{"id":26848,"date":"2023-04-22T18:44:39","date_gmt":"2023-04-22T11:44:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26848"},"modified":"2023-04-22T21:24:05","modified_gmt":"2023-04-22T14:24:05","slug":"ung-thu-vu-giai-doan-3-phac-do-dieu-tri-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-3-phac-do-dieu-tri-theo-bo-y-te\/","title":{"rendered":"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf"},"content":{"rendered":"

Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 l\u00e0 m\u1ed9t trong nh\u1eefng giai \u0111o\u1ea1n nghi\u00eam tr\u1ecdng c\u1ee7a ung th\u01b0 v\u00fa, khi kh\u1ed1i u \u0111\u00e3 ph\u00e1t tri\u1ec3n v\u00e0 lan sang c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan l\u00e2n c\u1eadn. B\u00e0i vi\u1ebft s\u1ebd cung c\u1ea5p ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 (tr\u1eeb T3N1M0) theo b\u1ed9 Y t\u1ebf nh\u1eb1m h\u01b0\u1edbng d\u1eabn c\u00e1c b\u00e1c s\u0129 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, gi\u00fap n\u00e2ng cao c\u01a1 h\u1ed9i s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 ung th\u01b0 v\u00fa<\/h2>\n

Ung th\u01b0 v\u00fa (UTV)<\/a> l\u00e0 lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong h\u00e0ng \u0111\u1ea7u do ung th\u01b0 \u1edf ph\u1ee5 n\u1eef tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. M\u1ed7i n\u0103m n\u01b0\u1edbc ta c\u00f3 kho\u1ea3ng h\u01a1n 15.230 ph\u1ee5 n\u1eef m\u1edbi m\u1eafc v\u00e0 h\u01a1n 6.100 ng\u01b0\u1eddi t\u1eed vong do UTV. Ung th\u01b0 v\u00fa nam chi\u1ebfm kho\u1ea3ng 1% c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTV. \u0110a s\u1ed1 UTV xu\u1ea5t ph\u00e1t t\u1eeb c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 c\u1ee7a v\u00fa. B\u1ec7nh Paget c\u1ee7a v\u00fa c\u00f3 th\u1ec3 k\u00e8m theo UTV. Do v\u1eady, khi c\u00f3 th\u00e0nh ph\u1ea7n ung th\u01b0 tr\u00ean Paget v\u00fa c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 UTV th\u00f4ng th\u01b0\u1eddng v\u1edbi giai \u0111o\u1ea1n t\u01b0\u01a1ng \u1ee9ng.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng quan tr\u1ecdng bao g\u1ed3m: k\u00edch th\u01b0\u1edbc u nguy\u00ean ph\u00e1t, s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch di c\u0103n, th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc, \u0111\u1ed9 m\u00f4 h\u1ecdc, t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft, t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 y\u1ebfu t\u1ed1 ph\u00e1t tri\u1ec3n bi\u1ec3u b\u00ec ng\u01b0\u1eddi s\u1ed1 2 (human epidermal growth factor receptor-HER2), tu\u1ed5i.<\/p>\n

\"minh-hoa-ung-thu-vu-o-phu-nu\"
Ung th\u01b0 v\u00fa l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong do ung th\u01b0 \u1edf ph\u1ee5 n\u1eef<\/figcaption><\/figure>\n

2. Nguy\u00ean nh\u00e2n \u2013 C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/h2>\n
    \n
  • Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc UTV, \u0111\u1eb7c bi\u1ec7t c\u00f3 t\u1eeb 2 ng\u01b0\u1eddi m\u1eafc tr\u1edf l\u00ean \u1edf l\u1ee9a tu\u1ed5i tr\u1ebb<\/li>\n
  • \u0110\u1ed9t bi\u1ebfn gen BRCA1<\/em> v\u00e0 BRCA2<\/em><\/li>\n
  • C\u00f3 kinh l\u1ea7n \u0111\u1ea7u s\u1edbm, m\u00e3n kinh mu\u1ed9n, ph\u1ee5 n\u1eef \u0111\u1ed9c th\u00e2n, kh\u00f4ng sinh con, kh\u00f4ng cho con b\u00fa, sinh con \u0111\u1ea7u l\u00f2ng mu\u1ed9n<\/li>\n
  • B\u00e9o ph\u00ec, ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u ch\u1ea5t b\u00e9o, s\u1eed d\u1ee5ng r\u01b0\u1ee3u c\u0169ng g\u00f3p ph\u1ea7n t\u0103ng nguy c\u01a1 b\u1ecb b\u1ec7nh<\/li>\n
  • Vi\u00eam v\u00fa trong khi sinh \u0111\u1ebb v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh v\u00fa l\u00e0nh t\u00ednh<\/li>\n
  • Tu\u1ed5i c\u00e0ng cao<\/li>\n<\/ul>\n

