{"id":29444,"date":"2023-05-04T17:25:55","date_gmt":"2023-05-04T10:25:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29444"},"modified":"2023-05-14T16:57:54","modified_gmt":"2023-05-14T09:57:54","slug":"tien-liet-tuyen","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/tien-liet-tuyen\/","title":{"rendered":"Ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn: Ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i"},"content":{"rendered":"

Ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn (UTTLT) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf nam gi\u1edbi, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u00ean 50 tu\u1ed5i. Tuy nhi\u00ean, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn th\u01b0\u1eddng g\u1eb7p kh\u00f3 kh\u0103n do c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh r\u1ea5t gi\u1ed1ng v\u1edbi c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c c\u1ee7a ti\u1ec1n li\u1ec7t tuy\u1ebfn. Do \u0111\u00f3, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 nhanh ch\u00f3ng.<\/strong><\/p>\n

1. Ch\u1ea9n \u0111o\u00e1n<\/strong><\/h1>\n

1.1. L\u00e2m s\u00e0ng <\/strong><\/h2>\n

1.1.1. Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng <\/strong><\/h3>\n

R\u1ea5t nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn \u1edf th\u1ec3 \u1ea9n, kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c \u00a0ph\u00e1t hi\u1ec7n b\u1ec7nh t\u00ecnh c\u1edd, ho\u1eb7c gi\u1ea3i ph\u1eabu t\u1eed thi sau khi t\u1eed vong do nh\u1eefng nguy\u00ean nh\u00e2n kh\u00e1c. C\u00f3 2 l\u00fd do l\u00e0m cho ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i \u0111i kh\u00e1m b\u1ec7nh:<\/p>\n

– R\u1ed1i lo\u1ea1n ti\u1ec3u ti\u1ec7n.<\/p>\n

– C\u00e1c d\u1ea5u hi\u1ec7u v\u1ec1 u lan to\u1ea3 ho\u1eb7c \u0111\u00e3 c\u00f3 di c\u0103n.<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng ti\u1ebft ni\u1ec7u th\u01b0\u1eddng g\u1eb7p l\u00e0:<\/p>\n

– \u0110\u00e1i kh\u00f3, tia \u0111\u00e1i nh\u1ecf.<\/p>\n

– \u0110\u00e1i nhi\u1ec1u l\u1ea7n m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau, tu\u1ef3 theo s\u1ef1 k\u00edch th\u00edch, c\u1ea3m gi\u00e1c \u0111\u00e1i kh\u00f4ng h\u1ebft do c\u00f3 n\u01b0\u1edbc ti\u1ec3u d\u01b0 trong b\u00e0ng quang.<\/p>\n

– \u0110\u00e1i kh\u00f4ng t\u1ef1 ch\u1ee7.<\/p>\n

– B\u00ed \u0111\u00e1i c\u1ea5p.<\/p>\n

\u1ede giai \u0111o\u1ea1n mu\u1ed9n, kh\u1ed1i u th\u01b0\u1eddng nhi\u1ec1u \u1ed5, lan to\u1ea3 x\u00e2m l\u1ea5n bao x\u01a1 v\u00e0 di c\u0103n, c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng r\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n tr\u1ea7m tr\u1ecdng, th\u1ec3 tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh suy s\u1ee5p, k\u1ebft th\u00fac cu\u1ed1i c\u00f9ng l\u00e0 t\u1eed vong.<\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u ti\u1ebfn tri\u1ec3n lan tr\u00e0n th\u01b0\u1eddng g\u1eb7p l\u00e0:<\/p>\n

– \u0110au x\u01b0\u01a1ng<\/p>\n

– \u0110au t\u1ea7ng sinh m\u00f4n<\/p>\n

– Ph\u00f9 n\u1ec1 chi d\u01b0\u1edbi<\/p>\n

– Xu\u1ea5t tinh ra m\u00e1u<\/p>\n

– C\u00e1c d\u1ea5u hi\u1ec7u to\u00e0n th\u00e2n kh\u00e1c: NB c\u00f3 th\u1ec3 \u0111\u1ebfn vi\u1ec7n trong t\u00ecnh tr\u1ea1ng suy th\u1eadn, v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n g\u1ea7y s\u00fat, ph\u00f9 n\u1ec1, xanh nh\u1ee3t, thi\u1ebfu m\u00e1u. C\u00e1c di c\u0103n kh\u00e1c \u1edf ph\u1ed5i, gan \u00edt khi l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean, di c\u0103n n\u00e3o c\u0169ng hi\u1ebfm g\u1eb7p.<\/p>\n

