Ung Th Hc i Cng 2005

Bi 5: nguyn nhn ung th

Mc tiu hc tp

1. Trnh b y c cc yu t vt l gy ung th 2. Trnh b y c cc tc nhn ho hc gy ung th 3. Trnh b y c cc tc nhn sinh hc gy ung th

Ni dung

Ng y nay ngi ta bit r ung th khng phi do mt nguyn nhn gy ra. Ty theo mi loi ung th m c nhng nguyn nhn ring bit. Mt tc nhn sinh ung th c th gy ra mt s loi ung th v ngc li mt loi ung th c th do mt s tc nhn khc nhau. C nhiu yu t lin quan n sinh bnh ung th trong c 3 nhm tc nhn chnh gy ung th: vt l, ho hc v sinh hc.
1. Tc nhn vt l

1.1. Bc x ion ha Bc x ion ha chnh l ngun tia phng x pht ra t cc cht phng x t nhin hoc t ngun x nhn to c dng trong khoa hc v y hc c kh nng ion ha vt cht khi b chiu x. Ngi ta bit rng c nhiu c quan xut hin ung th sau khi b chiu x nhng loi nguyn nhn n y ch chim 2 n 3% trong s cc trng hp ung th, ch yu l ung th tuyn gip, ung th phi v ung th bch cu. T th k 16, ngi ta thy nhiu cng nhn m Joachimstal (Tip Khc) v Schneeberg (c) mc mt loi bnh phi v cht. V sau cho thy chnh l ung th phi do cht phng x trong qung en c cha uranium. iu n y cn c ghi nhn qua t l mc ung th phi kh cao cc cng nhn khai m uranium gia th k 20. Nhiu nh X quang u tin ca th gii khng bit tc hi to ln ca tia X i vi c th. H khng bit t bo v v nhiu ngi trong s h mc ung th da v bnh bch cu cp. Ung th bch cu cp c t l kh cao nhng ngi sng st sau v th bom nguyn t ca M 2 th nh ph Nagasaki v Hiroshima nm 1945. Gn y ngi ta ghi nhn khong 200 thiu nin b ung th tuyn gip v Leucemie sau v n nh my in nguyn t Chernobyl. Tc ng ca tia phng x gy ung th ngi ph thuc 3 yu t: - Tui tip xc c ng nh c ng nguy him (nht l b o thai). Vic s dng siu m chn on cc bnh thai nhi thay cho X quang l tin b rt ln. - Mi lin h liu - p ng. - C quan b chiu x: Cc c quan nh tuyn gip, ty xng rt nhy cm vi tia x. 1.2. Bc x cc tm

Ung Th Hc i Cng 2005

Tia cc tm c trong nh sng mt tri. C ng gn xch o tia cc tm c ng mnh. Tc nhn n y ch yu gy ra ung th da. Nhng ngi l m vic ngo i tri nh nng dn v th xy dng, cng nhn l m ng c t l ung th t b o y v t b o vy vng da h (u, c, gy) cao hn ngi l m vic trong nh . i vi nhng ngi da trng sng vng nhit i, t l ung th hc t cao hn hn ngi da m u. Cn phi lu tr o lu tm nng thi qu ngi da trng chu nh hng nhiu cu tia cc tm. Tr em cng khng nn tip xc nhiu vi tia cc tm.
2. Thuc l

