Zvichida wakanzwa nezvesarenji yakagamuchira- kanzvadzi yepamu nekenza yeHER2 yakanaka yepamu. Iwe unogona kunge wakanzwa zvakare nezvekenza katatu isina kushaya bonde. Asi chii chinokonzerwa nekenza yepamusoro yepabonde?
Hazvishamisi kuti kenza yemazamu ive estrogen receptor positive (ER +), progesterone receptor positive (PgR +), uye HER2 / neu positive (HER2 +).
Ndezvipi izvi katatu zvakanaka mazamu emakamu akasiyana nezvimwe zvikamu zvemukenza webonde maererano nezvose zvekuita kwechirwere uye mishonga inoshanda zvakanakisisa? Ndezvipi zvimwe zvaunofanira kuziva uye ndezvipi zvinonzi?
Tsanangudzo
Izwi rokuti "kenza katatu rakanaka yepamu" haisijai kune vanhu vazhinji. Ichokwadi, vamwe vanogona kufunga kuti ipo typo uye kuti isu tiri kunyatsofunga nezvekenza katatu isina mucheche.
Izvi ndezvokuti zvidzidzo zve "kanhi dzakanaka" kenza yemazamu hazvisati zvatsva panzvimbo yacho, kunyange zvazvo zvikamu zvitatu zvakanaka zvinoratidzika sechikamu chakasiyana chekenza yemazamu. Pakuedzwa, izvi zvipuka zvinowanikwa kuva ER, PgR +, uye HER2 / neu +.
Nezvose zveestrogen receptor uye HER2 chine mishonga yemazamu, kune mapuroteni anogamuchira pamusoro pekenza yemavhesi emvere iyo inokonzerwa nekufambisa kukura kwekenza. Kazhinji mazamu mazamu ane esrogen uye HER2 receptors. Mune mamiriro ekutura-receptor-positive, pane zvakawanda zvakawedzerwa nhamba yezvikwata izvi.
Kushandurudza kana kuwedzera kwenhamba (geni kukurudzira) kunoita mukugadzirwa kwemamwe mapuroteni.
Apo estrogen inosunga kune estergen receptors, inokurudzira kukura kwesero. NeHER2, ndiko kukura kwezvinhu zvinosungirirwa kune zvakagadzirwa kuti zvikurudzire kukura. Mune HER2 kenza yakanaka yepamu dzemazamu, kune mazana anopfuura makumi matanhatu akawanda emapapiro aya sezvinowanzoita mazamu emvere.
Nepo kune huri kukakavhiringidza kwekenza katatu yakanaka yepabonde kuva chikamu chakasiyana, aya kanzira inoratidzika kuita nenzira yakasiyana maererano nezvose zvinoitwa nekenza uye mhinduro yekurapa. Kakawanda, zvipembenene zvitatu zvakanaka zvinowanzoita zvakanyanya seestrogen receptor positive uye HER2 nhengo dzisina kunaka, kunyange kune kufanana pakati pekatatu yakanaka uye katatu isina kenza yemazamu yemazamu zvakare.
Triple Positive vs. HER2 +
Kanzira dzepabonde dziri HER2 dzakanaka dzinogona kusiyana zvikuru kubva kune mumwe. Muzhinji, zvipfeko izvo zvinonzi HER2 zvakanaka zvinowanzova zvehasha, zvine mikana yekurarama, uye hazviwanzoiti kutora hormonal therapy. HER2 mishonga yakanaka iyo inonzi estrogen receptor positive (katatu yakanaka) zvisinei, inogona kuita zvakanyanya seestrogen receptor ine mishonga yakanaka uye inogona kunge isingadzvinyiriri mukuwedzera pakupindura kumashonga emuhomoni.
Kuti unzwisise kenza katatu yakanaka yepabonde mune zvakadzika, zvingave zvichibatsira kutarisa zvimwe zvekusiyana pakati peHER2 yakanaka uye HER2 kenza yepamu isina kunaka .
Triple Positive vs. ER +
Mishonga ine katatu yakanaka inowanzova nehasha pane iyo iri ER + chete. Hormonal therapy inogona kunge isiri yashanda, uye chemotherapy, pamwe nevana vepamuviri-kutanga, inogona kusanyanya kushanda.
Nhatu dzekamu dzemuviri dzinenge dzisingave dzakawanda dzingave dzine lymph nodes dzakanaka kudarika iyo inonzi estrogen receptor yakanaka chete.
