ung thu biết sớm trị lành

Bifiu GHI BifiN MUC TRUOC XUAT BAN , DV0C THVC HlfiN Bdl THU VlfiN KHTH TP. HCM Nguyin Chan Hiing Ung thu biet scfm tri 14nh / Nguyen Chan Hung. - TP Ho Chi Minh : Nxb. T6ng htjp Thinh pho Ho Chi Minh, 2013. 412 tr.: minh hpa ; 20.5 cm ISBN 978-604-58-0121-5 l.Ungthil. 1. Cancer. 616.994 - dc 22 N573-H94 GS. BS. Nguyen Chan Hung Ung thii Biet s6m Tri lanh THLT VJBJ TINH B!NH THUAN NHA XUAT BAN T6NG HOfP THANH PH6 H6 CHf MINH uc LOITACGIA 9 PHANI HIEU BIET UNG THl/ CHl/ONG 1. B$NH UNG THI/LA Gi 1. Loai ngildi nang ganh ung thil 17 2. Tif ndi sau tham cua sU song 26 3. Hop den da md 35 CHUONG 2. SAO CHO NHE GANH 1. Cai gi gay benh ung thii 41 2. Coi chiing sat thu can ke 46 3. Ngiia benh nhiem, chan ung thU 52 4. Btic xa gay ung thii 57 5. Phong tranh til xa 66 6. Cung nhau lam nhe ganh nang ung thU 73 CHUONG 3. LAM SAO DINH B£NH 1. Lam sao biet sdm ung thif 83 2. Lam the nao dinh benh ung thii 92 3. Noi soi, sieu am giiip ra benh 95 4. Thay thuoc nhii c6 mat than 98 5. Thii mau biet diidc ung thii? 102 6. Sinh thiet dinh benh chinh xac nhat 106 CHl/ONG 4. BIET S6M TRI LANH 1. Them nhieu gam mau tiioi sang hon 113 2. Dieu tri ung thii bang each mo hay la phau tri 116 3. Dung tia phong xa de dieu tri ung thii hay la xa tri 125 4. Dung thuoc dieu tri ung thii hay la hoa tri 132 5. Lieu phap nham triing dich (hay la dieu ehinh cac xao tron gen) 148 CHl/ONG 5. Sl/ONG MU DAN TAN ,,,.) 1. Ky thii quyen sach cua sii song 161 2. Cuoc rap mi kbit khao 165 3. Diia ve eai chet an bai 171 4. Ngii6i giang cau nhan nai 175 5. Thay thuoc nuot vi triing 179 PHANH CAC BENH UNG THl/ CHl/ONG 1. UNG THl/ VU VA CAC BENH LANH 1. Ung thii vii 187 2. Ke them chuyen doi go 197 3. Chup hinh vii bang tia X hay la nhu anh 204 4. Cac benh lanh cua vii 208 CHUONG 2. CAC UNG THl/ PHU KHOA 1. Ung thii CO tii cung 217 2. Ung thii buong triing 226 3. Ung tha noi mac tii cung 233 4. Ung thii nhau thai 235 CHUONG 3. CAC UNG THl/VUNG DAU VA CO 1. Ungthtimieng 239 2. Ung tha hong 243 3. Ung thu vom hong 247 4. Ung thii thanh quan 251 5. Ung thii tuyen giap 256 6. Ung thii cae tuyen niidc bpt 263 CHl/ONG 4. UNG THl/ PHOI 1. Ung thii phoi khong te bao nho 271 2. Ung thU phoi te bao nho 279 CHl/ONG 5. CAC UNG THU TIEU HOA 1. Ung thif thiie quan 283 2. Ung thii da day 286 3. Ung thii rupt gia 294 4. Ung thii gan 301 5. Ung thii tuyen tuy 308 CHUONG 6. CAC UNG THU NifiU-DUC 1. Ung thif than 315 2. Ung thil bong dai 319 3. Ung thU diiong vat 324 4. Ung thU tuyen tien liet 329 5. Ung thU tinh hoan 336 CHUONG 7. UNG THU H$ TAO HUYET 1. Ung thu mau (benh bach cau) 343 2. Ung thu hach lympho (lymphom) 351 CHUONG 8, UNG THU* DA, UNG THU XUONG VA UNG THUTREEM 1. Ung thu da 359 2. Ung thu xUOng 368 3. UngthUtreem 372 THAY