He mea paʻakikī ke hoʻopuka i nā huaʻōlelo i ka makaʻu a me ka haʻalulu āu e ʻike ai ke ʻike ʻoe he maʻi ʻaʻai umauma kou. He nui nā nīnau i loko o kou manaʻo. He mea maʻamau ka loaʻa ʻana o nā nīnau e like me, "No ke aha i hiki mai ai kēia iaʻu?", "He aha kaʻu e hana ai i kēia manawa?", "Hiki ke ho'ōla ʻia kēia?". Ma kēia huakaʻi, ke ho'āʻo nei au e wehewehe maʻalahi i nā mea a ma kahi ʻōlelo hiki iā ʻoe ke hoʻomaopopo. ʻO ka ʻike pono i ke ʻano o ka maʻi ʻaʻai āu e loaʻa nei ua like ia me ka hoʻomaopopo ʻana i ka ʻenemi ma mua o ka hoʻomaka ʻana i ke kaua. ʻO ia ka hana mua a koʻikoʻi loa i ke koho ʻana i ka lāʻau lapaʻau kūpono iā ʻoe.
Ka maʻi ʻaʻai umauma maikaʻi loa no ka mea loaʻa ka hormone
ʻO kēia ke ʻano maʻamau o ka maʻi ʻaʻai umauma. Ma ke ʻano laulā, ma kahi o 80 o kēlā me kēia 100 mau maʻi ʻaʻai umauma e hāʻule ana i loko o kēia māhele.
No laila he aha ke ʻano o kēia "hormone-dependent"?
E noʻonoʻo wale i ia mea. Loaʻa i ko mākou kino, ʻoiai ke kino o nā wahine, ʻelua mau hormones kūlohelohe i kapa ʻia ʻo estrogen a me progesterone . He mea nui kēia no nā kaʻina hana maʻamau i loko o ko mākou kino. Eia nō naʻe, ua "hoʻopili" loa kekahi mau cell cancer i kēia mau hormones. ʻO ia hoʻi, ma luna o ka ʻili o kēia mau cell cancer, aia nā "receptors" liʻiliʻi a i ʻole nā puka e hiki ai i kēia mau hormones ke hele mai a pipili. Ke hele mai ka hormone estrogen a kīkēkē ma kēlā puka, loaʻa i ka cell cancer ka meaʻai mai ia mea a hoʻomaka e ulu a māhelehele. E like me kou hoʻoinu ʻana i kahi mea kanu, ulu nui ia.
Inā ʻōlelo kāu hōʻike lapaʻau he `ER-positive` (Estrogen Receptor-Positive), ʻo ia hoʻi, ua maʻalahi kāu mau hunaola kanesa i ka hormone estrogen. Inā ʻōlelo ʻia he `PR-positive` (Progesterone Receptor-Positive), ʻo ia hoʻi, ua maʻalahi ia i ka hormone progesterone. Inā maʻalahi ia i kekahi o kēia mau mea, ua kapa ʻia ke kanesa he kanesa hormone receptor-positive .
He nūhou maikaʻi kēia ma kekahi ʻano. No ka mea, inā ʻike mākou i ka mea a ke kanesa e hoʻohana ai e ulu, hiki iā mākou ke ālai i kēlā ala a kāohi i ke kanesa. ʻO ia ke kumu o ka "hormone therapy" .
ʻO ka maʻamau, hāʻawi ʻia ka lāʻau lapaʻau hormone ma hope o ke ʻoki ʻana, ka chemotherapy, a i ʻole ka radiation e pale ai i ka hoʻi hou ʻana mai o ke kanesa. Hana kēia mau lāʻau lapaʻau ma ka pani ʻana i nā "puka" ma nā hunaola kanesa, a i ʻole ma ke kāohi ʻana i ke kino mai ka hana ʻana i ka estrogen.