Triple Positive vs. Triple Negative
Pakutanga kuonekwa, zvinenge zvingaita sokuti kufungidzirwa kwekamu kanomwe kanema mazamu echeche kuchave kwakakwirira, kuteverwa nemakumbo anongova esrogen receptor chaiyo kana HER2 positive, kuteverwa nemakumbo anenge katatu asina kunaka.
Izvozvo hazviratidzika sezvakangoita uye zviputi zvinokwana katatu zvakajeka zvimwe zviitiko kune izvo zvinotapira katatu. Nepo dzimwe nhatu dzisina kunaka dzakaora dzinoshanda zvakadai seE ER + tumor, dzimwe dzezviremara izvi zvakafanana zvakafanana nemakumbo matatu-asingagadziri anobva pamaronda aya achiita zvechisimba, achiitika achiri muduku, ane chiremera chepamusoro chepamusoro pakuongorora, uye ane mikana yakawanda yekudzoka zvose zviri munharaunda, mharaunda, uye mastatically.
Kuwanda
Chirwere chetatu chinotapira chinenge chisina kujairika. Inofungidzirwa kuti inenge 20 kusvika ku25 muzana yemakondombera ezamu (15 kusvika ku30 muzana mune zvimwe zvidzidzo) ndeyeHER2 yakanaka. Zvimwe zvakajairika, zvinenge makumi manomwe kubva muzana zvekondomu dzezamu ndezverrogen receptor positive, akawanda aya ari progesterone receptor akanaka zvakare.
Pamakirini ayo ari HER2 akanaka, anenge makumi mashanu kubva muzana anowanikwawo ari estrogen receptor positive, kunyange kutaura kweestrogen inogona kunge iri pamadanho maduku. Kakawanda, zvinenge 10 muzana yemamota inogona, kuburikidza nekuderedzwa, inofungidzirwa kuti inofadza katatu, kunyange zvazvo zvikwidzi zvikuru zvakatarisa chirwere chepachirwere chinoshaikwa. Mukuwedzera, chiyero cheestrogen positivity chinogona kusiyana pakati pemakumbo aya.
Treatment Approaches
Ndezvipi kurapwa kwekenza yepazamu kunoshanda zvakanakisisa nokuda kwekenza katatu yakanaka yepamu?
Zvinotaridzika kuti zvipembenene izvo zvose zviri zveestrogen receptor uye HER2 zvakanaka zvinopindura kaviri pamwe nekurapa. Hazvifanirwi here kurapwa kweHER2 kanhi yekenza yepamu iyo inobatsira zvinonzi estrogen receptors inowedzera kusvika pakujekesa zviri nani pane kurapwa kweE ER + kana HER2 + tumarara chete?
Zvinosuruvarisa, izvi hazvisizvo. Kune mamwe maronda, kushandisa aya maviri ekurapa pamwe kunogona kukonzera kudarika uye kuwedzera mungozi wemigumisiro. Asi kunyange kana zviviri zvese zvinoratidzirwa, hazvisi zvishoma.
Zvidzidzo zvinotarisa kutanga kwepamuviri zvirwere zvekenza zvakagadzikana zvishoma kubva kuneHER2 inotarisirwa kurapwa apo uwandu hwezvinhu zvose zvakagadzirwa nepamusoro. Aya ndiwo maperembudzi anoita zvakadai seE ER + / HER2 neg (luminal A) matumbo. Asi kubudirira kwakaderedzwa kwemishonga yemakemikari yakataurwawo zvakare. Sei izvi zvisingaiti, uye nei zvisingazove zvakanyanya kubudirira? Kuti tinzwisise izvi tinofanira kutarisa "crosstalk" pakati peestrogen neHER2 receptors.
HER2 / Estrogen Receptor Crosstalk
Cancers iyo inobata katatu inogona kuita zvakasiyana pane inogona kutarisirwa inobva paHER2 kana estrogen receptor positivity chete uye inogona kukanganiswa nehukama pakati pezvinogamuchirwa. Iyi kubatana pakati pemakiti ekutora kunotumidzwa nevatsvakurudzi se "crosstalk."
Nzira iri pakati peHER2 neE ER inogona kushandiswa kuratidza kumira kwehomoni. Mune mamwe mazwi, kutaurirana pakati pemakwenzi (inotaura HER2 neEER) kunogona kuita kuti anti-estrogen therapy irege kushanda zvakanaka mumatumbu akanaka matatu. Nenzira imwecheteyo, kushandiswa kwechiratidzo chekugamuchira isrogen (yakabatana kuva ER +) kunogona kukonzera kushorwa kweHER2-inorapwa mazano. Izvi zvinogona kutsanangura zvimwe zvekusiyana pakati peHER2 matumbo akanaka, mamwe ayo anopindura zvakanyanya kupfuura vamwe kune HER2 kudzivirira mishonga.
