{"id":19184,"date":"2023-04-12T19:59:48","date_gmt":"2023-04-12T12:59:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19184"},"modified":"2023-04-13T09:47:33","modified_gmt":"2023-04-13T02:47:33","slug":"huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"

Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (UTBMTBG) l\u00e0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0 c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong s\u00e1u lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean th\u1ebf gi\u1edbi v\u00e0 n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam. UTBMTBG \u0111\u1ee9ng \u0111\u1ea7u trong\u00a0 c\u00e1c nguy\u00ean nh\u00e2n t\u1eed vong li\u00ean quan \u0111\u1ebfn ung th\u01b0 t\u1ea1i Vi\u1ec7t Nam.\u00a0<\/strong><\/p>\n

1. D\u1ecaCH T\u1ec4 H\u1eccC UTBMTBG V\u00c0 C\u00c1C Y\u1ebeU T\u1ed0 NGUY C\u01a0 <\/b><\/h2>\n

1.1. D\u1ecbch t\u1ec5 h\u1ecdc\u00a0<\/b><\/h3>\n

UTBMTBG l\u00e0 lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed\u00a0 vong li\u00ean quan \u0111\u1ebfn ung th\u01b0 t\u1ea1i Vi\u1ec7t Nam theo \u01b0\u1edbc t\u00ednh c\u1ee7a T\u1ed5 ch\u1ee9c Ghi nh\u1eadn Ung\u00a0 th\u01b0 to\u00e0n c\u1ea7u (GLOBOCAN) n\u0103m 2018. T\u1ea1i Vi\u1ec7t Nam ch\u01b0a c\u00f3 s\u1ed1 li\u1ec7u qu\u1ed1c gia\u00a0 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 ch\u00ednh th\u1ee9c v\u1ec1 xu\u1ea5t \u0111\u1ed9 UTBMTBG. M\u1ed9t nghi\u00ean c\u1ee9u ghi nh\u1eadn s\u1ed1 li\u1ec7u\u00a0 UTBMTBG t\u1ea1i mi\u1ec1n Trung v\u00e0 mi\u1ec1n Nam Vi\u1ec7t Nam l\u00e0 24091 tr\u01b0\u1eddng h\u1ee3p trong th\u1eddi\u00a0 gian 2010 \u0111\u1ebfn 2016, trong \u0111\u00f3 62,3% c\u00f3 nhi\u1ec5m virus vi\u00eam gan B (HBV) m\u1ea1n v\u00e0\u00a0 26% c\u00f3 nhi\u1ec5m virus vi\u00eam gan C (HCV) m\u1ea1n. Vi\u1ec7t Nam l\u00e0 n\u01b0\u1edbc c\u00f3 xu\u1ea5t \u0111\u1ed9 nhi\u1ec5m\u00a0 HBV cao, \u01b0\u1edbc t\u00ednh c\u00f3 kho\u1ea3ng 12,3% nam gi\u1edbi v\u00e0 8,8% n\u1eef gi\u1edbi c\u00f3 nhi\u1ec5m HBV m\u1ea1n.\u00a0 Tuy vi\u1ec7c ch\u1ee7ng ng\u1eeba HBV cho tr\u1ebb em t\u1ea1i Vi\u1ec7t Nam \u0111\u00e3 l\u00e0m gi\u1ea3m ph\u1ea7n n\u00e0o xu\u1ea5t \u0111\u1ed9\u00a0 vi\u00eam gan virus B m\u1ea1n, nh\u01b0ng v\u1eabn \u0111ang c\u00f3 t\u00ecnh tr\u1ea1ng b\u00f9ng ph\u00e1t ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf\u00a0 b\u00e0o gan li\u00ean quan \u0111\u1ebfn nhi\u1ec5m HBV t\u1ea1i Vi\u1ec7t Nam.\u00a0<\/span><\/p>\n

1.2. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 ch\u00ednh\u00a0<\/b><\/h3>\n

– <\/span>HBV<\/b>: theo s\u1ed1 li\u1ec7u c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) n\u0103m 2016, d\u1ef1a tr\u00ean m\u1ed9t s\u1ed1\u00a0 nghi\u00ean c\u1ee9u t\u1eeb 2003 \u0111\u1ebfn 2014, t\u1ec9 l\u1ec7 nhi\u1ec5m HBV \u1edf ng\u01b0\u1eddi l\u1edbn t\u1ea1i Vi\u1ec7t Nam kho\u1ea3ng\u00a0 8,2-19%. Nhi\u1ec1u nghi\u00ean c\u1ee9u ph\u00e2n t\u00edch g\u1ed9p (meta-analysis) \u0111\u00e3 ch\u1ee9ng t\u1ecf nguy c\u01a1\u00a0 UTBMTBG \u1edf nh\u1eefng ng\u01b0\u1eddi nhi\u1ec5m HBV cao h\u01a1n 15-20 l\u1ea7n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi\u00a0 kh\u00f4ng nhi\u1ec5m. Nguy c\u01a1 b\u1ecb UTBMTBG trong cu\u1ed9c \u0111\u1eddi c\u1ee7a ng\u01b0\u1eddi nhi\u1ec5m HBV\u00a0 m\u1ea1n l\u00e0 kho\u1ea3ng 10-25%. C\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 l\u00e0m t\u0103ng nguy c\u01a1 UTBMTBG \u1edf ng\u01b0\u1eddi\u00a0 nhi\u1ec5m HBV m\u1ea1n, bao g\u1ed3m c\u00e1c y\u1ebfu t\u1ed1 v\u1ec1 h\u00ecnh th\u00e1i (nam gi\u1edbi, tu\u1ed5i l\u1edbn, ti\u1ec1n s\u1eed\u00a0 gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb UTBMTBG), v\u1ec1 virus (m\u1ee9c \u0111\u1ed9 nh\u00e2n b\u1ea3n HBV cao, ki\u1ec3u\u00a0 h\u00ecnh HBV, th\u1eddi gian nhi\u1ec5m HBV, \u0111\u1ed3ng nhi\u1ec5m v\u1edbi HCV, HIV, HDV), v\u1ec1 l\u00e2m\u00a0 s\u00e0ng (c\u00f3 x\u01a1 gan) v\u00e0 v\u1ec1 m\u00f4i tr\u01b0\u1eddng v\u00e0 l\u1ed1i s\u1ed1ng (ph\u01a1i nhi\u1ec5m v\u1edbi Aflatoxin,\u00a0 nghi\u1ec7n r\u01b0\u1ee3u n\u1eb7ng, h\u00fat thu\u1ed1c l\u00e1).\u00a0<\/span><\/p>\n

– <\/span>HCV<\/b>: theo s\u1ed1 li\u1ec7u c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) n\u0103m 2016, d\u1ef1a tr\u00ean m\u1ed9t s\u1ed1\u00a0 nghi\u00ean c\u1ee9u t\u1eeb 2003 \u0111\u1ebfn 2014, t\u1ec9 l\u1ec7 nhi\u1ec5m HCV \u1edf ng\u01b0\u1eddi l\u1edbn t\u1ea1i Vi\u1ec7t Nam kho\u1ea3ng\u00a0 1-3,3%. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p tr\u00ean m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u b\u1ec7nh-ch\u1ee9ng (case-control\u00a0 studies) cho th\u1ea5y ng\u01b0\u1eddi c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng HCV c\u00f3 nguy c\u01a1 b\u1ecb UTBMTBG g\u1ea5p\u00a0 17 l\u1ea7n so v\u1edbi ng\u01b0\u1eddi kh\u00f4ng c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng HCV.\u00a0<\/span><\/p>\n

