{"id":35498,"date":"2024-05-30T15:50:30","date_gmt":"2024-05-30T07:50:30","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&#038;p=35498"},"modified":"2025-02-11T13:40:25","modified_gmt":"2025-02-11T05:40:25","slug":"esmo-2024-huong-dan-chan-doan-kiem-soat-va-theo-doi-ung-thu-vu-giai-doan-som","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/esmo-2024-huong-dan-chan-doan-kiem-soat-va-theo-doi-ung-thu-vu-giai-doan-som\/","title":{"rendered":"ESMO 2024: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n, ki\u1ec3m so\u00e1t v\u00e0 theo d\u00f5i ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm"},"content":{"rendered":"\n<p>V\u00e0o n\u0103m 2020, \u01b0\u1edbc t\u00ednh c\u00f3 kho\u1ea3ng 2.3 tri\u1ec7u tr\u01b0\u1eddng h\u1ee3p m\u1eafc m\u1edbi ung th\u01b0 v\u00fa tr\u00ean to\u00e0n c\u1ea7u, chi\u1ebfm 12% s\u1ed1 ca m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ung th\u01b0. Ung th\u01b0 v\u00fa l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a 685.000 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong m\u1ed7i n\u0103m. C\u00f9ng v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00f4ng ngh\u1ec7, vi\u1ec7c ph\u00e1t hi\u1ec7n ung th\u01b0 v\u00fa ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, t\u1ef7 l\u1ec7 t\u1eed vong c\u0169ng gi\u1ea3m trong v\u00e0i n\u0103m tr\u1edf l\u1ea1i \u0111\u00e2y \u1edf c\u00e1c n\u01b0\u1edbc ph\u01b0\u01a1ng T\u00e2y, tuy v\u1eady, ung th\u01b0 v\u00fa v\u1eabn l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong li\u00ean quan \u0111\u1ebfn ung th\u01b0 tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. \u0110a s\u1ed1 c\u00e1c b\u00eanh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1eefa b\u1eb1ng nhi\u1ec1u bi\u1ec7n ph\u00e1p kh\u00e1c nhau, nh\u01b0ng t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng t\u00f9y thu\u1ed9c nhi\u1ec1u v\u00e0o giai \u0111o\u1ea1n l\u00e2m s\u00e0ng v\u00e0 subtype c\u1ee7a ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa.<\/p>\n\n\n\n<p>\u0110\u1ea7u n\u0103m 2024, Hi\u1ec7p h\u1ed9i Ung th\u01b0 N\u1ed9i khoa Ch\u00e2u \u00c2u (European Society of Medical Oncology \u2013 ESMO) \u0111\u00e3 c\u00f4ng b\u1ed1 h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n, ki\u1ec3m so\u00e1t v\u00e0 theo d\u00f5i ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm. B\u00e0i vi\u1ebft nh\u1eb1m t\u00f3m t\u1eaft \u0111i\u1ec3m ch\u00ednh c\u1ee7a h\u01b0\u1edbng d\u1eabn \u0111\u1ebfn b\u1ea1n \u0111\u1ecdc.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>S\u00c0NG L\u1eccC, CH\u1ea8N \u0110O\u00c1N, SINH B\u1ec6NH H\u1eccC V\u00c0 SINH H\u1eccC PH\u00c2N T\u1eec<\/strong><\/h2>\n\n\n\n<p><strong>Khuy\u1ebfn c\u00e1o<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ch\u1ee5p nh\u0169 \u1ea3nh th\u01b0\u1eddng xuy\u00ean (m\u1ed7i 2 n\u0103m) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i 50 \u2013 69 c\u00f3 nguy c\u01a1 trung b\u00ecnh [I, A]. Ch\u1ee5p nh\u0169 \u1ea3nh c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf ph\u1ee5 n\u1eef 45 \u2013 59 tu\u1ed5i v\u00e0 70 \u2013 74 tu\u1ed5i, m\u1eb7c d\u00f9 c\u00f3 \u00edt b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch \u1edf ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i n\u00e0y [I, B].<\/li>\n\n\n\n<li>S\u00e0ng l\u1ecdc \u1edf ph\u1ee5 n\u1eef c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh ho\u1eb7c c\u00f3 d\u00f2ng m\u1ea7m&nbsp;<em>BRCA1\/2<\/em>&nbsp;v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 c\u00f3 nguy c\u01a1 g\u00e2y b\u1ec7nh kh\u00e1c n\u00ean tu\u00e2n th\u1ee7 h\u01b0\u1edbng d\u1eabn c\u1ee7a ESMO \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 v\u00e0 theo d\u00f5i ung th\u01b0 v\u00fa v\u00e0 bu\u1ed3ng tr\u1ee9ng di truy\u1ec1n [III, A].<\/li>\n\n\n\n<li>C\u00e1c b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n ti\u1ebfp theo t\u00f9y thu\u1ed9c v\u00e0o k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, bao g\u1ed3m nh\u0169 \u1ea3nh 2 b\u00ean v\u00e0 si\u00eau \u00e2m c\u1ea3 2 v\u00fa v\u00e0 c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft v\u00f9ng ho\u1eb7c ch\u1ee5p nh\u0169 \u1ea3nh k\u1ef9 thu\u1eadt s\u1ed1 2 chi\u1ec1u (two-dimensional digital mammography) \u1edf b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng [I, A].<\/li>\n\n\n\n<li>Ch\u1ee5p nh\u0169 \u1ea3nh k\u1ef9 thu\u1eadt s\u1ed1 c\u1eaft l\u1edbp (k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m theo ch\u1ee5p nh\u0169 \u1ea3nh t\u1ed5ng h\u1ee3p) v\u00e0 ch\u1ee5p nh\u0169 \u1ea3nh t\u0103ng c\u01b0\u1eddng \u0111\u1ed9 t\u01b0\u01a1ng ph\u1ea3n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111\u1ec3 thay th\u1ebf n\u1ebfu c\u00f3 th\u1ec3 v\u00e0 h\u1ee3p l\u00fd [II, B].<\/li>\n\n\n\n<li>Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb v\u00fa \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 ch\u1ec9 \u0111o\u00e1n khi ch\u1ec9 d\u1ef1a tr\u00ean ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh ti\u00eau chu\u1ea9n v\u00e0 \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t (ch\u1eb3ng h\u1ea1n ung th\u01b0 v\u00fa gia \u0111\u00ecnh c\u00f3 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t bi\u1ebfn d\u00f2ng m\u1ea7m&nbsp;<em>BRCA1\/2&nbsp;<\/em><em>(gBRCA1\/2m)<\/em>&nbsp;v\u00e0 c\u00e1c bi\u1ebfn th\u1ec3 c\u00f3 nguy c\u01a1 cao kh\u00e1c ho\u1eb7c ung th\u01b0 ti\u1ec3u th\u00f9y, nghi ng\u1edd ung th\u01b0 \u0111a \u1ed5 (multifocality)\/\u0111a v\u00f9ng (multicentricity), b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1eb7t t\u00fai ng\u1ef1c) [I, A].