Kansarka kaadi mareenka
Sida lagu sheegay warbixintii ugu dambeysay ee ka soo baxday Xarumaha Xakamaynta iyo Ka-hortagga Cudurrada ee Maraykanka (CDC), dhacdooyinka ku dhowaad dhammaan kansarrada ayaa hoos u dhacay labaatankii sano ee la soo dhaafay, halka tirada kansarka ilmo-galeenka uu kor u kacay. Dhakhaatiirtu waxay bilaabeen inay fiiro gaar ah u yeeshaan xaaladdan waxayna haweenka xasuusiyeen inay fiiro gaar ah u yeeshaan dhowr arrimood oo muhiim u ah cudurkan.
Noocyada kansarka makaanka
Kansarka makaanka ayaa loola jeedaa kansar kasta oo ka bilaabma ilma -galeenka. Marka loo eego tirakoobyada Ururka Kansarka Ameerika (ACS), in ka badan 90% kansarrada makaanka ayaa ku dhaca endometrium, oo loo yaqaan kansarka endometrial.
Nooc kale oo kansarka ilmogaleenka ah waa sarcoma makaanka. Noocan kansarka ah wuxuu ka samaysmay muruqyada iyo unugyada isku xira ilmo-galeenka waana wax aan caadi ahayn-kaliya qiyaastii 4% dhammaan xaaladaha kansarka ilma-galeenka.
Waxyaabaha halista u ah kansarka makaanka
Laga soo bilaabo 1999 ilaa 2016, dhacdooyinka kansarka ilmogaleenka cusub ayaa kordhay 0.7% sanadkiiba, koror 12% ah muddada daraasadda. Heerka dhimashada ayaa sidoo kale kordhay 1.1% sanadkiiba, ama kororka guud ee 21%, oo ku dhowaad labanlaabmay. Sababaha halista ugu weyn waa:
Haweenka Caucasian iyo madow waxay leeyihiin khataro aad uga sarreeya kuwa Aasiya iyo Isbaanishka
Haweenka cayilan ee cayilan ama cayilan ayaa laba ilaa afar jeer u badan inay qaadaan kansarka endometrial marka loo eego dumarka miisaanka leh. (Cadadka adipose wuxuu soo saaraa heerar aan caadi ahayn oo ah estrogen, kaas oo kiciya kansarka xasaasiga u ah hormoonka.)
Dumarka da'doodu ka weyn tahay 55 sano ayaa halis ugu jira. Haweenka premenopausal-ka ah badiyaa kuma dhacaan kansarka endometrial, waana sababta dumarka badankooda loogu ogaado heerka 1-sababtoo ah haweenkan ayaa hore u maray caadada, markay bilaabaan inay yeeshaan dheecaan casaan ah ama dhiig-bax aan caadi ahayn ayaa keena feejignaan.
Caadooyinka caadada aan caadiga ahayn waxay u horseedi karaan wareegga xad -dhaafka ah ee estrogen ee jirka, taasoo keenta in unugyada ilma -galeenka ay xakameeyaan.
Noocyada kansarka makaanka
Kansarka makaanka ayaa loola jeedaa kansar kasta oo ka bilaabma ilma -galeenka. Marka loo eego tirakoobyada Ururka Kansarka Ameerika (ACS), in ka badan 90% kansarrada makaanka ayaa ku dhaca endometrium, oo loo yaqaan kansarka endometrial.
Nooc kale oo kansarka ilmogaleenka ah waa sarcoma makaanka. Noocan kansarka ah wuxuu ka samaysmay muruqyada iyo unugyada isku xira ilmo-galeenka waana wax aan caadi ahayn-kaliya qiyaastii 4% dhammaan xaaladaha kansarka ilma-galeenka.
Ogaanshaha iyo saadaalinta kansarka ilma -galeenka
Badi kansarrada makaanka waxay leeyihiin saadaal wanaagsan. Sida laga soo xigtay Xarumaha Xakamaynta iyo Kahortagga Cudurrada Mareykanka, qiyaasta badbaadada qaraabada ee shanta sano waa 80% ilaa 90%. Sababtoo ah kansarka ilma -galeenka sida caadiga ah goor hore ayaa la ogaan karaa, astaamihiisa caadiga ah waa dhiig -bax aan caadi ahayn ka hor iyo ka dib caadada, miisaanka oo yaraada iyo xanuunka miskaha.
