{"id":29568,"date":"2023-04-29T22:09:49","date_gmt":"2023-04-29T15:09:49","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29568"},"modified":"2023-05-04T16:23:49","modified_gmt":"2023-05-04T09:23:49","slug":"ung-thu-noi-mac-tu-cung-chan-doan-phan-loai","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/ung-thu-noi-mac-tu-cung-chan-doan-phan-loai\/","title":{"rendered":"Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung: Ch\u1ea9n \u0111o\u00e1n, ph\u00e2n lo\u1ea1i"},"content":{"rendered":"

Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung (EC) l\u00e0 lo\u1ea1i ung th\u01b0 ph\u1ee5 khoa ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf M\u1ef9, chi\u1ebfm t\u1edbi 6% ung th\u01b0 \u1edf n\u1eef v\u1edbi 63.230 ca h\u1ecfi m\u1edbi v\u00e0 11.350 ca t\u1eed vong n\u0103m 2018. T\u1ea1i Vi\u1ec7t Nam, theo GLOBOCAN 2018 , m\u1ed7i n\u0103m c\u00f3 4.150 ca m\u1edbi truy v\u1ea5n v\u00e0 1.156 ca t\u1eed vong, \u0111\u1ee9ng th\u1ee9 11 v\u1ec1 t\u1ef7 l\u1ec7 m\u1eafc.<\/span><\/span><\/strong><\/p>\n

1. Gi\u1edbi thi\u1ec7u v\u1ec1 u<\/span><\/span>ng th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung\u00a0<\/span><\/span><\/strong><\/h2>\n

Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung l\u00e0 lo\u1ea1i ung th\u01b0 ph\u1ee5 khoa ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf M\u1ef9, chi\u1ebfm t\u1edbi 6% c\u00e1c ung th\u01b0 \u1edf n\u1eef v\u1edbi 63.230 ca m\u1eafc m\u1edbi v\u00e0 11.350 ca t\u1eed vong n\u0103m 2018. T\u1ea1i Vi\u1ec7t Nam, theo GLOBOCAN 2018, m\u1ed7i n\u0103m c\u00f3 4.150 ca m\u1edbi m\u1eafc v\u00e0 1.156 ca t\u1eed vong, \u0111\u1ee9ng h\u00e0ng th\u1ee9 11 v\u1ec1 t\u1ef7 l\u1ec7 m\u1eafc. B\u1ec7nh g\u1eb7p ch\u1ee7 y\u1ebfu \u1edf ng\u01b0\u1eddi \u0111\u00e3 m\u00e3n kinh (75%), th\u01b0\u1eddng g\u1eb7p \u1edf \u0111\u1ed9 tu\u1ed5i \u226555 tu\u1ed5i. Ch\u1ec9 c\u00f3 5% tr\u01b0\u1eddng h\u1ee3p m\u1eafc d\u01b0\u1edbi 40 tu\u1ed5i. Nguy c\u01a1 m\u1eafc b\u1ec7nh t\u0103ng \u1edf nh\u1eefng ng\u01b0\u1eddi b\u00e9o ph\u00ec, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, c\u00f3 c\u00e1c chu k\u1ef3 kh\u00f4ng ph\u00f3ng no\u00e3n. Ph\u1ee5 n\u1eef ch\u01b0a sinh \u0111\u1ebb, c\u00f3 kinh s\u1edbm, m\u00e3n kinh mu\u1ed9n, \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft thay th\u1ebf b\u1eb1ng estrogen, m\u1ea5t c\u00e2n b\u1eb1ng estrogen trong th\u1eddi gian d\u00e0i, d\u00f9ng thu\u1ed1c tamoxifen k\u00e9o d\u00e0i \u0111\u1ec1u l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung. B\u00ean c\u1ea1nh \u0111\u00f3, ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc ung th\u01b0 bu\u1ed3ng tr\u1ee9ng, ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng, h\u1ed9i ch\u1ee9ng Lynch II, ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 ung th\u01b0 v\u00fa c\u0169ng g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh.<\/p>\n

V\u1ec1 m\u00f4 b\u1ec7nh h\u1ecdc, ung th\u01b0 bi\u1ec3u m\u00f4 tuy\u1ebfn n\u1ed9i m\u1ea1c t\u1eed cung chi\u1ebfm 90% ung th\u01b0 th\u00e2n t\u1eed cung. Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh li\u00ean quan ch\u1eb7t ch\u1ebd t\u1edbi giai \u0111o\u1ea1n v\u00e0 ph\u00e2n lo\u1ea1i m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a u.<\/p>\n