1.1.2. Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 <\/strong><\/h3>\n

– Th\u0103m kh\u00e1m TTL qua tr\u1ef1c tr\u00e0ng: \u0110\u00e2y l\u00e0 c\u00e1ch th\u1ee9c \u0111\u01a1n gi\u1ea3n, r\u1ebb ti\u1ec1n v\u00e0 h\u1eefu hi\u1ec7u ph\u00e1t hi\u1ec7n UTTTL. H\u1ea7u h\u1ebft UTTTL xu\u1ea5t hi\u1ec7n \u1edf v\u00f9ng ngo\u1ea1i vi c\u1ee7a TTL v\u00e0 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n qua th\u0103m tr\u1ef1c tr\u00e0ng. B\u1eb1ng vi\u1ec7c ph\u1ed1i h\u1ee3p v\u1edbi n\u1ed3ng \u0111\u1ed9 PSA, th\u0103m kh\u00e1m TTL qua tr\u1ef1c tr\u00e0ng \u0111\u00e3 g\u00f3p ph\u1ea7n ch\u1ea9n \u0111o\u00e1n \u0111a s\u1ed1 c\u00e1c UTTTL.<\/p>\n

– Kh\u00e1m to\u00e0n th\u00e2n ph\u00e1t hi\u1ec7n di c\u0103n h\u1ea1ch, m\u1ed9t s\u1ed1 \u00edt tr\u01a3\u1eddng h\u1ee3p ph\u00e1t hi\u1ec7n di c\u0103n xa.<\/p>\n

1.2. C\u1eadn l\u00e2m s\u00e0ng <\/strong><\/h2>\n

1.2.1. N\u1ed3ng \u0111\u1ed9 PSA trong <\/strong>ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn<\/strong><\/h3>\n

Hi\u1ec7n nay n\u1ed3ng \u0111\u1ed9 PSA \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n UTTTL v\u1eabn \u0111ang c\u00f2n \u0111\u01a3\u1ee3c b\u00e0n c\u00e3i. Tuy nhi\u00ean ng\u01a3\u1eddi ta th\u1ea5y r\u1eb1ng n\u1ed3ng \u0111\u1ed9 PSA c\u00e0ng cao th\u00ec kh\u1ea3 n\u0103ng t\u1ed3n t\u1ea1i UTTTL c\u00e0ng l\u1edbn. Tuy nhi\u00ean, ngay c\u1ea3 khi n\u1ed3ng \u0111\u1ed9 PSA < 4 ng\/mL c\u0169ng c\u00f3 m\u1ed9t t\u1ef7 l\u1ec7 nh\u1ea5t \u0111\u1ecbnh m\u1eafc UTTTL. M\u1eb7c d\u00f9 v\u1eady, \u0111\u1ec3 tr\u00e1nh ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft qu\u00e1 m\u1ee9c, H\u1ed9i Ni\u1ec7u khoa v\u00e0 th\u1eadn h\u1ecdc Vi\u1ec7t Nam (VUNA) khuy\u1ebfn ngh\u1ecb l\u1ea5y m\u1ee9c PSA b\u1ea5t th\u01a3\u1eddng l\u00e0 >4ng\/mL.<\/p>\n

T\u1ec9 l\u1ec7 PSA t\u1ef1 do\/to\u00e0n ph\u1ea7n l\u00e0 th\u00f4ng s\u1ed1 \u0111\u01a3\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong l\u00e2m s\u00e0ng \u0111\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eefa t\u0103ng sinh l\u00e0nh t\u00ednh v\u00e0 UTTTL. T\u1ec9 l\u1ec7 n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong tr\u01a3\u1eddng h\u1ee3p 6 n\u1ed3ng \u0111\u1ed9 PSA t\u1eeb 4 \u0111\u1ebfn 10 ng\/mL v\u00e0 th\u0103m kh\u00e1m tr\u1ef1c tr\u00e0ng kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nghi ng\u1edd UTTTL.<\/p>\n