Kiniinnada xakameynta dhalmada iyo hormoonka IUD waxaa ku jira progesterone, kaasoo ka hortegi kara estrogen -ka xad -dhaafka ah ee jirka.
Mid ka mid ah daraasadihii ugu waaweynaa uguna dheeraa ee lagu daabacay Joornaalka Mareeykanka ee Dhalmada iyo Dhallaanka sannadka 2017 ayaa lagu ogaaday in halista qaadashada kiniinnada xakameynta dhalmada iyo kansarka endometrial-ka la yareeyay qiyaastii 33%. Tani waxay sidoo kale la xiriirtaa yareynta halista kansarka ugxansidaha iyo malawadka.
Ikhtiyaarada daaweynta kansarka makaanka
Qalliinka kansarka makaanka
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), buro reduction surgery (removing as much cancer as possible) can be performed.
Radiotherapy ee kansarka ilmogaleenka
Radiation therapy uses high-energy radiation (such as Raajooyin) to kill cancer cells. It can treat endometrial cancer in two ways:
Geli walxaha shucaaca jirka. Tan waxaa loo yaqaan daaweynta shucaaca gudaha ama brachytherapy.
Adigoo isticmaalaya qalabka shucaaca shucaaca sida mindida shucaaca, xawaaraha toosan, mindida Tomo, iwm., haddii xaaladaha dhaqaale ay ogolaadaan, waxaad sidoo kale dooran kartaa daaweynta shucaaca proton oo sax ah oo leh waxyeelooyin yar. 7998).
Chemotherapy
Chemotherapy (chemo) waa isticmaalka daawooyinka lagu dilo unugyada kansarka. Daawadu waa xidid ama afka. Raac dhiiga oo geli jirka oo dhan. Sidaa darteed, marka kansarka endometrial uu ku faafo meel ka baxsan endometrium oo aan qaliinka suurtogal ahayn, kiimoterabiga ayaa ah daaweynta ugu weyn.
Dawooyinka kiimoteraabiga ee hadda loo isticmaalo daaweynta kansarka endometrial:
Paclitaxel (Taxol®)
· Carboplatin
· Doxorubicin ama doxorubicin liposomal
· Cisplatin
Docetaxel
Haddii ay tahay sarcoma, ifosfamide (IFEX ®) badiyaa waxaa loo isticmaalaa wakiil keliya ama cisplatin ama paclitaxel. Trastuzumab (Herceptin®) oo ah daroogada la beegsaday ayaa lagu dari karaa HER2 sarcoma uterine-positive. (HER2 waa borotiin kaa caawin kara qaar ka mid ah unugyada kansarka inay koraan oo si dhaqso ah ugu faafaan.)
Daaweynta Hormoonka
Waxaa inta badan loo isticmaalaa in lagu daweeyo heerka sare (marxaladda III ama IV) ama kansarka endometrial soo noqnoqda waxaana badiyaa loo isticmaalaa kiimoterabi. Daaweynta hormoonka waxaa ka mid ah:
Progesterone (Tani waa daawaynta hoormoonka ugu weyn ee la isticmaalo.)
Tamoxifen
· Luteinizing hormoonka sii deynaya hormoonka hormoonka (agonist LHRH)
Aromatase inhibitors (AIs)
Waqtigan xaadirka ah, ma jiro daweyn hormoon oo la ogaaday inuu ugu fiican yahay kansarka endometrial.
Daaweynta Targeted
Waqtigan xaadirka ah, kaliya dhowr daaweyn oo la beegsaday ayaa loo isticmaali karaa kansarka endometrial, badiyaa daaweynta kansarka endometrial ee halista ah iyo metastasis ama soo noqnoqoshada.
Bevacizumab
Bevacizumab (Avastin®) waa ka hortag angiogenesis ah. Koritaanka kansarka iyo faafinta waxay u baahan tahay in la abuuro xididdo dhiig oo cusub si ay nafahooda u quudiyaan (habka angiogenesis). Daroogadu waxay ku dhegtaa borotiin la yiraahdo VEGF (oo tilmaamaya sameynta xididdada dhiigga cusub) waxayna hoos u dhigtaa ama ka hortagtaa koritaanka kansarka.
