Uterine cancer
Maererano neshumo ichangoburwa kubva kuUS Centers for Disease Control and Prevention (CDC), huwandu hweanenge ese cancers hwadzikira mumakumi maviri emakore apfuura, nepo chiitiko chegomarara rechibereko chakakwira. Vanachiremba vakatanga kutarisisa mamiriro ezvinhu aya uye vakayeuchidza vakadzi kuti vateerere kune akati wandei nyaya dzechirwere ichi.
Mhando dzekenza yechibereko
Gomarara rechibereko rinoreva chero kenza inotangira muchibereko. Zvinoenderana nezviverengero kubva kuAmerican Cancer Society (ACS), zvinopfuura makumi mapfumbamwe kubva muzana zvegomarara remudumbu rinoitika mu "endometrium", inonzi "endometrial cancer".
Imwe mhando yekenza yechibereko ndeye uterine sarcoma. Rudzi urwu rwegomarara rwunoumbwa mumhasuru uye nyama inobatanidza yechibereko uye haina kujairika-chete ingangoita 4% yezviitiko zvese zvecancer yechibereko.
Njodzi zvinhu zvecancer yechibereko
Kubva 1999 kusvika 2016, chiitiko chekenza nyowani yechibereko chakawedzera ne0.7% pagore, kuwedzera kwe12% panguva yekudzidza. Huwandu hwevakafa hwakawedzerawo ne1.1% pagore, kana kuwedzera kwese kwe21%, zvakapetwa kaviri. Zvinonyanya kukonzera njodzi ndeizvi:
Vakadzi veCaucasian uye vatema vane njodzi dzakakwirisa kupfuura maAsia neSpanish
Vakadzi vakafutisa vakafutisa kana vakafutisa vane mikana miviri kana mina yekukura kenza yemendometriya kupfuura vakadzi vane huremu hwakasimba. (Adipose tishu inoburitsa isina kujairika mazinga eestrogen, iyo inomutsa kenza-inonzwisisa kenza.)
Vakadzi mushure memakore makumi mashanu nemashanu ekuberekwa ndivo vari panjodzi zvakanyanya. Vakadzi vemuPresmenopausal havawanzo gadzira endometrial cancer, ndosaka vakadzi vazhinji vachionekwa vari muchikamu chekutanga-nekuti vakadzi ava vakatopfuura panguva yekuguma kuenda kumwedzi, pavanotanga kuve nekubuda kwepingi kana kubuda kweropa zvisina kujairika kunokonzeresa kutariswa.
Nguva dzekuenda kumwedzi zvisina kujairika dzinogona kutungamira mukuwandisa kwesrogen mumuviri, zvichikonzera kuti maseru ari muchibereko atadze kutonga.
Mhando dzekenza yechibereko
Gomarara rechibereko rinoreva chero kenza inotangira muchibereko. Zvinoenderana nezviverengero kubva kuAmerican Cancer Society (ACS), zvinopfuura makumi mapfumbamwe kubva muzana zvegomarara remudumbu rinoitika mu "endometrium", inonzi "endometrial cancer".
Imwe mhando yekenza yechibereko ndeye uterine sarcoma. Rudzi urwu rwegomarara rwunoumbwa mumhasuru uye nyama inobatanidza yechibereko uye haina kujairika-chete ingangoita 4% yezviitiko zvese zvecancer yechibereko.
Kuongororwa uye kufungidzira kwechirwere chechibereko
Kazhinji kenza dzechibereko dzine fungidziro yakanaka. Zvinoenderana neUS Centers for Disease Control and Prevention, inofungidzirwa makore mashanu ekupona kwehukama iri 80% kusvika 90%. Nekuti kenza yechibereko inowanzoonekwa ichikurumidza, zviratidzo zvaro zvakajairika ndezvekubuda ropa zvisina kujairika pamberi uye mushure mekuguma kuenda kumwedzi, kuonda uye kurwadziwa kwepamuviri.
Mapiritsi ekudzivirira kuberekwa uye mahormone maIUD ane progesterone, inogona kupokana neestrogen yakawandisa mumuviri.
