Kuliah Atma 270111 Kanker Paru Dan Tumor Mediastinum - Copy
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Pudjo Astowo
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Pendahuluan
Kanker paru dalam arti luas ialah - semua penyakit keganasan di paru - keganasan yang berasal dari paru sendiri - keganasan dari luar paru(metastase) Dalam pengertian kanker paru ialah tumor ganas yang berasal dari epitel bronkus, yakni karsinoma bronkus (bronchogenic carcinoma).
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Epidemiologik • Prevalensi yang terus meningkat baik pada laki-laki maupun perempuan• Jepang, sebelumnya kanker gastrointestinal menduduki peringkat pertama, tetapi saat ini diduduki oleh kanker paru• Indonesia kanker paru menduduki peringkat ke-3 setelah kanker leher rahim dan kanker payudara
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Cancer• A cellular disorder, clonal origin• Progressive accumulation of a mass of
cells• Progressive invasion of surrounding
tissues and organs• Ability to metastasize to distant organs
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Cancer• Essentially, a genetic disease• Mutation of genes:
• Oncogenes• Tumor suppressor genes• Mismatch repair genes
• Germline mutation: hereditary or familial cancer
• Somatic mutation: sporadic cancer
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The doubling process
Normalcell
Dividing
Malignanttransformation
2 cancercells
Doubling 4 cells
Doubling
8 cells
Doubling
16 cells
1 million cells(20 doublings)undetectable
1 billion cells(30 doublings)lump appears
1 trillion cells(40 doublings – 2 lb/1kg)
41 – 43doublings— Death
Exponential growth
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Gambaran klinik • Massa tumor terbatas pertumbuhannya / belum melibatkan organ-organ lain atau jaringan lain di sekitarnya tidak akan memberikan keluhan dan tanda-tanda klinis yang berarti
• Massa tumor lebih besar dan melibatkan organ- lain di sekitarnya akan memberikan keluhan- keluhan
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GEJALA-GEJALA KANKER PARU
• Batuk-batuk kronik• Batuk darah• Sakit dada• Sesak napas• Nafsu makan berkurang• Berat badan turun (drastis)
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TANDA-TANDA KHUSUS• Jari tabuh (osteoartropati)• Sindroma vena kava superior (SVCS)• Sindroma Horner’s • Pembesaran kelenjar getah bening• Efusi pleura hemoragis / masif• Sindroma paraneoplastik
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DIAGNOSISKANKER PARU• Anamnesis• Pemeriksaan jasmani• Pemeriksaan penunjang (jenis PA & staging)
– Foto rontgen (PA & lateral)– CT Scanning– Bone scanning– Sitologi / patologi anatomi sputum sitologi,
bronkoskopi, biopsi (KGB, TTB, TBLB, torakoskopi)
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Jenis histologi (WHO 1980) Ada 4 jenis utama kanker paru a. Karsinoma sel skuamosa (karsinoma epidermoid, Skuamous)b. Karsinoma adeno (adenocarcinoma)c. Karsinoma sel kecil (small cell carcinoma)d. Karsinoma sel besar (large cell carcinoma)
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Penderajatan (staging)(UICC/AJCC tahun 1997)
Karsinoma bukan sel kecil dipakai) Karsinoma sel skuamosa Karsinoma adeno
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THE NEW TNM SYSTEM LUNG CANCER
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TNM system 1987 TNM system 1997 Stage TNM Stage TNM
I T1N0M0 IA T1N0M0 T2N0M0 IB T2N0M0
II T1-2N1M0 IIA T1N1M0 IIB T2N1M0 T3N0M0
IIIA T3N0M0 IIIA T3N1M0 T3N1M0 T1-3N2M0 T1-3N2M0
IIIB anyTN3M0 IIIB anyT3M0 T4 anyNM0 T4 any NM0
IV anyT anyNM1 IV any T any N M1
Oncology (suppl) 1998;12:1-4
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T1 <3cm T1a <2cm T1b 2-3cm
T2 >3cm T2a < 5cm T2b 5-7cm
T3 (invasion) T3 >7cm T3 (invasion)
T4 (same lobe) T3
T4 (extension) T4
( J Thorac Oncology 2007 ; 2 : 706-14
New Staging NSCLC TNM System 2007
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Recommend changing the classification of patients with malignant pleural effusions. Those patients who have either cytologically positive fluid or fluid that is bloody and/or exudative and appears clinically associated with the underlyinglung cancer should henceforth be given a distinct classification of stage IVA.