– <\/span>\u0110\u1ed3ng nhi\u1ec5m HBV v\u00e0 HCV<\/b>: l\u00e0m t\u0103ng nguy c\u01a1 b\u1ecb UTBMTBG. Trong m\u1ed9t\u00a0 nghi\u00ean c\u1ee9u 24091 tr\u01b0\u1eddng h\u1ee3p UTBMTBG t\u1ea1i mi\u1ec1n Trung v\u00e0 mi\u1ec1n Nam Vi\u1ec7t Nam trong th\u1eddi gian 2010 \u0111\u1ebfn 2016, t\u1ec9 l\u1ec7 \u0111\u1ed3ng nhi\u1ec5m HBV v\u00e0 HCV l\u00e0 2,7%.<\/span><\/p>\n

– <\/span>S\u1eed d\u1ee5ng \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n<\/b>: m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p tr\u00ean 19 nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u ghi\u00a0 nh\u1eadn nguy c\u01a1 UTBMTBG t\u0103ng 16% \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1eed d\u1ee5ng t\u1eeb 3 \u0111\u01a1n v\u1ecb \u0111\u1ed3 u\u1ed1ng\u00a0 c\u00f3 c\u1ed3n tr\u1edf l\u00ean m\u1ed7i ng\u00e0y v\u00e0 t\u0103ng 22% \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1eed d\u1ee5ng t\u1eeb 6 \u0111\u01a1n v\u1ecb \u0111\u1ed3\u00a0 u\u1ed1ng c\u00f3 c\u1ed3n tr\u1edf l\u00ean m\u1ed7i ng\u00e0y, v\u00e0 nguy c\u01a1 n\u00e0y c\u0169ng t\u0103ng ngay c\u1ea3 khi ch\u1ec9 s\u1eed d\u1ee5ng\u00a0 l\u01b0\u1ee3ng c\u1ed3n th\u1ea5p nh\u1ea5t m\u1ed7i ng\u00e0y (25g m\u1ed7i ng\u00e0y, t\u01b0\u01a1ng \u1ee9ng v\u1edbi 2 \u0111\u01a1n v\u1ecb \u0111\u1ed3 u\u1ed1ng\u00a0 c\u00f3 c\u1ed3n m\u1ed7i ng\u00e0y). \u1ede Vi\u1ec7t Nam, ch\u01b0a c\u00f3 s\u1ed1 li\u1ec7u ch\u00ednh th\u1ee9c v\u1ec1 m\u1ed1i li\u00ean quan gi\u1eefa\u00a0 UTBMTBG v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n. Theo m\u1ed9t nghi\u00ean c\u1ee9u tr\u00ean 1617\u00a0 b\u1ec7nh nh\u00e2n UTBMTBG t\u1ea1i mi\u1ec1n Trung v\u00e0 mi\u1ec1n Nam Vi\u1ec7t Nam, c\u00f3 68,6% b\u1ec7nh\u00a0 nh\u00e2n \u0111\u00e3 v\u00e0 \u0111ang s\u1eed d\u1ee5ng \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n v\u1edbi nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau.\u00a0<\/span><\/p>\n

1.3. Ph\u00f2ng ng\u1eeba UTBMTBG\u00a0<\/b><\/h3>\n

– <\/span>N\u00ean s\u1eed d\u1ee5ng vaccin ch\u1ee7ng ng\u1eeba HBV cho tr\u1ebb em, nh\u1ea5t l\u00e0 tr\u1ebb s\u01a1 sinh \u0111\u1ec3 ng\u0103n\u00a0 ng\u1eeba vi\u1ec7c nhi\u1ec5m HBV. N\u00ean \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i v\u00e0 hi\u1ec7u qu\u1ea3 cho c\u00e1c b\u1ec7nh nh\u00e2n\u00a0 nhi\u1ec5m HBV m\u1ea1n v\u00e0 c\u00f3 b\u1ec7nh l\u00fd gan \u0111ang ho\u1ea1t \u0111\u1ed9ng.\u00a0<\/span><\/p>\n

– <\/span>N\u00ean \u0111i\u1ec1u tr\u1ecb vi\u00eam gan virus C cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng virus b\u1ec1n\u00a0 v\u1eefng (sustained virologic response – SVR). Nguy c\u01a1 UTBMTBG s\u1ebd gi\u1ea3m \u0111\u00e1ng\u00a0 k\u1ec3 n\u1ebfu c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam gan virus C m\u1ea1n \u0111\u1ea1t \u0111\u01b0\u1ee3c SVR. Tuy nhi\u00ean, ngay c\u1ea3\u00a0 khi \u0111\u1ea1t \u0111\u01b0\u1ee3c SVR, c\u00e1c b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u th\u1ea5p, v\u00e0\/ho\u1eb7c c\u00f3 x\u01a1\u00a0 gan v\u1eabn c\u00f3 nguy c\u01a1 UTBMTBG cao v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c t\u1ea7m so\u00e1t.\u00a0<\/span><\/p>\n

– <\/span>N\u00ean \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd chuy\u1ec3n h\u00f3a nh\u01b0 b\u1ec7nh gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u\u00a0 (Non-alcoholic Fatty Liver Disease – NAFLD), b\u1ec7nh vi\u00eam gan tho\u00e1i h\u00f3a m\u1ee1\u00a0 kh\u00f4ng do r\u01b0\u1ee3u (Non-alcoholic Steatohepatitis – NASH) v\u00ec c\u00e1c b\u1ec7nh l\u00fd n\u00e0y l\u00e0m\u00a0 t\u0103ng nguy c\u01a1 UTBMTBG, nh\u1ea5t l\u00e0 khi \u0111\u00e3 c\u00f3 x\u01a1 gan. C\u00e1c h\u1ed9i ch\u1ee9ng chuy\u1ec3n h\u00f3a,\u00a0 \u0111\u1eb7c bi\u1ec7t l\u00e0 ti\u1ec3u \u0111\u01b0\u1eddng v\u00e0 b\u00e9o ph\u00ec, l\u00e0m t\u0103ng nguy c\u01a1 UTBMTBG tr\u00ean c\u00e1c b\u1ec7nh\u00a0 nh\u00e2n b\u1ecb NASH.\u00a0<\/span><\/p>\n

2. T\u1ea6M SO\u00c1T UTBMTBG\u00a0<\/b><\/h2>\n

2.1. \u0110\u1ed1i t\u01b0\u1ee3ng t\u1ea7m so\u00e1t\u00a0<\/b><\/h3>\n

– <\/span>Nh\u00f3m nguy c\u01a1 cao: c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m HBV m\u1ea1n v\u00e0 HCV m\u1ea1n ch\u01b0a \u0111i\u1ec1u tr\u1ecb,\u00a0 \u0111ang \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u00e3 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus, v\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u01a1\u00a0 gan kh\u00f4ng li\u00ean quan \u0111\u1ebfn nhi\u1ec5m virus vi\u00eam gan.\u00a0<\/span><\/p>\n

– <\/span>Nh\u00f3m nguy c\u01a1 r\u1ea5t cao: c\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u01a1 gan c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u00eam gan do virus (HBV, HCV).\u00a0<\/span><\/p>\n

