NH THUC NG Y GIA TRUYN TH XUN NG K lc Guiness nh thuc ng y gia truyn nhiu i nht Vit Nam

Cha bnh ung th hiu qu bng phng php p dng quy lut sinh hc v y hc mi trng ca Nam y ti Th Xun ng.

UNG TH TUYN GIP1. Khi nim u tuyn gip l gTuyn gip l mt tuyn nm c. C hai loi t bo sn xut hormon. Cc t bo nang (cc t bo to thnh cc hnh ti nh hay cn gi l nang tuyn) sn xut hormon tuyn gip, n nh hng n nhp tim, nhit v mc nng lng ca c th. Cc t bo C sn xut calcitonin, mt hormon gip kim sot mc calci trong mu.

Tuyn gip hnh con bm, nm trc c, bn cnh hp thanh m. N c hai phn hoc hai thu. Hai thu phn cch nhau bi mt phn mng gi l eo.

Tuyn gip thng khng th s thy qua da. Mt thu gip sng to c th nhn thy hay s thy nh mt cc trc c. Tuyn gip sng to c gi l bu gip. Phn ln cc bu gip sinh ra do khng iod trong thc n. Iod l mt cht tm thy trong loi gip xc (s, tm, cua) v mui iod.

Tm hiu v ung th tuyn gip l gUng th l mt nhm nhiu bnh lin quan. Tt c cc ung th bt u trong cc t bo, n v sng c s ca c th. Cc t bo to nn cc m v cc m to nn cc c quan ca c th.

Bnh thng cc t bo phn chia v to thnh cc t bo mi khi c th cn n chng. Khi cc t bo gi v cht, cc t bo mi thay th chng.

i khi qu trnh c trt t ny b sai st. Cc t bo mi hnh thnh khi c th khng cn chng v cc t bo gi khng cht khi l ra chng phi cht. Cc t bo tha ny to thnh mt khi m c gi l u. U tuyn gip c gi l nhn u.

Cc nhn u tuyn gip c th lnh tnh hay c tnh:

- Cc nhn u lnh tnh khng phi l ung th. Cc t bo t cc nhn u lnh tnh khng lan trn ti cc phn khc ca c th. Chng khng e do n i sng. Hu ht cc nhn u ca tuyn gip (trn 90%) l lnh tnh.

- Cc nhn tuyn gip l ung th. Chng thng nghim trng hn v c th e do n i sng. Cc t bo ung th c th xm nhp v ph hu cc m v cc c quan gn. ng thi cc t bo ung th cng c th tch khi cc nhn u c tnh xm nhp vo dng mu v h thng bch mch. l l do v sao ung th c th lan trn t ung th ngun gc (u nguyn pht) to thnh mt u mi trong cc c quan khc. S lan trn ca ung th c gi l di cn.

2. Di y l cc dng chnh ca bnh ung th tuyn gip- Ung th biu m nh v nang chim ti 80 n 90% tt c cc ung th tuyn gip. C hai loi bt ngun t cc t bo nang ca tuyn gip. Hu ht cc ung th nh v nang c xu hng pht trin chm. Nu chng c pht hin sm, hu ht c th c iu tr c hiu qu.

- Ung th tuyn gip th tu chim 5 n 10% cc trng hp ung th tuyn gip. N pht sinh t cc t bo C, khng phi t cc t bo nang. Ung th tuyn gip th tu c th d dng kim sot nu n c tm thy v iu tr trc khi n lan trn ra cc phn khc ca c th.

- Ung th tuyn gip mt bit ho l loi ung th tuyn gip t ph bin nht (ch chim 1 - 2% cc trng hp). N pht sinh trong cc t bo nang. Cc t bo ung th bt thng cao v kh nhn bit. Loi ny ca ung th rt kh kim sot v cc t bo ung th c xu hng pht trin v lan trn rt nhanh.

Nu ung th tuyn gip lan trn (di cn) ra ngoi tuyn gip, cc t bo ung th c tm thy gn hch bch huyt, dy thn kinh hoc cc mch mu. Nu ung th xm nhp c vo cc hch bch huyt, cc t bo ung th cng c th lan trn ti cc hch bch huyt khc hoc ti cc c quan khc nh phi hoc xng.

Khi ung th lan trn t mt v tr ngun gc (ban u) ti mt phn khc ca c th, u mi c cc t bo bt thng cng loi v cng tn vi u nguyn pht. V d nu ung th tuyn gip lan trn ti phi, cc t bo ung th phi l t bo ung th tuyn gip. Bnh l ung th tuyn gip di cn, khng phi l ung th phi. N c iu tr nh mt ung th tuyn gip, khng phi nh mt ung th phi. i khi cc bc s gi u mi l "bnh xa" hoc bnh di cn.

3. Ai c nguy c mc ung th tuyn gip?

Khng ai bit cc nguyn nhn chnh xc ca ung th tuyn gip. Cc bc s khng bao gi ct ngha c v sao ngi ny mc bnh v ngi khc khng mc bnh. Tuy nhin r rng l ung th tuyn gip khng ly. Khng ai c th ly nhim ung th t mt ngi khc.

Cc nghin cu va chng minh rng nhng ngi c mt s yu t nguy c d pht sinh ung th tuyn gip hn nhng ngi khc. Yu t nguy c l mt ci g lm tng c hi ca mt ngi pht sinh bnh.

Nhng yu t nguy c di y kt hp vi tng c hi pht sinh ung th tuyn gip:

- X tr: Nhng ngi phi nhim vi cc mc cao ca tia x d b pht sinh ung th nh hoc nang tuyn gip hn nhng ngi khc.

Mt ngun quan trng ca nhim x l iu tr bng tia X. Gia nhng nm 1920 v 1950, cc bc s s dng tia X liu cao iu tr cc tr em c a-mi-an xng to, mn trng c v cc vn khc nh hng n vng u v c. Sau ny, cc nh khoa hc tm thy rng mt s ngi c iu tr theo hnh thc ny pht sinh ung th tuyn gip. Cc tia X c s dng chn on thng quy nh chp phim X quang rng, chp phim lng ngc s dng mt liu rt nh tia X. Li ch ca n thng vt xa rt nhiu so vi cc nguy c. Tuy nhin phi nhim nhc li c th co hi, v vy mt tng tt cho mi ngi l hy hi nha s v bc s ca mnh v yu cu cho mi ln chp X quang v ngh s dng cc trng che (shield) bo v cc phn khc ca c th.

