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PHC 畛 I畛U TR畛 UNG TH働 畉I TRNG Ung th動 畉i trng 達 ph畉u thu畉t (ch動a di cn xa) B畛nh xu畉t vi畛n, h畉n t叩i kh叩m l畉i sau 3 tu畉n 畉 h畛i ch畉n h坦a x畉. X辿t nghi畛m c畉n lm: CTM, Sinh h坦a m叩u (ch畛c nng gan, ch畛c nng th畉n..), CEA, CA19- 9, X quang ph畛i, si棚u 但m b畛ng, CT Scan b畛ng, L畉y k畉t qu畉 GP b畛nh l箪 (ch畉n o叩n giai o畉n TNM) 1. Tis; T1, No, Mo kh担ng c畉n h坦a tr畛 h坦a tr畛 h畛 tr畛 (Adjuvant Therapy) T2, No, Mo kh担ng c畉n h坦a tr畛 h坦a tr畛 h畛 tr畛 2. T3, No, Mo kh担ng c坦 y畉u t畛 nguy c董 t叩i ph叩t (Low risk) H坦a tr畛 theo ph叩c 畛: Folfox4 Capecitabine hay 5- FU + Leucovorin. 3. T3, No, Mo (nguy c董 t叩i ph叩t cao: T4, c坦 3 hay 4 sang th動董ng, d鱈nh vo ph炭c m畉c, t畉c ru畛t) ho畉c T4, No, Mo H坦a tr畛 theo ph叩c 畛: Folfox4 Capox Ung th動 畉i tr畛c trng di cn gan ho畉c/v ph畛i: 1 .N畉u ph畉u thu畉t 動畛c (c畉t b畛 kh畛i u 畉i tr畛c trng+ kh畛 u di cn) H坦a tr畛 h畛 tr畛 v畛i ph叩c 畛: Folfox4 Capox.
Ho畉c h坦a tr畛 t但n h畛 tr畛 (neoadjuvant therapy) Folfiri/ Folfox/ CapeOX +/- Bevacizumab hay Folfiri/ Folfox +/- Panitumumab hay Folfiri +/- Cetuximab (KRAS Wild-type gene only) 叩nh gi叩 l畉i, x辿t ch畛 畛nh ph畉u thu畉t sau 2- 3 chu k畛 h坦a tr畛. 2. N畉u b畛nh qu叩 ch畛 畛nh ph畉u thu畉t Folfiri/ Folfox/ CapeOX +/- Bevacizumab hay Folfiri/ Folfox +/- Panitumumab hay Folfiri +/- Cetuximab (KRAS Wild-type gene only) Cho 畉n khi b畛nh ti畉n tri畛n Ch畉 畛 theo d探i sau h坦a tr畛 : T叩i kh叩m m畛i 3 th叩ng trong 2 nm 畉u, m畛i 6 th叩ng trong 3 nm ti畉p theo: CTM, sinh h坦a m叩u, si棚u 但m b畛ng, x quang ph畛i. CEA, CA19-9 ki畛m tra m畛i 3 th叩ng, NS 畉i trng 1 nm sau ph畉u thu畉t, l畉p l畉i sau 3 nm, r畛i 5 nm. N畉u CEA tng sau ph畉u thu畉t, 畛 ngh畛 NS 畉i trng, CTScan ng畛c b畛ng, x畉 h狸nh x動董ng. N畉u k畉t qu畉 b狸nh th動畛ng m CEA v畉n tng th狸 ti畉p t畛c ki畛m tra l畉i m畛i 3 th叩ng, cho 畉n khi ph叩t hi畛n 動畛c b畛nh, hay 畉n khi CEA 畛n 畛nh hay xu畛ng th畉p. CT scan ng畛c b畛ng ki畛m tra hng nm trong 3-5 nm. Reference: De Gramont A et al. 2007 ASCO annual meeting. Abstract 4007. Goldberg RM et al. J Clin Oncol 2006; 24; 4085 Andre. T et al. N Engl J med 2004; 350; 2343. Reference: Schmoll H et al. J Clin Oncol 2007; 25: 102 Fuchs CS et al. J Clin oncol 2007; 25: 4779.
PHC 畛 I畛U TR畛 UNG TH働 TR畛C TRNG 1. T1, No (叩nh gi叩 qua endorectal ultrasound hay MRI) C畉t b畛 u qua 動畛ng h畉u m担n n畉u 動畛c (transanal excision) T1, Nx, b畛 sang th動董ng kh担ng c坦 t畉 bo ung th動: ch狸 c畉n theo d探i, kh担ng c畉n h坦a x畉. T1, Nx,+ High risk (b畛 sang th動董ng c坦 t畉 bo ung th動, u c坦 畛 bi畛t h坦a k辿m) Hay T2, Nx. Ti畉n hnh ph畉u thu畉t qua 動畛ng b畛ng (m畛 n畛i soi ho畉c m畛 h畛) N畉u T1-T2, No, Mo th狸 ti畉p t畛c theo d探i. N畉u T3, No, Mo hay T1-3, N1-2 h坦a tr畛 FOLFOX hay CAPOX. N畉u kh担ng c畉t b畛 動畛c u qua 動畛ng h畉u m担n, th狸 m畛 b畛ng ngay t畛 畉u. Ch畉 畛 theo d探i sau h坦a tr畛 : T叩i kh叩m m畛i 3 th叩ng trong 2 nm 畉u, m畛i 6 th叩ng trong 3 nm ti畉p theo: CTM, sinh h坦a m叩u, si棚u 但m b畛ng, x quang ph畛i. CEA, CA19-9 ki畛m tra m畛i 3 th叩ng, NS 畉i trng 1 nm sau ph畉u thu畉t, l畉p l畉i sau 3 nm, r畛i 5 nm. N畉u CEA tng sau ph畉u thu畉t, 畛 ngh畛 NS 畉i trng, CTScan ng畛c b畛ng, x畉 h狸nh x動董ng. N畉u k畉t qu畉 b狸nh th動畛ng m CEA v畉n tng th狸 ti畉p t畛c ki畛m tra l畉i m畛i 3 th叩ng, cho 畉n khi ph叩t hi畛n 動畛c b畛nh, hay 畉n khi CEA 畛n 畛nh hay xu畛ng th畉p. CT scan ng畛c b畛ng ki畛m tra hng nm trong 3-5 nm.
