{"id":28335,"date":"2023-04-29T17:17:39","date_gmt":"2023-04-29T10:17:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28335"},"modified":"2023-04-29T17:17:52","modified_gmt":"2023-04-29T10:17:52","slug":"dieu-tri-ung-thu-vu-giai-doan-i-ii-va-t3n1m0","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/dieu-tri-ung-thu-vu-giai-doan-i-ii-va-t3n1m0\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n I, II v\u00e0 T3N1M0"},"content":{"rendered":"

Ung th\u01b0 v\u00fa (UTV) 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. Vi\u1ec7c s\u1eed d\u1ee5ng m\u1ed9t hay nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00eau tr\u00ean c\u0103n c\u1ee9 v\u00e0o giai \u0111o\u1ea1n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 b\u1ec7nh h\u1ecdc tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3. B\u00e0i vi\u1ebft d\u01b0\u1edbi d\u00e2y s\u1ebd h<\/strong>\u01b0\u1edbng d\u1eabn chi ti\u1ebft \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa\u00a0 giai \u0111o\u1ea1n <\/strong>giai \u0111o\u1ea1n I, II v\u00e0 T3N1M0<\/strong><\/p>\n

1. Ph\u1eabu thu\u1eadt trong \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n I, II v\u00e0 T3N1M0<\/h2>\n
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  • Ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n (c\u1eaft r\u1ed9ng u v\u00e0 v\u00e9t h\u1ea1ch n\u00e1ch) n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u. C\u1ea7n ki\u1ec3m tra di\u1ec7n c\u1eaft khi ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n. N\u1ebfu di\u1ec7n c\u1eaft d\u01b0\u01a1ng t\u00ednh, c\u1ea7n c\u1eaft l\u1ea1i. \u0110\u1eb7t clip gi\u01b0\u1eddng u \u0111\u1ec3 l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb ch\u00ednh x\u00e1c. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTV \u0111a \u1ed5, UTV trong 6 th\u00e1ng \u0111\u1ea7u th\u1eddi k\u1ef3 mang thai, c\u00f3 h\u00ecnh \u1ea3nh vi canxi h\u00f3a lan t\u1ecfa tr\u00ean phim ch\u1ee5p x-quang v\u00fa, \u0111\u00e3 \u0111\u01b0\u1ee3c x\u1ea1 tr\u1ecb v\u00e0o ng\u1ef1c\/di\u1ec7n v\u00fa tr\u01b0\u1edbc \u0111\u00f3 ho\u1eb7c di\u1ec7n c\u1eaft d\u01b0\u01a1ng t\u00ednh dai d\u1eb3ng m\u1eb7c d\u00f9 \u0111\u00e3 c\u1eaft l\u1ea1i. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p u l\u1edbn (so v\u1edbi k\u00edch th\u01b0\u1edbc v\u00fa), b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh h\u1ec7 th\u1ed1ng, u n\u1eb1m d\u01b0\u1edbi n\u00fam v\u00fa.<\/li>\n
  • Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa v\u00e0 v\u00e9t h\u1ea1ch n\u00e1ch (c\u1eaft tuy\u1ebfn v\u00fa tri\u1ec7t c\u0103n bi\u1ebfn \u0111\u1ed5i), m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 c\u1eaft tuy\u1ebfn v\u00fa ti\u1ebft ki\u1ec7m da (skin-sparing mastectomy), c\u1eaft tuy\u1ebfn v\u00fa c\u00f3 b\u1ea3o t\u1ed3n n\u00fam v\u00fa (nipple sparing mastectomy) n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/li>\n
  • V\u00e9t h\u1ea1ch n\u00e1ch l\u00e0 th\u1ee7 thu\u1eadt th\u01b0\u1eddng quy. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ea5y di c\u0103n h\u1ea1ch n\u00e1ch tr\u00ean l\u00e2m s\u00e0ng, ch\u1ec9 c\u1ea7n v\u00e9t ch\u1eb7ng I v\u00e0 II. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p khi v\u00e9t th\u1ea5y di c\u0103n h\u1ea1ch \u1edf ch\u1eb7ng I v\u00e0 II n\u00ean v\u00e9t ti\u1ebfp \u1edf ch\u1eb7ng III.<\/li>\n<\/ul>\n
      \n