Thuc l l nguyn nhn ca khong 90% ung th ph qun. Tnh chung thuc l gy ra khong 30% trong s cc trng hp ung th ch yu l ung th ph qun v mt s ung th vng mi hng, ung th ty, ung th ng tit niu. Trong khi thuc l cha rt nhiu cht Hydrocarbon thm. Trong phi k n cht 3 - 4 Benzopyren l cht gy ung th trn thc nghim. Qua thng k cho thy ngi ht thuc l c nguy c mc ung th ph qun gp 10 ln ngi khng ht. Nu nghin nng trn 20 iu/1 ng y c t 15 n 20 ln nguy c cao hn ngi khng ht. Ht thuc tui c ng tr c ng c nguy c cao. Ht thuc l nu c nguy c cao hn thuc l v ng. Vit Nam, ht thuc l o, n tru thuc cng c nguy c cao hn, k c ung th khoang ming. i vi ngi ang nghin m b ht thuc cng gim c nguy c. Tuy nhin cn lu na mi gim c s ngi ht thuc v ng y nay s tr em tp ht thuc kh cao, nht l tui hc ng. Ph n ht thuc, c bit l ph n Chu u ht nhiu v nghin nh nam gii. T l s ngi ht thuc cao phn n o gii thch t l ung th phi v ung th ty tng cao. Vi nhng ngi khng ht thuc m sng trong mt khong khng gian hp vi ngi ht thuc khi thuc cng c nguy c ung th. c gi l ht thuc th ng. iu lu c bit l tr em nhim khi thuc l rt nguy hi. Mc d bit r tc hi sinh ung th ca thuc l nhng vic xa b thuc l, gim sn xut v bun bn thuc l l vn kh khn. Nguyn nhn chnh l vn li nhun. Thc s y l vn m x hi m cc quc gia cn quan tm.
3. Dinh dng

- Dinh dng ng vai tr khong 35 % trong cc nguyn nhn gy bnh ung th. Nhiu bnh ung th c lin quan n dinh dng nh ung th thc qun, ung th d d y, ung th gan, ung th i trc tr ng, ung th vm mi hng, ung th v, ung th ni tit... Mi lin quan gia dinh dng vi ung th c th hin hai kha cnh chnh: trc ht l s c mt ca cc cht gy ung th c trong cc thc phm, thc n, vn th hai c lin quan n sinh bnh hc ung th l s hin din ca cc cht ng vai tr l m gim nguy c sinh ung th (Vitamin, cht x...) ng thi s mt cn i trong khu phn n cng l mt nguyn nhn sinh bnh. - Cc cht gy ung th cha trong thc phm, thc n: + Nitrosamin v cc hp cht N-Nitroso khc, l nhng cht gy ung th thc nghim trn ng vt. Nhng cht n y thng c mt trong thc phm vi mt lng nh. Cc cht Nitrit v Nitrat thng c t nhin trong cc cht bo qun tht, c v cc thc

Ung Th Hc i Cng 2005

phm ch bin. Tiu th nhiu thc n c cha Nitrit, Nitrat c th gy ra ung th thc qun, d d y. Nhng nghin cu ch ra rng cc loi thc phm p mui, hay ngm mui nh c mui c h m lng Nitrosamin cao. Cc nc khu vc ng Nam thng tiu th loi thc phm n y c lin quan n sinh bnh ung th vm mi hng. Cc nh khoa hc Nht Bn ch ra vic tiu th nc mm, cha mt h m lng Nitrosamin cao, lin quan n ung th d d y. - Aflatoxin sinh ra t nm mc Aspergillus flavus. y l mt cht gy ra bnh ung th gan, bnh ph bin cc nc nhit i. Loi nm mc n y thng c cc ng cc b mc nht l lc mc. - S dng mt s phm nhum thc phm, c th gy ra ung th, nh cht Paradimethyl Amino Benzen dng nhum b th nh b v ng c kh nng gy ung th gan. Ti cc nc n y s dng cc phm nhum thc n cng nh cc cht ph gia c kim duyt rt nghim ngt m bo an to n thc phm. Cc thc phm c cha cc d lng, t n tch ca cc thuc tr su, khng ch c th gy ra ng c cp tnh m cn c kh nng gy ung th. - Mt s cch nu thc n v bo qun thc phm c th s to ra cht gy ung th. Nhng thc n hun khi c th b nhim Benzopyrene. Vic nng trc tip tht nhit cao c th s to ra mt s sn phm c kh nng gy t bin gen. - Khu phn ba n ng mt vai tr quan trng trong gy bnh ung th nhng ngc li, c th li l m gim nguy c gy ung th. C mi lin quan gia bnh ung th i trc tr ng vi ch n nhiu m, tht ng vt. Ch n m, tht gy ung th qua c ch l m tit nhiu axt mt, cht c ch qu trnh bit ho ca cc t b o nim mc rut. - Trong hoa qu v rau xanh cha nhiu vitamin v cht x. Cc cht x l m hn ch sinh ung th do cht x thc y nhanh lu thng ng tiu ho l m gim thi gian tip xc ca cc cht gy ung th vi nim mc rut, mt khc bn thn cht x c th gn v c nh cc cht gy ung th b i tit theo phn ra ngo i c th. Cc loi vitamin A, C, E l m gim nguy c ung th biu m, ung th d d y, ung th thc qun, ung th phi...thng qua qu trnh chng oxy ho, chng gy t bin gen.
4. Nhng yu t ngh nghip

