Growth Factor Receptor 2 Ukuvavanywa kwi-Breast Cancer Update. http://www.asco.org/practice-guidelines/quality-guidelines/guidelines/breast-cancer#/9751
> Lim, T., Lim, A., Thike, A., Tien, S., kunye noP. Tan. Impembelelo yokuhlaziywa kwama-American American Society of Clinical Oncology / iKholeji yama-American Pathologists Isikhokelo seNgcaciso kwi-Human Epidermal Growth Factor I-Receptor 2 I-Gene Testing Ukusebenzisa i-Immunohistochemistry kunye ne-Fluorescence kwi-Situation Hybridization kwi-Cancer Breast. I-Archives of Pathology kunye neLab Medicine . 2016. 140 (2): 140-7.
> Ezantsi, E., Khan, S., Kennedy, D., no R. Baughman. Ukuxabana kwe-Estrogen Receptor kunye ne-HER-2 / neu kwi-Cancer yaseBesters ukusuka kwiLesion yasePrayimari ukuya kwiSibini sokuQala kunye neSibini seMetastatic Site. Isifo somhlaza webele (i-Dove Medical Press) . 2017. 5: 515-520.