{"id":26968,"date":"2023-04-22T21:49:39","date_gmt":"2023-04-22T14:49:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26968"},"modified":"2023-04-22T21:59:13","modified_gmt":"2023-04-22T14:59:13","slug":"ung-thu-vu-giai-doan-4-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-4-phac-do-dieu-tri-theo-bo-y-te\/","title":{"rendered":"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf"},"content":{"rendered":"

Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 l\u00e0 giai \u0111o\u1ea1n nghi\u00eam tr\u1ecdng nh\u1ea5t c\u1ee7a b\u1ec7nh ung th\u01b0 v\u00fa, khi kh\u1ed1i u \u0111\u00e3 lan sang c\u00e1c c\u01a1 quan v\u00e0 m\u00f4 kh\u00e1c trong c\u01a1 th\u1ec3. B\u1ed9 Y t\u1ebf Vi\u1ec7t Nam \u0111\u00e3 \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 giai \u0111o\u1ea1n 4 nh\u1eb1m gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian 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. Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 l\u00e0 g\u00ec?<\/h2>\n

Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 (hay c\u00f2n g\u1ecdi l\u00e0 ung th\u01b0 v\u00fa di c\u0103n) l\u00e0 giai \u0111o\u1ea1n cu\u1ed1i c\u00f9ng v\u00e0 nghi\u00eam tr\u1ecdng nh\u1ea5t c\u1ee7a ung th\u01b0 v\u00fa, khi kh\u1ed1i u \u0111\u00e3 lan sang c\u00e1c c\u01a1 quan v\u00e0 m\u00f4 kh\u00e1c trong c\u01a1 th\u1ec3. C\u00e1c v\u1ecb tr\u00ed di c\u0103n ph\u1ed5 bi\u1ebfn c\u1ee7a ung th\u01b0 v\u00fa bao g\u1ed3m x\u01b0\u01a1ng, ph\u1ed5i, gan v\u00e0 n\u00e3o.<\/p>\n

M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 l\u00e0 ki\u1ec3m so\u00e1t v\u00e0 l\u00e0m ch\u1eadm s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a kh\u1ed1i u, gi\u1ea3m \u0111au v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u1eb1m c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4<\/h2>\n

\u0110\u1ed1i v\u1edbi UTV di c\u0103n, \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ec7nh kh\u00f4ng th\u1ec3 ch\u1eefa kh\u1ecfi. \u0110i\u1ec1u tr\u1ecb nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u1ed1i u, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng. V\u00ec v\u1eady, n\u00ean \u00e1p d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p v\u1eeba c\u00f3 hi\u1ec7u qu\u1ea3 v\u1eeba c\u00f3 \u0111\u1ed9c t\u00ednh th\u1ea5p.<\/p>\n