| Māhele lapaʻau | Ka wehewehe maʻalahi a me nā laʻana |
|---|---|
| Nā SERM (Nā Modulator ER Koho) | Hoʻopale kēia i ka mea loaʻa hormone ma ke kele kanesa, e pale ana i ke komo ʻana o ka hormone. Nā laʻana: Tamoxifen, Toremifene . |
| Nā SERD (Nā mea hoʻohaʻahaʻa i ka Estrogen Receptor Selective) | ʻAʻole wale kēia e ālai i ka mea loaʻa, akā e luku pū iā ia. Nā laʻana: Fulvestrant (Faslodex), Elacestrant (Orserdu) . |
| Nā mea pale ʻala | Hoʻōki kēia i ke kino mai ka hana ʻana i ka hormone estrogen (hāʻawi pinepine ʻia i nā wahine postmenopausal). Nā laʻana: Anastrozole (Arimidex), Letrozole (Femara) . |
| Nā Agonists LHRH | Hoʻōki kēia i nā ovaries mai ka hana ʻana i ka estrogen no kekahi manawa. Nā Laʻana: Goserelin (Zoladex), Leuprolide (Lupron) . |
| Nā Lapaʻau ʻē aʻe i hoʻolālā ʻia | Nā lāʻau ʻē aʻe e hoʻonui ai i ka holomua o ka lāʻau lapaʻau hormone. Nā laʻana: Palbociclib (Ibrance), Ribociclib (Kisqali), Alpelisib (Piqray) . |
Ka maʻi ʻaʻai umauma HER2-Positive
I kēia manawa, e kamaʻilio kākou e pili ana i kekahi ʻano ʻē aʻe. ʻO kekahi mau hunaola maʻi ʻaʻai umauma (ma kahi o 20% o nā maʻi ʻaʻai āpau) e hana i ka nui o ka protein kūikawā ma ko lākou ʻili i kapa ʻia ʻo HER2 (Human Epidermal growth factor Receptor 2) .
E noʻonoʻo iā HER2 ma ke ʻano he antenna liʻiliʻi e haʻi aku i ke kelepona kanesa e "ulu wikiwiki, māhele wikiwiki." Loaʻa i kahi kelepona maʻamau kekahi mau antenna. Akā, he nui kēia mau antenna i kahi kelepona kanesa HER2-positive. ʻO ia ke kumu e hiki ai i kēia mau ʻano kanesa ke ʻoi aku ka ikaika .
Akā, aia kekahi nūhou maikaʻi ma ʻaneʻi. Me ka holomua o ka ʻepekema, aia i kēia manawa nā " therapy i kuhikuhi ʻia" e kuhikuhi ana a luku i kēia mau antennae HER2. No ka mea, ʻike kēia mau mea a hoʻouka wale i nā cell i loaʻa ka nui o ka HER2, ua emi ka pōʻino i nā cell maʻamau.
ʻO ka lāʻau lapaʻau nui a maikaʻi loa i hāʻawi ʻia no kēia ʻo Trastuzumab (Herceptin) . Kōkua nui kēia i ka pale ʻana i ka hoʻi hou ʻana mai o ke kanesa. Eia nō naʻe, aia kahi pilikia liʻiliʻi o kekahi mau hopena ma ka puʻuwai a i ʻole nā māmā i ka wā e lawe ai i kēia lāʻau. Mai hopohopo no kēlā , e nānā mau kāu kauka iā ia.
| Nā lāʻau lapaʻau ʻē aʻe i hoʻohana ʻia no nā maʻi kanesa HER2-positive | |
|---|---|
| ʻO Pertuzumab (Perjeta) | Ado-trastuzumab emtansine (Kadcyla) |
| ʻO Lapatinib (Tykerb) | ʻO Neratinib (Nerlynx) |
| ʻO Tucatinib (Tukysa) | ʻEnhertu (Fam-trastuzumab deruxtecan-nxki) |
Ka maʻi ʻaʻai umauma "ʻEkolu-Nānā"
ʻO kēia ke ʻano nui ʻekolu. Ma kahi o 10%-20% o nā maʻi ʻaʻai umauma e hāʻule ana i loko o kēia ʻano. Ua ʻike anei ʻoe i ke kumu i kapa ʻia ai ʻo "triple-negative" a i ʻole "triple negative"?