Bevacizumab waxaa badanaa lagu siiyaa kiimoterabi, ama waxaa la siin karaa kaligeed. Dhiig -xidh ku sii 2 ilaa 3 toddobaad kasta.
inhibitor mTOR
Daawooyinkan ayaa xannibaya borotiinka unugyada mTOR, oo caadiyan caawiya unugyada inay koraan oo u kala baxaan unugyo cusub. Waxaa la maamuli karaa kaligeed ama daaweynta kiimiko ama daaweynta hoormoonka si loo daaweeyo kansarka endometrial ee horumarsan ama soo noqnoqda. Hadda la ansixiyey waa everolimus (Afinitor®) iyo tansimolimus (TORISEL®).
Horumarkii ugu dambeeyay ee kansarka ilma -galeenka
- Avelumab (Bavincia monoclonal antibody) oo lagu daray talazoparib (tarazopanib)
Tijaabo uu hoggaaminayo Konstantinopoulos ayaa isticmaalay avelumab ka -hortagga is -difaaca jirka oo ay weheliso talazoparib inhibitor -ka PARP. (Ka -hortagayaasha isbaarooyinka waxay u banneeyaan habka difaaca jirka inuu ku weeraro kansarka; ka -hortagayaasha PARP waxay burburiyaan unugyada kansarka iyagoo hor istaagaya awooddooda inay dayactiraan DNA -ga burburay.) Tijaabadii hore, avelumab waxay ahayd Bukaan qaba “aan degganayn” kansarka endometrial aad bay waxtar u leeyihiin, laakiin waa muhiim aan firfircoonayn sida caadiga ah “microsatellite st
karti u leh ”(MSS) ee cudurka. Maxkamaddu waxay baari doontaa haddii isku -darka avelumab iyo ka -hortagayaasha PARP ay waxtar badan u leedahay bukaannada qaba cudurka MSS.
2. Pembrolizumab (pabolizumab) oo lagu daray mirvetuximab
Tijaabo isku daraysa barta koontaroolka ee pembrolizumab iyo mirvetuximab. (Pembrolizumab waxay bartilmaameedsanaysaa borotiinka isbaarada difaaca ee loo yaqaan PD-1; mirvetuximab waxay ku darsataa unugyada ka-hortagga molecules daroogada kuwaas oo bar-tilmaameedsada qaababka muhiimka ah ee unugyada kansarka si degdeg ah u qaybinaya. Bukaanka qaba kansarka endometrial ee MSS.
3. abemaciclib + LY3023414 + daaweynta hormoonka
Tijaabo kale oo uu hoggaaminayo Konstantinopoulos ayaa tijaabin doonta isku -darka dawada la beegsanayo abemaciclib + LY3023414 + daaweynta hoormoonka. . Iyagoo ku daraya abemaciclib iyo LY3023414 (waxay taaban karaan laba qaybood oo isla waddada molikalikada ah) ee hormoonka xannibaadda hormoonnada, cilmi -baarayaashu waxay rajaynayaan inay ka gudbaan dhibaatada iska -caabbinta daroogada.
4.AZD1775
Tijaabo uu hoggaaminayo Joyce Liu, MD, PHD, Agaasimaha Cilmi-baarista Daawada, Dana-Farber Gynecologic Oncology, ayaa u isticmaashay AZD1775 bukaanada qaba kansarka ilma-mareenka ee heerka sare ah kaas oo lagu xisaabiyey 10-15% kansarka endometrial. Kansarrada noocan oo kale ah ayaa ah kuwo dagaal badan oo caadi ahaan soo noqnoqda daaweynta caadiga ah kadib. Tijaabada dhowaan la furay waxay salka ku haysaa daraasad ay hormuud ka yihiin Dr. Liu iyo Ursula Matulonis, oo ah agaasimaha Waaxda Dana-Farber ee Dhakhaatiirta Kansarka ee Haweenka, taas oo muujinaysa in AZD1775 ay ku firfircoon tahay qaab bukaan qaba kansarka ugxanta serous ee heerka sare.
5. dostarlimab (TSR-042)
Natiijooyinka tijaabada Wajiga I / II ee GARNET ayaa dhowaan la daabacay, iyo guud ahaan heerka waxtarka leh ee PD-1 inhibitor dostarlimab (TSR-042) ee bukaannada qaba soo noqnoqda ama kansarka endometrial wuxuu ku dhow yahay 30%.
Intaa waxaa dheer, labada xasilooni-darrada sare ee microsatellite (MSI-H) iyo xasiloonida microsatellite-ka (MSS) labaduba waa joogto.