2. T3, No hay Tany, N1-2 H坦a x畉 tr動畛c m畛. Sau 坦 ph畉u thu畉t c畉t b畛 u qua 動畛ng b畛ng Ti畉p t畛c h坦a tr畛 sau m畛 FOLFOX4, CAPOX. 3. T any, N any, M1 Ph畉u thu畉t c畉t u + kh畛i di cn 畛ng th畛i n畉u 動畛c. H坦a tr畛 ph叩c 畛 ph畛i h畛p: FOLFIRI + Bevacizumab hay Cetuximab (n畉u Kras+) FOLFOX+ Bevacizumab hay Cetuximab (n畉u Kras+) CAPOX + Bevacizumab hay Cetuximab (n畉u Kras+) 4. T any, N any, M1 (kh担ng c畉t 動畛c u hay kh畛i di cn) h坦a tr畛 theo ph叩c 畛 tr棚n.
PHC 畛 I畛U TR畛 K 畛NG H畉U MN. 1. Ung th動 畛ng h畉u m担n: ti畉n hnh Biopsy (carcinoma squamous cell) Kh叩m tr畛c trng o畉n tr棚n 叩nh gi叩 h畉ch b畉n, biopsy hay FNA n畉u c坦 h畉ch nghi ng畛 NS 畛ng h畉u m担n, CTScan ng畛c b畛ng. Th畛 HIV Kh叩m ph畛 khoa, NS c畛 t畛 cung (畛 bn n畛) T1-2, No s畛 d畛ng Mitomycin/ 5-FU +x畉 T3-4, No Mitomycin/ 5-FU +x畉 Metastase s畛 d畛ng Cisplatin+ 5-FU+ x畉. Theo d探i: 叩nh gi叩 l畉i sau 8-12 tu畉n B畛nh ti畉n tri畛n: biopsy 叩nh gi叩 l畉i giai o畉n T叩i ph叩t t畉i ch畛: ph畉u thu畉t kho辿t b畛 TSM, sau 坦 theo d探i m畛i 3-6 th叩ng trong 5 nm. C坦 di cn xa: h坦a tr畛 5-FU+ Cisplatin. N畉u b畛nh kh担ng ti畉n tri畛n: 叩nh gi叩 l畉i sau 4 tu畉n: B畛nh ti畉n tri畛n: lm nh動 tr棚n B畛nh tho叩i lui: ti畉p t畛c theo d探i, 叩nh gi叩 l畉i sau 3 th叩ng B畛nh thuy棚n gi畉m hon ton: theo d探i m畛i 3-6 th叩ng trong v嘆ng 5 nm. T叩i ph叩t t畉i ch畛: ph畉u thu畉t c畉t b畛 u+ n畉o h畉ch b畉n. T叩i ph叩t h畉ch b畉n: PT c畉t b畛 h畉ch b畉n+ x畉 n畉u tr動畛c 坦 ch動a x畉 Di cn xa: h坦a tr畛 s畛 d畛ng ph叩c 畛 Cisplatin+ 5-FU. Reference: Ajani JA et al. JAMA 2008; 299; 1914. Flam, M et al. J Clin oncol 1996; 14; 2527.