All patients with M1 disease would be at stage IVB.
New Staging NSCLC TNM System 2007
( J Thorac Oncology 2007 ; 2 : 706-14
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New Staging NSCLC TNM System 2007• Solitary nodule T1 T1a T1b T2 T2a T2b• Multiple nodule
• Same lobe T4 T3• Other lobe M1 T4
• Lobar consolidation T4 T3
• Pseudo pneumonic pattern M1 T4• Malignant pleural Effusion T4 M (M1a)
( J Thorac Oncology 2007 ; 2 : 706-14
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TNM system 1997 TNM system 2007Stage TNM TNM
IA T1 N0 M0 T1a N0 M0 T1b N0 M0 IB T2 N0 M0 T2a N0 M0
IIA T1 N1 M0 T1a N1 M0 T1b N1 M0 T2b N0 M0
IIB T2 N1 M0 T2b N1 M0 T3 N0 M0 T3 N0 M0
( J Thorac Oncology 2007 ; 2 : 706-14
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TNM system 1997 TNM system 2007Stage TNM TNM
IIIA T3 N1 M0 T1-2 N2 M0 T1-3 N2 M0 T3 N1-2 M0 T4 N0 M0
IIIB anyT N3 M0 T4 N1-2 M0 T4 any N M0 anyT N3 M0
IV any T any N M1 IVA anyT anyN M1a IVB anyT anyN M1b
( J Thorac Oncology 2007 ; 2 : 706-14
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NEW STAGING SCLC
With TNM system
• Limited Disease Stage I Stage II Stage III
• Extensive disease Stage IV
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Histopathological classification of lung cancer WHO 2004
• WHO 1999• SQUAMOUS CELL Ca• SMALL CELL Ca• ADENOCARCINOMA• LARGE CELL Ca
• WHO 2004• SQUAMOUS CELL Ca• SMALL CELL Ca• ADENOCARCINOMA Adenoca, mixed type Acinar Adenoca Papillary Adenoca Bronchioloalveolar Ca Solid Adenoca mucin prod• LARGE CELL Ca
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•TNM SYSTEM VERSION 7 , 2009NON-SMALL CELL LUNG CANCER
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•TNM SYSTEM VERSION 7 , 2009NON-SMALL CELL LUNG CANCER
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PenderajatanKarsinoma sel kecil • 1. Terbatas (limited) • tumor maksimal melibatkan organ intratoraks • dinding dada, KGB supraklavikula ipsilateral, • efusi pleura
• 2. Luas (extensive)• penyebaran tumor ke arah kontralateral dan/atau • metastasis jauh (otak, hati, tulang dll)
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Prosedur diagnostik dan penderajatan (staging)
TNM
• Lokasi tumor / metastasis ( M) • Besarnya tumor ( T )• Keterlibatan KGB ( N )• Jenis histologis penderajatan
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Prosedur diagnostik dan penderajatan (staging)• Anamnesis• Pemeriksaan fisis dan keadaan umum
(performance status)• Pemeriksaan penunjang - Foto toraks dan Ct sken toraks / otak - Bronkoskopi ( biopsi, TBLB, BAL) - Skening tulang - USG abdomen• Laboratorium (petanda tumor, dll)
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Tumor paru
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Inoperable mass encapsulating the right main pulmonary artery
pulmonary artery
TN
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Positivity of sputum cytologyMethod Direct
%Inhalation
%Saccomano
%
Endardjo1990 5.2
Astowo1995 16 26
Titin M S2002 4.3 18.3
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Tumor Paru Lokasi : Trunkus intermedius kanan
Tumor paruLokasi: bronkus utama kanan
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Tumor trakeaLokasi : 1/3 distal trakea
Tumor trakeaLokasi : 1/3 distal trakea
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Subtype in the histology of lung cancer
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Karsinoma sel kecil(SCLC)
• Histologi
• Sitologi
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Karsinoma sel skuamosa
HistologiSitologi
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Adenokarsinoma(Adeno)
• Histologi
• Sitologi
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Karsinoma sel besar
• Histologi
• Sitologi
