{"id":1227,"date":"2023-04-06T11:30:21","date_gmt":"2023-04-06T04:30:21","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=1227"},"modified":"2023-04-13T06:40:38","modified_gmt":"2023-04-12T23:40:38","slug":"hoi-chung-lynch","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/06\/hoi-chung-lynch\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng Lynch: \u0110\u1eb7c \u0111i\u1ec3m, nguy\u00ean nh\u00e2n v\u00e0 ch\u1ea9n \u0111o\u00e1n"},"content":{"rendered":"<h2>1. Gi\u1edbi thi\u1ec7u<\/h2>\n<p>H\u1ed9i ch\u1ee9ng Lynch l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a ung th\u01b0 \u0111\u1ea1i <a href=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/03\/giai-phau-hoc-ung-dung-vung-truc-trang\/\">tr\u1ef1c tr\u00e0ng<\/a> (CRC) di truy\u1ec1n. \u0110\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gia t\u0103ng \u0111\u00e1ng k\u1ec3 nguy c\u01a1 CRC v\u00e0 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung, c\u0169ng nh\u01b0 m\u1ed9t s\u1ed1 kh\u1ed1i u \u00e1c t\u00ednh kh\u00e1c.<\/p>\n<p>B\u00e0i vi\u1ebft n\u00e0y c\u00f3 \u0111\u1ec1 c\u1eadp m\u1ed9t s\u1ed1 kh\u00e1i ni\u1ec7m:<\/p>\n<ul>\n<li class=\"bulletIndent1\">Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng kh\u00f4ng do di truy\u1ec1n (HNPCC) \u0111\u1ec1 c\u1eadp \u0111\u1ebfn b\u1ec7nh nh\u00e2n\u00a0<span class=\"nowrap\">v\u00e0 \/ ho\u1eb7c<\/span> gia \u0111\u00ecnh \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed Amsterdam.<\/li>\n<li class=\"bulletIndent1\">H\u1ed9i ch\u1ee9ng Lynch \u0111\u1ec1 c\u1eadp \u0111\u1ebfn b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh c\u00f3 \u0111\u1ed9t bi\u1ebfn d\u00f2ng m\u1ea7m \u1edf m\u1ed9t trong c\u00e1c gen s\u1eeda ch\u1eefa DNA kh\u00f4ng ph\u00f9 h\u1ee3p (MLH1, MSH2,\u00a0<em>MSH6, PMS2<\/em>) ho\u1eb7c gen\u00a0<em>EPCAM<\/em>.<\/li>\n<\/ul>\n<p id=\"H345552210\" class=\"headingAnchor\"><span class=\"h1\">H\u1ed9i<\/span><span class=\"headingEndMark\">\u00a0<\/span>ch\u1ee9ng Lynch l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n tr\u1ed9i NST g\u00e2y ra b\u1edfi \u0111\u1ed9t bi\u1ebfn d\u00f2ng m\u1ea7m \u1edf m\u1ed9t trong m\u1ed9t s\u1ed1 gen s\u1eeda ch\u1eefa DNA kh\u00f4ng ph\u00f9 h\u1ee3p ho\u1eb7c m\u1ea5t bi\u1ec3u hi\u1ec7n c\u1ee7a\u00a0<em>MSH2\u00a0<\/em>do x\u00f3a trong gen\u00a0<em>EPCAM<\/em>\u00a0(tr\u01b0\u1edbc \u0111\u00e2y g\u1ecdi l\u00e0\u00a0<em>TACSTD1<\/em>). C\u00e1c gen s\u1eeda ch\u1eefa kh\u00f4ng ph\u00f9 h\u1ee3p (MMR) c\u00f3 li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Lynch bao g\u1ed3m:<\/p>\n<ul>\n<li class=\"bulletIndent1\"><em>MLH1<\/em>\u00a0(MutL homolog 1), n\u1eb1m tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 3p22.2<\/li>\n<li class=\"bulletIndent1\"><em>MSH2<\/em>\u00a0(MutS homolog 2), n\u1eb1m tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 2p21-16<\/li>\n<li