- Mt ngun bc x khc ca c th l bi phng x. Ngun bi phng x ny c th t cc v th v kh ht nhn (nh cc v th v kh ht nhn M v cc ni khc ch yu trong nhng nm 1950 v 19600, tai nn ca nh my in nguyn t (nh v n nh my in nguyn t Cher-no-byl nm 1986 Lin x c) hoc bi phng x thot ra t nh my ch to v kh ht nhn (nh nh my Hanford bang Washington vo cui nhng nm 1940. Cc bi phng x ny c cha iod phng x (I-131). Nhng ngi phi nhim vi mt hay nhiu ngun I-131, c bit, nu l tr em vo thi im phi nhim c th tng nguy c vi bnh tuyn gip.

- Lch s gia nh. Ung th biu m tuyn gip th tu c th gy nn do mt bin i hoc tn hi trong mt gen gi l RET. Gen RET b tn hi c th c truyn t b m cho con. Hu nh mi ngi c gen RET b tn hi s pht sinh ung th tuyn gip th tu. Mt xt nghim mu c th pht hin c gen RET b tn hi. Nu mt gen RET b tn hi c pht hin mt ngi ung th biu m tu tuyn gip, bc s c th gi cc thnh vin trong gia nh xt nghim gen RET. Vi nhng ngi c mang gen RET bin i, bc s c th yu cu xt nghim thng xuyn hoc phu thut ct b tuyn gip trc khi ung th pht sinh. Khi ung th tuyn gip th tu xy ra trong mt gia nh, bc s c th gi y l "ung th tuyn gip th tu gia nh" hoc "hi chng nhiu u ni tit" (hi chng MEN). Nhng ngi c hi chng MEN c xu hng pht sinh mt s loi ung th khc.

Mt s nh nhng ngi c lch s gia nh mc bnh bu gip hoc mt s po-lyp tin ung th i trng c nguy c pht sinh ung th tuyn gip th tu.

- L ph n. Ti M, ph n c nguy c mc ung th tuyn gip cao hn nam gii t 2 n 3 ln.

- Tui. Hu ht cc bnh nhn ung th tuyn gip tui trn 40. Nhng ngi vi ung th tuyn gip mt bit ho thng trn 65 tui.

- Chng tc. Ti M, nhng ngi M ngun gc chu Phi thng b ung th tuyn gip nhiu hn.

- Khng iod trong ch n. Tuyn gip cn iod sn xut hormon ca mnh. Ti mt s nc v Vit nam iod c b sung vo mui bo v ngi dn khi b bnh tuyn gip. Ung th tuyn gip hnh nh t ph bin hn nhng nc iod khng l mt phn ca khu phn n.

- Nhiu ngi c cc yu t nguy c bit khng b ung th tuyn gip. Tri li nhiu ngi mc ung th tuyn gip nhng khng c bt k yu t no trong cc yu t nguy c ny. Nhng ngi ngh rng mnh c nguy c pht sinh ung th tuyn gip c th trnh by nhng bn khon ca mnh vi bc s. Bc s c th gi cc phng php lm gim nguy c hoc c th lp cc k hoch thch hp kim tra.

4. Cc triu chng ca ung th tuyn gipUng th tuyn gip sm thng khng gy cc triu chng. Tuy nhin khi bnh pht trin, cc triu chng c th bao gm:

Mt u hay mt nhn trc c vng tuyn gip.

Ging khn hoc kh ni ging bnh thng.

Hch bch huyt xng to, c bit l cc hch c.

Kh nut hoc kh th.

au hng hoc c.

Cc du hiu ny khng phi l du hiu chc chn ca ung th tuyn gip. Mt nhim trng, mt bu gip lnh tnh hoc mt vn khc cng c th gy nn cc triu chng ny. Mt ngi no c cc triu chng ny cn i khm bc s cng sm cng tt. Ch c bc s mi c th chn on v iu tr cc biu hin bnh ny.

6. Chn on ung th tuyn gipNu mt ngi c cc triu chng gi ung th tuyn gip, bc s c th thc hin khm thc th v hi v lch s bnh ca c nhn bnh nhn v gia nh. Bc s cng c th ch nh cc xt nghim hoc cc th nghim chn on hnh nh c cc hnh nh ca tuyn gip v cc vng khc.

Vic khm v xt nghim c th bao gm:

- Khm thc th. Bc s s s vng c, tuyn gip v cc hch c pht hin nhng pht trin (nhn u) hoc xng to bt thng.

- Cc xt nghim mu. Bc s c th xt nghim cc mc bt thng ca hormon kch thch tuyn gip TSH trong mu. TSH cng kim sot cc t bo ca tuyn gip nhanh nh th no.

Nu mt ung th tuyn gip th tu b nghi ng, bc s s kim tra mc cao bt thng ca calci trong mu. Bc s cng c th ch nh cc xt nghim mu pht hin gen RET bin i hoc tm mc cao ca calcitonin.

- Siu m

My siu m s dng sng m con ngi khng nghe thy c. Cc sng dch chuyn qua tuyn gip v mt my vi tnh s dng cc m ny to nn hnh nh gi l siu m . Trn hnh nh ny, bc s c th nhn thy c bao nhiu nhn u trong tuyn gip, chng ln bng no v liu chng l c hay cha y dch bn trong.

- Qut hnh y hc ht nhn

Bc s c th yu cu xt nghim qut hnh y hc ht nhn. Phng php ny s dng mt lng rt nh vt liu phng x lm cho cc nhn u tuyn gip hin hnh trn nh. Cc nhn hp th t cc vt liu phng x hn m tuyn gip xung quanh gi l nhn lnh. Cc nhn lnh c th lnh tnh hay c tnh. Cc nhn nng hp th nhiu cc vt liu phng x hn m tuyn gip xung quanh v thng l lnh tnh.

- Sinh thit

K thut ly m tm t bo ung th gi l sinh thit. Sinh thit c th cho bit ung th, nhng thay i m dn n ung th v cc bnh khc. Sinh thit l phng php duy nht bit liu mt nhn u c phi l ung th khng.