Khi l m vic trong mi trng ngh nghip con ngi tip xc vi c bc x ion ha v virut, nhng nhng tc nhn sinh ung th quan trng nht trong ngh nghip chnh l cc ha cht c s dng. c tnh nhm nguyn nhn n y gy ra khong t 2 n 8% s ung th ty theo mi khu vc cng nghip. Ng y nay do cng nghip ha pht trin mnh m, ung th ngh nghip khng ch c cc nc pht trin m cn cc nc ang pht trin. Cc ung th do ngh nghip thng xy ra cc c quan tip xc trc tip nh da v c bit l c quan h hp, ngo i ra phi k n ung th c quan c nhim v b i tit cc cht chuyn ha cn hot tnh nh ng tit niu. Ung th ngh nghip c cp t lu, v o nm 1775, Percival Pott, bc s ngi Anh lu cc trng hp ung th biu m da bu ngi th l m ngh no ng khi hoc khi tui thiu nin l m ngh n y. Cc th n y thng mc mt loi qun kiu bo h lao ng c cc cht b hng dnh bt qun l nguyn nhn sinh ra loi ung th trn. Ng y nay do x hi pht trin nn nhiu ng nh cng nghip khc c lin quan vi mt s ung th chng hn nh s dng asbestos c nguy c xut hin ung th

Ung Th Hc i Cng 2005

m ng phi do ngi th ht bi amian gy x ha phi lan ta v d y m ng phi. Si asbestos l nguyn nhn chnh gy ung th trung m m ng phi. Ung th b ng quang cng l loi ung th hay gp trong nhm nguyn nhn ngh nghip. Cui th k 19 ngi ta gp cc trng hp ung th b ng quang nhng ngi th nhum do tip xc vi anilin. Anilin c ln tp cht cha 4 - amindiphenye, v 2 - aphthylamin gy ung th. Cc cht n y c ht v o qua ng th v thi qua ng niu gy ung th b ng quang. Cht benzen c th gy chng suy ty v trong s c 1 s biu hin bnh ung th bch cu ty cp. Ngo i ra n c th gy bnh a u ty xng v u lympho c tnh. Cn nhiu loi cht ha hc ngh nghip khc c nguy c ung th, c bit l cc ngh lin quan vi cng nghip ha du, khai thc du do tip xc cc sn phm th ca du m hoc cht nhn c cha hydrocacbon thm.
5. Mt s thuc v ni tit

Ngi ta thy cc kiu ha tr ung th khc nhau r r ng l m tng nguy c bnh bch cu nhng bnh nhn cn sng hn mt nm sau khi c chn on (Bng 5). Bng 5: Cc ha cht c hot tnh sinh ung th (IARC 1988) Ngi Busulphan Chlorambucil Cyclophosphamide Melphalan Methyl - CCNU& Treosulphan ng vt* BCNU+ CCNU& Cisplatin Dacarbazine Mitomycin C Nitrogen mustard Procarbazine HCL Thio - Tepa Adriamycin Uracil mustard * Cha chng minh gy c ung th trn ngi
+ &