LOil KET 1. Doi dong tarn sU cua thay thuoc ung bu6u 387 2. Mot cong trinh cua tam huyet va niem tin 391 3. "Ung thu biet s6m tri lanh" 398 4. Nhe bifdc cung cuoc d6i 402 5. "Nu cUcJi luon dong hanh v6i toi" 407 Ldi Tac gia H ieu biet nhieu ve ung thif da diia tdi s\i tien bp vilcrt biic ve phong tranh; phat hien s6m va dieu tri benh ung thif. Cac nha khoa hoc da hieu ve benh ung thii trong ba thap nien han la nhflng gi hoc dfldc trong bao nhieu the ky trfldc. Tat ca hieu biet khoa hoc deu dfla tren kien thflc tich luy do tien nhan chiing ta, va con nhieu dieu phai hoc hoi nfla. TCr ncri sau tham Ung thfl la mot nhom benh gom tren 100 loai c6 chung vai dac tinh co ban quan trong. Ung thfl bat nguon tfl ncri sau tham ciia sfl song: DNA bi hfl hai la do phai trai vcri cai gi do trong moi trfldng song, thi du nhfl khoi thuoc la, cac virut, anh nang. Ung thfl nao cung do sfl tang trfldng qua da, sinh soi v6 to chflc cua cac te bao bat thfldng. Hang ti ti cac te bao nay tich tu lai thanh khoi budu (khoi u), de ep, xam Ian va pha buy cac vung mo binh thfldng Ian can. That ky la, cac te bao ung thfl di dong dfloc, lang thang day do, Ian Ian nam quyen chu dong, roi tan hai cO the cho den sum luon. 10 - Nguyen Chan Hung Cling nhau lam nhe ganh nang ung thU Da bie't cdi gi gay ung thU. Khong phai trdi keu. Khoang 80% la do nhflng gi con ngfl6i an uong, hit thd, co xat hoac phoitrai. Khoi thuoc la gay ra 1/3 ganh nang ung thfl tren hanh tinh. Thuoc la la sat thu can ke em ai ma het sflc tan doc, khong chi hai ngfl6i nuot khoi ma ca nhflng ngfldi hit ke. Mot so viriit, vi khuan gay 1/5 cac ung thfl ctia loai ngfl6i. Cac sat thu v6 hinh am tham mai phuc, nay Ian mai Ifla, benh tro ra thi trd tay khong kip. Viem gan do virut HBV va HCV lau ngay dan den ung thfl. Cac viriit HPV gay ra ung thfl c6 tfl cung va nhieu thfl khac. Ngfldi ban thiet lau ddi cua con ngflcfi, vi khuan H. pylori gay ra ung thfl da day. An uong khong lanh kem theo thieu van dong va beo phi tao 1/3 ganh nang. Dung la benh theo mieng ma vao. Bflc xa gop phan gay kho. Tia cflc tim trong anh nang c6 the gay ung thfl da. R6 ri phong xa tfl cac nha may hat nhan gay ung thfl tuyen giap trang, ung thfl mau, ve dai ve lau gay cac ung thfl xflang, phoi, vu. Diing de benh nhap vao. Nam 2010, Hiep hoi Quoc te chong Ung thfl (UICC) gdi thong diep "c6 the phong ngfla khoang 40% so ngfldi mac benh ung thfl tren toan cau". Khong de benh nhap vao la each rat hay c6 tiem nang 16n nhat, hieu qua nhat va lau dai lam cho nhe ganh ung thfl. Moi ngfldi nen theo nep song tot. Loai bo khoi thuoc la, chu y ca hut va hit ke. Tranh uong rflcJu qua da. An dung an lanh, Ung thi/BietsdmTrj lanh-11 tap the due deu. Phong tranh benh nhiem. Mot nghich ly hay ho: cac ung thfl