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 Th
Trang 1Bifiu GHI BifiN MUC TRUOC XUAT B A N ,
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
THLT V J B J TINH B!NH THUAN
N H A X U A T B A N T 6 N G HOfP T H A N H P H 6 H 6 CHf MINH
Trang 2uc
L O I T A C G I A 9
P H A N I HIEU BIET UNG T H l / CHl/ONG 1 B$NH UNG T H I / L A Gi
1 Loai ngildi nang ganh ung thil 17
2 Tif ndi sau tham cua sU song 26
3 Hop den da md 35
C H U O N G 2 SAO CHO NHE G A N H
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
C H U O N G 3. L A M SAO DINH B £ N H
1 Lam sao biet sdm ung thif 83
Trang 32 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 S 6 M TRI L A N H
1 Them nhieu gam mau tiioi sang hon 113
2 Dieu t r i ung thii bang each mo hay la phau t r i 116
3 Dung tia phong xa de dieu t r i ung thii hay la xa t r i 125
4 Dung thuoc dieu t r i ung thii hay la hoa t r i 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 m i 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 L A N H
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
C H U O N G 2 CAC U N G T H l / P H U K H O A
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
C H U O N G 3 CAC U N G T H l / V U N G D A U VA C O
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
C H l / O N G 4 U N G T H l / P H O I
1 Ung thii phoi khong te bao nho 271
2 Ung thU phoi te bao nho 279
C H l / O N G 5 CAC U N G T H U T I E U H O A
1 Ung thif thiie quan 283
2 Ung thii da day 286
3 Ung thii rupt gia 294
4 Ung thii gan 301
Trang 45 Ung thii tuyen tuy 308
C H U O N G 6 C A C U N G T H U N i f i U - D U C
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
C H U O N G 7 U N G T H U H $ T A O H U Y E T
1 Ung thu mau (benh bach cau) 343
2 Ung thu hach lympho (lymphom) 351
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
Hieu 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
Trang 510 - 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 t n 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
Trang 612 - 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, K i m Yen, Ngan Ha, Vinh Huy,
Hong Dung, Duy Tinh, Hanh Dang, Ngoc Diem va A n h
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
N G U Y E N C H A N H U N G
Phan I HIEU BIET UNG THU
Trang 7Chuoing 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
Trang 8Loai nguai
nang ganti ung ihu
Nhd nha cham dieu thuoc Khoi huyen bay len cay."
(tho Ho Dzenh) That nen thcr A i 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
Trang 918 - 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 v i
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 l i 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 A n 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
Trang 1020 - 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 t i m 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, gapore Co ngoai le la A n Dp xuat dp nam 92,9/ 100.000 thap hern nfl 105,5 dp ung thU cp t i cung va vu d phu nii wfcJt trpi nhifng la cac Ipai tri tpt, cdn til vpng nam van cap
Sin-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
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 Q U P C 37,4 (nam)
va 13,7 (nii) Thdi quen nhau bi t i cap ke nhiem aflatdxin
Trang 1122 - Nguyen Chan Hung
trong thiic an nhiem moc giiip cho virut tan cong gan nhif
vao thanh khong nha trong
Ung thU phoi hoanh hanh Xap xi ung thii gan, khong
chi 6 dan ong ma ca phu nfl Chac ai cung hieu vi sao Tac
hai cua khoi thuoc la that ro Dan ong da danh bung lam da
chm, phu nfl nildc ta it hut thuoc, lai quen hit khoi ke Nam
2008, CO 37,6 ca tren 100.000 dan ong va 16,4 tren 100.000
phu nfl Nhin sang lang gieng Ung thil phoi la loai thifdng
gap nhat d dan ong Trung Quoc (45,9) va thil nhi d phu nfl
(21,3)
Ung thU da day van de doa chiing ta Cung chia se nguy
ca cao d Han Quoc (41,4/100.000), Nhat Ban (31,1) va
Trung Quoc (29,9) Moi lien he v6i nhiem khuan H pylori
va thiic an muoi man da diigfc xac dinh, them khoi thuoc la
lien thu khien nguy ca vxiat troi 6 dan ong
Ung thu dqi - trUc trang la loai c6 the tri tot Xuat dp la
9,2 / 100.000 Thil so sanh v6i cac mf6c chau A khac (Han
Quoc, Nhat Ban va Singapore) xuat do den 30 - 40/ 100.000,
phu hop gia tang nguy cO cua cac nilofc cong nghiep do nep
song phiidng Tay: che do an nhieu chat beo, it rau qua, hiit
thuoc, ngoi mot cho, it van dong va beo phi do fastfood
Nbi ban khoan cua phu nvt Cac ba thiidng than thd: phu
nii kho lam Y am chi noi lo ung thii vu va c6 tii cung Diing
la ung thif nao cung dang so Nhifng chi em phu nfl dau biet
rang cac benh nay cua phu nfl khong de doa bang cac loai
khac (3 nfldc ta ung thU vu con nhfldng ung thfl gan va ung
thfl phoi So mdi mac la 15,6/ 100.000 phu nfl 6 cac nfldc
giau nhfl Tay Au va Bac M y nguy cO cao lam: 89/ 100.000
Ung thir Biet sdm Tri lanh-23
Phu nfl Trung Quoc c6 nguy ca cao hon (21,6), Han Quoc
38,9, Nhat Ban 42,7 Sat ben ta, Singapore lai vflot troi 59,9 Phai chang do nep song phflOng Tay: doc than, c6 con dau long tre, khong cho con bii me, che do an beo, thieu van
dong Ung thu c6 tii cung xuong hang roi, chi con 11,4/
100.000 That dang mflng Vai chuc nam trfldc day la ung
thfl thfldng gap nhat cua phu nfl d TPHCM Da nhe hon
nfla ganh roi That hay nhd chflOng trinh ra tim gom kham phu khoa dinh ky vdi xet nghiem Pap M6i day lai biet ro cac virut HPV 16-18 cung vai typ khac gay ung thfl Da c6 vacxin
Co doi sack Cac loai ung thfl thfldng gap phoi gan, da
day, rat ac, thfldng phat hien tre dieu tri rat kho lai la nhflng benh phong ngfla dflcrc
Cac ung thfl thfldng gap khac nhfl vu, c6 tfl cung, ruot
gia thi CO cof phat hien sdm va tri lanh
Ket qua dieu trj mot so loai ung thU
Nhieu ngfldi muon biet kha nang song con cua loai ung thfl minh bi Co ngfldi thay dieu nay chang giup gi minh
Co ngfldi lai khong muon biet Ti le song con 5 nam chi t i le phan tram cua cac benh nhan song toi thieu 5 nam sau khi chan doan benh D i nhien c6 nhieu benh nhan song hon 5 nam va nhieu ngfldi khoi benh
Sau day la mot so ket qua dieu tri theo Hoi ung thfl My,
2013 de tham khao Ket qua dieu tri cua cac ung thfl gan (15%), phoi (16,3%), da day (27%) thap hon so vdi cac ung thfl khac nhfl ung thfl dai trang (65,2%), tuyen tien liet (99,9%),
Trang 1224 - Nguyen Chan Hung
vu (90%) va CO tii cung (90%) Ung thUgan: tinh chung song
con 5 nam la 15%, thdi ky khu trii tai cho 28%, benh Ian ra
vung Ian can song con la 10%, di can xa chi c6 3% Ung thU
phoi khong tehao nhd phat hien liic con khu trii ti le song con
5 nam la 52,6%, nhiing chi c6 15% dilOc chan doan scfm, khi
Ian tran sang cac cd quan khac thi ti le song con chi c6 3,5%,
tinh chung cho cac giai doan chi c6 15% Ket qua dieu tri ung
thUda day cung khiem ton, tinh chung khoang 27% d cac giai
doan scrm ti le song con khoang 71% - 46%, ket qua dieu tri di
can xa chi c6 4% Ung thU dqi trUc trdng khoang 70% ung thif
nam d dai trang, 30% nam d triic trang, c6 khoang 40% giai
doan sdm, 35% Ian ra vung Ian can, 20% di can xa, ti le song
con 5 nam: tinh chung cac giai doan 65%, khu trii tai cho 90%,
Ian ra vimg Ian can 70%, di can xa 10% Ung thU tuyen tien liet:
tinh chung song con 5 nam gan 99%, 10 nam khoang 98%, 15
nam khoang 93%, thdi ky khu trii song con gan 100%, thdi ky
tai vung gan 100%, di can song con chi c6 28% Ung thii vu va
ung thii CO tii cung d phu nfl c6 tien lifgfng tot
Song vcfl benh ung thiC
Chi mcri vai miioi nam trildc, cai nhin ve nhCtng ngiidi
benh ung thii khac bay gid xa lam 6 Hoa Ky, trong nhiing
nam 1970, ciJ hai ngifcri diioc dinh benh ung thii thi c6 mot
song it nhat 5 nam Bay gid cii ba ngiidi thi hai ngifdi song
con 5 nam Hien nay c6 hon 11 trieu ngifdi song v6i ung thif
tai nildc My Tren toan cau c6 khoang tren 4 trieu phu nii
mac ung thii vu song con 5 nam, di nhien c6 nhieu ngiidi
song lau hon va khoi benh
Lai CO them van de mdi Phai lifu tam cho chat lifdng
cuQc song va tiiOng lai dai lau cua nhiing ngildi tiep tuc
Ung thiiBietsdmTrj lanh-25
song con Ve mat y hoc c6 cac van de nhil tac dung phu cua viec dieu tri, c6 the bi ung thif thijf hai lai doi hoi theo doi deu dan Con van de tam ly va thach thijtc trong xa hoi, nhii
la bao hiem y te, phan biet doi xU trong tuyen dung va con
phai tap quen vdi tinh huong benh tai phat