3.1. \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00edch<\/h3>\n
    \n
  • \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh, ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng \u1edf x\u01b0\u01a1ng, ph\u1ea7n m\u1ec1m ho\u1eb7c \u1edf t\u1ea1ng nh\u01b0ng s\u1ed1 l\u01b0\u1ee3ng v\u00e0 k\u00edch th\u01b0\u1edbc t\u1ed5n th\u01b0\u01a1ng nh\u1ecf, b\u1ec7nh ti\u1ebfn tri\u1ec3n ch\u1eadm, kh\u00f4ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng.<\/li>\n
  • C\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft trong v\u00f2ng 1 n\u0103m tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c AI n\u1ebfu \u0111\u00e3 m\u00e3n kinh. C\u1eaft bu\u1ed3ng tr\u1ee9ng (b\u1eb1ng ph\u1eabu thu\u1eadt ho\u1eb7c x\u1ea1 tr\u1ecb) ho\u1eb7c \u1ee9c ch\u1ebf bu\u1ed3ng tr\u1ee9ng (b\u1eb1ng ch\u1ea5t \u0111\u1ed3ng v\u1eadn GnRH) \u1edf ph\u1ee5 n\u1eef ch\u01b0a m\u00e3n kinh v\u00e0 k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c nh\u01b0 \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0111\u00e3 m\u00e3n kinh. L\u1ef1a ch\u1ecdn kh\u00e1c \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y l\u00e0 tamoxifen nh\u01b0ng \u0111\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p k\u00e9m hi\u1ec7u qu\u1ea3 h\u01a1n.<\/li>\n
  • C\u00e1c b\u1ec7nh nh\u00e2n \u0111ang ho\u1eb7c ng\u01b0ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft trong v\u00f2ng 1 n\u0103m, n\u1ebfu \u0111\u00e3 m\u00e3n kinh, c\u1ea7n chuy\u1ec3n sang c\u00e1c thu\u1ed1c kh\u00e1c v\u1edbi c\u00e1c thu\u1ed1c d\u00f9ng tr\u01b0\u1edbc \u0111\u00f3. C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f2n kinh, c\u00f3 th\u1ec3 c\u1eaft bu\u1ed3ng tr\u1ee9ng ho\u1eb7c \u1ee9c ch\u1ebf bu\u1ed3ng tr\u1ee9ng (b\u1eb1ng ch\u1ea5t \u0111\u1ed3ng v\u1eadn GnRH) k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c nh\u01b0 \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef \u0111\u00e3 m\u00e3n kinh.<\/li>\n
  • N\u1ebfu tr\u01b0\u1edbc \u0111\u00f3 b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng tamoxifen, hi\u1ec7n \u0111\u00e3 m\u00e3n kinh c\u00f3 th\u1ec3 chuy\u1ec3n sang AI ho\u1eb7c ng\u01b0\u1ee3c l\u1ea1i, b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb AI c\u00f3 th\u1ec3 chuy\u1ec3n sang tamoxifen. C\u00e1c b\u1ec7nh nh\u00e2n m\u00e3n kinh \u0111\u00e3 th\u1ea5t b\u1ea1i v\u1edbi AI lo\u1ea1i kh\u00f4ng steroid v\u1eabn c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i \u00edch khi d\u00f9ng AI lo\u1ea1i steroid. Fulvestrant c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn ngay b\u01b0\u1edbc \u0111\u1ea7u ho\u1eb7c sau th\u1ea5t b\u1ea1i v\u1edbi tamoxifen v\u00e0\/ho\u1eb7c AI \u1edf ph\u1ee5 n\u1eef \u0111\u00e3 m\u00e3n kinh.<\/li>\n
  • \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nam, khi s\u1eed d\u1ee5ng AI, n\u00ean d\u00f9ng ch\u1ea5t \u0111\u1ed3ng v\u1eadn GnRH \u0111\u1ed3ng th\u1eddi.<\/li>\n