gan, phoi, da day c6 the phong tranh dflcfe, con khi tro ra thi kho tri lam. Ung thu biet s6m trj lanh Khi chfla co trieu chflng, c6 the ra tim biet sdm cac ung thfl vu, CO tfl cung, dai trvfc trang, tuyen tien liet, mieng, da va tuyen giap qua tham kham sflc khoe dinh ky. Phai that Iflu tam mot so trieu chiing bdo dong benh mdi chdm. Phai di kham benh khong dflgfc y y, khong dflcJc trung trinh. Nhieu ngfldi van cfl coi ung thfl nao cung khong tn khoi. Cfl nghi bi ung thfl la trdi keu ai nay da. Buong xuoi chay thay chay thuoc dan gian den luc benh hanh qua chiu khong thau, den benh vien thi thay thuoc vat va lam. Neu ma detre de thdnh nan y. Dau phai trdi keu! Cac thay thuoc nhU co mat than. Ngay nay bac si co nhieu each dinh ro benh rat hay. Gi6 day ec( the con ngfldi trd nen trong suot. Cac ong soi mem mai vao tan trong cac ngo ngach nhfl cuong phoi, bao tfl, ruot Dau do sieu am nhe nhang tham do khap than ngfldi. Cac thiet bi CT, MRI va PET thay dfldc ro rang ea hinh anh nao va npi tang. Phflang phap chan doan phan tfl chop dflde nhflng gi ran vd trong gen cua phan tfl DNA. Biet sdm tri lanh. Vice tan cong ung thfl ngay cang hieu qua. Co mot kho vu khi dieu tri. Phau tri thfldng dflcre dung nhat, Ifldi dao mo bflng tan goe khoi bfldu. Xa tri la dung tia phong xa pha huy khoi bfldu ung thfl. Hda tri la dung thuoc de giet cac te bao ung thfl rai rac va troi noi khap chon xa. 12 - Nguyen Chan Hung Mdi day c6 them lieu phap nham triing dich dieu chinh cac xao trpn gen. Cac gam mau tUdi sang hdn. Ra tim khi benh chiia c6 trieu chiJng va lilu y cac trieu chiing bao dong giup phat hien scrm nhieu benh ung thii de tri tot. Phoi hcJp nhuan nhuyen cac kieu dieu tri hien dai ngay cang dem den hieu qua tot hofn cho ngif6i benh. Thay thuoc that chuyen mon, liidi dao mo diu dang han, cac may xa tri than ky hern, nhieu thuoc dac tri hieu qua hdn, lieu phap nham trung dich dang nd ro. Ung thii biet s6m tri lanh. Ngii6i benh phai quyet tam kien tri dieu tri chuan mifc. Con ngiidi dang ve ra bt(c tranh phdng chong ung thu rat song dong vdi cac gam mau ngay cang tUdi sang hdn. Cam crn cac ban thay thuoc Do Hong Ngoc, Pho Dilc Man, Phan Thanh Hai, Nguyen Hong Ri, Tran Van Thiep, Le Hoang Minh, Pham Xuan Dung, Dang Huy Quoc Thanh va nha van nha bao Tran Trong Thilc, Minh Hien, Nguyen Ho, Tam Chanh, Nguyen Quang Tuyen, Cao Nguyen Ldi, Diiofng Thanh Truyen, The Thanh, Viet Linh, Minh Thu, Thuy Nga, Que Phiictog, Kim Yen, Ngan Ha, Vinh Huy, Hong Dung, Duy Tinh, Hanh Dang, Ngoc Diem va Anh Thii, da dong vien va gop y chan tinh cho ngiidi viet. Rat cam men Linh Tran, Hong Diem va Bich Thuy het long giup soan thao bai vd. Ngiidi ban ddi Tran Kim Lien va cac con cua tac gia lo cham chut ban thao. Chan thanh cam ta Nha