1.3 bis 2 - chlorethylnitrourea 1 -(-2 - chloroethyl) -3-cyclohexyl-1-nitrosourea

Cc thuc thuc nhm ankyl nh melphalan, chlorambucil v cyclophosphamide c lin quan r nht mc d s s dng thng xuyn cc loi thuc ha tr phi hp i khi l m ngi ta kh xc nh loi thuc n o c vai tr chnh. Cc thuc chng ung th quan trng khc nh adriamycin v cisplatin cng c tnh sinh ung th ng vt thc nghim, nhng cho n nay vn khng thy c tnh sinh ung th ngi. Mc d nguy c bnh bch cu tng cao (Bng 6) sau khi iu tr mt s ung th chn lc nhng ngi ta vn so snh iu n y vi thun li iu tr ha cht cc bnh nh bnh bch cu limph tr em, bnh Hodgkin v ung th tinh ho n loi t b o mm.

Ung Th Hc i Cng 2005

Tuy nhin, quan trng l s quan tm nguy c mc bnh c tnh th hai khi nh gi trong mt thi gian d i cc phc ha tr ung th v tm kim cc cch iu tr xen k l m gim mi nguy c n y. Vn p dng c bit cho cc bnh nh l Hodgkin v loi bnh n y c tin lng rt tt vi cch iu tr hin nay. Bng 6: RR b bnh bch cu khng thuc dng limphm (ALM) sau ha tr liu (Kaldor, et al., 1990)
V tr/loi ung th nguyn pht RR Dc phm dng

Bung trng V Phi (t b o nh) Limphm a u ty

100* 24 130 65 210

Melphalan, cyclophosphamide Melphalan Nhiu loi tiu biu l cht alkylan Nhiu loi tiu biu l cht alkylan Nhiu loi tiu biu l cht alkylan

(* Nguy c pht trin AML i vi ph n b ung th bung trng cha th nh cng bng melphalan v cyclophosphamide l 100 ln cao hn 1 ph n cng tui trong cng ng. AML c th xut hin t 1-2 nm sau iu tr nhng nh cao l 5-7 nm sau t iu tr u tin bng ha cht.)

Cc ung th ph khc c bo co nhng bnh nhn sng st lu d i sau ha tr ung th nh limphm khng Hodgkin sau bnh Hodgkin v ung th phi v b ng quang sau iu tr bng cyclophosphamide bnh limphm khng Hodgkin. Cc loi thuc khc gy ung th cc bnh nhn c iu tr l cc hn hp gim au cha phenacetin, chng l m tng nguy c ung th thn v ung th biu m ng niu khc; thuc c ch min dch azaathioprien gy cc u da, limphm khng Hodgkin v cc bnh c tnh him gp khc; v s phi hp 8 - methoxypsoralen v tia cc tm loi A c th gy ung th da sau khi dng iu tr cc ri lon da nh bnh vy nn. Cc nghin cu trn ng vt xc nh tnh sinh ung ca mt s thuc iu tr khc nh metronidasole, griseofulivn, phenobarbital, phenoxybenzamine v phenytoin. S c ch min dch sau khi cy ghp c quan, cng l m bnh nhn c nguy c cao mc bnh ung th (xem s suy gim min dch). Tuy nhin vai tr sinh ung ca cc thuc dng l m c ch min dch vn cn c b n c i. Mt s loi ni tit t c dng trong cc l nh vc thc h nh y khoa khc nhau. Ngi ta thy mt s nhm ni tit t l m tng nguy c ung th sau khi dng chng. Ngi ta xc nh rng thuc diethylstillbestrol (DES) m tng c dng rng r i v o u thai k gim cn bun nn v nga da xy thai, th c th gy ung th m o cc con gi ca bnh nhn c iu tr v l m tng nguy c b ung th tinh ho n cho cc con trai ca h. iu tr thay th estrogen ngi ta dng gim cc triu chng m n kinh, gim nguy c bnh tim do mch v nh bng cch l m tng lipoprotein cholesterol t trng cao v bo tn nng mui khong trong xng nga chng lo ng xng v g y