PHC 畛 I畛U TR畛 UNG TH働 TH畛C QU畉N 1.X辿t nghi畛m 叩nh gi叩 NS th畛c qu畉n- d畉 dy + biopsy. CTScan ng畛c b畛ng. PET/CT 叩nh gi叩 di cn CTM v sih h坦a m叩u SA n畛i soi Soi PQ n畉u u 畛 ngay hay tr棚n Carena. 2.Ph但n lo畉i Tis, T1a-1b, No: Endoscopic Mucosal Resection (EMR), sau 坦 ti畉p t畛c theo d探i qua n畛i soi. T2- T4a Neoadjuvant chemoradiation +/- Sugery for resectable cancer 5-FU + Cisplatin + RT Reference: Bedenne L et al. J Clin Oncol 2007; 25: 1160. 5- FU + Cisplatin + RT + Sugery Reference: Walsh TN et al. N Eng J Med 1996; 335: 462. 5-FU + Cisplatin + Vinblastine + RT + Sugery Reference: Urba SG et al. J Clin Oncol 2001; 19: 305. PERIOPERATIVE CHEMOTHERAPY FOR RESECTABLE ADENOCARCINOMA OF ESOPHAGOGASTRIC JUNCTION AND LOWER ESOPHAGUS ECF + SURGERY + ECF (Q3w x 3 cycles) Epirubicin 50mg/m2 iv d1 Cisplatin 60 mg/m2 iv d1 5-FU 200mg/m2/d civi Surgery 3 6 weeks after chemothepary: 6 12 weeks after surgery, repeat the chemotherapy: Epirubicin 50mg/m2 iv d1 Cisplatin 60 mg/m2 iv d1
5-FU 200mg/m2/d civi Q3w x 3 cycles Reference: Cunningham D et al. N Eng J Med 2006; 355:11. FP + Surgery +/- FP 5-FU 800 mg/m2/d civi d1 5 Cisplatin 100mg/m2 iv over 1 h d1 or d2 Q4w x 2 3 cycles Surgery 4-6 weeks after chemotherapy 4 6 weeks after surgery, repeat the chemotherapy if response to preoperative chemotherapy or stable disease with pN+: 5-FU 800 mg/m2/d civi d1 5 Cisplatin 100mg/m2 iv over 1 h d1 or d2 Q4w x 2 3 cycles Reference: Boige V et al. 2007 ASCO annual meeting, Abstract 4510. Sau h坦a x畉 c畉n 叩nh gi叩 l畉i: NS 動畛ng ti棚u h坦a tr棚n, PET/CT, CTScan ng畛c b畛ng Kh担ng ph叩t hi畛n b畛nh: theo d探i B畛nh ph叩t tri畛n t畉i ch畛: ph畉u thu畉t c畉t th畛c qu畉n, h坦a tr畛 h畛 tr畛. Epirubicin Cisplatin 5FU (ECF) Epirubicin 50mg/m2 I.V day 1 every 3 weeks Cisplatin 50 mg/m2 I.V day 1 every 3 weeks 5-FU 200mg/m2/day I.V. for 6 months
B畛nh di cn: test HER2/neu, h坦a tr畛: CHEMOTHERAPY FOR STAGE IV (METASTATIC) CANCER 5-FU + Cisplatin Q3w 5-FU 1000 mg/m2/d civi d1 5 Cisplatin 100mg/m2 iv d1 Reference: Bleiberg, H et al. Eur J Cancer 1997; 33:1216 Cisplatin + Paclitaxel Q3w Cisplatin 75 mg/m2 iv d2 Paclitaxel 200 mg/m2 civi over 24hrs d1 G-CSF support Reference: Ilson, DH et al. Cancer J 2000; 6:316 Cisplatin + Irinotecan Qw Cisplatin 30 mg/m2 iv Irinotecan 65 mg/m2 iv Reference: Ilson, DH et al. J Clin Oncol 1999; 17:3270 Epirubicin + Cisplatin + 5-FU (ECF) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Cisplatin 60 mg/m2 iv d1 q3w x 8 cycles 5-FU 200 mg/m2/d civi for 6 months Reference: Cunningham D et al. N Eng J Med 2008: 358:36 Ross, P et al. J Clin Oncol 2002; 20:1996
Epirubicin + Cisplatin + Capecitabine (ECX) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Cisplatin 60 mg/m2 iv d1 q3w x 8 cycles Capecitabine 625 mg/m2 po bid x 6 months Reference: Cunningham D et al. N Eng J Med 2008: 358:36 Oxaliplatin + Capecitabine Q3w Oxaliplatin 130 mg/m2 iv d1 Capecitabine 850-1000 mg/m2 po bid x 14 days Reference: Meerten EV et al. Br J Cancer 2007; 96: 1348. Jatoi A et al. Ann Oncol 2006; 17:29 Epirubicin + Oxaliplatin + 5-FU (EOF) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Oxaliplatin 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles 5-FU 200 mg/m2/d civi x 6 months Reference: Cunningham D et al. N Eng J Med 2008; 358:36 Epirubicin + Oxaliplatin + Capecitabine (EOX) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Oxaliplatin 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles Capecitabine 625 mg/m2 po bid x 6 months Reference: Cunningham D et al. N Eng J Med 2008; 358:36
Paclitaxel Q3w Paclitaxel 250 mg/m2 civi over 24 hrs Filgrastim support Reference: Ajani, JA et al.J Natl Cancer Inst 1994; 86:1086. Vinorelbine Qw Vinorelbine 25 mg/m2 iv Reference: Conroy, T et al.J Clin Oncol 1996; 14:164 Docetaxel To be repeated every 3 weeks Docetaxel 70 mg/m2/IV infusion over 1-2 hrs Reference: Muro K et al : Ann Oncol. 2004 Jun; 15(6):955-9 Theo d探i: m畛i 3-6 th叩ng trong 1-2 nm 畉u. 6-12 th叩ng trong 3-5 nm sau.