Xiia moi ngUdi ngai noi tieng "ung thii" ndi cho dong ngiidi Benh nhan hiem khi nhan minh la ngiidi tri khoi ung thvf Nay tren the gidi c6 nhieu ngiidi danh tieng va cac lanh tu quoc gia cong khai ban luan va chia se kinh nghiem cua ho Quan niem ung thii la nan y va noi sgf hai can benh
da thay doi dan dan
Trang 13Tii nai sau tham
cua su song
thii la mot nhom benh gom tren mot tram loai c6
chung vai dac tinh ca ban quan trong M o i loai ung thif deu
dinh liu den cac te bao cua cof the, dan vi ca ban cua s\i
song Ung thtf nao cung do sU tang trUdng qua da va sU Ian
trdn cua cac tebdo khong binh thudng Phan ttf DNA trong
nhan cua moi te bao va dieu dong moi boat dong Cac te bao
ung thit phat sinh txi cac hii hai cua phan tii DNA, do phofi
Gen va Ung thU
Ung thir Biet sdm Tri lanh - 27
trai v6i cai gi do trong moi triidng song, thi du nhii khoi
thuoc la, cac viriit, anh nang Vay la ung thxi bat nguon tif noi sau tham cua s\i song
Phan Idn cac thii gay ung thii (tac nhan gay ung) tao ra cac dot bien gen dan den cac nhom te bao bat thiidng (goi la cac dong te bao) Theo thdi gian cac dong dot bien lai thanh cac dong ac hcin Nhieu dot bien lam ung thii manh len Nay ngifdi ta c6 the do dung cho hii hai cua gen
CO nhiem vu rieng, te bao nay mang khi oxy, thii khac thi tao
nen da, thii khac nfla thi tao ra xildng
6 ngiidi binh thiidng cac te bao cua cd the sinh s6i nay
nd de gifl cho cd the diidc khoe manh va boat dong tot, va roi den liic nao do te bao chet di Cac te bao nay chet, c6 cac
te bao mcri the cho Cd the luon luon che tao cac te bao mdi
hoac mot phan mo de the cai cu theo ne nep an hai
Bat tit quay phd Khong theo ne nep an bai, cac te bao
ung thii tiep tuc tang tmdng, sinh soi nay nd khong ngiing,
trd thanh bat tii Doi vdi cd the, cac te bao ung th\i khong c6
kha nang hoan thanh nhiem vu cua cac te bao binh thiidng
giong nh\i nhiing diia con hii hong trong gia dinh, an bam
ma gay nguy hai
Trang 1428 - Nguyen Chan Hung
.Carcinogen Phan bao ^Mll Ton thrfdng DNA
Mo binh thiTdng C^'^ ''^o tSng tnTdng " ^ M a c h mk\x
th^nh ung thu"
g ^ ^ * Mach
^ ^ ^ ^ lyinph6 Ung thiTxam Ian viing
S U s i n h u n g v a dien tien u n g t h U
Ian can va di cSn tdi cdc nc(i khac trong ccJ the
Mfchmau
Xam Ian va Ian trdn Cac te bao nay tich tii lai thanh budu
(u) hay kho'i hudu (khoi u); tieng Anh la tumor Biidu c6 the
de ep, xam Ian va pha huy cac vung mo binh thildng Ian can
Mot khi tach ra khoi khoi biidu nguyen phat, cac te bao ung
thif CO the troi noi trong dong
tuan hoan mau, hoac trong
mang tuan hoan lympho (hay
la bach huyet) de tdi nhflng
viing khac ciia ca the Tai cac
noi nay chiing c6 the dinh cif
va lai sinh soi nay nd thanh
cac 6 ung thii mdi goi la di can
(c6 nghia la chuyen goc) Khi
Ian tran nhii vay, ung thii van
gia ten cua bo phan co the ban
dau Thi du nhii, ung thii vii di
Cac te b^o u n g thiT t i c h kh6i vi tri n g u y e n phat, trdi noi t h e o
d o n g m a u v a tao cac 6 di c a n trong cor the
UngthaBietsdmTri lanh-29
can den phoi thi goi la ung thii vii di can phoi Ta hieu vi sao cac te bao ung thii Ian Ian nam phan chu dong, lam tan hai
ccf the roi khien ca the sum luon
A i 6 vung song nii6c, c6 the hinh dung mot khoi bifdu ung thii cung giong nhii mot dam luc binh nam d bai song Niidc dang len va chay xiet keo vai gie luc binh tach ra troi noi theo dong nifdc (mot so te bao ung thtf r6i biidu, troi trong dong tuan hoan mau hoac lympho) Vai bui viidng
vao hd nam do, hoac mac can roi kho heo, hoac troi tap vao
mot viing day biin du niidc sinh soi nay nd, chang bao lau sau thanh mot dam luc binh 16n, sum sue Khac chi vai te bao ung thU troi dat den nOi nao do roi nam i m lim (ngu
yen), vai te bao ket vao ndi ma s\ic de khang cua ccr the du
sdc giet chet va mot so te bao ung thii troi den mot vung
dat tot (mo thit thich hgfp) thi sinh soi phat trien thanh 6
di can
BrfdTu Iknh Bifdfu dc (Ung thrf)
Cac te bao chi tang tnTclng C a c te bao xam Ian mo tai chS.khong the Ian tran Ian can, vao cac mach
Thai gian
BUoru lanh v a biTdu a c
Trang 1530 - Nguyen Chan Hung
Ung thii CO the giet ngU6i bang nhieu each Gay cho cd the
suy nhifoc den cuoi cung thi sum Lam te het mot ccr quan
khien khong the boat dong Gay mot ap life manh trong so
va nao Lam nghen dildng thd hoac nghen mach mau Idn
Lam roi loan s\i dong mau khien chi can vet thiloing nho
C l i n g lam chay mau kho cam Lam mat phan ling de khang
khien ca the khong chong lai benh tat dxiac Gay dau ddn
Noi chung la da so ngifofi benh ung thii chet vi dau ddn, vi
suy kiet hoac vi ca the bi ung thii trd nen bat life triidc cac
benh tat khac
Giai dap mot SO thac mac
Ung thU lien quan gi tdi con cua? Thay thuoc lifng danh
Hy Lap Hippocrates (460 - 370 TCN) da lay hinh anh "con
cua CO cac cang tua tua" ra
de minh boa mot ung thil
vu khi da tien trien nhieu
Roi tif do, ngiidi ta dung con
cua tUdng trUng cho ung thU
fchfl cancer c6 goc Hy Lap
carcinos va carcinoma la con
cua) Cac hoi phong chong
ung thif dung "lifdi gifcrm dam con cua" lam bieu tiicrng
diet ung thii Co the dung hinh anh cay c6 goc re an luon
trong dat de minh boa benh ung thii: ung thi( nhin bang
mat thifdng chi la mot cue u, mot khoi hxidu, nhUng that ra
tren kinh hien vi thi khong c6 v6 ngan each ban vdi nbflng
mo binh thildng chung quanh, ma lai cho nhieu nhanh "bo
Ung thirBietsdrnTri lanh-31
a Ung tha khi con khu tru tai cho giong nhu mot cay c6 goc vdi nhieu re an luon trong dat hay mot con cua v6i nhieu cang tua tua
b Khi ung thU Ian tran trong cO the (di can) thi giong nhU cay me c6 mot hoac nhieu con
v6i" vao vung ke can Thi du nhfl ung thfl vii tuy r6 thay nho bang dau ngon tay, van d trong mo vii nbflng "bo voi"
ra chung quanh Nbflng ung thfl di can thi phai dung them hinh anh khac: mot cay Idn da eo trai chin, gio thoi lam mot hoac nhieu trai rung kha xa goc, gap dat tot, mot hoac nhieu cay eon moc len, cung eo goc c6 re, (ehang khac gi di can bach nach hoac di can gan, phoi la cac bfldu thfl phat nam rat xa bfldu nguyen phat d vu)
Ung thU khong chi la mot benh Co nhieu loai ung thfl Co
tren mot tram loai khac nhau: c6 ung thfl moc tfl bap thit va xfloing (tfl y hoe goi la sarcom hay ung thfl mo lien ket; tieng Phap: sarcome; tieng Anh: sarcoma), eo thfl eo goc tfl da
hoac Idp lot mat cac ca quan (goi la earcinom hay ung thfl
bieu mo, tieng Phap: careinome, tieng Anh: carcinoma), c6 thfl xuat phat tfl mau (ung thfl mau hay la benh bach cau),
Trang 1632 - Nguyen Chan Hung
Cic ung thUthUorng gap
CO ung thii moc til he lympho (ung thil hach hay lymphom)
Co loai phat trien cham, c6 loai nhanh, c6 thii phinh to nh\i
trai bong, c6 thii an luon, c6 thiJ de tri, c6 thil kho tri, c6
thijf thiidng gap d tre con, c6 thii lai thay d ngildi gia, c6 thii
thildng gap d xii nay, c6 thii de gap d xii khac
Ung thU dc nhieu dc it Ung thil can den hai mifofi hoac
ba milofi nam m6i xuat hien Mot khi da hien ra roi, chiing
lai Idn len va Ian tran theo kieu each, nhip do khac nhau Vi
du CO loai ung thU da gpi la ung thU tebdo ddy thi \dn len
het siic cham va hiem khi Ian tran tdi cho khac, con mot loai
ung thii da khac goi la melanom (ung thil hac to) thi Idn het
siic mau va Ian tran nhanh Vay la ung thU tebdo day thi c6
do ac tinh thap, con melanom c6 do ac tinh cao GiUa hai
do nay thi c6 v6 so loai khac nhau ve sif tang triidng, ve do
Ian tran
Ung thu'BietsdmTrj lanh-33
Ung thU CO lay Ian khdng? Khong! Ngay nay cac nha khoa
hoc da xac dinh dxiac mot so virut va vi khuan dinh liu den
mot so loai ung thif Dieu nay c6 y nghia rat Idn cho cong tac phong benh va dieu tri Nhieu ngifdi khi biet dilpc dieu nay rat lo lang Cac nha khoa hoc da khang dinh ung thil khong lay Ian, khong truyen nhiem Cac virut gay benh ung thil theo each "vong vo" chd khong triic tiep Viriit HBV gay
ra viem gan cap tinh roi thanh man tinh phai mat rat nhieu nam, nhifng chi mot t i le nao do viem gan man mdi trd
thanh ung thif Ung th\i c6 tii cung cung dinh liu vdi mot
loai viriit goi la HPV Virut nay gay nhiem trung ngay mot chiit, gay them viem c6 t i i cung am dao, khoang miicfi nam
sau mdi thanh di san (tien ung thU) roi cung phai 5-10 nam
niia thi mdi c6 the thanh ung thif that sii Vay khong ai c6
the lay ung thii cho ngxidi khac Khong so vcr lay chong, me
lay con Hieu dieu nay, chiing ta cang nen quan tam, giiip dd ngil6i benh Tranh khong de ho rdi vao tam trang tui than, mac cam do bi c6 lap