2.2. Ph\u01b0\u01a1ng ti\u1ec7n v\u00e0 t\u1ea7n su\u1ea5t t\u1ea7m so\u00e1t\u00a0<\/b><\/h3>\n

– <\/span>T\u1ea7m so\u00e1t b\u1eb1ng si\u00eau \u00e2m b\u1ee5ng v\u00e0 x\u00e9t nghi\u1ec7m ph\u1ed1i h\u1ee3p c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc AFP, AFP-L3, PIVKA II.\u00a0<\/span><\/p>\n

– <\/span>T\u1ea7m so\u00e1t m\u1ed7i 6 th\u00e1ng \u0111\u1ed1i v\u1edbi nh\u00f3m nguy c\u01a1 cao v\u00e0 m\u1ed7i 3 th\u00e1ng \u0111\u1ed1i v\u1edbi nh\u00f3m\u00a0 nguy c\u01a1 r\u1ea5t cao. N\u1ebfu ph\u00e1t hi\u1ec7n c\u00f3 t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd UTBMTBG v\u00e0\/ho\u1eb7c gi\u00e1\u00a0 tr\u1ecb c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc t\u0103ng th\u00ec n\u00ean ch\u1ee5p CT scan b\u1ee5ng c\u00f3 c\u1ea3n quang ho\u1eb7c MRI\u00a0 b\u1ee5ng c\u00f3 t\u01b0\u01a1ng ph\u1ea3n t\u1eeb. <\/span><\/p>\n

3. CH\u1ea8N \u0110O\u00c1N UTBMTBG\u00a0<\/b><\/h2>\n

3.1. Kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u1ea7n l\u00e0m<\/b><\/h3>\n

<\/b>– <\/span>C\u1ea7n t\u00ecm hi\u1ec3u c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh nh\u00e2n:<\/span><\/p>\n

+ <\/span>B\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eebng b\u1ecb nhi\u1ec5m hay \u0111\u00e3 ho\u1eb7c \u0111ang \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV v\u00e0\/ho\u1eb7c\u00a0 HCV.\u00a0<\/span><\/p>\n

+ <\/span>Gia \u0111\u00ecnh b\u1ec7nh nh\u00e2n (cha m\u1eb9, v\u1ee3 ch\u1ed3ng, anh ch\u1ecb em ru\u1ed9t) c\u00f3 ng\u01b0\u1eddi \u0111\u00e3 t\u1eebng b\u1ecb\u00a0 nhi\u1ec5m hay \u0111\u00e3 ho\u1eb7c \u0111ang \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m HBV v\u00e0\/ho\u1eb7c HCV, ho\u1eb7c \u0111\u00e3 \u0111\u01b0\u1ee3c\u00a0 ch\u1ea9n \u0111o\u00e1n b\u1ecb UTBMTBG.\u00a0<\/span><\/p>\n

+ <\/span>\u0110\u00e3 t\u1eebng \u0111\u01b0\u1ee3c truy\u1ec1n m\u00e1u hay t\u1eebng s\u1eed d\u1ee5ng kim ti\u00eam chung v\u1edbi ng\u01b0\u1eddi kh\u00e1c. <\/span><\/p>\n

+ <\/span>T\u00ecnh tr\u1ea1ng s\u1eed d\u1ee5ng th\u1ee9c u\u1ed1ng c\u00f3 c\u1ed3n (s\u1ed1 l\u01b0\u1ee3ng, t\u1ea7n su\u1ea5t, th\u1eddi gian, \u2026). <\/span><\/p>\n

+ <\/span>\u0110\u00e3 t\u1eebng ti\u1ebfp x\u00fac v\u1edbi c\u00e1c lo\u1ea1i \u0111\u1ed9c t\u1ed1 hay h\u00f3a ch\u1ea5t (lo\u1ea1i, th\u1eddi gian ti\u1ebfp x\u00fac\u2026).\u00a0<\/span><\/p>\n

+ <\/span>L\u00fd do \u0111\u1ebfn kh\u00e1m b\u1ec7nh (\u0111au b\u1ee5ng, v\u00e0ng da, b\u1ee5ng to, \u2026 hay ch\u1ec9 l\u00e0 ki\u1ec3m tra s\u1ee9c\u00a0 kh\u1ecfe).\u00a0<\/span><\/p>\n

+ <\/span>C\u00e1c b\u1ec7nh l\u00fd kh\u00e1c \u0111i k\u00e8m (n\u1ebfu c\u00f3).\u00a0<\/span><\/p>\n

– <\/span>Kh\u00e1m l\u00e2m s\u00e0ng:\u00a0<\/span><\/p>\n

+ <\/span>Ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG ch\u1ec9 c\u00f3 \u0111au b\u1ee5ng m\u01a1 h\u1ed3 ho\u1eb7c \u0111\u01b0\u1ee3c ph\u00e1t\u00a0 hi\u1ec7n t\u00ecnh c\u1edd.\u00a0<\/span><\/p>\n

+ <\/span>\u0110\u00e1nh gi\u00e1 to\u00e0n tr\u1ea1ng, d\u1ea5u hi\u1ec7u sinh t\u1ed3n, t\u00ecnh tr\u1ea1ng v\u00e0ng da ni\u00eam m\u1ea1c. <\/span><\/p>\n

+ <\/span>Kh\u00e1m t\u1ed5ng th\u1ec3, kh\u00e1m b\u1ee5ng, ch\u00fa \u00fd c\u00f3 s\u1edd th\u1ea5y gan to hay kh\u00f4ng. <\/span><\/p>\n

– <\/span>C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u1ea7n l\u00e0m:\u00a0<\/span><\/p>\n

+ <\/span>C\u00f4ng th\u1ee9c m\u00e1u, ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u to\u00e0n b\u1ed9, \u0111\u01b0\u1eddng huy\u1ebft.\u00a0<\/span><\/p>\n

+ <\/span>Ch\u1ee9c n\u0103ng gan th\u1eadn: ALT, AST, Bilirubin, Albumin, Ure, Creatinin m\u00e1u. <\/span><\/p>\n

+ <\/span>C\u00e1c x\u00e9t nghi\u1ec7m mi\u1ec5n d\u1ecbch v\u1ec1 virus vi\u00eam gan B, C: HBsAg, AntiHCV <\/span><\/p>\n

+ <\/span>Ch\u1ec9 d\u1ea5u sinh h\u1ecdc c\u1ee7a UTBMTBG: AFP, AFP-L3, PIVKA II (DCP). <\/span><\/p>\n

+ <\/span>C\u00e1c ch\u1ec9 d\u1ea5u ung th\u01b0 kh\u00e1c (n\u1ebfu c\u1ea7n): CEA, CA 19.9, PSA, CA 12.5, \u2026 <\/span>+ <\/span>X quang ph\u1ed5i th\u1eb3ng.\u00a0<\/span><\/p>\n

+ <\/span>Si\u00eau \u00e2m Doppler m\u1ea1ch m\u00e1u gan.\u00a0<\/span><\/p>\n

+ <\/span>CT scan b\u1ee5ng c\u00f3 c\u1ea3n quang (v\u00e0 MRI b\u1ee5ng c\u00f3 t\u01b0\u01a1ng ph\u1ea3n t\u1eeb n\u1ebfu c\u1ea7n). <\/span><\/p>\n