xuat ban Tong hgfp Thanh pho Ho Chi Minh da tao moi dieu kien de tac pham dilgfc ra mat ban doc. Tha thiet mong cac ban doc quy men chi giiip nhflng sd sot. Ngay 22 thdng 10 nam 2013 NGUYEN CHAN HUNG Phan I HIEU BIET UNG THU Chuoing 1 B§nh ung tha la gi Toan hdnh tinh c6 12,7 trieu ngifdi mdi m6c va 7,8 trieu ngi/di chet. Ung thi/thi/dng gap dphoi, vu, ruotgia (dgi-trUc trang). Ung thu gay chit nhieu nhat la ung thu phoi, dg day va gan. Nam 2030 se CO xdp XI21,4 trieu ca mdi va 13,2 trieu ca chit httng nam. Ung thu id mot nhom benh gom tren mot tram logi c6 chung vai dgc tinh cabin quan trpng. Ung thunao cung do si/tang trUdng qua da va si/lan tran cOa cac tibao i^bong binb thudng. Cac tibao ung tbUphat sinh tiicac huhgi cua phan tCtDNA, do phai trai vdi cai gi do trong mdi trifdng song, thidu nhifl<hdi thuoc la, cac virut, anh ning May id ung thUbSt nguon tiinai sau th&m cua sit song. Bdc si Bert Vogelstein, nha nghien cCtu noi tiing ve gen ung thu, dd tuyen bo: "tibao ung thula cdi hop den, nay cdi hop nay dUdc md ra; chung tdi cam thay tran day hy vgng". 1. Loai ngudi nqng gdnh ung thif 2. Tif nai sau thSm cua si/ song 3. Hop den da md Loai nguai nang ganti ung ihu Nhd nha cham dieu thuoc. Khoi huyen bay len cay." (tho Ho Dzenh). That nen thcr. Ai c6 ngd, khoi thuoc la lai bay v6 sau den nhan cua tifng te bao trong cd the, danh pha cac gen. Khoi thuoc thay nhe tenh nhiing lam triu nang ganh ung thii cua loai ngiidi. 12,7 trieu ca mdi • \ 7,8 trieu ca tCf vong G^nh n|ng ung thutoan cau 2008 "iWJ VIEW TiiMHBIN'HTHUAN 18 - Nguyen Chan Hung Ganh nang ung thutoan cau Ngay 01.06.2010, Ca quan Quoc te Nghien ctiu Ung thif (lARC) cong bo ganh nang ung thiJ tren toan cau cua nam 2008 (GLOBOCAN 2008). Ung thxi la sat thu manh tay nhat so v6i cac benh khac. Toan hanh tinh c6 12,7 trieu ngiidi mdi mac va 7,8 trieu ngiidi chet. Ung thif thifdng gap d phoi, vii, ruot gia (dai - triic trang). Ung thif gay chet nhieu nhat la ung thu phoi, da day va gan. Nam 2030 se c6 xap xi 21,4 trieu ca m6i va 13,2 trieu ca chet hang nam. Co stf khac biet Idn cac loai ung thii t\i viing nay sang vung khac. Ung thif triu nang hon d cac vung kem phat trien. Ung thu phoi la loai thiidng gap nhat, chiem 12,7% tong so ca ung thif mdi tren toan cau. Tii suat ciing chiem vi tri dau (18,2% tong so). Tac hai cua khoi thuoc la that ro, chii yeu ciia dan ong. Phu nii hut it hon nhiing hit ke nen nguy cd van dang lo. Ung thu vu diing hang thil hai toan cau (10,9% cac loai ung thif) chiem 23% ung thii phu nii. Co stf khac biet rat Idn: d Tay Au c6 xuat do 89,9/100.000, nghia la hang nam CO 89,9 phu nii m6i mac benh tinh tren 100.000 ngiidi; d Dong Phi xuat do chi la 19,3. li le cao d cac nifdc giau, thap d cac nifofc ngheo. R6 la c6 moi