Umdlavuza we-uterine
Ngokombiko wakamuva ovela e-US Centers for Disease Control and Prevention (CDC), izehlakalo cishe zonke izinhlobo zomdlavuza ziye zancipha kule minyaka engamashumi amabili edlule, kuyilapho izinga lomdlavuza wesibeletho likhuphukile. Odokotela baqala ukunaka lesi simo futhi bakhumbuza abesifazane ukuthi banake izinkinga eziningana ezibalulekile zalesi sifo.
Izinhlobo zomdlavuza wesibeletho
Umdlavuza wesibeletho usho noma yimuphi umdlavuza oqala esibelethweni. Ngokwezibalo ze-American Cancer Society (ACS), ngaphezu kuka-90% womdlavuza wesibeletho wenzeka e-endometrium, ebizwa ngomdlavuza we-endometrium.
Olunye uhlobo lomdlavuza wesibeletho yi-uterine sarcoma. Lolu hlobo lomdlavuza lwakhiwa emisipheni nasezicukweni ezixhumanayo zesibeletho futhi aluvamile kakhulu-kuphela cishe ngama-4% azo zonke izimo zomdlavuza wesibeletho.
Izici ezinobungozi zomdlavuza wesibeletho
Kusuka ku-1999 kuya ku-2016, izehlakalo zomdlavuza omusha wesibeletho zikhuphuke ngo-0.7% njalo ngonyaka, ukwanda ngo-12% esikhathini sokufunda. Izinga lokushona kwabantu lenyuke futhi ngo-1.1% minyaka yonke, noma ukwanda okuphelele kwama-21%, cishe okuphindwe kabili. Izici eziyingozi kakhulu yilezi:
Abesifazane baseCaucasus nabamnyama banezingozi eziphakeme kakhulu kunezase-Asiya naseSpanishi
Abesifazane abakhuluphele abakhuluphele noma abakhuluphele banamathuba aphindwe kabili kuya kwamane okuba nomdlavuza we-endometrium kunabesifazane abanesisindo esinempilo. (Izicubu ze-Adipose zikhiqiza amazinga angavamile e-estrogen, avusa umdlavuza ozwela ngama-hormone.)
Abesifazane ngemuva kweminyaka engama-55 ubudala basengozini enkulu. Abesifazane be-premenopausal imvamisa abawutholi umdlavuza we-endometrial, yingakho abesifazane abaningi betholakala besesigabeni 1-ngoba laba besifazane sebedlulile esikhathini sokuya esikhathini, lapho beqala ukukhipha i-pink noma ukuphuma kwegazi ngokungajwayelekile kuzodala ukunakwa.
Ukuya esikhathini ngokungajwayelekile kungaholela ekusakazeni ngokweqile kwe-estrogen emzimbeni, kubangele ukuthi amaseli esibelethweni ahluleke ukulawula.
Izinhlobo zomdlavuza wesibeletho
Umdlavuza wesibeletho usho noma yimuphi umdlavuza oqala esibelethweni. Ngokwezibalo ze-American Cancer Society (ACS), ngaphezu kuka-90% womdlavuza wesibeletho wenzeka e-endometrium, ebizwa ngomdlavuza we-endometrium.
Olunye uhlobo lomdlavuza wesibeletho yi-uterine sarcoma. Lolu hlobo lomdlavuza lwakhiwa emisipheni nasezicukweni ezixhumanayo zesibeletho futhi aluvamile kakhulu-kuphela cishe ngama-4% azo zonke izimo zomdlavuza wesibeletho.
Ukuxilongwa nokubikezela umdlavuza wesibeletho
Iningi lomdlavuza wesibeletho unesibikezelo esihle. Ngokusho kwezikhungo ze-US zokuLawulwa nokuVinjelwa kwezifo, isilinganiso seminyaka emihlanu sokusinda esilinganiselwe singama-80% kuya ku-90%. Ngenxa yokuthi umdlavuza wesibeletho uvame ukutholakala kusenesikhathi, izimpawu zawo ezijwayelekile ukopha okungavamile ngaphambi nangemva kokuyeka ukuya esikhathini, ukwehla kwesisindo kanye nobuhlungu be-pelvic.