Imwe yedzakakura uye dzakareba-nguva dzedzidzo dzakaburitswa muAmerican Journal yeObstetrics neGynecology muna2017 yakaona kuti njodzi yekutora mapiritsi ekudzivirira kubereka uye kenza yemendometri yakaderedzwa neinosvika 33%. Izvi zvakare zvine chekuita nekuderedza njodzi yeovarian uye colorectal cancer.
Kurapa sarudzo yekenza yechibereko
Kuvhiya kwekenza yechibereko
Kuvhiya kazhinji ndiko kurapwa kukuru kwegomarara reendometrial, kusanganisira hysterectomy, kazhinji inoperekedzwa ne fallopian chubhu ovectomy uye lymph node dissection. Mune zvimwe zviitiko, kugeza pelvic, kubvisa omentum, uye / kana peritoneal biopsy inoitwa. Kana gomarara rapararira kuchiuno chese nedumbu (dumbu), kuvhiyiwa kwekudzikisa bundu (kubvisa kenza yakawanda sezvinobvira) kunogona kuitwa.
Radiotherapy yekenza yechibereko
Kurapa kwemwaranzi kunoshandisa mwaranzi ine simba guru (senge X-rays) kuuraya maseru egomarara. Inogona kurapa endometrial cancer nenzira mbiri:
Isa radioactive zvinhu mumuviri. Izvi zvinonzi internal radiation therapy kana brachytherapy.
Nekushandisa X-ray radiotherapy michina yakadai seradiographic banga, linear accelerator, Tomo banga, nezvimwewo, kana mamiriro ehupfumi achibvumidza, unogona zvakare kusarudza yakanyatsorongeka proton radiotherapy ine mashoma mhedzisiro. 7998).
Kurapwa
Chemotherapy (chemo) kushandiswa kwemishonga kuuraya masero egomarara. Kurapa kunoitwa netsinga kana nemuromo. Tevera ropa uye pinda muviri wese. Nokudaro, kana kenza ye endometrial yapararira kupfuura endometrium uye kuvhiyiwa hakugoneki, chemotherapy ndiyo inonyanya kurapa.
Chemotherapy zvinodhaka izvozvi zvinoshandiswa kurapa kenza yemendometri:
Paclitaxel (Taxol®)
· Carboplatin
· Doxorubicin kana liposomal doxorubicin
· Cisplatin
· Docetaxel
Kana iri sarcoma, ifosfamide (IFEX ®) inowanzo shandiswa senhengo imwe chete kana necisplatin kana paclitaxel. Targeted drug trastuzumab (Herceptin®) inogona kuwedzerwa kune HER2-yakanaka uterine sarcoma. (HER2 ipuroteni inogona kubatsira mamwe maseru egomarara kukura nekupararira nekukurumidza.)
Hormone therapy
Iyo inowanzo shandiswa kurapa yemhando yepamusoro (nhanho III kana IV) kana kudzoka kenza yemendometri uye inowanzo shandiswa nekemotherapy. Hormonal therapy inosanganisira:
Progesterone (Iyi ndiyo hormone therapy inoshandiswa.)
· Tamoxifen
Luteinizing mahormone-anoburitsa mahormoni (LHRH agonist)
· Aromatase inhibitors (AI)
Parizvino, hapana kurapwa kwehomoni kwakawanikwa kuve kwakanakisa kenza yemendometri.
Targeted therapy
Parizvino, vashoma chete tarisiro yekurapa inogona kushandiswa kenza yemendometri, kunyanya pakurapa gomarara remakemikari ekupedzisira uye metastasis kana kudzoka.
Bevacizumab
Bevacizumab (Avastin®) inonzi angiogenesis inhibitor. Kenza kukura uye kupararira kunoda kugadzirwa kwemidzi mitsva yeropa kuti vazvidye ivo (maitiro eangiogenesis). Mushonga unonamira kune protein inonzi VEGF (inoratidza kuumbwa kwemidzi mitsva yeropa) uye inononoka kana kudzivirira kukura kwegomarara.