    • C\u00e1c tr\u01b0\u1eddng h\u1ee3p N0 tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 sinh thi\u1ebft h\u1ea1ch c\u1eeda (h\u1ea1ch g\u00e1c). N\u1ebfu tr\u00ean l\u00e2m s\u00e0ng nghi ng\u1edd h\u1ea1ch d\u01b0\u01a1ng t\u00ednh c\u1ea7n ch\u1ecdc h\u00fat kim nh\u1ecf ho\u1eb7c sinh thi\u1ebft kim, n\u1ebfu h\u1ea1ch \u00e2m t\u00ednh m\u1edbi sinh thi\u1ebft h\u1ea1ch c\u1eeda. H\u1ea1ch c\u1eeda c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nhu\u1ed9m m\u00e0u (b\u1eb1ng xanh methylene ho\u1eb7c isosulfan) ho\u1eb7c \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 99m Tc ho\u1eb7c k\u1ebft h\u1ee3p c\u1ea3 nhu\u1ed9m m\u00e0u v\u00e0 \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1. Khi t\u00ecm \u0111\u01b0\u1ee3c h\u1ea1ch c\u1eeda, ti\u1ebfn h\u00e0nh sinh thi\u1ebft h\u1ea1ch n\u00e0y. N\u1ebfu h\u1ea1ch \u00e2m t\u00ednh khi sinh th\u1ebft t\u1ee9c th\u00ec, c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n v\u00e9t h\u1ea1ch n\u00e1ch. N\u1ebfu h\u1ea1ch c\u1eeda d\u01b0\u01a1ng t\u00ednh s\u1ebd v\u00e9t h\u1ea1ch n\u00e1ch th\u01b0\u1eddng quy.<\/li>\n
    • \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa c\u00f3 th\u1ec3 xem x\u00e9t ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o tuy\u1ebfn v\u00fa n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u v\u00e0 v\u1ec1 m\u1eb7t ung th\u01b0 h\u1ecdc kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t li\u1ec7u ngo\u1ea1i lai ho\u1eb7c c\u00e1c v\u1ea1t da c\u01a1 t\u1ef1 th\u00e2n ho\u1eb7c k\u1ebft h\u1ee3p c\u1ea3 hai. T\u00e1i t\u1ea1o tuy\u1ebfn v\u00fa c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ngay trong khi c\u1eaft tuy\u1ebfn v\u00fa ho\u1eb7c v\u00e0o th\u1eddi \u0111i\u1ec3m n\u00e0o \u0111\u00f3 sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb. Ng\u01b0\u1eddi ta c\u00f3 th\u1ec3 \u0111\u1eb7t t\u00fai gi\u00e3n m\u00f4 tr\u01b0\u1edbc, sau \u0111\u00f3 m\u1edbi \u0111\u1eb7t m\u00f4 v\u00fa nh\u00e2n t\u1ea1o. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n c\u00f3 th\u1ec3 c\u1eaft tuy\u1ebfn v\u00fa ti\u1ebft ki\u1ec7m da, t\u1ea1o h\u00ecnh ngay ho\u1eb7c c\u1ea5y t\u00fai gi\u00e3n m\u00f4 t\u1ea1m tr\u01b0\u1edbc x\u1ea1 tr\u1ecb. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n, m\u00f4 v\u00fa b\u1ecb khuy\u1ebft, c\u00f3 th\u1ec3 l\u1ea5p ch\u1ed7 khuy\u1ebft b\u1eb1ng v\u1ea1t da (c\u00f3 m\u00f4 m\u1ee1 d\u00e0y v\u00e0 m\u1ea1ch nu\u00f4i).<\/li>\n
    • Ngo\u00e0i ra, ng\u01b0\u1eddi ta c\u0169ng c\u1ea7n ph\u1eabu thu\u1eadt s\u1eeda v\u00fa \u0111\u1ed1i b\u00ean \u0111\u1ec3 cho c\u00e2n \u0111\u1ed1i v\u1edbi b\u00ean v\u00fa b\u1ecb b\u1ec7nh \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh b\u1eb1ng v\u1ea1t t\u1ef1 th\u00e2n c\u00f3 th\u1ec3 c\u1ea7n ph\u1eabu thu\u1eadt s\u1eeda l\u1ea1i t\u1ea1i v\u00fa \u0111\u01b0\u1ee3c t\u1ea1o h\u00ecnh v\u00e0 t\u1ea1i n\u01a1i l\u1ea5y v\u1ea1t da c\u01a1.<\/li>\n
    • Ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o v\u00fa t\u1ee9c th\u00ec, t\u00e1i t\u1ea1o qu\u1ea7ng v\u00fa v\u00e0 n\u00fam v\u00fa ho\u1eb7c x\u0103m qu\u1ea7ng v\u00fa c\u0169ng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 \u0111\u1ea1t s\u1ef1 ho\u00e0n m\u1ef9.<\/li>\n<\/ul>\n
      \"\u0110i\u1ec1u
      \u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa<\/figcaption><\/figure>\n