<\/li>\n\n\n\n<li>\u0110\u00e1nh gi\u00e1 di c\u0103n xa (x\u01b0\u01a1ng, gan v\u00e0 ph\u1ed5i) ch\u1ec9 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 giai \u0111o\u1ea1n \u2265 IIb (\u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ea1ch b\u1ea1ch huy\u1ebft ph\u00ec \u0111\u1ea1i), b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao khi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u v\u00e0\/ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng [III, A].<\/li>\n\n\n\n<li>\u0110\u00e1nh gi\u00e1 sinh b\u1ec7nh h\u1ecdc ti\u1ec1n \u0111i\u1ec1u tr\u1ecb, bao g\u1ed3m h\u00ecnh th\u00e1i m\u00f4 (histomorphological), h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch (immunohistochemical) v\u00e0 ph\u00e2n t\u1eed \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi ch\u1ea9n \u0111o\u00e1n n\u1ebfu c\u00f3 th\u1ec3 v\u00e0 n\u00ean bao g\u1ed3m m\u00f4 h\u1ecdc kh\u1ed1i u ti\u00ean ph\u00e1t v\u00e0 m\u00f4 h\u1ecdc\/t\u1ebf b\u00e0o h\u1ecdc h\u1ea1ch b\u1ea1ch huy\u1ebft \u1edf n\u00e1ch (n\u1ebfu nghi ng\u1edd) [I, A].<\/li>\n\n\n\n<li>\u0110\u00e1nh gi\u00e1 n\u00ean bao g\u1ed3m lo\u1ea1i m\u00f4 b\u1ec7nh h\u1ecdc, ph\u00e2n \u0111\u1ed9 v\u00e0 h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch c\u1ee7a th\u1ee5 th\u1ec3 estrogen (ER), th\u1ee5 th\u1ec3 progesterone (PgR) v\u00e0 th\u1ee5 th\u1ec3 y\u1ebfdu t\u1ed1 t\u0103ng tr\u01b0\u1edfng th\u01b0\u1ee3ng b\u00ec ng\u01b0\u1eddi 2 (HER2) v\u00e0 d\u1ea5u ch\u1ec9 t\u0103ng tr\u01b0\u1edfng kh\u1ed1i u (proliferation marker) ch\u1eb3ng h\u1ea1n nh\u01b0 Ki-67 [I, A]. FISH test n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 \u0111i\u1ec3m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch HER2 kh\u1ea3 nghi (HER2 2+) [I, A].<\/li>\n\n\n\n<li>Kh\u1ed1i u n\u00ean \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m theo subtype sinh h\u1ecdc, \u0111\u1ecbnh danh d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 m\u00f4 h\u1ecdc v\u00e0 h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch th\u01b0\u1eddng quy, ch\u1eb3ng h\u1ea1n nh\u01b0 luminal A, luminal B, HER2 (+) v\u00e0 b\u1ed9 ba \u00e2m t\u00ednh [I, A].<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa c\u00f3 HR (-), HER2 (-) m\u00e0 kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 c\u00e1c ch\u1ec9 \u0111\u1ecbnh c\u1ee7a h\u00f3a tr\u1ecb thi\u1ec7u b\u1ed5 tr\u1ee3 (sau khi \u0111\u00e3 c\u00e2n nh\u1eafc t\u1ea5t c\u1ea3 c\u00e1c y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng v\u00e0 b\u1ec7nh h\u1ecdc), c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng \u0111\u00e1nh gi\u00e1 bi\u1ec3u hi\u1ec7n gen v\u00e0 \u0111\u00e1p \u1ee9ng n\u1ed9i ti\u1ebft ti\u1ec1n ph\u1eabu [II, B].<\/li>\n\n\n\n<li>T\u1ebf b\u00e0o lympho th\u00e2m nhi\u1ec5m kh\u1ed1i u (tumour-infiltrating lymphocytes \u2013 TIL) c\u00f3 th\u1ec3 b\u1ed5 sung th\u00f4ng tin cho c\u00f4ng t\u00e1c ti\u00ean l\u01b0\u1ee3ng v\u00e0 ch\u1ea9n \u0111o\u00e1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u00eanh nh\u00e2n ung th\u01b0 v\u00fa b\u1ed9 ba \u00e2m t\u00ednh v\u00e0 HER (+) nh\u01b0ng ch\u01b0a c\u00f3 ng\u01b0\u1ee1ng TIL r\u00f5 r\u00e0ng \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb [I, B].<\/li>\n\n\n\n<li>M\u1ee9c \u0111\u1ed9 bi\u1ec3u hi\u1ec7n c\u1ee7a programmed death-ligand 1 (PD-L1) khoogn n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm [I, E].<\/li>\n\n\n\n<li>X\u00e9t nghi\u1ec7m d\u00f2ng m\u1ea7m v\u00e0 t\u01b0 v\u1ea5n di truy\u1ec1n v\u1ec1 sau cho c\u00e1c bi\u1ebfn th\u1ec3&nbsp;<em>BRCA1\/2<\/em>&nbsp;n\u00ean \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t cho b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p v\u00e0 cho b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 v\u1edbi olaparib [I, A].<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/d3jd234qd1wf8n.cloudfront.net\/fit-in\/1024x1024\/journals\/editor\/file-5ff469389ec09a5d968f17cd725f2b70.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>H\u00ecnh 1.<\/strong>&nbsp;Quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n \u0111\u1ed9 ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>KHUY\u1ebeN C\u00c1O PH\u00c2N \u0110\u1ed8 GIAI \u0110O\u1ea0N V\u00c0 \u0110\u00c1NH GI\u00c1 NGUY C\u01a0<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Giai \u0111o\u1ea1n b\u1ec7nh v\u00e0 \u0111\u00e1nh gi\u00e1 sinh b\u1ec7nh cu\u1ed1i c\u00f9ng n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean ph\u00e2n lo\u1ea1i c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) v\u00e0 T\u1ed5 ch\u1ee9c ki\u1ec3m so\u00e1t Ung th\u01b0 Qu\u1ed1c t\u1ebf (UICC) [V, A].<\/li>\n\n\n\n<li>X\u00e9t nghi\u1ec7m m\u00e1u c\u01a1 b\u1ea3n (c\u00f4ng th\u1ee9c m\u00e1u to\u00e0n b\u1ed9, x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan, th\u1eadn, alkaline phosphatase v\u00e0 n\u1ed3ng \u0111\u1ed9 calci) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt v\u00e0 \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p b\u1ed5 tr\u1ee3 h\u1ec7 th\u1ed1ng\/t\u00e2n b\u1ed5 tr\u1ee3 h\u1ec7 th\u1ed1ng [V, A].