Bc s c th ly m bng kim hay trong khi phu thut:

Ht kim nh: Vi nhiu bnh nhn, bc s ly mu m t nhn u tuyn gip bng mt kim nh. Bc s gii phu bnh (bc s bnh hc) quan st cc t bo di knh hin vi tm ung th. i khi bc s s dng my siu m hng dn kim vo nhn u.

Sinh thit phu thut: nu mt chn on khng th thc hin c bng ht kim nh, bc s c th m ly nhn u. Sau bc s gii phu bnh s kim tra m ny tm cc t bo ung th.

Mt ngi cn lm sinh thit c th hi bc s cc cu hi di y hiu r hn v sinh thit:

Loi sinh thit no s c thc hin cho ti?

Sinh thit ko di bao lu? Ti c b au khng?

Ti c so trn c sau khi sinh thit khng?

Ti s c kt qu sm khng? Ai s ct ngha kt qu cho ti?

Nu chng may ti b ung th, ai s ni vi ti v k hoch iu tr?

7. Giai on bnh ung th tuyn gipNu mt chn on tuyn gip l ung th, bc s cn bit giai on bnh (hay s lan trn ca bnh) lp k hoch iu tr mt cch tt nht. Xc nh giai on l mt vic lm thn trng bit liu ung th lan trn cha v nu lan trn th ung th lan trn ti phn no ca c th.

Bc s c th s dng siu m, chp cng hng t ht nhn (cn gi l MRI) hoc chp ct lp vi tnh (cn gi l CT) tm hiu liu ung th lan trn n hch bch huyt hoc cc vng khc c cha. Bc s cng c th s dng quyt hnh y hc ht nhn ton c th, chng hn nh "quyt hnh ton c th bng I-131 chn on" hoc cc xt nghim chn on hnh nh khc bit liu ung th tuyn gip lan trn ti cc v tr xa ca c th cha.

8. iu tr ung th tuyn gipNhng ngi mc ung th tuyn gip thng mun tham gia tch cc vo cc quyt nh chm sc sc kho cho mnh. H mun bit tt c nhng iu h c th bit v bnh ca mnh v s la chn tt nht cho vic iu tr bnh. Tuy nhin c sc v sang chn tinh thn mnh sau khi bit mnh c chn on l ung th thng lm cho h kh c th ngh v mi iu h mun hi bc s. Thng bnh nhn nn ghi trc cc cu hi mnh mun hi bc s. gip nh c bc s ni g, bnh nhn c th ghi li hoc nu c iu kin bnh nhn c th xin php bc s ghi m li nhng iu bc s gii thch. Mt s bnh nhn mun c mt thnh vin gia nh hoc mt ngi bn cng c mt khi h ni chuyn vi bc s tham gia vo vic tho lun ghi chp hoc cng nghe.

Bc s c th gi bnh nhn n cc bc s ung th hc chuyn v iu tr ung th hoc bnh nhn c th hi cc trung tm t vn. Cc chuyn gia iu tr ung th bao gm cc bc s ngoi khoa, cc nh ni tit hc (chuyn iu tr cc bnh tuyn ni tit), cc nh ung th hc ni khoa (cc bc s chuyn iu tr bnh ung th bng thuc) v cc nh ung th hc x tr. iu tr thng bt u vi tun sau chn on. Lm nh vy c thi gian bnh nhn hi bc s v vic la chn bin php iu tr, nghe thm mt kin th hai v hc hi nhiu hn v ung th tuyn gip.

- Nghe thm mt kin th hai

Trc khi bt u iu tr, bnh nhn nn nghe mt kin th hai v chn on v k hoch iu tr bnh. Cch tt nht l tham kho kin ca mt bc s gii phu bnh v mt bc s chuyn v ung th hc. Bc s gii phu bnh c th gip bnh nhn hiu r thm v cc th gii phu bnh ca bnh ung th tuyn gip v tin trin ca tng th bnh. Cng vic ny i hi mt t thi gian. Trong nhiu trng hp, s chm li mt thi gian ngn khng lm vic iu tr km hiu qu hn.

- Chun b cho vic iu tr

Bc s c th gii thch cho bnh nhn vic la chn bin php iu tr v cc kt qu hy vng t c vi tng cch iu tr. Bc s v bnh nhn c th cng hp tc lp mt k hoch iu tr ph hp vi yu cu ca bnh nhn.

Vic iu tr ph thuc vo mt s yu t, bao gm loi (gii phu bnh) ung th tuyn gip, kch thc ca nhn u, tui ca bnh nhn v liu ung th lan trn hay cha.

C mt s cu hi bnh nhn c th mun hi bc s:

Loi ung th tuyn gip no ti mc?

Ung th lan trn cha?

Bnh ca ti thuc giai on no?

Ti c cn lm thm cc xt nghim kim tra s lan trn ca bnh khng?

Nhng kh nng la chn trong iu tr ca ti l g? Ai c th c vn cho ti? V sao?

Li ch ca mi loi iu tr l g?

Cc nguy c v cc tc dng ph ca mi loi iu tr l g?

iu tr tn km khong bao nhiu? Bo him y t c thanh ton tin cho ti khng?

Vic iu tr s nh hng n cc hot ng bnh thng ca ti nh th no?

Bnh nhn cng khng nht thit phi hi bc s tt c cc cu hi hoc hiu tt c cc cu tr li ca bc s mt ln. H s cn c cc c hi khc hi bc s nhng iu h cha r trong nhng ln gp trc v hi nhiu thng tin hn.

Cc phng php iu tr

Bnh ung th tuyn gip c nhiu cch iu tr. Ph thuc vo loi gii phu bnh v giai on, ung th tuyn gip c th c iu tr bng phu thut, iod phng x, iu tr bng hormon, x ngoi hoc ho tr. Mt s bnh nhn c iu tr kt hp.

Bc s l ngi trnh by tt nht cc phng php iu tr chn lc v tho lun v cc kt qu hy vng t c.

Phu thut l phng php iu tr ph bin nht vi ung th tuyn gip. Phu thut vin ct b mt phn hay ton b tuyn gip. Loi phu thut ph thuc vo loi v giai on bnh ca ung th tuyn gip, kch thc u v tui ca bnh nhn.