      2. \u0110i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n I, II v\u00e0 T3N1M0<\/h2>\n
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      • V\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh c\u00f3 th\u1ec3 m\u1ed5 \u0111\u01b0\u1ee3c khi m\u1edbi ch\u1ea9n \u0111o\u00e1n, \u0111\u1ee7 ti\u00eau chu\u1ea9n b\u1ea3o t\u1ed3n v\u00fa v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u b\u1ea3o t\u1ed3n ngo\u1ea1i tr\u1eeb v\u1ea5n \u0111\u1ec1 u l\u1edbn c\u1ea7n \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n tr\u01b0\u1edbc m\u1ed5 v\u1edbi c\u00e1c ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb nh\u01b0 \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3. N\u1ebfu c\u00f3 th\u1ec3, n\u00ean \u0111\u00e1nh d\u1ea5u (b\u1eb1ng clip) ranh gi\u1edbi u tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a ch\u1ee5p X-quang tuy\u1ebfn v\u00fa ho\u1eb7c si\u00eau \u00e2m tuy\u1ebfn v\u00fa.<\/li>\n
      • N\u1ebfu kh\u1ed1i u \u0111\u00e1p \u1ee9ng v\u1edbi ho\u00e1 tr\u1ecb, xem x\u00e9t \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n khi \u0111\u1ee7 ti\u00eau chu\u1ea9n. Vi\u1ec7c sinh thi\u1ebft h\u1ea1ch c\u1eeda c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi h\u1ea1ch \u00e2m t\u00ednh c\u1ea3 tr\u01b0\u1edbc v\u00e0 sau \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 (cN0 v\u00e0 ycN0). C\u00e1c tr\u01b0\u1eddng h\u1ee3p ban \u0111\u1ea7u h\u1ea1ch d\u01b0\u01a1ng t\u00ednh (\u2265cN1) nh\u01b0ng chuy\u1ec3n sang \u00e2m t\u00ednh sau \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 (ycN0), ch\u1ec9 sinh thi\u1ebft h\u1ea1ch c\u1eeda \u1edf m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p r\u1ea5t ch\u1ecdn l\u1ecdc.<\/li>\n
      • N\u1ebfu sau ho\u00e1 tr\u1ecb, kh\u1ed1i u kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c b\u1ec7nh ti\u1ebfn tri\u1ec3n, c\u1ea7n ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa, v\u00e9t h\u1ea1ch n\u00e1ch. -B\u1ec7nh nh\u00e2n c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh, n\u00ean k\u1ebft h\u1ee3p h\u00f3a tr\u1ecb v\u1edbi trastuzumab tr\u01b0\u1edbc m\u1ed5. N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n c\u00e2n nh\u1eafc k\u1ebft h\u1ee3p trastuzumab v\u00e0 pertuzumab v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u1ed1i u >2cm ho\u1eb7c h\u1ea1ch d\u01b0\u01a1ng t\u00ednh. Kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c kh\u00e1ng HER2 v\u1edbi anthracycline. Sau m\u1ed5, ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng kh\u00e1ng HER2 b\u1ed5 tr\u1ee3 (nh\u01b0 tr\u00ecnh b\u00e0y trong m\u1ee5c h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3).<\/li>\n
      • \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
      • B\u1ec7nh nh\u00e2n c\u00f3 thai kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng h\u00f3a tr\u1ecb trong qu\u00fd \u0111\u1ea7u (3 th\u00e1ng \u0111\u1ea7u) n\u1ebfu gi\u1eef thai, ch\u1ec9 h\u00f3a tr\u1ecb t\u1eeb qu\u00fd th\u1ee9 hai tr\u1edf \u0111i v\u1edbi c\u00e1c thu\u1ed1c \u00edt g\u00e2y h\u1ea1i thai nhi nh\u01b0 doxorubicin, cyclophosphamide, 5 fluorouracil, taxane… C\u00e1c thu\u1ed1c kh\u00e1ng HER2 v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong su\u1ed1t th\u1eddi k\u1ef3 mang thai.<\/li>\n<\/ul>\n