  • \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh, HER2 \u00e2m t\u00ednh, c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mTOR (nh\u01b0 everolimus…), \u1ee9c ch\u1ebf CDK 4\/6 (ribociclib) k\u1ebft h\u1ee3p v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft cho k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t h\u01a1n so v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft \u0111\u01a1n thu\u1ea7n. M\u1ed9t s\u1ed1 thu\u1ed1c \u1ee9c ch\u1ebf CDK 4\/6 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01a1n thu\u1ea7n trong nh\u1eefng t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t.<\/li>\n
  • \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh, HER2 \u00e2m t\u00ednh, k\u00e8m theo c\u00f3 \u0111\u1ed9t bi\u1ebfn PIK3CA, \u0111\u00e3 th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb v\u1edbi AI, k\u1ebft h\u1ee3p thu\u1ed1c \u1ee9c ch\u1ebf PI3K (alpelisib) v\u1edbi fulvestrant cho k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n fulvestrant \u0111\u01a1n thu\u1ea7n.<\/li>\n
  • \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh, HER2 d\u01b0\u01a1ng t\u00ednh c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft v\u1edbi thu\u1ed1c kh\u00e1ng HER2 n\u1ebfu ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh h\u00f3a tr\u1ecb k\u1ebft h\u1ee3p kh\u00e1ng HER2 ho\u1eb7c b\u1ec7nh ti\u1ebfn tri\u1ec3n ch\u1eadm. C\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n kinh t\u1ebf \u0111\u1ec3 s\u1eed d\u1ee5ng kh\u00e1ng HER2, c\u00f3 th\u1ec3 h\u00f3a tr\u1ecb \u0111\u01a1n thu\u1ea7n ho\u1eb7c \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft \u0111\u01a1n thu\u1ea7n n\u1ebfu kh\u00f4ng th\u1ec3 h\u00f3a tr\u1ecb.<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft \u0111\u1ed3ng th\u1eddi v\u1edbi h\u00f3a tr\u1ecb kh\u00f4ng cho l\u1ee3i \u00edch v\u1ec1 th\u1eddi gian s\u1ed1ng th\u00eam, kh\u00f4ng n\u00ean \u00e1p d\u1ee5ng ngo\u00e0i c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng.<\/li>\n
  • \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft duy tr\u00ec \u1edf b\u1ec7nh nh\u00e2n c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh, \u0111\u00e3 \u1ed5n \u0111\u1ecbnh sau h\u00f3a tr\u1ecb cho b\u1ec7nh di c\u0103n l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn h\u1ee3p l\u00fd.<\/li>\n
  • \u0110\u1ed1i v\u1edbi UTV nam, \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft c\u0169ng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean n\u1ebfu ER d\u01b0\u01a1ng t\u00ednh, tr\u1eeb khi lo ng\u1ea1i ho\u1eb7c c\u00f3 b\u1eb1ng ch\u1ee9ng b\u1ec7nh kh\u00e1ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft ho\u1eb7c b\u1ec7nh ti\u1ebfn tri\u1ec3n nhanh c\u1ea7n h\u00f3a tr\u1ecb.<\/li>\n<\/ul>\n

