mkerdis simsivne erT-erTi gavrcelebuli daavadebaa, romelic
ZiriTadad qalebSi gvxvdeba. rogorc yvela simsivne, xasiaTdeba simsivnuri ujredebis ukontrolo zrdiT, avTvisebiani simsivnis dros metastazirebiT.
mkerdis simsivne SeiZleba warmoiqmnas rogorc sarZeve jirkvalSi, ise sadinrebSi
istoria
mkerdis kibo aRweril iqna jer kidev:
Cvens welTaRricxvamde 1600 wliT adreegvipteSi
papirusis furcelze 8 SemTxveva iqna aRwerili
(“es daavadeba ar eqvemdebareba mkurnalobas,
mas mudam sikvdilamde mivyavarT”) mkurnalobismeTodad iyenebdnen mkerdis moSanTvas cecxliT
XVII saukunidan moyolebuli (safrangeTi Sveicaria) mkerds kveTaven mis axlosmdebare limfur kvanZebTan erTad
axlandel droSi ikvleven 17 816-gens, romelTa eqspresiis dadgenis Semdeg mkurnalobis gansxvavebul meTodebs mimarTaven
mkerdis simsivnis statistika
—daavadeba ZiriTadad gvxvdeba 13 wlidan 90 wlamde, avaddeba qalTa 1:13 ;
—simsivniT daavadebuli mamakacebis 1%-s aqvs mkerdis simsivne
— simsivniT daavadebul qalTa Soris mkerdis simsivne meore adgilzea- 26%-iT
—sikvdilianobis mixedviT – 15%-iT
—progesteronisa da estrogenis mimarT mgrZnobiarea, mkerdis simsivneTa – 22,9%
—2008 wels mkerdis simsivniT 458 503 (13,7%) gardaicvala
risk faqtorebi
—mcire Sobadoba
—pirveli mSobiaroba 30 wlisSemdeg
—adreuli ciklis dawyeba (12wlamde)
—dagvianebuli menopauza (55 wlis Semdeg)
—genetikuri winaswarganwyoba
—sxva simsivnis arseboba
—sarZeve jirkvlis travmebi
—gacximovneba
—Saqriani diabeti, hipertoniuli daavadebebi
—alkoholizmi, sigareTis moweva, dabali fizikuri aqtivoba
—egzogenuri hormonebis gamoyeneba 10 welze metxans
perevenciuli zomebi
—adreuli diagnostika
—pirveladi da meoradiprofilaqtika
—adekvaturi mkurnaloba
mkerdis simsivne da apoptozi.
simsivnis warmoqmnis mizezebi
apoptozi Cveulebrivi normaluri procesia, sadac TviTon ujredi TamaSobs did rols sakuTar sikvdilSi. apoptozis ZiriTadi mizezi dnm-s dazianebaa, rac SeiZleba gamoiwvios Tavisufalma radikalebma, dasxivebam, virusulma infeqciebma. mkerdis da zogadad simsivneebis dros adgili aqvs mutaciebs apoptozis warmmarTvel genebSi.
mag:
mutaciebi simsivnis supresor genebSi: P53, BRCA1, BRCA2
P53- aqvs didi roli ujredis ciklis kontrolSi da apoptozSi. misi mutaciisas simsivnur ujredebs saSualeba eZlevaT gamravldnen. Cveulebriv ujredebSi
am cilis done dabalia. dnm-s dazianeba da sxva stresuli signalebi zrdian mis dones. misi mTavari funqciebia: dnm-s "SekeTeba", ujreduli ciklis SeCereba, ris Sedegadac dazianebuli dnm-s replikacia (gaormageba) ar moxdeba.
apoptozisgan damcavi genebis mutacia: PI3K, AKT, RAS, MEK, ERK, PTEN
CCND1- s maRali eqspresia , romelic monawielobs ujredul ciklSi
HER2 - genis amplifikacia,misi gazrdili aqtivoba asocirdeba simsivnis zrdasaTan da progresirebasTan.
estrogeni da mkerdis simsivne
estrogens aqvs erT-erTi gadamwyveti roli mkerdis simsivnis ganviTarebaSi, radgan mas SeuZlia mkerdis qsovilis zrdis stimulireba,Sesabamisad Tu es qsovili gadagvarebul ujredebsac moicavs, estrogenis stimuli gamoiwvevs simsivnis Camoyalibebas.
simsivnuri markerebi
yovel simsivnes aqvs specifiurad misTvis damaxasiaTebeli markerebi, romlebic gamoiyeneba mis diagnostikaSi da mkurnalobaSi.