    3. Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 l\u00e0 g\u00ec?<\/h2>\n

    \u0110\u1ed1i v\u1edbi ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3, ung th\u01b0 \u0111\u00e3 lan r\u1ed9ng ra kh\u1ecfi v\u00fa v\u00e0 c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft l\u00e2n c\u1eadn. C\u1ee5 th\u1ec3, giai \u0111o\u1ea1n 3 \u0111\u01b0\u1ee3c chia th\u00e0nh 3 lo\u1ea1i:<\/p>\n

      \n
    • Giai \u0111o\u1ea1n 3A: Kh\u1ed1i u \u0111\u00e3 ph\u00e1t tri\u1ec3n l\u1edbn h\u01a1n 5 cm v\u00e0 \u0111\u00e3 lan \u0111\u1ebfn c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft g\u1ea7n \u0111\u00f3, ho\u1eb7c kh\u1ed1i u nh\u1ecf h\u01a1n 5 cm nh\u01b0ng \u0111\u00e3 lan \u0111\u1ebfn c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft g\u1ea7n \u0111\u00f3 v\u00e0 th\u00e0nh ng\u1ef1c ho\u1eb7c da.<\/li>\n
    • Giai \u0111o\u1ea1n 3B: Kh\u1ed1i u c\u00f3 th\u1ec3 c\u00f3 k\u00edch th\u01b0\u1edbc b\u1ea5t k\u1ef3 v\u00e0 \u0111\u00e3 lan \u0111\u1ebfn th\u00e0nh ng\u1ef1c ho\u1eb7c da, v\u00e0 c\u00f3 th\u1ec3 \u0111\u00e3 lan \u0111\u1ebfn c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft g\u1ea7n \u0111\u00f3.<\/li>\n
    • Giai \u0111o\u1ea1n 3C: Kh\u1ed1i u \u0111\u00e3 lan \u0111\u1ebfn c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft tr\u00ean ho\u1eb7c d\u01b0\u1edbi x\u01b0\u01a1ng \u0111\u00f2n, ho\u1eb7c \u0111\u00e3 lan \u0111\u1ebfn c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft \u1edf n\u00e1ch.<\/li>\n<\/ul>\n

      C\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 ph\u1ee5 thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc v\u00e0 v\u1ecb tr\u00ed c\u1ee7a kh\u1ed1i u, m\u1ee9c \u0111\u1ed9 li\u00ean quan \u0111\u1ebfn h\u1ea1ch b\u1ea1ch huy\u1ebft, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a th\u1ee5 th\u1ec3 hormone v\u00e0 t\u00ecnh tr\u1ea1ng HER2 \/ neu, v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0 s\u1ee9c kh\u1ecfe v\u00e0 s\u1edf th\u00edch t\u1ed5ng th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 lo\u1ea1i b\u1ecf ho\u1eb7c ti\u00eau di\u1ec7t c\u00e0ng nhi\u1ec1u ung th\u01b0 c\u00e0ng t\u1ed1t v\u00e0 ng\u0103n ng\u1eeba s\u1ef1 t\u00e1i ph\u00e1t c\u1ee7a n\u00f3.<\/p>\n