Co may ngUdi het benh ung thU? 6 Chau Au, trong thap nien 1990, cii 10 ngildi benh thi c6 han 4 ngiidi diit benh
5 nam Hien nay binh quan cii 3 ngii6i mac benh thi c6
1 ngil6i khoi benh CI Hoa Ky, trong thap nien 1930, cii 5 ngiJdi bi ung thii thi khong difcrc 1 ngiidi lanh benh 5 nam Den nhiing nam 60, cii 3 ngildi benh thi t r i difcfc 1 Vao nam 2000, Hoi ung thii My lidc tinh cii 10 ngUdi benh ung
thii da CO 5 ngildi lanh benh 5 nam, ma lanh benh 5 nam c6
nhieu ca may khoi benh luon Nay cii 3 ngii6i thi c6 2 ngiidi
diicfc t r i tot
Trang 1734 - Nguyen Chan Hung
UngthiTvaungbUdu
Cancer (tieng Anh, tieng Phap) chuyen sang tieng Viet la
ung thii Khoang 2.500 nam trUdc thay thuoc Hippocrates,
"cha to y hoc", dung tii carcinos de mo ta cac loai bilofu do
thay benh nay Ian toa goi dang con cua
lhay thuoc La Ma Celsus (2 - 50 TCN) chuyen lai thanh tieng Latin
la cancrum, tieng Anh la cancer
Den nay tii cancer cua Hippocrates
va Celsus luon diicrc dung
Nhiing cancer cua y hoc hien dai khong phai la benh ung thii trong sach y hoc c6 phifcrng Dong
Svf nhap nhang dan den nhieu dieu dang tiec Phifong phap
dan gian hoac y hoc c6 truyen t r i ung thii lai dem ap dung
cho cancer, khac nao "biJtt rau ong no cam cam ba kia"
Oncos Galen, bac thay La Ma khac (the ky thii 2 SCN)
dung tif oncos chi mot biidu, mot u Oncology tieng A n h
chi nganh nghien ciiu ve cac loai biidu Tif nam 1976, tac
gia chuyen tii oncology sang tieng Viet la ung bii6u
Td'Moblnhthirdng
DOt bi6n m^t
D0t bife'n hai
Bac SI Bert Vogelstein,
nha nghien ciJu noi tieng ve gen ung thii, lam viec tai dai hoc John Hopkin d Baltimore (Hoa Ky) da tuyen bo: "te bao
ung thxi la cai hop den, nay cai hop nay dxigc md ra; chiing toi
cam thay tran day hy vong"
Xodn doi DNA? Vao giijfa
the ky 20 cac nha khoa hoc
mdi CO the soi roi bi an sinh
hoc ung thif Nam 1953, cau true ciia xoan doi D N A duac
J Watson va F Crick kham pha D N A la ban thiet ke cd ban cua ma di truyen cam trich moi hoat dong cua cac te bao D N A nhif c6 lai do chd von di truyen cua muon loai den ben ddi ddi Roi cac nha khoa hoc hieu diidc cac gen hoat dong ra sao va c6 the hi dot bien, do la sii thay doi
hoac sa sot trong cac gen
Ke noi thu Nam 1981, giao sii Robert Weinberg va cac
Cactebao^ctinb
Nhieu dot bien dan den ung thir
Trang 1836 - Nguyen Chan Hung Ung th J Biet s6m Tri lanh - 37
cong s\i da phan lap dxiac oncogen dau tien cua con ngifdi,
dat ten la Ras Den nay, ngiJcfi ta da biet diioc nhieu oncogen
ngiidi, hdn 40 loai c6 ten goi xa la HER-2/neu, ras, myc, src,
Bcl-2 Cac nha khoa hoc da biet lam the nao va tai sao
ung thil phat trien Phan Idn cac oncogen (gen ung bildu,
oncogene) la cac dot bien cua cac gen binh thifdng nao do
goi la Proto-oncogen hay tien oncogen Proto-oncogen la
cac gen tot, binh thiidng kiem soat te bao lam gi va sinh soi
the nao Khi tien oncogen bi dot bien thanh oncogen, chiing
trd thanh cac gen "xau" roi cd cam dau cam c6 lam viec,
khong theo chi dao, te bao tang triidng luong tuong, dan tdi
ung thii That la trd mat roi quay pha Mot chiec xe hoi chay
ngon lanh thi phai c6 ban dap ga tot Proto-oncogen boat
dong nhii mot ban dap ga, dieu tiet te bao phat trien va sinh
soi Khi nhan ga xe vot nhanh, roi ban dap dinh khan luon,
khong chiu nha ra, xe vpt hoai gay nguy hiem, thi cung nhii
oncogen lam te bao sinh soi v6 to chiic
Mot t h i du: viriit HPV 1 6 - 1 8 chui vao te bao c6 t i i cung, mang hai oncogen E6 - E7 vao khoa tay hai gen de bvidu p53 va Rb khien te bao sinh soi v6 to chiic thanh ung
thii CO tii cung
Co cac loai gen de nen bUdu Day la cac gen binh thifdng
CO vai tro lam cham s\i sinh soi cua te bao, siia chfla cac hii
hai DNA khong cho ung thii ngoc dau Co nhieu gen mang cac ten la tai nhii p53, RBI, APC, BRCAl, BRCA2 cac gen
nay de nen hxidu trd nen te liet thi te bao phat trien thanh
ac tinh khi cac gen de nen biicru bi dot bien thi giong nhii cai thang xe kem khong de xe chay nhanh qua Khi bi dot bien, cac gen khong con kem cap thi ung thif xuat hien, nhU thang xe khong an
S\f tang trtfdng te' bao ba't thtf&ng: Cac oncogen
11""'"' ^ ^ ^ J
Cac proto-oncogen—»-cac oncogen
Viec kham pha cac oncogen va gen de nen dot bien da thao gd cac be tac de hieu diicrc ccr sd phan tii va di truyen cua benh ung thii Cac oncogen cung cung cap sif hieu biet lien quan tdi viec dieu hoa tang trifdng, chuyen biet hoa
va chet an bai cua te bao binh thudng Viec xac dinh cac oncogen hiia hen mot tiem nang mdi trong dieu tri ung thii
Mot the he m6i dung thuoc nham vao dich oncogen, tieu
diet CO chon loc te bao ac tinh tranh te bao binh thiidng Lieu
Trang 1938 - Nguyen Chan Hung
phap nham triing dich hiia hen phoi hcfp nhuan nhuyen v6i
hoa tri, xa t r i va phau t r i trong tiidng lai gan
Nham vao cdcgen ran vd Mot the he thuoc dac tri diicfc
dieu che nham t6i cac gen bat thifcJng da tao ra cac te bao
ung thii ngay tii liic con "tnJng niidc" Bac si Denns Slamon,
Dai hoc UCLA (bang CaUfornia - Hoa Ky) rat phan khdi:
"Bay gid chiing toi bat dau nhin ro cai gi ran vd, cai gi hif
hong trong te bao ung thil va c6 gang nham vao do" V i moi
gen cam trich cho mot protein, nen cac gen hif hong se cho
cac protein hii hong; nhii vay c6 khi mot protein diicrc che
tao qua yeu cau, c6 khi mot protein nao khac qua it hoac
mot protein lam lac khong lam diing chiic nang Nham vao
cac protein benh hoan, troi tay chung lai bang nhieu each
Khoa tay cac oncogen Cach nay diioc goi la lieu phap
trung dich hay la nham dich phan tii Tii thap nien 1970,
Stanley va Levi-Montalcini kham pha diidc cac te bao noi
va Idng nghe nhau bang tin hieu goi la yeu to tang triidng
(giai Nobel 1986) Den nay da biet diioc hang tram loai
That la khe hcfp, nhieu yeu to tang triidng bi dot bien thanh
oncogen Thuoc cetuximab nham vao oncogen EGFR, dieu
tri ung thii vung dau c6 va ruot gia Yeu to tang triidng mach
mau CO ten la VEGF, nam 2004 da c6 thuoc bevacizumab
khoa tay oncogen nay, dung dieu t r i ung thif rupt gia di can
va mot so ung thil khac Lieu phap nham triing dich dang
nd ro Cac nha nghien cilu rat lac quan ve tiidng lai cua cac
dieu t r i nham vao dich la cac oncogen
20 nam trd lai day thoi, ngiidi ta da biet benh ung thii
nhieu hon nhflng gi gom gop trong bao the ky triidc Con
nhieu dieu phai hoc nfla
Chacing 2 Sao cho nh? ganh
Da 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<hdng phai la cupc dau tranh giCra ngUdi ghien thuoc va ngUdi khong hut thuoc, ma ciing tao cho
chung ta va con chau bau khong khi trong lanh Qua that benh nhiem gay ra ung thu Udc tinh khodng mot phan
nam (20%) ganh ngng ung thutoan cau do benh nhiem Van dgng cho deu, an uong cho lanh con phai nang niu giac ngu
nOathiphbng tranh ung thumdi that tot 40% so ngudi mac ung thiile ra c6 thephbng ngiia duac Do la dieu ma UlCC nh6n gdi moi ngUdi tren hanh tinh vao nam 2010 Phdt hien benh that sdm khi chiia thay trieu chitng (rd tim) Kiem
tra sCfc khoe todn dien c6 It/u y ve ung thu Cdc trieu chitng bdo dgng Thay doi thoi quen cua rugt vd bgng ddi Mot cho Idloet khong chiu Idnh Chdy mdu hodc tiet bat thudng
Cho ddy (cue u) d vu hodcdndi ndo do
1 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
Trang 20Cai gi gay benh ung thu'
Da biet nhieu nguyen nhan cua ung thU
Vao nam 2012, Cd quoc Quoc te Nghien ciiu Ung
thii (lARC) da xac dinh difcfc tren 100 tac nhan gay ung (carcinogen) hoa hoc, vat ly va sinh hoc Dang tap trung tim them cac carcinogen m6i gop phan phong ngiJa ung thii Vao nam 1915, Katsusaburo Yamagiwa va Koichi Ichikawa thuoc Dai hoc Tokyo gay diidc ung thif loai vat trong labo Ian dau tien bang each boi chat hac in trong than vao da con tho Hofn 150 nam troi qua tif khi John Hill 6 Luan Don nhan ra thuoc la la mot carcinogen
Bung lam da chju
Ngay nay con ngifdi
biet nhieu nguyen nhan
gay benh Khoang 80%
do nhflng gi con ngif6i an
uong, hit thd, co xat hoac
phoii trai
Trang 2142 - Nguyen Chan Hung
Khoi thuoc M d i khoang 30 nam triidc, van
de thuoc la va ung thif m6i diioc bao dong
hxidc dau Roi cac tuyen ngon chong thuoc la
ngay cang manh me Thuoc la ra don sat thu
em ai ma het siic tan doc Khoi thuoc la chtfa
hcfn 60 chat gay ung thii, khong chi hai ngiidi
nuot khoi ma ca nhufng ngxidi hit khoi ke
Trong the ky 20, thuoc la giet khoang 100 trieu
