Ciwon mahaifa
A cewar sabon rahoto daga cibiyar yaki da cututtukan Amurka (CDC), lamarin kusan dukkanin cututtukan daji ya ragu a cikin shekaru ashirin da suka gabata, yayin da cutar kansa ta mahaifa ta tashi. Doctors sun fara ba da hankali ga wannan halin kuma sun tunatar da mata da su mai da hankali ga mahimman batutuwan wannan cuta.
Nau'oin cutar sankarar mahaifa
Ciwon mahaifa na nufin duk wata cutar daji da ta fara a cikin mahaifa. Dangane da ƙididdiga daga Canungiyar Cancer ta Amurka (ACS), fiye da 90% na cututtukan mahaifa na faruwa a cikin endometrium, wanda ake kira endometrial cancer.
Wani nau'in cutar sankarar mahaifa shine sarcoma na mahaifa. Wannan nau'in ciwon daji an kirkireshi ne a cikin tsokoki da kayan mahada na mahaifa kuma ba kasafai ake samunsu ba-kusan kashi 4 cikin XNUMX na dukkan cutar kansa ta mahaifa.
Dalilai masu hadari don cutar sankarar mahaifa
Daga 1999 zuwa 2016, yawan cutar sankarar mahaifa ta karu da kashi 0.7% a kowace shekara, karuwar kashi 12% bisa lokacin karatu. Yawan mace-mace kuma ya karu da 1.1% a shekara, ko kuma ƙarin ƙaruwa na 21%, kusan ninki biyu. Babban dalilan haɗarin sune:
Matan Caucasian da baƙar fata suna da haɗari sosai fiye da Asians da Hispanic
Mata masu kiba wadanda suke da kiba ko masu kiba sun fi sau biyu zuwa sau huɗu kan iya kamuwa da cutar kansa ta endometrial fiye da matan da ke da ƙoshin lafiya. (Adipose nama yana haifar da matakan mahaukacin estrogen, wanda ke haifar da cutar kansa mai saurin kamawa.)
Mata bayan shekaru 55 suna cikin haɗari. Matan da ba su yi aure ba yawanci ba sa kamuwa da cutar kansa ta endometrial, wannan shi ya sa yawancin mata ake kamuwa da su a mataki na 1-saboda waɗannan mata sun riga sun gama yin al'ada, lokacin da suka fara samun ruwan hoda ko zubar jini mara kyau zai haifar da hankali.
Halin al'ada na al'ada ba zai iya haifar da yaduwar isrogen a cikin jiki, wanda zai haifar da ƙwayoyin da ke cikin mahaifa su rasa iko.
Nau'oin cutar sankarar mahaifa
Ciwon mahaifa na nufin duk wata cutar daji da ta fara a cikin mahaifa. Dangane da ƙididdiga daga Canungiyar Cancer ta Amurka (ACS), fiye da 90% na cututtukan mahaifa na faruwa a cikin endometrium, wanda ake kira endometrial cancer.
Wani nau'in cutar sankarar mahaifa shine sarcoma na mahaifa. Wannan nau'in ciwon daji an kirkireshi ne a cikin tsokoki da kayan mahada na mahaifa kuma ba kasafai ake samunsu ba-kusan kashi 4 cikin XNUMX na dukkan cutar kansa ta mahaifa.
Bincike da hangen nesa na cutar sankarar mahaifa
Yawancin cututtukan daji na mahaifa suna da kyakkyawan hangen nesa. A cewar Cibiyoyin Kula da Rigakafin Cututtuka na Amurka, kimanin shekaru biyar na dangin rayuwa ya kai 80% zuwa 90%. Saboda yawanci ana iya gano kansar mahaifa da wuri, mafi alamun alamun ita ce zub da jini ba na al'ada ba kafin da bayan gama al'ada, rage nauyi da ciwan ciki.
Magungunan hana haihuwa da kuma IUDs suna dauke da progesterone, wanda zai iya magance estrogen mai yawa a jiki.