Dostarlimab (TSR-042) waa bani-aadam anti-PD-1 monoclonal antibody oo ay si wadajir ah u soo saareen TESARO iyo AnaptysBio. Waxay ku xidhan tahay soo-dhoweeyaha PD-1 oo leh xiriir aad u sarreeya, taas oo xannibeysa ku-xirnaanta PD-L1 iyo PD-L2 ligands.
Natiijooyinku waxay muujiyeen in heerka waxtarka leh ee dadka oo dhan uu ahaa 29.6%, heerka waxtarka leh ee kooxda bukaanka MSI-H wuxuu ahaa 48.8%, iyo heerka wax ku oolka ah ee kooxda MSS wuxuu ahaa 20.3%. Lix bukaan (2 MSI-H iyo 4 MSS) ayaa lahaa cafis dhammaystiran.
Dabagal dhexdhexaad ah 10 bilood ka dib, 89% bukaannada ayaa la daweeyey> 6 bilood, 49% bukaannaduna waxay heleen daaweyn> 1 sano ah. Intaa waxaa dheer, 84% bukaannada leh daaweyn wax -ku -ool ah ayaa weli helaya daaweyn.
Ugu dambayntii, 85% jawaabeyaasha MSI-H, wadarta culeyska burooyinka ayaa hoos u dhacay ≥50%, iyo 69% bukaannada qaba MSS waxay leeyihiin hoos u dhigidda culeyska burada ≥50%.
Dostarlimab waa rajo cusub oo ku saabsan daaweynta kansarka endometrial waxaana laga yaabaa inay beddesho pembrolizumab, maxaa yeelay pembrolizumab waxay si fiican ugu shaqaysaa bukaanka qaba MSI-H, Dostarlimabna uma baahna in la tixgeliyo.
Cilmi-baarayaashu waxay bilaabi doonaan daraasado III oo dheeraad ah qeybta labaad ee 2019. Dostarlimab iyo chemotherapy waxaa lagu dari doonaa daaweynta safka koowaad ee kansarka endometrial. Waxaan rajeyneynaa inaan helno natiijooyin rajo leh dhowaan!
Tijaabo kasta waxay wax ka qabataa cilladaha daaweynta caadiga ah ama dhibaatooyinka laga helay tijaabooyinka daroogada cusub ee hore. Tusaale ahaan, labada tijaabo ee hore waxaa loogu talagalay in lagaga gudbo xaaladda ay hadda ku sugan yihiin dadka saboolka ah immunotherapy bukaanka qaba cudurka MSS. Midda saddexaad waxay xallisaa dhibaatada iska -caabbinta daaweynta hoormoonka, tan afraadna waxay bartilmaameedsataa nooc -hoosaadyo gaar ah oo kansarka endothelial ah.
In badan oo ku saabsan horumarka cilmi -baarista ee ugu dambeeyay iyo qorshaha dawaynta ugu fiican ee kansarka sanbabada, kaliya khabiirada sare ee kansarka ee gudaha iyo dibaddaba waxay leeyihiin waayo -aragnimo caafimaad oo hodan ah. Waxaad codsan kartaa la -tashiga khubarada awoodda leh iyada oo loo marayo Shabakadda Oncologist Global si aad u hesho qorshaha ogaanshaha iyo daaweynta ugu fiican.
Badi kansarrada makaanka waxay leeyihiin saadaal wanaagsan. Sida laga soo xigtay Xarumaha Xakamaynta iyo Kahortagga Cudurrada Mareykanka, qiyaasta badbaadada qaraabada ee shanta sano waa 80% ilaa 90%. Sababtoo ah kansarka ilma -galeenka sida caadiga ah goor hore ayaa la ogaan karaa, astaamihiisa caadiga ah waa dhiig -bax aan caadi ahayn ka hor iyo ka dib caadada, miisaanka oo yaraada iyo xanuunka miskaha.
Kiniinnada xakameynta dhalmada iyo hormoonka IUD waxaa ku jira progesterone, kaasoo ka hortegi kara estrogen -ka xad -dhaafka ah ee jirka.
Mid ka mid ah daraasadihii ugu waaweynaa uguna dheeraa ee lagu daabacay Joornaalka Mareeykanka ee Dhalmada iyo Dhallaanka sannadka 2017 ayaa lagu ogaaday in halista qaadashada kiniinnada xakameynta dhalmada iyo kansarka endometrial-ka la yareeyay qiyaastii 33%. Tani waxay sidoo kale la xiriirtaa yareynta halista kansarka ugxansidaha iyo malawadka.
