Benh ung thtf phoi can phat hieri '^^
( •frBslDONG STTINH
U
ng thu phdi la khd'i u dc tinh dUdc hinh thanh do sif phat trien mat kiem soat cua cdc te bao cau tao ndn phdi. Ddy la loai ung thu phd biln nha't trong nhufng nam gan day; nam 2012 tren toan the gidi cd khoang 1,8 trigu ngUdi mdc ung thu phdi va gay td vong cao nhdt, trdn cd ung thU gan va ung thU da day.Tai Viet Nam, ung thU phdi ddng hang thd hai sau ung thu gan va chiem 20% trong tdng so ngUdi mac ung thu cac loai. Tdn sud't cua benh nay d Viet Nam la 140/100.000 dan, nghia la cd khoang 150 ngan ca ung thu phdi hang nam. Moi nam cd khodng 20.000 ca mdc ung thU phdi mdi va 17.000 tnfdng htfp td vong. Nam gidi cao gap 2,5 lan nfl gidi.
Nguygn nhdn gay ra benh ung thU phdi la do sU phdt trien dot bien cua cac te' bao d phdi. Nhdng yg'u td ldm kich boat qud trinh phat trien nay la:
- Hut thuoc Id: 90% tnfdng hdp ung thu phoi cd lign quan den hut thudc. Khdi thudc la cd htfn 4.000 loai hda chat, trong dd trdn 40 chd't cd the gay ung
thu. Ngudi hut thudc la thu ddng cd nguy cd mac ung thu phdi cao hon 26% so vdi ngUdi khong tiep xuc vdi khdi thud'c. Cimg hut thud'c nhu nhau nhung phu nd cd ty lg mac bgnh nay cao gap 1,5 lan so vdi nara gidl vi cd the phu nd de hd'p thu vd nhay cam khi tigp xuc vdi cac thanh phdn trong kbdi thud'c.
- Song trong moi traOng 6 nhiem: nbiftig ngifdi sd'ng trong vCmg hi nhilm chat phdng xa...
- Tiep xiic thudng xuyen cdc chdt ddc hai: amidng trong ky nghe lam tdm ldp, radon (trong cdc md khai thdc vang), crom, nicken, hdc in..
- NgUdi benh daac xa tri vung ngUc: nhu u tnmg that, benh Hodgkin..,
- Yeu td gia dinh: trong gia dinh cd ngUdi bi ung thu phdi.
Sii ke't htfp nhieu ye^u td' nguy cd ldm tang gap nhieu lan kha nang mdc bgnh. Vi du ngUdi hut thud'c cd nguy ctf cao gap 11 lan so vdi ngUdi khdng hut thudc, ngudi phtfi nhilm chdt asbestos cd nguy cd ga'p 6 ldn ngudi khdng bi phdi nhilm chd't ndy. Nhifng ne'u mdt
r' nhieu rUtfu. Udng 4 ly mdi ngay ddn din loang xUdng la do dc che' Sii tao xUdng mdi cung vdi giam mufc hormon testosteron d cd ddn dng ldn tudi va tre tuoi. Ud'ng rUdu cung tang nguy ctf bi te nga.
Beo b u n g
Beo bung lam cho ca dan dng va dan ba tang nguy ctf hi loang xUdng. Trong nhilu nam qua, ngUdi ta tin rdng phu nU beo phi cd nguy cd thap phdt trien loang xUdng va lUtfng md tich tu nhilu trong cd the bao ve chd'ng lai mat xUtfng. Mdt nghien cdU da nhdn thay qud nhieu md d bung cd dnh hudng xau de'n sdc khde ciia xUdng. Cdn nghign cdu khac thi tha'y rdng vdng eo to, beo phi Id yg'u td'nguy cd mat xUtfng vd giam sU chde chdn cho xUtfng d ddn dng. Dieu quan trgng la nam gidi phdi nhan thdc dugc sii tich tu md qua mdc d bung khdng chi la yeu to nguy ctf benh tim mach vd 20
dai thdo dudng md nd cdn la nguy ctf cua sii mat xUtfng.