Th\u00f4ng th\u01b0\u1eddng l\u1ea5y m\u1ee9c PSA t\u1ef1 do\/ PSA to\u00e0n ph\u1ea7n c\u00f3 \u00fd ngh\u0129a l\u00e0 < 0,1. Nh\u1eb1m m\u1ee5c \u0111\u00edch t\u0103ng \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 chuy\u00ean bi\u1ec7t c\u1ee7a x\u00e9t nghi\u1ec7m PSA, c\u00e1c x\u00e9t nghi\u1ec7m chuy\u00ean s\u00e2u nh\u01a3 \u0111o v\u1eadn t\u1ed1c PSA, t\u1ef7 tr\u1ecdng PSA, PSA theo tu\u1ed5i.<\/p>\n

1.2.2. Si\u00eau \u00e2m <\/strong><\/h3>\n

Si\u00eau \u00e2m qua tr\u1ef1c tr\u00e0ng<\/strong>: Kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u00f3 th\u1ec3 th\u1ea5y \u0111\u01a3\u1ee3c h\u00ecnh \u1ea3nh kinh \u0111i\u1ec3n c\u1ee7a m\u1ed9t v\u00f9ng gi\u1ea3m \u00e2m \u1edf ngo\u1ea1i vi c\u1ee7a tuy\u1ebfn ti\u1ec1n li\u1ec7t qua si\u00eau \u00e2m. Si\u00eau \u00e2m qua tr\u1ef1c tr\u00e0ng kh\u00f4ng th\u1ec3 ph\u00e1t hi\u1ec7n v\u00f9ng UTTTL v\u1edbi \u0111\u1ed9 tin c\u1eady \u0111\u1ea7y \u0111\u1ee7. Do \u0111\u00f3, sinh thi\u1ebft c\u00e1c v\u00f9ng nghi ng\u1edd kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng nh\u01a3 l\u00e0 m\u1ed9t ph\u01a3\u01a1ng ph\u00e1p th\u1eeb\u1eddng quy \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n. Tuy nhi\u00ean, c\u00f3 th\u1ec3 c\u00f3 \u00edch khi sinh thi\u1ebft th\u00eam c\u00e1c khu v\u1ef1c nghi ng\u1edd.<\/p>\n

Si\u00eau \u00e2m \u1ed5 b\u1ee5ng<\/strong>: c\u00f3 gi\u00e1 tr\u1ecb \u0111\u1ecbnh h\u01a3\u1edbng ch\u1ea9n \u0111o\u00e1n, \u0111\u00e1nh gi\u00e1 di c\u0103n trong \u1ed5 b\u1ee5ng – Ch\u1ee5p c\u1ed9ng h\u01a3\u1edfng t\u1eeb (CHT) ti\u1ec3u khung: Ch\u1ee5p CHT ti\u1ec3u khung c\u00f3 gi\u00e1 tr\u1ecb g\u00f3p ph\u1ea7n v\u00e0o ch\u1ea9n \u0111o\u00e1n, \u0111\u1ecbnh h\u01b0\u1edbng cho vi\u1ec7c sinh thi\u1ebft TTL. Ngo\u00e0i ra c\u00f2n gi\u00fap cho ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 x\u00e2m l\u1ea5n c\u1ee7a kh\u1ed1i u v\u00e0o t\u1ed5 ch\u1ee9c xung quanh v\u00e0 h\u1ea1ch v\u00f9ng.<\/p>\n

1.2.3. C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c<\/strong><\/h3>\n

– Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh<\/strong>: Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh v\u1eeba cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 x\u00e2m l\u1ea5n t\u1ea1i ch\u1ed7 c\u1ee7a kh\u1ed1i u (T), \u0111\u1ed3ng th\u1eddi cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n di c\u0103n, \u0111\u1eb7c bi\u1ec7t l\u00e0 di c\u0103n h\u1ea1ch ch\u1eadu. Gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c n\u00e2ng cao nh\u1edd v\u00e0o c\u00e1c k\u1ef9 thu\u1eadt ch\u1ee5p m\u1edbi.<\/p>\n

