Izvo Zvakanaka Here Kana Kuti Zvakaipa Kuve neHER2 Chibereko Chakanaka Chechirwere?
Kana iwe wakamboudzwa kuti kenza yako yepafu iHER2 yakanaka, iwe unogona kunge une mibvunzo yakawanda pamusoro pezvinoreva izvi. Asi kana iwe wakafanana nevamwe vakawanda, mubvunzo wako wekutanga ungave uri, "Zvakanaka here kana kuti zvakaipa kuva HER2 zvakanaka?" Mune mamwe mazwi, "zviri nani" kana chironda chako chiri HER2 chakanaka kana HER2 chakaipa here?
Sezvatinodzidza kuti kenza yemazamu haisi chirwere chimwe chete asi pane zvirwere zvizhinji zvinopesana pamaseroti, aya mibvunzo inokosha.
Mhinduro mhinduro ndeyokuti HER2 positivity inogona kuva yakanaka uye yakaipa. Ngationgororei kuti hutachiona hweHER2 hunoita sei zvinhu zvose kubva mukushungurudza kwechirwere, kumasarudzo ekurapa, kune ngozi yekudzokorora uye kufungidzira.
Kukurukurwa Pfupi
Kenza yepabonde haisi chirwere chimwechete-chaizvoizvo, hapana kanzura mbiri yakafanana-asi isu iye zvino tine simba rekuputsa aya kanisuru pasi muzvikamu zvakasiyana-siyana zvinoenderana ne "mamiriro ekugamuchira" emakumbo. Zvinodhaka zvepabonde zvakasiyana mumapurotini akawana sero pamusoro, mapuroteni anokonzerwa nekukura kwemakumbo. Izvozvi mapuroteni aripo akafanana zvakasiyana nezvisizvo zvakasiyana-siyana mumararamiro emakenza emukenza.
Vanhu vazhinji vanoziva chirwere chinonzi estrogen receptor-positive , iyo isrogen inosunga kuwedzera kuwanda kwezvinogamuchirwa pamasero emumabere echeche kuti zvikurudzire kukura kwemarara.
Chii chinoitika neHER2 chine mishonga yemazamu muzvakafanana, asi iyo yakasiyana-siyana yekugamuchira pamusana pekenza yemusero inotungamirira kukura nekupararira kwechirwere.
Kuwedzera kune anestrogen receptors panzvimbo yemasero (izvo zvinokurudzirwa nesrogen ), pane HER2 receptors pamusoro pemasero (ayo anokonzerwa nekukura kwezvinhu zvinotyaira kukura).
IHER2 geni (epidermal growth factor receptor 2 kana HER2 / neu) inonzi geni (imwe yatinayo yese) iyo inoratidzira mapuroteni anowanikwa mukukura kwemazamu emvere.
Inonziwo ERBB2 geni uye inonzi gene (protooncogene) inowanikwa pane chromosome 17.
HER2 mapeji anotakura mirayiridzo yekuita HER2 mapuroteni. Izvo mapuroteni anoshanda seyakagadzirirwa pazamu mazamu. Apo mabhuku akawanda akawanda eHER2 gene aripo (nekuda kwekukuvadza kune mazai emagetsi muchitokisi kana kuti kuchinja-chinja) zvinoguma mukuwandisa kwepamusoro (kana "kuwedzera") kweHER2.
Zvakakosha kuziva kuti mazamu ose emvere-ari maviri ane kenza uye asingatauriki-ane HER2 receptors pamusoro pekamuri. Misiyano ndeyokuti HER2 yakanaka mazamu emasero epamu ane 40 kusvika zana nguva iyi nhamba. Kana kukura kwezvinhu mumutumbi kusungirirwa kune izvi zvinogamuchirwa, zvinoguma nekuwedzera kwezamu mazamu.
Sezvo tine mishonga inopesana neestrogen receptor (kana kuderedza isrogen mumuviri) kurapa chirwere chesaurogen chepamuviri-chema, isu iye zvino tine mishonga inopesana neHER2 receptors paHER2 yakanaka yekenza yemazamu.
Inenge 25 kubva muzana (15 kusvika ku30 muzana) yemakondomu emucheche inobatsira HER2 (HER2 kuwedzera).