<\/li>\n\n\n\n<li>Ch\u1ee5p CT ng\u1ef1c, b\u1ee5ng (si\u00eau \u00e2m, CT ho\u1eb7c MRI) v\u00e0 scan x\u01b0\u01a1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n c\u00f3:\n<ul class=\"wp-block-list\">\n<li>D\u01b0\u01a1ng t\u00ednh tr\u00ean l\u00e2m s\u00e0ng v\u1edbi h\u1ea1ch \u1edf n\u00e1ch<\/li>\n\n\n\n<li>Kh\u1ed1i u l\u1edbn<\/li>\n\n\n\n<li>B\u1eb1ng ch\u1ee9ng sinh h\u1ecdc c\u00f4ng k\u00edch<\/li>\n\n\n\n<li>D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng, bi\u1ec3u hi\u1ec7n ho\u1eb7c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m sinh h\u00f3a g\u1ee3i \u00fd c\u00f3 di c\u0103n [III, A].<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Ti\u1ec1n s\u1eed b\u1ec7nh v\u00e0 ti\u1ec1n s\u1eed gia \u0111\u00ecnh ho\u00e0n ch\u1ec9nh nen \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1, bao g\u1ed3m c\u1ea3 tr\u1ea1ng th\u00e1i m\u00e3n kinh (n\u1ebfu khi ng\u1edd, n\u00ean \u0111o l\u01b0\u1eddng n\u1ed3ng \u0111\u1ed9 estradiol huy\u1ebft thanh v\u00e0 n\u1ed3ng \u0111\u1ed9 hormone k\u00edch th\u00edch nang tr\u1ee9ng) [V, A].<\/li>\n\n\n\n<li>18F-FDG PET\/CT c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn thay v\u00ec CT v\u00e0 x\u1ea1 h\u00ecnh x\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao n\u1ebfu kh\u00f4ng th\u1ec3 \u0111\u01b0a ra k\u1ebft lu\u1eadn ch\u1ec9 d\u1ef1a tr\u00ean c\u00e1c bi\u1ec7n ph\u00e1p truy\u1ec1n th\u1ed1ng [II, B].<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>KI\u1ec2M SO\u00c1T UNG TH\u01af V\u00da GIAI \u0110O\u1ea0N S\u1edaM<\/strong><\/h2>\n\n\n\n<p><strong>Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb chung<\/strong><\/p>\n\n\n\n<p>H\u01b0\u1edbng d\u1eabn cung c\u1ea5p c\u00e1c khuy\u1ebfn c\u00e1o \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean, quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb cho m\u1ed7i b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean ph\u00e2n t\u00edch l\u1ee3i \u00edch-nguy c\u01a1 \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a sau khi c\u00e2n nh\u1eafc c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m, g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt v\u00e0 s\u1edf th\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n. Quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean sau khi th\u1ea3o lu\u1eadn v\u1edbi b\u1ec7nh nh\u00e2n. N\u00ean \u0111\u1ec3 b\u1ec7nh nh\u00e2n tham gia v\u00e0o quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb khi c\u00f3 th\u1ec3.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/d3jd234qd1wf8n.cloudfront.net\/fit-in\/1024x1024\/journals\/editor\/file-ede824a43ffd2ebae12c01d65c3f168d.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>H\u00ecnh 2.&nbsp;<\/strong>T\u1ed5ng quan \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm<\/p>\n\n\n\n<p><strong><em>Khuy\u1ebfn c\u00e1o<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Khi c\u00f3 th\u1ec3, \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i chuy\u00ean khoa\/trung t\u00e2m ung b\u01b0\u1edbu\/ung th\u01b0 v\u00fa b\u1edfi \u0111\u1ed9i nh\u00f3m h\u1ee3p t\u00e1c li\u00ean ng\u00e0nh c\u00f3 th\u1ec3 t\u01b0 v\u1ea5n chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn chuy\u00ean khoa ph\u00f9 h\u1ee3p [III, A].<\/li>\n\n\n\n<li>Tham gia v\u00e0o c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o [V, A].<\/li>\n\n\n\n<li>Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb cho m\u1ed7i b\u1ec7nh nh\u00e2n n\u00ean d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 ph\u00e2n t\u00edch l\u1ee3i \u00edch \u2013 nguy c\u01a1 sau khi c\u00e2n nh\u1eafc g\u00e1nh n\u1eb7ng c\u1ee7a kh\u1ed1i u (k\u00edch th\u01b0\u1edbc, v\u1ecb tr\u00ed c\u1ee7a kh\u1ed1i u ti\u00ean ph\u00e1t, s\u1ed1 l\u01b0\u1ee3ng sang th\u01b0\u01a1ng v\u00e0 t\u00ecnh tr\u1ea1ng ph\u00ec \u0111\u1ea1i h\u1ea1ch b\u1ea1ch huy\u1ebft), sinh h\u1ecdc (sinh b\u1ec7nh h\u1ecdc, bao g\u1ed3m d\u1ea5u ch\u1ec9 sinh h\u1ecdc v\u00e0 bi\u1ec3u hi\u1ec7n gen), tu\u1ed5i t\u00e1c, tr\u1ea1ng th\u00e1i m\u00e3n kinh, t\u1ed5ng tr\u1ea1ng s\u1ee9c kh\u1ecfe v\u00e0 s\u1edf th\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n [I, A].<\/li>\n\n\n\n<li>Tu\u1ed5i t\u00e1c n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c v\u00e0 kh\u00f4ng n\u00ean l\u00e0 y\u1ebfu t\u1ed1 x\u00e1c \u0111\u1ecbnh \u0111\u1ea7u ti\u00ean khi \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb [IV, A].<\/li>\n\n\n\n<li>Sinh s\u1ea3n v\u00e0 b\u1ea3o t\u1ed3n sinh s\u1ea3n n\u00ean \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn v\u1edbi b\u1ec7nh nh\u00e2n ch\u01b0a m\u00e3n kinh tr\u1ebb tu\u1ed5i (b\u1ea5t k\u1ec3 giai \u0111o\u1ea1n b\u1ec7nh) tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u b\u1ea5t k\u1ef3 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ec7 th\u1ed1ng n\u00e0o [V, A].<\/li>\n<\/ul>\n\n\n\n<p><strong>Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 &#8211; t\u1ea1i v\u00f9ng (locoregional treatment)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n v\u00fa v\u1edbi x\u1ea1 tr\u1ecb h\u1eadu ph\u1eabu l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean cho \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm [I, A].