PHC 畛 I畛U TR畛 UNG TH働 D畉 DY 1.Tis hay T1a: EMR, theo d探i t叩i ph叩t qua NS th畛c qu畉n d畉 dy 畛nh k畛. 2.T1b, Mo: (叩nh gi叩 tr棚n CT Scan, v c叩c XN CLS kh叩c) ph畉u thu畉t 叩nh gi叩 sau ph畉u thu畉t T1, No theo d探i, kh担ng c畉n h坦a tr畛 T2, No h坦a tr畛 h畛 tr畛: 5-FU + Leucovorin hay Capecitabine T3-4 (Non-Metastatic), anyN: h坦a x畉 ph畛i h畛p 5-FU 425mg/m2/d IV d1-5 Leucovorin 20mg/m2/d IV d1-5 1 th叩ng sau 坦 5-FU 400mg/m2/d d1-4 and last 3 days of RT. Leucovorin 20mg/m2/d IV d1-4 and last 3 days of RT Radiotherapy 1 th叩ng sau khi hon thnh x畉 tri 5-FU 425mg/m2/d IV d1-5/q4w X 2 chu k畛. Leucovorin 20mg/m2/d IV d1-5/q4w X 2 chu k畛. N畉u 畛 b畛 t畛n th動董ng c坦 t畉 bo ung th動, c畉n h坦a x畉 h畛 tr畛. 3.T2, anyN, Mo: H坦a x畉 tr動畛c ph畉u thu畉t Ph畉u thu畉t H坦a tr畛 sau ph畉u thu畉t: ch畛n l畛a m畛t trong c叩c ph叩c 畛 sau
Epirubicin+ Cisplatin+ Capecitabin (ECX) Epirubicin 50 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Cisplatin 60 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Capecitabin 625 mg/m2 PO bid X 6 th叩ng Reference: Cunningham D et al. N Eng J med 2008; 358: 36. Epirubicin+ Oxaliplatin+ 5-FU (EOF) Epirubicin 50 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Oxaliplatin 130 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 5-FU 200 mg/m2/ngy X6 th叩ng Reference: Cunningham D et al. N Eng J med 2008; 358: 36. Epirubicin + Oxaliplatin + Capecitabin (EOX) Epirubicin 50 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Oxaliplatin 130 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Capecitabin 625 mg/m2 PO bid X6 th叩ng Reference: Cunningham D et al. N Eng J med 2008; 358: 36. Cisplatin+ Docetaxel (m畛i 3 tu畉n) Cisplatin 75 mg/m2 IV d 1 Docetaxel 75-85mg/m2 IV d 1 Reference: Roth AD et al. J Clin Oncol 2007; 25: 1217. Ajani JA et al. J Clin Oncol 2005; 23: 5660. Ridwelski, K et al. Ann Oncol 2001; 12: 47.
5-FU+ Cisplatin+ Docetaxel Cisplatin 75 mg/m2 IV d 1 (m畛i 3 tu畉n) Docetaxel 75-85mg/m2 IV d 1(m畛i 3 tu畉n) 5-FU 750 mg/m2/ d 1- d 5 Reference: Roth AD et al. J Clin Oncol 2007; 25: 1217. Ajani JA et al. J Clin Oncol 2005; 23: 5660. Ridwelski, K et al. Ann Oncol 2001; 12: 47. 4.T3-4, any N: Ph畉u thu畉t H坦a tr畛 sau ph畉u thu畉t 5.Giai o畉n 4, M1: x叩c 畛nh HER2/Neu H坦a tr畛 Cisplatin + Irinotecan + Bevacizumab (Q3w) Cisplatin 30mg/m2 IV d1,8 Irinotecan 65mg/m2 IV d1,8 Bevacizumab 15mg/kg IV d1 Reference: Shab MA et al. J Clin Oncol 2006; 24: 5201.
FUFOX + Cetuximab 5-FU 2000mg/m2 IV d1,8,15,22 q36d. Leucovorin 200mg/m2 IV d1,8,15,22 q36d. Oxaliplatin 50mg/m2 IV d1,8,15,22 q36d. Cetuximab 400mg/m2 IV then 250mg/m2 IV qw Reference: Lordick F et al.2007 ASCO Annual meeting, Abtract 4526. Paclitaxel + Cisplatin + 5-FU Paclitaxel 175mg/m2 IV d1. 5-FU 750mg IV d1-5 Cisplatin 20mg/m2 IV d1-5 L畉p l畉i chu k畛 m畛i 4 tu畉n. Reference: Kim et al+ cancer 85:295-301(1999) TI LI畛U THAM KH畉O 1.NCCN Guidelines Version 2.2012 (National Comprehensive Cancer Network) 2.Year Book of ONCOLOGY 2011. 3.TNM Classification of Malignant Tumours
PHC 畛 I畛U TR畛 UNG TH働 V 1. Lobular carcinoma in situ (LCIS): x叩c 畛nh qua sinh thi畉t u (Stage 0, Tis, No, Mo) ph畉u thu畉t c畉t b畛 u 2. Ductal carcinoma in situ (DCIS) (Stage 0, Tis, No, Mo) Cho bn ch畛p nh滴 畉nh 叩nh gi叩 ER(Estrogen Receptor)/ PR(Progesterol Receptor) Ph畉u thu畉t c畉t b畛 u, kh担ng n畉o h畉ch n叩ch. X畉 tr畛 ton b畛 tuy畉n v炭. Theo d探i sau ph畉u thu畉t: T叩i kh叩m l畉i m畛i 6 th叩ng trong 5 nm. Ch畛p nh滴 畉nh m畛i 12 th叩ng. N畉u ER(+) Tamoxifen 20mg u畛ng qd X 5years. 3. Invasive Breast cancer: C坦 ch畛 畛nh ph畉u thu畉t c畉t b畛 tuy畉n v炭 + n畉o h畉ch n叩ch + h坦a tr畛+ x畉 tr畛. Bs. NGUY畛N TR働畛NG TRC LM Khoa ngo畉i ti棚u h坦a (l畉u 4B1) BVCR.