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Distribution of pulmonary and bronchial metastases in necropsied carcinoma patients (Modified from Milton B Rosenblatt et al, 1966)
Primary site Pulmonary % Bronchial %COLON (91) 42.8 12.1BREAST (56) 73.2 35.7PANCREAS (51) 54.9 41.2STOMACH (36) 47.2 19.4OVARY (30) 26.6 3.3BILIARY TRACT (17) 29.4 17.6SKIN&MELANOMA (17)
82.3 11.7
PROSTATE (15) 53.3 40.0URINARY BKADDER (11)
45.4 27.2
KIDNEY (10) 100 80.0
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•Screening in Lung Cancer
•The role of Pathologist in early detection of lung cancer
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Gambaran bronkoskopi pada displasia skuamosa dan CIS
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Terapi
• Untuk menetapkan pengobatan perlu ditentukan terlebih dahulu
a. Jenis histologi• b. Derajat (stage)• c. Tingkat tampilan (performance status)
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Pengobatan kanker paru1. PEMBEDAHAN2. RADIOTERAPI3. KEMOTERAPI
(kuratif/paliatif) (tunggal/kombinasi)
4. TARGETTING THERAPY5. BSC (BEST SUPPORTIVE CARE)6. TERAPI ALTERNATIF(PILIHAN
LAIN - TACI - CRYO SURGERY - VACCINASI
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Terapi • Pembedahan• Radioterapi • Kemoterapi• Kombinasi (kemoradioterapi)• Neo Ajuvan• Ajuvan terapi• Imunoterapi
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Therapy
Stage I-II
surgery
+/_adjuvant
Stage III.A
Neo adjuvant
surgery
MODALITY THERAPY FOR NSCLC
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Therapy
Stage III.B
chemo
CT+RT
Stage IVchemo
RT
MODALITY THERAPY FOR NSCLC
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MODALITY THERAPY FOR SCLC
THERAPY
LD-SCLC
CHEMOTHERAPY
+ PCI
SURGERY
ED-SCLCCHEMOHERAPY
+ PCI
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CHEMOTHERAPY OR TARGETED THERAPY FOR NSCLC
BIOMOLECULER
HISTOPATHOLOGY
ADENOCARCINOMA
SQUAMOUS CELL CRACINOMA
EGFR
K-RAS
VEGF
OTHERS
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PEMBEDAHANpneumektomi
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PEMBEDAHANsegmentegtomi/lobektomi/bi-lobektomi
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PEMBEDAHANreseksi:wedge/sleeve
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RADIOTERAPI(“cobalt”)
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RADIOTERAPI(“linear accelerator”)
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Pengobatan Sindroma Vena Cava Superior(SVCS) : Sukses (Radioterapi Cito )
• Tn A• 68 th
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Methods of Cancer Treatments
-Surgery-Radiotherapy-Chemotherapy-Immunotherapy-Biological Therapy
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KEMOTERAPI• Definitif• Paliatif
• Ajuvan• Neo-ajuvan
• Kemoterapi-tunggal• Kombinasi(multimodaliti)
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KEMOTERAPIA. Kanker Paru jenis Karsinoma Sel Kecil
- CAV- Cisplatin + Etoposide
B. Kanker Paru jenis Karsinoma Bukan Sel Kecil
- Kombinasi dengan dasar : Cisplatin/Carboplatin
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“BEST SUPPORTIVE CARE” (BSC)• Terapi oksigen• Pemberian antibiotik• Obat-obat simtomatik/analgetik• Pemberian bronkodilator• Steroid• Radioterapi
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TERAPI PALIATIF
• TERAPI LASER• PEMASANGAN ‘STENT’• ‘PHOTHO DYNAMIC TERAPI (PDT)’
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TARGETED THERAPY
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PENGEMBANGAN MASA DEPAN / DALAM PENELITIAN
• Torakoskopi (VATS)• STENT• Brakiterapi• Imunoterapi• Terapi vaksin• Terapi gene• Anti-angiogenesis• “targeted therapy”
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Lung Cancer Team
• Pulmonologist• Radiologist• Pathologist• Surgeon• Internist• Medical rehabilitation specialist • Clinical pathologist, orthopedist, • Neurosurgeon