class=\"bulletIndent1\"><em>MSH6<\/em>\u00a0(MutS homolog 6), n\u1eb1m tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 2p16.3<\/li>\n<li class=\"bulletIndent1\"><em>PMS2\u00a0<\/em>(ph\u00e2n t\u00e1ch sau meiotic 2), n\u1eb1m tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 7p22.1<\/li>\n<\/ul>\n<h2>2. D\u1ecbch t\u1ec5<\/h2>\n<p>Kho\u1ea3ng 20% c\u00e1c tr\u01b0\u1eddng h\u1ee3p CRC c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc CRC \u1edf \u00edt nh\u1ea5t m\u1ed9t ng\u01b0\u1eddi th\u00e2n \u0111\u1ed9 m\u1ed9t. H\u1ed9i ch\u1ee9ng Lynch l\u00e0 h\u1ed9i ch\u1ee9ng nh\u1ea1y c\u1ea3m CRC di truy\u1ec1n ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 chi\u1ebfm kho\u1ea3ng 3% c\u00e1c tr\u01b0\u1eddng h\u1ee3p CRC m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 3% ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung. Ng\u01b0\u1eddi ta \u01b0\u1edbc t\u00ednh r\u1eb1ng 1 trong 279 d\u00e2n s\u1ed1 mang \u0111\u1ed9t bi\u1ebfn gen s\u1eeda ch\u1eefa DNA kh\u00f4ng ph\u00f9 h\u1ee3p.<\/p>\n<h2>3. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/h2>\n<p>Nguy c\u01a1 m\u1eafc ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng (CRC), ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 m\u1ed9t s\u1ed1 kh\u1ed1i u \u00e1c t\u00ednh kh\u00e1c cao h\u01a1n.<\/p>\n<h3>3.1. Bi\u1ec3u hi\u1ec7n \u1edf \u0111\u1ea1i tr\u00e0ng<\/h3>\n<p id=\"H3\" class=\"headingAnchor\">Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng cho \u0111\u1ebfn khi h\u1ecd c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng nh\u01b0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, \u0111au b\u1ee5ng ho\u1eb7c thay \u0111\u1ed5i th\u00f3i quen \u0111\u1ea1i ti\u1ec7n. Nguy c\u01a1 su\u1ed1t \u0111\u1eddi c\u1ee7a CRC \u0111\u1ebfn 70 tu\u1ed5i trong h\u1ed9i ch\u1ee9ng Lynch thay \u0111\u1ed5i t\u1eeb 10% \u0111\u1ebfn 47% t\u00f9y thu\u1ed9c v\u00e0o gi\u1edbi t\u00ednh v\u00e0 gen s\u1eeda ch\u1eefa kh\u00f4ng ph\u00f9 h\u1ee3p (MMR) b\u1ecb \u0111\u1ed9t bi\u1ebfn. M\u1eb7c d\u00f9 \u0111\u1ed9 tu\u1ed5i kh\u1edfi ph\u00e1t thay \u0111\u1ed5i theo ki\u1ec3u gen, CRC trong h\u1ed9i ch\u1ee9ng Lynch x\u1ea3y ra \u1edf \u0111\u1ed9 tu\u1ed5i tr\u1ebb h\u01a1n so v\u1edbi CRC th\u00f4ng th\u01b0\u1eddng (45 \u0111\u1ebfn 60 so v\u1edbi 69 tu\u1ed5i).<\/p>\n<p>Kho\u1ea3ng 7 ph\u1ea7n tr\u0103m nh\u1eefng ng\u01b0\u1eddi m\u1eafc h\u1ed9i ch\u1ee9ng Lynch c\u00f3 nhi\u1ec1u h\u01a1n m\u1ed9t b\u1ec7nh ung th\u01b0 v\u00e0o th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n. \u1ede nh\u1eefng ng\u01b0\u1eddi m\u1eafc h\u1ed9i ch\u1ee9ng Lynch ch\u1ec9 tr\u1ea3i qua c\u1eaft b\u1ecf ph\u00e2n \u0111o\u1ea1n cho ung th\u01b0 ru\u1ed9t k\u1ebft \u0111\u1ea7u ti\u00ean, 16% ph\u00e1t tri\u1ec3n CRC t\u00e1i ph\u00e1t ho\u1eb7c d\u1ecb ph\u00e1t sau 10 n\u0103m, 41% sau 20 n\u0103m v\u00e0 62% sau 30 n\u0103m. T\u01b0\u01a1ng t\u1ef1, \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc h\u1ed9i ch\u1ee9ng Lynch \u0111\u00e3 tr\u1ea3i qua ph\u1eabu thu\u1eadt ung th\u01b0 tr\u1ef1c tr\u00e0ng \u0111\u1ea7u ti\u00ean, 19% ph\u00e1t tri\u1ec3n CRC\u00a0 sau 10 n\u0103m, 47% sau 20 n\u0103m v\u00e0 69% sau 30 n\u0103m.