3.2. H\u00ecnh \u1ea3nh h\u1ecdc\u00a0<\/b><\/h3>\n

3.2.1. Si\u00eau \u00e2m<\/span>\u00a0<\/span><\/h4>\n
a. Si\u00eau \u00e2m 2D v\u00e0 si\u00eau \u00e2m Doppler m\u1ea1ch m\u00e1u gan\u00a0<\/span><\/i><\/h5>\n

Si\u00eau \u00e2m 2D v\u00e0 si\u00eau \u00e2m Doppler thu\u1eadn ti\u1ec7n v\u00e0 c\u00f3 chi ph\u00ed th\u1ea5p n\u00ean l\u00e0 c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n\u00a0 <\/span>\u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 t\u1ea7m so\u00e1t v\u00e0 theo d\u00f5i \u0111i\u1ec1u tr\u1ecb UTBMTBG, nh\u01b0ng kh\u00f4ng <\/span>\u00a0<\/span>d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n UTBMTBG. Si\u00eau \u00e2m \u0111\u00e1nh gi\u00e1 h\u00ecnh d\u1ea1ng, v\u1ecb tr\u00ed, s\u1ed1 l\u01b0\u1ee3ng, k\u00edch <\/span>\u00a0<\/span>th\u01b0\u1edbc kh\u1ed1i u gan, t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd gan n\u1ec1n, t\u00ecnh tr\u1ea1ng d\u1ecbch \u1ed5 b\u1ee5ng v\u00e0 c\u00e1c t\u1ed5n <\/span>\u00a0<\/span>th\u01b0\u01a1ng \u0111i k\u00e8m trong \u1ed5 b\u1ee5ng. Si\u00eau \u00e2m Doppler m\u1ea1ch m\u00e1u gan cho ph\u00e9p \u0111\u00e1nh gi\u00e1 <\/span>\u00a0<\/span>t\u00ecnh tr\u1ea1ng c\u1ea5p m\u00e1u c\u1ee7a kh\u1ed1i u, t\u00ecnh tr\u1ea1ng kh\u1ed1i u x\u00e2m l\u1ea5n v\u00e0 di c\u0103n v\u00e0o c\u00e1c m\u1ea1ch <\/span>\u00a0<\/span>m\u00e1u l\u00e2n c\u1eadn, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi.<\/span>\u00a0<\/span><\/p>\n

H\u1ec7 th\u1ed1ng D\u1eef li\u1ec7u v\u00e0 B\u00e1o c\u00e1o h\u00ecnh \u1ea3nh Gan (The Liver Imaging Reporting and Data System – LI-RADS) khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng si\u00eau \u00e2m kh\u00f4ng ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n \u0111\u1ec3 <\/span>t\u1ea7m so\u00e1t v\u00e0 theo d\u00f5i UTBMTBG \u1edf c\u00e1c b\u1ec7nh nh\u00e2n x\u01a1 gan v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 cao\u00a0 kh\u00e1c.\u00a0<\/span><\/p>\n

b. Si\u00eau \u00e2m c\u00f3 ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n (contrast-enhanced ultrasound – CEUS)<\/span><\/i><\/i><\/h5>\n

Nh\u1eefng thay \u0111\u1ed5i ch\u00ednh trong qu\u00e1 tr\u00ecnh sinh UTBMTBG bao g\u1ed3m s\u1ef1 h\u00ecnh th\u00e0nh\u00a0 <\/span>m\u1ea1ch, thay \u0111\u1ed5i t\u1ebf b\u00e0o gan, gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng v\u00e0 ch\u1ee9c n\u0103ng c\u1ee7a t\u1ebf b\u00e0o Kupffer, trong \u0111\u00f3 <\/span>\u00a0<\/span>s\u1ef1 thay \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng c\u1ee7a c\u00e1c n\u1ed1t, bao g\u1ed3m t\u0103ng l\u01b0u l\u01b0\u1ee3ng \u0111\u1ed9ng m\u1ea1ch v\u00e0 gi\u1ea3m l\u01b0u <\/span>\u00a0<\/span>l\u01b0\u1ee3ng t\u0129nh m\u1ea1ch c\u1eeda, l\u00e0 thay \u0111\u1ed5i quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n UTBMTBG. M\u1eadt \u0111\u1ed9 <\/span>\u00a0<\/span>t\u1ebf b\u00e0o Kupffer gi\u1ea3m c\u00f9ng v\u1edbi s\u1ef1 gi\u1ea3m bi\u1ec7t h\u00f3a c\u1ee7a n\u1ed1t x\u01a1 gan. C\u00e1c vi b\u00f3ng kh\u00ed <\/span>\u00a0<\/span>trong CEUS \u0111\u01b0\u1ee3c th\u1ef1c b\u00e0o b\u1edfi c\u00e1c t\u1ebf b\u00e0o Kupffer, n\u00ean h\u00ecnh \u1ea3nh t\u1ebf b\u00e0o Kupffer c\u00f3 <\/span>\u00a0<\/span>th\u1ec3 quan s\u00e1t \u0111\u01b0\u1ee3c, c\u00e1c kh\u1ed1i u \u00e1c t\u00ednh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t v\u1edbi v\u00f9ng gan quanh u do <\/span>\u00a0<\/span>ch\u00fang ch\u1ee9a \u00edt ho\u1eb7c kh\u00f4ng ch\u1ee9a t\u1ebf b\u00e0o Kupffer.<\/span>\u00a0<\/span><\/p>\n

H\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a UTBMTBG tr\u00ean CEUS l\u00e0 ng\u1ea5m thu\u1ed1c m\u1ea1nh th\u00ec \u0111\u1ed9ng m\u1ea1ch\u00a0 <\/span>(arterial phase hyperenhancement – APHE) v\u00e0 th\u1ea3i thu\u1ed1c nh\u1eb9 sau 60 gi\u00e2y. CEUS c\u00f3 <\/span>\u00a0<\/span>\u0111\u1ed9 nh\u1ea1y cao \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng gi\u1ea3m quang th\u00ec \u0111\u1ed9ng m\u1ea1ch v\u00e0 th\u1ec3 hi\u1ec7n t\u1ed1t h\u01a1n <\/span>\u00a0<\/span>d\u1ea5u hi\u1ec7u \u201cth\u1ea3i thu\u1ed1c\u201d nhanh (di\u1ec5n ra s\u1edbm, t\u1ea1i th\u1eddi \u0111i\u1ec3m 55-60 gi\u00e2y) \u0111\u1ed1i v\u1edbi b\u1ec7nh \u00e1c <\/span>\u00a0<\/span>t\u00ednh kh\u00f4ng ph\u1ea3i UTBMTBG v\u00e0 \u201cth\u1ea3i thu\u1ed1c\u201d r\u1ea5t mu\u1ed9n (sau 60 gi\u00e2y) \u0111\u1ed1i v\u1edbi <\/span>\u00a0<\/span>UTBMTBG. CEUS kh\u00f4ng c\u00f3 b\u1ee9c x\u1ea1 ion h\u00f3a v\u00e0 c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n c\u1ee7a CEUS <\/span>\u00a0<\/span>kh\u00f4ng g\u00e2y \u0111\u1ed9c cho th\u1eadn.<\/span>\u00a0<\/span><\/p>\n

