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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

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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

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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.

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�� 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

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Pathology

Radiology

Nuclear Medicine

Nurse

Psychology

Dietician

Oral care

Lab physician

Etc

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Peran bedahPeran bedah

�� PreventionPrevention

�� DiagnosticDiagnostic

�� TreatmentTreatment

�� Rehabilitation.Rehabilitation.

Prevention Prevention

�� PrimaryPrimary

�� Secondary Secondary

�� Tertiary Tertiary

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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

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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 !

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PhysicalPhysical

ExaminationExamination

Biopsy setBiopsy set

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Tumor

Node

Metastasis

cTNM = clinical stage

pTNM = pathological stage

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Staging Gastric CancerStaging Gastric Cancer

Treatment modalitiesTreatment modalities

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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

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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

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