Bevacizumab inowanzo kupihwa nekemotherapy, kana inogona kupihwa yega. Ipa mukati mekubaya mukati memavhiki maviri kusvika matatu.
mTOR inhibitor
Iyi mishonga inovhara mTOR maseru mapuroteni, ayo anowanzo batsira masero kukura nekukamurwa kuita maseru matsva. Inogona kupihwa yega kana nekemotherapy kana kurapwa kwehomoni yekurapa yakakwira kana inowanzoitika kenza yemendometri. Parizvino inogamuchirwa ndeye everolimus (Afinitor®) uye tansimolimus (TORISEL®).
Ikozvino kukura kwechirwere chechibereko
- Avelumab (Bavincia monoclonal antibody) inosanganiswa ne talazoparib (tarazopanib)
Muedzo unotungamirwa naKonstantinopoulos wakashandisa immune checkpoint inhibitor avelumab pamwe neIPARP inhibitor talazoparib. (Checkpoint inhibitors inojekesa nzira yekuti immune system irwise cancer; PARP inhibitors inoparadza maseru ekenza nekukanganisa kugona kwavo kugadzirisa DNA yakanganisika.) Mukuyedza kwakapfuura, avelumab yaive Varwere vane gomarara "risina kugadzikana" endometrial inoshanda, asi inonyanya isingashande mune yakajairika "microsatellite st
anokwanisa ”(MSS) chimiro chechirwere. Muedzo unozoongorora kuti kusanganisa avelumab neIPARP inhibitors kunonyanya kushanda kuvarwere vane chirwere cheMSS.
2. Pembrolizumab (pabolizumab) yakasanganiswa nemirvetuximab
Muedzo unobatanidza checkpoint inhibitor pembrolizumab ne mirvetuximab. (Pembrolizumab inonangana neprotein yeimmune yekuongorora inonzi PD-1; mirvetuximab inowedzera masoja ekudzivirira chirwere kumamorekuru ezvinodhaka anonangana nezvikamu zvakakosha mumasero egomarara anokurumidza kupatsanura.) Muedzo, wakatungamirwa naJennifer Veneris, MD, weGynecologic Oncology Project, uchaongorora musanganiswa Kubudirira. muvarwere vane MSS endometrial cancer.
3. abemaciclib + LY3023414 + hormone therapy
Imwe muyedzo inotungamirwa naKonstantinopoulos ichaedza musanganiswa wezvinotarisirwa zvinodhaka abemaciclib + LY3023414 + hormone therapy. (LY3023414 inokonzeresa enzyme yesero yekenza inonzi PI 3 kinase; abemaciclib inopindira nhanho yakakomba yesero kutenderera.) 70% kusvika 90% yekenza yemendometri inodyiswa neestrogen, kutanga ichipindura kuhormone ichivharira kurapwa, asi pakupedzisira kudzokazve. Nekuwedzera abemaciclib uye LY3023414 (vanogona kubata zvikamu zviviri zveiyo imwechete mamorekuru nzira) yehormoni inodzivirira kurapwa, vaongorori vanotarisira kukunda dambudziko rekurwisa zvinodhaka.
4. AZD1775
Chiyedzo chakatungamirwa naJoyce Liu, MD, PHD, Director weKiriniki Yekutsvagisa, Dana-Farber Gynecologic Oncology, yakashandisa AZD1775 yevarwere vane yakakwira-giredhi serous cancer kenza iyo yakaita 10-15% yekenza yemendometri. Gomarara rakadai rine hukasha uye rinowanzo dzoka mushure mekurapwa kwakajairika. Iyo ichangobva kuvhurwa kutongwa yakavakirwa pachidzidzo chakatungamirwa naDr Liu naUrsula Matulonis, director weDana-Farber department reGynecologic Oncology, zvichiratidza kuti AZD1775 iri kushanda mune yemurwere modhi ine yakakwira-giredhi serous ovarian kenza.
5. dostarlimab (TSR-042)
Mhedzisiro yemuyedzo wePhase I / II GARNET ichangobva kuburitswa, uye huwandu hunoshanda hwePD-1 inhibitor dostarlimab (TSR-042) kune varwere vane kenza yekudzokazve kana yepamusoro endometrial iri pedyo ne30%.