        3. H\u00f3a tr\u1ecb v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00edch b\u1ed5 tr\u1ee3<\/strong><\/h2>\n

        – Sau khi ph\u1eabu thu\u1eadt, \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 to\u00e0n th\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t. Quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean c\u00e2n nh\u1eafc gi\u1eefa l\u1ee3i \u00edch gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1 t\u00e1i ph\u00e1t, di c\u0103n v\u1edbi nguy c\u01a1 v\u1ec1 \u0111\u1ed9c t\u00ednh c\u1ee7a t\u1eebng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/p>\n

        H\u1ed9i ngh\u1ecb \u0111\u1ed3ng thu\u1eadn St. Gallen 2015 \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 h\u1ec7 th\u1ed1ng theo c\u00e1c th\u1ec3 b\u1ec7nh h\u1ecdc m\u1ed9t c\u00e1ch kh\u00e1i qu\u00e1t. B\u00ean c\u1ea1nh th\u1ec3 b\u1ec7nh h\u1ecdc, vi\u1ec7c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb c\u1ea7n d\u1ef1a v\u00e0o giai \u0111o\u1ea1n u, h\u1ea1ch sau m\u1ed5 c\u00f9ng c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, th\u1ec3 tr\u1ea1ng chung, b\u1ec7nh k\u00e8m theo v\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

        C\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh, HER2 \u00e2m t\u00ednh (l\u00f2ng \u1ed1ng A, l\u00f2ng \u1ed1ng B- HER2 \u00e2m t\u00ednh) l\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ea7n c\u00e2n nh\u1eafc nhi\u1ec1u nh\u1ea5t vi\u1ec7c c\u00f3 h\u00f3a tr\u1ecb hay kh\u00f4ng. \u0110\u1ed1i v\u1edbi typ l\u00f2ng \u1ed1ng A, di c\u0103n t\u1eeb 4 h\u1ea1ch ho\u1eb7c kh\u1ed1i u t\u1eeb T3 tr\u1edf l\u00ean c\u1ea7n h\u00f3a tr\u1ecb. N\u1ebfu di c\u0103n t\u1eeb 1 \u0111\u1ebfn 3 h\u1ea1ch, c\u1ea7n d\u1ef1a v\u00e0o nguy c\u01a1 t\u00e1i ph\u00e1t tr\u00ean l\u00e2m s\u00e0ng v\u00e0 m\u00f4 b\u1ec7nh h\u1ecdc bao g\u1ed3m giai \u0111o\u1ea1n u, c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m g\u1ee3i \u00fd m\u1ee9c \u0111\u1ed9 \u00e1c t\u00ednh (\u0111\u1ed9 m\u00f4 h\u1ecdc, s\u1ef1 t\u0103ng sinh, x\u00e2m l\u1ea5n m\u1ea1ch), m\u1ee9c \u0111\u1ed9 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m li\u00ean quan \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft bao g\u1ed3m m\u1ee9c b\u1ed9c l\u1ed9 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft th\u1ea5p, kh\u00f4ng b\u1ed9c l\u1ed9 PR, \u0111\u1ed9 m\u00f4 h\u1ecdc cao, b\u1ed9c l\u1ed9 cao c\u00e1c ch\u1ec9 \u0111i\u1ec3m t\u0103ng sinh. Do \u0111\u00f3, ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p typ l\u00f2ng \u1ed1ng B-HER2 \u00e2m t\u00ednh s\u1ebd c\u1ea7n h\u00f3a tr\u1ecb ti\u1ebfp theo b\u1eb1ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f3 ph\u00e2n \u0111\u1ecbnh c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m gen \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nguy c\u01a1 t\u00e1i ph\u00e1t, t\u1eeb \u0111\u00f3 c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh h\u00f3a tr\u1ecb hay kh\u00f4ng. V\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ea1ch \u00e2m t\u00ednh, kh\u1ed1i u \u22640,5cm, c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n h\u00f3a tr\u1ecb. \u0110\u1ed1i v\u1edbi c\u00e1c c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u1ed1i u tr\u00ean 0,5 cm nh\u01b0ng ch\u01b0a di c\u0103n h\u1ea1ch, n\u00ean l\u00e0m x\u00e9t nghi\u1ec7m gen \u0111\u00e1nh gi\u00e1 \u0111i\u1ec3m nguy c\u01a1 t\u00e1i ph\u00e1t. N\u1ebfu kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n l\u00e0m x\u00e9t nghi\u1ec7m gen, c\u00e2n nh\u1eafc gi\u1eefa ch\u1ec9 \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft hay h\u00f3a tr\u1ecb ti\u1ebfp theo b\u1eb1ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft s\u1ebd d\u1ef1a v\u00e0o c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh h\u1ecdc. V\u1ec1 s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch di c\u0103n, c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn c\u1ea3 s\u1ed1 h\u1ea1ch v\u00e9t \u0111\u01b0\u1ee3c.<\/p>\n