Amaphilisi okuvimbela inzalo nama-hormone IUD aqukethe iprogesterone, engamelana ne-estrogen eyeqile emzimbeni.
Esinye sezifundo ezinkulu neside kunazo zonke esashicilelwa kwi-American Journal of Obstetrics and Gynecology ngo-2017 sathola ukuthi ingozi yokuphuza amaphilisi okulawula ukubeletha kanye nomdlavuza we-endometrial yehliswe cishe ngama-33%. Lokhu kuhlobene nokunciphisa ubungozi besifo somdlavuza we-ovari kanye nocolorectal.
Izinketho zokwelashwa komdlavuza wesibeletho
Ukuhlinzwa komdlavuza wesibeletho
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), isisu reduction surgery (removing as much cancer as possible) can be performed.
I-Radiotherapy yomdlavuza wesibeletho
Radiation therapy uses high-energy radiation (such as X-ray) to kill cancer cells. It can treat endometrial cancer in two ways:
Faka izinto ezinemisebe emzimbeni. Lokhu kubizwa nge-internal radiation therapy noma i-brachytherapy.
By using X-ray radiotherapy equipment such as radiographic knife, linear accelerator, Tomo knife, etc., if economic conditions permit, you can also choose more accurate proton radiotherapy with fewer side effects. 7998).
Ukwelashwa ngamakhemikhali
Chemotherapy (chemo) is the use of drugs to kill cancer cells. Treatment is intravenous or oral. Follow the blood and enter the whole body. Therefore, when endometrial cancer has spread beyond the endometrium and surgery is not possible, chemotherapy is the main treatment.
Izidakamizwa zeChemotherapy ezisetshenziselwa ukwelapha umdlavuza we-endometrial:
· I-Paclitaxel (i-Taxol®)
· I-Carboplatin
· I-doxorubicin noma i-liposomal doxorubicin
· I-Cisplatin
· I-Docetaxel
Uma kuyi-sarcoma, ifosfamide (IFEX ®) ivame ukusetshenziswa njenge-ejenti eyodwa noma nge-cisplatin noma i-paclitaxel. Umuthi ohlosiwe we-trastuzumab (Herceptin®) ungangezwa nge-HER2-positive uterine sarcoma. (I-HER2 yiprotheni engasiza amanye amangqamuzana omdlavuza ukuthi akhule futhi asakazeke ngokushesha.)
Ukwelashwa kweHormone
Ijwayele ukusetshenziselwa ukwelapha umdlavuza osezingeni eliphakeme (isigaba III noma IV) noma umdlavuza we-endometrial obuye ubuye futhi uvame ukusetshenziselwa ukwelashwa ngamakhemikhali. Ukwelashwa kweHormonal kuhlanganisa:
· Progesterone (This is the main hormone therapy used.)
I-Tamoxifen
· I-Luteinizing hormone-ikhulula i-hormone agonist (i-agonist ye-LHRH)
I-Aromatase inhibitors (AI)
Njengamanje, alukho umuthi wokwelashwa kwamahomoni otholakale ukuthi ungcono kakhulu kumdlavuza we-endometrium.
Ukwelapha okuhlosiwe
Njengamanje, ukwelashwa okubhekiswe kuphela okungahle kusetshenziselwe umdlavuza we-endometrium, ikakhulukazi ekwelashweni komdlavuza omubi we-endometrial kanye ne-metastasis noma ukuphindeka.
Bevacizumab
I-Bevacizumab (Avastin®) i-angiogenesis inhibitor. Ukukhula komdlavuza nokusabalala kudinga ukwenziwa kwemithambo yegazi emisha ukuzondla (inqubo ye-angiogenesis). Isidakamizwa sinamathela kuprotheni ebizwa nge-VEGF (ekhombisa ukwakheka kwemithambo yegazi emisha) futhi yehlisa noma ivimbele ukukhula komdlavuza.
I-Bevacizumab ivame ukunikezwa nge-chemotherapy, noma inganikezwa yodwa. Nikeza ngemithambo yegazi njalo emavikini amabili kuya kwamathathu.