      4. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 (tr\u1eeb T3N1M0)<\/h2>\n
        \n
      • H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00f4ng m\u1ed5 \u0111\u01b0\u1ee3c v\u00e0 n\u00ean \u0111\u01b0\u1ee3c ho\u00e1 tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 v\u1edbi c\u00e1c ph\u00e1c \u0111\u1ed3 nh\u01b0 \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 n\u00f3i tr\u00ean. Khi b\u1ec7nh \u0111\u00e1p \u1ee9ng, ti\u1ebfp t\u1ee5c h\u00f3a tr\u1ecb cho \u0111\u1ee7 s\u1ed1 \u0111\u1ee3t c\u1ea7n thi\u1ebft. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 c\u1ea7n k\u1ebft h\u1ee3p trastuzumab v\u1edbi h\u00f3a tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 (kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c \u0111\u1ee3t c\u00f3 anthracycline) ngo\u1ea1i tr\u1eeb c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. C\u00f3 th\u1ec3 k\u1ebft h\u1ee3p pertuzumab v\u1edbi trastuzumab v\u00e0 h\u00f3a tr\u1ecb trong \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 (kh\u1ed1i u> 2cm ho\u1eb7c h\u1ea1ch d\u01b0\u01a1ng t\u00ednh). \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft t\u00e2n b\u1ed5 tr\u1ee3 \u0111\u01a1n thu\u1ea7n ho\u1eb7c k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb \u0111\u00edch ch\u1ec9 d\u00e0nh cho m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 h\u00f3a tr\u1ecb, th\u1ec3 l\u00f2ng \u1ed1ng nguy c\u01a1 th\u1ea5p.<\/li>\n
      • Sau ho\u00e1 tr\u1ecb, b\u1ec7nh chuy\u1ec3n th\u00e0nh m\u1ed5 \u0111\u01b0\u1ee3c, c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa tri\u1ec7t c\u0103n k\u00e8m v\u00e9t h\u1ea1ch n\u00e1ch ho\u1eb7c ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n (c\u1eaft r\u1ed9ng u k\u00e8m v\u00e9t h\u1ea1ch n\u00e1ch). Sau ph\u1eabu thu\u1eadt c\u1ea7n x\u1ea1 tr\u1ecb th\u00e0nh ng\u1ef1c (ho\u1eb7c v\u00fa) v\u00e0 h\u1ea1ch v\u00f9ng bao g\u1ed3m c\u1ea3 th\u01b0\u1ee3ng \u0111\u00f2n. N\u1ebfu c\u00f3 di c\u0103n h\u1ea1ch v\u00fa trong, tr\u01b0\u1eddng x\u1ea1 n\u00ean bao g\u1ed3m c\u1ea3 h\u1ea1ch v\u00fa trong. N\u1ebfu kh\u00f4ng di c\u0103n h\u1ea1ch v\u00fa trong, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc x\u1ea1 tr\u1ecb v\u00f9ng n\u00e0y ho\u1eb7c kh\u00f4ng tu\u1ef3 t\u00ecnh hu\u1ed1ng c\u1ee5 th\u1ec3. Th\u00f4ng th\u01b0\u1eddng c\u1ea7n x\u1ea1 tr\u1ecb theo giai \u0111o\u1ea1n cao nh\u1ea5t tr\u00ean l\u00e2m s\u00e0ng \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, giai \u0111o\u1ea1n b\u1ec7nh h\u1ecdc v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m kh\u1ed1i u. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh ho\u1eb7c kh\u00f4ng r\u00f5 t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u1edf giai \u0111o\u1ea1n s\u1edbm n\u00f3i tr\u00ean. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 v\u1edbi trastuzumab, pertuzumab v\u00e0 h\u00f3a tr\u1ecb, n\u1ebfu kh\u00f4ng c\u00f2n b\u1ec7nh t\u00edch tr\u00ean m\u00f4 b\u1ec7nh h\u1ecdc sau m\u1ed5, duy tr\u00ec cho \u0111\u1ee7 1 n\u0103m v\u1edbi trastuzumab (c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p pertuzumab ho\u1eb7c kh\u00f4ng). C\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh c\u00f2n t\u1ed3n t\u1ea1i sau \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng T-DM1 (trastuzumab-emtansine)14 \u0111\u1ee3t. N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c v\u1edbi T-DM1, s\u1eed d\u1ee5ng trastuzumab (c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p pertuzumab ho\u1eb7c kh\u00f4ng) cho \u0111\u1ee7 1 n\u0103m.<\/li>\n
      • N\u1ebfu b\u1ec7nh kh\u00f4ng m\u1ed5 \u0111\u01b0\u1ee3c (gi\u1eef nguy\u00ean ho\u1eb7c ti\u1ebfn tri\u1ec3n), c\u00e2n nh\u1eafc chuy\u1ec3n ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb kh\u00e1c ho\u1eb7c x\u1ea1 tr\u1ecb v\u00e0o t\u1ea5t c\u1ea3 c\u00e1c v\u1ecb tr\u00ed lan r\u1ed9ng c\u1ee7a u (50Gy), t\u0103ng c\u01b0\u1eddng li\u1ec1u v\u00e0o n\u01a1i b\u1ec7nh c\u00f2n l\u1ea1i (10-26Gy tu\u1ef3 thu\u1ed9c li\u1ec1u c\u01a1 quan c\u00f3 nguy c\u01a1). \u0110\u00e1nh gi\u00e1 trong khi x\u1ea1 tr\u1ecb \u0111\u1ec3 ch\u1ecdn ra c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 m\u1ed5 \u0111\u01b0\u1ee3c (sau 45-50Gy).<\/li>\n
      • M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh ti\u1ebfn tri\u1ec3n trong th\u1eddi gian ho\u00e1 tr\u1ecb, c\u1ea7n ph\u1eabu thu\u1eadt s\u1ea1ch s\u1ebd, sau \u0111\u00f3 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n.<\/li>\n<\/ul>\n

         <\/p>\n","protected":false},"excerpt":{"rendered":"

        Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 l\u00e0 m\u1ed9t trong nh\u1eefng giai \u0111o\u1ea1n nghi\u00eam tr\u1ecdng c\u1ee7a ung th\u01b0 v\u00fa, khi kh\u1ed1i u \u0111\u00e3 ph\u00e1t tri\u1ec3n v\u00e0 lan sang c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan l\u00e2n c\u1eadn. B\u00e0i vi\u1ebft s\u1ebd cung c\u1ea5p ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 (tr\u1eeb T3N1M0) theo b\u1ed9 Y t\u1ebf […]<\/p>\n","protected":false},"author":43,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[],"yoast_head":"\nUng th\u01b0 v\u00fa giai \u0111o\u1ea1n 3: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft s\u1ebd cung c\u1ea5p ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3 (tr\u1eeb T3N1M0) theo b\u1ed9 Y t\u1ebf nh\u1eb1m h\u01b0\u1edbng d\u1eabn c\u00e1c b\u00e1c s\u0129 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.\" \/>\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=\"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 3: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - 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