<\/li>\n\n\n\n<li>Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf to\u00e0n b\u1ed9 tuy\u1ebfn v\u00fa \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh\/\u01b0u ti\u00ean, ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o v\u00fa c\u0169ng n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean, ngo\u1ea1i tr\u1eeb kh\u1ed1i u vi\u00eam ti\u00ean ph\u00e1t v\u00e0 c\u00e1c kh\u1ed1i u kh\u00e1c c\u00f3 nguy c\u01a1 cao c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfu \u0111i\u1ec1u tr\u1ecb n\u1ebfu \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n\/x\u1ea1 tr\u1ecb ch\u1eadm tr\u1ec5 [V, A].<\/li>\n\n\n\n<li>Sinh thi\u1ebft h\u1ea1ch g\u00e1c l\u00e0 ph\u1eabu thu\u1eadt ti\u00eau chu\u1ea9n \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a h\u1ea1ch b\u1ea1ch huy\u1ebft tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 th\u0103m kh\u00e1m [I, A].<\/li>\n\n\n\n<li>N\u1ebfu ch\u01b0a t\u1eebng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb h\u1ec7 th\u1ed1ng tr\u01b0\u1edbc \u0111\u00e2y, b\u1ec7nh nh\u00e2n di c\u0103n v\u1edbi k\u00edch th\u01b0\u1edbc nh\u1ecf (micrometastatic) v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n h\u1ea1ch g\u00e1c h\u1ea1n ch\u1ebf (ch\u1ec9 1-2 h\u1ea1ch g\u00e1c) \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a h\u1ea1ch b\u1ea1ch huy\u1ebft tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 th\u0103m kh\u00e1m, ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n v\u00fa k\u00e8m theo x\u1ea1 tr\u1ecb to\u00e0n b\u1ed9 v\u00fa sau \u0111\u00f3, r\u1ed3i \u0111\u1ebfn c\u1ea3 ph\u1ea7n d\u01b0\u1edbi c\u1ee7a n\u00e1ch v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 h\u1ec7 th\u1ed1ng m\u00e0 kh\u00f4ng c\u1ea7n ph\u1eabu thu\u1eadt kh\u00e1c \u1edf v\u00f9ng n\u00e1ch [II, A].<\/li>\n\n\n\n<li>C\u1eaft b\u1ecf h\u1ea1ch b\u1ea1ch huy\u1ebft \u1edf n\u00e1ch sau khi c\u00f3 k\u1ebft qu\u1ea3 sinh thi\u1ebft h\u1ea1ch g\u00e1c d\u01b0\u01a1ng t\u00ednh v\u1edbi &lt; 3 h\u1ea1ch g\u00e1c li\u00ean quan ch\u1ec9 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt do h\u1ea1ch b\u1ea1ch huy\u1ebft \u1edf n\u00e1ch ho\u1eb7c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 h\u1ec7 th\u1ed1ng v\u1ec1 sau [II, A].<\/li>\n\n\n\n<li>K\u1ebf ho\u1ea1ch ph\u1eabu thu\u1eadt sau li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ec7 th\u1ed1ng ban \u0111\u1ea7u n\u00ean c\u00e2n nh\u1eafc t\u00ecnh hu\u1ed1ng sau khi \u0111i\u1ec1u tr\u1ecb h\u1ec7 th\u1ed1ng ban \u0111\u1ea7u [II, A].<\/li>\n\n\n\n<li>X\u1ea1 tr\u1ecb to\u00e0n b\u1ed9 v\u00fa \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o sau khi ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n v\u00fa [I, A].<\/li>\n\n\n\n<li>Chi\u1ebfn l\u01b0\u1ee3c x\u1ea1 tr\u1ecb gi\u1ea3m s\u1ed1 ph\u00e2n li\u1ec1u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o: trung b\u00ecnh (15 \u2013 16 li\u1ec1u v\u1edbi \u2264 3 Gy\/li\u1ec1u\/ng\u00e0y cho m\u1ecdi ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb h\u1eadu ph\u1eabu) v\u00e0 x\u1ea1 tr\u1ecb gi\u1ea3m t\u1ed1i \u0111a s\u1ed1 ph\u00e2n li\u1ec1u (26 Gy trong ph\u00e2n li\u1ec1u 5 ng\u00e0y cho to\u00e0n b\u1ed9 v\u00fa ho\u1eb7c th\u00e0nh ng\u1ef1c (kh\u00f4ng c\u00f3 t\u00e1i t\u1ea1o)) [I, A].<\/li>\n\n\n\n<li>X\u1ea1 tr\u1ecb m\u1ed9t ph\u1ea7n tuy\u1ebfn v\u00fa s\u1eed d\u1ee5ng m\u00e1y t\u0103ng t\u1ed1c l\u00e0 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf cho x\u1ea1 tr\u1ecb to\u00e0n b\u1ed9 v\u00fd \u1edf b\u1ec7nh nh\u00e2n m\u1eafc ung th\u01b0 v\u00fa x\u00e2m l\u1ea5n v\u00e0 ung th\u01b0 v\u00fa&nbsp;<em>in situ<\/em>&nbsp;c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t t\u1ea1i ch\u1ed7 th\u1ea5p [I, A].<\/li>\n\n\n\n<li>X\u1ea1 tr\u1ecb sau khi c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n m\u1eafc ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 nguy c\u01a1 cao, bao g\u1ed3m di\u1ec7n c\u1eaft c\u00f3 li\u00ean quan, \u2265 4 h\u1ea1ch b\u1ea1ch huy\u1ebft n\u00e1ch c\u00f3 li\u00ean quan, kh\u1ed1i u T3 \u2013 T4 v\u00e0 c\u00f3 nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c [I, A].<\/li>\n\n\n\n<li>X\u1ea1 tr\u1ecb sau khi c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa n\u00ean \u0111\u01b0\u1ee3c \u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 trung b\u00ecnh, bao g\u1ed3m b\u1ec7nh nh\u00e2n c\u00f3 1-3 h\u1ea1ch b\u1ea1ch huy\u1ebft n\u00e1ch d\u01b0\u01a1ng t\u00ednh [I, A].<\/li>\n\n\n\n<li>X\u1ea1 tr\u1ecb h\u1ea1ch b\u1ea1ch huy\u1ebft \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n c\u00f3 h\u1ea1ch h\u1ea1ch huy\u1ebft d\u01b0\u01a1ng t\u00ednh (\u0111\u00edch \u0111i\u1ec1u tr\u1ecb t\u00f9y thu\u1ed9c v\u00e0o y\u1ebfu t\u1ed1 nguy c\u01a1 bao g\u1ed3m s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch b\u1ea1ch huy\u1ebft li\u00ean quan, giai \u0111o\u1ea1n ung th\u01b0 v\u00e0 \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n \u0111\u1ea7u ti\u00ean [I, B].<\/li>\n\n\n\n<li>N\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh, x\u1ea1 tr\u1ecb sau khi c\u1eaft b\u1ecf tuy\u1ebfn v\u00fa c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh sau khi ph\u1eabu thu\u1eadt t\u00eda t\u1ea1o v\u00fa nhanh ch\u00f3ng [III, A].<\/li>\n<\/ul>\n\n\n\n<p><strong>Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm HR (+), HER2 (-)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>M\u1ecdi ung th\u01b0 ki\u1ec3u luminal n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p n\u1ed9i ti\u1ebft [I, A].