Ofaya daga cikin mafi girma da dogon lokacin karatu da aka buga a cikin American Journal of Obstetrics and Gynecology in 2017 ya gano cewa haɗarin shan kwayoyin hana haihuwa da kansar endometrial ya ragu da kusan 33%. Wannan ma yana da alaƙa da rage haɗarin kwan mace da sankarau.
Zaɓuɓɓukan magani don ciwon mahaifa
Yin tiyata don cutar sankarar mahaifa
Surgery is usually the main treatment for endometrial cancer, including hysterectomy, usually accompanied by fallopian tube ovectomy and lymph node dissection. In some cases, pelvic washing, omentum removal, and / or peritoneal biopsy are performed. If the cancer has spread to the entire pelvis and abdomen (abdomen), tumo reduction surgery (removing as much cancer as possible) can be performed.
Radiotherapy don cutar mahaifa
Radiation therapy uses high-energy radiation (such as Harkokin X) to kill cancer cells. It can treat endometrial cancer in two ways:
Saka kayan aikin rediyo a cikin jiki. Wannan shi ake kira na ciki radiation far ko farfadowa.
Ta amfani da kayan aikin rediyo na X-ray kamar wuka mai hoto, mai saurin layi, wuka Tomo, da sauransu, idan yanayin tattalin arziki ya ba da izini, zaku iya zaɓar ƙarin ingantaccen aikin rediyo na proton tare da ƙarancin illa. 7998).
jiyyar cutar sankara
Chemotherapy (chemo) shine amfani da kwayoyi don kashe kwayoyin cutar kansa. Jiyya na cikin jijiya ko ta baki. Bi jinin kuma shiga cikin jiki duka. Saboda haka, lokacin da ciwon daji na endometrial ya yadu fiye da endometrium kuma tiyata ba zai yiwu ba, chemotherapy shine babban magani.
Chemotherapy magunguna a halin yanzu ana amfani dasu don magance ciwon daji na endometrial:
Paclitaxel (Taxol®)
· Carboplatin
· Doxorubicin ko liposomal doxorubicin
· Ciki
· Docetaxel
Idan sarcoma ne, ifosfamide (IFEX ®) yawanci ana amfani dashi azaman wakili ɗaya ko tare da cisplatin ko paclitaxel. Za'a iya ƙara trastuzumab da aka niyya (Herceptin®) don HER2-sarcoma mai kyau na mahaifa. (HER2 furotin ne wanda zai iya taimaka wa wasu ƙwayoyin cutar kansa girma da yaɗuwa da sauri.)
Hormone far
An fi amfani da shi don magance ci gaba (mataki na III ko na IV) ko sake dawo da ciwon daji na ƙarshe kuma yawanci ana amfani da shi tare da chemotherapy. Hormonal far ya hada da:
Progesterone (Wannan shine babban maganin hormone da ake amfani dashi.)
· Tamoxifen
· Luteinizing hormone-sakewa agonist (LHRH agonist)
· Masu hana aromatase (AIs)
A halin yanzu, babu wani maganin maganin hormone da aka gano ya zama mafi kyau ga cutar kansa ta endometrial.
Farfesa da aka tsara
A halin yanzu, kawai therapyan maganin da aka yi niyya za a iya amfani da shi don cutar kansa ta endometrial, galibi don maganin mummunan cututtukan endometrial da metastasis ko sake dawowa.
Bevacizumab
Bevacizumab (Avastin®) shine mai hana angiogenesis. Ci gaban daji da yaduwa yana buƙatar ƙirƙirar sabbin jijiyoyin jini don ciyar da kansu (aikin angiogenesis). Magungunan suna haɗuwa da furotin da ake kira VEGF (yana nuna samuwar sabbin jijiyoyin jini) kuma yana jinkirta ko hana haɓakar kansa.
