Waxaa jira fursado badan oo daaweyneed oo la beegsado oo la heli karo
Tobankii sano ee la soo dhaafay, waxaan ogaanay in dhammaan kansarrada naasuhu isku mid yihiin. Marka laga soo tago isbeddellada lagu arki karo qiyaasta mikroskoob, waxaa jira faraqyo u dhaxeeya kansarrada kuwaas oo ku jira heer-jimicsi. Ka dib markaad leedahay dheecaan ama qalitaan, waxaad baraneysaa haddii kansarka naasahaagu yahay 'estrogen receptor positive' ama 'progesterone receptor positive', iyo sidoo kale xaaladdaada HER2.
Haddii laguu sheegay in kansarka naaskaaga uu yahay HER2 jawaabta, maxay micnaheedu tahay? Maxaa daaweyn ah oo si gaar ah ugu shaqeyn kara noocyadan kansarka naaska iyo wixii daweyno kale loo isticmaali karo?
Guudmarka Daaweynta Daaweynta
Dadka qaba kansarka naasaha 'HER2' ee naasaha waxaa lagu daaweyn karaa hab la mid ah dadka qaba HER2 negatifo siyaabaha qaarkood. Tusaale ahaan, qaliinka (ama lumpectomy ama mastectomy,) daaweynta kemotherabi, iyo / ama daaweynta hoormoonka (haddii burka uu yahay oogada hormoonka estrogen) ayaa loo isticmaali karaa.
Daawooyinka la beegsaday gaar ahaan HER2 burooyinka cajiibka ah ayaa sidoo kale loo isticmaalaa waxayna sare u kaceen heerarka badbaadada ee HER2-burqadlaha. Doorashooyinka daaweynta ee horeyba mar hore iyo cudurada murugsan ayaa lagu falanqeynayaa hoos.
Sidee buu u shaqeeyaa daaweynta
Qiyaas ahaan shan ama lix qof oo qaba kansarka naasuhu waxay yeelan doonaan burooyin kaas oo ah HER2 / neu. Tani waxay ka dhigan tahay in unugyada kansarka naasaha ee kansarka qaba ay leeyihiin waxqabadyo dheeri ah oo ku saabsan gen HER2, taas oo keenta kororka HER2 protein.
Barootinnimadani waxay ka shaqeeyaan sidii loo xoojin lahaa koritaanka unugyada kansarka.
HER2 Kansarrada naasaha naasaha waxay u muuqdaan kuwo aad u dagaalamaya, sanadaha horena waxay yeesheen natiijada saboolka ah. Sanadkii 1998 daawadii ugu horreysay ee si toos ah loogu bartilmaameedsado HER2 ayaa la ansaxiyay. Dawadani waa Herceptin (trastuzumab).
Laga soo bilaabo waqtigaa kale HER2 waxaa lagu heley daaweyn.
Perjeta (pertuzumab) iyo T-DM1 (trastuzumab emtansine) ayaa sidoo kale la ansixiyay.
Sannadkii 2017, dawada Nerlynx (neratinib) ayaa sidoo kale la ansixiyey dadka qaba cudurka kansarka naasaha ee HER2-positive ka dib markii la daweeyay Herceptin. Marka neratinib (tyrosine kinase inhibitor) lagu daro daaweynta caadiga ah ee kansarka naasaha ee daraasadda 2016, heerka jawaabaha buuxa ayaa ka sarreeya dadka lagu daaweeyo Herceptin iyo daaweynta caadiga ah.
Tykerb (lapatinib) waa tinosi kinase kale oo loo isticmaalo daaweynta ka dib markii lagu daaweeyo Herceptin ama daaweyn kale HER2.
Daaweynta Marxaladaha Hore
Daaweynta marxaladda hore ee kansarka naasaha ee HER2-ku waa isku mid ah kansarka naasaha HER2-negative, laakiin badanaa waxa kale oo ka mid ah isticmaalka daroogada HER2 ah sida Herceptin.
Fursadaha waxaa ka mid ah:
- Qaliinka: Labadaba lumpektomi ama mastektomi ayaa inta badan lagu taliyaa in laga saaro burooyinka. Haddii buro waa DCIS (marxaladda 0) ama haddii uu leeyahay astaamo hidde ah (tijaabo hidaha ah si loo ogaado halista soo noqoshada), daaweyn dheeraad ah ayaa loo baahan karaa. Kantaroolka weyn, iyo gaar ahaan kuwa leh qanjidhada firfircoon , daaweynta daaweynta ayaa inta badan lagula taliyaa.