Zvinogona kunge iri "chikwata" chinotsanangura kuti nei tisingaoni mhinduro kune hormonal therapy kana HER2 inotarisirwa kurapwa yatingaitarisira.
Inofungidzirwa kuti kushandiswa kwekusangana kweHER2 therapy (somuenzaniso, Herceptin) uye hormonal therapy (yakadai seTamoxifen kana Faslodex (fulvestrant), zvisinei, inogona kudzorera zvimwe zveestrogen receptor kudzivirira hormonal therapy.
Mukuwedzera, mamwe kenza yemakemikrasi yebhumbu inoshanda zvakanaka kana kuti yakaipa kune HER2 matumbo akanaka. Asi apo chemotherapy inogona kunge isingakwanisi kubatsirana nehutachiona-hutachiona chirwere, iyo inobatsira zvakasimba mune chirwere chemasastatic.
Metastatic Triple Positive Cancer
Mastastatic katatu yakanaka kanema yepamu yemazamu inowanzorapwa zvakasiyana nemasitamende HER2 chirwere chepachifu chinotapira . Kusiyana nematumbu ayo ari HER2 akanaka chete, zvinoita sokuti kuve kwakachena uye kuponesa kunobatsira kushandisa chemotherapy pamwe neHER2 kuvhara mahara. Izvi zvinogona kuteverwa ne hormonal therapy (yakadai se aromatase inhibitor).
Prognosis
Sezvo pane zvidzidzo zvishomanana, zvakaoma kufanotaura kufungidzira kwekenza katatu yakanaka yepabonde. Maitiro uye mhinduro yezvizhinji zvezviremara izvi zvakafanana neestrogen positive asi HER2 matumbo asina kunaka, zvichiratidza kufungidzira kwakanaka. Izvozvo zvakati, taona kuti pangave nekukwirirana pakati peHER2 uye estrogen receptors inotungamirira mukurwisana kwemarodal maviri neHER2 anorayirwa kurapwa.
Zvinotaridzika kuti kufungidzira kungave kuri nani kuvakadzi vane zvirwere zvitatu zvinonzi postmenopausal. Mune kumwe kuongorora kuenzanisa vakadzi vechikasikasi kuvakadzi veSpain neAsia, Asia nePacific Island vakanzi vaine vanhu vashoma kupfuura vakadzi vachena / vasiri veSpanishi vane maronda akanaka matatu.
Shoko Rinobva
Kakavhiringidza kunoramba kuripo kana katu kanomwe yakanaka yekenza yepamu chikamu chakasiyana chechirwere chacho, kunyange zvazvo maitiro ezviremera izvi pamwe nekupindura kurapwa zvinoratidzika kuratidza kuti ndeyezviitiko. Pasi pose, matamu aya anowanzo "kuita" zvakanyanya seestrogen receptor positive, HER2 matumbo asina kunaka, asi pane kuchinja kukuru.
Pane kusava nechokwadi pamusoro pemutambo wakanakisisa wokurapa kwezvikamu zvitatu zvakanaka, uye zvinoita sokuti pane zvakasiyana-siyana zvinyorwa zvichienderana nehuwandu hwekutaura kweE ER nezvimwe. Mukuwedzera, pane inogona kunge yakagadziriswa pakati pemarudzi akasiyana-siyana ekugamuchira, izvo zvinogona kutungamirira kumhinduro shoma kune zvinodhaka zvinotarisa rumwe rudzi. Kuwedzera kutsvakurudza kunodiwa kuti utsvake mhinduro, uyewo nzira dzekudzikisa ruvara runotungamirira kukurwisana.
Sezvakasiyana nemhando ipi neipi kana chikamu chekenza yengamabele, zvinokosha kudzidzisa iwe pamusoro pehosha yako. Bvunza mibvunzo yakawanda, dzidza kuti ungatsvakurudza sei kenza yako, uye iva wako mumutsigiri wekutarisira kwako. Kunyanya kubatanidzwa munharaunda yekusimbisa kenza yemazamu kunogona kubatsira zvikuru, sezvo ichi chinhu chishandiswa kuburikidza nacho kuti usangowana rubatsiro rwendo rwako asi kuti udzidze nezvezvinowanikwa zvitsva mukurapwa.
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