Kukho iindlela ezininzi zokwelapha ezijoliswe kuzo
Kwiminyaka embalwa edlulileyo, sifunde ukuba akusiyo yonke i-cancer yebele. Ukongeza kwimimandla engabonwa phantsi kwe-microscope, kukho ukungafani phakathi kwala ma-khansa kwinqanaba le-molecular. Emva kokuba ube ne-biopsy okanye utyando uza kufunda malunga nokuba umdlavuza wakho webele uyamukeli we-estrogen okanye i-progesterone receptor, kunye ne-HER2 yakho.
Ukuba uxelelwe ukuba umdlavuza wakho webele u-HER2 positive, ukuthini oko kuthetha ntoni? Ziziphi iindlela zonyango ezisebenza ngokukhethekileyo kulolu hlobo lomhlaza wesifuba kunye naluphi olunye unyango olunokusetyenziswa?
Inkcazo yeZonyango zokukhetha
Abantu abanesifo somhlaza we-H2-positive bangaphathwa ngendlela efana nabantu abane-HER2 negative tumors ngeendlela ezithile. Ngokomzekelo, utyando (mhlawumbi i-lumpectomy okanye i-mastectomy,) i-acrovant chemotherapy, kunye / okanye unyango lwe-hormonal (ukuba i-tumor is receptor positive) ingasetyenziswa.
Iipilisi ezijoliswe kuzo ezilungiselelwe i-HER2 ezixubileyo zisetyenzisiweyo kwaye zisetyenziselwe ukuphucula izinga lokusinda kwiimvumi ze-HER2. Okukhethwa kwonyango kokuqala kwinqanaba kunye nezifo ze-metastatic zixutyushwa ngezantsi.
Indlela yokuSebenza ekujoliswe ngayo
Phantse abantu abahlanu okanye abayisithandathu abanomdlavuza wesibeleko baya kuba neesifo se-HER2 / neu positive. Oku kuthetha ukuba iiseli zomhlaza zesisu zomhlaza zinomsebenzi owongezelelweyo kwiiGEN ze-H22, ezikhokelela ekuveliseni ukwanda kwama-HER2.
Ezi proteins zisebenza ukuqhuba ukukhula komhlaza weseli.
I-HER2 isifuba sebele sesifuba sinomdla kakhulu, kwaye kwiminyaka eyadlulileyo yayinomdla wokungcola. Ngo-1998 imithi yokuqala yokujolisa ngqo kwi-HER2 yavunywa. Eli mayeza aHerceptin (trastuzumab).
Ukususela ngelo xesha ezinye i-H2 ezijoliswe kwiipilisi zifunyenwe.
I-Perjeta (pertuzumab) kunye ne-T-DM1 (trastuzumab emtansine) nayo ivunyiwe.
Ngo-2017, iyeza uNerlynx (neratinib) yavunywa kwakhona kubantu abanomdlavuza webele we-HER2-positive emva kwonyango kunye no-Herceptin. Xa i-neratinib (i-tyrosine kinase inhibitor) yongezwa kwisifo esiqhelekileyo somhlaza wesifuba kwisifundo se-2016, iifom zokuphendula ezipheleleyo ziphezulu kunokuba abantu baphathwe no-Herceptin kunye neyeza eliqhelekileyo.
I-Tykerb (i-lapatinib) yenye inhibitor ye-tyrosine kinase engasetyenziselwa emva kokunyanga no-Herceptin okanye nezinye i-H32.
Unyango lweeNqanaba lokuqala
Unyango lwe-early-stage I-HER2-positive umdlavuza webele ufana nowe-HER2-negative negative cancer, kodwa kananjalo kubandakanya ukusetyenziswa kwezilwanyana ezijoliswe ku-HER2 njenge-Herceptin.
Khetha ziquka:
- Ugqirha: Nokuba i- lumpectomy okanye i- mastectomy ngokuqhelekileyo isinconywa ukususa isisu. Ukuba i-tumor i- DCIS (isigaba se-0) okanye ukuba ineprojekthi yezofuzo ezihle (ukuhlolwa kofuzo ukufumanisa ingozi yokuphindaphinda), kufuneka unyango olungaphezulu. Kuba iimvumi ezinkulu, kwaye ngokukodwa ezo zine- lymph nodes , i-adjuvant therapy ihlala ikhuthazwa.