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Phac do

  • 1. PHC 畛 I畛U TR畛 UNG TH働 畉I TRNG Ung th動 畉i trng 達 ph畉u thu畉t (ch動a di cn xa) B畛nh xu畉t vi畛n, h畉n t叩i kh叩m l畉i sau 3 tu畉n 畉 h畛i ch畉n h坦a x畉. X辿t nghi畛m c畉n lm: CTM, Sinh h坦a m叩u (ch畛c nng gan, ch畛c nng th畉n..), CEA, CA19- 9, X quang ph畛i, si棚u 但m b畛ng, CT Scan b畛ng, L畉y k畉t qu畉 GP b畛nh l箪 (ch畉n o叩n giai o畉n TNM) 1. Tis; T1, No, Mo kh担ng c畉n h坦a tr畛 h坦a tr畛 h畛 tr畛 (Adjuvant Therapy) T2, No, Mo kh担ng c畉n h坦a tr畛 h坦a tr畛 h畛 tr畛 2. T3, No, Mo kh担ng c坦 y畉u t畛 nguy c董 t叩i ph叩t (Low risk) H坦a tr畛 theo ph叩c 畛: Folfox4 Capecitabine hay 5- FU + Leucovorin. 3. T3, No, Mo (nguy c董 t叩i ph叩t cao: T4, c坦 3 hay 4 sang th動董ng, d鱈nh vo ph炭c m畉c, t畉c ru畛t) ho畉c T4, No, Mo H坦a tr畛 theo ph叩c 畛: Folfox4 Capox Ung th動 畉i tr畛c trng di cn gan ho畉c/v ph畛i: 1 .N畉u ph畉u thu畉t 動畛c (c畉t b畛 kh畛i u 畉i tr畛c trng+ kh畛 u di cn) H坦a tr畛 h畛 tr畛 v畛i ph叩c 畛: Folfox4 Capox.
  • 2. Ho畉c h坦a tr畛 t但n h畛 tr畛 (neoadjuvant therapy) Folfiri/ Folfox/ CapeOX +/- Bevacizumab hay Folfiri/ Folfox +/- Panitumumab hay Folfiri +/- Cetuximab (KRAS Wild-type gene only) 叩nh gi叩 l畉i, x辿t ch畛 畛nh ph畉u thu畉t sau 2- 3 chu k畛 h坦a tr畛. 2. N畉u b畛nh qu叩 ch畛 畛nh ph畉u thu畉t Folfiri/ Folfox/ CapeOX +/- Bevacizumab hay Folfiri/ Folfox +/- Panitumumab hay Folfiri +/- Cetuximab (KRAS Wild-type gene only) Cho 畉n khi b畛nh ti畉n tri畛n Ch畉 畛 theo d探i sau h坦a tr畛 : T叩i kh叩m m畛i 3 th叩ng trong 2 nm 畉u, m畛i 6 th叩ng trong 3 nm ti畉p theo: CTM, sinh h坦a m叩u, si棚u 但m b畛ng, x quang ph畛i. CEA, CA19-9 ki畛m tra m畛i 3 th叩ng, NS 畉i trng 1 nm sau ph畉u thu畉t, l畉p l畉i sau 3 nm, r畛i 5 nm. N畉u CEA tng sau ph畉u thu畉t, 畛 ngh畛 NS 畉i trng, CTScan ng畛c b畛ng, x畉 h狸nh x動董ng. N畉u k畉t qu畉 b狸nh th動畛ng m CEA v畉n tng th狸 ti畉p t畛c ki畛m tra l畉i m畛i 3 th叩ng, cho 畉n khi ph叩t hi畛n 動畛c b畛nh, hay 畉n khi CEA 畛n 畛nh hay xu畛ng th畉p. CT scan ng畛c b畛ng ki畛m tra hng nm trong 3-5 nm. Reference: De Gramont A et al. 2007 ASCO annual meeting. Abstract 4007. Goldberg RM et al. J Clin Oncol 2006; 24; 4085 Andre. T et al. N Engl J med 2004; 350; 2343. Reference: Schmoll H et al. J Clin Oncol 2007; 25: 102 Fuchs CS et al. J Clin oncol 2007; 25: 4779.
  • 3. PHC 畛 I畛U TR畛 UNG TH働 TR畛C TRNG 1. T1, No (叩nh gi叩 qua endorectal ultrasound hay MRI) C畉t b畛 u qua 動畛ng h畉u m担n n畉u 動畛c (transanal excision) T1, Nx, b畛 sang th動董ng kh担ng c坦 t畉 bo ung th動: ch狸 c畉n theo d探i, kh担ng c畉n h坦a x畉. T1, Nx,+ High risk (b畛 sang th動董ng c坦 t畉 bo ung th動, u c坦 畛 bi畛t h坦a k辿m) Hay T2, Nx. Ti畉n hnh ph畉u thu畉t qua 動畛ng b畛ng (m畛 n畛i soi ho畉c m畛 h畛) N畉u T1-T2, No, Mo th狸 ti畉p t畛c theo d探i. N畉u T3, No, Mo hay T1-3, N1-2 h坦a tr畛 FOLFOX hay CAPOX. N畉u kh担ng c畉t b畛 動畛c u qua 動畛ng h畉u m担n, th狸 m畛 b畛ng ngay t畛 畉u. Ch畉 畛 theo d探i sau h坦a tr畛 : T叩i kh叩m m畛i 3 th叩ng trong 2 nm 畉u, m畛i 6 th叩ng trong 3 nm ti畉p theo: CTM, sinh h坦a m叩u, si棚u 但m b畛ng, x quang ph畛i. CEA, CA19-9 ki畛m tra m畛i 3 th叩ng, NS 畉i trng 1 nm sau ph畉u thu畉t, l畉p l畉i sau 3 nm, r畛i 5 nm. N畉u CEA tng sau ph畉u thu畉t, 畛 ngh畛 NS 畉i trng, CTScan ng畛c b畛ng, x畉 h狸nh x動董ng. N畉u k畉t qu畉 b狸nh th動畛ng m CEA v畉n tng th狸 ti畉p t畛c ki畛m tra l畉i m畛i 3 th叩ng, cho 畉n khi ph叩t hi畛n 動畛c b畛nh, hay 畉n khi CEA 畛n 畛nh hay xu畛ng th畉p. CT scan ng畛c b畛ng ki畛m tra hng nm trong 3-5 nm.
