Mhando dzekuedza, kunyatso, uye kuchinja muHER2 Kuedza
Kana iwe wakanga uine biopsy kana kuti chirwere chekenza yepese iwe wakangodaro wakanzwa kuti tsvina yako HER2 yakanaka kana yakaipa. Kana iwe usina kumbonzwa, unofanira kubvunza wako oncologist pamusoro pemigumisiro yechiratidzo ichi. Zvakakosha kunzwisisa HER2 kuongororwa nemigumisiro, kunyange kana chirwere chako chiri HER2 chakaipa.
Basics of HER2 + Kanzura
HER2 mapuroteni anowanikwa pamusoro pezamu mazamu, angave ane kenza kana kuti akajairika.
A gene (iyo HER2 kana ERBB2 gene) isu tose tine mirayiridzo kana blueprint yekugadzira mapuroteni aya. Sero rimwe nerimwe rine mairi maviri ejeni. Apo paine maBhaibheri akawanda (HER2 kukurudzira) mugumisiro inowedzera nhamba yeHER2 receptors pamusoro pechiso chesafuri (HER2 kuwedzera). Kunyange zvazvo zvidimbu zvepamuviri zvemazamu zvinenge mamiriyoni maviri emagetsi aya, HER2 maitiro echetere emukamu ane mazana anopfuura makumi matanhatu aya.
Zviri nyore kuti, kana kukura kwezvinhu mumuviri kunamatira kune izvi zvinogamuchirwa, zvinoratidza sero kuti zviparadzanise uye zvinoguma mukunze kwekukura kwemazamu masero atinoti chirwere.
Inenge 25 muzana yevanhu vane kenza yemazamu ichava HER2 yakanaka. Munguva yakapfuura, kuva HER2 positive kwakabatanidzwa nehurombo husina kunaka. Iye zvino zvatakarovedza kurapwa (zvakadai saHercceptin (trastuzumab) ) inowanika, iyo inogona kupindira nemapapiro aya, zvinodaro zveHER2 yepabonde yepabonde zviri nani zvikuru.
Kukosha kwekuedzwa
Zvakakosha kuva nehutano hwehutano hweHER2 kuitira kuti uwane mikana yakanakisisa yokurapa yeHER2 chine kamu yemazamu akanaka . Izvi zvinosanganisira kusarudzwa kwezvirwere zvakarongwa zvakadai saHerceptin (trastuzumab), Perjeta (pertuzumab), Tykerb (lapatinib), uye Nerlynx (neratinib).
Mhando dzakasiyana dzekemotherapi yekenza yebonde inoshanda zvakanakisisa inogonawo kusiyana neHER2 chimiro.
Nzira yakarurama yeHER2 yakakoshawo mukurapa kwehutachiona hweHER2 yakanaka yepabonde chepamu . Muenzaniso we metastase, pamwe nekurapwa kwemasero ezvimwe zvemasimisita, zvinogona kusiyana zvichienderana neHER2 chimiro.
Nguva Yokuedzwa
Munhu wese ane chero ipi zvayo yepachirwere inopinda (infiltrating) yekenza yepamu inofanira kuva neyemarara yavo yakaedzwa kweHER2 chimiro. "Kushandisa" kenza yemazamu inotsanangurwa seyese yekenza iyo inopfuura chikamu 0 kana kuti carcinoma in situ . Zvimwe zvikamu zvese zvekenza yebonde, kubva pachigamba I kusvika kunechitanhatu IV, inofanira kuongororwa neHER2 chiitiko panguva yekuongororwa uye vasati vatanga kurapwa.
Mhando dzeZviedzo
Kune mhando dzakasiyana dzeongororo dzinogona kuitwa padumbu rekuona kuti kana kwete HER2 yakaipa. Izvi zvinosanganisira:
- HER2 Immunohistochemistry (IHC) : IHC yakaenzana nenhamba yeHER2 mapuroteni receptors pamusoro pekenza yepabonde yemvere kana kuti "HER2 kuwedzera"
- Inec hybridization (ISH) : ISH chiyero chenhamba yemakopi eHER2 mune imwe kenza yepabonde yebonde kana "HER2 kukurudzira." Kune zviyero zviviri zvakasiyana zvakasiyana zveS ISH: fluorescence (FISH) uye yakajeka munda ISH.
Pane gakava pamusoro pokuti zviyero zvipi zvakanyatsojeka.