ngiidi, cuoi the ky da c6 dai dich ung thii d cac
niidc giau Cii da nay se c6 hon 1 ti ngiicfi tti vong trong the
ky 21, phan Idn d cac niidc dang phat trien Can dich ung
thii do thuoc la dang chuyen til nha giau sang nha ngheo
tren hanh tinh chiing ta Thuoc la gay ra 1/3 ganh nang ung
thii tren hanh tinh
Mot so virut, vi khudn vd ky sinh trung gay 20% ung thii
cua loai ngiJdi Cac viriit am tham mai phuc, nay Ian mai
li3a, benh tro ra thi trd tay khong kip Viem gan do virut
HBV va HCV lau ngay dan den ung thii Cac virut HPV gay
ra nhieu ung thii, dac biet la c6 tii cung Vi khuan H pylori
CO the gay ung thif da day
Ung thu Biet sdm Trj lanh - 43
Benh theo mieng md vdo l/dc dinh an uong khong lanh
them 1/3 ganh nang ung thif Che do an khong lanh, thieu van dong, beo phi deu gay benh tat de doa mang song: tim mach, tieu diidng va ung thii
Diing de bung lam da chiu Hiep hoi Quoc te chong Ung
thii (UICC) CO thong diep 2010 danh dong tdi khoang 2,4 t i
ngiidi Khoang 40% cac ung thii c6 the phong tranh UICC khuyen khich moi ngiidi theo nep song tot, an lanh, loai bo khoi thuoc la, chii y ca hut va hit ke Tranh uong rifcJu qua
da Phong tranh benh nhiem Tap the due deu, an dung an lanh, giii can vifa phai
Vdo ndi sdu tham Tat ca cac loai ung thif deu c6 lien can
t6i stf boat dong true trac cua cac gen quan ly svf nay nd
va sU sinh soi cua cac te bao Khoang 5 - 1 0 % cac trUdng hdp thi di truyen ro rang, nghia la mot gen hii hai di truyen
khien cho mot ngiidi nao do c6 nguy ca rat cao mac cac
loai ung thii dac biet nao do Ngoai ra phan Idn cac triidng hdp ung thii thi khong bi di truyen, nhilng lai la ket qua cua sif ton hai cho cac gen (cac sii dot bien) Chung xay den d moi chang diidng ddi cua chiing ta, hoac la do cac yeu to ben trong nhvf la cac hormon hay la viec tieu hoa cac chat
dinh diidng ben trong te bao, hoac la do cac yeu to ben ngoai nhvf la cac hda chat (thuoc la) hay cac bijtc xa ion-hda (tia X, tia gamma hoac tia cvfc tim tif anh nang) hoac cac tac nhan gay nhiem (vi khuan, virut, ky sinh trung) Cac nha khoa hoc
Dich nhim phfln tuf
j-DOt bifTn gen (OncOgen)
l P M n t * D N A
Trang 2244 - Nguyen Chan Hung
da biet chinh DNA bi h\i hai do cac hoa chat va biic xa hoac
do cac doan DNA cua virut nhap vao da gay ra ung thii Co
the xac dinh dung vi tri hif hai tren mot gen dac hieu
Phan 16n cac carcinogen gay hii hai gen Theo thdi gian
cac dong dot bien gay tiep cac dong ac tinh hdn Roi ung
thif phat sinh vdi nhieu h\i hai di truyen va dot bien hofn
Sii khac biet 16n gifla cac mo binh thiidng va ung thil la cac
te bao binh thii6ng c6 DNA hii hai thi chet di con cac te
bao ung thif c6 hii hai gen thi khong chet ma thanh bat tii
Kham pha sii khac biet nay da giai dap dxiac nhieu cau hoi
lam cac nha khoa hoc roi ram tii rat nhieu nam
Cac yeu to hoan canh moi triidng vUdt troi han cac yeu to
di truyen Tii cac thilc an ma chiing ta diing, cac boat dong
vui chdi ma chiing ta hiidng thu, moi triidng song luon anh
hiidng den siic khoe ciia chiing ta Thay doi vai yeu to nguy
cor tii moi triidng song (nhii la hiit thuoc la) chiing ta c6 the
giam dang ke nguy ca ung thii cua minh
Viec phong tranh ung thU ngay cang hufa hen
Cang biet diidc nhieu ve cac nguyen nhan cua benh ung
thii, chiing ta cang c6 nhieu kha nang tim ra cac each phong
ngiia ung thii Mot mat trong phong thi nghiem, cac nha
khoa hoc cat liic khao sat cac nguyen nhan kha nghi cua
ung thii va c6 gang tim xem nhiJng gi thiic sii xay ra cho cac
te bao de chiing trd thanh ung thii Mat khac ngoai xa hoi,
cac nha nghien ciJu ciing c6 gang xac dinh cac yeu to nguy
ccr, do la cac dieu kien lam tang kha nang xuat hien cua ung
thit Ho cung tim kiem cac yeu to che chd, do la nhutng dieu
CO the lam giam nguy cor
Ung thirBietsdrnTrj lanh-45
Nhieu yeu to nguy cd c6 the loai bo diidc Nhieu thil
khac, cac yeu to c6 tinh di truyen chang han, thi khong the
loai bo dxiac, nhiing c6 the giiip bao dong ung thii
Ung thif CO di truyen khong?
KhodnglO% -15% cac trUdng hdp ung thii c6 moi lien he
gia dinh va gia toe Trong mot so gia dinh, ung thii xay ra d vai thanh vien trong gia dinh vdi t i le cao Nhiing gia dinh
CO xuat do ung thii cao hc(n miic trung binh thi bi ung thtf
vii, buong triJng, ruot gia hay noi mac tii cung nhieu horn
Ung thu mat d tre em (tii chuyen mon la biidu nguyen
bao vong mac) la thi du dien hinh ve ung thii va di truyen Khoang 40% tre em bi ung thii nay thiia hiidng mot gen Rb dot bien tii cha hoac me Khi cac tre thiia hiidng gen Rb tii cha hoac me thi cac dot bien nay se hien dien d tiing te bao trong cor the dila be, do do cd the phat hien diicfc chiing nhd xet nghiem DNA cua cac te bao Ngiidi bi benh dang di
truyen thi cung cd nguy ca cao bi them mot ung thii khac
niia (ung thii xiidng chan hoac hoc mat) Mot so ngiidi hiit thuoc la thi cd nguy ca bi ung thii phoi cao hdn cac ngiidi hiit thuoc khac vi cau triic di truyen cua ho
Mot so ung thu gan vdi benh sii gia dinh nhii ung thii vii,
buong tnlng, tuyen tien liet va ruot gia Mot loai benh cd tinh
di truyen goi la benh da polyp ruot gia trong gia dinh Ngiidi benh cd hang tram choi thit (polyp) trong ruot gia Cac polyp nay cd the hda thanh ung thii Cac loai khiem khuyet gen nhii
la hoi chiing Down cd the lien he vdi benh bach cau (ung thii
mau) Cac khiem khuyet cua he thong mien dich lam ca the
thanh cor dia tot cho lymphdm (ung thii hach)
Trang 23Coi Chung sat M can ke
Sang sdm mot ly ca phe mot dieu thuoc, that da! Nhau
lai rai phai c6 thuoc la Rit mot hdi khoi mdi lay hiing viet
tiep bai bao Ban c6 chju danh doi sxic khoe vdi cai thu tuyet
vdi khong Tren ca niidc nhat la d Thanh pho Ho Chi Minh,
ung thii phoi la loai benh ac tinh thifdng gap nhat d nam
gi6i Khoang 90% lien he thuoc la Trong cac loai benh man
tinh de doa mang song con ngifcri thi ung thil do thuoc la lai
CO tiem nang phong tranh nhat
Dai djch thuoc la
ChUa tiinggqp Ngay xifa dich hach, dich ta, dau mua gay
dai dich giet that nhieu ngiidi Ngay nay nhan loai dang vvfa
nuoi diiSng vxia chong choi dai dich thuoc la, moi de doa
siic khoe Idn nhat loai ngifdi chiia tilng gap Thuoc la gay
chet sdm cho khoang hon phan mia so ngif6i hiit lau hiit
nhieu Tinh chung thuoc la lam giam tho tif 8 - 10 nam
Theo To chile Y te The gidi hien nay tren the gidi khoang
1,3 t i ngifdi hiit thuoc, xap xi mot phan ba dan so toan cau,
tinh tii tuoi 15 Moi nam hcfn 5 trieu ngildi chet vi hiit thuoc
Ung thi/BietsdmTri lanh-47
Tac hai cua thuoc la
Bdnh nirdu rang Benh phdi t i c nghen man tinh
t viem phdi
-1 suy tim & dot quy benh mach mau ngoai bien Mien dich yeu
Tie'u dirdng typ 2
V 6 sinh nam nff
t lay tniyen sinh due
va hon 600.000 ca chet do hit khoi ke Nam 2030 se c6 hai t i ngiidi hiit Tii vong se len den 8,3 trieu, hdn 70% d cac nil6c ngheo Thuoc la gay 100 trieu ca tii vong trong the ky 20 l/dc tinh con so se len den 1 ti trong the ky 21
Sat thu nang tay Khong chi gay ung thU, thuoc la con gay
du thii benh tim mach, xao tron sinh due, eifcfm mat, viem
phoi, viem nxidu rang, phinh dong mach chu bung Nen
nhd cac benh tim mach, giet ngiidi cai rup con nhanh hon ung thu La sat thu hang dau tren hanh tinh, thuoc la khong chi gay ung thii phoi ma t6i khoang 15 loai ung thif gom thanh quan, da day, hoc mieng, hong, moi, vom hong, thUc quan, them tuy tang, bong dai, c6 tii cung, ung thif mau va vii, danh sach dai dang dac So vcri ngiidi khong hiit, ngiidi ghien thuoc la c6 nguy cO ung thii gap boi (10 Ian d phoi
va thanh quan, 7 Ian d hong, 4 Ian d mieng, thiic quan )
Trang 2448 - Nguyen Chan Hung
Chong hut vcf hit con ke Khong ngam dieu thuoc ma van
hit khoi goi la hiit thu dong Cho vui chdi dong ngiidi (quan
bar, quan ca phe), khoi thuoc diicfc phan phoi deu, moi
ngiidi "cung hifdng" Trong nha hang tiec ciidfi it ngtf6i hiit,
nhiing ngoai hanh lang, trong toa let mit mui khoi thuoc, ai
nay van than nhien hit khoi Moi trildng song bi c6 tinh lam
6 nhiem Hiit thuoc thu dong tang nguy ca ung thu phoi
20% - 50% Tre scf sinh cua cac ba me hiit thuoc hoac hiit
ke CO tang nguy ca sinh thieu can va chet trong tuoi tre em
Tre em ca the non nhay benh dildng ho hap, hen suyen va
thu6ng quat queo
Satthucankecrbenta
Vao ndi sau thdm "Nhdf nha cham dieu thuoc Khoi huyen
bay len cay" (thd Chieu cua Ho Dzenh) Hinh anh dep qua!