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The benefits of team work
1. Better diagnosis & staging 2. Better choice of treatment modalities and their sequences3. Better management in difficult cases, more professional support 4. Collective responsibility
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TUMOR MEDIASTINUMPendahuluan Anatomi
Tumor Mediastinum tumor yang terletak dalam rongga (mediastinum)
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TUMOR MEDIASTINUM* Diagnosis ~ Foto toraks ~ CT Scan Toraks ~ Bronkoskopi ~ TTB (Trans Torakal Biopsi)
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TUMOR MEDIASTINUMTumor mediastinum* Anterior ~ Timoma ~ Limfoma ~ Teratoma ~ Tuberkuloma ~ Tiroid intratoraks
* Posterior : tumor neurogenik (jar. Saraf) ~ Neurolemmoma ~ Neurosarkoma ~ Neurofibroma
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TUMOR MEDIASTINUM D/ * Asimptomatis pemeriksaan rutin foto toraks * Simptomatis
~ Perasaan tidak enak di dada ~ Sesak napas ~ Batuk / batuk darah ~ Pembengkakan di dada
* Keluhan ~ Lambat jinak ~ Cepat ganas
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TUMOR MEDIASTINUM ANTERIOR* Timoma ~ asal dari jaringan timus ~ 20% tumor mediastinum / 75% tumor med ant ~ Semua umur : - dewasa muda
- 70% (40-60) thn ~ Laki-laki/perempuan ~ Kadang tanpa gejala klinis / dengan klinis ~ (8-20%) miastenia gravis dengan timoma
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~ Timoma : (10-50)% dengan Miastenia gravis ~ Miastenia gravis : Auto Immune disease ~ Pertumbuhan lambat
* Klasifikasi : ~ Klinis : jinak / ganas ~ Histopatologis Rosai & Levino : - Limfositik (23%) - Epitelial (42%) - Limfoepitelial (35%) - Spindel
TUMOR MEDIASTINUM ANTERIOR
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TUMOR MEDIASTINUM ANTERIOR* Stadium Timoma (Masaoka 1991)Std I : Makroskopis : tumor memiliki kapsul sempurna
Mikroskopis : tidak terdapat invasi ke kapsulStd II : Makroskopis : invasi ke jar. lemak sekitarnya atau pleura mediastinal Mikroskopis : invasi ke jaringan & kapsulnyaStd III : Makroskopis : invasi ke jaringan sekelilingnya Mikroskopis : invasi ke jaringan sekelilingnyaStd IV : A. Penyebaran ke pleura &/ perikardial B. metastase limfogen & hematogen
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TUMOR TERATOID / GERM SEL TUMOR
Berasal dari jar. Germinal primitif Memberikan klinis pada dewasa muda Kadang berasal dari tempat lain (testis) Teratoma, karsinoma embrionik, teratokarsinoma choriocarcinomaTeratoma : asal : ekto, meso, endodermis Kista dermoid :- Kista - Komponen epidermis (gigi, tulang, rambut)- Gejala klinis : pendesakan terhadap organ sekitarnya
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LIMFOMA MALIGNUM Keganasan primer jaringan limfoid Hodgkin & non Hodgkin Patofisiologis : ???? - Immuno defisiensi
- Obat immuno supresan - Genetik
- Infeksi virus Epstein Barr Insidens : 2-6 / 100.000 Klinis : 24% / std lanjut
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LIMFOMA MALIGNUM Histopatologi jaringan yang terkena ~ Ro toraks / CT Scan toraks : KGB hilus >> ~ Cab. Darah : (N) / sumsum tulang Prognosis ~ Usia ~ PA ~ Lokasi ~ Tumor >>
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TUMOR MEDIASTINUM POSTERIOR* > tumor neurogenik (80%), tanpa gejala, jinak • Klinis : nyeri dada OK : penekanan pd vetebra
/saraf
* Neurilemmona ~ berasal dari selaput saraf sel schwan ~ jinak, berkapsul, tidak invasi ~ klinis batuk, nyeri dada
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* Neurofibroma ~ neural sheath cell ~ berkapsul, dapat membesar : penekanan ~ 10-15% deg. Maligna : Neuro Sarkoma
* Neurosarkoma ~ deg. Maligna dari Neurilemmona & Neurofibroma ~ Hipoglikemia (??)