– Ch\u1ee5p x\u1ea1 h\u00ecnh x\u01b0\u01a1ng v\u00e0 ch\u1ee5p PET\/CT:<\/strong> Ch\u1ee5p x\u1ea1 h\u00ecnh x\u01b0\u01a1ng v\u1edbi MDP-Tc99m: Ph\u00e1t hi\u1ec7n nh\u1eefng t\u1ed5n th\u01a3\u01a1ng di c\u0103n v\u00e0o x\u01b0\u01a1ng: X\u01b0\u01a1ng c\u1ed9t s\u1ed1ng, x\u01b0\u01a1ng s\u01a3\u1eddn, x\u01b0\u01a1ng c\u00e1nh ch\u1eadu, x\u01b0\u01a1ng s\u1ecd\u2026<\/p>\n

– Ch\u1ee5p PET\/CT<\/strong>: V\u1edbi F18-FDG \u00edt c\u00f3 gi\u00e1 tr\u1ecb ph\u00e1t hi\u1ec7n u nguy\u00ean ph\u00e1t, nh\u01b0ng gi\u00fap ph\u00e1t hi\u1ec7n ch\u00ednh x\u00e1c di c\u0103n, t\u00e1i ph\u00e1t, \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u00e1c ph\u01a3\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb, m\u00f4 ph\u1ecfng l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb. C\u00f3 th\u1ec3 ch\u1ee5p PET\/CT v\u1edbi C11-Acetate cho h\u00ecnh \u1ea3nh u nguy\u00ean ph\u00e1t r\u00f5 n\u00e9t h\u01a1n.<\/p>\n

1.3. Sinh thi\u1ebft ti\u1ec1n li\u1ec7t tuy\u1ebfn<\/strong><\/h2>\n

1.3.1. Sinh thi\u1ebft l\u1ea7n \u0111\u1ea7u<\/strong><\/h2>\n

Ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft tuy\u1ebfn ti\u1ec1n li\u1ec7t d\u1ef1a tr\u00ean c\u01a1 s\u1edf n\u1ed3ng \u0111\u1ed9 PSA v\u00e0\/ho\u1eb7c c\u00f3 nghi ng\u1edd khi th\u0103m kh\u00e1m tr\u1ef1c tr\u00e0ng. C\u0169ng c\u1ea7n ph\u1ea3i xem x\u00e9t \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 tu\u1ed5i, b\u1ec7nh k\u00e8m theo v\u00e0 h\u1eadu qu\u1ea3 \u0111i\u1ec1u tr\u1ecb n\u1ebfu ch\u1ea9n \u0111o\u00e1n qu\u00e1 m\u1ee9c. Ng\u01b0\u1eddi b\u1ec7nh ch\u1ec9 c\u00f3 n\u1ed3ng \u0111\u1ed9 PSA cao l\u1ea7n x\u00e9t nghi\u1ec7m \u0111\u1ea7u ti\u00ean kh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft ngay l\u1eadp t\u1ee9c.<\/p>\n

C\u1ea7n x\u00e9t nghi\u1ec7m l\u1ea1i PSA sau m\u1ed9t th\u00e1ng trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n ti\u00eau chu\u1ea9n (kh\u00f4ng xu\u1ea5t tinh v\u00e0 kh\u00f4ng l\u00e0m c\u00e1c th\u1ee7 thu\u1eadt nh\u01b0 \u0111\u1eb7t th\u00f4ng ni\u1ec7u \u0111\u1ea1o b\u00e0ng quang, soi b\u00e0ng quang ho\u1eb7c c\u1eaft \u0111\u1ed1t n\u1ed9i soi qua ni\u1ec7u \u0111\u1ea1o, kh\u00f4ng th\u0103m tr\u1ef1c tr\u00e0ng tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 kh\u00f4ng c\u00f3 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u) \u1edf c\u00f9ng m\u1ed9t n\u01a1i x\u00e9t nghi\u1ec7m v\u00e0 c\u00f9ng ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e3 ti\u1ebfn h\u00e0nh l\u1ea7n tr\u01b0\u1edbc. Sinh thi\u1ebft qua tr\u1ef1c tr\u00e0ng l\u00e0 ph\u01a3\u01a1ng ph\u00e1p \u0111\u01a3\u1ee3c \u0111\u1ec1 ngh\u1ecb trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd UTTTL. S\u1ed1 m\u1eabu sinh thi\u1ebft l\u00fd t\u01b0\u1edfng l\u00e0 10-12 m\u1eabu.<\/p>\n