V\u1ec1 m\u00f4 b\u1ec7nh h\u1ecdc, ung th\u01b0 bi\u1ec3u m\u00f4 tuy\u1ebfn n\u1ed9i m\u1ea1c t\u1eed cung chi\u1ebfm 90% ung th\u01b0 th\u00e2n t\u1eed cung. <\/span>Ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh li\u00ean quan ch\u1eb7t ch\u1ebd t\u1edbi giai \u0111o\u1ea1n v\u00e0 ph\u00e2n lo\u1ea1i m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a b\u1ea1n.<\/span><\/span><\/p>\n

\"Ung
Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung<\/span><\/span><\/figcaption><\/figure>\n

2. Ch\u1ea9n \u0111o\u00e1n ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung<\/span><\/span><\/h2>\n

2.1 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/span><\/span><\/strong><\/p>\n

Tri\u1ec7u ch\u1ee9ng hay g\u1eb7p nh\u1ea5t l\u00e0 ra m\u00e1u \u00e2m \u0111\u1ea1o b\u1ea5t th\u01b0\u1eddng ngo\u00e0i chu k\u1ef3 kinh (chi\u1ebfm t\u1edbi 90% c\u00e1c tr\u01b0\u1eddng h\u1ee3p). V\u00ec v\u1eady, t\u1ea5t c\u1ea3 ph\u1ee5 n\u1eef \u0111\u00e3 m\u00e3n kinh c\u00f3 ch\u1ea3y m\u00e1u \u00e2m \u0111\u1ea1o c\u1ea7n \u0111\u01b0\u1ee3c kh\u00e1m ph\u1ee5 khoa k\u1ef9 l\u01b0\u1ee1ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh. C\u00e1c ph\u1ee5 n\u1eef ch\u01b0a m\u00e3n kinh c\u00f3 kinh nguy\u1ec7t k\u00e9o d\u00e0i ho\u1eb7c ra m\u00e1u nhi\u1ec1u h\u01a1n b\u00ecnh th\u01b0\u1eddng ho\u1eb7c ra m\u00e1u gi\u1eefa k\u1ef3 kinh c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m tra (sinh thi\u1ebft n\u1ed9i m\u1ea1c t\u1eed cung). Ph\u1ee5 n\u1eef \u0111ang \u0111i\u1ec1u tr\u1ecb tamoxifen c\u00f3 ra m\u00e1u \u00e2m \u0111\u1ea1o c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c sinh thi\u1ebft n\u1ed9i m\u1ea1c t\u1eed cung.<\/p>\n

\u0110\u00f4i khi b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n \u0111au b\u1ee5ng d\u01b0\u1edbi (th\u01b0\u1eddng \u1edf giai \u0111o\u1ea1n mu\u1ed9n h\u01a1n).<\/p>\n

C\u00e1c bi\u1ec3u hi\u1ec7n \u1edf giai \u0111o\u1ea1n r\u1ea5t mu\u1ed9n bao g\u1ed3m t\u1eafc ru\u1ed9t, v\u00e0ng da, d\u1ecbch \u1ed5 b\u1ee5ng\u2026<\/p>\n