        C\u00e1c tr\u01b0\u1eddng h\u1ee3p HER2 d\u01b0\u01a1ng t\u00ednh (l\u00f2ng \u1ed1ng v\u00e0 kh\u00f4ng l\u00f2ng \u1ed1ng), \u0111\u01b0\u1eddng k\u00ednh kh\u1ed1i u >1cm c\u1ea7n \u0111\u01b0\u1ee3c h\u00f3a tr\u1ecb k\u1ebft h\u1ee3p trastuzumab. C\u00e1c tr\u01a3\u1eddng h\u1ee3p \u2264pT1bN0 c\u0169ng n\u00ean c\u00e2n nh\u1eafc v\u1edbi ch\u1ec9 \u0111\u1ecbnh n\u00e0y (xem x\u00e9t th\u00eam c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, b\u1ec7nh h\u1ecdc kh\u00e1c). Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb trastuzumab chu\u1ea9n l\u00e0 1 n\u0103m. \u0110\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 th\u1ea5p ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 \u0111i\u1ec1u ki\u1ec7n kinh t\u1ebf h\u1ea1n ch\u1ebf, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trastuzumab v\u1edbi th\u1eddi gian ng\u1eafn h\u01a1n, t\u1ed1i thi\u1ec3u 9 tu\u1ea7n. V\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ea1ch d\u01b0\u01a1ng t\u00ednh, c\u00e2n nh\u1eafc k\u1ebft h\u1ee3p h\u00f3a tr\u1ecb v\u1edbi trastuzumab v\u00e0 pertuzumab. Kh\u00f4ng d\u00f9ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c kh\u00e1ng HER2 v\u1edbi anthracycline.<\/p>\n

        Ung th\u01b0 v\u00fa b\u1ed9 ba \u00e2m t\u00ednh c\u0169ng c\u00f3 l\u1ee3i \u00edch t\u1eeb h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3, \u0111\u1eb7c bi\u1ec7t t\u1eeb pT1bN0 tr\u1edf l\u00ean. C\u00e2n nh\u1eafc h\u00f3a tr\u1ecb v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p u nh\u1ecf h\u01a1n.<\/p>\n

        \u0110\u1ed1i v\u1edbi c\u00e1c th\u1ec3 \u00edt g\u1eb7p, n\u00ean ch\u1ec9 \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft cho c\u00e1c th\u1ec3 m\u00f4 h\u1ecdc \u0111\u00e1p \u1ee9ng v\u1edbi n\u1ed9i ti\u1ebft nh\u01b0 th\u1ec3 \u1ed1ng nh\u1ecf (tubular), th\u1ec3 nh\u00fa (papillary) v\u00e0 th\u1ec3 nh\u1ea7y (mucinous), c\u00e2n nh\u1eafc h\u00f3a tr\u1ecb v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ea1ch d\u01b0\u01a1ng t\u00ednh. H\u1ea7u h\u1ebft c\u00e1c th\u1ec3 n\u00e0y \u0111\u1ec1u c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh v\u00e0 HER2 \u00e2m t\u00ednh. N\u1ebfu th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft \u00e2m t\u00ednh v\u00e0\/ho\u1eb7c HER d\u01b0\u01a1ng t\u00ednh; ho\u1eb7c ER v\u00e0 PR \u00e2m t\u00ednh v\u00e0 \u0111\u1ed9 m\u00f4 h\u1ecdc 1 th\u00ec c\u1ea7n l\u00e0m l\u1ea1i x\u00e9t nghi\u1ec7m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch. N\u1ebfu l\u00e0m l\u1ea1i x\u00e9t nghi\u1ec7m, k\u1ebft qu\u1ea3 ER v\u00e0 PR \u00e2m t\u00ednh th\u00ec \u0111i\u1ec1u tr\u1ecb nh\u01a3 c\u00e1c th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc th\u00f4ng th\u01b0\u1eddng. H\u00f3a tr\u1ecb cho c\u00e1c th\u1ec3 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi n\u1ed9i ti\u1ebft nh\u01a3 th\u1ec3 t\u1ee7y (medullary), th\u1ec3 d\u1ecb s\u1ea3n (metaplastic); v\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb h\u1ec7 th\u1ed1ng b\u1ed5 tr\u1ee3 v\u1edbi c\u00e1c th\u1ec3 thi\u1ebfu ni\u00ean ch\u1ebf ti\u1ebft (secretory juvenile), d\u1ea1ng tuy\u1ebfn nang (adenoid cystic) v\u00e0 ti\u1ebft r\u1ee5ng \u0111\u1ea7u (apocrine) n\u1ebfu kh\u00f4ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 cao.<\/p>\n