1.3.2. Sinh thi\u1ebft l\u1eb7p l\u1ea1i \u00a0<\/strong><\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh cho sinh thi\u1ebft l\u1eb7p l\u1ea1i l\u00e0:<\/p>\n

    \n
  • PSA t\u0103ng v\u00e0\/ho\u1eb7c cao li\u00ean t\u1ee5c<\/li>\n
  • Th\u0103m kh\u00e1m tuy\u1ebfn ti\u1ec1n li\u1ec7t c\u00f3 nghi ng\u1edd;<\/li>\n
  • T\u0103ng sinh d\u1ea1ng nang nh\u1ecf kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (atypical small acinar proliferation);<\/li>\n
  • T\u00e2n sinh trong bi\u1ec3u m\u00f4 tuy\u1ebfn lan t\u1ecfa (extensive prostatic intraepithelial neoplasia – PIN).<\/li>\n<\/ul>\n

    Sinh thi\u1ebft l\u1ea7n th\u1ee9 ba ho\u1eb7c nhi\u1ec1u l\u1ea7n h\u01a1n kh\u00f4ng \u0111\u01a3\u1ee3c khuy\u1ebfn c\u00e1o, c\u1ea7n ph\u1ea3i xem x\u00e9t tr\u00ean t\u1eebng c\u00e1 th\u1ec3 ri\u00eang bi\u1ec7t.<\/p>\n

    \"\"
    Sinh thi\u1ebft TTL d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m n\u1ed9i tr\u1ef1c tr\u00e0ng<\/strong>. Ngu\u1ed3n<\/strong>: B\u1ed9 Y t\u1ebf 2020<\/em><\/figcaption><\/figure>\n

    1.4. M\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a <\/strong>ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn<\/strong><\/h2>\n

    Ph\u00e2n \u0111\u1ed9 m\u00f4 h\u1ecdc theo h\u1ec7 th\u1ed1ng thang \u0111i\u1ec3m Gleason hi\u1ec7n nay \u0111\u01a3\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong ch\u1ea9n \u0111o\u00e1n UTTTL nh\u1eb1m ph\u1ee5c v\u1ee5 cho \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i, ti\u00ean l\u01b0\u1ee3ng.<\/p>\n

    \u0110i\u1ec3m Gleason l\u00e0 t\u1ed5ng c\u1ee7a \u0111\u1ed9 m\u00f4 h\u1ecdc Gleason chi\u1ebfm \u01b0u th\u1ebf nh\u1ea5t v\u00e0 nh\u00ec. N\u1ebfu ch\u1ec9 c\u00f3 m\u1ed9t \u0111\u1ed9 m\u00f4 h\u1ecdc, th\u00ec \u0111i\u1ec3m \u0111\u01b0\u1ee3c t\u00ednh b\u1eb1ng c\u00e1ch nh\u00e2n \u0111\u00f4i \u0111\u1ed9 m\u00f4 h\u1ecdc \u0111\u00f3. N\u1ebfu m\u1ed9t \u0111\u1ed9 m\u00f4 h\u1ecdc <5% kh\u1ed1i l\u01b0\u1ee3ng ung th\u01b0, th\u00ec lo\u1ea1i n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c t\u00ednh trong \u0111i\u1ec3m Gleason (quy t\u1eafc 5%). \u0110\u1ed9 m\u00f4 h\u1ecdc \u01b0u th\u1ebf nh\u1ea5t v\u00e0 nh\u00ec \u0111\u01b0\u1ee3c bi\u1ec3u di\u1ec5n th\u00f4ng qua s\u1ed1 \u0111i\u1ec3m Gleason (v\u00ed d\u1ee5 Gleason s\u1ed1 7 [4 + 3]).<\/p>\n