  • 4. 2. T3, No hay Tany, N1-2 H坦a x畉 tr動畛c m畛. Sau 坦 ph畉u thu畉t c畉t b畛 u qua 動畛ng b畛ng Ti畉p t畛c h坦a tr畛 sau m畛 FOLFOX4, CAPOX. 3. T any, N any, M1 Ph畉u thu畉t c畉t u + kh畛i di cn 畛ng th畛i n畉u 動畛c. H坦a tr畛 ph叩c 畛 ph畛i h畛p: FOLFIRI + Bevacizumab hay Cetuximab (n畉u Kras+) FOLFOX+ Bevacizumab hay Cetuximab (n畉u Kras+) CAPOX + Bevacizumab hay Cetuximab (n畉u Kras+) 4. T any, N any, M1 (kh担ng c畉t 動畛c u hay kh畛i di cn) h坦a tr畛 theo ph叩c 畛 tr棚n.
  • 5. PHC 畛 I畛U TR畛 K 畛NG H畉U MN. 1. Ung th動 畛ng h畉u m担n: ti畉n hnh Biopsy (carcinoma squamous cell) Kh叩m tr畛c trng o畉n tr棚n 叩nh gi叩 h畉ch b畉n, biopsy hay FNA n畉u c坦 h畉ch nghi ng畛 NS 畛ng h畉u m担n, CTScan ng畛c b畛ng. Th畛 HIV Kh叩m ph畛 khoa, NS c畛 t畛 cung (畛 bn n畛) T1-2, No s畛 d畛ng Mitomycin/ 5-FU +x畉 T3-4, No Mitomycin/ 5-FU +x畉 Metastase s畛 d畛ng Cisplatin+ 5-FU+ x畉. Theo d探i: 叩nh gi叩 l畉i sau 8-12 tu畉n B畛nh ti畉n tri畛n: biopsy 叩nh gi叩 l畉i giai o畉n T叩i ph叩t t畉i ch畛: ph畉u thu畉t kho辿t b畛 TSM, sau 坦 theo d探i m畛i 3-6 th叩ng trong 5 nm. C坦 di cn xa: h坦a tr畛 5-FU+ Cisplatin. N畉u b畛nh kh担ng ti畉n tri畛n: 叩nh gi叩 l畉i sau 4 tu畉n: B畛nh ti畉n tri畛n: lm nh動 tr棚n B畛nh tho叩i lui: ti畉p t畛c theo d探i, 叩nh gi叩 l畉i sau 3 th叩ng B畛nh thuy棚n gi畉m hon ton: theo d探i m畛i 3-6 th叩ng trong v嘆ng 5 nm. T叩i ph叩t t畉i ch畛: ph畉u thu畉t c畉t b畛 u+ n畉o h畉ch b畉n. T叩i ph叩t h畉ch b畉n: PT c畉t b畛 h畉ch b畉n+ x畉 n畉u tr動畛c 坦 ch動a x畉 Di cn xa: h坦a tr畛 s畛 d畛ng ph叩c 畛 Cisplatin+ 5-FU. Reference: Ajani JA et al. JAMA 2008; 299; 1914. Flam, M et al. J Clin oncol 1996; 14; 2527.