CEUS c\u00f3 ph\u00e2n \u0111\u1ed9 theo LI-RADS \u0111\u01b0\u1ee3c Hi\u1ec7p h\u1ed9i Nghi\u00ean c\u1ee9u B\u1ec7nh gan\u00a0 <\/span>ch\u00e2u \u00c1 Th\u00e1i B\u00ecnh D\u01b0\u01a1ng (APASL) v\u00e0 H\u1ed9i Ung th\u01b0 N\u1ed9i khoa ch\u00e2u \u00c2u (ESMO)<\/span> khuy\u1ebfn c\u00e1o d\u00f9ng trong ch\u1ea9n \u0111o\u00e1n UTBMTBG nh\u01b0ng ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u1ed3ng thu\u1eadn \u0111\u01b0a <\/span>\u00a0<\/span>v\u00e0o c\u00e1c h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n UTBMTBG kh\u00e1c tr\u00ean th\u1ebf gi\u1edbi do kh\u00f3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c <\/span>\u00a0<\/span>ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt trong gan v\u1edbi UTBMTBG trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p. B\u00ean c\u1ea1nh <\/span>\u00a0<\/span>\u0111\u00f3, v\u1eabn ph\u1ea3i ch\u1ec9 \u0111\u1ecbnh CT v\u00e0\/ho\u1eb7c MRI \u0111\u1ed9ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh giai \u0111o\u1ea1n b\u1ec7nh tr\u01b0\u1edbc khi <\/span>\u00a0<\/span>\u0111i\u1ec1u tr\u1ecb.<\/span>\u00a0<\/span><\/p>\n

3.2.2. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT) v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI)\u00a0<\/span><\/h4>\n

H\u00ecnh \u1ea3nh h\u1ecdc \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n v\u00e0 trong vi\u1ec7c \u0111\u01b0a ra quy\u1ebft\u00a0 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb UTBMTBG nh\u1edd v\u00e0o vi\u1ec7c m\u00f4 t\u1ea3 \u0111\u1ea7y \u0111\u1ee7 h\u00ecnh th\u00e1i gan v\u00e0 n\u00eau l\u00ean \u0111\u01b0\u1ee3c\u00a0 \u0111\u1ed9ng h\u1ecdc t\u01b0\u1edbi m\u00e1u gan. T\u1ed5n th\u01b0\u01a1ng UTBMTBG c\u00f3 s\u1ef1 thay \u0111\u1ed5i \u0111i\u1ec3n h\u00ecnh l\u00e0 t\u0103ng\u00a0 ngu\u1ed3n c\u1ea5p m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch v\u00e0 gi\u1ea3m ngu\u1ed3n c\u1ea5p m\u00e1u t\u1eeb t\u0129nh m\u1ea1ch c\u1eeda.\u00a0<\/span><\/p>\n

\u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n UTBMTBG, c\u1ea7n c\u00f3 CT \u0111a d\u00e3y \u0111\u1ea7u d\u00f2 ch\u1ee5p \u0111\u1ee7 4 th\u00ec v\u00e0\/ho\u1eb7c MRI\u00a0 \u0111\u1ed9ng c\u00f3 th\u00ec \u0111\u1ed9ng m\u1ea1ch tr\u1ec5, th\u00ec t\u0129nh m\u1ea1ch c\u1eeda v\u00e0 th\u00ec mu\u1ed9n (kho\u1ea3ng 3-5 ph\u00fat sau khi\u00a0 ti\u00eam ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb). CT \u0111\u1ed9ng v\u00e0 MRI \u0111\u1ed9ng cho ph\u00e9p \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ph\u00e2n b\u1ed1\u00a0 m\u1ea1ch m\u00e1u t\u1ea1i kh\u1ed1i u, v\u1edbi h\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a UTBMTBG l\u00e0 ng\u1ea5m thu\u1ed1c m\u1ea1nh \u1edf\u00a0 th\u00ec \u0111\u1ed9ng m\u1ea1ch v\u00e0 th\u1ea3i thu\u1ed1c \u1edf th\u00ec t\u0129nh m\u1ea1ch c\u1eeda v\u00e0\/ho\u1eb7c \u1edf th\u00ec mu\u1ed9n.\u00a0<\/span><\/p>\n

MRI c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n nh\u1eefng kh\u1ed1i u c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf, nh\u1ea5t l\u00e0 c\u00e1c kh\u1ed1i u < 2cm, d\u1ef1a v\u00e0o s\u1ef1 kh\u1ea3o s\u00e1t tr\u00ean nhi\u1ec1u chu\u1ed7i xung, \u0111\u1eb7c bi\u1ec7t l\u00e0 MRI \u0111\u1ed9ng v\u00e0 chu\u1ed7i xung\u00a0 khu\u1ebfch t\u00e1n r\u1ea5t nh\u1ea1y trong ch\u1ea9n \u0111o\u00e1n. MRI cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t r\u1ea5t t\u1ed1t gi\u1eefa\u00a0 UTBMTBG v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng khu tr\u00fa kh\u00e1c trong gan nh\u01b0 u m\u00e1u, u tuy\u1ebfn (adenoma), t\u0103ng sinh d\u1ea1ng n\u1ed1t khu tr\u00fa (focal nodular hyperplasia-FNH), di c\u0103n gan\u00a0 ho\u1eb7c n\u1ed1t t\u00e2n t\u1ea1o trong x\u01a1 gan. Trong h\u1ea7u h\u1ebft c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 gi\u00e1 tr\u1ecb trong ch\u1ea9n\u00a0 \u0111o\u00e1n UTBMTBG, MRI \u0111\u1ec1u c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n CT v\u1edbi \u0111\u1ed9 chuy\u00ean bi\u1ec7t t\u1eeb 85% \u0111\u1ebfn\u00a0 100%, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u1ecf. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y khuy\u1ebfn c\u00e1o\u00a0 ch\u1ee5p MRI v\u1edbi ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb gan-m\u1eadt gadoxetate disodium (Gd-EOB-DTPA- <\/span>gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid) c\u00f3 \u0111\u1ed9 nh\u1ea1y cao h\u01a1n\u00a0 CT \u0111\u1ed9ng v\u00e0 MRI s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb kh\u00e1c.\u00a0<\/span><\/p>\n

H\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh c\u1ee7a UTBMTBG tr\u00ean CT\/MRI l\u00e0 gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 \u1edf th\u00ec ch\u01b0a ti\u00eam <\/span>\u00a0<\/span>thu\u1ed1c, ng\u1ea5m thu\u1ed1c m\u1ea1nh \u1edf th\u00ec \u0111\u1ed9ng m\u1ea1ch (arterial phase hyperenhancement –<\/span> APHE) v\u00e0 th\u1ea3i thu\u1ed1c (wash-out) \u1edf th\u00ec t\u0129nh m\u1ea1ch c\u1eeda hay th\u00ec mu\u1ed9n.<\/span>\u00a0<\/span><\/p>\n

Ngo\u00e0i gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n, CT\/MRI c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 sau\u00a0 \u0111i\u1ec1u tr\u1ecb UTBMTBG. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ph\u00e2n \u0111\u1ed9 theo LI-RADS (Ph\u1ee5 l\u1ee5c 2 v\u00e0 3) \u0111\u1ec3\u00a0 h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.\u00a0<\/span><\/p>\n

C\u00e1c t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd l\u00e0 UTBMTBG n\u1ebfu c\u00f3 ng\u1ea5m lipiodol t\u1ea1i t\u1ed5n th\u01b0\u01a1ng sau\u00a0 khi l\u00e0m N\u00fat m\u1ea1ch h\u00f3a ch\u1ea5t (TACE) th\u00ec \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 UTBMTBG.\u00a0<\/span><\/p>\n