    H\u1ec7 th\u1ed1ng ph\u00e2n lo\u1ea1i m\u00f4 b\u1ec7nh h\u1ecdc m\u1edbi nh\u1ea5t c\u1ee7a UTTTL d\u1ef1a tr\u00ean h\u1ed9i ngh\u1ecb \u0111\u1ed3ng thu\u1eadn c\u1ee7a Hi\u1ec7p h\u1ed9i qu\u1ed1c t\u1ebf v\u1ec1 b\u1ec7nh h\u1ecdc ti\u1ebft ni\u1ec7u 2014 (International Society of Urological Pathology – ISUP).<\/p>\n

    H\u1ec7 th\u1ed1ng n\u00e0y chia ra 5 \u0111\u1ed9 d\u1ef1a tr\u00ean \u0111i\u1ec3m Gleason nh\u01b0 sau:<\/p>\n

    – \u0110\u1ed9 1: \u2264 6 \u0111i\u1ec3m<\/p>\n

    – \u0110\u1ed9 2: 3+4 = 7 \u0111i\u1ec3m<\/p>\n

    – \u0110\u1ed9 3: 4+3 = 7 \u0111i\u1ec3m<\/p>\n

    – \u0110\u1ed9 4: 8 \u0111i\u1ec3m<\/p>\n

    – \u0110\u1ed9 5: 9-10 \u0111i\u1ec3m<\/p>\n

    2. Ph\u00e2n lo\u1ea1i giai \u0111o\u1ea1n c\u1ee7a ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn<\/strong><\/h2>\n

    Ch\u1ec9 \u0111\u1ecbnh c\u00e1c x\u00e9t nghi\u1ec7m (XN) \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb:.<\/p>\n

      \n
    • \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 lan r\u1ed9ng c\u1ee7a kh\u1ed1i u (T)<\/strong>: D\u1ef1a v\u00e0o si\u00eau \u00e2m, CLVT, ho\u1eb7c MRI.<\/li>\n
    • \u0110\u00e1nh gi\u00e1 di c\u0103n h\u1ea1ch (N)<\/strong>: th\u1ef1c hi\u1ec7n khi c\u00f3 k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb tri\u1ec7t c\u0103n. Ng\u01b0\u1eddi b\u1ec7nh giai \u0111o\u1ea1n T2 ho\u1eb7c \u00edt h\u01a1n, PSA <20 ng\/mL v\u00e0 \u0111i\u1ec3m Gleason <6 c\u00f3 kh\u1ea3 n\u0103ng di c\u0103n h\u1ea1ch th\u1ea5p h\u01a1n 10% c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n \u0111\u00e1nh gi\u00e1 h\u1ea1ch<\/li>\n
    • \u0110\u00e1nh gi\u00e1 di c\u0103n (M) x\u01b0\u01a1ng<\/strong>: x\u1ea1 h\u00ecnh x\u01a3\u01a1ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT, PET\/CT\u2026<\/li>\n
    • Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f3 \u0111\u00e1nh gi\u00e1, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh PET\/CT (C-11choline PET\/CT ho\u1eb7c F-18 fluciclovine ho\u1eb7c sodium PET\/CT), ho\u1eb7c ch\u1ee5p PET\/CT v\u1edbi 18FDG \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c t\u1ed5n th\u01b0\u01a1ng di c\u0103n \u1edf h\u1ec7 th\u1ed1ng h\u1ea1ch, \u1edf c\u00e1c t\u1ea1ng, x\u01b0\u01a1ng, \u2026<\/li>\n<\/ul>\n
      \"\"
      \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u0110\u00e1nh gi\u00e1 tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb. Ngu\u1ed3n<\/strong>: B\u1ed9 Y t\u1ebf 2020 <\/em><\/figcaption><\/figure>\n

      \u0110\u00e1nh gi\u00e1 giai \u0111o\u1ea1n theo AJCC l\u1ea7n th\u1ee9 8 \u2013 2017<\/p>\n