  • 6. PHC 畛 I畛U TR畛 UNG TH働 TH畛C QU畉N 1.X辿t nghi畛m 叩nh gi叩 NS th畛c qu畉n- d畉 dy + biopsy. CTScan ng畛c b畛ng. PET/CT 叩nh gi叩 di cn CTM v sih h坦a m叩u SA n畛i soi Soi PQ n畉u u 畛 ngay hay tr棚n Carena. 2.Ph但n lo畉i Tis, T1a-1b, No: Endoscopic Mucosal Resection (EMR), sau 坦 ti畉p t畛c theo d探i qua n畛i soi. T2- T4a Neoadjuvant chemoradiation +/- Sugery for resectable cancer 5-FU + Cisplatin + RT Reference: Bedenne L et al. J Clin Oncol 2007; 25: 1160. 5- FU + Cisplatin + RT + Sugery Reference: Walsh TN et al. N Eng J Med 1996; 335: 462. 5-FU + Cisplatin + Vinblastine + RT + Sugery Reference: Urba SG et al. J Clin Oncol 2001; 19: 305. PERIOPERATIVE CHEMOTHERAPY FOR RESECTABLE ADENOCARCINOMA OF ESOPHAGOGASTRIC JUNCTION AND LOWER ESOPHAGUS ECF + SURGERY + ECF (Q3w x 3 cycles) Epirubicin 50mg/m2 iv d1 Cisplatin 60 mg/m2 iv d1 5-FU 200mg/m2/d civi Surgery 3 6 weeks after chemothepary: 6 12 weeks after surgery, repeat the chemotherapy: Epirubicin 50mg/m2 iv d1 Cisplatin 60 mg/m2 iv d1
  • 7. 5-FU 200mg/m2/d civi Q3w x 3 cycles Reference: Cunningham D et al. N Eng J Med 2006; 355:11. FP + Surgery +/- FP 5-FU 800 mg/m2/d civi d1 5 Cisplatin 100mg/m2 iv over 1 h d1 or d2 Q4w x 2 3 cycles Surgery 4-6 weeks after chemotherapy 4 6 weeks after surgery, repeat the chemotherapy if response to preoperative chemotherapy or stable disease with pN+: 5-FU 800 mg/m2/d civi d1 5 Cisplatin 100mg/m2 iv over 1 h d1 or d2 Q4w x 2 3 cycles Reference: Boige V et al. 2007 ASCO annual meeting, Abstract 4510. Sau h坦a x畉 c畉n 叩nh gi叩 l畉i: NS 動畛ng ti棚u h坦a tr棚n, PET/CT, CTScan ng畛c b畛ng Kh担ng ph叩t hi畛n b畛nh: theo d探i B畛nh ph叩t tri畛n t畉i ch畛: ph畉u thu畉t c畉t th畛c qu畉n, h坦a tr畛 h畛 tr畛. Epirubicin Cisplatin 5FU (ECF) Epirubicin 50mg/m2 I.V day 1 every 3 weeks Cisplatin 50 mg/m2 I.V day 1 every 3 weeks 5-FU 200mg/m2/day I.V. for 6 months
  • 8. B畛nh di cn: test HER2/neu, h坦a tr畛: CHEMOTHERAPY FOR STAGE IV (METASTATIC) CANCER 5-FU + Cisplatin Q3w 5-FU 1000 mg/m2/d civi d1 5 Cisplatin 100mg/m2 iv d1 Reference: Bleiberg, H et al. Eur J Cancer 1997; 33:1216 Cisplatin + Paclitaxel Q3w Cisplatin 75 mg/m2 iv d2 Paclitaxel 200 mg/m2 civi over 24hrs d1 G-CSF support Reference: Ilson, DH et al. Cancer J 2000; 6:316 Cisplatin + Irinotecan Qw Cisplatin 30 mg/m2 iv Irinotecan 65 mg/m2 iv Reference: Ilson, DH et al. J Clin Oncol 1999; 17:3270 Epirubicin + Cisplatin + 5-FU (ECF) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Cisplatin 60 mg/m2 iv d1 q3w x 8 cycles 5-FU 200 mg/m2/d civi for 6 months Reference: Cunningham D et al. N Eng J Med 2008: 358:36 Ross, P et al. J Clin Oncol 2002; 20:1996
  • 9. Epirubicin + Cisplatin + Capecitabine (ECX) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Cisplatin 60 mg/m2 iv d1 q3w x 8 cycles Capecitabine 625 mg/m2 po bid x 6 months Reference: Cunningham D et al. N Eng J Med 2008: 358:36 Oxaliplatin + Capecitabine Q3w Oxaliplatin 130 mg/m2 iv d1 Capecitabine 850-1000 mg/m2 po bid x 14 days Reference: Meerten EV et al. Br J Cancer 2007; 96: 1348. Jatoi A et al. Ann Oncol 2006; 17:29 Epirubicin + Oxaliplatin + 5-FU (EOF) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Oxaliplatin 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles 5-FU 200 mg/m2/d civi x 6 months Reference: Cunningham D et al. N Eng J Med 2008; 358:36 Epirubicin + Oxaliplatin + Capecitabine (EOX) Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Oxaliplatin 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles Capecitabine 625 mg/m2 po bid x 6 months Reference: Cunningham D et al. N Eng J Med 2008; 358:36
  • 10. Paclitaxel Q3w Paclitaxel 250 mg/m2 civi over 24 hrs Filgrastim support Reference: Ajani, JA et al.J Natl Cancer Inst 1994; 86:1086. Vinorelbine Qw Vinorelbine 25 mg/m2 iv Reference: Conroy, T et al.J Clin Oncol 1996; 14:164 Docetaxel To be repeated every 3 weeks Docetaxel 70 mg/m2/IV infusion over 1-2 hrs Reference: Muro K et al : Ann Oncol. 2004 Jun; 15(6):955-9 Theo d探i: m畛i 3-6 th叩ng trong 1-2 nm 畉u. 6-12 th叩ng trong 3-5 nm sau.