<\/p>\n<p>CRC trong h\u1ed9i ch\u1ee9ng Lynch kh\u00e1c v\u1edbi CRC th\u00f4ng th\u01b0\u1eddng \u1edf ch\u1ed7 ch\u00fang ch\u1ee7 y\u1ebfu n\u1eb1m \u1edf ph\u00eda b\u00ean ph\u1ea3i t\u1ea1i ch\u1ed7. M\u1eb7c d\u00f9 CRC li\u00ean quan \u0111\u1ebfn Lynch ti\u1ebfn h\u00f3a t\u1eeb u tuy\u1ebfn, c\u00e1c u tuy\u1ebfn c\u00f3 xu h\u01b0\u1edbng l\u1edbn h\u01a1n, ph\u1eb3ng h\u01a1n, th\u01b0\u1eddng g\u1ea7n h\u01a1n v\u00e0 c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng c\u00f3 lo\u1ea1n s\u1ea3n m\u1ee9c \u0111\u1ed9 cao <span class=\"nowrap\">v\u00e0 \/ ho\u1eb7c<\/span> m\u00f4 h\u1ecdc nhung mao so v\u1edbi u tuy\u1ebfn. Tr\u00ecnh t\u1ef1 ung th\u01b0 bi\u1ec3u m\u00f4 tuy\u1ebfn c\u0169ng ti\u1ebfn tri\u1ec3n nhanh h\u01a1n nhi\u1ec1u trong h\u1ed9i ch\u1ee9ng Lynch so v\u1edbi CRC (35 th\u00e1ng so v\u1edbi 10 \u0111\u1ebfn 15 n\u0103m). Tuy nhi\u00ean, t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 10 n\u0103m kh\u1ecfi CRC trong h\u1ed9i ch\u1ee9ng Lynch l\u00e0 cao (91%).<\/p>\n<h3 id=\"H4\" class=\"headingAnchor\">3.2. Bi\u1ec3u hi\u1ec7n ngo\u00e0i \u0111\u1ea1i tr\u00e0ng<\/h3>\n<p class=\"headingAnchor\">\u00a0Kh\u1ed1i u\u00a0<span class=\"h2\">ngo\u00e0i \u0111\u1ea1i tr\u00e0ng<\/span> ph\u1ed5 bi\u1ebfn nh\u1ea5t trong h\u1ed9i ch\u1ee9ng Lynch l\u00e0 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung. Nguy c\u01a1 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung kh\u00e1c nhau t\u00f9y thu\u1ed9c v\u00e0o gen MMR b\u1ecb \u0111\u1ed9t bi\u1ebfn. Nh\u1eefng ng\u01b0\u1eddi m\u1eafc h\u1ed9i ch\u1ee9ng Lynch c\u0169ng c\u00f3 nguy c\u01a1 cao b\u1ecb ung th\u01b0 bu\u1ed3ng tr\u1ee9ng, d\u1ea1 d\u00e0y, ru\u1ed9t non, h\u1ec7 th\u1ed1ng gan m\u1eadt, khung ch\u1eadu v\u00e0 ni\u1ec7u qu\u1ea3n th\u1eadn, n\u00e3o (u th\u1ea7n kinh \u0111\u1ec7m) v\u00e0 u b\u00e3 nh\u1eddn.<\/p>\n<p>C\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 ung th\u01b0 tuy\u1ebfn t\u1ee5y, tuy\u1ebfn ti\u1ec1n li\u1ec7t, v\u00fa v\u00e0 c\u1ed5 t\u1eed cung. Ung th\u01b0 thanh qu\u1ea3n, ung th\u01b0 v\u1ec1 huy\u1ebft h\u1ecdc, ung th\u01b0 v\u1ecf th\u01b0\u1ee3ng th\u1eadn v\u00e0 sarcoma \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, nh\u01b0ng kh\u00f4ng r\u00f5 li\u1ec7u t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c b\u1ec7nh ung th\u01b0 n\u00e0y c\u00f3 t\u0103ng so v\u1edbi d\u00e2n s\u1ed1 n\u00f3i chung hay kh\u00f4ng.