Khong phai vay dau! (3 can ke ben ta, sat thu diu dang
gay 1/3 ung thif cua loai ngiidi Khoi thuoc kich boat nhieu
Ung thu Biet sdm Trj lanh - 49
chat sinh ung (carcinogen) manh nhat, thoi thiic t\i tif dot
bien gen cua cac te bao lot difdng ho hap roi dan den ung thii Cac carcinogen khong chif a te bao nao trong co the, tan
cong phan t\i DNA, nofi sau tham cua sif song Thuoc la dau
loc, b6t chat nhtfa lam khoi nhe hon lai difa cac carcinogen vao sau hdn trong phoi
Thuoc ddi mdi chiia nhieu nitrat, dot chay tao nhieu nitrosamin sinh ung manh hen Doi sang hiit dieu thuoc nho xiu it nhUa, it nicotin cho yen tam thi lai hiit nhieu dieu Dau vao day thoi Nguy cO ung thii tang vdi tuoi bat dau hiit, so liidng thuoc va thdi gian hiit
Kieu nU diu dang Khong gay ung thii, nhiing chinh
nicotin quyen r i i lam ngiJofi hiit ghien thuoc, khoi thuoc thanh sat thu diu dang Ra tay that nhanh, trong 15 giay nicotin da tdi nao Khong co nicotin cac cong ty thuoc la
se tieu timg LiiOng nicotin vao ngiidi nhieu ciing gay hai (6i miia, dong kinh, suy sup than kinh, cham 16n) Nen biet nicotin diidc dung nhieu trong thuoc diet con triing
Thuoc ngon niia dieu Nh6 lai chang cao boi quang cao
thuoc dau loc Marlboro nhflng nam 1954 - 1992 That mia mai, hai chang dong vai cao boi Marlboro (Marlboro man) deu chet vi ung thii phoi Wayne Mc Laren va David McClean bi ep hiit tdi nam goi moi ngay de quay phim va chup anh Ca hai deu chet khoang miidi nam sau khi giai nghe Do la chuyen cu Con chuyen m6i Vai hom triidc toi
Trang 2550 - Nguyen Chan Hung
CO xem benh cho mot nha kinh doanh uy tin do tuoi 50
-dang xuan! Hach c6 di can tCf mot dom trong phoi Sd qua,
bo hut ba thang Muon roi, anh hut tif nam 23, moi ngay so
sol mot goi Bo veston trang nha, chiec Mercedes dcfi mdi
giiip gi ni3a dau
Cd thegidi chong dich C( cac quoc gia so ngiidi hiit tang
cao thi benh tat cang nang triu cho nen kinh te va siic
khoe That kho khan cho moi quoc gia chien dau dcfn doc
v6i dai dich thuoc la, nhieu nildc da doan ket nham giam
stf tieu thu thuoc va giam moi de doa 6 nhiem tren hanh
tinh Nhieu nxi6c thtlc hien cac bien phap: phap lenh phong
chong thuoc la, tang thue tren gia thuoc, cam quang cao
thuoc la va cam hut thuoc ncri cong cong, thiet lap cac diem
tif van bo thuoc, giao due tac hai thuoc la trong hoc diidng
Biidc dau c6 hieu qua tich cvfc d Anh, Hoa Ky va mot so
nude cong nghiep khac Nha niidc ta can thiic hien c6 hieu
qua hofn nUa chien lifcfc chong tac hai thuoc la Mdi may
nam nay cac bao thuoc c6 ghi hang chfl "hut thuoc c6 the
gay ung thtf phoi" hoac "thuoc la c6 the gay viem tac diidng
ho hap" Co tien bo roi! Nhifng chiia nham nho
Tin mifng la ngiing hiit lam giam cac ton thvfctog tien
ung thif va giam dan nguy co ung thii phoi Bo hut mot
minh hoac hay nhd sii giup d5, tuy thuoc vao y thiic va y
chi Co nhieu ngifdi bo thuoc cai rup Hay qua Thay hieu
qua lien Hcri thcf trd lai thdm thd, liidi thay nxidc mieng c6
vi ngot, giac ngu em hcfn Lau hon thi rang bdt vang khe
"Vao phi triidng khoi phai chui v^o cai long khi, hit khoi
muon chet" Phai biet lo cho minh va gia dinh va dilng quen
nhijtng ngiidi quanh minh Tao moi triidng sach khoi thuoc
khong phai la cuoc dau tranh gifla ngUdi ghien thuoc va
Ung thaBietsdmTrj lanh-51
ngU6i khong hut thuoc, ma cung tao cho chiing ta va con chau bau khong khi trong lanh
De ngiTori vdi thuoc la
Lula da Silva, nguyen tong thong niidc Brazil rat diidc
long dan, bi ung thii thanh quan vao nam 2011 Dieu tri sdm diing thay dung thuoc Bac si cho biet siic khoe on dinh, lai Ian xa vao chinh triidng Lula nhan ra hut thuoc lien tu bat tan da gay tai hoa
XUdng hoa hoc mini dieu thuoc chiia hon 4000 hoa chat,
trong so nay c6 250 chat gay hai va khoang 60 chat sinh ung thii loai manh nhat Ke scr sc(: NhiJa thuoc tron Ion nhieu chat, lam ham rang vang khe, lam phoi den thui, benzen, arsenic gay ung, hai tim mach, cadmium c6 trong cue pin, formol dung Udp xac, hydrocarbon thdm da vong rat Ua DNA, nitrosamin lam hii hai DNA, acrenolin eo liic diigfc dung lam vu khi hoa hoc Ban liet ke con dai
Nicotin
Trang 26Ngiia benh nhiem,
Chan ung thif
day, ngoi sao Hollywood lilng danh Michael
Douglas 68 tuoi cho rang ung thif hong giai doan 4 cua ong
la do virut HPV, lay truyen theo kieu lam tinh mieng trong
cuoc phong van cua bao Guardian ngay 02.06.2013 Tin giat
gan hon la Angelina Jolie tung he chuyen cho nao ca hai vii
de tranh nguy cd ung thii v i mang gen BRCA1
Qua that benh nhiem gay ra ung thu l/dc tinh khoang
mot phan nam (20%) ganh nang ung thii toan cau do benh
nhiem Mot con vi khuan Helicobacter pylori gay ung thii
da day, ba con virut gom HBV, H C V gay ung thif gan, HPV
gay ung thif co tH cung Be lu bon ten nay gay 15% cac ung
thil cua loai ngiidi •
Virut HPV, hanh tung ky la
Khdngphdi trdi keu. Nam 1983 Harald Zur Hausen chi
ra virut HPV-16 roi HPV-18 la thu pham gay khoang 70%
ung thif CO tii cung R6 roi, do quan he tinh due, khong phai
UngthaBietsdmTrj lanh-53
tr6i keu Zur Hausen nhdn gidi Nobel Y hoc nam 2008 HPV
di t i l ngif6i nay sang ngifdi khac trong cuoc ai an Virut lay
nhiem khi lam tinh nga am dao Nhiem virut ddn den ung
thu can khodng20 - 30 nam Hai vdcxin Gardasil vd Cervarix
ngiia dUdc 70% cac ung thU co tii cung do HPV 16-18 gay ra,
vay con 30% lot ludi Tuoi quy dinh tiem vdcxin tai cac nUdc
Au My Id 9 den 26 tuoi, chUa co quan he tinh due Hy vong la
vdcxin gdy mien dich Idu ddi, nhUngphai chd thdi gian Ddu
CO tiem vdcxin dung cdch dung lieu, phu nit da quan he tinh due van phdi khdm phu khoa dinh ky vd Idm xet nghiem Pap
HPV con gay ung thil am ho, am dao va hau mon d phu nil
Ung thu dUOng vat, ung thif mieng hong va hau mon d dan
ong 6 nhflng ngiidi dong tinh nam, HPV-16 tang nguy cd
ung thu hau mon
Chuyen cac cd Lam tinh mieng co the dem virut tU he
sinh due vao hong Cac nha khoa hoc mdi t i m thay
HPV-16 la thu pham cac ung thU vung mieng hong 6 Hoa Ky
CO 14.000 ca ung thif hong mdi hang nam, khoang 70 phan tram dinh liu tdi HPV-16 virut Chac Michael Douglas da nghe chuyen nay
Hai sat thu am tham ma tan doc:
virut HBV va HCV
Co ngifdi dang manh son sdn, kham sUc khoe dinh ky lai
ra ung thif gan Tifdng nhif benh tren trdi rdt xuong N h d
lai CO bi viem gan B hay C gi do ma bo qua, van nhau nhet
tdi ben
Trang 2754 - Nguyen Chan Hung
DNA
H B V
HBV,HCVvaung thUgan
Hai virut viem gan B (HBV) va viem gan C (HCV) rd la
thu pham gay ung thU gan Truyen ngUdi sang ngUdi, hoac
lay qua tndu nhiem, nhiem qua tiem chich, quan he tinh due,
con sinh ra tit me nhiem Am tham tan cong cac te bao gan,
lam ra xa gan, ung thif gan HBV (viriit DNA) thildng gay
trieu chiing hcfn nhxi cam ciim va vang da, hoi phuc trong
vong vai thang Mot so nho mang HBV man tinh c6 nguy ca
cao ung thif gan H C V (viriit RNA) mofi difOc biet gan day
(1989), ten tifong tvf nhifng khac han HBV, lai cung sd thich
la lia cac te bao gan, gay viem, dan den xa gan, c6 the Ian
mat khong de tac hai Khoang ba trong bon ngifdi nhiem c6
gan xo trong vai mxiai nam
Cac nguyen nhan khac lien thu gom ruau, thuoc la,
aflatoxin Doc to aflatoxin, do nam moc d bap, dau phong,
Ilia gao va liia mi, c6 the dan tdi ung thii gan HBV lien thu
Ung thirBietsdmTrj lanh-55
v6i aflatoxin vui dap la gan, gay ung thil gan 60 Ian cao hon
HBV rieng le Bi nhiem H C V ma uong rii^u, xO gan va ung
thu bung len nhii do dau vao lifa
Dai dich ung thUgan d nUdc ta NhiJng noi nao viem gan
man do HBV va HCV hoanh hanh ciing la nhfing ncri c6 xuat do ung thii gan cao nhat Viem gan man gay ra 75 -85% ung thii gan tren toan cau Nhiem HBV la dai dich d
Trung Quoc, d nildc ta va mot so noi khac cua chau A Phan 16n nhiem viriit tif liic nho va 8 - 10% dan so triidng thanh
bi nhiem man tinh 6 nildc ta, ung thil gan la loai thiicfng gap nhat Dan ong mac nhieu gap boi phu nut Phai chang
cac dang may rau thiidng nham nhi v6i du thii moi nhau thiic an moc meo Phai tranh xa HBV/HCV nhii tranh
xa HIV-AIDS Tranh nhiem HBV, HCV Mifng la c6 vacxin ngifa HBV, c6 thuoc t r i viem gan B tot M d i c6 thuoc t r i HCV, chiia c6 vacxin Quan he tinh due an toan Canh giac thiic an moc meo Can than xam hinh da, chan may, x6 tai, x6 miii deo bong
Satthuvonlabanthiet:
vi khuan Helicobacter pylori
Nhiem suot ddi, gay viem loet, c6 the gay ung thU Xoan
khuan thiidng trii trong da day phan niia so ngiidi tren trai dat, khoang 58.000 nam trUdc Diing la ban thiet cua loai
ngiidi Gidi Nobel y hoc 2005 vinh danh hai ngUdi Uc Barry
Marshall va Robin Warren ve sU khdm phd H pylori nam
1984 Song trong da day (vung mon vi) va ta trang nen c6
ten la Helicobacter pylori - xoan khuan mon vi ifdc tinh c6
Trang 2856 - Nguyen Chan Hung
Helicobacter pylori gay benh
khodngSO - 60% cdc ung thUda day tren todn cdu lien he chat
che vdi H pylori Khodng 10 - 20% nhUng ngUdi nhiem khudn
se hi benh loet dq day, roi viem man tinh, mot so it nqng len
thdnh viem dq day dqng teo, cd the dan den ung thU
Dd CO thuoc tri viem loet dq ddy do nhiem H pylori, hiia
hen gidm nguy cd ung thU dq ddy Nghi viem loet da day ta
trang thi nen di kham Bac si se cho thii hcJi thd hoac noi soi
da day Co xoan khuan bac si can nhac dieu tri diing each
Uong du thuoc diing lieu, ket qua tot Dieu tri khang khuan
nay cung lam giam nhe lymphom MALT, mot loai ung thii
hach rat dac biet cua da day do H pylori gay ra
Nha niidc can phai liiu tarn gap boi vai tro cac benh
nhiem de xay diing cac ke hoach chong ung thii NhUng moi
ngifdi phai biet lo cho minh va gia dinh Phai tich ci£c phong
ngiia, dieu t r i tot cac benh nhiem nay trifdc khi chiing gay
ung thii
Blic xa gay ung thir
Chuyen tiic ciicri Vai ngay sau tham hoa hat nhan Fukushima d Nhat Ban, ham dpi 7 Hai quan Hoa Ky c6 trang bi tan rang tren diidng den giiip d5 lai phai lui lai trU6c moi hiem nguy v6 hinh: chat phong xa ro ri Ngay nay con ngiidi da hieu bilc xa phuc vu con ngifcfi va ciing nguy hai cho nhan loai
Cac blic xa "ion-hoa" gay ung thii cho con ngiidi la dieu diidc xac nhan tii lau Cac te bao c6 the bi ton hai do biic
xa ion-hoa tii cac thiet bi dung tia X (X- quang), cac chat
phong xa, cac tia iil vu tru xam nhap trai dat chiing ta va
mot so nguon biic xa khac Lieu cao cac biic xa c6 the gay ung thii va cac loai benh khac Cac ngiicri song sot sau vu no bom nguyen ti( d niidc Nhat cho thay la cac biic xa nay lam gia tang nguy cO benh bach cau (ung thii mau), tuyen giap
va cac loai ung thii vii, phoi, da day
Triidc nam 1950, cac tia X difdc dung de dieu t r i mot so ngiidi bi benh lanh tinh (tuyen hung phi dai, amidan phi dai, mun ) d tre em va thanh nien Nhflng nam sau thi ngiidi ta nhan thay t i le ung thii tuyen giap tang cao hern 6 nhiing benh nhan nay
Trang 2958 - Nguyen Chan Hung
Cac ngif di benh ung thiJ dxiac xa tri c6 the bi ung thii thut
hai Nguy ca nay con tuy thuoc vao tuoi benh nhan liic diicfc
dieu tri cung nhii phan ccf the dxiac dieu tri
Bufc xa la gl?