  • 11. PHC 畛 I畛U TR畛 UNG TH働 D畉 DY 1.Tis hay T1a: EMR, theo d探i t叩i ph叩t qua NS th畛c qu畉n d畉 dy 畛nh k畛. 2.T1b, Mo: (叩nh gi叩 tr棚n CT Scan, v c叩c XN CLS kh叩c) ph畉u thu畉t 叩nh gi叩 sau ph畉u thu畉t T1, No theo d探i, kh担ng c畉n h坦a tr畛 T2, No h坦a tr畛 h畛 tr畛: 5-FU + Leucovorin hay Capecitabine T3-4 (Non-Metastatic), anyN: h坦a x畉 ph畛i h畛p 5-FU 425mg/m2/d IV d1-5 Leucovorin 20mg/m2/d IV d1-5 1 th叩ng sau 坦 5-FU 400mg/m2/d d1-4 and last 3 days of RT. Leucovorin 20mg/m2/d IV d1-4 and last 3 days of RT Radiotherapy 1 th叩ng sau khi hon thnh x畉 tri 5-FU 425mg/m2/d IV d1-5/q4w X 2 chu k畛. Leucovorin 20mg/m2/d IV d1-5/q4w X 2 chu k畛. N畉u 畛 b畛 t畛n th動董ng c坦 t畉 bo ung th動, c畉n h坦a x畉 h畛 tr畛. 3.T2, anyN, Mo: H坦a x畉 tr動畛c ph畉u thu畉t Ph畉u thu畉t H坦a tr畛 sau ph畉u thu畉t: ch畛n l畛a m畛t trong c叩c ph叩c 畛 sau
  • 12. Epirubicin+ Cisplatin+ Capecitabin (ECX) Epirubicin 50 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Cisplatin 60 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Capecitabin 625 mg/m2 PO bid X 6 th叩ng Reference: Cunningham D et al. N Eng J med 2008; 358: 36. Epirubicin+ Oxaliplatin+ 5-FU (EOF) Epirubicin 50 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Oxaliplatin 130 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 5-FU 200 mg/m2/ngy X6 th叩ng Reference: Cunningham D et al. N Eng J med 2008; 358: 36. Epirubicin + Oxaliplatin + Capecitabin (EOX) Epirubicin 50 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Oxaliplatin 130 mg/m2 IV d 1 (m畛i 3 tu畉n) X8 chu k畛 Capecitabin 625 mg/m2 PO bid X6 th叩ng Reference: Cunningham D et al. N Eng J med 2008; 358: 36. Cisplatin+ Docetaxel (m畛i 3 tu畉n) Cisplatin 75 mg/m2 IV d 1 Docetaxel 75-85mg/m2 IV d 1 Reference: Roth AD et al. J Clin Oncol 2007; 25: 1217. Ajani JA et al. J Clin Oncol 2005; 23: 5660. Ridwelski, K et al. Ann Oncol 2001; 12: 47.
  • 13. 5-FU+ Cisplatin+ Docetaxel Cisplatin 75 mg/m2 IV d 1 (m畛i 3 tu畉n) Docetaxel 75-85mg/m2 IV d 1(m畛i 3 tu畉n) 5-FU 750 mg/m2/ d 1- d 5 Reference: Roth AD et al. J Clin Oncol 2007; 25: 1217. Ajani JA et al. J Clin Oncol 2005; 23: 5660. Ridwelski, K et al. Ann Oncol 2001; 12: 47. 4.T3-4, any N: Ph畉u thu畉t H坦a tr畛 sau ph畉u thu畉t 5.Giai o畉n 4, M1: x叩c 畛nh HER2/Neu H坦a tr畛 Cisplatin + Irinotecan + Bevacizumab (Q3w) Cisplatin 30mg/m2 IV d1,8 Irinotecan 65mg/m2 IV d1,8 Bevacizumab 15mg/kg IV d1 Reference: Shab MA et al. J Clin Oncol 2006; 24: 5201.
  • 14. FUFOX + Cetuximab 5-FU 2000mg/m2 IV d1,8,15,22 q36d. Leucovorin 200mg/m2 IV d1,8,15,22 q36d. Oxaliplatin 50mg/m2 IV d1,8,15,22 q36d. Cetuximab 400mg/m2 IV then 250mg/m2 IV qw Reference: Lordick F et al.2007 ASCO Annual meeting, Abtract 4526. Paclitaxel + Cisplatin + 5-FU Paclitaxel 175mg/m2 IV d1. 5-FU 750mg IV d1-5 Cisplatin 20mg/m2 IV d1-5 L畉p l畉i chu k畛 m畛i 4 tu畉n. Reference: Kim et al+ cancer 85:295-301(1999) TI LI畛U THAM KH畉O 1.NCCN Guidelines Version 2.2012 (National Comprehensive Cancer Network) 2.Year Book of ONCOLOGY 2011. 3.TNM Classification of Malignant Tumours
  • 15. PHC 畛 I畛U TR畛 UNG TH働 V 1. Lobular carcinoma in situ (LCIS): x叩c 畛nh qua sinh thi畉t u (Stage 0, Tis, No, Mo) ph畉u thu畉t c畉t b畛 u 2. Ductal carcinoma in situ (DCIS) (Stage 0, Tis, No, Mo) Cho bn ch畛p nh滴 畉nh 叩nh gi叩 ER(Estrogen Receptor)/ PR(Progesterol Receptor) Ph畉u thu畉t c畉t b畛 u, kh担ng n畉o h畉ch n叩ch. X畉 tr畛 ton b畛 tuy畉n v炭. Theo d探i sau ph畉u thu畉t: T叩i kh叩m l畉i m畛i 6 th叩ng trong 5 nm. Ch畛p nh滴 畉nh m畛i 12 th叩ng. N畉u ER(+) Tamoxifen 20mg u畛ng qd X 5years. 3. Invasive Breast cancer: C坦 ch畛 畛nh ph畉u thu畉t c畉t b畛 tuy畉n v炭 + n畉o h畉ch n叩ch + h坦a tr畛+ x畉 tr畛. Bs. NGUY畛N TR働畛NG TRC LM Khoa ngo畉i ti棚u h坦a (l畉u 4B1) BVCR.