lien he ung thil vii va nep song phiiong Tay. Ung thaBietsdmTrj lanh-19 Ung thu rudtgid (dai - trUc trdng) la loai thiidng gap thil ba. Co den 60% xuat hien d cac nifdc giau, nguy co 6 Uc va Tay Au cao gap 10 Ian d chau Phi (trif Nam Phi). Che do am thtfc khac nhau giai thich sii chenh lech ve nguy cO. Ung thu da day (bao tii) dilng hang thii tif sau ung thii phoi, vu va dai - triic trang. Hoanh hanh d Bac A (Nhat, Han Quoc, Trung Quoc). Dich nhiem vi khuan H. pylori, khoi thuoc la va che do dinh dtfdng thieu rau trai, thiic an man la cac yeu to nguy cd. Ung thu gan la ganh nang cho cac nifdc dang phat trien, rat ac, gay tii vong hang thii ba toan cau. Nguy cd that cao d Dong A (Trung Quoc), Dong Nam A, Trung va Tay Phi, gan chat vcfi nguy cO dai dich viem gan B va C, nghien rtfOu nang va nhiem doc to aflatoxin tif cac hat (dau phong, bap ) bi nam moc. Khong phai trdi keu (3 An Do, ung thU hoc mieng (moi, ludi, viem mac ma ) chiem 30% ung thif deu ca dan ong Ian dan ba. Cam la trau tem voi goi mot mieng cau, mot cue thuoc la, bo vao mieng nhai, thinh thoang ngam mot ben khoe mieng. Den New Delhi toi ngoi xe xuong le dildng chuyen tro va xem ho an trau, giong d xii minh. Ung thif hoc mieng ciing hoanh hanh d Pakistan, Bangladesh, tdi xa tan vung dao Fiji va Papua New Guinea, noi tuc an trau thinh hanh. Nifdc ta nay rat hiem ngifcfi an trau, ung thif moi mieng cua may ba gia trau Cling bien luon. 20 - Nguyen Chan Hung C3 ntfdc Uc, ung thU da cao nhat the gi6i. Mau da sang cua ngifdi Uc (hau due cua ngifdi da trang tif chau Au) khong chiu noi nang chay vung gan xich dao. It nhat hai trong ba ngiidi hi ung thil da vao khoang tuoi 70. Tia cvfc tim cua nang nhiet ddi gay ton hai phan i\i DNA, lam dot bien gen cua te bao da dan den ung thif. d Singapore, ung thU ruotgia cao vpt tif 30 nam qua, nay chiem vi tri dau bang phong than. Ngiidi Hoa d day c6 nguy CO cao hdn ngUdi Hoa d Hong Kong, ThiJcJng Hai, xap xi d phifong Tay (Anh, Uc va My). Day la thi du ve sU gia tang ung thif ruot d cac niidc cong nghiep do nep song phiiong Tay: che do an thieu rau trai tv(o(i, nhieu chat beo, hut thuoc, ngoi mot cho, it van dong va beo phi do fastfood (thiic an nhanh). Ganh nang rieng cua nirdc ta Nam 2008 so ngii6i mdi mac la 116.000, so tv( vong la 82.000. Cii 100.000 ngifdi dan, thi c6 138,7 ngiidi mdfi mac (xuat dp: 138,7/ 100.000), c6 101 ngUdi chet. Cac Ipai ung thii thifdng gap la gan chiem 23%, phoi 21%, da day 15%, dai trtfc trang 7%, vu 6,1%, CO tii cung 4,6% Phu nfl ganh nhe hPn gidi may rau. Dan ong m6i mac 154,4/ 100.000 con dan ba la 127,7 - tii vong dan ong cao hpn nhieu 122,6 so vdi 85,0. Cling hieu difgfc thoi, nam gidi mac cac benh ung thil Hen he dac biet vdi thii vui tao nha Ung thirBietsdrnTrj lanh-21 nPi tra dinh tiiu quan uong riiou hiit thuoc, cao liiPng my vi. CJ dau Cling vay: Trung Quoc, Nhat Ban, Han Quoc, Sin- gapore. Co ngoai le la An Dp xuat dp nam 92,9/ 100.000 thap hern nfl 105,5 dp ung thU cp ti cung va vu d phu nii wfcJt trpi nhifng la cac Ipai tri tpt, cdn til vpng nam van cap vi mac cac Ipai ung thii rat ac (gan, phpi, da day). 