Vamwe vatsvakurudzi vanodavira kuti FISH ISH yakarurama, asi IHC inowanzoitwa muUnited States. Sezvo nzvimbo iyi iri kuchinja zvikuru kwazvo, zvakakosha kutaurirana neoncologist yako pamusoro pekuedza kwawakaita uye nei iyo nzira chaiyo inogona kusarudzwa.
Mhinduro Dzokuedzwa
Maererano nehurukuro yeAsco / CAP yegore ra2013, kana kuongorora kweHER2 kuchidzoka semuganhu wemuganhu kana kuti wakaenzana, "kuongorora kufungisisa" (kuenderera mberi kune imwe muedzo) kunofanira kuitwa neimwe nzira yekuedza. Somuenzaniso, kana IHC yakapa miganhu yemiganhu, ISH inofanira kuitwa pane imwe samples, uye kana ISH iri muganhu, IHC inofanira kuitwa zvisati zvaitika.
Dzimwe nguva migumisiro yekuongorora kwakasiyana kweHER2, somuenzaniso, zvose IHC neFISH ISH ichava mumiganhu yakasvibiswa, indeterminate, kana equivocal. Hatisati tine mitemo yakazara pamusoro pokuti tingazoenderera mberi sei kana izvi zviri izvo, uye iwe uye wako oncologist uchada kukurukura kuti ungaenderera mberi sei.
Kuedza Kukwaniswa
Mukuwedzera pakuva nemigumisiro yechiratidzo iyo isina kunaka kana kuti isina kunaka asi pane mhirizhonga kana kuti yakaenzana, pane zvimwe zvingakwanisi kuedza. Izvi zvinosanganisira:
- Inaccuracy (zvikanganiso): Nechinangwa chipi nechipi chekuongorora mabhakato kune nguva dzose njodzi yekukanganisa.
- Kukundikana kudzokorora kuedza kana chikonzero chacho chiri muganhu, chisingadi, kana chekuita: Kana muedzo unodzoka semuganhu wakare, unofanirwa kudzokororwa.
- Heterogenicity: Chirevo chemuviri wehutano huri hutsva uye chinogona kuvhiringidza. Sezvo kanzeramu masero ari kuramba achichinja, panogona kuva nezvikamu zvemuviri unoedza HER2 positive uye zvimwe zvikamu zvinoedza HER2 zvisina kunaka. Izvi zviri nyore kunzwisisa kana taona kuti marudzi akasiyana emuviri unogona kuva nemhando dzakasiyana-siyana zvemasero pasi pe microscope pamwe chete.
- Shanduko: Tumors inogona kuchinja imwe nzvimbo yeHER2.
Kuchinja muHER2 Mamiriro
Isu tinowanzofunga nezvekenza sechinhu chinokanganisa seki rimwechete iro masero ose akafanana, asi izvi hazvisi izvozvi. Tinoziva kuti masero emukenza anoenderera mberi nekuvandudza kuchinja patsva uye kuchinja. Zvikamu zvakasiyana zvechirwere chimwechete chinogona kuve nemasero emukenza ane maitiro akasiyana-siyana (tumarara heterogeneity) uye izvi zvinogona kuitika kunyanya kuoneka apo bundu rinopfuurira, zvakadai sekudzoka kana chirwere chemasastatic.
Haisi HER2 chete iyo inogona kuchinja. Estrogen receptor (ER) uye progesterone receptor (PR) chimiro chinogonawo kuchinja kana chirwere chichidzoka kana kuti chichigadziriswa, uye shanduko iyi mumamiriro ekugamuchira inonzi "kusagadzikana." Chirwere chinogona kuchinja kubva pakuva nemafungiro kune zvakaipa kune chimwe chezvipo izvi, kanawo, kubva pakuva asina kunaka kune zvakanaka.
Kazhinji sei tumarara inoshanduka? Mukana wekusawirirana pakati pemakumbo ekutanga uye metastasis yekutanga kana yechipiri (zvichibva pakushata kusvika kune chakanaka kana kubva pane zvakanaka kusvika kune zvakaipa) ndeyotevera:
- ER: 20.7 muzana
- PR: 40.7 muzana
- HER2: 19.6 muzana
Muchidzidzo ichi, anenge makumi maviri kubva muzana emakumbo akashandura chimiro kubva kuHER2 chine kunaka kune chakaipa kana chisina kunaka. Kuziva kana chirwere chakashanduka chakakosha pakusarudza nzira dzakanakisisa dzokurapa,
Izvo zvakanaka here kana zvakaipa kana HER2 mamiriro ekugamuchira chichichinja? Chero bedzi shanduko ichitsvaga (nekuita kudzokorora kuedza) kuitira kuti kurapa kwakanakisisa kunakurudzirwe, hazviiti sekuti kuchinja mumamiriro ekugamuchira zvinotamba basa guru mukufungidzira. Muchidzidzo chechidzidzo ichi chakange chisingabvumirwi neHER2 (chakashandurwa kuva chine chakanaka kana chakaipa) chakanga chichifananidzira kufanana kune zviremara izvo zvisina kuchinja mamiriro eHER2 receptor.