    3.2. H\u00f3a tr\u1ecb v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00edch<\/h3>\n
      \n
    • C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft \u00e2m t\u00ednh, ho\u1eb7c th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh nh\u01b0ng di c\u0103n t\u1ea1ng c\u00f3 tri\u1ec7u ch\u1ee9ng, b\u1ec7nh ti\u1ebfn tri\u1ec3n nhanh, \u0111e d\u1ecda t\u00ednh m\u1ea1ng ho\u1eb7c \u0111\u00e3 kh\u00e1ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft n\u00ean \u0111\u01b0\u1ee3c ho\u00e1 tr\u1ecb n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. C\u00f3 th\u1ec3 d\u00f9ng \u0111\u01a1n ho\u00e1 ch\u1ea5t ho\u1eb7c ph\u1ed1i h\u1ee3p \u0111a thu\u1ed1c. \u0110i\u1ec1u tr\u1ecb v\u1edbi \u0111\u01a1n h\u00f3a ch\u1ea5t tu\u1ea7n t\u1ef1 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n do \u0111\u1ed9c t\u00ednh th\u1ea5p, ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1ea3m b\u1ea3o. Ph\u1ed1i h\u1ee3p \u0111a thu\u1ed1c trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh ti\u1ebfn tri\u1ec3n nhanh, di c\u0103n t\u1ea1ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng, khi c\u1ea7n b\u1ec7nh \u0111\u00e1p \u1ee9ng nhanh \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng. G\u1ea7n \u0111\u00e2y, h\u00f3a tr\u1ecb li\u1ec1u th\u1ea5p, nh\u1ecbp \u0111\u1ed9 d\u00e0y (metronomic chemotherapy) l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn h\u1ee3p l\u00fd trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng y\u00eau c\u1ea7u \u0111\u00e1p \u1ee9ng nhanh.<\/li>\n
    • C\u00e1c tr\u01b0\u1eddng h\u1ee3p HER2 d\u01b0\u01a1ng t\u00ednh c\u1ea7n ph\u1ed1i h\u1ee3p h\u00f3a tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1ng HER2 (h\u00f3a tr\u1ecb k\u1ebft h\u1ee3p trastuzumab ho\u1eb7c h\u00f3a tr\u1ecb k\u1ebft h\u1ee3p c\u1ea3 trastuzumab v\u00e0 pertuzumab) ho\u1eb7c s\u1eed d\u1ee5ng \u0111\u01a1n ch\u1ea5t T-DM1, ho\u1eb7c h\u00f3a tr\u1ecb k\u1ebft h\u1ee3p thu\u1ed1c \u1ee9c ch\u1ebf tyrosine kinase c\u1ee7a th\u1ee5 th\u1ec3 HER2 (lapatinib), ho\u1eb7c ph\u1ed1i h\u1ee3p trastuzumab v\u1edbi lapatinib.<\/li>\n
    • C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9t bi\u1ebfn BRCA1\/2 d\u00f2ng m\u1ea7m, thu\u1ed9c nh\u00f3m b\u1ed9 ba \u00e2m t\u00ednh ho\u1eb7c th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh v\u00e0 HER2 \u00e2m t\u00ednh \u0111\u00e3 ti\u1ebfn tri\u1ec3n sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft, \u0111\u00e3 h\u00f3a tr\u1ecb anthracycline c\u00f3 ho\u1eb7c kh\u00f4ng taxane (b\u1ed5 tr\u1ee3 ho\u1eb7c cho b\u1ec7nh di c\u0103n) c\u00f3 th\u1ec3 \u01b0u ti\u00ean s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf PARP. C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9t bi\u1ebfn BRCA1\/2 d\u00f2ng m\u1ea7m, thu\u1ed9c nh\u00f3m b\u1ed9 ba \u00e2m t\u00ednh c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 c\u00f3 platin.<\/li>\n
    • C\u00e1c b\u1ec7nh nh\u00e2n b\u1ed9 ba \u00e2m t\u00ednh, PD-L1 d\u01b0\u01a1ng t\u00ednh, k\u1ebft h\u1ee3p thu\u1ed1c kh\u00e1ng PD-L1 (atezolizumab) v\u1edbi h\u00f3a tr\u1ecb c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn.<\/li>\n
    • Th\u00f4ng th\u01b0\u1eddng, m\u1ed9t ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng li\u00ean t\u1ee5c \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n ho\u1eb7c khi \u0111\u1ed9c t\u00ednh kh\u00f4ng ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c (bao g\u1ed3m \u0111\u1ed9c t\u00ednh t\u00edch l\u0169y v\u1edbi tim c\u1ee7a anthracycline).<\/li>\n<\/ul>\n