711§ c^c loai Nio, thin kinh 2,996 Vf^m hong 3.2% B^nh b?ch cSu — 3.9% CitCtcung 4,6% D»i - tiVc tring 6.6% 5 loai ung thi/thudng gSp Nam NCf Hai gidi Gan Gan Gan Phoi Phoi Phoi Da day Vu DadJy Bai-trifc trang Da day fiai-trUctrting 116.000 so ca m6i G^nh nang ung thUViet Nam 2008 That dang lo. Ba Ipai thiidng gap that khd tri: Cut 100.000 dan thi cd 29,3 ngUdi mac ung thil gan, 25,7 ung thii phdi va 18,9 dinh ung thii da day. Ung thU gan triu nang. Hien cd cPn dich nhiem viriit viem gan HBV va HCV d niidc ta. Rd rang nhiem viriit viem gan dan den ung thii gan. Day la ganh nang chp cac niidc dang phat trien, Ipai nay gay tii vpng hang thii ba tpan cau. Lpai nay thiidng gap d nam gidi. Viet Nam cd nguy cP cap lam, 42,3 nam va 18,5 nfl mdi mac tinh tren 100.000 dan hang nam. Cdn cap hpn nguy ca d Trung QUPC 37,4 (nam) va 13,7 (nii). Thdi quen nhau bi ti cap ke nhiem aflatdxin [...]... Cai gi gay benh ung thif 2 Col chi/ng sat thu can ke 3 Ngila benh nhiem, chqn ung thU 4 Bite xg gay ung thu 5 Phong tranh ti^xa 6 Cung nhau Idm nhe ganh ngng ung thU Cai gi gay benh ung thu' Da biet nhieu nguyen nhan cua ung thU Vao nam 2012, Cd quoc Quoc te Nghien ciiu Ung t h i i (lARC) da xac dinh difcfc tren 100 tac nhan gay ung (carcinogen) hoa hoc, vat ly va sinh hoc Dang tap trung t i m them... nhieu T i n h chung thuoc la lam giam tho tif 8 - 10 nam Sat thu nang tay Khong chi gay ung thU, thuoc la con gay du thii benh t i m mach, xao tron sinh due, eifcfm mat, viem phoi, viem nxidu rang, phinh dong mach chu bung Nen nhd cac benh t i m mach, giet ngiidi cai rup con nhanh h o n ung thu La sat thu hang dau tren hanh tinh, thuoc la khong chi gay ung thii phoi ma t 6 i khoang 15 loai ung thif gom... biet nhieu nguyen nhan cua ung thU Vao nam 2012, lARCxac dinh duac tren 100 tdc nhan gay ung hoa hoc, vat ly va sinh hoc Tao moi trUcsng sgch khoi thuoc l . 5. Ung thU tinh hoan 336 CHUONG 7. UNG THU H$ TAO HUYET 1. Ung thu mau (benh bach cau) 343 2. Ung thu hach lympho (lymphom) 351 CHUONG 8, UNG THU* DA, UNG THU XUONG VA UNG THUTREEM. gia 294 4. Ung thii gan 301 5. Ung thii tuyen tuy 308 CHUONG 6. CAC UNG THU NifiU-DUC 1. Ung thif than 315 2. Ung thil bong dai 319 3. Ung thU diiong vat 324 4. Ung thU tuyen . 2. CAC UNG THl/ PHU KHOA 1. Ung thii CO tii cung 217 2. Ung thii buong triing 226 3. Ung tha noi mac tii cung 233 4. Ung thii nhau thai 235 CHUONG 3. CAC UNG THl/VUNG DAU