<\/p>\n<p id=\"H5\" class=\"headingAnchor\"><span class=\"h2\"><a href=\"http:\/\/H\u1ed9i ch\u1ee9ng Muir-Torre\">H\u1ed9i ch\u1ee9ng Muir-Torre<\/a>, <\/span>\u00a0\u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi kh\u1ed1i u b\u00e3 nh\u1eddn v\u00e0 u gi\u00e1c m\u1ea1c da, ngo\u00e0i c\u00e1c b\u1ec7nh ung th\u01b0 li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Lynch. C\u00e1c kh\u1ed1i u b\u00e3 nh\u1eddn \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf nh\u1eefng ng\u01b0\u1eddi mang c\u1ea3 b\u1ed1n gen MMR, nh\u01b0ng nh\u1eefng ng\u01b0\u1eddi c\u00f3 \u0111\u1ed9t bi\u1ebfn\u00a0<em>MSH2<\/em> d\u01b0\u1eddng nh\u01b0 \u0111\u1eb7c bi\u1ec7t d\u1ec5 m\u1eafc ph\u1ea3i.<\/p>\n<p><a href=\"http:\/\/H\u1ed9i ch\u1ee9ng Turcot\">H\u1ed9i ch\u1ee9ng Turcot<\/a> l\u00e0 m\u1ed9t thu\u1eadt ng\u1eef l\u1ecbch s\u1eed ban \u0111\u1ea7u m\u00f4 t\u1ea3 m\u1ed1i li\u00ean quan c\u1ee7a CRC gia \u0111\u00ecnh v\u1edbi c\u00e1c kh\u1ed1i u n\u00e3o (ch\u1ee7 y\u1ebfu l\u00e0 u nguy\u00ean b\u00e0o t\u1ee7y v\u00e0 u th\u1ea7n kinh \u0111\u1ec7m). Khi di truy\u1ec1n c\u1ee7a CRC gia \u0111\u00ecnh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, r\u00f5 r\u00e0ng l\u00e0 c\u00e1c kh\u1ed1i u n\u00e3o c\u00f3 li\u00ean quan \u0111\u1ebfn c\u1ea3 polyp tuy\u1ebfn gia \u0111\u00ecnh (FAP) v\u00e0 h\u1ed9i ch\u1ee9ng Lynch. Ph\u1ea7n l\u1edbn c\u00e1c kh\u1ed1i u n\u00e3o li\u00ean quan \u0111\u1ebfn FAP l\u00e0 u nguy\u00ean b\u00e0o t\u1ee7y, trong khi \u1edf h\u1ed9i ch\u1ee9ng Lynch, u th\u1ea7n kinh \u0111\u1ec7m ph\u1ed5 bi\u1ebfn h\u01a1n.<\/p>\n<h2 id=\"H506714695\" class=\"headingAnchor\"><span class=\"h3\">4. Ti\u00eau ch\u00ed Amsterdam<\/span><\/h2>\n<p class=\"headingAnchor\"><span class=\"headingEndMark\">Ti\u00eau <\/span>ch\u00ed Amsterdam I \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng c\u00e1 nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng mang \u0111\u1ed9t bi\u1ebfn cho h\u1ed9i ch\u1ee9ng Lynch. C\u00e1c ti\u00eau ch\u00ed n\u00e0y \u0111\u00f2i h\u1ecfi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a CRC kh\u1edfi ph\u00e1t tr\u1ebb b\u00ean c\u1ea1nh ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ba CRC li\u00ean quan \u0111\u1ebfn hai th\u1ebf h\u1ec7 k\u1ebf ti\u1ebfp. Theo ti\u00eau ch\u00ed Amsterdam II, h\u1ed9i ch\u1ee9ng Lynch n\u00ean \u0111\u01b0\u1ee3c nghi ng\u1edd \u1edf nh\u1eefng ng\u01b0\u1eddi \u0111\u00e1p \u1ee9ng t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed sau:<\/p>\n<ul>\n<li class=\"bulletIndent1\">Ba ho\u1eb7c nhi\u1ec1u ng\u01b0\u1eddi th\u00e2n b\u1ecb ung th\u01b0 li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Lynch \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c minh v\u1ec1 m\u1eb7t m\u00f4 h\u1ecdc (CRC, ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung ho\u1eb7c ru\u1ed9t non, ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o chuy\u1ec3n ti\u1ebfp c\u1ee7a ni\u1ec7u qu\u1ea3n ho\u1eb7c khung ch\u1eadu th\u1eadn), m\u1ed9t trong s\u1ed1 \u0111\u00f3 l\u00e0 h\u1ecd h\u00e0ng \u0111\u1ed9 m\u1ed9t c\u1ee7a hai ng\u01b0\u1eddi kia v\u00e0 trong \u0111\u00f3 polyp tuy\u1ebfn gia \u0111\u00ecnh (FAP) \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb.<\/li>\n<li class=\"bulletIndent1\">Ung th\u01b0 li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Lynch li\u00ean quan \u0111\u1ebfn \u00edt nh\u1ea5t hai th\u1ebf h\u1ec7.<\/li>\n<li class=\"bulletIndent1\">M\u1ed9t ho\u1eb7c nhi\u1ec1u b\u1ec7nh ung th\u01b0 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc tu\u1ed5i 50.<\/li>\n<\/ul>\n<h2>5. Ch\u1ea9n \u0111o\u00e1n<\/h2>\n<p>C\u1ea7n nghi ng\u1edd h\u1ed9i ch\u1ee9ng Lynch \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng \u0111\u1ed3ng ph\u00e1t ho\u1eb7c d\u1ecb ph\u00e1t, tr\u01b0\u1edbc 50 tu\u1ed5i, nhi\u1ec1u b\u1ec7nh ung th\u01b0 li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Lynch (v\u00ed d\u1ee5: CRC v\u00e0 n\u1ed9i m\u1ea1c t\u1eed cung, bu\u1ed3ng tr\u1ee9ng, d\u1ea1 d\u00e0y, ru\u1ed9t non ho\u1eb7c <span class=\"nowrap\">khung ch\u1eadu \/ ni\u1ec7u qu\u1ea3n th\u1eadn),<\/span>\u00a0v\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p gia \u0111\u00ecnh m\u1eafc h\u1ed9i ch\u1ee9ng Lynch li\u00ean quan \u0111\u1ebfn ung th\u01b0. M\u1ed9t \u0111\u1ed9t bi\u1ebfn d\u00f2ng m\u1ea7m g\u00e2y b\u1ec7nh trong s\u1eeda ch\u1eefa kh\u00f4ng ph\u00f9 h\u1ee3p (MMR) ho\u1eb7c gen\u00a0<em>EPCAM<\/em> l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/p>\n<p>C\u1ea7n x\u00e9t nghi\u1ec7m di truy\u1ec1n:<\/p>\n<ul>\n<li class=\"bulletIndent1\">T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc CRC (thay v\u00e0o \u0111\u00f3, nh\u1eefng ng\u01b0\u1eddi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc 70 tu\u1ed5i)<\/li>\n<li class=\"bulletIndent1\">Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung tr\u01b0\u1edbc 60 tu\u1ed5i<\/li>\n<li class=\"bulletIndent1\">H\u1ecd h\u00e0ng \u0111\u1ed9 m\u1ed9t c\u1ee7a nh\u1eefng ng\u01b0\u1eddi c\u00f3 \u0111\u1ed9t bi\u1ebfn gen\u00a0<span class=\"nowrap\">MMR \/\u00a0<em>EPCAM<\/em><\/span>\u00a0\u0111\u00e3 bi\u1ebft<\/li>\n<li class=\"bulletIndent1\">Nh\u1eefng ng\u01b0\u1eddi c\u00f3 CRC v\u1edbi &gt;5% kh\u1ea3 n\u0103ng \u0111\u1ed9t bi\u1ebfn gen MMR theo c\u00e1c m\u00f4 h\u00ecnh d\u1ef1 \u0111o\u00e1n<\/li>\n<li class=\"bulletIndent1\">Ti\u1ec1n s\u1eed ung th\u01b0 gia \u0111\u00ecnh \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed Amsterdam I ho\u1eb7c II ho\u1eb7c h\u01b0\u1edbng d\u1eabn Bethesda s\u1eeda \u0111\u1ed5i<\/li>\n<\/ul>\n<h2>6. