Post on 14-Feb-2019
12/4/2010
1
Peran Bedah Pada Solid TumorPeran Bedah Pada Solid Tumor
Emir T PasaribuEmir T Pasaribu
Divisi Onkologi Dept. Ilmu Bedah Divisi Onkologi Dept. Ilmu Bedah FK USU/ RS HAM MEDANFK USU/ RS HAM MEDAN
Tumor typesTumor types
CarcinomaCarcinoma EpithelialEpithelial
SarcomaSarcoma MesenchymalMesenchymal
BlastomaBlastoma EmbryonalEmbryonal
LymphomaLymphoma Lymphoreticular Lymphoreticular
LeucaemiaLeucaemia Blood cellsBlood cells
TypeType Tissue originTissue origin
Solid
12/4/2010
2
Th
e 1
2 m
ajo
r ca
nce
rs
12/4/2010
3
10 kanker terbanyak di RI 200210 kanker terbanyak di RI 2002
�� Pada wanitaPada wanita
1 leher rahim1 leher rahim
2 payudara2 payudara
3 ovarium3 ovarium
4 kulit4 kulit
5 tiroid5 tiroid
6 rektum6 rektum
7 kel.limf7 kel.limf
8 korpus uteri8 korpus uteri
9 kolon9 kolon
10nasofaring10nasofaring
�� Pada lelakiPada lelaki
1 nasofaring1 nasofaring
2 kulit2 kulit
3 kel. Limf3 kel. Limf
4 rektum4 rektum
5 prostat5 prostat
6 kandung kemih6 kandung kemih
7 kolon7 kolon
8 jar. Lunak8 jar. Lunak
9 paru9 paru
10rongga hidung10rongga hidung
12/4/2010
4
10 kanker terbanyak di RI 200510 kanker terbanyak di RI 2005
�� Pada wanitaPada wanita
1 leher rahim1 leher rahim
2 payudara2 payudara
3 ovarium3 ovarium
4 kulit4 kulit
5 tiroid5 tiroid
6 rektum6 rektum
7 korpus uteri7 korpus uteri
8 nasofaring8 nasofaring
9 kolon9 kolon
10kel. limf10kel. limf
�� Pada lelekiPada leleki
1 nasofaring1 nasofaring
2 prostat2 prostat
3 rektum3 rektum
4 kulit4 kulit
5 kel. Limf5 kel. Limf
6 kolon6 kolon
7 kandung kemih7 kandung kemih
8 jaringan lunak8 jaringan lunak
9 rongga hidung9 rongga hidung
10paru.10paru.
Ca
use
s o
f ca
nce
rC
au
se
s o
f ca
nce
r
�� Ionizing irradiationIonizing irradiation•• Leucaemia, Thyroid cancerLeucaemia, Thyroid cancer
•• Squamous cell carcinomaSquamous cell carcinoma
�� Inhaled or ingested carcinogensInhaled or ingested carcinogens•• Cigarette smoke : Lung, Larynx, BladderCigarette smoke : Lung, Larynx, Bladder
•• Aromatic amines : BladderAromatic amines : Bladder
�� Occupational factorsOccupational factors•• Asbestos : mesotheliomaAsbestos : mesothelioma
�� Lifestyle and dietLifestyle and diet•• Overnutrition : increases riskOvernutrition : increases risk
•• Vitamines : diminish riskVitamines : diminish risk
�� PathogensPathogens•• Schistosoma : BladderSchistosoma : Bladder
•• Viruses : HIV, Kaposi, EBV, NasopharynxViruses : HIV, Kaposi, EBV, Nasopharynx
12/4/2010
5
Pathology
Radiology
Nuclear Medicine
Nurse
Psychology
Dietician
Oral care
Lab physician
Etc
12/4/2010
6
Peran bedahPeran bedah
�� PreventionPrevention
�� DiagnosticDiagnostic
�� TreatmentTreatment
�� Rehabilitation.Rehabilitation.
Prevention Prevention
�� PrimaryPrimary
�� Secondary Secondary
�� Tertiary Tertiary
12/4/2010
7
PreventionPrevention
Underlying condition Assosiated cancer Underlying condition Assosiated cancer SurgerySurgery
Cryptorchidism Testicular OrchiopexyCryptorchidism Testicular Orchiopexy
Polyposis coli ColonPolyposis coli Colon ColectomyColectomy
Familial colon cancer ColonFamilial colon cancer Colon ColectomyColectomy
Ulcerative colotisUlcerative colotis ColonColon ColectomyColectomy
MEN II & III MEN II & III Medullary thyroid CaMedullary thyroid Ca ThyroidectomyThyroidectomy
Familial breast Ca Familial breast Ca BreastBreast MastectomyMastectomy
Familial ovarian Ca Familial ovarian Ca OvaryOvary OophorectomyOophorectomy
Diagnostik. Diagnostik.
�� FNABFNAB
�� Core biopsiCore biopsi
�� Insisi biopsiInsisi biopsi
�� Eksisi biopsiEksisi biopsi
12/4/2010
8
Strategy in OncologyStrategy in Oncology
Clinical diagnosisClinical diagnosis
Microscopic diagnosis and stagingMicroscopic diagnosis and staging
Treatment planningTreatment planning( curative or palliative )( curative or palliative )
Diagnosis and stage first !Diagnosis and stage first !
12/4/2010
9
PhysicalPhysical
ExaminationExamination
Biopsy setBiopsy set
12/4/2010
10
Tumor
Node
Metastasis
cTNM = clinical stage
pTNM = pathological stage
12/4/2010
11
Staging Gastric CancerStaging Gastric Cancer
Treatment modalitiesTreatment modalities
12/4/2010
12
locoregional treatmentlocoregional treatmentsurgerysurgery
radiotherapyradiotherapy
systemic treatmentsystemic treatment
cancer drugscancer drugs
Factors
Tumor type and biological behaviour
Localisation and extend of disease
Age and general condition of the patient
Competence of staff and facilities
TreatmentTreatment
- reduce the bulk of residual disease
- resection of metastatic disease with curative
- onkologic emergecies
- palliation
- reconstruction and rehabilitation
12/4/2010
13
Few tumors can be treated with Few tumors can be treated with curative intent even if they curative intent even if they have spread hematogeneoushave spread hematogeneous
Testicular cancerTesticular cancer
Malignant lymphomaMalignant lymphoma
Childhood cancerChildhood cancer
Thyroid cancerThyroid cancer
Osteogenic sarcomaOsteogenic sarcoma
CRC with liver metastaseCRC with liver metastase
SummarySummaryCancer is a word, not a sentenceCancer is a word, not a sentence
Cancer is unrestricted growth of cellsCancer is unrestricted growth of cells
Tumor development occurs in stagesTumor development occurs in stages
A tumor is present long before it is clinically detectableA tumor is present long before it is clinically detectable
Cancer care is not (yet) the most expensive part of health Cancer care is not (yet) the most expensive part of health carecare
Tobacco and diet are the top two causes of cancerTobacco and diet are the top two causes of cancer
A histological diagnosis is obligatory before treatmentA histological diagnosis is obligatory before treatment
Every cancer should be TNM staged Every cancer should be TNM staged
Most cancer patients survive their tumorMost cancer patients survive their tumor
Early detection is more effective than intensive treatmentEarly detection is more effective than intensive treatment
12/4/2010
14