       <\/p>\n

      * Giai \u0111o\u1ea1n T theo l\u00e2m s\u00e0ng (cT) <\/strong><\/p>\n

      cTx Kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c u nguy\u00ean ph\u00e1t<\/p>\n

      cT0 Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a u nguy\u00ean ph\u00e1t<\/p>\n

      cT1 U nguy\u00ean ph\u00e1t kh\u00f4ng r\u00f5 r\u00e0ng tr\u00ean l\u00e2m s\u00e0ng, kh\u00f4ng s\u1edd th\u1ea5y<\/p>\n

      cT1a U x\u00e1c \u0111\u1ecbnh b\u1eb1ng m\u00f4 b\u1ec7nh h\u1ecdc \u22645% trong t\u1ed5 ch\u1ee9c l\u1ea5y \u0111\u01b0\u1ee3c<\/p>\n

      cT1b U x\u00e1c \u0111\u1ecbnh b\u1eb1ng m\u00f4 b\u1ec7nh h\u1ecdc >5% trong t\u1ed5 ch\u1ee9c l\u1ea5y \u0111\u01b0\u1ee3c<\/p>\n

      cT1c U x\u00e1c \u0111\u1ecbnh b\u1eb1ng sinh thi\u1ebft kim \u1edf m\u1ed9t b\u00ean ho\u1eb7c c\u1ea3 hai b\u00ean nh\u01b0ng u kh\u00f4ng s\u1edd th\u1ea5y<\/p>\n

      cT2 Kh\u1ed1i u s\u1edd th\u1ea5y v\u00e0 khu tr\u00fa \u1edf tuy\u1ebfn ti\u1ec1n li\u1ec7t<\/p>\n

      cT2a U \u1edf \u2264 m\u1ed9t n\u1eeda c\u1ee7a m\u1ed9t th\u00f9y<\/p>\n

      cT2b U nhi\u1ec1u h\u01a1n m\u1ed9t n\u1eeda th\u00f9y nh\u01a3ng kh\u00f4ng \u1edf c\u1ea3 2 th\u00f9y<\/p>\n

      cT2c U \u1edf c\u1ea3 hai th\u00f9y<\/p>\n

      cT3 U x\u00e2m l\u1ea5n qua bao tuy\u1ebfn ti\u1ec1n li\u1ec7t nh\u01a3ng ch\u01a3a c\u1ed1 \u0111\u1ecbnh, ch\u01a3a x\u00e2m l\u1ea5n c\u1ea5u tr\u00fac xung quanh.<\/p>\n

      cT3a X\u00e2m l\u1ea5n v\u1ecf bao 1 ho\u1eb7c 2 b\u00ean.<\/p>\n

      cT3b X\u00e2m l\u1ea5n t\u00fai tinh.<\/p>\n

      cT4 U c\u1ed1 \u0111\u1ecbnh hay x\u00e2m l\u1ea5n c\u01a1 quan l\u00e2n c\u1eadn ngo\u00e0i t\u00fai tinh: b\u00e0ng quang, c\u01a1 v\u00f2ng h\u1eadu m\u00f4n, tr\u1ef1c tr\u00e0ng, th\u00e0nh ch\u1eadu.<\/p>\n

      Giai \u0111o\u1ea1n T theo m\u00f4 b\u1ec7nh h\u1ecdc (pT) <\/strong><\/p>\n

      pT2 U khu tr\u00fa trong tuy\u1ebfn ti\u1ec1n li\u1ec7t<\/p>\n

      pT3 U x\u00e2m l\u1ea5n qua bao tuy\u1ebfn ti\u1ec1n li\u1ec7t.<\/p>\n

      pT3a X\u00e2m l\u1ea5n v\u1ecf bao 1 ho\u1eb7c 2 b\u00ean, ho\u1eb7c x\u00e2m l\u1ea5n c\u1ed5 b\u00e0ng quang tr\u00ean vi th\u1ec3<\/p>\n

      pT3b X\u00e2m l\u1ea5n t\u00fai tinh.<\/p>\n

      pT4 U c\u1ed1 \u0111\u1ecbnh hay x\u00e2m l\u1ea5n c\u01a1 quan l\u00e2n c\u1eadn ngo\u00e0i t\u00fai tinh: b\u00e0ng quang, c\u01a1 v\u00f2ng h\u1eadu m\u00f4n, tr\u1ef1c tr\u00e0ng, c\u01a1 th\u1eaft ngo\u00e0i, th\u00e0nh ch\u1eadu<\/p>\n