Ung Th Hc i Cng 2005

xng. Liu php n y l m tng nguy c ung th ni mc t cung cng nh khi s dng thuc nga thai ung thng xuyn. Mt khc, cc thuc nga thai ung loi phi hp c l lin quan vi nguy c thp b ung th ni mc t cung v bung trng nhng c th gy tng nh nguy c b cc u gan l nh v c tnh. Vic s dng thuc nga thai ung c gy ung th v hay khng vn cn ang b n c i, mc d c v nguy c ung th v tng cao cc ph n tr v cc ph n sm s dng thuc nga thai ng ung loi phi hp trong i sng sinh dc ca h.
6. Cc tc nhn sinh hc

6.1. Virt sinh ung th C 4 loi virut lin quan n c ch sinh bnh ung th: - Virut Epstein - Barr Loi ung th n y u tin thy c mt bnh ung th h m di ca tr em vng Uganda (loi bnh n y do Eptein v Barr phn lp nn virut n y c mang tn virut Eptein - Barr). V sau ngi ta cn phn lp c loi virut n y trong cc khi ung th vm mi hng, bnh c nhiu cc nc ven Thi Bnh Dng c bit l Qung ng - Trung Quc v mt s nc ng Nam , trong c Vit Nam. nhiu bnh ung th vm cn thy khng th chng li khng nguyn ca virut Epstein - Barr. Tuy nhin ngi ta cha khng nh vai tr gy bnh trc tip ca virut Epstein - Barr i vi ung th vm mi hng. Trong dn chng t l nhim loi virut n y tng i cao nhng s trng hp ung th vm khng phi l nhiu. Hng nghin cu v virut Epstein - Barr ang cn tip tc v c bit ng dng phn ng IgA khng VCA tm ngi c nguy c cao nhm ch ng pht hin sm ung th vm mi hng. - Virut vim gan B gy ung th gan nguyn pht hay gp Chu Phi v Chu trong c Vit Nam. Virut n y khi thm nhp c th gy vim gan cp, k c nhiu trng hp thong qua. Tip theo l mt thi k d i vim gan m n tin trin khng c triu chng. Tn thng n y qua mt thi gian d i s dn n hai bin chng quan trng l x gan to n b v ung th t b o gan. iu n y phn n o gii thch s xut hin nhiu nh trong ung th gan v tnh cht ti pht sm sau ct gan. Ngo i ra x gan l m cho tin lng ca bnh ung th gan xu i rt nhiu. Vic khng nh virut vim gan B gy ung th gan gi vai tr rt quan trng. N m ra mt hng phng bnh tt bng cch tim chng chng vim gan B. Pht hin nhng ngi mang virut bng xt nghim HBsAg (+) v nhng ngi n y nn dng vaccin. - Virut gy u nh thng truyn qua ng sinh dc. Loi n y c coi l c lin quan n cc ung th vng m h, m o v c t cung, cc nghin cu ang tip tc. - Virut HTLV1 l loi virut (rtr virut) lin quan n gy bnh bch cu t b o T gp Nht Bn v vng Carib. 6.2. K sinh trng v vi khun c lin quan n ung th Ch mt loi k sinh trng c coi l nguyn nhn ung th, l sn Schistosoma. Loi sn n y thng c mt vi ung th b ng quang v mt s t ung th niu qun nhng ngi Rp vng Trung ng, k c ngi Rp di c. C ch sinh ung th ca loi sn n y cha c gii thch r. Loi vi khun ang c cp n vai tr gy vim d d y m n tnh v ung th d d y l vi khun Helicobacter Pylori. Cc nghin cu ang c tip tc nhm mc

Ung Th Hc i Cng 2005

ch h thp tc hi Helicobacter Pylori v gim tn s ung th d d y, c bit l cc nc Chu .