TUMOR MEDIASTINUM POSTERIOR
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Pengobatan Operasi Radioterapi Kemoterapi Radiokemoterapi
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DOMO ARIGATO GOSAIMASHU
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PDPI Consensus on Diagnosis of Lung Cancer
(Bali, July 2000)
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AnamnesisPemeriksaan FisikPenilaian Tampilan(Karnofsky /ECOG)Hasil Laboratorium
Untuk menentukan Lokasi dan Stage
(TNM)
Untuk menentukan Jenis histologis
Pemeriksaan Tumor Marker
ALUR TINDAKAN UNTUK DIAGNOSIS KANKER PARU
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AnamnesisPemeriksaan FisikPenilaian Tampilan(Karnofsky /ECOG)Hasil Laboratorium
Untuk menentukan Lokasi dan Stage
(TNM)
Untuk menentukan Jenis histologis
Pemeriksaan Tumor Marker
ALUR TINDAKAN UNTUK DIAGNOSIS KANKER PARU
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Pemeriksaan Tumor Marker
Untuk menentukan Lokasi dan Stage
(TNM)
AnamnesisPemeriksaan FisikPenilaian Tampilan(Karnofsky /ECOG)Hasil Laboratorium
Untuk menentukan Jenis histologis
Sitologi SputumSitologi Bilasan/Sikatan Bronkus
Sitologi BJH KGBSitologi TTB, Sitologi Cairan Pleura
Histologi Biopsi Bronkus, Histologi Biopsi KGB, Biopsi Pleura, TLTB, Torakoskopi,
Biopsi Paru Terbuka, Torakotomi Eksplorasi
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Untuk menentukan Jenis histologis
Pemeriksaan Tumor Marker
Untuk menentukan Lokasi dan Stage
(TNM)
AnamnesisPemeriksaan FisikPenilaian Tampilan(Karnofsky /ECOG)Hasil Laboratorium
Catatan: Prosedur diagnostik harus dimulai dari tindakan yang non invasif namun dapat memberikan hasil yang dibutuhkan
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PDPI Consensus on the Treatment of Nonsmall Lung Cancer
KANKER PARU JENIS KARSINOMA BUKAN SEL KECIL (KPKBSK)
cStage TNM < IIB
Stage IIIA
Stage IIIB
Stage IV
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PDPI Consensus on the Treatment of Nonsmall Lung Cancer
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KANKER PARU JENIS KARSINOMA BUKAN SEL KECIL (KPKBSK)
cStage TNM < IIB
Stage IIIA
Stage IIIB
Stage IV
Segmentektomi / Lobektomi
pTNM > IIBpTNM < IIB
PenatalaksanaanSesuai Stagingkemoterapi
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StageIII A
Terapi Neoadjuvan:Kemoterapi 3x, Radiasi 4000 cGy
Restaging
Stage TetapStage Turun
Bedah
Lanjutkan Kemoterapi Radioterapi
KANKER PARU JENIS KARSINOMA BUKAN SEL KECIL (KPKBSK)
Stage IV
Stage IIIB
cStage TNM < IIB
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KANKER PARU JENIS KARSINOMA BUKAN SEL KECIL (KPKBSK)
cStageTNM < IIB
StageIIIA
Stage IVStage
IIIB
PS > 70Ps < 70
Terapi PaliatifKemoterapi PaliatifRadioterapi Paliatif
Best Suportive Care (BSC)
Kemoradioterapi*) bila mungkin
seperti Stage IIIA(kasus khusus)
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KANKER PARU JENIS KARSINOMA BUKAN SEL KECIL (KPKBSK)
cStadium TNM < IIB
Stadium IIIA
Stadium IIIB Stadium
IV
PS < 70PS > 70
Kemoterapi /Kemoradioterapi
Terapi PaliatifBest Supportive Care (BSC)
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PDPI Consensus on the Treatment of Small Cell Lung Cancer
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K P K S K
PENATALAKSANAAN KANKER PARU JENIS KARSINOMA SEL KECIL (KPKSK)
TERBATAS(Limited Disease)
L U A S(Extensive Disease)
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TERBATAS(Limited Disease)
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Kemoterapi Dapat Diberikan *)
Respons Komplit
KPKSK TERBATAS(Limited Disease)
Kemoterapi Tidak Dapat Diberikan
Kemoradioterapi
Prophylactic CranialIrradiation (PCI)
Respons Sebagian
Ganti RejimenKemoterapi
*) Tampilan > 70, sitostatika tidak tersedia
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Kemoterapi Dapat Diberikan
KPKSK TERBATAS(Limited Disease)
Kemoterapi Tidak Dapat Diberikan **)
Terapi Suportif / Best Suportive Care
(BSC)
**) tampilan < 70, sitostatika tidak tersedia
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KPKSK LUAS(Extensive Disease)