I-mTOR inhibitor
Le mithi ivimba amaprotheni wamaseli we-mTOR, okuvame ukusiza amaseli akhule futhi ahlukane abe ngamaseli amasha. Inganikezwa yodwa noma nge-chemotherapy noma i-hormone therapy ukwelapha umdlavuza we-endometrial osezingeni eliphakeme noma ophindaphindiwe. Okwamanje kuvunyelwe i-everolimus (Afinitor®) ne-tansimolimus (TORISEL®).
Ukuthuthukiswa kwakamuva komdlavuza wesibeletho
- I-Avelumab (iBavincia monoclonal antibody) ehlangene ne-talazoparib (tarazopanib)
Icala eliholwa nguKonstantinopoulos lisebenzise i-immune checkpoint inhibitor avelumab ngokuhlangana ne-PARP inhibitor talazoparib. (Ama-Checkpoint inhibitors avula indlela yokuthi amasosha omzimba ahlasele umdlavuza; ama-PARP inhibitors aqeda amangqamuzana omdlavuza ngokuvimbela amandla awo okulungisa i-DNA elimele.) Ocwaningweni olwedlule, i-avelumab kwakuyiziguli ezinomdlavuza "ongazinzile" we-endometrium ziyasebenza kakhulu, kepha empeleni ziyasebenza ayisebenzi endaweni ejwayelekile ye- “microsatellite st
ukwazi ”(MSS) kwalesi sifo. Icala lizohlola ukuthi ukuhlanganisa i-avelumab ne-PARP inhibitors kusebenza kangcono ezigulini ezinesifo se-MSS.
2. Pembrolizumab (pabolizumab) combined with mirvetuximab
A test combining the checkpoint inhibitor pembrolizumab with mirvetuximab. (Pembrolizumab targets an immune checkpoint protein called PD-1; mirvetuximab adds antibodies to drug molecules that target key structures in rapidly dividing cancer cells.) The trial, led by Jennifer Veneris, MD, of the Gynecologic Oncology Project, will examine the combination Effectiveness in patients with MSS endometrial cancer.
3. abemaciclib + LY3023414 + ukwelashwa kwamahomoni
Olunye uvivinyo oluholwa uKonstantinopoulos luzohlola inhlanganisela yezidakamizwa ezibhekiswe ku-abemaciclib + LY3023414 + therapy ye-hormone. (I-LY3023414 ihlose i-enzyme yeseli yomdlavuza ebizwa nge-PI 3 kinase; i-abemaciclib iphazamisa isigaba esibucayi somjikelezo wamaseli.) Ama-70% kuya kuma-90% omdlavuza we-endometrial ondliwa yi-estrogen, eqala ngokuphendula ekwelashweni okuvimba i-hormone, kepha ekugcineni abuyele emuva. Ngokwengeza i-abemaciclib ne-LY3023414 (bangathinta izingxenye ezimbili zendlela efanayo yamangqamuzana) yokwelashwa okuvimba ama-hormone, abacwaningi banethemba lokunqoba inkinga yokungazweli emithini.
4. AZD1775
Isivivinyo esiholwa nguJoyce Liu, MD, PHD, uMqondisi weClinical Research, uDana-Farber Gynecologic Oncology, sisebenzise i-AZD1775 yeziguli ezinomdlavuza ophakeme wesibeletho wesibeletho obune-10-15% yomdlavuza we-endometrium. Imidlavuza enjalo inolaka futhi imvamisa iyabuya emuva kokwelashwa okujwayelekile. Isivivinyo esisanda kuvulwa sisuselwa ocwaningweni oluholwa nguDkt Liu no-Ursula Matulonis, umqondisi woMnyango we-Dana-Farber we-Gynecologic Oncology, okukhombisa ukuthi i-AZD1775 iyasebenza kumodeli yesiguli enomdlavuza ophezulu we-serous ovarian.
I-5.dostarlimab (TSR-042)
Imiphumela yohlolo lweSigaba I / II GARNET isanda kushicilelwa, futhi izinga elisebenzayo lilonke le-PD-1 inhibitor dostarlimab (TSR-042) ezigulini ezinomdlavuza we-endometrial obuyelwe kabusha noma othuthukisiwe usondele ku-30%.
Ngaphezu kwalokho, womabili ama-microsatellite high instability (MSI-H) nama-microsatellite stability (MSS) amaqembu ayaphikelela.