<\/li>\n\n\n\n<li>\u0110a s\u1ed1 kh\u1ed1i u ki\u1ec3u luminal A kh\u00f4ng c\u1ea7n h\u00f3a tr\u1ecb li\u1ec7u, ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt [I, A].<\/li>\n\n\n\n<li>Trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a h\u00f3a tr\u1ecb li\u1ec7u b\u1ed5 tr\u1ee3 (sau khi c\u00e2n nh\u1eafc c\u00e1c y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng v\u00e0 sinh b\u1ec7nh h\u1ecdc), c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng k\u1ebft qu\u1ea3 ki\u1ec3m tra bi\u1ec3u hi\u1ec7n gen ho\u1eb7c \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng n\u1ed9i ti\u1ebft \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u1ec1 h\u00f3a tr\u1ecb li\u1ec7u b\u1ed5 tr\u1ee3 [I, A].<\/li>\n\n\n\n<li>Ung th\u01b0 HR (+) luminal B, HER2 (-) luminal B n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi h\u00f3a tr\u1ecb li\u1ec7u sau khi \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p n\u1ed9i ti\u1ebft. H\u00f3a tr\u1ecb li\u1ec7u n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 l\u00e2m s\u00e0ng cao (ch\u1eb3ng h\u1ea1n nh\u01b0 c\u00f3 nhi\u1ec1u h\u1ea1ch b\u1ea1ch huy\u1ebft d\u01b0\u01a1ng t\u00ednh, b\u1ec7nh nh\u00e2n ti\u1ec1n m\u00e3n kinh c\u00f3 h\u1ea1ch b\u1ea1ch huy\u1ebft d\u01b0\u01a1ng t\u00ednh, ti\u1ebfn tri\u1ec3n t\u1ea1i ch\u1ed7) v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 0 \u2013 3 h\u1ea1ch b\u1ea1ch huy\u1ebft li\u00ean quan v\u00e0 c\u00f3 nguy c\u01a1 cao (ch\u1eb3ng h\u1ea1n nh\u01b0 k\u1ebft qu\u1ea3 \u0111\u00e1nh gi\u00e1 bi\u1ec3u hi\u1ec7n gen cho th\u1ea5y nguy c\u01a1 cao) [I, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n ti\u1ec1n m\u00e3n kinh n\u00ean \u0111\u01b0\u1ee3c \u0111\u01a1n tr\u1ecb v\u1edbi tamoxifen (luminal A, giai \u0111o\u1ea1n I) [I, A] ho\u1eb7c n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao, \u1ee9c ch\u1ebf bu\u1ed3ng tr\u1ee9ng v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng bu\u1ed3ng tr\u1ee9ng (OFS)-tamoxifen ho\u1eb7c OFS \u2013 ch\u1ea5t \u1ee9c ch\u1ebf aromatase[I, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n h\u1eadu m\u00e3n kinh n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf aromataseho\u1eb7c tamoxifen sau khi \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf aromatase[I, A].\n<ul class=\"wp-block-list\">\n<li>Tamoxifen c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn cho b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p ho\u1eb7c kh\u00f4ng dung n\u1ea1p ch\u1ea5t \u1ee9c ch\u1ebf aromatase[I, A].<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Biphosphonate (cho \u0111\u1ebfn 5 n\u0103m) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ee9c n\u0103ng bu\u1ed3ng tr\u1ee9ng (h\u1eadu m\u00e3n kinh ho\u1eb7c \u0111ang \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng bu\u1ed3n tr\u1ee9ng), \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao [I, A] ho\u1eb7c b\u1ec7nh nh\u00e2n b\u1ecb m\u1ea5t x\u01b0\u01a1ng do \u0111i\u1ec1u tr\u1ecb [I, A].&nbsp;<\/li>\n\n\n\n<li>B\u1ed5 sung abemaciclib trong v\u00f2ng 2 n\u0103m v\u00e0o tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 &#8211; t\u1ea1i v\u00f9ng kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm giai \u0111o\u1ea1n III ho\u1eb7c giai \u0111o\u1ea1n II c\u00f3 nguy c\u01a1 cao [I, A].<\/li>\n\n\n\n<li>Li\u1ec7u ph\u00e1p n\u1ed9i ti\u1ebft d\u00e0i h\u01a1n 5 n\u0103m n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 nguy c\u01a1 cao [I, A]. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb trong v\u00f2ng 7 \u2013 8 n\u0103m c\u00f3 th\u1ec3 h\u1ee3p l\u00fd v\u1edbi \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao [I, A].<\/li>\n\n\n\n<li>Sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 &#8211; t\u1ea1i v\u00f9ng v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3\/b\u1ed5 tr\u1ee3, olaparib b\u1ed5 tr\u1ee3 1 n\u0103m \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3&nbsp;<em>gBRCA1\/2<\/em>&nbsp;v\u00e0 HER 2 (-), HR (+) v\u1edbi nhi\u1ec1u h\u1ea1ch b\u1ea1ch huy\u1ebft d\u01b0\u01a1ng t\u00ednh sau ph\u1eabu thu\u1eadt ban \u0111\u1ea7u ho\u1eb7c b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 nguy c\u01a1 t\u1ed3n d\u01b0 cao sau h\u00f3a tr\u1ecb li\u1ec7u t\u00e2n b\u1ed5 tr\u1ee3 [I, A].<\/li>\n\n\n\n<li>Tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft n\u00ean \u0111i k\u00e8m v\u1edbi olaparib b\u1ed5 tr\u1ee3 \u1edf b\u1ec7nh nh\u00e2n c\u00f3&nbsp;<em>gBRCA1\/2m<\/em>&nbsp;[I, A].<\/li>\n\n\n\n<li>Olaparib v\u00e0 abemaciclib kh\u00f4ng n\u00ean ph\u1ed1i h\u1ee3p do \u0111\u1ed9c t\u00ednh ch\u1ed3ng l\u1ea5p, nh\u01b0ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n theo th\u1ee9 t\u1ef1 (olaparib tr\u01b0\u1edbc) [V, A].<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/d3jd234qd1wf8n.cloudfront.net\/fit-in\/1024x1024\/journals\/editor\/file-811873ed8bc0ae883be8fea8382cc704.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>H\u00ecnh 3.<\/strong>&nbsp;Vai tr\u00f2 c\u1ee7a tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft b\u1ed5 tr\u1ee3 \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm HR (+)<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/d3jd234qd1wf8n.cloudfront.net\/fit-in\/1024x1024\/journals\/editor\/file-92400f6fbfdfb945439a7150294dd636.