L o a n g xUcfng la n g u y e n n h a n gdy chuang g u lUng
Su bien doi cua loang xUtfng thudng anh hudng lgn cot sd'ng va CO xUdng dui. Ng'u bi loang xUdng d cdt sd'ng, cac ddt xUdng sd'ng cd the hi gay va dieu nay dUa de'n gii lung. Khdng cd each gi de chd'ng lai chijfng gu lung do bidn dang ciia cdt sd'ng nhung cd thd phdng ngifa hdng each dung du lUdng calci vd vitamin D theo khuyg'n cdo, ChiXng b i e n g an t h a n k i n h va l o a n g xUofng
NhCftig ngudi mac chiJttig rdi loan an ud'ng nhu chiing big'ng dn, se ed khuynh hudng phdt trien loang xUdng. Chl do an ddng vai trd quan trong trong ca sii khdi phdt bgnh loang xUdng va chUa tri, che' dd dn udng dUdc xem la "bgnh tham lang"
bdi vi nd tie'n trien trong nhieu ndm. An khdng du hoac rdi loan hap thu calci va •vitamin D se din den mat xUdng. Calci la mpt chat khoang can thiet cho tao xUong, neu an lUdng calci hang ngay khdng dij se dan den thieu chat xUdng. Tuy nhien, chi bo sung calci se khong du ma can phai co vitamin D vi ccf the can vitamin D de hap thu calci.
Loang xaang l<hdng chl xiy ra d phu nO THUOC & SUC KHOE sd515 (01.01.2015)
tilnti inh Xquang nghi ngd ung thu phoi
ngudi vifa hut thudc vCfa phdi nhiem amidng thi nguy cd mdc ung thU phdi tdng ldn din 59 ldn.
T r i p u chuTng
O giai doan dau b§nh thudng khdng cd trieu chdng, chi dg'n khi bgnh phdt t r i l n thi trigu chdng mdi xua't hign, thudng gdp nha't Id: ho keo ddi khdng dap dng vdi dieu tri thdng thudng, ho ra mdu, khdn tilng, dau ngUc, khd thd, thd khd khd, vidm phdi hay viem phe qudn tdi di tdi lai, dau vai hay cdnh tay, phu d mdt, vdng cd, m^t mdi, chdn dn, sut cdn khdng rd nguygn nhdn...
Ngodi ra cdn cd nhufng trigu chdng lign quan de'n cac cd quan hi di cdn nhU nao, gan, xUdng, tuye'n thugng th§n..
De chdn dodn, bdc si se diing nhieu phUtfng phap nhdm xdc dinh loai ung thU vd giai doan tie'n trien cua b?nh. X quang Id phUdng phdp ddn gidn, it t i n kdm vd rd't cd ich de phdt hien tdn thUtfng d phdi.
Chup cdt ldp giup xdc dinh chinh xdc vi tri ton thUtfng.
Sinh thig't d l khao sat va phan loai tinh cha't md hoc cua ung thu phoi.
Co 2 Ioai ung thu phoi: te' bdo nhd va khong phai t l bdo nhd. Ung thU khdng phdi t l bdo nhd thudng gdp htfn, chie'm tren 80%, loai nay phdt trien cham vd khdng lan nhanh den cdc ctf quan khdc. Ung thu t i b d o nhd it gdp: chUa den 20% nhung phat trien rat nhanh va lan din cdc ctf quan khdc cung rat nhanh.
Viec phan loai giai doan benh cd y nghia rat quan trpng trong viee lUa chgn phUtfng phdp dieu t n cung nhu tign lUtfng ciia ngUdi benh. Co bdn giai doan chinh:
• Giai doan 1: budu chi d phdi.
• Giai doan 11: bUdu chi lan din hach gan (rdn phdi).
• Giai doan HI: bUdu lan din cd quan lan can hoac hach trung thd't ddi bgn/hach thUdng ddn.
• Giai doan IV: budu da lan din cdc phdn khae cua cd t h i (di cdn).