HER2 Chinhu Chakanaka: Zvakanaka Kana Zvakaipa?
Kuti mugone kupindura mubvunzo iwoyo kana kuti chiri chinhu chakanaka kana chinhu chakaipa kuva HER2 chakanaka, zvakakosha kutaura nezvekusiyana pakati pemakumbo ari HER2 akanaka uye ayo ari HER2 asina kunaka.
Mhinduro mhinduro ndeyokuti inogona kuva yakanaka kana yakaipa. Pakupedzisira, vanhu vazhinji vanoda kuziva kuti sei kuva neHER2 kenza yakanaka yepamu kuve nekurarama, asi kunyange iyo nhamba dzinogona kutsausa pasina kunzwisisa kuti kuva HER2 kwakanaka kunobatsira sei kuwedzera kwekenza.
Muenzaniso wekuenzanisira pfungwa iyi ndeyeyemuti wepabonde muvakadzi vechidiki . Kakawanda, kuponeswa kwepabonde kwakaderedza vakadzi vaduku zvikuru vane chirwere asi izvi zvinogona kunge zvichinyengedza. Muvanhu vaduku, chirwere ichi chinowanzoongororwa muzvikamu zvepamusoro. Saka kunyange zvazvo mukadzi wechidiki angabvumira kurapwa zviri nani uye ave nehupenyu hwakanaka pane imwe nzvimbo, hupenyu hwehuwandu hushoma hwakaderera nekuda kwezvikamu zvakakwirira pakuongororwa.
Mhinduro yakakurumidza yokuti kana ane HER2 yakanaka yepamu kansa yakanaka kana yakaipa ndeyokuti "inotenderera." Saka tinoda kutarisa nzira iyo hutachiona hweHER2 hunogona kuchinja kenza. Izvi zvinosanganisira:
- Mhando yevanhu vanokura rudzi urwu rwemarara (somuenzaniso, muvhareji wemakore)
- Nharaunda iyo HER2 kanzira inowanikwa, inopesana neHER2 matumbo asina kunaka
- Kunyangwe chironda chacho chiriwo isrogen receptor chakanaka
- Mishonga inoshandiswa inowanikwa
- Ngozi yekudzoka zvakare
- Kuparara kwepasi rose
Zvakakoshawo kuziva kuti HER2 chiitiko dzimwe nguva chisina kururama uye chinogona kuchinja pashure pokudzoka (ona pasi apa).
Kusiyanana Nengozi
Kunyange zvazvo pane zvakawanda zvakapindirana, vamwe vanhu vanowanzoita kupfuura vamwe kuti vave neHER2 yakanaka yepabonde kenza. Zvidzidzo zviviri, ruzivo rweLaCE uye PATHWAYS kuongorora, zvakatarisa maitiro evanhu vanogona kunge vari HER2 akanaka kana asina kunaka.
- Vakadzi vane zviremara zvinonyanyisa zveHER2 uye estrogen receptor zvakaipa zvinowanzova vaduku, havakwanisi kushandisa hormone replacement therapy, uye vanogona kunge vari Asia kana Indanishi.
- Mishonga iyo HER2 yakanaka haina kuonekwa kuti inobatanidza newaini yekudya kana kusvuta, uye kusiyana neestrogen receptor inorapa zvirwere zvekuita basa hazviiti seine chidziviriro chinodzivirira chirwere.
- Varume vane kenza yemazamu havakwanisi kudarika vakadzi kuti vave neHER2 vane mimba yakanaka.
- Zvinonakidza kuti zvakawanikwa kuti ductal carcinoma in situ (DCIS) kana kuti chikwata 0 zviremara zvinowanzova HER2 zvakanaka kudarika zvirwere zvechirwere zvisingasviki, izvo vamwe vaongorori vanotenda kuti zvine chokuita nehutachiona hwekukura.
- Dzimwe mhando dzekenza dzemazamu dzingave dzisingakwanisi kuva HER2 dzakanaka. Semuenzaniso, hazvishamisi kuti muchengeti wemukati (colloidal) wemazamu , medullary carcinoma, kana tubular carcinoma yemazamu kuva HER2 akanaka.