Cac tia X la mot thi du ve bile xa, anh sang phat ra tii
mat trcfi cung vay Biic xa la s\i phong nang liiOng tii bat cii
nguon nao Khi noi ve bijfc xa va ung thif, nhieu ngildi nghi
tofi cac loai biJc xa dac biet nhu cac tia X hoac biic xa phat
ra til cac 16 phan iJng hat nhan That ra c6 nhieu loai biic xa,
phan Idn khong dinh dang den ung thii
Cac loai hiic xa Biic xa di til loai nang lilctog (tan so) that
cao cho den nang lilctog (tan so) rat thap Cac dang chinh
cua biic xa gom: cac tia gamma, cac tia X, cac tia ciic tim
(UV), anh sang, cac tia hong ngoai, cac song viba, cac song
radio, cac biic xa tan so cilc thap Cac biic xa gay hai cho siic
khoe dxiac phan loai theo sii ion-hoa hay khong
BiCc xq khong ion-hoa la biic xa tan so thap, khong dti
nang lilong de lay cac electron hoac gay ton hai cho DNA,
gom cac tia UV nang lilong thap, anh sang mat trcfi, cac tia
hong ngoai, cac song viba va cac song radio Ngoai tril cac
tia UV, cac biic xa khong ion-hoa khong lam tang nguy ca
ung thil
Bufc xa ion-hoa gay ung t h u
Biic xq ion-hoa c6 du nang lilgfng de moc cac electron
til cac nguyen til hoac cac phan tii Day la sii ion-hoa Cac
Ung thu Biet sdrnTrj lanh-59
Xo^ndoiDNA Cactebao
Biic xa ion-hoa: cac phan tiif urani be thanh cac phan tuf nhd hon va
cac hat v6 trong te bao ngUori, bin pha nhan te bao va gay ton hai DNA
phan tii ion-hoa trd nen khong ben va nhanh chong gay cac sii thay doi hoa hoc Biic xa di xuyen qua te bao trong
CO the, CO the dila den nhiing dot bien (sii thay doi) trong DNA phan tii mang cac gen Dieu nay c6 the gop phan gay ung thil, hoac gay chet te bao Miic do ton hai trong te bao tuy thuoc lieu lildng biic xa bi tiep nhan Sii ton hai chi xay
ra trong mot phan cua giay, nhilng cac thay doi khac chang han nhil sii khdi dau cua ung thil thi can nhieu nam m6i hinh thanh
Cac biic xa ion-hoa gom cac tia X, cac tia gamma, vai biic xa ciic tim (UV) nang lilctog cao, vai hat nhan alpha
va proton Cac dang nay c6 cac nang lUdng khac nhau va xuyen thau cac te bao v6i miic do khac nhau nhilng deu c6 the gay sii ion-hoa
Trang 3060 - Nguyen Chan Hung
Ung thif ph^i
Tuy^n giap Ung thuf Tuy xrfdng Ung thif mdu
\k suy tang
miln djch
Gilm c&c thdnh phin
ci5a m^u NhiSm nh^
S6't, rung 16ng t6c,
n6n mCca \k ti€u chiy
Tic hai cua ph6ng xa
Blic xa ion-hoa dtfgfc chdng minh la tac nhan gay ung
thU cho con ngildi qua nghien ciiu nhflng ngif6i song sot
sau vu no bom nguyen tii d Nhat, nhflng ngiidi nhiem xa
trong vu no nha may hat nhan Chernobyl, nhflng ngiidi
benh mac ung thif hoac cac benh khac diioc dieu tri bang
blic xa lieu cao, nhflng ngiidi phai nhiem btic xa tai noi lam
viec, cac cong nhan ham mo urani chang ban
Phan 16n cac nghien ciiu moi lien he bijfc xa - nguy cd
ung thif difa tren nhi3ng ngiidi phoi nhiem lieu xa cao Kho
xac dinh nguy cO ung thif tii do nhiem xa thap Tuy nhien
cac nha nghien ciiu va cac cof quan kiem soat an toan biic
xa deu dong y la ngay cac lieu nho cua biic xa ion-hoa cung
Ung thi/BietsdmTrj lanh-61
lam tang nguy co Ung thif cang tang khi miic phoi nhiem v6i lieu biic xa cang cao Miic phoi nhiem cang thap thi miic
nguy CO cang it Nhifng khong c6 Ian miic an toan nao difOc
xac dinh
Cdc loai ung thU lien he
vdi biic xa ion-hoa Biic
xa ion-hoa lam tang nguy
cd va gay ung thif cac loai khac nhau Tuyen giap trang va tuy xifcrng dac biet nhay Ung thif tuyen giap
va benh bach cau (ung thif mau), mot loai ung thif phat xuat tif tuy xifong, la cac loai thifdng gap nhat
Benh bach cau c6 the xuat hien s6m chi vai nam sau nhiem xa Phoi nhiem xa ciing gay cac loai ung thif khac, nhifng thifdng can th6i gian lau hon (thifdng la ttf 10 - 15 nam) Vai loai dang lifu y: ung thif phoi, da, tuy xUOng, vii
va da day Tuoi la yeu to quan trong Co the tre em dang Idn thi nhay xa hon ngif6i trtf6ng thanh
Phong xa hat nhan dac biet c6 2 chat nguy hiem gay ung thif la 1-131 (lot phong xa) va Cesium-137 Khi 1-131 di vao
CO the con ngifdi thi se tich tu tai tuyen giap trang Chat lot
nay ton tai lau ngay se gay nen benh ung thif tuyen giap Chat lot phong xa c6 thdi gian ban hiiy ngan, chi trong vong tif 7 - 20 ngay la c6 the tan bet trong khong gian Chat
Trang 3162 - Nguyen Chan Hung
ph6ng xa manh hdn la Cesium-137 c6 thdi gian ban huy lau
den 30 nam khi phat tan se ton tai trong khong khi nhieu
hang tram nam, phong ra cac tia gamma hai nhieu cO quan
chute nang trong cO the, dac biet tan cong va pha huy cac te
bao non trong tuy xUctog
Cac cuoc thCf nghiem va cac nha may hat nhan
Cac cuoc thii nghiem Chinh phu Hoa Ky tien hanh cac
thi nghiem hat nhan trong long dat d Nam Thai Binh DilOng
va d tieu bang Nevada trong khoang 1945 va 1962 Nhieu
nhan vien quan dpi bi nhiem xa Dan thifdng song gan hoac
diidi hiJcfng gio tiJ cac trung tarn thtf nghiem hat nhan cung
bi nhiem cac chat phong xa Co miic do phong xa cao d cac
nofi nay nhilng cac hat phong xa con Ian vao khong khi va
du hanh rat xa, roi ha canh nhflng noi xa goc hang ngan
dam NhCitng ngifdi lam viec d cac nha may hat nhan thi bi
phc(i nhiem cao hcfn la dan thu6ng, mac dau ho dilpc cham
soc can than
Fukushima dem ph6ng xa ra bien
)ai difdng (mifa, s6ng)
*dem ph6ng xa trd vao Nhat Ban
Ung thU Biet sdm Trj lanh - 63
Cac nha may hat nhan Do gia dau liia
tang cao va ban khoan
ve hieu utng nha kinh,
tif nam 2001 "sU tai
sinh hat nhan" dxiac
dung chi s\i hoi sinh
cong nghe nang liipng hat nhan nham t i m nguon nang liipng
sach Nhieu 16 dang xay d Trung Quoc, Han Quoc, A n Do
va Nga Tham hoa Fukushima lam khiing lai moi thii Mot nhac nhd dau ddn: nang liicrng hat nhan rat mong manh va that dang sgf
Trung Quoc, mfdc tieu thu nang liicrng nhieu nhat the gidfi hien c6 14 nha may dang boat dong va 27 16 phan ling dang xay Dai Loan c6 ba nha may giong nhii nha may
Fukushima, tuoi tho 40 nam, dxiac xay tren dai diiong, cung
cap 20% nang lupng Dai Loan va Nhat nam tren v6ng lufa Thai Binh DifOng Nhat Ban c6 54 nha may hat nhan cung cap 30%, liidng dien toan quoc Hoa Ky 104 nha may hat nhan, tren 31 tieu bang Nang lifdng hat nhan tao ra 20% lupng dien quoc gia Tong thong Obama hifdng ve nang liipng hat nhan, dau c6 tham hoa tai nha may Fukushima Kien tri chien liipc nang lUpng sach
Biic xa hat nhan xuat hien til thanh tifu cua khoa hoc, c6 cong hien 16n lao cho con ngildi, ciing gay khon kho cho con ngiJ6i That la tii con ngiidi, vi con ngii6i va tai con ngU6i
Trang 3264 - Nguyen Chan Hung
Bufcxa cifctim (UV)
Bxic xa U V la tia khong nhin thay, chu yeu den tii mat
trofi Tia U V trong anh nang can thiet cho te bao da tong
hdp vitamin D, nhilng cung gay ung thxi da manh d cac dan
toe CO mau da sang nhii la nhflng ngUdi phdi nang nhieu
Nang liidng tia U V difdc xep trung gian: nhieu hdn anh
sang nhiing it han cac tia X U V thiicrng c6 du nang liidng
de gay ton hai cho DNA trong cac te bao, nghia la c6 the gay
ung thii Nhiing U V khong c6 du nang lilcrng xuyen thau
sau vao cd the, nen chi tac dung tren da
BiJc xa U V de dpa mau da sang, c6 the gay ton hai cho
phan tii DNA, hau qua tram trong la melanom (melanoma),
loai ung thii nguy hiem cua da CI Hoa Ky moi nam khoang
54.000 ngiidi mac melanom va c6 8.000 ngii6i tii vong
Ngiidi My goc Au c6 nguy ca cao nhat, gap miidi Ian ngiidi
My goc Phi Ngifdi Uc va New Zealand d chau Dai Diiong
CO ty le melanom cao nhat the gi6i De hieu thoi: hp mang
mau da sang den vung nhiet ddi rUc nang
Con cac ban khoan