3.2.3. PET v\u00e0 PET\/CT\u00a0<\/span><\/h4>\n

Ch\u1ec9 c\u00f3 kho\u1ea3ng 40% c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG c\u00f3 h\u1ea5p thu Fluorodeoxyglucose F 18 (<\/span>18<\/span>F) khi ch\u1ee5p PET v\u00e0 PET\/CT, v\u00e0 h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG bi\u1ec7t h\u00f3a\u00a0 cao \u0111\u1ec1u cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh khi ch\u1ee5p PET v\u00e0 PET\/CT. Tuy nhi\u00ean, PET v\u00e0 PET\/CT\u00a0 r\u1ea5t c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng di c\u0103n ngo\u00e0i gan c\u1ee7a UTBMTBG, nh\u1ea5t l\u00e0\u00a0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ea5y t\u1ed5n th\u01b0\u01a1ng UTBMTBG m\u1edbi hay ti\u1ebfn tri\u1ec3n t\u1ea1i gan\u00a0 sau khi \u0111i\u1ec1u tr\u1ecb. Ngo\u00e0i ra c\u00f3 th\u1ec3 ch\u1ee5p PET\/CT v\u1edbi <\/span>11<\/span>C-Choline \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u1ed5n\u00a0 th\u01b0\u01a1ng t\u1ea1i gan, ngo\u00e0i gan t\u1ed1t h\u01a1n <\/span>18<\/span>F.\u00a0<\/span><\/p>\n

3.2.4. C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c\u00a0<\/span><\/h4>\n

– <\/span>X\u1ea1 h\u00ecnh x\u01b0\u01a1ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi 99mTc-MDP \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n\u00a0 th\u01b0\u01a1ng di c\u0103n x\u01b0\u01a1ng, ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n b\u1ec7nh tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i \u0111\u00e1p \u1ee9ng\u00a0 \u0111i\u1ec1u tr\u1ecb, \u0111\u00e1nh gi\u00e1 t\u00e1i ph\u00e1t v\u00e0 di c\u0103n.\u00a0<\/span><\/p>\n

– <\/span>X\u1ea1 h\u00ecnh th\u1eadn ch\u1ee9c n\u0103ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi 99mTc-DTPA \u0111\u1ec3\u00a0 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb v\u00e0 sau \u0111i\u1ec1u tr\u1ecb.\u00a0<\/span><\/p>\n

– <\/span>X\u1ea1 h\u00ecnh – SPECT gan v\u1edbi 99mTc-Sulfure Colloid: h\u00ecnh \u1ea3nh kh\u1ed1i cho\u00e1n ch\u1ed7\u00a0 trong gan, \u00e1p d\u1ee5ng trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p.\u00a0<\/span><\/p>\n

– <\/span>X\u1ea1 h\u00ecnh gan m\u1eadt trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p\u00a0<\/span><\/p>\n

3.3. Ch\u1ec9 d\u1ea5u sinh h\u1ecdc\u00a0<\/b><\/h3>\n

3.3.1. Alpha-fetoprotein (AFP)\u00a0<\/span><\/h4>\n

Vai tr\u00f2 c\u1ee7a AFP trong ch\u1ea9n \u0111o\u00e1n UTBMTBG ch\u01b0a r\u00f5 r\u00e0ng. AFP c\u00f3 th\u1ec3 t\u0103ng trong\u00a0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam gan ho\u1ea1t \u0111\u1ed9ng v\u00e0 x\u01a1 gan, v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m \u0111i khi \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u00ecnh\u00a0 tr\u1ea1ng vi\u00eam gan b\u1eb1ng c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb HBV v\u00e0 HCV. Ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng\u00a0 c\u1ee7a AFP th\u01b0\u1eddng l\u00e0 20 ng\/ml, ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a AFP l\u00e0 400 ng\/ml. AFP\u00a0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi si\u00eau \u00e2m \u0111\u1ec3 t\u1ea7m so\u00e1t UTBMTBG tr\u00ean c\u00e1c \u0111\u1ed1i\u00a0 t\u01b0\u1ee3ng nguy c\u01a1.\u00a0<\/span><\/p>\n

3.3.2. Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)\u00a0<\/span><\/h4>\n

AFP-L3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t s\u1ef1 gia t\u0103ng AFP trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p\u00a0 UTBMTBG v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p u l\u00e0nh t\u00ednh \u1edf gan. Ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a\u00a0 AFP-L3 l\u00e0 5%.\u00a0<\/span><\/p>\n

3.3.3. Prothrombin induced by vitamin K absence-II (PIVKA II) hay c\u00f2n g\u1ecdi l\u00e0\u00a0 Des-gamma-carboxyprothrombin (DCP)<\/span><\/h4>\n

PIVKA II l\u00e0 m\u1ed9t prothombin b\u1ea5t th\u01b0\u1eddng, t\u0103ng trong huy\u1ebft thanh c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p\u00a0 UTBMTBG. Ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a PIVKA II l\u00e0 40 mAU\/ml.\u00a0<\/span><\/p>\n

3.3.4. M\u1ed9t s\u1ed1 ch\u1ec9 d\u1ea5u sinh h\u1ecdc kh\u00e1c trong huy\u1ebft thanh\u00a0\u00a0<\/span><\/h4>\n

C\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc kh\u00e1c nh\u01b0 Glypican-3 (GPC3), Golgi protein 73 (GP73), Osteopontin, circulating cell free DNA, v\u00e0 c\u00e1c microRNA ch\u01b0a c\u00f3 vai tr\u00f2 r\u00f5 r\u00e0ng\u00a0 v\u1ec1 chuy\u00ean m\u00f4n l\u1eabn hi\u1ec7u qu\u1ea3 v\u1ec1 kinh t\u1ebf.\u00a0<\/span><\/p>\n

3.3.5. K\u1ebft h\u1ee3p c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc trong huy\u1ebft thanh\u00a0<\/span><\/h4>\n

S\u1ef1 k\u1ebft h\u1ee3p c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc AFP, AFP-L3 v\u00e0 PIVKA II trong huy\u1ebft thanh c\u00f3\u00a0 th\u1ec3 c\u1ea3i thi\u1ec7n \u0111\u1ed9 nh\u1ea1y trong t\u1ea7m so\u00e1t v\u00e0 ch\u1ea9n \u0111o\u00e1n UTBMTBG m\u00e0 kh\u00f4ng l\u00e0m gi\u1ea3m\u00a0 \u0111i \u0111\u1ed9 chuy\u00ean bi\u1ec7t, do \u0111\u00f3 n\u00ean s\u1eed d\u1ee5ng vi\u1ec7c k\u1ebft h\u1ee3p n\u00e0y trong th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng.\u00a0<\/span><\/p>\n