      3.3. Thu\u1ed1c t\u00e1i t\u1ea1o x\u01b0\u01a1ng<\/h3>\n

      – \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 di c\u0103n x\u01b0\u01a1ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c t\u00e1i t\u1ea1o x\u01b0\u01a1ng (c\u00f2n g\u1ecdi l\u00e0 c\u00e1c thu\u1ed1c bi\u1ebfn \u0111\u1ed5i x\u01b0\u01a1ng) c\u00f9ng v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p h\u00f3a tr\u1ecb, \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft, \u0111i\u1ec1u tr\u1ecb \u0111\u00edch n\u00f3i tr\u00ean. C\u00e1c thu\u1ed1c th\u01b0\u1eddng d\u00f9ng l\u00e0 bisphosphonate: zoledronic acid, pamidronate, clodronate; kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng \u1ee9c ch\u1ebf RANK.<\/p>\n

      3.4. C\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p kh\u00e1c<\/h3>\n
        \n
      • C\u00e1c tr\u01b0\u1eddng h\u1ee3p g\u00e3y x\u01b0\u01a1ng d\u00e0i ho\u1eb7c c\u00f3 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng c\u1ea7n c\u00e2n nh\u1eafc c\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng, sau \u0111\u00f3 x\u1ea1 tr\u1ecb. N\u1ebfu kh\u00f4ng c\u00f3 nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng, x\u1ea1 tr\u1ecb l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn.<\/li>\n
      • Ch\u00e8n \u00e9p t\u1ee7y s\u1ed1ng c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u00e0 x\u1eed l\u00fd c\u1ea5p c\u1ee9u. Th\u00f4ng th\u01b0\u1eddng, ph\u1eabu thu\u1eadt gi\u1ea3i ph\u00f3ng ch\u00e8n \u00e9p \u0111\u01b0\u1ee3c xem x\u00e9t tr\u01b0\u1edbc. N\u1ebfu kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt, c\u00f3 th\u1ec3 x\u1ea1 tr\u1ecb c\u1ea5p c\u1ee9u. T\u1ea1o h\u00ecnh \u0111\u1ed1t s\u1ed1ng (vertebroplasty) c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn.<\/li>\n
      • C\u00e1c tr\u01b0\u1eddng h\u1ee3p di c\u0103n n\u00e3o \u0111\u01a1n \u1ed5 ho\u1eb7c \u1ed5 nh\u1ecf, c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt ho\u1eb7c x\u1ea1 ph\u1eabu \u0111\u1ecbnh v\u1ecb b\u1eb1ng dao Gamma, Cyber, x\u1ea1 tr\u1ecb \u0111\u1ecbnh v\u1ecb tr\u00ean m\u00e1y gia t\u1ed1c…. X\u1ea1 tr\u1ecb to\u00e0n n\u00e3o sau \u0111\u00f3 c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc gi\u1eefa l\u1ee3i \u00edch ki\u1ec3m so\u00e1t b\u1ec7nh v\u00e0 di ch\u1ee9ng \u0111\u1ed1i v\u1edbi n\u00e3o c\u1ee7a x\u1ea1 tr\u1ecb (v\u1edbi b\u1ec7nh nh\u00e2n s\u1ed1ng l\u00e2u sau di c\u0103n n\u00e3o). C\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7, xem x\u00e9t x\u1ea1 tr\u1ecb to\u00e0n n\u00e3o.<\/li>\n
      • U v\u00fa v\u1ee1 lo\u00e9t, \u0111au do u, h\u1ea1ch ch\u00e8n \u00e9p c\u0169ng c\u00f3 th\u1ec3 x\u1ea1 tr\u1ecb \u0111\u1ec3 gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng.<\/li>\n
      • Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i c\u1ea7n \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7. Ch\u1ecdc th\u00e1o d\u1ecbch khi c\u00f3 tri\u1ec7u ch\u1ee9ng, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i \u0111\u00e1ng k\u1ec3 tr\u00ean l\u00e2m s\u00e0ng. S\u1eed d\u1ee5ng b\u1ed9t talc, bleomycin, c\u00e1c thu\u1ed1c bi\u1ebfn \u0111\u1ed5i sinh h\u1ecdc g\u00e2y x\u01a1 d\u00ednh m\u00e0ng ph\u1ed5i c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn nh\u01b0ng c\u1ea7n c\u00e2n nh\u1eafc t\u1edbi di ch\u1ee9ng \u1ea3nh h\u01b0\u1edfng t\u1edbi ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n
      • Tr\u00e0n d\u1ecbch m\u00e0ng b\u1ee5ng, m\u00e0ng tim c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ecdc th\u00e1o n\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/li>\n
      • Ph\u1eabu thu\u1eadt l\u1ea5y b\u1ecf u nguy\u00ean ph\u00e1t cho UTV giai \u0111o\u1ea1n IV m\u1edbi ch\u1ea9n \u0111o\u00e1n ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n c\u00f3 ch\u1ecdn l\u1ecdc \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t khi ch\u1ec9 di c\u0103n x\u01b0\u01a1ng, c\u00f3 th\u1ec3 l\u1ea5y tr\u1ecdn u, v\u1edbi m\u1ee5c \u0111\u00edch c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng.<\/li>\n
      • M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p di c\u0103n \u0111\u01a1n \u1ed5, di c\u0103n v\u1edbi l\u01b0\u1ee3ng b\u1ec7nh \u00edt, nh\u1ea1y v\u1edbi \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n, c\u00f3 th\u1ec3 tho\u00e1i lui ho\u00e0n to\u00e0n, th\u1eddi gian s\u1ed1ng l\u00e2u d\u00e0i, c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb \u0111a ph\u01b0\u01a1ng ph\u00e1p bao g\u1ed3m c\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7, t\u1ea1i v\u00f9ng v\u1edbi d\u1ef1 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n.<\/li>\n
      • C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng c\u1ea7n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh c\u00f9ng v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u nh\u1eb1m n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n