7. Yu t di truyn v suy gim min dch

7.1. Yu t di truyn Nguyn nhn ca khong 33% ung th trn ngi ng y nay c bit, v cc yu t mi trng c cho l gi vai tr quan trng phn ln bnh ung th. iu n y yu t di truyn khng phi khng quan trng bi l c nhiu thng tin v cc yu t mi trng. C l phn ln s pht trin ca ung th c hai yu t mi trng v yu t di truyn u quan trng. V d: Mt v i nghin cu v men aryl hydrocarbon hydroxylase, mt enzym cn cho s chuyn ha hydrocarbon t khi thuc, gi rng s hin hu ca loi men n y trong phi con ngi v mt di truyn c th b kim sot bi mt gen n vi cp allen cao (H) v thp (L). So vi nhng ngi mang LL nhng ngi HH c nguy c b ung th phi gp 36 ln nhiu hn. Nh vy, ngay c trong ung th phi (ung th sinh ra t mi trng quan trng nht cho ti thi im hin ti), c th yu t di truyn c ngha. Nhng thng tin mi y lin h n chng xeroderma pigmentosum(mt bnh di truyn c in) ch rng bo v chng li cc bc x ca mt tri c th nga c s pht trin ca ung th da nhng i tng mc bnh n y. Mt s tnh hung v mt di truyn: 80 - 90% ngi s b ung th do h mang gen gy hi. U Wills, u nguyn b o vng mc 2 mt v nhng bnh nhn mang chng a plp c tnh cht gia nh l th d v cc loi ung th truyn theo tnh tri theo m hnh ca Mendel. Cc loi ung th n y c th ch l biu hin ca khuyt tt v di truyn (v d u nguyn b o vng mc mt 2 bn) nay c th l mt phn ca cc ri lon mang tnh h thng ca nhiu loi tn sn hay nhiu khuyt tt pht trin (v d hi chng carcinm t b o y dng nvi). Thm v o , c mt hi chng tin ung th mang tnh di truyn (hn lon s pht trin truyn theo th h) thng c di 10% biu hin c tnh. C 4 hi chng hay gp: - Hi chng u m tha (bnh a u x thn kinh, x c, bnh Hippel - Lindau, a u li ca xng, hi chng Peutz - Jeghers): Tnh tri ca nhim sc th vi cc d dng gi u mt s c quan vi mt s biu hin ca s bit ha khng y v ng v cc loi u khc nhau. - Bnh da c ngun gc gen (xeroderma pigmentosum, bch tng lon sn biu b dng mn cc, lon sn sng bm sinh v hi chng Werner): Tnh ln ca nhim sc th, vi nhiu ri lon ca da l m tin cho ung th da. Hi chng lon sn nvi l hi chng tri c khm ph mi y tin ca mlanm c. - Hi chng d v ca nhim sc th trong nui cy t b o (hi chng Bloom v thiu mu bt sn Fanconi): Tnh ln ca nhim sc th c th l m tin cho bnh bch cu. - Hi chng suy gim min dch a n limphm th vng (hi chng Wiscott Aldrich, tnh tri lin kt vi tia X, gim mch mu iu ha, tnh ln ca th nhim sc, cc d dng bm sinh t gp vi s suy gim min dch trm trng phi hp).

