Bwe tuwulira ekigambo kookolo w’amabeere, bangi ku ffe tutya. Naye ekisinga obukulu kye tulina okutegeera nti kookolo w’amabeere yenna si y’emu. Waliwo ebika byazo eby’enjawulo. Ekimu ku bika ebisinga okumanyibwa ye ‘estrogen receptor positive’ oba nga bwe tugiyita mu by’obusawo , ER+ (Estrogen-Receptor-Positive) kookolo w’amabeere . Mu butuufu, kookolo w’amabeere ebitundu 80% byokka azuuliddwa be wa kika kino. Kale leero tugenda kwogera ku kiraasi empya, ennungi ey’eddagala erizuuliddwa okujjanjaba kookolo w’amabeere ono ow’ekika kya ER+.
Okusooka, ka tulabe, kookolo w’amabeere ER+ kye ki?
Mu ngeri ennyangu, obusimu obuyitibwa estrogen obuli mu mubiri gwaffe buyamba obutoffaali buno obwa kookolo okukula. Teebereza nti obutoffaali buno obwa kookolo bulina ‘locks’ (receptors) ez’enjawulo ku ngulu kwazo obusimu bwa estrogen bwe busobola okwegattako. ‘Ekisumuluzo’ ekiyitibwa estrogen hormone bwe kiyingira mu ‘lock’ eno, obutoffaali bwa kookolo bufuna ‘signal’ okweyawulamu n’okukula.
Eno y’ensonga lwaki abasawo batera okuwa obujjanjabi bw’obusimu okujjanjaba kookolo wa ER+. Enzijanjaba zino ziyimiriza ‘ekisumuluzo’ (estrogen) okusiba ku ‘lock’ (receptors). Naye oluusi naddala nga kookolo asaasaanidde mu mubiri gwonna (advanced oba metastatic), obutoffaali buno bwa kookolo bufuuka bwa bukodyo nnyo. Zifuuka ezigumira obujjanjabi buno obw’obusimu, ekitegeeza nti teziddamu bulungi nga bwe zijjanjabwa. Wano we twetaaga obujjanjabi obupya, obukola obulungi.
‘Okukyusa okukula’ kw’obutoffaali bwa kookolo - obuzaale bwa PI3K ne PIK3CA
Abasawo ne bannassaayansi bwe baali banoonya ebivaako kookolo ono agumira obusimu, baazuula ekintu eky’enjawulo: ekikyamu mu kkubo lya PI3K (Phosphatidylinositol-3-Kinase) , enkola enkulu ey’obubonero obufuga okukula, okwawukana, n’okuwangaala kw’obutoffaali mu mubiri gwaffe.
Lowooza ku kkubo lino erya PI3K nga ‘switchboard’ enkulu mu katoffaali. Kifuga okusalawo oba akatoffaali kalina okukula oba okwawukana. Ekimu ku buzaale obukulu obufuga switchboard eno ye ggiini ya PIK3CA .
Mu balwadde ba kookolo abamu, obuzaale buno obwa PIK3CA bulina enkyukakyuka , ekitegeeza enkyukakyuka oba ekikyamu. Kiringa switch ya ‘growth’ ku switchboard ekwatiddwa era bulijjo ‘on’. Olwo obutoffaali ne butandika okwawukana ne bukula nga tebufugibwa. Kino kye kisinga okuvaako kookolo. Okunoonyereza kuzudde nti abalwadde nga 40% abalina kookolo w’amabeere ER+ balina enkyukakyuka eno ey’obuzaale bwa PIK3CA.
Kale bino ebiziyiza PI3K bye biruwa?
Wano, ng’eky’okugonjoola ekizibu kino, ekika ky’eddagala eriyitibwa PI3K inhibitors kiyingizibwa. Ekintu eky’angu eddagala lino kye likola kwe kuziyiza obulungi ‘growth switch’ (PI3K pathway) gye nnayogeddeko emabegako ekwatiddwa ‘on’.
Mu ngeri ennyangu, eddagala lino liringa omusawo w’amasannyalaze omukugu. Ayingira n’atereeza switchboard eyo eya short-circuit, n’ayimiriza akasannyalazo akateetaagisa. Mu ngeri y’emu, PI3K Inhibitors ziyimiriza akabonero k’okukula okuteetaagisa okugenda mu butoffaali bwa kookolo, ekivaako obutoffaali bwa kookolo okufa n’okuyamba ebizimba okukendeera.
Bino bitera okujja mu ngeri y’eddagala eriweebwa mu kamwa. Ebiseera ebisinga, eddagala lino liweebwa abalwadde nga ligattibwa wamu n’eddagala ly’obusimu eryayogeddwako emabegako (estrogen blocker).
Ntegeera ntya oba obujjanjabi buno bunsaanira?
Kino kibuuzo kikulu nnyo. Ebiziyiza PI3K tebiweebwa balwadde ba kookolo w’amabeere bonna. Zikoleddwa mu ngeri ey’enjawulo okusobola:
- Ku bakyala abava mu nsonga n’abalwadde abasajja.
- Kookolo alina okuba nga ya HR+ (Hormone-Receptor-Positive) ne HER2-Negative .