Ct tuyn gip ton b - Phu thut ly ton b tuyn gip c gi l ct tuyn gip ton b. Phu thut vin ly tuyn gip qua mt ng rch c. Cc hch bch huyt e gn cng c ly i. Nu bc s gii phu bnh tm thy cc t bo ung th trong cc hch, iu c ngha l bnh c th lan trn ra cc phn khc ca c th. Trong mt s nh cc trng hp, bc s ly cc m khc c b ung th xm nhp. Mt s bnh nhn c m ct tuyn gip ton b cng c dng iod phng x hoc x tr ngoi.

Ct b thu tuyn - Mt s bnh nhn ung th tuyn gip th nh v th nang c th c iu tr bng ct b thu tuyn. Thu tuyn c nhn ung th c ct b. Bc s phu thut cng c th ly mt phn m gip cn li hoc cc hch bch huuyt gn. Mt s bnh nhn c ct b thu tuyn cng c iu tr bng iod phng x hoc phu thut b sung ly m tuyn gip cn li.

Gn nh tt c cc bnh nhn c m ct mt phn hoc ton b tuyn gip c dng vin hormon tuyn gip thay th hormon t nhin.

Sau phu thut ln u, c th bc s cn m li vng c v ung th lan trn. Cc bnh nhn c tin hnh cc phu thut ny c th c c iu tr bng iod 131 (I-131) hoc x tr ngoi iu tr ung th tuyn gip lan xa.

Mt s cu hi bnh nhn c th mun hi bc s trc khi phu thut;

Loi phu thut no ti s c p dng?

Ti s cm thy nh th no sau phu thut?

Bc s s lm g cho ti nu ti b au?

Ti s phi nm li trong bnh vin trong bao nhiu lu?

Ti s c cc nh hng lu di?

Khi no ti c th tr li hot ng bnh thng?

So m ca ti s nh th no?

Ti c c hi c cha khi hon ton khng?

Ti c cn dng vin thuc hormon tuyn gip khng?

Ti cn i kim tra thng xuyn nh th no?

iu tr iod phng x s dng iod phng x (I-131) ph hu cc t bo ung th mi ni trong c th. iu tr thng c dng theo ng ming (dung dch hoc vin nang) vi liu nh khng gy tc dng ph cho nhng ngi d ng vi iod. Sau khi c hp thu rut, I-131 i theo ng mu v c tp trung trong cc t bo tuyn gip. Cc t bo ung th cn li vng c v cc t bo ung th lan ra cc phn khc ca c th b git khi chng hp th I-131.

Nu liu I-131 thp, bnh nhn thng c iu tr ngoi tr bng I-131. Nu liu I-131 cao, bc s c th bo v cc ngi khc khi b nhim x bng cch ly bnh nhn trong bnh vin trong thi gian iu tr. Hu ht cc phng x din ra trong mt vi ngy. Sau ba tun ch cn li cc vt iod phng x cn li trong c th.

Cc bnh nhn mc ung th tuyn gip th tu hoc ung th tuyn gip mt bit ho n chung khng c iu tr bng I-131. Cc loi ung th tuyn gip ny him khi p ng vi iu tr bng I-131.

iu tr ni tit t. iu tr ni tit t sau phu thut thng l mt phn ca k hoch iu tr cc ung th nh v nang. Khi bnh nhn ung vin hormon tuyn gip, s pht trin ca cc t bo ung th tuyn gip cn li, iu lm chm nguy c bnh ti pht tr li.

Sau phu thut hoc sau iu tr bng I-131 (ct b hoc ph hu m tuyn gip), cc bnh nhn vi ung th tuyn gip c th cn dng vin hormon tuyn gip thay th hormon tuyn gip t nhin.

Bnh nhn c th hi cc cu hi di y v iu tr bng iod phng x hoc iu tr hormon:

V sao ti cn loi iu tr ny?

iu tr s c tin hnh nh th no?

Ti c cn li trong bnh vin iu tr khng?

iu tr ny c gy tc dng ph khng? Ti phi lm g vi cc tc dng ph nay?

iu tr ny s ko di bao lu?

Ti s cn kim tra nh th no?

X tr ngoi. X tr ngoi s dng cc tia X nng lng cao git cc t ab ung th. Mt my ln s hng cc tia phng x vo vng c hoc vo cc vng ca c th c ung th lan trn.

X tr ngoi l iu tr ti ch. N ch tiu dit cc t bo ung th vng c iu tr. X tr ngoi c s dng ch yu iu tr cho nhng ngi ung th tuyn gip giai on mun khng p ng vi iu tr bng iod phng x. x tr ngoi, bnh nhn phi i n bnh vin, thng 5 ngy mt tun trong nhiu tun. X tr ngoi cng c s dng lm gim au hoc cha cc triu chng khc.

y l mt s cu hi bnh nhn c th mun hi bc s trc khi x tr bt u:

V sao ti cn phi x tr?

Khi no iu tr bt u? Khi no vic iu tr s kt thc?

Ti s cm thy nh th no trong khi iu tr?

Lm th no bit x tr ang c tc dng?

Ti c th tip tc hot ng bnh thng ca mnh trong qu trnh iu tr hay khng?

Ti cn c kim tra thng xuyn nh th no?

Ho tr - Ho tr, dng thuc git cc t bo ung th, i khi c s dng iu tr ung th tuyn gip. Ho tr (cn gi l iu tr ho cht) c bit l mt iu tr h thng v thuc i vo dng mu v i khp c th. Vi mt s bnh nhn ho tr c th kt hp vi x tr ngoi.

Bnh nhn c th mun hi cc cu hi di y v ho tr:

V sao ti cn loi iu tr ny?

Vic iu tr s c thc hin nh th no?

Ti s c cc tc dng ph khng? Ti c th lm g vi cc tc dng ph ny?

Vic iu tr s ko di bao lu?

Ti cn kim tra thng xuyn nh th no?

Cc tc dng ph ca iu tr ung th

V iu tr ung th c th lm tn thng cc t bo v m lnh, cc tc dng ph khng mong mun i khi xy ra. Cc tc dng ph ny ph thuc vo nhiu yu t, bao gm loi v s m rng ca iu tr. Cc tc dng ph ca mt iu tr ung th khc nhau vi mi ngi v thm ch chng c th khc nhau t ln iu tr ny so vi ln iu tr tip theo. Trc khi bt u iu tr, cc bc s c th ct ngha cc tc dng ph c th c v hng dn cc phng php eer gip bnh nhn x l cc tc dng ph ny.