- Iimpawu zokwelapha zaseHormonal: Ukuba i-tumor i- estrogen receptor , i- hormonal therapies iyanconywa ngokuphindaphindiweyo (emva kokhemotherapy kulabo baya kuba ne-chemotherapy adjuvant). Kubafazi be-premenopausal, ukhetho lokuqala luvame ukuba yi-tamoxifen, kunye ne-aromatase inhibitors enconywayo kubasetyhini abasemva kwe-postmenopausal. Ngaphandle koko, unyango lwe-ovarian, unyango lwe-ovarian, okanye unqabile, i-ovariectomy inganconywa kubafazi be-premenopausal ukunciphisa amanqanaba e-estrogen nokuvumela ukusetyenziswa kwe-aromatase inhibitors.
- I-Chemotherapy: Ngokuxhomekeke kwinqanaba lomhlaza wesifuba, ubungakanani, nokuba ukubandakanyeka kwe-lymph node kukhoyo, kunye nokuhlolwa kofuzo, i- chemotherapy e- adjuvant inganconywa . Oku kuvame ukuqala malunga nenyanga emva kwe-lumpectomy okanye i-mastectomy kwaye yenziwa ngaphezu kweenyanga ezine ukuya ezintandathu.
- I-H2 ejoliswe kumachiza: Njengoko kuphawuliwe ngasentla, ngoku kukho iindlela ezininzi zokunyanga okujoliswe kunyango lwe-HER2-positive, kubandakanya i-Herceptin (trastuzumab), i-Perjeta (pertuzumab), kunye ne-T-DM1 (trastuzumab emtansine), kunye nezinye iziyobisi ezivavanywa kwiklinikhi zilingo. Ngokuqhelekileyo, i-Herceptin isetyenziswa kuqala. I-Tykerb (lapatinib) i-tyrosine kinase inhibitor esebenzayo kwimiphunga emihle ye-H22. I-Nelynx (neratinib), enye i-kinase inhibitor, yayisandul 'ukuvunyelwa ukuba unyango lwe-HER2-positive cancer umdlalo belandela unyango kunye noHerceptin.
- Ukunyanga kwamayeza: Kubantu abakhetha i-lumpectomy, unyango lwe-radiation luvame ukukhuthazwa emva kokuhlinzwa. Kuba iimvumi ezine ezine-lymph nodes ezichanekileyo, unyango lwe-radiation emva kokuba i-mastectomy idlalwa ingqalelo. Ukuxhamla kunye neyesithathu kwi-lymph nodes ezihle kakhulu, kwaye kubalulekile ukuthetha kunye ne-oncologist yakho yezokwelapha kunye ne-radiation oncologist malunga neenzuzo ezinokwenzeka zonyango.
- Uvavanyo lwezonyango: Zininzi izilingo zeklinikhi eziqhubekayo zijongene nokuchonga okuhlukeneyo, i-chemotherapy, kunye neyeza zokwelapha imitha, kunye nokuthelekisa ezahlukeneyo ze-hormonal kunye ne-HER2. Kukho iinkolelo ezininzi malunga nokuhlolwa kweekliniki , kodwa ngamanye amaxesha ityala lonyango linika ithuba elihle lokunyanga. Kubalulekile ukuthetha ne-oncologist yakho malunga naziphi na izilingo zamakliniki ezinokulungele.
- Izidakamizwa eziguqula izidakamizwa: Kungekudala, ukongezwa kwonyango ye-bisphosphonate kuye kwacatshangelwa ekuqaleni kwesigaba somhlaza wesifuba njengoko kunokunciphisa umngcipheko weethambo zesifo kwixesha elizayo. Thetha kwi-oncologist yakho malunga nale nto.
Unyango lweZiko eliPhezulu
Nge-metastatic (isigaba se-4) somhlaza wesibele, israpies zokwelapha ukulawula isifo ngokuqhelekileyo injongo yonyango. Ugqirha kunye nokwelashwa kwamayeza kuthathwa njengezilwanyana zengingqi kwaye aziqhelekanga kusetyenziswe ngaphandle kweenjongo zokwehliswa (ukunciphisa intlungu kunye / okanye ukuthintela i-fractures).