- Ekisinga obukulu: Obutoffaali bwa kookolo bulina okuba n’enkyukakyuka y’obuzaale bwa PIK3CA .
Okusobola okumanya oba kookolo wo alina enkyukakyuka eno mu buzaale, omusawo ajja kukukebera mu ngeri ey’enjawulo. Kino kitera okuzingiramu omusaayi oba akatundu akatono akayitibwa tissue (biopsy) akaggyibwa mu kizimba. Ebinaava mu kukeberebwa okwo bye bijja okusalawo oba obujjanjabi buno bukusaanira.
| Okubeera n’ebisaanyizo by’okujjanjabibwa | Okunnyonnyola |
|---|---|
| Ekika kya kookolo | Kiteekwa okuba nga kookolo w’amabeere ow’omulembe ow’ekika kya HR+ (hormone receptor positive) ne HER2- (HER2 negative). |
| Enkyukakyuka mu buzaale | Enkyukakyuka y’obuzaale bwa PIK3CA erina okubaawo. Kino kikakasibwa okukeberebwa okw’enjawulo. |
| Okugumiikiriza | Kitera okusemba ku bakyala abava mu nsonga n’abalwadde abasajja. |
Eddagala lino liyinza okuvaako buzibu ki?
Okufaananako n’obujjanjabi bwonna obwa kookolo, eddagala eriziyiza PI3K liyinza okuleeta ebizibu ebimu. Kyokka bino tebibeerawo mu buli muntu mu ngeri y’emu. Ate era kati waliwo engeri y’okuddukanyaamu ebizibu bino.
Ebimu ku bisinga okuvaamu ebizibu bye bino:
- Okuziyira n’okusiiyibwa
- Okubulwa okwagala okulya n’okugejja
- Amabwa mu kamwa
- Okugwa kw’enviiri
- Ebikosa byonna ku nkola y’ekibumba, ekibumba oba olubuto
- Okusiiyibwa kw’olususu oluusi okw’amaanyi kuyinza okuvaako olususu okusekula oba okufuumuuka.
- Ssukaali Omungi mu Musaayi: Kino kizibu kya bulijjo ekikwata ku ddagala ery’ekika kino, kubanga ekkubo lya PI3K lyenyigira mu kukyusa ssukaali mu mubiri gwaffe.
Totya olw’ebizibu bino. Omusawo ajja kukukebera buli kiseera okulaba oba olaba bino. Bwe kiba kyetaagisa, ajja kukendeeza ku ddoozi y’eddagala, alekere awo okulimira okumala akaseera (medication holiday), oba akuwe eddagala eddala okufuga ebizibu ebivaamu. Tolekera awo kumira ddagala lyo oba okukyusa ddoozi nga tobuuzizza musawo.
Okunoonyereza kulaga nti okumira eddagala lya sukaali okufuga ssukaali mu musaayi oba okugoberera emmere erimu ebirungo ebitono, amasavu amangi ( ketogenic diet ) kiyinza okwongera ku bulungibwansi bw’eddagala lino. Wabula kikulu okwogera n’omusawo wo nga tonnaba kukola nkyukakyuka yonna mu mmere.
Ddala obujjanjabi buno bukola?
Yee. Kino kye kintu ekisinga obukulu. Okugezesebwa kungi kulaga nti abalwadde abalina kookolo w’amabeere ER+ abalina enkyukakyuka ya PIK3CA basobola okuganyulwa mu kiziyiza kya PI3K nga kigatta wamu n’obujjanjabi bw’obusimu.
Okunoonyereza okumu okunene kwazuula nti abalwadde abaafuna eddagala lino ery’omugatte baali bawangaala nga tebagenda mu maaso okumala emyezi nga 11. Kino kyali tekiwera myezi 6 eri abalwadde abalina enkyukakyuka y’emu mu buzaale abataafuna ddagala liziyiza PI3K. Eno nkyukakyuka nnene era essuubi ddene. Olw’obuwanguzi buno, kati eddagala eppya mu kiraasi y’eddagala lino likolebwa.
Obubaka Obutwala Awaka
- Kookolo w’amabeere yenna si y’emu. Okumanya ekika kya kookolo wo ekigere (e.g. ER+, HER2-, PIK3CA mutation) kikulu okulonda obujjanjabi obusinga okutuukirawo era obukola obulungi.
- PI3K Inhibitors ddagala lya mulembe, erigendereddwamu ku kookolo w’amabeere nga lirina enkyukakyuka mu buzaale bwa ER+ ne PIK3CA.
- Obujjanjabi buno si bwa buli muntu. Omusawo ajja kusalawo oba kikusaanira oluvannyuma lw’okukeberebwa mu ngeri ey’enjawulo.
- Eddagala lino liyinza okuvaako ebizibu naddala ssukaali omungi mu musaayi naye omusawo asobola okukuyamba okugufuga n’okuguddukanya.
- Okumanya obulungi enteekateeka yo ey’obujjanjabi n’okwogera mu lwatu n’omusawo kijja kukuwa amaanyi n’okufuga mu lugendo luno. Teweeraliikiriranga, eddagala ery'omulembe ligenda mu maaso buli lunaku.
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