2.2 C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng<\/strong><\/p>\n

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  • Ch\u1ee5p bu\u1ed3ng t\u1eed cung v\u00f2i tr\u1ee9ng: hi\u1ec7n \u00edt l\u00e0m<\/li>\n
  • Si\u00eau \u00e2m \u1ed5 b\u1ee5ng (qua th\u00e0nh b\u1ee5ng ho\u1eb7c qua \u00e2m \u0111\u1ea1o)<\/li>\n
  • N\u1ed9i soi bu\u1ed3ng t\u1eed cung, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi sinh thi\u1ebft n\u1ed9i m\u1ea1c t\u1eed cung.<\/li>\n
  • N\u1ea1o ho\u1eb7c h\u00fat bu\u1ed3ng t\u1eed cung l\u1ea5y b\u1ec7nh ph\u1ea9m l\u00e0m t\u1ebf b\u00e0o h\u1ecdc v\u00e0 gi\u1ea3i ph\u1eabu b\u1ec7nh.<\/li>\n
  • Ch\u1ee5p Xquang ng\u1ef1c, CT scan ng\u1ef1c ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng di c\u0103n.<\/li>\n
  • Soi b\u00e0ng quang, tr\u1ef1c tr\u00e0ng ph\u00e1t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng x\u00e2m l\u1ea5n.<\/li>\n
  • Ch\u1ee5p CT scan, MRI \u1ed5 b\u1ee5ng, ti\u1ec3u khung \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 x\u00e2m l\u1ea5n, di c\u0103n h\u1ea1ch v\u00f9ng.<\/li>\n
  • X\u1ea1 h\u00ecnh x\u01b0\u01a1ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi 99m<\/sup>Tc-MDP \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng di c\u0103n x\u01b0\u01a1ng, ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n b\u1ec7nh tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, \u0111\u00e1nh gi\u00e1 t\u00e1i ph\u00e1t v\u00e0 di c\u0103n.<\/li>\n
  • X\u1ea1 h\u00ecnh th\u1eadn ch\u1ee9c n\u0103ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi 99m<\/sup>Tc-DTPA \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb v\u00e0 sau \u0111i\u1ec1u tr\u1ecb.<\/li>\n
  • Ch\u1ee5p PET\/CT v\u1edbi 18<\/sup>F-FDG tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n u nguy\u00ean ph\u00e1t, ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n b\u1ec7nh; ch\u1ee5p sau \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, \u0111\u00e1nh gi\u00e1 t\u00e1i ph\u00e1t v\u00e0 di c\u0103n; m\u00f4 ph\u1ecfng l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb.<\/li>\n
  • Ch\u1ee5p MRI s\u1ecd n\u00e3o n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd di c\u0103n n\u00e3o.<\/li>\n
  • C\u00e1c x\u00e9t nghi\u1ec7m m\u00e1u, sinh h\u00f3a, n\u01b0\u1edbc ti\u1ec3u, vi sinh th\u01b0\u1eddng quy.<\/li>\n
  • X\u00e9t nghi\u1ec7m ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m kh\u1ed1i u (tumor marker): CEA, CA 12-5; CA 15-3 t\u0103ng cao trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p. C\u00f3 gi\u00e1 tr\u1ecb theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, ph\u00e1t hi\u1ec7n b\u1ec7nh t\u00e1i ph\u00e1t, di c\u0103n xa.<\/li>\n
  • X\u00e9t nghi\u1ec7m \u0111\u1ed9t bi\u1ebfn gen: MLH1, MSH2, MSH6, PMS2, EPCAM, PTEN, TP53, STK11 \u2026<\/li>\n
  • Gi\u1ea3i tr\u00ecnh t\u1ef1 nhi\u1ec1u gen.<\/li>\n<\/ul>\n

    3. Ph\u00e2n lo\u1ea1i<\/h2>\n

    H\u1ea7u h\u1ebft c\u00e1c kh\u1ed1i u \u00e1c t\u00ednh ph\u00e1t sinh trong n\u1ed9i m\u1ea1c t\u1eed cung (kho\u1ea3ng 80 ph\u1ea7n tr\u0103m) l\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 (u \u00e1c t\u00ednh bi\u1ec3u m\u00f4), \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh hai lo\u1ea1i ch\u00ednh d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng.\u00a0Lo\u1ea1i t\u00e1c \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt v\u00e0 h\u1eadu ph\u1eabu.<\/p>\n

    Ph\u00e2n lo\u1ea1i ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung theo FIGO \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 lan t\u1ecfa c\u1ee7a ung th\u01b0 trong c\u01a1 th\u1ec3 v\u00e0 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/p>\n

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    Theo ph\u00e2n lo\u1ea1i FIGO, ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung \u0111\u01b0\u1ee3c chia th\u00e0nh c\u00e1c giai \u0111o\u1ea1n nh\u01b0 sau:<\/p>\n

    Giai \u0111o\u1ea1n 0: Ung th\u01b0 ch\u1ec9 t\u1eadp trung \u1edf l\u1edbp m\u00e0ng trong c\u1ee7a t\u1eed cung (mucosa) v\u00e0 kh\u00f4ng tr\u00e0n v\u00e0o m\u00f4 xung quanh.<\/p>\n