3.4. Sinh thi\u1ebft gan\u00a0<\/b><\/h3>\n

Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng \u1edf gan kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n\u00a0 \u0111o\u00e1n d\u01b0\u1edbi \u0111\u00e2y th\u00ec sinh thi\u1ebft gan cho ph\u00e9p x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n UTBMTBG v\u00e0 ph\u00e2n\u00a0 bi\u1ec7t v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u00e1c t\u00ednh nguy\u00ean ph\u00e1t kh\u00e1c t\u1ea1i gan nh\u01b0 ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt,\u00a0 ung th\u01b0 gan-m\u1eadt k\u1ebft h\u1ee3p, c\u0169ng nh\u01b0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u00e1c t\u00ednh th\u1ee9 ph\u00e1t t\u1ea1i gan c\u00e1c u\u00a0 th\u1ea7n kinh n\u1ed9i ti\u1ebft v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng di c\u0103n t\u1ea1i gan. C\u00e1c nguy c\u01a1 nh\u01b0 ch\u1ea3y m\u00e1u hay\u00a0 gieo r\u1eafc t\u1ebf b\u00e0o ung th\u01b0 \u0111\u1ec1u c\u00f3 t\u1ec9 l\u1ec7 r\u1ea5t th\u1ea5p, c\u00f3 th\u1ec3 x\u1eed tr\u00ed \u0111\u01b0\u1ee3c v\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng\u00a0 \u0111\u1ebfn quy\u1ebft \u0111\u1ecbnh l\u00e0m sinh thi\u1ebft gan khi c\u1ea7n thi\u1ebft.\u00a0<\/span><\/p>\n

K\u1ebft qu\u1ea3 sinh thi\u1ebft gan c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ed1i chi\u1ebfu v\u1edbi c\u00e1c d\u1eef li\u1ec7u v\u1ec1 h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 ch\u1ec9 d\u1ea5u\u00a0 sinh h\u1ecdc \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh n\u00ean sinh thi\u1ebft l\u1ea1i hay n\u00ean theo d\u00f5i ti\u1ebfp. N\u1ebfu quy\u1ebft \u0111\u1ecbnh theo\u00a0 d\u00f5i ti\u1ebfp th\u00ec n\u00ean \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u1ed5n th\u01b0\u01a1ng b\u1eb1ng h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 ch\u1ec9 d\u1ea5u sinh h\u1ecdc sau\u00a0 02 th\u00e1ng.\u00a0<\/span><\/p>\n

3.5. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh UTBMTBG\u00a0<\/b><\/h3>\n

Khi t\u1ed5n th\u01b0\u01a1ng \u1edf gan c\u00f3 m\u1ed9t trong ba ti\u00eau chu\u1ea9n sau:\u00a0<\/span><\/p>\n

– <\/span>H\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh* c\u1ee7a UTBMTBG tr\u00ean CT scan b\u1ee5ng c\u00f3 c\u1ea3n quang ho\u1eb7c MRI\u00a0 b\u1ee5ng c\u00f3 t\u01b0\u01a1ng ph\u1ea3n t\u1eeb + AFP <\/span>\u2265 <\/span>400 ng\/ml.\u00a0<\/span><\/p>\n

– <\/span>H\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh* c\u1ee7a UTBMTBG tr\u00ean CT scan b\u1ee5ng c\u00f3 c\u1ea3n quang ho\u1eb7c MRI\u00a0 b\u1ee5ng c\u00f3 t\u01b0\u01a1ng ph\u1ea3n t\u1eeb + AFP t\u0103ng cao h\u01a1n b\u00ecnh th\u01b0\u1eddng (nh\u01b0ng ch\u01b0a \u0111\u1ebfn 400\u00a0 ng\/ml) + c\u00f3 nhi\u1ec5m HBV v\u00e0\/ho\u1eb7c HCV. C\u00f3 th\u1ec3 l\u00e0m sinh thi\u1ebft gan \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n\u00a0 x\u00e1c \u0111\u1ecbnh n\u1ebfu b\u00e1c s\u0129 l\u00e2m s\u00e0ng th\u1ea5y c\u1ea7n thi\u1ebft.\u00a0<\/span><\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n n\u00f3i tr\u00ean \u0111\u1ec1u ph\u1ea3i l\u00e0m sinh thi\u1ebft kh\u1ed1i u gan\u00a0 (c\u00f3 th\u1ec3 ph\u1ea3i l\u00e0m nhi\u1ec1u l\u1ea7n) \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh. N\u1ebfu sinh thi\u1ebft l\u1ea1i v\u1eabn \u00e2m t\u00ednh th\u00ec\u00a0 c\u00f3 th\u1ec3 theo d\u00f5i v\u00e0 l\u00e0m l\u1ea1i c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 ch\u1ec9 d\u1ea5u sinh h\u1ecdc m\u1ed7i 2\u00a0 th\u00e1ng.\u00a0<\/span><\/p>\n

– <\/span>C\u00f3 b\u1eb1ng ch\u1ee9ng gi\u1ea3i ph\u1eabu b\u1ec7nh l\u00fd l\u00e0 UTBMTBG.\u00a0<\/span><\/p>\n

* <\/span><\/i>H\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh tr\u00ean CT scan b\u1ee5ng c\u00f3 c\u1ea3n quang ho\u1eb7c MRI b\u1ee5ng c\u00f3 t\u01b0\u01a1ng\u00a0 ph\u1ea3n t\u1eeb: kh\u1ed1i u b\u1eaft thu\u1ed1c tr\u00ean th\u00ec \u0111\u1ed9ng m\u1ea1ch gan v\u00e0 th\u1ea3i thu\u1ed1c (wash-out)\u00a0 tr\u00ean th\u00ec t\u0129nh m\u1ea1ch c\u1eeda hay th\u00ec ch\u1eadm. N\u00ean ch\u1ee5p MRI v\u1edbi ch\u1ea5t t\u01b0\u01a1ng ph\u1ea3n t\u1eeb gan – m\u1eadt gadoxetate disodium (Gd-EOB-DTPA – gadolinium ethoxybenzyl\u00a0 diethylenetriamine pentaacetic acid) \u0111\u1ec3 t\u0103ng kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4\u00a0 t\u1ebf b\u00e0o gan.<\/span><\/i><\/p>\n

S\u01a1 \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n UTBMTBG\u00a0<\/i><\/b><\/p>\n

\"S\u01a1<\/span><\/p>\n

3.6. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t\u00a0<\/b><\/h3>\n

– <\/span>U m\u00e1u \u1edf gan (hemangioma): kh\u1ed1i u b\u1eaft thu\u1ed1c t\u0103ng d\u1ea7n t\u1eeb th\u00ec \u0111\u1ed9ng m\u1ea1ch gan \u0111\u1ebfn th\u00ec\u00a0 ch\u1eadm tr\u00ean CT scan ho\u1eb7c MRI, ch\u1ec9 d\u1ea5u sinh h\u1ecdc c\u1ee7a UTBMTBG b\u00ecnh th\u01b0\u1eddng, c\u00f3 th\u1ec3\u00a0 c\u00f3 ho\u1eb7c kh\u00f4ng nhi\u1ec5m HBV v\u00e0\/ho\u1eb7c HCV.\u00a0<\/span><\/p>\n

– <\/span>C\u00e1c u l\u00e0nh \u1edf gan nh\u01b0 u tuy\u1ebfn (adenoma), t\u0103ng sinh d\u1ea1ng n\u1ed1t (focal nodular\u00a0 hyperplasia \u2013 FNH), \u00e1p xe gan, n\u1ed1t v\u00f4i h\u00f3a \u1edf gan, \u2026: h\u00ecnh \u1ea3nh kh\u00f4ng \u0111i\u1ec3n h\u00ecnh tr\u00ean CT scan ho\u1eb7c MRI, ch\u1ec9 d\u1ea5u sinh h\u1ecdc c\u1ee7a UTBMTBG b\u00ecnh th\u01b0\u1eddng, c\u00f3 th\u1ec3 c\u00f3\u00a0 ho\u1eb7c kh\u00f4ng nhi\u1ec5m HBV v\u00e0\/ho\u1eb7c HCV, c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1edd MRI b\u1ee5ng c\u00f3 t\u01b0\u01a1ng\u00a0 ph\u1ea3n t\u1eeb \u0111\u1eb7c hi\u1ec7u ho\u1eb7c sinh thi\u1ebft gan.\u00a0<\/span><\/p>\n