I-Dostarlimab (TSR-042) i-anti-PD-1 anti-anti-PD-1 antibody ehlanganiswe nabantu eyenziwe ngokuhlanganyela yi-TESARO ne-AnaptysBio. Ibopha ukwamukela kwe-PD-1 ngobudlelwano obuphezulu, ngaleyo ndlela kuvimbe ukubopha kwayo kwi-PD-L2 ne-PD-LXNUMX ligands.
Imiphumela ikhombise ukuthi inani elisebenzayo labantu bonke lalingu-29.6%, izinga elisebenzayo leqembu lesiguli le-MSI-H lalingama-48.8%, kanti izinga elisebenzayo eqenjini le-MSS lalingu-20.3%. Iziguli eziyisithupha (2 MSI-H ne-4 MSS) zathola ukuxolelwa okuphelele.
Ngemuva kokulandelwa okuphakathi kwezinyanga eziyi-10, iziguli ezingama-89% zathola ukwelashwa> izinyanga eziyisithupha, kwathi iziguli ezingama-6% zathola ukwelashwa unyaka> owodwa. Ngaphezu kwalokho, iziguli ezingama-49% ezinokwelashwa okusebenzayo zisathola ukwelashwa.
Ekugcineni, kuma-85% wabaphenduli be-MSI-H, umthwalo ophelele we-tumor wehle ngo- ≥50%, kwathi i-69% yeziguli ezine-MSS zancipha ngokuphelele umthwalo we-tumor of50%.
I-Dostarlimab iyithemba elisha lokwelashwa komdlavuza we-endometrial futhi ingathatha indawo ye-pembrolizumab, ngoba i-pembrolizumab isebenza kahle kuphela ezigulini ezine-MSI-H, futhi iDostarlimab ayidingi ukucatshangelwa.
Abaphenyi bazoqala ezinye izifundo ze-III engxenyeni yesibili ka-2019. I-Dostarlimab ne-chemotherapy kuzohlanganiswa nokwelashwa kokuqala komdlavuza we-endometrium. Silangazelele ukuthola imiphumela ethembisayo kungekudala!
Isivivinyo ngasinye sibhekana nokushiyeka kokwelashwa okujwayelekile noma izinkinga ezitholwe ezivivinyweni ezintsha ezidlule zezidakamizwa. Isibonelo, izivivinyo ezimbili zokuqala kuhloswe ngazo ukunqoba isimo samanje sabampofu immunotherapy ezigulini ezinesifo seMSS. Owesithathu uxazulula inkinga yokumelana nokwelashwa kwamahomoni, kanti owesine ukhomba ama-subtypes athile womdlavuza we-endothelial.
Okuningi ngenqubekela phambili yocwaningo lwakamuva kanye nohlelo lwemithi oluhamba phambili lomdlavuza wamaphaphu, kuphela ochwepheshe abaphezulu besifo somdlavuza ekhaya nakwamanye amazwe abanolwazi olunothile lomtholampilo. Ungafaka isicelo sokubonisana nochwepheshe abanegunya nge-Global Oncologist Network ukuthola uhlelo oluhle kakhulu lokuxilongwa nokwelashwa.
Iningi lomdlavuza wesibeletho unesibikezelo esihle. Ngokusho kwezikhungo ze-US zokuLawulwa nokuVinjelwa kwezifo, isilinganiso seminyaka emihlanu sokusinda esilinganiselwe singama-80% kuya ku-90%. Ngenxa yokuthi umdlavuza wesibeletho uvame ukutholakala kusenesikhathi, izimpawu zawo ezijwayelekile ukopha okungavamile ngaphambi nangemva kokuyeka ukuya esikhathini, ukwehla kwesisindo kanye nobuhlungu be-pelvic.
Amaphilisi okuvimbela inzalo nama-hormone IUD aqukethe iprogesterone, engamelana ne-estrogen eyeqile emzimbeni.
Esinye sezifundo ezinkulu neside kunazo zonke esashicilelwa kwi-American Journal of Obstetrics and Gynecology ngo-2017 sathola ukuthi ingozi yokuphuza amaphilisi okulawula ukubeletha kanye nomdlavuza we-endometrial yehliswe cishe ngama-33%. Lokhu kuhlobene nokunciphisa ubungozi besifo somdlavuza we-ovari kanye nocolorectal.