Ukuba umdlavuza webele we-HER2 unomdla wokusabalalisa umdlavuza webele wamandulo, kubalulekile ukuba uqaphele ukuba isimo se-HER2 (kunye nesimo se-receptor status) singatshintsha. I-biopsy yesayithi ye-metastasis kwaye iphinda iphindwe i-receptor izifundo zivame ukucetyiswa. I-tumor eyayiqala i-HER2 positive ingaba i-H32 ingalunganga ngokuphindaphindiweyo kunye nakwezinye.
Ulwaphulo lokuqala lokuqala lwe-HER2-positive cancer yombele luya kuxhomekeka kwezi zifundo ze-receptor. Kwabo ba-HER2 positive, enye ye-HER2 ejoliswe kwiipilisi isetyenziswa rhoqo. Ukuba i-tumor ibuye ne-estrogen receptor efanelekileyo, nokuba ngaba unyango lwe-hormonal, unyango lwe-HER2, okanye zombini unokuqwalaselwa. I-Chemotherapy ingasetyenziselwa iinyanga eziliqela.
Kubalulekile ukuba uqaphele ukuba injongo yokunyanga komhlaza wesifuba se-metastatic ihlala ihluke kunokuba isifo somhlaza wesifuba sokuqala, ngokokuba unyango oluncinane kangako ukuze kulawulwe isifo luvame ukucetyiswa.
Ukuba i-tumor isele iphathwe nge-Herceptin (trastuzumab) kwisimo esilungileyo, emva kwexesha lokungabikho konyango (kulinganiswa ukusuka ekupheleni kwe-adjuvant trastuzumab) engaphantsi kweenyanga ezintandathu kweyonyango olukhethiweyo lwesibini ludla ngokuba yi-T-DM1 (ado -trastuzumab emtansine). Ngaphandle koko, ukuba i-tumor sele isele iphathwe no-Herceptin kwisimo esiyi-adjuvant, emva kwexesha elingenasiphelo lexesha elingangeenyanga ezintandathu I-Perjeta (pertuzumab) inxulumene ne-trastuzumab kunye nerhafu ingasetyenziswa.
Kwizigulane ezenza inkqubela emva kwetrastuzumab kunye nerhafu kwi-setting ye metastatic, i-T-DM1 iyona khetho olukhethiweyo. Kwizigulane ezingakhange ziphathwe kunye noHerceptin ngaphambili, ukuhlanganiswa kweHerceptin kunye nePerjeta kunye neerhafu kufuneka zisetyenziswe.
Ukuba umhlaza uphumelele naphezu kwezi zonyango, i-Tykerb (lapatinib) kunye neXeloda (capecitabine) ingazama. Olunye uhlobo lwe-chemotherapy regimens okanye i-hormonal therapies lungahlolwa.
I-HER2 isifo somhlaza wesifuba esifanelekileyo sisenokusasazeka kwingqondo kunye nesibindi kunama-tumors angalunganga a-HER2. Ngethamsanqa, uHerceptin, kwaye mhlawumbi i-Perjeta ibonakala idlula kwinqanaba leengqondo zegazi kunye nokunciphisa ubuninzi bobuchopho be-brain. Kubantu abanesifo se-boneastases, amathambo aguqula iziyobisi ezifana ne-bisphosphonates ayinokunciphisa kuphela umngcipheko wezahlukileyo kodwa angaphucula nokuphila.
ZoNyango
Abantu abaninzi babuza malunga nokufumana ezinye iindlela zokwelapha xa befumene ukuba nomhlaza wesibele. Ngexesha langoku, akukho naluphi na uhlobo "oluthile" lwemithi efunyenwe ngempumelelo ekuphatheni umdlavuza webele. Endaweni yoko, abanye abantu abakhethele le miba yonyango ngaphandle kwezobuqheko eziqhelekileyo baye balahlekelwa kwimiba ebonakalisiwe ukuba iyasebenza.
Kodwa kubalulekile ukuba ungaphonsa umntwana ngaphandle kwamanzi okuhlamba. Kukho iindlela ezinxulumene nomdlavuza oye wafunyanwa ukunceda abantu bajamelane neempawu zesifo kunye nomhlaza wonyango, ukususela ekukhathala kunye nokuxhalabisa kwimeko yokunyamekela, ukuphazamiseka kwentsholongwane kunye nokunye. Ezinye zezonyango eziye zafundiswa ngokukodwa kubasetyhini abanomdlavuza webele, ziquka i- yoga , ukucamngca , ukunyanga i-massage , kunye ne- acupuncture .