- Daaweynta Hormooniga: Haddii buro waa sidoo kale daaweynta hormoonka estrogen , daaweynta hoormoonka waxaa badanaa lagula taliyaa (ka dib kiimiko ku daaweynta kuwa kuwaas oo iyaguna yeelan kara kiimiko daaweyn ah). Dumarka hormoodka ah, doorashada ugu horreysa badi waa tamoxifen, iyada oo aromatase xannibaadayaasha lagula taliyay haweenka uurka leh ee postmenopausal. Haddii kale, daaweynta xakameynta ugxan-sidaha, ugxan-sidaha ugxan-la'aanta, ama dhif-dhifka ah, ugxan-diiseed ayaa lagu talin karaa haweenka premenopausal-ka si loo yareeyo heerarka estrogen iyo in loo oggolaado isticmaalka aromatase inhibitoro.
- Chemotherapy: Iyadoo ku xiran marxaladda kansarka naasaha, xajmiga, haddii uu ku lug lahaanayo limfa noode, iyo baaritaanka hiddaha, daaweynta kiimikada ee daaweynta ayaa lagu talin karaa. Tani waxay badanaa bilaabmaysaa qiyaastii hal bil ka dib lumpectomy ama mastektomi waxaana la sameeyaa muddo afar ilaa lix bilood ah.
- HER2 Tilmaamaha Dabiiciga ah: Sida kor ku xusan, hadda waxaa jira dhowr fursadood oo loogu talagalay daaweynta la beegsado ee burooyinka naasaha HER2-positive, oo ay ku jiraan Herceptin (trastuzumab), Perjeta (pertuzumab), iyo T-DM1 (trastuzumab emtansine), daawooyinka kale ee lagu qiimeeyo daaweynta tijaabooyin. Inta badan, Herceptin waxaa loo isticmaalaa marka hore. Tykerb (lapatinib) waa tiirosiin kinase inhibitor ah oo waxtar u leh HER2 burooyinka muuqda. Nelynx (neratinib), kalkaaliye kinase kale, ayaa sidoo kale dhowaan loo ansixiyey daaweynta hore ee kansarka naasaha HER2-positive ka dib markii lagu daaweeyo Herceptin.
- Daweynta shucaacu: Dadka loogu talagalay lumpektomi, daaweynta shucaaca waxaa badanaa lagu taliyaa qalliinka ka dib. Kantaroolka leh afarta ama kabadan qanjidhada wanaagsan, daaweynta shucaaca ka dib mastektomi badanaa waa la tixgeliyaa. Tumors leh hal illaa saddex sedex qumman oo qumman ayaa ku jira aag caan ah, waana muhiim inaad la hadasho labadaba dhakhtarkaaga kansarka iyo sheybaarka shucaaca ee ku saabsan faa'iidooyinka suurtagalka ah ee daaweynta.
- Dhibaatooyinka Clinical: Waxaa jira tijaabo caafimaad oo badan oo la socda eegida qaliinka kala duwan, daaweynta kiimikada, iyo fursadaha daweynta shucaaca, iyo sidoo kale isbarbardhigida daaweynta hormoonada ah ee HER2 iyo HER2. Waxaa jira khuraafaad badan oo ku saabsan tijaabooyinka kiliinikada , mararka qaarkood tijaabo caafimaad ayaa bixiya fursada ugu fiican ee daaweynta. Waa muhiim inaad la hadasho dhakhtarkaaga kansarka oo ku saabsan tijaabo kasta oo caafimaad oo kugu habboon.
- Daawooyinka isbeddelinta lafaha: Dhawaan, dheeriga daaweynta bisphosphonate ayaa loo tixgeliyey heerka hore ee kansarka naasaha maxaa yeelay waxay yareyn kartaa khatarta lafaha lafaha ee mustaqbalka. Kala hadal suuxdintaada ku saabsan suurtogalnimada.
Daaweynta Marxaladaha Heerka Sare
Marka la eego qiyaasta 4 (kansarka naasaha), kansarka naasaha, daaweynta nidaamsan ee xakamaynta cudurka ayaa badanaa ah ujeeddada daaweynta. Qalitaanka iyo daaweynta shucaaca waxaa loo tixgeliyaa daaweynta maxalliga ah mana badanaa la isticmaalo marka laga reebo ujeedooyinka ujeedada leh (si loo yareeyo xanuunka iyo / ama ka hortagga jabka).