Nguy cd cuagiUdng tao ram da Bao CNiVngay 27.05.2010
diia tin giifcJng tao ram da (dang thinh hanh d My) lam tang
nguy ccr melanom Lam ram da trong nha bang tia U V nhan
tao CO 75% nguy cO melanom hon ngiicfi thiiofng Ca quan
Quan ly Thiic an va Thuoc (FDA) cua Hoa Ky cam tre em
dildi 18 tuoi dung giiidng ram da To chiic Y te The gidi coi
cac thiet bi nay la gay ung thif
Ung thu' Biet sdm Trj lanh - 65
Dien thoai di dong Cho
den nay, cac nghien ciiu khong thay dien thoai d i dong va cac tram thu phat lam tang nguy cd ung thii
Nhiing nhieu nha khoa hoc thay can nhieu nghien
ciiu nfla Biic xa ion-hoa
CO the dUdc dung de diet khudn lam cho thiic an an
toan va d\i trii lau hcfn Nen biet la biJc xa khong ton lai trong thiic an Cac may rd de kiem tra an ninh phi triicJng,
dung tia X rat yeu de lay hinh anh toan than Theo cac quan chijfc M y thi bien phap nay khong gay hai, mac dau c6 nhieu keu reu
Trang 33hong tranh lu xa
1 rang Tii day: "Ngu khong mong m i , thiic chang lo
au, an khong cau ky, hit thd tham sau" Danh y Hoa Da
dan: "Niidc giiia dong ma khong thoi la vi chay luon Con
ngiidi muon cho manh me phai nang van dong" Y nhii
la ngiidi xifa hiidng dan chung ta each song tot va phong
tranh ung thii
Tin nong hoi tii Canada "Lam viec theo ca kip ve dem
hon 30 nam c6 the tang gap doi nguy ca ung thif vii" d phu
nxi lam nganh nghe ban hang, giat nia va trtfc dien thoai
(thang 7 nam 2013) Tni6c do c6 tin tiiOng tif "Xao trpn giac
ngu lam tang gap doi nguy cO ung thii tuyen tien liet d dan
ong 16n tuoi" theo nghien ciiu cua Bac si Sigurdardottir, Dai
hoc Iceland, Reykjavik (07.05.2013)
A i ngd gifl can diing mdc, van dong deu dan, an uong
cho lanh, ngu du ngu ngon giiip tranh ung thif t\i xa
An khong lanh, tap khong deu, ngu khong du
Bung lam da chiu Ung thii va nhieu benh dinh liu tcri nep
song Co so heu tin cay tU Hoa Ky (2010) Dai dich 16 can va
Ung thi/BietsdmTrj lanh-67
beo phi d 72% dan ong va 64% phu nijt chu yeu do an khong
lanh va thieu van dong Beo phi keo theo huyet ap cao, tim mach, tieu diidng va ung thii Khoang 41% dan so M y se
d\i0c dinh benh ung thif trong suot cuoc ddi
Riidu qua da Nhiing ngildi nghien riipu c6 nguy cO gia
tang cac loai ung thii mieng, hong thtic quan va gan Nghien riipu di doi v6i nghien thuoc la thi nguy cO ung thii con gia tang gap bpi Ngiidi ta con nhan thay cac phu nfl chi uong riipu viia phai thoi ciing c6 nguy cO ung thil vii tang len Neu ban thich uong rifpu (bia, vang hoac riipu manh) nen
uong CO dieu dp
Cac loai ung thil lien quan am thUc la ung thii vii (sau man kinh), npi mac t i i cung, rupt gia, than, mieng, hpng, thanh quan va thiic quan
Gidc ngu va ung thu Trcri dat lam ra cho chiing ta mot
dong ho sinh hpc ky dieu theo chu ky anh sang - bong toi cua Trai dat Hon the ky qua, the gidi van minh thanh mot
xa hpi san xuat da lam ngay dai ra va lam dem ngan lai, dong ho sinh hpc bi be gay, melatonin cP the bi xao trpn Con ngifdi nhan het cac tac hai Tii nhiing nam 1990, cac nha khoa hpc da nghi ngd lam viec suot dem giac ngu bi dao Ion, (phong khong du toi, hoac khong du gid ngu) la nguy hai cho siic khoe Nam 2001 cac nha nghien cijtu cua Dai hpc Y khoa Harvard da bao cao la cac dieu difdng lam viec
ca kip ve dem ditdng nhit "c6 tang viia phai (30%) nguy cP ung thii vu" Co ghi nhan hormon melatdnin bi suy giam Nam 2007 Co quan Quoc te Nghien ciJtu Ung thii (lARC) xac dinh "lam viec ca kip ban dem" la mot yeu to gay ung thiJ cho con ngUdi - tiiPng tii tia ciic tim
Trang 3468 - Nguyen Chan Hung Ung thi/BietsdmTrj lanh-69
Ngu du giam nguy cd ung thif ruot gia Ngu diidi 6 gid
moi dem tang 50% nguy cd hi benh polyp ruot gia so v6i
ngu it nhat 7 gid moi dem Polyp neu khong dieu t r i c6 the
chuyen thanh ung thii Co moi lien he vdi liiOng melatonin
thap (Tap chi Cancer 15.2.2011)
Tien si McClain tom gon "Hay van dong tot va ngu cho
du de tranh ung thii" tai hoi nghi quoc te ve phong ngila
ung thii tai thu do Washington (17.11.2008)
GiuT can cho tot, van dong moi ngay
The nao la can nang viia du? Tinh chi so B M I diia vao
moi lien he giiia chieu cao va trong liictog Can glut B M I
diidi 25 Nen ban v6i bac si Dif can, beo phi lam tang nguy
CO nhieu loai ung thii, do cO the san xuat nhieu estrogen
hormon nay kich boat ung thii The due lam giam can dU
thifa, dieu hoa hormon va giiip he mien dich Van dong viia
phai nhii la bach bo, dap xe, lam vifdn, cham soc nha ciia
kem vcri hit thd sau day Tap luyen cat life van dung cO bap giup tim dap nhanh hon, thd hit mau hon sau hon, ra nhieu
mo hoi Khong can cau ky ma phai tap deu moi ngay, it nhat niia gid Tranh ngoi y, nam dai xem T V hay choi game
An cho lanh uong cho sach
Phai biet c6 thiJ ban an lam tang nguy cO ung thif, c6 thii ban
an lam giam nguy co ung thil Nen chon an lanh, chii khong phai an kieng Khong chi tranh ne ung thii, that ra la nang niu
siJtc khoe minh, thay tho thdi hdn chong lai nhieu benh
Ifu tien cho dinh dudng thUc vat gom cac loai rau, trai
tiidi, hot, cu, dau nguyen trang Thiic vat nen chiem phan nvfa hoac hai phan ba biifa an Rau trai chiia it chat beo, nhieu chat xcr va nhieu chat khang ung thii Phan con lai danh cho
ca, thit, tnJng va thiJc an tii suta Rau trai c6 mau dam sang
la cac thiic an khang oxid hoa, che chd tranh ung thif Tdi, gifng, bot ca r i la cac gia vi tot Uong nifdc cho du, chat qui nay kich boat mien dich, dif a chat dinh dUdng khap cO the, riia sach chat doc Tranh cac loai giai khat c6 dUdng Xo la mot phan cua rau trai cu ma cO the khong tieu hoa diloc, lai giiip gifl he tieu hoa lanh sach, loi nhanh cac yeu to gay ung
ra ngoai Khong c6 xo trong thit, ca, diidng, thutc an tif sfla, gao trang va hot Thit rat can cho co the nhiing dung nhieu thit khong phai an lanh Thit chiia nhieu beo gay ung, che bien (nhii qua nong, chay khet) mang them cac chat sinh ung Nen dung ca, thit ga nhieu hon thit do (bd, heo, ciiu) Chon chat beo lanh Tranh md trong thit do, thiic an tii siia Dung dau thiic vat Bdt cac thiic an bun khdi, muoi man,
lam dxia,
Trang 3570 - Nguyen Chan Hung
Hoi Ung thU Hoa Ky c6 hudng dan an uong ngifa ung thii
Bfla an giau thtfc vat, nhieu rau trai, dau cu hot hang ngay
Bdft thit, it beo, it muoi, it diidng Che bien bao quan an
toan It riidu hoac khong Tranh xa thuoc la Tap deu, it nhat
30 phut moi ngay Gixi can tot hoai
Lot song va dinh dudng dephong nguy cd cua mot so loai
ung thii thifdng gap:
Ung thii vii: nen han che uong cac loai nxidc c6 nicru, nen
an nhieu rau qua, tich ctfc van dong cO the va tranh beo phi
Ung thii rupt gia (dai trang): nen dung cac thiJc an
CO nguon goc thiic vat (cac loai rau qua, cac loai hat con
nguyen, cac loai dau) Coi chiing cac thijtc an nhieu md va
cac loai thit do c6 the tang nguy ca ung thii ruot Map phi
va it van dong c6 the tang nguy co bi benh
Ung thif phoi: tranh hut thuoc la va nen an rau qua nhieu
Ian trong ngay
Cac ung thii mieng va thtfc quan: thuoc la, thuoc nhai, bpt
hit va riigfu, diing rieng hoac chung deu lam tang nguy cof cac
loai ung thii d mieng va thvfc quan An nhieu rau qua lam
giam nguy ca Diing hut thuoc la, difng uong nhieu nigfu
Ung thii da day: che do dinh diidng, nhiem vi khuan
Helicobacter pylori va khoi thuoc la c6 anh hiidng den nguy
ca ung thii da day
Chat chiu tuyen tung
Thiic day sau khi ngu day giac, ban thay thcr thdfi, tiioi
tan, day nang liipng Ban c6 biet la ban da dau tii vao viec
ngiia ung thif cho chinh minh?