Ung Th Hc i Cng 2005

Cc hi chng d dng thuc ung th c th nhp li th nh cc loi khc. Vi mt s khuyt tt bm sinh ngi bnh c nguy c cao hn nhiu mc trung bnh, c khi 1000 ln nhiu hn. Trc y, phng php kho st cc bt thng v cu trc lin quan n ung th cn b gii hn vic khm ph nhng bt thng nhim sc th nh ba nhim sc 21, 13q. del. dnh vi u nguyn b o vng mc mt hoc 11q.del. lin h vi u Wilm. thi im hin ti con ngi c th tm c im a dng ca oncogen hay cc chui DNA c hiu tiu biu cho cc cht nh du tnh "nhy" ca ung th. Cc h thng mang tnh tng i ca cc cht nh du di truyn da trn s pht hin trc tip ca tnh a dng ca chui DNA vi cc men c ch (RFLP). Ngi ta c th lp ra bn lin kt gen chi tit ngi bng cch da v o cc h thng va nu. Th di truyn mi xc lp bi cc mnh ca dng DNA vi nhng biu hin ca gen c th hoc khng m chc nng th khng c bit. Ngi ta c th nh v gen trong bnh a plp mang tnh gia nh nhim sc th s 5, trong bnh Von Reclinghausen nhim sc th s 17, trong ung th a c ngun gc ni tit nhim sc th s 10 (MEN 2A) hoc nhim sc th s 11 (MEN -1). Nhng ngi mang gen trong cc hi chng trn c th c xc nh bng s ng lc DNA qua phn tch mi lin kt gen vi nhau. Th d u nguyn b o vng mc mt ngi ta xc nh c gen gy bnh v c ch r cho mt phn ca mt lp gen mi (gen khng ung th) v chnh gen n y kim ch s to lp t b o. Bc nhy trong lnh vc di truyn v cc nghin cu v nhim sc th s cho nhiu iu hiu bit tuyt diu hn v mi lin h qua li gia mi trng v yu t di truyn. 7.2. Suy gim min dch v AIDS Trn ng vt thc nghim s gia tng v mi nguy c b ung th i i vi s suy gim min dch. Ngi b suy gim min dch mang tnh di truyn hay mc phi thng d b ung th v thi gian bnh ngn hn, ch yu l bnh limphm h vng. nhng bnh nhn ghp c quan - s suy gim min dch do thuc r nht. Theo di trong mt thi gian d i 16.000 bnh nhn ghp thn v c iu tr bng cc loi thuc c ch min dch ngi ta thy nguy c bnh limphm khng Hodgkin tng 32 ln, ung th gan v ng mt trong gan tng 30 ln, ung th phi tng 2 ln, ung th bng i hn 5 ln, ung th c t cung gn 5 ln, cc mlanm c v ung th tuyn gip tng ln 4 ln. S nn min dch cng cn l m tng nguy c nhim virt, c hai loi virt gy ung th v nhng loi b nghi ng. S gia tng cc t b o limphm B c tnh, bin chng ca s suy gim min dch i l hu qu ca s nhn ln hn n ca cc t b o B nhim EBV gia tng ri lon to limphm a clonal v c xp v o limphm khng Burkitt loi lan ta. Ch yu bnh xy ra sau suy gim min dch th pht, trong ghp c quan th l do dng thuc, trong suy gim min dch l do nhim HIV, AIDS. Bnh sinh ca loi bnh n y c hiu r trong nhng nm gn y. Nhng n vn l mt trong nhng bin chng ch yu lin h vi s c ch min dch. Ngi c HIV dng tnh c nguy c cao b sarcm Kaposi v limphm khng Hodgkin (NHL). Sarcm Kaposi c th xy ra bt c lc n o sau khi b nhim HIV,