      Giai \u0111o\u1ea1n N <\/strong><\/p>\n

      Nx: Kh\u00f4ng th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c h\u1ea1ch v\u00f9ng<\/p>\n

      N0: Kh\u00f4ng c\u00f3 di c\u0103n h\u1ea1ch v\u00f9ng<\/p>\n

      N1: Di c\u0103n h\u1ea1ch v\u00f9ng<\/p>\n

      Giai \u0111o\u1ea1n M <\/strong><\/p>\n

      M0: Ch\u01b0a c\u00f3 di c\u0103n xa<\/p>\n

      M1: C\u00f3 di c\u0103n xa<\/p>\n

      M1a: Di c\u0103n h\u1ea1ch lympho ngo\u00e0i h\u1ea1ch v\u00f9ng<\/p>\n

      M1b: Di c\u0103n x\u01b0\u01a1ng<\/p>\n

      M1c: Di c\u0103n t\u1ea1ng kh\u00e1c c\u00f3\/kh\u00f4ng k\u00e8m di c\u0103n x\u01b0\u01a1ng<\/p>\n

      \"\"
      \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ph\u00e2n lo\u1ea1i giai \u0111o\u1ea1n theo AJCC 8th, 2017. Ngu\u1ed3n<\/strong>: B\u1ed9 Y t\u1ebf 2020<\/em><\/figcaption><\/figure>\n

      X\u1ebfp nh\u00f3m nguy c\u01a1: \u00a0<\/strong><\/p>\n

        \n
      • Nguy c\u01a1 r\u1ea5t th\u1ea5p<\/strong>: T1c v\u00e0 \u0111i\u1ec3m Gleason \u2264 6 v\u00e0 PSA <10 ng\/ml v\u00e0 \u00edt h\u01a1n 3 m\u1eabu sinh thi\u1ebft d\u01a3\u01a1ng t\u00ednh v\u00e0 t\u1ec9 tr\u1ecdng PSA ><0,15ng\/ml. – Nguy c\u01a1 th\u1ea5p: (T1 hay T2a) v\u00e0 (\u0111i\u1ec3m Gleason \u22646) v\u00e0 (PSA><10 ng\/ml). – Nguy c\u01a1 trung b\u00ecnh: (T2b hay T2c) hay (\u0111i\u1ec3m s\u1ed1 Gleason = 7) hay (PSA trong kho\u1ea3ng 10-20 ng\/ml. – Nguy c\u01a1 cao: T3a hay \u0111i\u1ec3m s\u1ed1 Gleason t\u1eeb 8 – 10 hay PSA>20ng\/ml.<\/li>\n
      • Nguy c\u01a1 r\u1ea5t cao:<\/strong> T3b-4 hay \u0111\u1ed9 MBH 5.<\/li>\n
      • Di c\u0103n h\u1ea1ch <\/strong><\/li>\n
      • Di c\u0103n xa<\/strong><\/li>\n<\/ul>\n

        Ngu\u1ed3n tham kh\u1ea3o<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 tuy\u1ebfn ti\u1ec1n li\u1ec7t c\u1ee7a B\u1ed9 Y t\u1ebf 2020<\/p>\n","protected":false},"excerpt":{"rendered":"

        Ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn (UTTLT) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf nam gi\u1edbi, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u00ean 50 tu\u1ed5i. Tuy nhi\u00ean, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn th\u01b0\u1eddng g\u1eb7p kh\u00f3 kh\u0103n do c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh r\u1ea5t gi\u1ed1ng v\u1edbi c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c c\u1ee7a ti\u1ec1n li\u1ec7t […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"\nUng th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn: Ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i - Vinmec<\/title>\n<meta name=\"description\" content=\"Ung th\u01b0 ti\u1ec1n li\u1ec7t tuy\u1ebfn (UTTLT) l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf nam gi\u1edbi, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u00ean 50 tu\u1ed5i\" \/>\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 ti\u1ec1n li\u1ec7t tuy\u1ebfn: Ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i - 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