Theo cdc nghien cdU d My, neu ung thu cdn d giai doan IA nghia Id khi bUdu cdn nhd < 3cm va chUa Ian dg'n cdc hach Idn can thi ty le sd'ng 5 ndm sau dieu tri Id 75%, nhUng khi ung thU da di can thi ty lg THUOC & SUC K H 6 E sd515 (01,01.2015)
nay chi cdn 2%. Vi vay viec phat hien benh dang cdn trong giai doan sdm la vd cung quan trgng, dang tiec d Vigt Nam khoang 90% benh nhan ung thU phdi khi den kham tai henh vien da d giai doan tre, khong mo dUdc. Ngay tai My, cd de'n 58% bgnh nhan ung thU td vong trong vong 1 nam sau khi dugc chan doan xdc dinh vl phat hien tre. Viec dieu tri d giai doan sdm bang phdu thuat khdng chi mang lai hieu qua cao md cdn It bien chdng va chi phi thdp htfn nhieu so vdi cac phUtfng phdp khac.
Dilu tri ung thU phoi cd muc dich tieu digt hay kiem soat te bao ung thU. Cd 4 phUtfng phap dieu tri chinh la: phdu thuat, xa tri, hda tri va dieu tri dich.
Vigc Ilia chgn phuong phap dieu tri tuy thugc vdo kich thudc, vi tri, md benh hgc cua khdi u, giai doan bgnh cung nhu tdng trang ciia ngUdi bgnh.
- Phdu thudt: cat toan bg to chde ung thU phdi vd ede hach bach huyg't lan can.
- Xa tri: la su" dung tia bdc xa nang lupng eao vdi muc dich tieu diet te bao ung thU hay kilm ham sU phdt trien va lan tran cua chdng.
- Hoa tri: Id dUa mot lUtfng thud'c vao cd the, ed the dung dUdng truyin tinh maeh hay udng. Lugng thud'c nay se di vao trong mau rdi de'n cd quan bi ung thu de tigu diet te bao ung thu.
- Dilu tri dich: dung cde loai thudc d l ngan ehdn sU tang trUdng va lan tran cua cdc tg' bdo ung tbU bang each can thiep vao cae phan td dae hieu (cac dich phan td) trong ctf ehe sinh ung thU va sii tdng trudng cua khd'i u.
Ngoai ra cdn can de'n nhihig phUtfng phap dieu tri ho trg khac nhu: dieu tri giam dau, dilu tri miln dich, dinh dudng, huylt hgc...
P h o n g b p n h
Ung thu phdi la bgnh co the phdng ngifa dUtfe.
NhiJng yg'u td nguy ctf gay ung thU phdi da dUdc big't, trong dd cd den 90% lign quan den hut thud'c la, vi vdy ngUng hut thud'c c6 the lam gidm dUdc bgnh ung thu phdi. Dieu nay khdng thiic sU de dang vi tuy thugc vao y thdc cua ngUdi dan vd tinh higu qua cua viec thi hanh luat cam hut thud'c ntfi eong cgng ctia Nha nUdc. Gili ^ n mdi trUdng sd'ng va ldm vigc khdng bi d nhilm, an toan ve sinh lao dgng eflng rat can dUtfc quan tdm de phdng ngda bgnh ung thU phdi.
Phat hien sdm cd the eai thien thdi gian sd'ng edn.
Tam soat cho nhflng ngUdi eo nguy ed la each tdt nha't d l phat hign sdm ung thU phdi. Nhu'ng dd'i tUdng nay la ngudl tren 40 tudi cd hut thude Id can phai khdm sdc khde dinh ky vd di kiem tra neu cd: trieu chdng ho bdt thudng, dam cd vUdng mau, gia dinh ed ngudi bi ung thu phdi, sut can chUa ro nguyen nhdn, tdn thUtfng mdi bat ky tren X quang phdi.
Tdm lai, ung thu phoi la benh kha pho big'n vd la nguyen nhan gdy tuf vong hang dau trong cdc loai benh ung thu. 90% trudng hdp bi ung thu phdi cd lign quan dg'n hut thud'c la. Day la bgnh ed the phdng ngifa duge. Phat hien sdm la each duy nha't giup dilu t n
dat hieu qua tot. 5^