Phu thut

Bnh nhn thng khng thoi mi trong nhng ngy u sau iu tr. Tuy nhin c th dng thuc lm gim au. Bnh nhn c th ngh bc s hoc cc iu dng vin c iu tr gim au. Bnh nhn cng thng cm thy mt mi v yu. Thi gian hi phc sau phu thut thay i theo tng bnh nhn.

Sau phu thut ct b tuyn gip v cc m v cc c quan gn, chng hn nh cc tuyn cn gip, cc bnh nhn c th cn dng thuc (hormon tuyn gip) hoc vitamin v cc cht b sung mui khong (vitamin D v calci). Trong mt s t trng hp, cc dy thn kinh v c c th b tn thng hoc ly i trong khi phu thut. Nu iu xy ra, bnh nhn c th c bin i ging ni hoc mt bn vai c th thp hn vai bn kia.

iu tr iod phng x (I-131)

Bnh nhn c th c nn v bun nn trong ngy u iu tr I-131. M tuyn gip cn li c sau phu thut c th sng v au. Nu ung th tuyn gip lan trn n cc phn khc ca c th, I-131 tp trung y c th gy au v sng. C hin tng sng v au nh vy v I-131 ph hu cc t bo ung th nn gy phn ng vim ti ch.

Bnh nhn cng c th b kh ming v mt v gic hoc khu gic (ngi) trong mt thi gian ngn sau iu tr bng I-131. Nhai ko cao su khng ng hoc mt ko cng khng ng c th lm gim cc triu chng ny.

Trong qu trnh iu tr, bnh nhn c gng ung nhiu nc v cc dch khc. V cc dch gip I-131 i qua c th nhanh hn, vic tip xc ca bng quang vi I-1131 gim i. Nh vy s m bo cho bng quang t b nh hng ca I-131.

V iu tr bng iod phng x ph hu cc t bo sn xut hormon tuyn gip, bnh nhn cn dng vin hormon tuyn gip thay th hormon t nhin.

Mt tc dng ph nam gii c iu tr bng cc liu ln I-131 l mt kh nng sinh sn. ph n, I-131 c th khng gy mt kh nng sinh sn, nhng mt s bc s khuyn cc bnh nhn n gii trnh c mang trong mt nm sau khi iu tr bng I-131.

M s nh nghin cu bo co l mt s rt nh bnh nhn c th pht sinh bnh bch cu mt s nm sau iu tr bng I-131.

iu tr hormon (ni tit t)

Cc vin hormon tuyn gip khng bao gi gy cc tc dng ph. Tuy nhin, mt s bnh nhn c th b ni mn da hoc rng mt s tc trong nhng thng u iu tr.

Bc s s phi theo di cht ch mc hormon tuyn gip trong mu trong nhng ln n kim tra. Qu nhiu hormon tuyn gip c th gy st cn v cm thy nng v tot m hi. N cng c th gy au ngc, chut rt, v a chy. Cc biu hin ny c gi l "cng gip". Nu mc hormon tuyn gip qu thp, bnh nhn c th tng cn, cm thy lnh v c da v tc kh. Bc s thng gi cc biu hin ny l "thiu nng tuyn gip". Nu cn thit bc s s iu chnh liu bnh nhn c dng liu.

X tr ngoi

X tr ngoi c th lm cho bnh nhn rt mt mi khi iu tr tip tc. Ngh ngi l quan trng nhng bc s thng khuyn bnh nhn c gng duy tr hot ng n mc c th c. Thm vo , khi bnh nhn nhn x tr ngoi, biu hin kh ph bin l da bnh nhn tr nn , kh v cng trong vng iu tr. Khi vng c c x tr ngoi, bnh nhn c th cm thy ging khn hoc kh nut. Cc biu hin khc ph thuc vo vng c th c iu tr. Nu ho tr c thc hin vo cng thi im, cc tc dng ph c th nng hn. Bc s c th gi cc phng php lm gim nh tc dng ny.

Ho tr

Cc tc dng ph ca ho tr ph thuc vo cc thuc c hiu c s dng. Cc tc dng ph ph bin nht bao gm nn, bun nn, au ming, v rng tc. Mt s tc dng ph c th dng thuc lm gim nh.

Theo di sau iu tr

Theo di sau iu tr ung th tuyn gip l mt phn quan trng ca k hoch iu tr ni chung. Kim tra u n m bo bt c mt thay i no v sc kho u c ghi nhn. Nhng vn pht hin c phi c iu tr sm nht c th c.Vic kim tra c th bao gm khm lm sng thn trng, chp X quang v cc xt nghim chn on hnh nh khc (nh qut hnh y hc ht nhn) v cc xt nghim trong phng xt nghim (nh xt nghim mu tm calcitonin). Bc s cng c th gii thch k hoch theo di cho bnh nhn: bnh nhn phi i khm thng xuyn nh th no v cc loi xt nghim no l cn thit.

Xt nghim quan trng sau iu tr ung th tuyn gip l o mc thyroglobulin trong mu. Hormon tuyn gip c lu gi trong tuyn gip c gi l thyroglobulin. Nu tuyn gip c ct b, c th c rt t hoc khng c thyroglobulin trong mu. Mc cao ca thyroglobulin c th c ngha l cc t bo ung th tuyn gip pht trin tr li.

Su tun trc khi xt nghim thyroglobulin, bnh nhn phi dng ung vin hormon tuyn gip. Trong thi gian ny, mt s bnh nhn c th ung loi hormon tuyn gip khc tc dng ngn hn. Tuy nhin, tt c cc bnh nhn phi dng ung mi loi hormon tuyn gip trong hai tun cui cng trc khi xt nghim. Khi khng c c mc hormon tuyn gip thch hp bnh nhn s cm thy khng thoi mi. H s b tng cn v cm thy rt mt mi. Bnh nhn cn hi bc s v cc phng php i ph vi nhng kh khn ny. Sau khi xt nghim, bnh nhn li tr li vi vic iu tr bng vin hormon tuyn gip nh thng l.