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>H\u00ecnh 4.<\/strong>&nbsp;\u0110i\u1ec1u tr\u1ecb h\u1ec7 th\u1ed1ng b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm HR (+), HER2 (-)<\/p>\n\n\n\n<p><strong>Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm HER2 (+)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tr\u1ecb li\u1ec7u tr\u1ef1c ti\u1ebfp tr\u00ean HER2 (v\u1edbi h\u00f3a tr\u1ecb li\u1ec7u \u0111\u1ed3ng th\u1eddi kh\u1edfi ph\u00e1t) n\u00ean k\u00e9o d\u00e0i trong 12 th\u00e1ng, bao ph\u1ee7 c\u1ea3 giai \u0111o\u1ea1n t\u00e2n tr\u1ecb li\u1ec7u b\u1ed5 tr\u1ee3 v\u00e0\/ho\u1eb7c tr\u1ecb li\u1ec7u b\u1ed5 tr\u1ee3 [I, A].\n<ul class=\"wp-block-list\">\n<li>C\u00f3 th\u1ec3 ph\u1ed5i h\u1ee3p (n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh) v\u1edbi x\u1ea1 tr\u1ecb v\u00e0 tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft [I, A]. \u1ede nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p c\u00f3 ch\u1ecdn l\u1ecdc, 6 th\u00e1ng tr\u1ecb li\u1ec7u anti HER2 c\u00f3 th\u1ec3 kh\u00f4ng thua k\u00e9m.<\/li>\n\n\n\n<li>\u0110\u00e1nh gi\u00e1 tim m\u1ea1ch th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o (tr\u01b0\u1edbc, trong khi v\u00e0 sau tr\u1ecb li\u1ec7u) tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u h\u00f3a tr\u1ecb li\u1ec7u [II, B].<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa HER2 (+) giai \u0111o\u1ea1n II \u2013 III, h\u00f3a tr\u1ecb li\u1ec7u t\u00e2n b\u1ed5 tr\u1ee3 h\u1ec7 th\u1ed1ng v\u1edbi li\u1ec7u ph\u00e1p anti HER2 bao g\u1ed3m trastuzumab\u2013pertuzumab l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean [I, A].<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi h\u00f3a tr\u1ecb li\u1ec7u x\u01b0\u01a1ng s\u1ed1ng, ph\u00e1c \u0111\u1ed3 anthracycline \u2013 taxane ho\u1eb7c taxane \u2013 carboplatin d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng \u0111\u1ed9c l\u1eadp v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p t\u00e2n b\u1ed5 tr\u1ee3 ho\u1eb7c li\u1ec7u ph\u00e1p b\u1ed5 tr\u1ee3 [I, A].<\/li>\n\n\n\n<li>Ch\u1eb9n k\u00e9p v\u1edbi trastuzumab\u2013pertuzumab (so v\u1edbi trastuzumab \u0111\u01a1n tr\u1ecb) ph\u1ed1i h\u1ee3p v\u1edbi h\u00e1o tr\u1ecb li\u1ec7u \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng sinh b\u1ec7nh h\u1ecdc ho\u00e0n ch\u1ec9nh cao h\u01a1n v\u00e0 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho li\u1ec7u ph\u00e1p t\u00e2n b\u1ed5 tr\u1ee3 [I, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh x\u00e2m l\u1ea5n t\u1ed3n d\u01b0 (kh\u00f4ng \u0111\u00e1p \u1ee9ng sinh b\u1ec7nh h\u1ecdc ho\u00e0n ch\u1ec9nh sau h\u00f3a tr\u1ecb li\u1ec7u t\u00e2n b\u1ed5 tr\u1ee3 v\u00e0 tr\u1ecb li\u1ec7u anti HER2) n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 v\u1edbi trastuzumab emtansine v\u1edbi 14 chu k\u1ef3 [I, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm giai \u0111o\u1ea1n I HER2 (+), c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt ban \u0111\u1ea7u [III, B], ti\u1ebfp \u0111\u1ebfn \u0111i\u1ec1u tri b\u1ed5 tr\u1ee3 trong 12 tu\u1ea7n v\u1edbi paclitaxel v\u1edbi trastuzumab trong 1 n\u0103m n\u1ebfu giai \u0111oan l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1edfi sinh b\u1ec7nh h\u1ecdc [III, B].<\/li>\n\n\n\n<li>\u1ede b\u1ec7nh nh\u00e2n d\u01b0\u01a1ng t\u00ednh v\u1edbi h\u1ea1ch b\u1ea1ch huy\u1ebft, b\u1ed5 sung pertuzumab v\u1edbi trastuzumab n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 b\u1ea5t k\u1ec3 tr\u1ea1ng th\u00e1i HR [I, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n HR (+) c\u00f3 nguy c\u01a1 cao c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111\u1ec3 m\u1edf r\u1ed9ng \u0111i\u1ec1u tr\u1ecb v\u1edbi neratinib trogn 1 n\u0103m sau khi ho\u00e0n th\u00e0nh 1 n\u0103m \u0111i\u1ec1u tr\u1ecb v\u1edbi trastuzumab ho\u1eb7c tr\u1ecb li\u1ec7u d\u1ef1a tr\u00ean n\u1ec1n t\u1ea3ng trastuzumab [I, B].<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/d3jd234qd1wf8n.cloudfront.net\/fit-in\/1024x1024\/journals\/editor\/file-d1ec39bbcbc61a9cba5c982279b905be.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>H\u00ecnh 5.<\/strong>&nbsp;Ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm HER2 (+)<\/p>\n\n\n\n<p><strong>Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm b\u1ed9 3 \u00e2m t\u00ednh<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>HER2 (-) v\u1edbi bi\u1ec3u hi\u1ec7n ER v\u00e0\/ho\u1eb7c PgR 1 \u2013 9% l\u00e0 nh\u00f3m b\u1ec7nh kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n sinh h\u1ecdc t\u01b0\u01a1ng t\u1ef1 b\u1ed9 ba \u00e2m t\u00ednh. Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh cho nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y, do nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 c\u00f3 \u0111\u00e1p \u1ee9ng cao h\u01a1n v\u1edbi h\u00f3a tr\u1ecb li\u1ec7u v\u00e0 gi\u1ea3m hi\u1ec7u l\u1ef1c c\u1ee7a tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft so [II, B].<\/li>\n\n\n\n<li>Ung th\u01b0 b\u1ed9 ba \u00e2m t\u00ednh n\u00ean \u0111\u01b0\u1ee3c h\u00f3a tr\u1ecb li\u1ec7u k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch (ch\u1eb3ng h\u1ea1n pembrolizumab) [I, A], ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n \u00e2m t\u00ednh v\u1edbi h\u1ea1ch b\u1ea1ch huy\u1ebft thu\u1ed9c subtype m\u00f4 h\u1ecdc \u0111\u1eb7c bi\u1ec7t ch\u1eb3ng h\u1ea1n nh\u01b0 ung th\u01b0 bi\u1ec3u m\u00f4 nang tuy\u1ebfn (adenoid cystic carcinoma) ho\u1eb7c secretory carcinoma ho\u1eb7c c\u00f3 nguy c\u01a1 l\u00e2m s\u00e0ng r\u1ea5t th\u1ea5p (pT1a pN0) [II, B].