Ung Th Hc i Cng 2005

tri li NHL c khuynh hng xut hin trn c a suy gim min dch trm trng. ngi b nhim HIV, nguy c n y gia tng khong 6% mi nm trong vng 9 - 10 nm. iu n y c bit r qua nhng nghin cu theo di nhng ngi nhim HIV (nam ng tnh luyn i, ngi mc bnh mu khng ng b nhim HIV do truyn mu) v qua cc d kin tng ng v nhim HIV v ghi nhn ung th. Nguy c xut hin sarcm Kaposi cng c lin quan n cch thc nhim HIV mc phi. Trong khi mt phn nm nam ng tnh luyn i c nguy c b sarcm Kaposi th ch c khong mt phn ba mi ngi b nhim HIV qua ngi m hoc trong thi k chu sinh. Nhn nh n y v cc quan st dch t hc khc gip a n kt lun l sarcm Kaposi c lin quan n tc nhn thng ly nhim qua quan h tnh dc v c l cng cng mt tc nhn nh trong cc ca xut hin ring l hoc cc ca c lin h AIDS (SIDA). C mt s thng tin mang tnh cht bn l gi nhim HIV c th l m tng nguy c mc bnh Hodgkin (loi t b o hn hp), ung th hu mn, ung th gan v ung th c t cung. iu n y cn c l m r thm. iu quan trng cn lu l s gia tng mi loi ung th ring l k trn chng minh hoc gi c th c mi lin quan n vic nhim virut, v c th c mt c ch qua c a suy gim min dch ngi nhim nhim HIV c th l m tng kh nng mc ung th do virt. Cc quan st mi y v s gia tng nguy c mc limphm Burkitt trong qu trnh nhim HIV gi ngh c yu t khc hn l s suy yu ca chc nng t b o T nh vic kch hot khng nguyn mn tnh chng hn.
Cu hi lung gi

1. Trnh b y yu t vt l gy ung th. 2. Trnh b y nhng yu t ho hc gy ung th. 3. Trnh b y yu t sinh hc gy ung th. 4. Nhng tc nhn c th gy ra ung th vm l : a. Nitrosamin c. Aflatoxin e. M ng vt g. Thuc l i. EBV 5. Nhng tc nhn c th gy ra ung th d d y l : a. Nitrosamin c. Aflatoxin e. M ng vt g. Thuc l i. EBV 6. Nhng tc nhn c th gy ra ung th gan l : a. Nitrosamin b. Vi rt vim gan B b. Vi rt vim gan B d. HIV f. Helicobactepylori h. 3-4 Benzopyren b. Vi rt vim gan B d. HIV f. Helicobactepylori h. 3-4 Benzopyren

Ung Th Hc i Cng 2005

c. Aflatoxin e. M ng vt g. Thuc l i. EBV

d. HIV f. Helicobactepylori h. 3-4 Benzopyren

7. Nhng tc nhn c th gy ra ung th i trc tr ng l : a. Aflatoxin b. M ng vt c. Thuc l a. Nitrosamin b. Aflatoxin c. M ng vt 9. Nhng tc c th gy ra ung th b ng quang l : a. Nitrosamin b. Aflatoxin c. M ng vt 10. Nitrosamin c th gy ra bnh ung th : a. Ung th vm d. Ung th i trc tr ng quang a. Ung th vm d. Ung th i trc tr ng quang a. Ung th vm d. Ung th i trc tr ng quang a. Ung th vm d. Ung th i trc tr ng quang a. Ung th vm b. Ung th d d y e. Ung th phi c. Ung th gan f. Ung th b ng d. Thuc l e. EBV f. Vi rt vim gan B d. EBV e. Vi rt vim gan B f. Helicobactepylori d. Thuc l e. Vi rt vim gan B f. Helicobactepylori

8. Nhng tc nhn c th gy ra ung th phi l :

11. Aflatoxin c th gy ra bnh ung th : b. Ung th d d y e. Ung th phi c. Ung th gan f. Ung th b ng

12. M ng vt c th gy ra bnh ung th: b. Ung th d d y e. Ung th phi c. Ung th gan f. Ung th b ng

13. Thuc l c th gy ra bnh ung th: b. Ung th d d y e. Ung th phi c. Ung th gan f. Ung th b ng

14. EBV c th gy ra bnh ung th : b. Ung th d d y c. Ung th gan

Ung Th Hc i Cng 2005

d. Ung th i trc tr ng quang a. Ung th vm d. Ung th i trc tr ng quang a. Ung th vm d. Ung th i trc tr ng quang

e. Ung th phi

f.

Ung

th

b ng

15. HPV c th gy ra bnh ung th : b. Ung th d d y e. Ung th phi c. Ung th gan f. Ung th b ng

16. Helicobactepylori c th gy ra bnh ung th: b. Ung th d d y e. Ung th phi c. Ung th gan f. Ung th b ng