        C\u00f3 nhi\u1ec1u ph\u00e1c \u0111\u1ed3 ho\u00e1 tr\u1ecb kh\u00e1c nhau c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3. V\u1edbi m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n, c\u00e1c thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ee7 li\u1ec1u. C\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng anthracycline c\u00f3 th\u1ec3 d\u00f9ng c\u00e1c ph\u00e1c \u0111\u1ed3 kh\u00f4ng c\u00f3 anthracycline. C\u00e1c tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 t\u00e1i ph\u00e1t th\u1ea5p c\u00f3 th\u1ec3 d\u00f9ng c\u00e1c ph\u00e1c \u0111\u1ed3 AC ho\u1eb7c TC v\u1edbi 4 chu k\u1ef3.<\/p>\n

          \n
        • V\u1edbi b\u1ec7nh nh\u00e2n UTV b\u1ed9 ba \u00e2m t\u00ednh, sau h\u00f3a tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 v\u1edbi anthracycline, taxane, alkyl h\u00f3a….\u0111\u1ee7 s\u1ed1 \u0111\u1ee3t c\u1ea7n thi\u1ebft v\u00e0 ph\u1eabu thu\u1eadt, n\u1ebfu b\u1ec7nh c\u00f2n t\u1ed3n t\u1ea1i tr\u00ean m\u00f4 b\u1ec7nh h\u1ecdc, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc d\u00f9ng th\u00eam capecitabine 6-8 \u0111\u1ee3t.<\/li>\n
        • Tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 (v\u1edbi h\u00f3a tr\u1ecb \u0111\u1ee7 s\u1ed1 \u0111\u1ee3t v\u00e0 kh\u00e1ng HER2), n\u1ebfu kh\u00f4ng c\u00f2n b\u1ec7nh tr\u00ean m\u00f4 b\u1ec7nh h\u1ecdc sau ph\u1eabu thu\u1eadt, duy tr\u00ec kh\u00e1ng HER2 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 (trastuzumabemtansine) 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<\/ul>\n

          4. X\u1ea1 tr\u1ecb b\u1ed5 tr\u1ee3<\/strong><\/h2>\n

          Sau ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n nh\u1ea5t thi\u1ebft ph\u1ea3i x\u1ea1 tr\u1ecb. X\u1ea1 tr\u1ecb to\u00e0n b\u1ed9 v\u00fa 45-50,4Gy chia th\u00e0nh 25-28 ph\u00e2n li\u1ec1u ho\u1eb7c 40-42,5Gy chia th\u00e0nh 15-16 ph\u00e2n li\u1ec1u (x\u1ea1 tr\u1ecb gi\u1ea3m ph\u00e2n li\u1ec1u- hypofractionated radiation therapy). T\u0103ng c\u01b0\u1eddng li\u1ec1u (boost) \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p nguy c\u01a1 t\u00e1i ph\u00e1t t\u1ea1i ch\u1ed7 cao: tu\u1ed5i<50, \u0111\u1ed9 m\u00f4 h\u1ecdc 3, UTBM t\u1ea1i ch\u1ed7 th\u1ec3 \u1ed1ng lan r\u1ed9ng, x\u00e2m l\u1ea5n m\u1ea1ch ho\u1eb7c c\u1eaft b\u1ecf u kh\u00f4ng tri\u1ec7t c\u0103n. Li\u1ec1u t\u0103ng c\u01b0\u1eddng \u0111i\u1ec3n h\u00ecnh l\u00e0 10-16Gy chia th\u00e0nh 4-8 ph\u00e2n li\u1ec1u. X\u1ea1 tr\u1ecb m\u1ed9t ph\u1ea7n tuy\u1ebfn v\u00fa sau ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n UTV giai \u0111o\u1ea1n s\u1edbm (giai \u0111o\u1ea1n I), u \u0111\u01a1n \u1ed5, ER d\u01b0\u01a1ng t\u00ednh, 60 tu\u1ed5i tr\u1edf l\u00ean. X\u1ea1 tr\u1ecb c\u00f3 th\u1ec3 b\u1eb1ng \u00e1p s\u00e1t 34 Gy chia 10 ph\u00e2n li\u1ec1u, 2 l\u1ea7n\/ng\u00e0y ho\u1eb7c x\u1ea1 tr\u1ecb ngo\u00e0i v\u00e0o n\u1ec1n u 38,5 Gy chia 10 ph\u00e2n li\u1ec1u, 2 l\u1ea7n\/ng\u00e0y.<\/p>\n