- HER2 chimiro chinogona kusiyana nemajini ekugadzirisa zvinokonzerwa nekenza yemvere. Semuenzaniso, BRCA1 inosangana nekenza yekamu haikwanisi kuva HER2 yakanaka.
Kururamisa kuedza uye kuchinja muhutano
Isu tinowanzotaura pamusoro peHER2 chimiro sekunge chikafu uye chichena, asi hachisi nguva dzose. Kune maitiro akasiyana-siyana ekuedzwa anogona kusiyana nenzira yakarurama. Kunewo zvakasiyana "maitiro" ekuti positivity. Somuenzaniso, tumarara inogona kuva 1+, 2+, kana 3+. Mishonga ine "shoma shoma" inogona kutaurwa seine kunyanya kufungidzira kweHER2 pane kuva HER2 yakanaka.
Iko zvino yakakurudzirwa kuti vakadzi vane chiratidzo chimwe chekuedzwa vadzoserwe zvakare, sezvimwe nzira dzekuedza dzisina kururama kupfuura dzevamwe. Kudzorera kunobvunzwawo kana muedzo unodzorerwa se "borderline." Zvakakoshawo kutaura nezvehutano hwemakumbo; imwe chikamu chemuviri wepamu inogona kunge iri HER2 yakanaka kana imwe chikamu chiri HER2 chakaipa.
HER2 chimiro chinogona kuchinja, uye izvi zvave zvichivhiringidza kune vanhu vakawanda. Chirwere chinotanga HER2 chingave chingava HER2 chakaipa kana chichidzoka kana kupararira. Saizvozvowo, bundu rinotanga HER2 rakaipa rinogona kuva HER2 rakanaka kana richidzoka. HER2 chiitiko chinofanira kugara chichidzorerwa shure kwekudzoka zvakare.
Aggressiveness
HER2 mazamu emakwenzi akanaka anowanzova ane hasha kupfuura HER2 matumbo asina kunaka.
Mvere dzemazamu dzinopiwa bhesi yepamusoro panguva yekuongororwa maererano nekuonekwa kwemasero pasi pe microscope. Tumor grade ndiyo nhamba inopiwa kurondedzera kushungurudzwa kwechirwere, ine nhamba imwe chete isinganyanyi kurwisa, uye nhamba mitatu ndiyo inonyanyisa. HER2 matumbo akanaka anowanzova nechirwere chemahara matatu. Izvi zvinokonzera kukura zvakakurumidza kupfuura matumire ekirasi yepamusoro uye zvinowanzopararira kune lymph nodes.
Spread to Lymph Nodes
HER2 mazamu emakumbo anowanzopararira kune lymph nodes. Sezvo zvakadaro, danho rekuongororwa rinogona kunge rakakwirira kudarika HER2 matumbo asina kunaka.
Kurapa Mhinduro
Isati yasvika pakuvandudzwa kwemishonga inotarisirwa neHER2 yakanaka yekenza yemazamu, yakadai saHercceptin (trastuzumab) , kupindura kwevanhu vane kenza yakanaka yeAIDS kwakanga isina kunaka kune avo vane zvirwere zvisina kunaka zveHER2.
Targeted therapy yeHER2 chirwere chakanaka chepamu chakashandura kufungidzira, uye zvino mitsva yekurapa inenge yakangofanana neHER2 nhengo dzisina kunaka (kunyange zvazvo HER2 matumire inowanzova yakakura). Maererano neNational Cancer Institute, mishonga iyi yakashandura kufungidzira kwepakati pekutanga kusvika kune imwe nhanho yeHER2 kanema yepachifu yepamuviri kubva kune varombo kusvika kune yakanaka.
Herceptin inoderedza dambudziko rekudzoka uye inovandudza mitero yekupona kwemakore gumi kune avo vane danho rekutanga kusvika kune imwe nzvimbo yezvirwere zvitatu zvinenge 30 muzana.
Pane, kunyange zvakadaro, mungozi mukuru wekudzokazve uye masastasis ane hutano hwakanaka hweHER2, uye hupenyu hwehutachiwana huri hwakaderera pane HER2 isina kunaka asi isrogen yakagadzikana-tumarara.
Vanhu vane HER2 matumbo akanaka haawanzopinduri nekenza yemachira yekenza kupfuura avo vasina kunaka.