Bc s c th yu cu qut hnh I-131 ton c th. Xt nghim ny c th c gi l qut hnh chn on I-131 ton c th". Trong mt thi gian nht nh (thng l 6 tun) trc khi qut hnh ny, bnh nhn phi ngng dng vin hormon tuyn gip. Cc t bo ung th u trong c th s hin ln trn hnh qut. Sau st nghim ny bac s s ni vi bnh nhn khi no c dng tr li vin hormon tuyn gip.

H tr cc bnh nhn ung th tuyn gipSng vi mt bnh trm trng nh ung th khng phi dng. Mt s bnh nhn thy cn s gip i ph vi nhng xc ng v thc trng bnh tt ca h. Vic thnh lp cc nhm h tr c th hu ch. Trong cc nhm ny, bnh nhn hoc cc thnh vin trong gia nh ca h tp hp vi nhau chia x nhng iu h hc hi c v i ph vi bnh tt v nhng hiu qu ca iu tr.

Nhng ngi sng vi ung th c th lo lng v chm sc gia nh h, gi vic lm ca h v tip tc cc hot ng hng ngy. Nhng lo lng v vic iu tr v khc phc cc tc dng ph, vic phi li trong bnh vin v thanh ton vin ph cng l nhng lo lng ph bin. Do ngi bnh cn s h tr ca gia nh, c quan, cng ng dn c ni h sinh sng.

Cc danh t

c tnh: Ung th. Cc u c tnh c th xm nhp v ph hu m gn v lan trn n cc phn khc ca c th.

Bu gip: Mt tuyn gip to. N c th c to nn do qu t iod trong thc n hoc do cc bnh khc. Hu ht cc bu gip khng phi l ung th.

Bi phng x: Cc tiu phn phng x ri xung t trong v sau khi n bom nguyn t, th v kh ht nhn, hoc tai nn nh my in nguyn t.

Bnh bch cu: Ung th bt ngun t m to mu chng hn nh tu xng v gy nn mt s lng ln t bo mu c sn xut ra v i vo dng mu.

Ct b thu: Phu thut ly i mt thu ca mt c quan.

Ct b uyn gip: Phu thut ly mt phn hoc ton b tuyn gip.

Calcitonin: Mt hormon c sn xut bi cc t bo C trong tuyn gip. N gip duy tr mc bnh thng ca calci trong mu. Khi mc calci qu cao, n lm h thp mc ny.

Chn on hnh nh: Cc xt nghim to ra cc hnh nh ca cc vng bn trong c th.

Cht lng sng: S thch th chung ca cuc sng. Nhiu th nghim lm sng nh gi hiu qu ca ung th v vic iu tr bnh trn cht lng cuc sng. Cc nghin cu ny o kh nng cm nhn ca c th v s sung mn sc kho v kh nng thc hin cc hot ng khc nhau.

Chp ct lp vi tnh: Chp ct lp vi tnh cn c gi tt l qut hnh CT (CT scan). Mt lot cc hnh nh chi tit ca cc vng bn trong c th c chp t cc gc khc nhau, cc hnh nh c to nn bi mt my vi tnh gn vi mt my chp X quang. Phng php ny cn c gi l chp ct lp vi tnh ho v chp ct lp trc vi tnh ho (CAT scan).

Chp cng hng t (MRI): Mt phng php trong cc sng radio v mt t tnh mnh gn vi mt my tnh c s dng to ra cc hnh nh chi tit ca cc vng trong c th. Cc hnh nh c th cho thys khc nhau gia cc m bnh thng v bnh l ca c th. MRI to nn cc hnh nh ca cc c quan v m mm tt hn cc k thut qut hnh khc qut hnh CT hoc chp X quang. MRI c bit c li trong vic chn on hnh nh ca no, xng sng, m mm ca khp v bn trong xng. Cng gi l chp cng hng t ht nhn.

Di cn: Ung th lan trn t mt phn ca c th ti phn khc. Mt u c hnh thnh t cc t bo va lan trn c gi l "u di cn" hay "di cn". U di cn c cha cc t bo ging cc t bo trong u ngun gc (u nguyn pht).

i trng: Phn di nht ca i trng (rut gi), l mt c quan hnh ng ni vi rut non mt u v hu mn u kia. i trng hp thu li nc, mt s cht dinh dng v in gii t thc n c tiu ho mt phn ( rut non). Vt liu cn li c, c thi ra c gi l phn, c vn chuyn qua i trng ti trc trng v ri c th qua hu mn.

iu tr h thng: iu tr s dng cc cht lu thng trong dng mu, tip cn v nh hng ti cc t bo ca ton c th.

iu tr hormon (iu tr ni tit t): iu tr b sung, phong to hoc loi b hormon. Trong mt s bnh (chng hn nh i ng hoc mn kinh), cc hormon c a vo iu chnh cc mc hormon thp. lm chm hoc lm dng s pht trin ca mt s ung th (nh ung th tuyn tin lit v ung th v), cc hormon tng hp hoc mt s c th c dng ngn chn cc hormon t nhin ca c th. i khi phu thut l cn thit ct b mt tuyn sn xut ra mt s hormon. Cng gi l liu php hormon, iu tr hormon, liu php ni tit.

Eo: Mt phn hp bn trong c th ni lin hai cu trc rng hn.

Gen: n v chc nng v thc th ca di truyn c truyn t ngi b cho con. Cc gen l cc loi ADN, v hu ht cc gen c cha cc thng tin to nn mt protein c hiu.

Gim nng tuyn gip: Qu t hormon tuyn gip. Cc triu chng bao gm tng cn, to bn, kh da v nhy cm vi lnh. Cng goi l tuyn gip gim hot ng.

Giai on: S lan trn ca ung th trong c th. Vic nh giai on da trn kch thc u, cc hch c cha cc t bo ung th hay khng, v ung th lan trn t v tr ban u ti cc phn khc trong c th cha.

Hch bch huyt: Mt khi hnh ht u ca m lympho c bao bc bi mt v lin kt. Cc hch bch huyt lc dch bch huyt v chng cha cc lympho bo (t bo mu trng). Chng nm dc theo cc mch bch huyt. Cng c gi l tuyn bch huyt.