            \n
          • Sau ph\u1eabu thu\u1eadt c\u1eaft tuy\u1ebfn v\u00fa tri\u1ec7t c\u0103n bi\u1ebfn \u0111\u1ed5i, ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb theo h\u1ea1ch v\u00f9ng di c\u0103n tr\u01b0\u1edbc, ti\u1ebfp theo \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c:<\/li>\n
          • C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1eeb 4 h\u1ea1ch n\u00e1ch tr\u1edf l\u00ean d\u01b0\u01a1ng t\u00ednh, lu\u00f4n c\u1ea7n x\u1ea1 tr\u1ecb (th\u00e0nh ng\u1ef1c, v\u00f9ng h\u1ea1 \u0111\u00f2n, th\u01b0\u1ee3ng \u0111\u00f2n, v\u00fa trong v\u00e0 b\u1ea5t k\u1ef3 ph\u1ea7n n\u00e1ch c\u00f3 nguy c\u01a1).+ C\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eeb 1-3 h\u1ea1ch n\u00e1ch d\u01b0\u01a1ng t\u00ednh, c\u00e2n nh\u1eafc (thi\u00ean v\u1ec1) x\u1ea1 tr\u1ecb th\u00e0nh ng\u1ef1c v\u00e0 h\u1ea1ch v\u00f9ng nh\u01b0 tr\u00ean.+ C\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ea1ch n\u00e1ch \u00e2m t\u00ednh, kh\u1ed1i u >5cm ho\u1eb7c di\u1ec7n c\u1eaft d\u01b0\u01a1ng t\u00ednh nh\u01b0ng kh\u00f4ng th\u1ec3 c\u1eaft l\u1ea1i \u0111\u01b0\u1ee3c (b\u1ea5t kh\u1ea3 kh\u00e1ng), c\u1ea7n x\u1ea1 tr\u1ecb th\u00e0nh ng\u1ef1c c\u00f3 th\u1ec3 k\u00e8m theo ho\u1eb7c kh\u00f4ng x\u1ea1 tr\u1ecb v\u00f9ng h\u1ea1 \u0111\u00f2n, th\u01b0\u1ee3ng \u0111\u00f2n, v\u00fa trong v\u00e0 b\u1ea5t k\u1ef3 ph\u1ea7n n\u00e1ch c\u00f3 nguy c\u01a1 t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3. C\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ea1ch n\u00e1ch \u00e2m t\u00ednh, kh\u1ed1i u \u2264 5cm nh\u01b0ng b\u1edd di\u1ec7n c\u1eaft < 1mm, c\u00e2n nh\u1eafc (thi\u00ean v\u1ec1) x\u1ea1 tr\u1ecb th\u00e0nh ng\u1ef1c c\u00f3 th\u1ec3 k\u00e8m theo ho\u1eb7c kh\u00f4ng x\u1ea1 tr\u1ecb h\u1ea1ch v\u00f9ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 (u trung t\u00e2m ho\u1eb7c ph\u00eda trong c\u1ee7a v\u00fa, ho\u1eb7c u >2cm, th\u1ec3 t\u00edch v\u00fa nh\u1ecf, tu\u1ed5i tr\u1ebb, x\u00e2m nh\u1eadp b\u1ea1ch m\u1ea1ch). C\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ea1ch n\u00e1ch \u00e2m t\u00ednh, kh\u1ed1i u \u2264 5cm, b\u1edd di\u1ec7n c\u1eaft \u2265 1mm, kh\u00f4ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00f3i tr\u00ean, c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n x\u1ea1 tr\u1ecb. Ngo\u00e0i ra, vi\u1ec7c c\u00e2n nh\u1eafc x\u1ea1 tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c t\u00ednh \u0111\u1ebfn c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m kh\u1ed1i u (th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc, \u0111\u1ed9 m\u00f4 h\u1ecdc, t\u00ecnh tr\u1ea1ng c\u00e1c th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft, HER2,…) c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh k\u00e8m theo.\n