Dambudziko rekudzokazve
HER2 kenza yakanaka yepamu inonyanya kudzoka (dzoka) uye HER2 kenza yepamu isina kunaka. Zvidzidzo zvakawana kuti pakutanga mazamu emakemikari (danho I uye gadziriro II) zvinowanikwa kaviri kana katatu zvakanyanya kuti zvidzoke kupfuura HER2 matumbo asina kunaka. Kunyange zviduku zvikuru HER2 matumbo akanaka (mashoma kupfuura 1 cm kana hafu inch in diameter) ane lymph nodes asina kunaka ane ngozi yakawanda kwazvo yekudzoka maererano nemamota ayo ari HER2 asina kunaka. Kurapa naHerceptin kunogona kuderedza ngozi iyi nehafu.
Muenzaniso wekudzoka kwekenza yebonde ingasiyanawo. Zvidumbu zviduku zvinowedzerawo kuva nekudzoka kwechimiro (zvakasiyana nekudzoka kwekune imwe nzvimbo kana zvekune dzimwe nyika) kana vari HER2 akanaka.
Metastasis
Chero HER2 mishonga yakanaka inowanzoita kuti mastasize isati yanyanya kufanana nemakumbo asingabatsiri anobva kune nzvimbo dzemasarasi emumabere wepabonde watinofunga . Dambudziko remasastases rose, kunyanya metastases yeuropi, inofungidzirwa kuwedzerwa, asi zvizhinji zvezviongorori zvakaitwa vasati vashandiswa zvikuru neHerceptin.
Zvidzidzo zvakaitwa mushure mokutanga kweHerceptin (uye dzimwe HER2 dzakarongwa nemishonga) vakawana kuti HER2 dzakanaka mazamu emishonga anoenderera mberi ane huwandu hwakanyanya hwehutachiona hwehuropi. HER2 matumbo akanaka anowedzera kupararira munguva yechirwere ichi kusvika kune-axillary lymph nodes, mapapu, marora emapfupa, mazamu, uye mahedheni adrenal.
Mikana ye metastases neHER2 matumbo akanaka angave akasiyana zvichienderana nokuti kana chirwere chacho hachisiwo isrogen receptor yakanaka. Dambudziko reuropi, chiropa, mapfupa , uye mapapu emapapu muHER2 matumbo akanaka anokanganiswawo kana chironda ichi chiri estrogen receptor chakanaka kana chakaipa zvakare.
Dambudziko remasastase rinogonawo kuvimba nezvinhu zvinobatanidzwa. Semuenzaniso, njodzi yehutachiva hwemashuga kubva kune kenza yepamuviri yakakosha neHER2 mutezo akanaka kana vanhu vopisa.
Triple Positive Breast Cancer
Zvinenge makumi mashanu kubva muzana zveHER2 mishonga yakanaka ichava isrogen receptor yakanaka. Zvidzidzo zvakawana kuti kusangana uku kunogona kukonzera imwe nzira yakasiyana yekudzokazve, asi zvidzidzo zvishomanana zvakatarisa maitiro uye hutano hwemakumbo matatu akanaka.
Mishonga yekenza iyo ndiyo estrogen receptor yakanaka uye HER2 yakaipa (luminal A) ine chirevo chekanakisisa chakanaka zvachose. Izvo zvinonzi estrogen receptor zvakanaka uye HER positive (B luminal (B luminal) ane chimiro chakashata, asi kufungidzira kunoramba kuri nani kune vanhu vane katatu-negative kana estrogen receptor isina uye HER2 kupfuura-kuratidza kenza yemazamu.
Zvikanganiso Mukurapa
Iyi nhauriro ingadai isingagumi pasina kutaura kuti dzimwe nguva kenza yepamu inowanikwa zvisina kururama seHER2 yakanaka kana HER2 isina kunaka. Miedzo inowanikwa pakugadzirisa hutano hweHER2 haisi benzi. Zvakakosha kubvunza wako oncologist izvo zviyero zvakaitwa uye kana iwe haufaniri kudzorerwa zvakare.