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h2>\n<ul>\n<li><a href=\"http:\/\/\u0110\u1ed9t bi\u1ebfn soma k\u00e9p trong nghi ng\u1edd h\u1ed9i ch\u1ee9ng Lynch\">\u0110\u1ed9t bi\u1ebfn soma k\u00e9p trong nghi ng\u1edd h\u1ed9i ch\u1ee9ng Lynch<\/a><\/li>\n<li>AFAP v\u00e0 polyp li\u00ean quan \u0111\u1ebfn\u00a0<em>MUTYH<\/em>\u00a0(MAP)<\/li>\n<li>H\u1ed9i ch\u1ee9ng thi\u1ebfu h\u1ee5t s\u1eeda ch\u1eefa kh\u00f4ng ph\u00f9 h\u1ee3p hi\u1ebfn ph\u00e1p (CMMR-D)<\/li>\n<li>Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng gia \u0111\u00ecnh lo\u1ea1i X\u00a0(FCCTX)<\/li>\n<li>H\u1ed9i ch\u1ee9ng gi\u1ed1ng\u00a0Lynch (LLS)<\/li>\n<\/ul>\n<h2>7. T\u00f3m t\u1eaft v\u00e0 khuy\u1ebfn ngh\u1ecb<\/h2>\n<ul>\n<li class=\"bulletIndent1\">H\u1ed9i ch\u1ee9ng Lynch l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n tr\u1ed9i NST g\u00e2y ra b\u1edfi \u0111\u1ed9t bi\u1ebfn d\u00f2ng m\u1ea7m \u1edf m\u1ed9t trong m\u1ed9t s\u1ed1 gen s\u1eeda ch\u1eefa DNA kh\u00f4ng ph\u00f9 h\u1ee3p (MMR) (MLH1, MSH2,\u00a0<em>MSH6, PMS2<\/em>) ho\u1eb7c m\u1ea5t bi\u1ec3u hi\u1ec7n c\u1ee7a\u00a0<em>MSH2<\/em>\u00a0do x\u00f3a trong gen\u00a0<em>EPCAM, <\/em>nh\u1ea1y c\u1ea3m v\u1edbi ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng di truy\u1ec1n (CRC) ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 chi\u1ebfm kho\u1ea3ng 3% c\u00e1c tr\u01b0\u1eddng h\u1ee3p CRC m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 3% ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung.<\/li>\n<li class=\"bulletIndent1\">Nguy c\u01a1 su\u1ed1t \u0111\u1eddi c\u1ee7a CRC \u0111\u1ebfn 70 tu\u1ed5i l\u00e0 kho\u1ea3ng t\u1eeb 10% \u0111\u1ebfn 47% t\u00f9y thu\u1ed9c v\u00e0o gi\u1edbi t\u00ednh v\u00e0 gen MMR b\u1ecb \u0111\u1ed9t bi\u1ebfn. Nh\u1eefng ng\u01b0\u1eddi m\u1eafc h\u1ed9i ch\u1ee9ng Lynch c\u0169ng c\u00f3 nguy c\u01a1 m\u1eafc ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 m\u1ed9t s\u1ed1 kh\u1ed1i u \u00e1c t\u00ednh kh\u00e1c bao g\u1ed3m ung th\u01b0 bu\u1ed3ng tr\u1ee9ng, khung ch\u1eadu th\u1eadn, ni\u1ec7u qu\u1ea3n, d\u1ea1 d\u00e0y, ru\u1ed9t non, \u1ed1ng m\u1eadt, da (u b\u00e3 nh\u1eddn) v\u00e0 n\u00e3o (u th\u1ea7n kinh \u0111\u1ec7m).<\/li>\n<li class=\"bulletIndent1\">CRC trong h\u1ed9i ch\u1ee9ng Lynch kh\u00e1c v\u1edbi CRC ri\u00eang l\u1ebb \u1edf ch\u1ed7 ch\u00fang ch\u1ee7 y\u1ebfu n\u1eb1m \u1edf v\u1ecb tr\u00ed b\u00ean ph\u1ea3i. M\u1eb7c d\u00f9 CRC d\u01b0\u1eddng nh\u01b0 ti\u1ebfn h\u00f3a t\u1eeb u tuy\u1ebfn, c\u00e1c u tuy\u1ebfn c\u00f3 xu h\u01b0\u1edbng l\u1edbn h\u01a1n, ph\u1eb3ng h\u01a1n, th\u01b0\u1eddng g\u1ea7n h\u01a1n v\u00e0 th\u01b0\u1eddng c\u00f3 lo\u1ea1n s\u1ea3n m\u1ee9c \u0111\u1ed9 cao <span class=\"nowrap\">v\u00e0 \/ ho\u1eb7c<\/span> m\u00f4 h\u1ecdc nhung mao so v\u1edbi u tuy\u1ebfn l\u1ebb t\u1ebb. Tr\u00ecnh t\u1ef1 adenoma &#8211; ung th\u01b0 bi\u1ec3u m\u00f4 c\u0169ng ti\u1ebfn tri\u1ec3n nhanh h\u01a1n nhi\u1ec1u trong h\u1ed9i ch\u1ee9ng Lynch so v\u1edbi CRC l\u1ebb t\u1ebb. Nh\u1eefng ng\u01b0\u1eddi m\u1eafc h\u1ed9i ch\u1ee9ng Lynch c\u00f3 nguy c\u01a1 gia t\u0103ng c\u1ea3 CRC \u0111\u1ed3ng b\u1ed9 v\u00e0 \u1ea9n.