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Hình ảnh PET/CT với hạch ung thư.  

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12:04 20/04/2011

Chẩn đoán nguyên nhân hạch to thường dễ, nếu chỉ là một triệu chứng nằm trong một bệnh cảnh có nhiều hội chứng cấp tính hơn. Nhưng nếu hạch to là một triệu chứng duy nhất.. [..]

tu van ung thư - những điều bạn chưa biết về căn bệnh thư

1. Kiểm tra kỹ những bộ phận có cùng một loại mê như hạch: gan, lách, amidan…

2. Theo dõi tính chất nơi khu trú và tiến triển của hạch, tình trạng toàn thân: sốt, xanh xao, chảy máu…

3. Làm một số xét nghiệm

- Công thức máu.

- Sinh thiết hạch. Trừ những bệnh về máu gây  hạch to như các bệnh bạch cầu hoặc các bệnh sốt phát ban trong đó hạch to chỉ là một triệu chứng  không quan trọng lắm, còn nói chung nếu hạch to là triệu chứng  nổi bật  thì phải tiến hành sinh thiết hạch để chẩn đoán chính ác.

Để hệ thống hoá những bệnh gây hạch to thường gặp, chúng tôi tóm tắt vào bảng sau đây:

Bệnh

Tính chất hạch

Triệu chứng kém

Xét nghiệm cần làm

Lao

- Thường bắt đầu ở cổ rồi lan xuống dưới.

- Bao giờ cũng có hạch cứng, hạch mềm. Có thể có lỗ rò.

- Tiến triển chậm.

- Gặp  ở người trẻ tuổi.

- Sức khoẻ toàn thân tương đối tốt  trong  thời gian dài.

- Phản ứng bì (+).

- Sinh thiết hạch thấy  tế bào khổng lồ, hang lao và bã đậu.

Ung thư hạch

- To cả hai bên

- Rất rắn, dễ bị loét

- Dính vào nhau hoặc vào các mô xung quanh

- Chèn ép bó mạch thần kinh  bên cạnh.

- Tiến triển nhanh

- Gặp nhiều ở người có tuổi

- Sức khoẻ toàn thân suy sụp nhanh.

- Bệnh tiến triển liên tục.

Sinh thiết hạch  thấy tế bào ung thư.

Hodgkin

- Hạch nhiều, cái to, cái nhỏ, thường ở hố thượng đòn trước.

- Hơi rắn, lúc đầu di động dễ, hạch riêng rẽ.

- Không bao giờ rò.

- Gặp nhiều ở người có tuổi

- Tiến triển từng đợt: sốt ngứa.

- Tình trạng toàn thân suy sụp dần.

- Có thễ có hạch ở nội tạng, trung thất, ở bụng.

Sinh thiết hạch  thấy hình thức đa dạng tế bào, có nhiều Sternberg.

Bệnh bạch cầu

- Hạch to đều hai bên nhiều nơi.

- Di động dễ dàng, bờ tròn nhẵn, dễ giới hạn.

- Không bao giờ rò.

Bạnh cầu kinh:

- Người có tuổi.

- Có thể thêm  lách to.

- Thiếu máu ít.

Bạch cầu cấp:

- Trẻ tuổi

- Sốt. Chảy máu nhiều nơi.

- Thiếu máu nhiều

- Bạch cầu  tuỷ tăng cao.

- Không cần làm sinh thiết hạch.

 

BS.Nguyễn Xuân Thanh (TT. U Bướu-BV.Bạch Mai)

 


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