Pane kukanganisa mukuongororwa (kusarudzwa kwakaipa) umo chirwere cheHER2 chine ngozi chinoratidzika sechakaipa chinogona kukonzera kuti munhu arege kupiwa chirongwa chinotarisirwa; mishonga inogona kuvandudza kupona. Zvechokwadi, kuonekwa kuti kune HER2 zvirwere zvakanaka izvo chaizvoizvo HER2 zvisina kunaka zvingaguma mukushandisa mishonga isingabatsiri (kunyange zvazvo mamwe mamiriyo asina HER2 akazoita Herceptin).
Summary of Differences
Ichi chinyorwa chakaongorora kusiyana kukuru pakati peHER2 yakanaka uye HER2 nharo dzekenza dzisina kunaka, uye kuti kusiyana uko kunogona kuchinja sei kufungidzira.
HER2 mazamu emakwenzi akanaka paanoenzaniswa nemakumbo eestrogen-positive anowanzova:
- Zvimwe zvechisimba (zvine chikwata chepamusoro chepamusoro)
- Inowanikwa kuvakadzi vaduku (uye kenza yemazamu mumadzimai madzimai anowanzoonekwa mune zvidzidzo zvakapfuura)
- Zvichida zvakangofanana zvekuita kurapwa ikozvino kuti HER2 inotarisira kurapwa inowanikwa
- Zvimwe zvinogona kudzoka zvakare
- Zvichida zvakanyanya kuitika, kunyanya kune nzvimbo dzakadai seuropi
Izvozvi mapfupa anewo huwandu hushoma hwehurombo (kunyange vashandi vatsva vakagamuchirwa, mumwe muna 2017, uye isu hatizivi kuti izvi zvichaita sei kusarudzwa.)
Iko kune chokwadi kunze kwezviwanikwa izvi uye tinoda kugara tichifunga kuti munhu wese, uye kenza yese yebonde, yakasiyana.
Shoko Rinobva
Kunyange zvazvo huwandu hwehutachiona hweHER2 hwakanaka hunoita sehurombo kune huri izvo zvinonzi estrogen receptor zvakanaka asi HER2 isina kunaka, kupararira kwemaHER2 kurapwa kwakapararira kuri kuita mutsauko muhutano hwehupenyu uyewo pangozi yekudzokorora.
Sezvo HER2 kurapwa kune zvitsva pachiitiko, uye mishonga yakawanda mitsva yakagamuchirwa muna 2017 yoga, nhamba haisi iyo inonyanya kukosha. Kana uri kurarama neHER2 kamu yakanaka yepamu, iyo iyo mhinduro yekurapa ikozvino muHER2 matumire akanaka akaenzana neeestrogen receptor maitiro ari kukurudzira.
Nezvose zvese zvinoshandiswa pakurapa, uye nekuwedzera mishonga inodzidziswa mumakiriniki ekuedzwa, zvakakosha kudarika kare kutora basa rinoshanda mukurapa kwako. Tora nguva kuti uongorore mamwe mazano ekuti ungava sei mumutsigiri wako mukuchengetedzwa kwekenza .
> Sources:
> Ellingiord-Dale, M., Vos, L., Hjerkind, K., Hjartaker, A. et al. Doro, Chiitiko Chemuviri, Kusvuta uye Kanzvadzi Yemazamu Mutsara muChikuru Chine Nested Case-Control Yokudzidza Kubva kuNorway Breast Cancer Screening Programme. Cancer Epidemiology Biomarkers uye Kudzivirira . 2017 Sep 6. (Epub mberi kwekudhinda).
> National Cancer Institute. Nyaya Yokuwana: HER2's Genetic Link kuBeast Cancer Spurs Kuvandudzwa kweNew Treatments. https://www.cancer.gov/research/progress/discovery/HER2
> Parise, C., uye V. Caggiano. Kuponeswa Kwepabonde Kwebereki Kunotsanangurwa ne ER / PR / HER2 Subtypes uye Kurongeka Kwakaitwa Maererano neTumor Grade uye Immunohistochemical Biomarkers. Nhoroondo yeCcercer Epidemiology . 2014. 469251: 1-11.
> Schettini, F., Buono, G., Cardalesi, C. et al. Hormone Receptor / Human Epidermal Growth Factor Receptor 2-Chiitiko Chakanaka Kanzera: Kwatiri Tiri Iye Zvino uye Kwatinoenda. Cancer Treatment Reviews . 2016. 46: 20-6.