Ichi chidzidzo chakawana kuwirirana pakati pekutanga kwemasastase uye metastasis yekutanga kana yechipiri, asi kusawirirana kunogona kuitika pakati pekutanga uye yechipiri metastasis zvakare.
Dzokorora Kuedzwa
Mukuwedzera kune kuongororwa kweHER2 kunofanira kuitirwa munhu wese panguva yekuongororwa, kune mamiriro ekuedzwa kunofanira kudzokororwa. Izvi zvinosanganisira:
- Panguva yekudzoka , ingave inharaunda, inharaunda, kana inoshandiswa zvakare.
- Kana kenza yemazamu inopararira uye nedzimwe zviratidzo zvitsva.
- Kana iwe uye wako oncologist uchinzwa kuti kuongorora kweHER2 wawakanga waita hakusi yakarurama sekuedzwa kwetsva.
Misdiagnosis
Chii chinoitika kana nzvimbo yako yeHER2 isina kuongororwa? Kana chirwere chako chiri HER2 chakanaka asi iwe unowana chibereko cheHER2 chakaipa, iwe unogona kusagamuchira kuponesa kunatsiridza kurapwa. Kune rumwe rutivi, kana yako HER2 chimiro chisina kunaka asi iwe unowana chirongwa cheHER2 chakanaka, unoisa pangozi kuve nemigumisiro yemigumisiro yeHER2-inorapwa mishonga isina kubatsirwa (kunyange vamwe vanhu avo vane HER2 zvisina kunaka vane zviremera zvakapindura izvi zvinotarisirwa kurapwa).
Shoko Rinobva
HER2 kuongororwa, pamwe neesrogen uye progesterone receptor test, inofanira kuitwa pane zvose zvinoputika (danho I kusvika kunegadziriro IV) yekenza yepamusoro panguva yekuongororwa uye vasati vapiwe mushonga (pamwe nenguva imwe chete kunze kwekugadzirwa kwekuvhiya).
Kuedza kunofanirwa zvakare kudzokororwa kana iwe uine muedzo wakadzoka sewe indeterminate, kana wako oncologist achinzwa rudzi rwakasiyana rwekuedza rwakarurama, kana kana kenza yako inodzoka kana kupararira. HER2 chimiro chemuviri chinogona kuchinja munguva, kunyange munzvimbo dzakasiyana dzechirwere chimwechete.
Izvo zvakarurama HER2 chiitiko chakakosha pakusarudza nzira dzakanakisisa dzokurapa dzekenza yako nekuderedza migumisiro yemigumisiro yezvokurapa zvishoma zvisingabatsiri. Pane mhirizhonga pamusoro pematambudziko akanaka eHER2, uye mitsva itsva uye yakashandurwa iri kuongororwa nhasi. Izvi zvinorevei kuti zvakakosha kubvunza mibvunzo uye kuva mutevedzeri wako mumuchengetedzi wako.
> Sources:
> American Society of Clinical Oncology. Practice and Guidelines. Chirwere chepabonde. Zvikurudziro zvevanhu Epidermal Growth Factor Receptor 2 Kuongororwa muchirwere cheKenza cheBabonde. http://www.asco.org/practice-guidelines/quality-guidelines/guidelines/breast-cancer#/9751
> Lim, T., Lim, A., Thike, A., Tien, S., uye P. Tan. Zvinokonzerwa neHamendeji yeAmerica yeChristal Clinic Oncology / Chikoro cheAmerican Pathologist Guideline Zvirongwa pamusoro pevanhu Epidermal Growth Factor Receptor 2 Gene Testing Kushandisa Immunohistochemistry uye Fluorescence In Situ Hybridization for Breast Cancer. Archives of Pathology uye Lab Medicine . 2016. 140 (2): 140-7.
> Pasi, E., Khan, S., Kennedy, D., naR. Baughman. Kuparadzana kweEstrogen Receptor uye HER-2 / neu muBritain Kenza Kubva Pachikoro Chokutanga kusvika Kukutanga uye Kechipiri ChechiMetastatic Site. Chirwere Chepabonde (Dove Medical Press) . 2017. 5: 515-520.