Haddii kiniiniga naasaha ee HER2-naas-nuujinta uu yahay kansar naas-nuujin ah oo soo noqnoqda oo ah kansarka naasaha ee hore, waa muhiim in la ogaado in xaaladda HER2 (iyo sidoo kale xaaladda qiyaasta estrogen) ay isbedeli karto. Baadhitaanka baakteeriyada metastasis iyo soo celinta daraasadaha aqbalaadda ayaa badanaa lagu taliyaa. Buro oo hore ahayd HER2 positive waxay noqon kartaa HER2 negative ka dib soo noqoshada iyo sida kale.
Daaweynta safka hore ee kansarka naas-nuujinta HER2-positive waxay ku xirnaan doontaa daraasadahan. Kuwa loogu talagalay HER2 wax ku ool ah, mid ka mid ah HER2 dabiiciga ah ayaa loo isticmaalaa sida caadiga ah. Haddii buro sidoo kale waa xajiinta hormoonka estrogen, labada daaweyn hormoon, HER2 daaweyn, ama labadaba waa la tixgelin karaa. Chemotherapy waxaa sidoo kale loo isticmaali karaa dhowr bilood.
Waxaa muhiim ah in la ogaado in hadafka daaweynta kansarka naasuhu ay badanaa ka duwan tahay tan koowaad ee kansarka naasaha, taas oo ah daaweynta yar ee suurtogalka ah si loo xakameeyo cudurka sida caadiga ah lagu taliyo.
Haddii buro hore loo daaweeyay Herceptin (trastuzumab) oo ku yaala goobta daaweynta, ka dib marka la bilaabo isbeddel bilaa daaweyn ah (oo lagu qiyaaso dhamaadka daaweynta trastuzumab) ee ka yar lix bilood daaweynta daaweynta labaad ee caadiga ah caadi ahaan T-DM1 (ado -trastansumab emtansine). Haddii kale, haddii burka horey loo daaweeyay Herceptin oo ku yaal goobta xaalada, ka dib markii loo baahdo mudo lix bilood ah Perjeta (pertuzumab) oo lagu daro trastuzumab iyo taxane ayaa loo isticmaali karaa.
Wixii bukaan ah oo horumara ka dib marka loo eego trastuzumab iyo taxane ah goobta hawada sare, T-DM1 waa doorasho la door bidayo. Bukaannada aan hore loo daaweynin Herceptin, isku dhafka Herceptin iyo Perjeta oo lagu daray taxane waa in la isticmaalo.
Haddii kansarku uu sii kordhay inkastoo daaweynadan, isku-darka Tykerb (lapatinib) iyo Xeloda (capecitabine) ayaa la isku dayi karaa. Noocyada kale ee kemotherabi ama daaweynta hoormoonka ayaa sidoo kale laga yaabaa in la isku dayo.
HER2 kansarka naasaha ee hagaagsan waxay u badan tahay inuu ku faafo maskaxda iyo beerka marka loo eego HER2 burooyinka taban. Nasiib wanaag, Herceptin, iyo malaha Perjeta waxay u muuqanaysaa inay ka gudubto xuddunta dhiiga maskaxda waxayna yareysaa cabbirka maskaxda maskaxda. Dadka qaba lafaha lafaha, daawooyinka isbeddelka lafaha sida befosphonates waxay yareyn karaan halista jabka ama waxay kaloo hagaajin kartaa badbaadada.
Daaweynta Integrative
Dad badan ayaa weydiiya suurtogalnimada daaweyn kale marka la ogaado kansarka naasaha. Waqtigan xaadirka ah, ma jiraan wax daaweyn ah oo "alternative" ah oo laga heley daaweyn kansarka naasaha. Taa baddalkeeda, dadka qaarkood ayaa doortay daaweyntan inay ka baxaan daaweynta dabiiciga ah ayaa ka lumay daawooyinka lagu muujiyay in ay wax ku ool yihiin.
Laakiin waxaa muhiim ah in aan ilmaha la saarin biyaha qubayska. Waxaa jira dhowr daaweyn isku dhafan oo loogu talagalay kansarka laga helay in laga caawiyo dadka inay la qabsadaan calaamadaha cudurada iyo daaweynta kansarka, oo ay ka mid yihiin daal iyo walwal si lallabbo, xuubka nullopathy , iyo intaa ka badan. Qaar ka mid ah daawooyinka lagu barto dumarka qaba kansarka naasuhu waxaa ka mid ah yoga , fekerka , daaweynta duugista , iyo qashinka .