Ung thU Biet sdmTrj lanh-71
Nang niu tuyen tung
Nang niu dong ho sink hoc Tuyen tung qua (hinh trai
thong), chi Idn cd hot dau, bong dem xuong nha melatonin diia ta vao giac ngu, tdi dinh cao 1-2 gid sang, giam dan tif
5 gid den sang Xao tron giac ngu lam giam liidng hormon
nay Tac hai nang ne Nhieu nghien cviu cho thay melatonin giup cac te bao cua ca the chong lai cac chat oxid hoa, siia
chfla phan tvf DNA, tii do kem che cac te bao ung thU, con giiip he mien dich tang san xuat cac te bao diet ung thii
Giac ngu la mot phan cua ddi song Trung tarn Phong
Chong Benh (CDC) cua Hoa Ky nhan dinh "Thieu ngu di v6i benh tat Giac ngu khong phai la dieu xa xi - Do la dieu thiet yeu quyet dinh cho siic khoe tot" Thieu ngu lam ddi song ngan lai, gia tang benh tim mach, dot quy, tieu diidng, huyet ap, beo phi, tram cam Quy lam sao giac ngu du Nay lai biet them giac ngu c6 the giiip tranh ung thil
Ve sinh giac ngu Thdi buoi nay giac ngu thiidng diicfc
coi la phi pham Nen ngu 7-8 gic( / dem Triidc ngu tranh
an no Phong ngu cang toi cang tot Giii mat nhiet do trong
Trang 3672 - Nguyen Chan Hung
phong Difng dung dong ho re Idn qua Tap thoi quen len
giildng em a, tranh xa riiou, ca phe buoi toi, kem long triicfc
cuon sach hay phim T V hap dan Tranh may vi tinh triidc
ngu it nhat 1 giof De qua ben cac au lo cho sang hom sau
Ngu diing gi6 moi dem, thiic cung gid moi sang Buoi sang
phdi nang mot chiit, dong ho sinh hoc can anh sang de tvf
dieu chinh Mot dem ngon giac don san cho cac thoi quen
tot khac: hang hai tap the due, khong can nxidc ngot trcf luc,
khoi nhd ca phe cho tinh ngiidi
Van dong cho deu, an uong cho Idnh con phdi nang niu
giac ngu nUa thi phong tranh ung thu mdi that tot
Cung nhau lam nhe ganh nang ung thu
U n g thii la do con ngiidi Phong tranh diicfc 40% Co
the phong tranh nhd da biet nhieu nguyen nhan gay benh
Dai dick ung thU do thuoc la CMa han 60% chat gay ung
thu (carcinogen), khoi thuoc la khong chi hai ngiidi nuot khoi ma ca nhxing ngiidi hit khoi ke, gay ra han 15 loai ung
thii, khong chi d phoi, mieng, hong, thanh quan ma con tang nguy ca ung thii d da day, tuy tang, bong dai, ruot, thiic
quan, vu va c6 tii cung Cii ba ngiidi bi ung thii thi mot ngiidi la do hut thuoc la
Benh nhiem lam ganh nang them 20% cac ung thii lien
quan den benh nhiem Viem gan do virut HBV va HCV lau ngay dan den ung thii Cac virvit HPV gay ra nhieu ung thii,
dac biet la ung thil c6 tU cung Vi khuan H pylori c6 the gay
ung thif da day
Benh theo mieng ma vdo lARC (Ca quan Quoc te
Nghien ciiu Ung thil) lidc tinh, an uong khong lanh gay 1/3 ganh nang ung thii Thiic an muoi man, hun khoi, che do
Trang 3774 - Nguyen Chan Hung
an nhieu thit do, md beo, it an rau qua tuoi, it van dong,
fastfood va beo phi lam tang nguy ca, dac biet ung thif da
day, diidng ruot, v u
Cac yeu to nguy cd hat tay nhau Viriit HBV, HCV, bia
rifgfu va aflatoxin lien thu tan pha la gan Xoan khuan H
pylori, khoi thuoc la, thiic an muoi man "danh hoi dong" da
day H I V gay suy giam mien dich tao thdi ca cho sarcom
Kaposi, lymphom moc len
4 0 % so ngUdi mac ung thU
le ra c6 the phong ngCra dUofc
Do la dieu ma Hiep hoi Quoc te chong Ung thii nhan
gdi moi ngifdi tren hanh tinh vao nam 2010 Phai khai thac
cac nguy ca va khuyen khich moi ngiidi theo nep song lanh
manh, loai bo khoi thuoc la, tranh uong riicJu qua da, phong
Ung thLf Biet sdmTrj lanh-75
tranh benh nhiem, tap the due deu, an diing an lanh, gifl can viia phai Ngiia benh c6 tiem nang 16n nhat, hieu qua va lau dai trong cupc chien chong ung thii Cac ung thU phoi, gan, da day kho tri, nhifng c6 the phong tranh tot Nen lifu
y phong benh v6i vacxin (chong HBV va HPV), quan he tinh due an toan, bao quan thiic an dung, bo thoi quen an
ca song, dung cac san pham mau an toan Tiem vacxin ngiia
HPV, xet nghiem dieu t r i H pylori Tich c\ic phong ngila
cac benh nhiem nay trifdc khi chung gay ung thii
Phong ngCra cac benh thUcfng gap
Phdng tranh ung thU gan Phai tranh xa hai
viriit viem gan HBV/
HCV nhii tranh xa AIDS Cac viriit nay lay Ian tii ngiidi sang ngiidi qua difdng mau (truyen
HIV-mau, tiem chich kim da)
hoac do quan he tinh due
Tre so sinh c6 the bi lay tii
me Tranh quan h? tinh due khong an toan Tiem thuoc phai diing kim v6 trung Coi chifng khi xam tham my chan may hay xam hinh tren da, x6 16 tai, 16 mui de deo bong
Nang niu la gan
Co thuoc dieu trj viem gan BviC
Tiem chung HBV moi lijfa tuoi ChUa CO vicxin ngiTa HCV
Cknh giac aflatoxin va HBV, rUOu
vk HCV
Trang 3876 - Nguyen Chan Hung
Da CO thuoc tri hieu qua HBV, chung ngila HBV Tre em
nen dxiac tiem chung that s6m, mdi sinh den 1 tuoi HCV
mdi CO thuoc tri, chiia c6 vacxin
Phdng chong tdc hai thuoc Id vd ung thUphoi Nhieu nvidc
thUc hien cac bien phap: phap lenh phong chong thuoc la,
tang thue tren gia thuoc, cam quang cao thuoc la va cam
hiit thuoc ncri cong cpng, thiet lap cac diem tii van bo thuoc,
giao due tac hai thuoc la trong hoc difofng
NgUng hiit lam giam cac ton thiiPng tien ung thii va
giam dan nguy cP ung thif phoi Moi ngiidi phai biet lo cho
minh va gia dinh va dilng quen nhiJng ngvfdi quanh minh
Tao moi trildng sach khoi thuoc la chia khoa giam nhe ung
thii phoi, sat thvi can ke cua loai ngUdi
Phong trdnh ung thU da day Xet nghiem H pylori de c6
xi£ ly thich hpp An lanh: Nhieu rau trai cu tUPi Tranh che
dp an muoi man Tranh xa khoi thuoc la
Ung thi/BietsdmTrj lanh-77
rau trai tUori Xet nghiem H pylori Clim thuoc
Ldi khuyen phdng trdnh ung thU vu GiU can dung - The due deu dan Khong can qua tich cifc va qua nha nghe ma
can deu dan moi ngay D i bp, bPi Ipi, yoga, thai c\ic quyen, theo phiJPng phap diiSng sinh Nguyen Van Hiidng Song
vui Ngu du 7-8 gid/ngay Giam au lo trong cupc song
Thiidng xuyen thii gian Vui song trong gia dinh, vcfi be
ban Nep song dung rifpu it thoi, tranh khoi thuoc An lanh
nhieu rau qua, it beo, it thit
Trang 3978 - Nguyen Chan Hung
TU khdm de hieu ro bo ngvfc minh Can biet each W
kham vu de ra tim mot hot nho trong vii hoac cac dau hieu
khac Ttf kham khong giiip tranh ung thii vu, nhiing giup
hieu ranh s\i thay doi binh thiidng va s6m thay nhiJng cai
gila la
Phong ngiia va phdt Men sdm ung thu mot gid Phong
ngiCa: can doi che do an va nep song Che do an lanh nhieu
rau trai tiioi, it beo va nhieu chat xo, it thit do c6 the lam
giam nguy cO ung thii ruot
B()t thit do, Ixnthitc&nche'bi&n
Dirng u^ng rtf^u
Giam, phan nufa
Cit p61yp ru$t
Rd tim hang ndi soi ruot Ti le txi vong do ung thii dai triic
trang da giam xuong trong nhflng nam gan day Do la nhd
s\i tang them canh giac va ra tim sdm bang noi soi ruot
Ung thu'Biet sdm Tri lanh-79
Ong soi mem c6 the phat hien cac ung thii d giai doan
sdm nhat, nhd do chiJa khdi benh TU tuoi 50, dan ong va phu nil nen ra tim A i cd nguy co cao thi nen xet nghiem
sdm hon Khi soi cd the thay mot hoac vai choi thit cd cuong goi la polyp lanh Cat bd cac polyp nay la phdng ngiia hieu qua ung thu:
Polyp ruot
Polyp Ncp ruol Ong soi rugl
Phdng ngiia ung thU c6 tvC cung bang vdcxin Co hai loai
vacxin ngila HPV Gardasil, phdng ngifa bon typ: HPV 16
-18 (gay ung thif c6 tvf cung) va HPV 6 - 1 1 (gay cac biidu
nhii sinh due lanh), dung cho be gai va phu nut tif 9 - 26 tuoi
Cervarix ngiia HPV
16 - 18 Cervarix
difOc dung cho be
gai va phu nfl til 10
- 25 tuoi Hai loai
vacxin deu cd hieu qua vdi HPV 16 -
18 trong viec ngiia
VScxin ngira HPV duofc tiem cho be gai ung thll CO tii CUng,
Trang 4080 - Nguyen Chan Hung
nghia la 70% Tiem du ba lieu trong sau thang Vacxin c6
hieu qua nhat neu diing cho cac thieu niJ trifdc khi bat dau
quan he tinh due trong ddi Nen biet dau c6 tiem vacxin
diing each thi cung c6 30% lot liidi vi con cac typ HPV khac
HPV 16-18 gay ung thii c6 tii cung thi cac vacxin nay bo tay
Nen nh6 dau c6 tiem vacxin du lieu cung phai kham phu
khoa dinh ky va xet nghiem Pap
Xet nghiem PAP
ChUdng 3 Lam sao djnh bf nh
Thay thuoc ngay nay nhUco m6t than Ngi sol la diing ong soi mem di/a vao hong, thanh quan, cuong phoi, dg day, rugt, giup thay thuoc tim ra vet loet Dau do sieu am giup thay dugc bitdu ben ngoai hogc trong ngitdi Cac thiet bi tan ky nhUcdt Idp dien toan (CT), cgng hUdng tCf(MRI), PET cho biet khoi bifdu ndm dau trong cOquan nao
RdtdepddiCTvaMRI CTbSt dau sCf dung nam 1972,bdy nam sau Cormark va Hounsfield nhgn gidi Nobel Chdng bao lau sau, Peter Mansfield vao cugc, MRI ra ddi vao dau thgp nien 1980
Lautebur va Mansfield di/gc trao gidi Nobel Yhgc 2003
Do Dau hieu sinh hgc budu {diing chung vdiX-quang hogc cac xet nghiem khac) c6 the giup phat hien va chan dodn mot sologi ung thu Quan trgng la chido Dau hieu sinh hgc bitdu thi khdng dit
de chan dodn benh Chan doan ung thUgan nhuluon luon dUa vao viec khdo sat mau te bao hogc mau mo bang kinh hien vi Lay mot mau (ti'bao
hogc mo) de thCfggi la sinh thiet
1 Lam sao biet sdm ung thw
2 Lam the nao dinh benh ung thu
3 Ngi soi, sieu am giup ra benh
4 Thay thuoc nhif CO mat than
5 Thutmdu biet dugc ung thu?
6 Sinh thiet dinh benh chinh xac nhat