<\/li>\n\n\n\n<li>H\u00f3a tr\u1ecb li\u1ec7u n\u00ean k\u00e9o d\u00e0i trong 12 \u2013 24 tu\u1ea7n (4-8 chu k\u1ef3), t\u00f9y htuoojc v\u00e0o giai \u0111o\u1ea1n ung th\u01b0, lo\u1ea1i ph\u00e1c \u0111\u1ed3 v\u00e0 b\u1ea5t k\u1ec3 thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch s\u1eed d\u1ee5ng [I, A].<\/li>\n\n\n\n<li>Khi l\u1ef1a ch\u1ecdn h\u00f3a tr\u1ecb li\u1ec7u c\u00f3 li\u1ec7u tr\u00ecnh d\u00e0y v\u1edbi y\u1ebfu t\u1ed1 k\u00edch th\u00edch d\u00f2ng b\u1ea1ch c\u1ea7u h\u1ea1t, n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc do l\u1ee3i \u00edch \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u01b0\u1ee3t tr\u1ed9i h\u01a1n li\u1ec7u tr\u00ecnh b\u00ecnh th\u01b0\u1eddng [I, A].<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi cT1c-4 N0 ho\u1eb7c b\u1ed9 ba \u00e2m t\u00ednh N \u00e2m t\u00ednh b\u1ea5t k\u1ef3, tr\u1ecb li\u1ec7u b\u1ed5 tr\u1ee3 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean [I, A].<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi cT2-4 N0 ho\u1eb7c b\u1ed9 ba \u00e2m t\u00ednh (giai \u0111o\u1ea1n II \u2013 III) N \u00e2m t\u00ednh b\u1ea5t k\u1ef3 n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi h\u00f3a tr\u1ecb li\u1ec7u t\u00e2n b\u1ed5 tr\u1ee3 k\u00e8m v\u1edbi pembrolizumab, tr\u1eeb khi b\u1ec7nh nh\u00e2n c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 ng\u1ed9 \u0111\u1ed9c mi\u1ec5n d\u1ecbch li\u00ean quan \u0111\u1ebfn thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch qu\u00e1 m\u1ee9c [I, A].<\/li>\n\n\n\n<li>Pembrolizumab n\u00ean \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n m\u1ed7i 3 tu\u1ea7n trong su\u1ed1t pha \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 [I, A] v\u00e0 trong 9 chu k\u1ef3 3 tu\u1ea7n trong su\u1ed1t pha \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3, b\u1ea5t k\u1ec3 tr\u1ea1ng th\u00e1i \u0111\u00e1p \u1ee9ng ho\u00e0n to\u00e0n sinh b\u1ec7nh h\u1ecdc [I, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi pemprolizumab n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd c\u00e1c bi\u1ebfn c\u1ed1 c\u00f3 h\u1ea1i do \u0111\u1ed9c t\u00ednh mi\u1ec5n d\u1ecbch trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb [V, A].<\/li>\n\n\n\n<li>Ch\u1ea5t \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 m\u00e0 kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3 v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch tr\u01b0\u1edbc \u0111\u00f3 [V, D].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n\u00a0<em>gBRCA1\/2m<\/em>\u00a0v\u00e0 b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa b\u1ed9 ba \u00e2m t\u00ednh c\u00f3 nguy c\u01a1 cao (kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng ho\u00e0n to\u00e0n sinh b\u1ec7nh h\u1ecdc ho\u1eb7c ung th\u01b0 giai \u0111o\u1ea1n II \u2013 III) n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 v\u1edbi olaparib trong 1 n\u0103m [I, A].\n<ul class=\"wp-block-list\">\n<li>Ph\u1ed1i h\u1ee3p ch\u1ea5t \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch v\u00e0 olaparib c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n [V, C].<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh t\u1ed3n d\u01b0 kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 v\u1edbi capecitabine 6 \u2013 8 chu k\u1ef3 [I, A].\n<ul class=\"wp-block-list\">\n<li>Kh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh ph\u1ed1i h\u1ee3p olaparib v\u00e0 capecitabine \u1edf b\u1ec7nh nh\u00e2n&nbsp;<em>gBRCAm<\/em>&nbsp;[V, C].<\/li>\n\n\n\n<li>Ph\u1ed1i h\u1ee3p ch\u1ea5t \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch v\u00e0 capecitabine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n [V, C].<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/d3jd234qd1wf8n.cloudfront.net\/fit-in\/1024x1024\/journals\/editor\/file-d5bf22aabe649c1dd48623bd16e2a4ce.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><strong>H\u00ecnh 6.<\/strong>&nbsp;Ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm b\u1ed9 ba \u00e2m t\u00ednh<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>KHUY\u1ebeN C\u00c1O THEO D\u00d5I V\u00c0 C\u00c1C BI\u1ebeN CH\u1ee8NG L\u00c2U D\u00c0I<\/strong><\/h2>\n\n\n\n<p><strong>C\u00e2n nh\u1eafc chung<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Theo d\u00f5i th\u01b0\u1eddng quy m\u1ed7i 3 th\u00e1ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong 3 n\u0103m \u0111\u1ea7u ti\u00ean sau khi ho\u00e0n th\u00e0nh \u0111i\u1ec1u tr\u1ecb (m\u1ed7i 6 th\u00e1ng cho b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 nguy c\u01a1 th\u1ea5p), m\u1ed7i 6 th\u00e1ng k\u1ec3 t\u1eeb n\u0103m th\u1ee9 4 \u2013 5 v\u00e0 m\u1ed7i n\u0103m sau \u0111\u00f3 n\u1eefa. Kho\u1ea3ng c\u00e1ch gi\u1eefa c\u00e1c l\u1ea7n th\u0103m kh\u00e1m c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u00f9y theo nguy c\u01a1 t\u00e1i ph\u00e1t v\u00e0 nhu c\u1ea7u c\u1ee7a b\u1ec7nh nh\u00e2n [I, A].