<\/li>\n<li class=\"bulletIndent1\">C\u00e1c kh\u1ed1i u trong h\u1ed9i ch\u1ee9ng Lynch th\u01b0\u1eddng cho th\u1ea5y s\u1ef1 m\u1ea5t \u1ed5n \u0111\u1ecbnh vi v\u1ec7 tinh (MSI) v\u00e0 m\u1ea5t nhu\u1ed9m protein MMR khi x\u00e9t nghi\u1ec7m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch (IHC). So v\u1edbi CRC l\u1ebb t\u1ebb, ch\u00fang th\u01b0\u1eddng c\u00f3 d\u1ea1ng nh\u1ea7y, t\u1ebf b\u00e0o v\u00f2ng d\u1ea5u hi\u1ec7u ho\u1eb7c lo\u1ea1i m\u00f4 h\u1ecdc t\u1ee7y, bi\u1ec7t h\u00f3a k\u00e9m v\u00e0 c\u00f3 th\u00e2m nhi\u1ec5m t\u1ebf b\u00e0o lympho nhanh ho\u1eb7c \u0111\u01b0\u1ee3c bao quanh b\u1edfi ph\u1ea3n \u1ee9ng b\u1ea1ch huy\u1ebft s\u1ea3n xu\u1ea5t trung t\u00e2m m\u1ea7m gi\u1ed1ng Crohn.<\/li>\n<li class=\"bulletIndent1\">M\u1ed9t s\u1ed1 ti\u00eau ch\u00ed l\u00e2m s\u00e0ng b\u1ec7nh l\u00fd (v\u00ed d\u1ee5: ti\u00eau ch\u00ed Amsterdam) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c c\u00e1 nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc h\u1ed9i ch\u1ee9ng Lynch. Tuy nhi\u00ean, ch\u00fang b\u1ecb h\u1ea1n ch\u1ebf v\u1ec1 \u0111\u1ed9 nh\u1ea1y, v\u1eabn ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng \u0111\u1ec3 nghi ng\u1edd kh\u1ea3 n\u0103ng m\u1eafc h\u1ed9i ch\u1ee9ng di truy\u1ec1n v\u00e0 g\u1ee3i ra ti\u1ec1n s\u1eed gia \u0111\u00ecnh ch\u00ednh x\u00e1c.<\/li>\n<li class=\"bulletIndent1\">C\u1ea7n nghi ng\u1edd \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n CRC \u0111\u1ed3ng ph\u00e1t ho\u1eb7c d\u1ecb ph\u00e1t, CRC tr\u01b0\u1edbc 50 tu\u1ed5i, nhi\u1ec1u b\u1ec7nh ung th\u01b0 li\u00ean quan \u0111\u1ebfn\u00a0 v\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Lynch gia \u0111\u00ecnh.<\/li>\n<li class=\"bulletIndent1\">Do nh\u1eefng h\u1ea1n ch\u1ebf trong ti\u00eau ch\u00ed l\u00e2m s\u00e0ng b\u1ec7nh l\u00fd v\u00e0 m\u00f4 h\u00ecnh d\u1ef1 \u0111o\u00e1n trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh c\u00e1c c\u00e1 nh\u00e2n c\u00f3 nguy c\u01a1, ch\u00fang t\u00f4i \u0111\u1ec1 ngh\u1ecb \u0111\u00e1nh gi\u00e1 di truy\u1ec1n v\u1ec1 s\u1ef1 thi\u1ebfu h\u1ee5t s\u1eeda ch\u1eefa kh\u00f4ng ph\u00f9 h\u1ee3p c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c CRC m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n (ho\u1eb7c c\u00e1ch kh\u00e1c, nh\u1eefng ng\u01b0\u1eddi d\u01b0\u1edbi 70 tu\u1ed5i). C\u00e1c ch\u1ec9 \u0111\u1ecbnh kh\u00e1c \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 di truy\u1ec1n bao g\u1ed3m:\n<ul>\n<li class=\"bulletIndent2\">Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung tr\u01b0\u1edbc 60 tu\u1ed5i<\/li>\n<li class=\"bulletIndent2\">H\u1ecd h\u00e0ng \u0111\u1ed9 m\u1ed9t c\u1ee7a nh\u1eefng ng\u01b0\u1eddi c\u00f3 \u0111\u1ed9t bi\u1ebfn gen\u00a0<span class=\"nowrap\">MMR \/\u00a0<em>EPCAM<\/em><\/span>\u00a0\u0111\u00e3 bi\u1ebft<\/li>\n<li