Ana bayar da Bevacizumab yawanci tare da chemotherapy, ko ana iya bayar da shi shi kaɗai. Bada intravenously kowane sati 2 zuwa 3.
mTOR mai hanawa
Wadannan kwayoyi suna toshe kwayoyin sunadarin mTOR, wanda yawanci yakan taimaki kwayoyi suyi girma kuma su rarraba zuwa sabbin kwayoyin halitta. Ana iya gudanar dashi shi kaɗai ko tare da chemotherapy ko maganin hormone don magance ci gaba ko maimaita cutar kansa ta ƙarshe. A halin yanzu an yarda sune everolimus (Afinitor®) da tansimolimus (TORISEL®).
Sabon cigaban cutar sankarar mahaifa
- Avelumab (Bavincia monoclonal antibody) haɗe tare da talazoparib (tarazopanib)
Gwajin da Konstantinopoulos ya jagoranta ta yi amfani da avelumab mai hana shigar rigakafi a hade tare da mai hana mai PARP talazoparib. (Masu hana ruwa gudu na binciken hanya don tsarin rigakafi su afka wa cutar kansa; masu hana PARP sun lalata kwayoyin cutar kansa ta hanyar hana su damar gyara DNA da ta lalace.) A wani gwaji da ya gabata, avelumab ya kasance Marasa lafiya tare da “rashin daidaito” kansar endometrial suna da matukar tasiri, amma suna da mahimmanci rashin aiki a cikin mafi gama gari “microsatellite st
iya ”(MSS) nau'in cutar. Gwajin zai bincika ko hada avelumab tare da masu hana PARP ya fi tasiri ga marasa lafiya da cutar ta MSS.
2. Pembrolizumab (pabolizumab) hade da mirvetuximab
Gwajin da ke haɗa mai hanawa pembrolizumab tare da mirvetuximab. (Pembrolizumab yana hari da sunadarin rigakafin rigakafi da ake kira PD-1; mirvetuximab yana ƙara ƙwayoyin rigakafi zuwa ƙwayoyin ƙwayoyi waɗanda ke yin niyya ga mahimman tsarin a cikin saurin rarraba ƙwayoyin cutar kansa.) Gwajin, wanda Jennifer Veneris, MD, ya jagoranta, na Aikin Gynecologic Oncology Project, zai bincika Haɗin Tasirin Tasirin. a cikin marasa lafiya da ciwon daji na endometrial MSS.
3. abemaciclib + LY3023414 + maganin hormone
Wani gwajin da Konstantinopoulos ya jagoranta zai gwada haɗakar magungunan abemaciclib + LY3023414 + na maganin hormone. (LY3023414 yana niyya kan enzyme din kwayar cutar kanjamau da ake kira PI 3 kinase; abemaciclib yana tsoma baki tare da wani mahimmin matakin zagayen kwayar.) Ta hanyar ƙara abemaciclib da LY70 (za su iya taɓa ɓangarori biyu na wannan hanyar kwayar halitta) don maganin toshewar hormone, masu binciken suna fatan shawo kan matsalar juriya da maganin.
4. AZD1775
Gwajin da Joyce Liu, MD, PHD, Darakta na Clinical Research, Dana-Farber Gynecologic Oncology ta jagoranta, ta yi amfani da AZD1775 ga marasa lafiya da ke fama da cutar sankarar mahaifa wanda ya kai kashi 10-15% na cutar kansa. Irin waɗannan cututtukan daji suna da rikici kuma yawanci suna dawowa bayan daidaitaccen magani. Gwajin da aka buɗe kwanan nan ya dogara ne akan binciken da Dokta Liu da Ursula Matulonis suka jagoranta, darekta na Dana-Farber Department of Gynecologic Oncology, yana nuna cewa AZD1775 yana aiki a cikin samfurin marasa lafiya tare da babban kwayar cutar sankarar jakar kwai.
5. Dostarlimab (TSR-042)
Sakamakon gwajin GARNET na Mataki na I / II kwanan nan an buga, kuma jimlar tasiri na PD-1 inhibitor dostarlimab (TSR-042) ga marasa lafiya da suka sake dawowa ko ciwon daji na endometrial yana kusa da 30%.