– <\/span>Ung th\u01b0 \u0111\u01b0\u1eddng m\u1eadt trong gan: kh\u1ed1i u b\u1eaft thu\u1ed1c kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u, kh\u00f4ng c\u00f3 hi\u1ec7n\u00a0 t\u01b0\u1ee3ng th\u1ea3i thu\u1ed1c, ch\u1ec9 d\u1ea5u ung th\u01b0 CEA, CA 19.9 c\u00f3 th\u1ec3 t\u0103ng cao. Ch\u1ea9n \u0111o\u00e1n x\u00e1c\u00a0 \u0111\u1ecbnh nh\u1edd sinh thi\u1ebft gan.\u00a0<\/span><\/p>\n

– <\/span>Di c\u0103n gan c\u1ee7a c\u00e1c ung th\u01b0 kh\u00e1c (ung th\u01b0 d\u1ea1 d\u00e0y, ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, ung th\u01b0\u00a0 ph\u1ed5i, ung th\u01b0 v\u00fa, \u2026): h\u00ecnh \u1ea3nh b\u1eaft thu\u1ed1c d\u1ea1ng vi\u1ec1n tr\u00ean CT scan ho\u1eb7c MRI, c\u00e1c ch\u1ec9\u00a0 d\u1ea5u ung th\u01b0 t\u01b0\u01a1ng \u1ee9ng t\u0103ng cao, c\u00f3 t\u1ed5n th\u01b0\u01a1ng nguy\u00ean ph\u00e1t, \u2026\u00a0<\/span><\/p>\n

3.7. Ph\u00e2n chia giai \u0111o\u1ea1n b\u1ec7nh\u00a0<\/b><\/h3>\n

C\u00e1c H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ee7a Nh\u00f3m Ung th\u01b0 gan Barcelona (BCLC), H\u1ed9i Nghi\u00ean c\u1ee9u\u00a0 b\u1ec7nh gan ch\u00e2u \u00c2u (EASL), H\u1ed9i Ung th\u01b0 N\u1ed9i khoa ch\u00e2u \u00c2u (ESMO) v\u00e0 H\u1ed9i Nghi\u00ean\u00a0 c\u1ee9u b\u1ec7nh gan Hoa K\u1ef3 (AASLD) ph\u00e2n chia UTBMTBG th\u00e0nh 5 giai \u0111o\u1ea1n b\u1ec7nh: 0 (r\u1ea5t\u00a0 s\u1edbm), A (s\u1edbm), B (trung gian), C (ti\u1ebfn tri\u1ec3n), D (cu\u1ed1i), \u0111\u1ec3 \u0111\u1ec1 ra c\u00e1ch \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.\u00a0 Trong khi \u0111\u00f3, Hi\u1ec7p h\u1ed9i nghi\u00ean c\u1ee9u b\u1ec7nh gan ch\u00e2u \u00c1 Th\u00e1i B\u00ecnh D\u01b0\u01a1ng (APASL) kh\u00f4ng\u00a0 ph\u00e2n chia giai \u0111o\u1ea1n b\u1ec7nh, m\u00e0 d\u1ef1a tr\u00ean 6 y\u1ebfu t\u1ed1: di c\u0103n ngo\u00e0i gan, ch\u1ee9c n\u0103ng gan (\u0111\u00e1nh\u00a0 gi\u00e1 b\u1eb1ng h\u1ec7 th\u1ed1ng Child-Pugh), kh\u1ea3 n\u0103ng c\u1eaft gan \u0111\u01b0\u1ee3c, x\u00e2m nh\u1eadp m\u1ea1ch m\u00e1u l\u1edbn, s\u1ed1\u00a0 l\u01b0\u1ee3ng u, k\u00edch th\u01b0\u1edbc u, \u0111\u1ec3 ch\u1ecdn l\u1ef1a c\u00e1c \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.\u00a0<\/span><\/p>\n

B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/b><\/a> \u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n, g\u00e2y m\u00ea v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn gan. \u0110\u1ec3 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, Qu\u00fd kh\u00e1ch vui l\u00f2ng b\u1ea5m s\u1ed1 HOTLINE<\/b><\/a>\u00a0ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp\u00a0T\u1ea0I \u0110\u00c2Y<\/b><\/a>. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean\u00a0\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.<\/p>\n

Ngu\u1ed3n: GLOBOCAN. B\u1ed9 Y t\u1ebf, \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (UTBMTBG) l\u00e0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0 c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong s\u00e1u lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean th\u1ebf gi\u1edbi v\u00e0 n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam. UTBMTBG \u0111\u1ee9ng \u0111\u1ea7u trong\u00a0 c\u00e1c nguy\u00ean nh\u00e2n t\u1eed […]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[3],"yoast_head":"\nH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf<\/title>\n<meta name=\"description\" content=\"Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam.\" \/>\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\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf\" \/>\n<meta property=\"og:description\" content=\"Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-12T12:59:48+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-13T02:47:33+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/screenshot_1681284758-300x167.png\" \/>\n<meta name=\"author\" content=\"Minh Tang Phuong\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Minh Tang Phuong\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"17 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\",\"name\":\"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-12T12:59:48+00:00\",\"dateModified\":\"2023-04-13T02:47:33+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/1f3505046718c2227ed72bac35a0fbcc\"},\"description\":\"Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/1f3505046718c2227ed72bac35a0fbcc\",\"name\":\"Minh Tang Phuong\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/0.gravatar.com\/avatar\/9e7ed909e33d316b6e99b9f5d3eba70d?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/0.gravatar.com\/avatar\/9e7ed909e33d316b6e99b9f5d3eba70d?s=96&d=mm&r=g\",\"caption\":\"Minh Tang Phuong\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/tangphuongminh1994gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf","description":"Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf","og_description":"Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","og_site_name":"Vinmec","article_published_time":"2023-04-12T12:59:48+00:00","article_modified_time":"2023-04-13T02:47:33+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/screenshot_1681284758-300x167.png"}],"author":"Minh Tang Phuong","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Minh Tang Phuong","Est. reading time":"17 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","name":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-12T12:59:48+00:00","dateModified":"2023-04-13T02:47:33+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/1f3505046718c2227ed72bac35a0fbcc"},"description":"Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-chan-doan-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan theo B\u1ed9 Y t\u1ebf"}]},{"@type":"WebSite","@id":"http:\/\/noithathoaphat.in\/ctv\/#website","url":"http:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"http:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/1f3505046718c2227ed72bac35a0fbcc","name":"Minh Tang Phuong","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/0.gravatar.com\/avatar\/9e7ed909e33d316b6e99b9f5d3eba70d?s=96&d=mm&r=g","contentUrl":"http:\/\/0.gravatar.com\/avatar\/9e7ed909e33d316b6e99b9f5d3eba70d?s=96&d=mm&r=g","caption":"Minh Tang Phuong"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/tangphuongminh1994gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/19184"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=19184"}],"version-history":[{"count":2,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/19184\/revisions"}],"predecessor-version":[{"id":19383,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/19184\/revisions\/19383"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=19184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=19184"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=19184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}