Hi chng a u ni tit: Mt xu hng di truyn pht sinh ung th tuyn gip v cc ung th khc ca h thng ni tit. Gen b bin i c th c pht hin bng xt nghim mu.

H thng bch huyt: Cc m v cc c quan sn xut, tng tr v vn chuyn cc t bo mu trng, cc t bo chng cc nhim trng v cc bnh khc. H thng ny bao gm tu xng, lch, tuyn c, cc hch bch huyt v cc mch bch huyt (mt li cc ng mnh mang bch huyt v cc t bo mu trng. Cc mch bch huyt chia nhnh, ging nh cc mch mu, vo tt c cc m ca c th.

Ho tr: Ho tr (cn gi l iu tr ho cht) l iu tr bng cc thuc git cc t bo ung th.

Hormon kch thch tuyn gip (TSH): Mt hormon sn xut bi tuyn yn. TSH kch thch gii phng hormon tuyn gip t thyroglobulin. N cng kch thch s pht trin ca cc t bo nang ca tuyn gip. Mc TSH bt thng c th c ngha l h thng iu ho hormon tuyn gip khng c kim sot, thng l hu qu ca mt bnh lnh tnh (cng tuyn gip hoc thiu nng tuyn gip).

Hormon tuyn gip: Mt loi hormon nh hng n nhp tim, huyt p, nhit c th. Hormon tuyn gip c sn xut trong tuyn gip v cng c sn xut trong phng th nghim.

Ht kim nh: Ly m hoc dch bng mt kim nh xt nghim di knh hin vi. Cng gi l sinh thit kim nh.

Iod phng x: Mt dng phng x ca iod, thng c s dng chn on hnh nh hoc iu tr ung th tuyn gip v mt s ung th khc. xt nghim chn on hnh nh, bnh nhn dng mt liu nh iod phng x, n tp trung trong cc t bo tuyn gip v mt s loi u v c th c pht hin bng mt my qut hnh. iu tr ung th tuyn gip, bnh nhn dng mt liu ln iod phng x, cht ny s git cc t bo tuyn gip. Iod phng x cng c s dng trong x tr trong vi ung th tuyn tin lit, u hc t ni nhn cu (mt), v cc u carcinoid (u dng carcinom). Iod phng x cng c s dng bng cch truyn hoc lm thnh cc ht c t gn khi u git cc t bo ung th.

Iod: Mt thnh phn cn thit cho c th sn xut ra hormon tuyn gip. N c trong loi gip st v mui iod.

Lnh tnh: Khng phi ung th, ch u khng xm nhp cc m xung quanh v khng lan trn ti cc phn khc ca c th.

Liu php vng: iu tr nh hng n cc t bo trong u v vng lin quan mt thit vi n.

M: Mt nhm t bo hoc mt lp t bo cng hot ng thc hin mt chc nng c hiu.

Nhn lnh: Khi mt vt liu phng x c s dng xt nghim tuyn gip bng mt my qut hnh, cc nhn (u) tp trung t vt liu phng x hn cc m tuyn gip xung quanh c gi l nhn "lnh". Mt nhn lnh khng sn xut hormon tuyn gip. Cc nhn lnh c th lnh tnh hoc ung th. Cc nhn lnh i khi c gi l cc nhn thiu nng.

Nhn lnh: Khi mt vt liu phng x c s dng xt nghim tuyn gip bng mt my qut hnh, cc nhn tp trung nhiu vt liu phng x hn m tuyn gip xung quanh c coi l nhn "nng". Cc nhn nng t khi l c tnh, cc nhn nng cn c gi cc nhn cng nng (tng nng).

Nhn u: Mt u c th l ung th hoc khng.

Nh bnh hc (bc s gii phu bnh): Bc s xc nh cc bnh bng vic nghin cu cc t bo v m di knh hin vi.

Nh ni tit hc: Mt bc s chuyn chn on v iu tr bnh ni tit (bnh hormon).

Nh ung th hc ni khoa (bc s ung th hc ni khoa): Bc s chuyn v chn on v iu tr ung th, s dng ho tr, iu tr hormon v iu tr sinh hc. Nh ung th hc ni khoa thng l ngi chm sc sc kho chnh cho nhng ngi b ung th. Nh ung th hc ni khoa cng l ngi cung cp chm sc h tr v c th t chc vic hp tc iu tr bi cc chuyn gia khc.

Nh ung th hc x tr: Bc s chuyn s dng phng x iu tr ung th.

Nh ung th hc: Mt bc s chuyn v iu tr ung th. Mt s nh ung th hc chuyn v mt loi c bit ca iu tr ung th. V d, mt nh ung th hc x tr chuyn v iu tr ung th bng phng x.

Phu thut vin: Bc s ct b hoc sa cha mt phn ca c th bng phu thut trn bnh nhn.

Phng x: Nng lng c gii phng ra di dng cc tiu phn hoc sng in t. Cc ngun phng x chung bao gm kh ra-on (pht sinh t ra-i-um), cc tia v tr t khong khng v tr, v tia X dng trong y hc.

Phu thut: Mt phng php ly i hoc sa cha mt phn ca c th hoc tm xem c bnh khng.

Polyp tin ung th: S pht trin li ln t mt mng nim mc. Cc polyp tin ung th c th (hoc rt c th) tr thnh ung th.

Qut hnh y hc ht nhn: Mt phng php chn on hnh nh s dng mt lng nh vt liu phng x. Bnh nhn c tim mt cht dch c cha cht phng x, cht ny s tp trung trong mt vng ca c th c chn on hnh nh. Nhng dng c tinh vi pht hin cht phng x v x l cc thng tin ny thnh hnh nh.

Qut hnh y hc ht nhn: Mt xt nghim to nn cc hnh nh ca cc phn bn trong c th. Mt ngi c tim hay ung mt lng nh cht phng x; sau mt my c gi l my qut s o hot ng phng x trong mt s c quan.

Siu m : Hnh nh trn my vi tnh ca mt vng bn trong c th c to nn bi s dn truyn cc sng m nng lng cao (siu m) cu cc m hoc c quan bn trong.

Siu m : Mt phng php trong cc sng m nng lng cao (siu m) c chuyn dch khi cc m hoc c quan to thnh m vang (echo). Cc hnh thi m vang c biu hin trn mn hnh ca my siu m, to thnh mt hnh nh ca m c th c gi l siu m .