No ka mea, i loko o kēia mau hunaola kanesa ,
1. ʻAʻohe estrogen receptor (ETU) .
2. ʻAʻohe mea loaʻa progesterone (PR).
3. ʻAʻole nui ka protein HER2 .
Ma muli o ka nele o kēia mau hunaola kanesa i nā pahuhopu nui ʻekolu a mākou i kūkākūkā ai ma mua, ʻaʻole hana ka lāʻau lapaʻau hormone a me nā lāʻau lapaʻau i kuhikuhi ʻia e HER2 e like me Herceptin ma luna o lākou. No laila, hiki ke paʻakikī iki ka mālama ʻana iā lākou.
Hoʻokumu pinepine ʻia kēia ʻano maʻi kanesa e BRCA1.Ua pili ia me kahi mutation i loko o kahi gene i kapa ʻia ʻo . No laila, inā loaʻa iā ʻoe ka maʻi kanesa triple-negative, hiki i kāu kauka ke kuhikuhi i ka hoʻāʻo genetic.
Hoʻōla nui ʻia kēia ʻano me ke ʻoki kino, chemotherapy, a me ka radiation . Eia nō naʻe, aia i kēia manawa nā lāʻau lapaʻau hou e pili ana i kēia ʻano.
- Nā mea pale PARP: Hoʻohana ʻia nā lāʻau lapaʻau e like me Olaparib (Lynparza) a me Talazoparib (Talzenna) no ka poʻe me nā hoʻololi ʻana o ka gene BRCA. Ke ālai nei kēia i ka hiki o nā hunaola kanesa ke hoʻoponopono iā lākou iho.
- Immunotherapy: ʻO nā lāʻau lapaʻau e like me Atezolizumab (Tecentriq) e kōkua i ka hakakā ʻana i nā hunaola kanesa ma o ka hoʻohana ʻana i kā mākou mau hunaola ponoʻī.
Me he mea lā he mea paʻakikī iki kēia. He mea maʻamau kēlā. ʻO ka mea nui e hoʻomanaʻo ʻoiai he aha ke ʻano o ka maʻi kanesa āu, aia nā lāʻau lapaʻau i loaʻa i kēia lā e kūpono no ia. E hana pū kāu kauka a me ka hui lapaʻau me ʻoe e hana i ka hoʻolālā lapaʻau maikaʻi loa nāu.
Leka Lawe-Home
- Ua māhele ʻia ke kanesa o ka umauma i 3 mau ʻano nui: Hormone Receptor-Positive, HER2-Positive, a me Triple-Negative .
- He mea nui ka ʻike ʻana i ke ʻano o ka maʻi ʻaʻai āu e loaʻa ai no ka hoʻolālā ʻana i ka mālama ʻana.
- Hoʻolohe maikaʻi nā maʻi ʻaʻai hormone-positive i ka lāʻau lapaʻau hormone.
- ʻOiai ke ulu wikiwiki nei nā maʻi ʻaʻai HER2-positive , aia nā ʻano lāʻau lapaʻau i hoʻolālā pono ʻia no lākou.
- ʻOiai he paʻakikī ka mālama ʻana i nā maʻi ʻaʻai triple-negative , hiki ke hakakā ʻia me ka chemotherapy a me nā lāʻau lapaʻau hou i hoʻolālā ʻia.
- Inā he mau nīnau kāu e pili ana i kekahi mea i loko o kāu moʻolelo lapaʻau, mai makaʻu e nīnau . E noi i kāu kauka no kahi wehewehe maopopo. ʻAʻole ʻoe hoʻokahi, a he nui ka poʻe e hiki ke kōkua iā ʻoe.
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