CA 15,3 mkerdis simsivnisa da sakvercxis simsivnis mTvari markeria
agreTve SeiZleba markerad gamoyenebul iqnas TRU – QUANT da CA 27,29
Tuki simsivne metastazirebis Sedegad sxva organoebze gadava magaliTad:
msxvil nawlavze, filtvebsa da RviZlze markerad SeiZleba gamoyenebul iqnas: CEA
diagnostika
1.mamografia – sarZeve jirkvlis rentgenografia
2.biofsia – mikroskopireba
3.magnito rezonansi, radiologia
4.estrogen progesteronis receptorebisgansazRvra
5.simsivnis zrdis siCqaris – stadiisgansazRvra
qromosomebis aneuploidia (aranormaluri raodenoba) simsivnis swrafi tempiT zrdis niSania
6.HER2 receptoris
eqspresia
7. imunohistoqimia - specifiuri antisxeulebiT xdeba simsivnuri markerebis gansazRvra
diagnostika stadiebis mixedviT
AI stadiisTvisac ki ucilebelia: sisxlis saerTo analizis, sisxlis bioqimiuri, samkurnalo fermentebis gamovlena, fosfatazis, kalcis, menstrualuri ciklis Seferxebis
II-IV stadiisas iyeneben rendgenografias, Zvlebis radioizotopiur skanirebas,sisxlZarRvebis rendgenogramas,
swori Terapiis SerCevisaTvis adgenen simsivnis mgrZnobelobas hormonebismimarT
simsivnis Terapia
—qirurgia
—radiaciuli Terapia
•damxmare Terapia
—qimioTerapia: Adriamycin, Ellence,Cytoxan, and Taxol
—hormono Terapia: Tamoxifen( is ukavSirdeba estrogenis receptors, magram ar aaqtiurebs mas ), ERDownregulators, Aromataseinhibitors
—imunoTerapia
imunoTerapia
simsivnis imunoTerapiisas gamoiyeneba monoklonuri antisxeulebi,romlebic ukavSirdebian simsivnuri ujredis komponnetebs mag: ujredis zedapiris cilas (receptors), es kavSiri iwvevs ujredebis ganadgurebas ori gziT
1. antisxeulebi mimarTaven imunur sistemas ujredis winaaRmdeg
2. antisxeulebs ukavSireben radioaqtiur nivTierebas, Sedegad es nivTiereba iwvevs specifiurad simsivnuri ujredis ganadgurebas
qvemoT moyvanili preparatebi warmoadgenen monoklonur antisxeulebs, romlebic mimarTulia her2 da her1 receptorebisken, antisxeulebi aneitraleben maT moqmedebas, kerZod zRudaven ujredebis momdevno proliferaciasa da metastazirebas
Trastuzumab- anti-HER2/neu “humanized” monoclonal antibody
Cetuximab- HER1mab
Lapatinib - HER2 da EGFR inhibitor
wamlis miRebis dozebi
cikluri qimioTerapia antracikliniT saSualod 4 jer
adiuvanturi trastuzumabis SemTxvevaSi:
1 xel – 3 kviraSi, doza 6 mg/kg-ze
an 1 xel – 1 kviraSi, doza 2 ml/kg daaxloebiT 1 wlis ganmavlobaSi
taqsonebTan erTad maTi miReba SeiZleba
xolo antraciklinebTan erTad miReba dauSvebelia, raTa ar moyveskardiologiuri garTulebebi
sicocxlis xangrZlivoba
10 weli cocxloben:
pacientTa 5% mkurnalobis gareSe
pacientTa 10% optimaluri mkurnalobiT
am fotoze gamosaxulia qali, romelsac mkerdis simsivnis diagnozi orsulobisas daudgines, mas sruliad jamrTeli bavSvi SeeZina. qimio Terapia mSobiarobis Semdgom gaukeTda, mas Semdeg ori weli gavida is jer kidev cocxalia
bavSvs xSirad aviwydeba da ekiTxeba xolme dedas: " deda mkerdi sad waiRe?" :))
gisurvebT jamrTelobas
yovelwliurad daaxloebiT 12 milioni axali SemTxveva fiqsirdeba (kanis-melanomebisa da arainvaziuri simsivneebis gamoklebiT), xolo daaxloebiT 7 milioni adamiani iRupeba yovelwliurad kiboTi.
1. asaki