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

        Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 l\u00e0 giai \u0111o\u1ea1n nghi\u00eam tr\u1ecdng nh\u1ea5t c\u1ee7a b\u1ec7nh ung th\u01b0 v\u00fa, khi kh\u1ed1i u \u0111\u00e3 lan sang c\u00e1c c\u01a1 quan v\u00e0 m\u00f4 kh\u00e1c trong c\u01a1 th\u1ec3. B\u1ed9 Y t\u1ebf Vi\u1ec7t Nam \u0111\u00e3 \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 giai \u0111o\u1ea1n 4 nh\u1eb1m gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng […]<\/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 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u1ed1i u, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng.\" \/>\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 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec\" \/>\n<meta property=\"og:description\" content=\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u1ed1i u, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-22T14:49:39+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-22T14:59:13+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322-300x170.jpg\" \/>\n<meta name=\"author\" content=\"Lam Le Tran Khanh\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Lam Le Tran Khanh\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 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\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/\",\"name\":\"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-22T14:49:39+00:00\",\"dateModified\":\"2023-04-22T14:59:13+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/7ff060baec52fd1fe9754261db7aa412\"},\"description\":\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u1ed1i u, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb 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\/7ff060baec52fd1fe9754261db7aa412\",\"name\":\"Lam Le Tran Khanh\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/2.gravatar.com\/avatar\/e6480f68b26ea9d272773a22139ae421?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/2.gravatar.com\/avatar\/e6480f68b26ea9d272773a22139ae421?s=96&d=mm&r=g\",\"caption\":\"Lam Le Tran Khanh\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/20lam-ltkvinuni-edu-vn\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec","description":"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u1ed1i u, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng.","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":"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec","og_description":"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u1ed1i u, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/","og_site_name":"Vinmec","article_published_time":"2023-04-22T14:49:39+00:00","article_modified_time":"2023-04-22T14:59:13+00:00","og_image":[{"url":"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-1-2136-1645583322-300x170.jpg"}],"author":"Lam Le Tran Khanh","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Lam Le Tran Khanh","Est. reading time":"9 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/","name":"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo b\u1ed9 Y t\u1ebf - Vinmec","isPartOf":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-22T14:49:39+00:00","dateModified":"2023-04-22T14:59:13+00:00","author":{"@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/7ff060baec52fd1fe9754261db7aa412"},"description":"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4 nh\u1eb1m m\u1ee5c \u0111\u00edch gi\u1ea3m tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u1ed1i u, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/ung-thu-vu-giai-doan-4-phac-do-dieu-tri-theo-bo-y-te\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n 4: Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb 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\/7ff060baec52fd1fe9754261db7aa412","name":"Lam Le Tran Khanh","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/2.gravatar.com\/avatar\/e6480f68b26ea9d272773a22139ae421?s=96&d=mm&r=g","contentUrl":"http:\/\/2.gravatar.com\/avatar\/e6480f68b26ea9d272773a22139ae421?s=96&d=mm&r=g","caption":"Lam Le Tran Khanh"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/20lam-ltkvinuni-edu-vn\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/26968"}],"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\/43"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=26968"}],"version-history":[{"count":1,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/26968\/revisions"}],"predecessor-version":[{"id":26985,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/26968\/revisions\/26985"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=26968"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=26968"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=26968"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}