Uye zvakare, ese ari maviri microsatellite kukwirira kusagadzikana (MSI-H) uye microsatellite kugadzikana (MSS) mapoka anoramba aripo.
Dostarlimab (TSR-042) inorwisa anti-PD-1 monoclonal antibody yakabatana neTESARO uye AnaptysBio. Iyo inosunga kune iyo PD-1 receptor nehukama hwakakwira, nokudaro ichivharira kusunga kwayo kune PD-L1 uye PD-L2 ligands.
Mhedzisiro yacho yakaratidza kuti mwero unoshanda wehuwandu hwevanhu hwese hwaive 29.6%, chiyero chinoshanda cheboka revarwere veMSI-H chaive 48.8%, uye chiyero chinoshanda muboka reMSS chaive 20.3%. Varwere vatanhatu (2 MSI-H uye 4 MSS) vakaregererwa zvakakwana.
Mushure mekuteedzana kwepakati pemwedzi gumi, 10% yevarwere vakagamuchira kurapwa> mwedzi mitanhatu, uye 89% yevarwere vakagamuchira kurapwa kwe> 6 gore. Uye zvakare, 49% yevarwere vane kurapwa kwakanaka vachiri kugamuchira kurapwa.
Chekupedzisira, muna 85% yevapinduri veMSI-H, iyo yakazara bundu mutoro yakadzikira ne ≥50%, uye 69% yevarwere vane MSS vaive nehuremu hwese mutoro kudzora kwe ≥50%.
Dostarlimab ndiyo tariro nyowani yekurapa kenza ye endometrium uye inogona kutsiva pembrolizumab, nekuti pembrolizumab inoshanda chete mune varwere vane MSI-H, uye Dostarlimab haidi kutariswa.
Vatsvakurudzi vachatanga zvimwe zvidzidzo zvechitatu muhafu yepiri ye2019. Dostarlimab uye chemotherapy ichasanganiswa neyekutanga-kurapwa kurapwa kwekenza yemendometri. Tinotarisira kuwana mibairo inovimbisa munguva pfupi!
Chiyedzo chega chega chinogadzirisa kusakwana kwekurapa kwakajairwa kana matambudziko anowanikwa mukuyedza kutsva kwezvinodhaka. Semuenzaniso, miedzo miviri yekutanga yakanangana nekukunda mamiriro aripo ehurombo immunotherapy muvarwere vane MSS chirwere. Yechitatu inogadzirisa dambudziko rekupokana nehomoni kurapwa, uye yechina inotarisa chaiwo subtypes endothelial cancer.
Zvizhinji pane yazvino kufambira mberi kwekutsvagisa uye chirongwa chakanakisa chemushonga wekenza yemapapu, chete ivo vepamusoro gomarara nyanzvi kumba nekune dzimwe nyika vane hupfumi hwekurapa Iwe unogona kunyorera kubvunzurudza neane masimba masimba kuburikidza neGlobal Oncologist Network kuti uwane yakanakisa kuongororwa uye chirongwa chekurapa.
Kazhinji kenza dzechibereko dzine fungidziro yakanaka. Zvinoenderana neUS Centers for Disease Control and Prevention, inofungidzirwa makore mashanu ekupona kwehukama iri 80% kusvika 90%. Nekuti kenza yechibereko inowanzoonekwa ichikurumidza, zviratidzo zvaro zvakajairika ndezvekubuda ropa zvisina kujairika pamberi uye mushure mekuguma kuenda kumwedzi, kuonda uye kurwadziwa kwepamuviri.
Mapiritsi ekudzivirira kuberekwa uye mahormone maIUD ane progesterone, inogona kupokana neestrogen yakawandisa mumuviri.
Imwe yedzakakura uye dzakareba-nguva dzedzidzo dzakaburitswa muAmerican Journal yeObstetrics neGynecology muna2017 yakaona kuti njodzi yekutora mapiritsi ekudzivirira kubereka uye kenza yemendometri yakaderedzwa neinosvika 33%. Izvi zvakare zvine chekuita nekuderedza njodzi yeovarian uye colorectal cancer.