            + Li\u1ec1u x\u1ea1 t\u1ea1i th\u00e0nh ng\u1ef1c l\u00e0 45-50,4Gy chia th\u00e0nh 25-28 ph\u00e2n li\u1ec1u, c\u00f3 th\u1ec3 t\u0103ng c\u01b0\u1eddng v\u00e0o s\u1eb9o m\u1ed5 v\u1edbi t\u1ed5ng li\u1ec1u x\u1ea5p x\u1ec9 60Gy. Li\u1ec1u x\u1ea1 t\u1ea1i h\u1ea1ch v\u00f9ng l\u00e0 45- 50,4 Gy chia th\u00e0nh 25-28 ph\u00e2n li\u1ec1u. T\u1ea5t c\u1ea3 \u0111\u1ec1u theo li\u1ec7u tr\u00ecnh 5 ng\u00e0y\/tu\u1ea7n<\/li>\n

          • C\u1ea7n l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb theo t\u1eebng c\u00e1 th\u1ec3 v\u00e0 n\u00ean l\u1eadp k\u1ebf ho\u1ea1ch d\u1ef1a tr\u00ean ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh \u0111\u1ec3 t\u0103ng t\u00ednh ch\u00ednh x\u00e1c. S\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt m\u1edbi nh\u01b0 x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn li\u1ec1u (IMRT), x\u1ea1 tr\u1ecb theo v\u00f2ng cung \u0111i\u1ec1u bi\u1ebfn th\u1ec3 t\u00edch (VMAT) m\u1ed7i khi c\u00f3 th\u1ec3 v\u00ec s\u1ebd cho li\u1ec1u x\u1ea1 t\u1ed1i \u01b0u t\u1edbi kh\u1ed1i u, gi\u1ea3m thi\u1ec3u t\u00e1c d\u1ee5ng c\u00f3 h\u1ea1i t\u1edbi m\u00f4 l\u00e0nh.<\/li>\n
          • Tr\u01b0\u1eddng h\u1ee3p h\u00f3a tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3, k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb c\u1ea7n d\u1ef1a v\u00e0o giai \u0111o\u1ea1n tr\u01b0\u1edbc v\u00e0 sau \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 v\u00e0 giai \u0111o\u1ea1n theo m\u00f4 b\u1ec7nh h\u1ecdc sau m\u1ed5.<\/li>\n
          • V\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 thai, x\u1ea1 tr\u1ecb l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong su\u1ed1t th\u1eddi k\u1ef3 mang thai, ch\u1ec9 \u0111\u01b0\u1ee3c x\u1ea1 tr\u1ecb sau khi \u0111\u00e3 sinh ho\u1eb7c \u0111\u00ecnh ch\u1ec9 thai ngh\u00e9n.<\/li>\n<\/ul>\n

            5.\u00a0 \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft b\u1ed5 tr\u1ee3<\/em><\/strong><\/h2>\n

            \u0110i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft \u00e1p d\u1ee5ng cho 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.<\/p>\n

            6. \u0110i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 v\u1edbi thu\u1ed1c t\u00e1i t\u1ea1o x\u01b0\u01a1ng<\/h2>\n

            Bisphosphonate \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m nguy c\u01a1 di c\u0103n x\u01b0\u01a1ng \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 m\u00e3n kinh v\u00e0 b\u1ec7nh nh\u00e2n ch\u01b0a m\u00e3n kinh nh\u01b0ng \u0111\u00e3 \u1ee9c ch\u1ebf ho\u1eb7c c\u1eaft bu\u1ed3ng tr\u1ee9ng. C\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng hi\u1ec7n nay: zoledronic acid, clodronate.<\/p>\n

            Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n

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

            Ung th\u01b0 v\u00fa (UTV) 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 […]<\/p>\n","protected":false},"author":49,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,33],"tags":[],"yoast_head":"\n\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n I, II v\u00e0 T3N1M0 - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n I, II v\u00e0 T3N1M0 g\u1ed3m c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 ph\u1eabu thu\u1eadt, \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3, h\u00f3a tr\u1ecb v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u00edch b\u1ed5 tr\u1ee3\" \/>\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=\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n I, II v\u00e0 T3N1M0 - 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