Prognosis
Ngaphambi kokuba iHER2 ijoliswe kwiipilisi, kwakungekho nonyango oluthile olufumanekayo lwe-HER2 ezixubileyo, kwaye ezi zinto zazibhekwa njengeengxaki zomhlaza. Nangona kufikeleleka kwonyango ejoliswe kuyo, nangona kunjalo, oku kuye kwatshintshile.
Ucwaningo lwango-2017 lubonise ukuba abafazi abanomdlavuza webele we-HER2 wesifuba esifanelekileyo babenomlinganiselo ophezulu wokusinda kunabesifazana ababenemigangatho ye-HER2 xa unyango lwe-Herceptin lusetyenziswa. Izinga lokusinda kakhulu kunazo zonke zithathwa kubafazi abano-cancer abathathu abangenayo.
Ukufumana inkxaso
Ngethamsanqa, ukuqwashisa nokwazisa ngemali yomhlaza wesifuba kuye kwabangela ubuninzi bezinto ezincedisayo ukubanceda abantu bajamelane nesi sifo. Amacandelo enkxaso kunye noluntu lwenkxaso lufumaneka kubasetyhini abanomdlavuza wesibeleko ngokubanzi, kunye nalabo bajongana ngqo nomhlaza wesifo semitha. Iindawo zasekuhlaleni kunye namaqela e-Facebook abantu abane-HER2-positive umdlavuza webele abuthana ndawonye njengoko bejamelana nemingeni ekhethekileyo.
Ukuthatha inxaxheba kumajelo asekuhlaleni kuye kwaba ngumthombo wenkxaso kunye nemfundo kubantu abaninzi abanesifo. Ukuba ukhetha ukubandakanyeka ngale ndlela, ke, thabatha umzuzwana ufunde indlela yokwabelana ngesifo somhlaza wakho kwi-intanethi ngokukhuselekileyo.
I-intanethi yindawo enkulu kwaye ngamanye amaxesha kunzima ukufumana abantu abajongene nohambo olufanayo ukuya kwakho. Ukuze udibanise nabanye abahlala nabo, okanye unyango, umdlavuza webele, usebenzisa i-hashtag #BCSM inceda gqitha. I-BCSM imele i-media yomdlavuza woluntu lwebele.
ILizwi
Kwixesha elidlulileyo, umdlavuza webele we-HER2 wayebhekwa njengesisu esinamandla ngaphandle kwonyango oluthile olukhoyo. Oko konke kwatshintsha ngo-1998 ngokuvunyelwa kwe-HER2 yokuqala yonyango, uHerceptin. Ukususela ngelo xesha, ezinye iyeza ziye zafumaneka ziquka i-Perjeta, i-T-DM1, i-lapatinib kunye ne-neratinib yakutshanje, kunye nezinye iziyobisi ezivavanywa kwizilingo zeclini. I-H2 ekujoliswe kuyo imithi inganciphisa ingozi yokuphindaphinda kwinqanaba lokuqala le-HER2-positive cancer umdlalo kunye nokuphucula izinga lokusinda kwi-metastatic HER2-positive cancer.
Ukongeza kwiipilisi ezijoliswe ku-HER2, unyango lwe-HER2-positive cancer cancers lubandakanya unyango lwe-H22 izifo ezingalunganga ezifana nokuhlinzwa, unyango lwe-hormone (xa kusebenza), i-chemotherapy, unyango lwe-radiation, unyango oluthile lwee-metastase, kunye nokufumaneka kwezilingo zamachiza .
> Imithombo:
> Chan, A., Delaloge, S., Holmes, F. et al. I-Neratinib Emva kwe-Trastuzumab-Based Based Adjuvant Therapy kwizigulane ezine-HER2-Positive Cancer Breast (ExteNET): I-Multicentre, Randomized, i-Double-Blind, i-Placebo-Controlled Phase 3 Trial. Lancet Oncology . 17 (3): 367-77.
> Kast, K., Schoffer, O., Isixhumanisi, T. et al. I-Trastuzumab kunye Nokusinda kwezilwelisi ezine-Canast Metastatic Breast Cancer. IiNqolobane zeGynecology kunye ne-Obstetrics . 2017. 296 (2): 303-312.
> Ipaki, J., Liu, M., Yee, D. et al. I-Adaptive Randomzation ye-Neratinib kwi-Early Breast Cancer. I-New England Journal of Medicine . 2016. 375 (1): 11-22.