Sinh thit: Ly cc t bo hoc cc m bc s gii phu bnh xt nghim. Bc s gii phu bnh c th nghin cu m di knh hin vi hoc lm cc xt nghim khc trn cc t bo hoc m. Khi ch c mt mu m c ly ra, phng php c gi l sinh thit rch. Khi ton b khi u c ly ra, phng php c gi l sinh thit ct b. Khi mt mu m hoc dch c ly ra bng mt kim, phng php ny c gi l sinh thit kim, sinh thit kim c li hoc ht kim nh.

Tng nng tuyn gip: Qu nhiu hormon tuyn gip. Cc triu chng bao gm st cn, au ngc, co git, a chy v hong s. Cng gi l tuyn gip hot ng qu mc.

Thanh qun: Mt vung ca hng c cha cc dy thanh m, c dng th, nut v ni. Cng c gi l hp thanh m.

Th nghim lm sng: Mt loi nghin cu kim tra mt phng php y hc mi hot ng trn ngi nh th no. Nhng nghin cu ny kim tra cc phng php mi sng lc, d phng, chn on v iu tr mt bnh. Cng c gi l th nghim lm sng.

Thu: Mt phn ca mt c quan, chng hn nh gan, phi, v, tuyn gip hoc no.

Thyroglobulin: Mt dng hormon tuyn gip s dng khi lu gi trong cc t bo tuyn gip. Nu tuyn gip c ct b, thyroglobulin khng cn c pht hin trn xt nghim mu. Bc s o mc thyroglobulin trong mu pht hin cc t bo ung th cn st li trong c th sau iu tr.

Tia X: Mt loi phng x nng lng cao. Vi cc liu thp, tia X c s dng chn on bng cch to nn cc hnh nh ca cc phn bn trong c th. Vi liu cao tia X c s dng iu tr ung th.

T bo C: Mt loi t bo trong tuyn gip. Cc t bo C sn xut calcitonin, mt hormon gip kim tra mc calci trong mu.

T bo nang tuyn gip: Mt loi t bo trong tuyn gip. Cc t bo nang sn xut hormon tuyn gip

T bo: n v sng c bn to nn cc m ca c th. Tt cc cc vt sng c to thnh t mt hoc nhiu t bo.

Triu chng: Mt du hiu l mt ngi c bnh. Mt s v d ca cc triu chng l au u, st, mt mi, nn, bun nn v au.

Tuyn gip: Mt tuyn khu tr cnh hp thanh m (thanh qun) v sn xut hormon tuyn gip. Tuyn gip gip iu ho s pht trin v chuyn ho.

Tuyn yn: Tuyn ni tit chnh. N sn xut cc hormon kim sot cc tuyn khc v nhiu chc nng ca c th, c bit l s pht trin.

Tuyn: Mt c quan to ra mt hay nhiu cht, chng hn nh hormon (ni tit t), cc dch tiu ho, m hi, nc mt, nc bt hoc sa. Cc tuyn ni tit bi tit cc cht trc tip vo dng mu. Cc tuyn ngoi tit bi tit cc cht vo mt ng hoc m vo trong hoc ra ngoi c th.

U nguyn pht: U ngun gc.

U nh: Mt u c hnh ging nh mt ci nm nh, vi cung u dnh vo lp biu m (ph bn trong) ca mt c quan.

U: Mt khi bt thng ca m sinh ra khi cc t bo sinh sn nhiu hn mc cn thit hoc khng cht khi chng cn phi cht.

Ung th biu m tu: Ung th pht sinh trong cc t bo C ca tuyn gip. Cc t bo C sn xut mt hormon (calcitonin), n gip duy tr mc bnh thng ca calci trong mu.

Ung th tuyn gip mt bit ho: Loi xm ln mnh, him gp ca ung th tuyn gip, trong cc t bo c tnh (ung th) trng rt khc vi cc t bo bnh thng.

Ung th tuyn gip th nang: Ung th xut pht t cc t bo trong cc vng nang ca tuyn gip. Mt trong cc loi ung th tuyn gip pht trin chm, kh nng iu tr khi cao.

Ung th: Mt danh t ch cc bnh trong cc t bo bt thng phn chia thiu s kim sot. Cc t bo ung th c th xm nhp vo cc m xung quanh v c th lan trn theo ng mu v h thng bch huyt ti cc phn khc ca c th. C nhiu loi ung th. Ung th biu m (carcinom)bt u da hoc cc m lt mt trong hoc ph mt ngoi cc c quan (ni tng). Sacm l ung th bt ngun t xng, sn, m, c, cc mch mu hoc mt m lin kt v nng khc. Bnh bch cu l mt ung th c ngun gc t cc m to mu nh tu xng v lm cho mt s lng ln cc t bo mu bt thng c sn xut v i vo dng mu. U lympho v a u tu l cc ung th bt u trong cc t bo ca h thng min dch.

X tr ngoi: X tr s dng mt my hng cc tia nng lng cao vo vng ung th. Cng c gi l x tr chm tia ngoi.

X tr: S dng phng x nng lng cao t cc tia X, cc tia gamma, cc n-trn v cc ngun khc git cc t bo ung th v lm co nh khi u. Phng x c th c ngun t mt my ngoi c th (x tr chm ngoi), hoc n c th c ngun gc t mt vt liu phng x t trong c th gn gn cc t bo ung th (x tr trong, x tr cy ghp, hoc x tr gn). X tr h thng s dng cht phng x, chng hn nh khng th n dng gn phng x, cc khng th ny lu thng khp c th.

Xac nh giai on: Thc hin khm v cc xt nghim bit s lan trn ca ung th trong c th, c bit bit liu ung th lan trn ti cc phn khc ca c th cha. Vic bit giai on bnh l quan trng lp k hoch iu tr tt nht.

Yu t nguy c: Mt yu t no lm tng c hi pht sinh mt bnh. Mt s v d ca cc yu t nguy c ung th bao gm tui, lch s gia nh ca mt s ung th, s dng cc sn phm ca thuc l, mt s thi quen n ung, bo ph, tip xc vi phng x hoc cc tc nhn gy ung th khc, v mt s bin i di truyn.

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