Bugu da kari, duka rashin karfin microsatellite mai karfi (MSI-H) da ƙungiyoyin kwanciyar hankali na microsatellite (MSS) suna ci gaba.
Dostarlimab (TSR-042) anti-PD-1 monoclonal antibody ne wanda ya haɗu tare wanda TESARO da AnaptysBio suka haɓaka. Yana ɗaure ga mai karɓar PD-1 tare da babban dangantaka, don haka yana hana ɗaurin sa zuwa PD-L1 da PD-L2 ligands.
Sakamakon ya nuna cewa yawan adadin mutanen duka ya kai 29.6%, ingancin tasiri na ƙungiyar masu haƙuri na MSI-H ya kai 48.8%, kuma ingancin tasiri a cikin ƙungiyar MSS ya kasance 20.3%. Marasa lafiya shida (2 MSI-H da 4 MSS) sun sami cikakkiyar gafartawa.
Bayan bin tsakiyar watanni 10, 89% na marasa lafiya sun sami magani> watanni 6, kuma kashi 49% na marasa lafiya sun sami magani na> shekara 1. Bugu da ƙari, 84% na marasa lafiya tare da ingantaccen magani har yanzu suna karɓar magani.
A ƙarshe, a cikin 85% na masu ba da amsa na MSI-H, jimlar nauyin tumo ya ragu da ≥50%, kuma 69% na marasa lafiya tare da MSS suna da nauyin rage yawan kumburi na ≥50%.
Dostarlimab shine sabon fata don maganin kansar endometrial kuma yana iya maye gurbin pembrolizumab, saboda pembrolizumab yana aiki ne kawai cikin marasa lafiya tare da MSI-H, kuma Dostarlimab baya buƙatar la'akari.
Masu binciken za su fara kara karatu na III a rabin na biyu na 2019. Dostarlimab da chemotherapy za a haɗasu tare da layin farko na kansar endometrial. Muna sa ran samun sakamako mai kyau nan ba da daɗewa ba!
Kowane gwaji na magance gazawar daidaitaccen magani ko matsalolin da aka samu a cikin sabbin gwajin magunguna da suka gabata. Misali, gwaji guda biyu na farko da nufin shawo kan halin talauci da ake ciki yanzu immunotherapy a cikin marasa lafiya da cutar ta MSS. Na uku yana magance matsalar juriya ga maganin hormone, kuma na huɗu yana ƙaddamar da takamaiman ƙananan ƙananan cututtukan endothelial.
Arin bayani game da ci gaban bincike na baya-bayan nan da mafi kyawun shirin shan magani don cutar sankarar huhu, kawai manyan masana kansar a gida da ƙasashen waje suna da wadataccen ƙwarewar asibiti. Kuna iya neman shawara tare da masana masu iko ta hanyar Global Oncologist Network don samun mafi kyawun ganewar asali da kuma tsarin kulawa.
Yawancin cututtukan daji na mahaifa suna da kyakkyawan hangen nesa. A cewar Cibiyoyin Kula da Rigakafin Cututtuka na Amurka, kimanin shekaru biyar na dangin rayuwa ya kai 80% zuwa 90%. Saboda yawanci ana iya gano kansar mahaifa da wuri, mafi alamun alamun ita ce zub da jini ba na al'ada ba kafin da bayan gama al'ada, rage nauyi da ciwan ciki.
Magungunan hana haihuwa da kuma IUDs suna dauke da progesterone, wanda zai iya magance estrogen mai yawa a jiki.
Ofaya daga cikin mafi girma da dogon lokacin karatu da aka buga a cikin American Journal of Obstetrics and Gynecology in 2017 ya gano cewa haɗarin shan kwayoyin hana haihuwa da kansar endometrial ya ragu da kusan 33%. Wannan ma yana da alaƙa da rage haɗarin kwan mace da sankarau.