Saadaasha
HER2 ka hor intaan la daaweynin daaweynta, ma jirin daaweyn gaar ah oo loogu talagalay HER2 burooyinka waxtar leh, kuwanna waxaa loo tixgeliyey kansarrada gardarrada. Hadafka daaweynta la beegsanayo, si kastaba ha ahaatee, tan ayaa isbedeshay.
Daraasad cilmi baaris ah oo lagu ogaaday 2017 ayaa lagu ogaaday in haweenka qaba kansarka naasaha 'HER2' ee kansarka naasuhu ay ka sareeyaan heerka dumarka HER2 negative markii daaweynta Herceptin la isticmaalay. Sicirada ugu hooseysa ee loo noolaado waxay u muuqdaan kuwo dumarka qaba kansarka naasaha saddex geesoodka ah.
Helitaanka Taageerada
Nasiib wanaag, wacyi galinta korodhka iyo maalgelinta kansarka naasuhu waxay kordhisay ilo dhaqaale oo badan si loogu caawiyo dadka inay la tacaalaan cudurka. Kooxaha taageerada iyo bulshooyinka taageerada ah ayaa diyaar u ah haweenka qaba kansarka naasaha guud ahaan, iyo sidoo kale kuwa si gaar ah ula tacaalaya kansarka faafa. Bulshada online iyo xitaa kooxaha Facebook ee dadka qaba HER2-positive kansarka naasaha ayaa isu soo ururay iyaga oo la kulma caqabado gaar ah.
Ka qaybqaadashada warbaahinta bulshada ayaa ah ilaha taageerada iyo waxbarashada dad badan oo qaba cudurka. Si kastaba ha ahaatee, haddii aad dooratid inaad ka qayb qaadato habkan, si kastaba ha ahaatee, qaado waqti aad ku barato sida loo wadaagayo safarkaaga internetka si badbaado leh.
Internetku waa meel weyn oo mararka qaarkood way adagtahay in la helo dadka raadinaya safar isku mid ah oo adiga kugu habboon. Si loola xiriiro dadka kale ee la nool, ama daaweynaya, kansarka naasaha, iyadoo la adeegsanayo ishtag #BCSM waa mid waxtar leh. BCSM waxay u taagan tahay warbaahinta bulshada ee kansarka naasaha.
Ereyga
Waagii hore, kansarka naasaha HER2-positive ayaa loo arkaa in uu yahay buro gardarro leh iyada oo aan la helin wax daaweyn gaar ah oo la heli karo. Taas oo dhan isbeddelay 1998-kii iyada oo la ansixiyey HER2 daaweynta ugu horreysa, Herceptin. Tan iyo wakhtigaas, daawooyinka kale ayaa la heli karaa oo ay ka mid yihiin Perjeta, T-DM1, lapatinib, iyo dhowaanahan neratinib, daawooyinka kale ee lagu qiimeeyo tijaabooyinka caafimaadka. HER2 daaweynta la beegsado ayaa labadoodaba yareyn kara khatarta soo noqoshada marxaladda hore ee HER2-kaankarada naasaha ee nafta iyo kor u qaadista heerka badbaadada ee kansarka naasaha ee HER2-positive.
Kansarrada naasaha ee HER2, daaweynta kansarka naasaha HER2-ga ayaa sidoo kale ka mid ah daaweynta HER2 negative disease sida qalliinka, daaweynta hoormoonka (marka lagu dabaqi karo), daaweynta kiimikada, daaweynta shucaaca, daaweynta qaasa ee metastases, iyo suurtagalnimada tijaabooyinka kiliinikada .
> Ilo:
> Chan, A., Delaloge, S., Holmes, F. et al. Neratinib Ka dib marka la daaweeyo daaweynta xanuunka loo yaqaan 'Trastuzumab-based Adjuvant Therapy' ee bukaanka qaba HER2-Kansarka Naasaha (ExteNET): Multicentre, Randomized, Double-Blind, Marxaladda Maaraynta Wajiga 3 Xilliga. Lancet Oncology . 17 (3): 367-77.
> Kast, K., Schoffer, O., Link, T. et al. Trastuzumab iyo Badbaadinta bukaanka qaba Kansarka Naasaha Naaska. Archives ee dumarka iyo umulisooyinka . 2017. 296 (2): 303-312.
> Park, J., Liu, M., Yee, D. et al. Nidaamka Iskudhinta ee Neratinib ee Kansarka Naasaha. Wargeyska New England Journal of Medicine . 2016. 375 (1): 11-22.