<\/li>\n\n\n\n<li>Ch\u1ee5p nh\u0169 \u1ea3nh 2 b\u00ean h\u00e0ng n\u0103m (sau khi \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u00fa) ho\u1eb7c nh\u0169 \u1ea3nh \u0111\u1ed1i b\u00ean (sau khi c\u1eaft b\u1ecf v\u00fa) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o, k\u00e8m v\u1edbi si\u00eau \u00e2m v\u00e0 MRI v\u00fa khi c\u1ea7n [II, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ung th\u01b0 v\u00fa n\u00ean tham gia c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh theo d\u00f5i qu\u1ed1c gia cho c\u00e1c b\u1ec7nh ung th\u01b0 kh\u00e1c [V, B].<\/li>\n\n\n\n<li>\u1ede b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, x\u00e9t nghi\u1ec7m sinh h\u00f3a ho\u1eb7c h\u00ecnh \u1ea3nh h\u1ecdc kh\u00e1c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o [I, D].<\/li>\n\n\n\n<li>Th\u0103m d\u00f2 theo tri\u1ec7u ch\u1ee9ng n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc [V, B].<\/li>\n\n\n\n<li>\u0110\u00e1nh gi\u00e1 m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf aromatase ho\u1eb7c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf ch\u1ee9c n\u0103ng bu\u1ed3ng tr\u1ee9ng [I, A].<\/li>\n\n\n\n<li>\u1ede b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng v\u1edbi ch\u1ee9c n\u0103ng tim b\u00ecnh th\u01b0\u1eddng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi bi\u1ec7n ph\u00e1p c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c tr\u00ean tim n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i tim m\u1ea1ch [III, B].<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi tamoxifen, ki\u1ec3m tra ph\u1ee5 khoa h\u00e0ng n\u0103m \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o [V, B]. Tuy nhi\u00ean, si\u00eau \u00e2m \u0111\u1ea7u d\u00f2 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o [V, D].<\/li>\n<\/ul>\n\n\n\n<p><strong>Nh\u1eefng c\u00e2n nh\u1eafc li\u00ean quan \u0111\u1ebfn sinh s\u1ea3n v\u00e0 sinh d\u1ee5c<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>M\u00e3n kinh s\u1edbm, v\u00f4 sinh v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng sinh d\u1ee5c n\u00ean \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn v\u00e0 x\u1eed tr\u00ed v\u1edbi b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb n\u1ebfu ph\u00f9 h\u1ee3p [V, A].<\/li>\n\n\n\n<li>B\u1ec7nh nh\u00e2n ti\u1ec1n m\u00e3n kinh c\u00e2n nh\u1eafc mang thai n\u00ean \u0111\u01b0\u1ee3c th\u00f4ng tin v\u1ec1 c\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 mang thai sau khi \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa [III, A].<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n r\u1ea5t mong mu\u1ed1n mang thai, gi\u00e1n \u0111o\u1ea1n tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft b\u1ed5 tr\u1ee3 t\u1ea1m th\u1eddi sau 18 \u2013 30 th\u00e1ng \u0111i\u1ec1u tr\u1ecb v\u1edbi tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft cho ph\u00e9p th\u1ea3i tr\u1eeb k\u00e9o d\u00e0i trong 3 th\u00e1ng v\u00e0 mang thai trong 2 n\u0103m, sau \u0111\u00f3 t\u00e1i \u0111i\u1ec1u tr\u1ecb v\u1edbi tr\u1ecb li\u1ec7u n\u1ed9i ti\u1ebft. Ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb ng\u1eaft qu\u00e3ng n\u00e0y kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 ung th\u01b0 v\u00fa ng\u1eafn h\u1ea1n \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm HR (+), HER2 (-) c\u00f3 nguy c\u01a1 th\u1ea5p.<\/li>\n<\/ul>\n\n\n\n<p><strong>C\u00e2n nh\u1eafc t\u00e2m l\u00fd<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c v\u1eadn \u0111\u1ed9ng tu\u00e2n th\u1ee7 l\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1ch, t\u1eadp th\u1ec3 d\u1ee5c th\u01b0\u1eddng xuy\u00ean, tr\u00e1nh t\u0103ng c\u00e2n v\u00e0 h\u1ea1n ch\u1ebf u\u1ed1ng r\u01b0\u1ee3u [II, A].<\/li>\n\n\n\n<li>Nh\u1eefng nhu c\u1ea7u cho cu\u1ed9c s\u1ed1ng l\u00e2u d\u00e0i sau khi \u0111i\u1ec1u tr\u1ecb ung th\u01b0 nh\u01b0 c\u00f4ng vi\u1ec7c, t\u00e2m sinh l\u00fd, giai \u0111\u00ecnh v\u00e0 sinh d\u1ee5c n\u00ean \u0111\u01b0\u1ee3c x\u1eed tr\u00ed [V, A].<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Ngu\u1ed3n:<\/strong><\/h3>\n\n\n\n<p>B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c l\u01b0\u1ee3c d\u1ecbch t\u1eeb Loibl S, Andr\u00e9 F, Bachelot T, et al; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024 Feb;35(2):159-182. doi: 10.1016\/j.annonc.2023.11.016.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>V\u00e0o n\u0103m 2020, \u01b0\u1edbc t\u00ednh c\u00f3 kho\u1ea3ng 2.3 tri\u1ec7u tr\u01b0\u1eddng h\u1ee3p m\u1eafc m\u1edbi ung th\u01b0 v\u00fa tr\u00ean to\u00e0n c\u1ea7u, chi\u1ebfm 12% s\u1ed1 ca m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ung th\u01b0.<\/p>\n","protected":false},"author":123,"featured_media":35535,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1438],"articles_languages":[1375],"articles_filters":[],"class_list":["post-35498","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/35498","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=35498"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/35498\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/35535"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=35498"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=35498"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=35498"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=35498"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=35498"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=35498"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}