class=\"bulletIndent2\">Nh\u1eefng ng\u01b0\u1eddi c\u00f3 CRC v\u1edbi &gt;5% kh\u1ea3 n\u0103ng \u0111\u1ed9t bi\u1ebfn gen MMR theo c\u00e1c m\u00f4 h\u00ecnh d\u1ef1 \u0111o\u00e1n<\/li>\n<li class=\"bulletIndent2\">Ti\u1ec1n s\u1eed ung th\u01b0 gia \u0111\u00ecnh \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed Amsterdam I ho\u1eb7c II<\/li>\n<\/ul>\n<\/li>\n<li class=\"bulletIndent1\">\u0110\u1ec3 th\u1ef1c hi\u1ec7n vi\u1ec7c th\u0103m kh\u00e1m v\u00e0 <a href=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/06\/tam-soat-ung-thu-dai-truc-trang-tren-nguoi-co-tien-su-gia-dinh-ung-thu-dai-truc-trang\/\">t\u1ea7m so\u00e1t ung th\u01b0<\/a>, qu\u00fd kh\u00e1ch vui l\u00f2ng \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, b\u1ea5m s\u1ed1 <a class=\"contact-button link-in-body\" href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/ai-nen-tam-soat-ung-thu-dai-trang\/#\"><b class=\"link-in-body\">HOTLINE<\/b><\/a>\u00a0ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp\u00a0<a class=\"appointment-button link-in-body\" href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/ai-nen-tam-soat-ung-thu-dai-trang\/#\"><b class=\"link-in-body\">T\u1ea0I \u0110\u00c2Y<\/b><\/a>. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean\u00a0<a class=\"link-in-body\" href=\"https:\/\/www.vinmec.com\/myvinmec\/\" target=\"_blank\" rel=\"noopener\">\u1ee9ng d\u1ee5ng MyVinmec<\/a>\u00a0\u0111\u1ec3 qu\u1ea3n l\u00fd, theo d\u00f5i l\u1ecbch v\u00e0 \u0111\u1eb7t h\u1eb9n m\u1ecdi l\u00fac m\u1ecdi n\u01a1i ngay tr\u00ean \u1ee9ng d\u1ee5ng.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>1. Gi\u1edbi thi\u1ec7u H\u1ed9i ch\u1ee9ng Lynch l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng (CRC) di truy\u1ec1n. \u0110\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gia t\u0103ng \u0111\u00e1ng k\u1ec3 nguy c\u01a1 CRC v\u00e0 ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung, c\u0169ng nh\u01b0 m\u1ed9t s\u1ed1 kh\u1ed1i u \u00e1c t\u00ednh kh\u00e1c. B\u00e0i vi\u1ebft n\u00e0y c\u00f3 \u0111\u1ec1 c\u1eadp m\u1ed9t [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":1253,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[4,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>H\u1ed9i ch\u1ee9ng Lynch: \u0110\u1eb7c \u0111i\u1ec3m, nguy\u00ean nh\u00e2n v\u00e0 ch\u1ea9n \u0111o\u00e1n - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng Lynch l\u00e0 b\u1ec7nh l\u00fd di truy\u1ec1n, nguy c\u01a1 m\u1eafc ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 m\u1ed9t s\u1ed1 kh\u1ed1i u \u00e1c t\u00ednh kh\u00e1c cao h\u01a1n b\u00ecnh th\u01b0\u1eddng.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H\u1ed9i ch\u1ee9ng Lynch: \u0110\u1eb7c \u0111i\u1ec3m, nguy\u00ean nh\u00e2n v\u00e0 ch\u1ea9n \u0111o\u00e1n - 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