    Giai \u0111o\u1ea1n I: Ung th\u01b0 \u0111\u00e3 x\u00e2m nh\u1eadp qua l\u1edbp m\u00e0ng trong c\u1ee7a t\u1eed cung v\u00e0o c\u01a1 t\u1eed cung. Giai \u0111o\u1ea1n I \u0111\u01b0\u1ee3c chia th\u00e0nh hai giai \u0111o\u1ea1n con:<\/p>\n

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    • Giai \u0111o\u1ea1n IA: Ung th\u01b0 ch\u1ec9 t\u1eadp trung \u1edf m\u1ed9t ph\u1ea7n c\u1ee7a c\u01a1 t\u1eed cung.<\/li>\n
    • Giai \u0111o\u1ea1n IB: Ung th\u01b0 \u0111\u00e3 lan r\u1ed9ng sang to\u00e0n b\u1ed9 c\u01a1 t\u1eed cung.<\/li>\n<\/ul>\n

      Giai \u0111o\u1ea1n II: Ung th\u01b0 \u0111\u00e3 lan r\u1ed9ng qua c\u01a1 t\u1eed cung v\u00e0 x\u00e2m nh\u1eadp v\u00e0o c\u1ed5 t\u1eed cung.<\/p>\n

      Giai \u0111o\u1ea1n III: Ung th\u01b0 \u0111\u00e3 lan r\u1ed9ng ra kh\u1ecfi t\u1eed cung v\u00e0 x\u00e2m nh\u1eadp v\u00e0o \u00e2m \u0111\u1ea1o ho\u1eb7c m\u00f4 xung quanh t\u1eed cung. Giai \u0111o\u1ea1n III \u0111\u01b0\u1ee3c chia th\u00e0nh ba giai \u0111o\u1ea1n con:<\/p>\n

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      • Giai \u0111o\u1ea1n IIIA: Ung th\u01b0 x\u00e2m nh\u1eadp v\u00e0o \u00e2m \u0111\u1ea1o, nh\u01b0ng kh\u00f4ng lan r\u1ed9ng sang x\u01b0\u01a1ng ch\u1eadu.<\/li>\n
      • Giai \u0111o\u1ea1n IIIB: Ung th\u01b0 \u0111\u00e3 lan r\u1ed9ng sang x\u01b0\u01a1ng ch\u1eadu.<\/li>\n
      • Giai \u0111o\u1ea1n IIIC: Ung th\u01b0 \u0111\u00e3 lan r\u1ed9ng \u0111\u1ebfn c\u00e1c b\u1ea1ch huy\u1ebft c\u01a1 th\u1ec3 (lymph node) xung quanh t\u1eed cung.<\/li>\n<\/ul>\n

        Giai \u0111o\u1ea1n IV: Ung th\u01b0 \u0111\u00e3 lan r\u1ed9ng ra ngo\u00e0i khu v\u1ef1c t\u1eed cung v\u00e0 lan tr\u00e0n v\u00e0o c\u00e1c c\u01a1 quan kh\u00e1c trong c\u01a1 th\u1ec3, ch\u1eb3ng h\u1ea1n nh\u01b0 b\u00e0ng quang ho\u1eb7c tr\u1ef1c tr\u00e0ng.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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

        Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung (EC) l\u00e0 lo\u1ea1i ung th\u01b0 ph\u1ee5 khoa ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf M\u1ef9, chi\u1ebfm t\u1edbi 6% ung th\u01b0 \u1edf n\u1eef v\u1edbi 63.230 ca h\u1ecfi m\u1edbi v\u00e0 11.350 ca t\u1eed vong n\u0103m 2018. T\u1ea1i Vi\u1ec7t Nam, theo GLOBOCAN 2018 , m\u1ed7i n\u0103m c\u00f3 4.150 ca m\u1edbi truy v\u1ea5n v\u00e0 1.156 ca […]<\/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":"\nUng th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung: Ch\u1ea9n \u0111o\u00e1n, ph\u00e2n lo\u1ea1i - Vinmec<\/title>\n<meta name=\"description\" content=\"Ung th\u01b0 n\u1ed9i m\u1ea1c t\u1eed cung \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng hay g\u1eb7p nh\u1ea5t l\u00e0 ra m\u00e1u \u00e2m \u0111\u1ea1o b\u1ea5t th\u01b0\u1eddng ngo\u00e0i chu k\u1ef3 kinh\" \/>\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 n\u1ed9i m\u1ea1c t\u1eed cung: Ch\u1ea9n \u0111o\u00e1n, ph\u00e2n lo\u1ea1i - 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