Kemoterapi 2x
KemoterapiDapat Diberikan *)
Kemoterapi Tidak Dapat Diberikan
*) Tampilan > 70, sitostatika tidak tersedia
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KPKSK LUAS(Extensive Disease)Kemoterapi
Dapat Diberikan
Kemoterapi 2x
Teruskan KemoterapiSampai 6 x
Respon Tidak Ada
Reevaluasi Hasil PA
Respon Ada
Respon SebagianRespon Komplit
Ganti Rejimen Kemoterapi
Prophylactic CranialIrradiation (PCI)
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KPKSK LUAS(Extensive Disease)
KemoterapiDapat Diberikan
Kemoterapi Tidak Dapat Diberikan **)
Terapi SuportifBest Supportive Care
(BSC)
**) tampilan < 70, sitostatika tidak tersedia
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PDPI Consensus on the Management of Malignant Pleural Effusion
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PENATALAKSANAAN EFUSI PLEURA GANAS
EFUSI PLEURA GANAS (EPG)
Tumor Paru Primer T4 Metastasis dari luar paru
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Tumor Paru Primer T4
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Tumor Paru Primer T4
Jenis (+) TNM (+)
Staging belum ditegakkanPunksi / WSD untukmengurangi keluhan
Cairan Masif / Produktif Cairan Tidak Masif
Punksi / WSDPleurodesis
Penatalaksanaan berdasarkan Jenis, Staging dan PS
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Tumor Paru Primer T4
Jenis (+) TNM (+)
Staging belum ditegakkanPunksi / WSD untukmengurangi keluhan
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Staging belum ditegakkanPunksi / WSD untukmengurangi keluhan
Cairan Masif / Produktif
Pleurodesis Bleomisin Intrapleura 40-60 mg
Teruskan Prosedur Diagnostik
Penatalaksanaan berdasarkan Jenis, Staging dan PS
Tumor Paru Primer T4
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PENATALAKSANAAN EFUSI PLEURA GANAS
EFUSI PLEURA GANAS
T4 pada Tumor paru(Tumor primer di paru)
Metastasis dari luar paru
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Metastasis dari luar paru
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Metastasis dari luar paru
Punksi / WSD Untuk Mengurangi Keluhan
Tumor Primer Diketahui
Penatalaksanaan Sesuai dengan Tumor Primer
Tumor Primer Tidak Diketahui
Punksi Berulang Pleurodesis, Dekortikasi
Pleuro-abdominal ShuntingWindow
Teruskan Prosedur Diagnostik
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PDPI Consensus on Superior Vena Cava Syndrome
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SINDROM VENA KAVA SUPERIOR
PDPI Consensus on Superior Vena Cava Syndrome
Foto Toraks PA / Lateral
Tidak jelasMasa / Tumor yang Menekan
Ada Tumor Paru /Tumor Mediastinum
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Tidak jelasMasa / Tumor yang Menekan
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CT-scan Toraks
Tidak Ada Massadi Mediastinal
Tumor Paru /Tumor Mediastinum
Konsul ke Bagian Terkait
Prosedur DiagnostikUntuk Kanker Paru / Tumor Mediastinum
Tidak jelasMasa / Tumor yang Menekan
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SINDROMA VENA KAVA SUPERIOR
Foto Toraks PA / Lateral
Tidak jelasMasa / Tumor yang Menekan
Ada Tumor Paru /Tumor Mediastinum
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Ada Tumor Paru /Tumor Mediastinum
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Ada Tumor Paru /Tumor Mediastinum
Keadaan Umum BaikKeadaan Umum Buruk
Radiasi1 x 8 Gy
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Keadaan Umum Baik
Ada Tumor Paru /Tumor Mediastinum
Hasil PA (-) Hasil PA (+)
Radiasi 2-3 Gy
Lanjutkan Prosedur Diagnostik
Sesak Hebat Sesak Tidak Hebat
Radiasi:3 Gy 10 x atau4 Gy 5 xLanjutkan TerapiSesuai Hasil PA
Sesuai denganPenatalaksanaan
Tumor Primer
Keadaan Umum Buruk
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PDPI Consensus on Early Detection
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PDPI Consensus on Early DetectionDETEKSI DINI KANKER PARU
(SKRINING)
Golongan Risiko Tinggi (GRT) Tanpa Gejala
GRT dengan gejala batuk kronik, sesak napas
batuk darah, berat badan turuntapi belum ada diagnosis pasti
Bukan GRT dengan gejala batuk kronik, sesak napas
batuk darah, berat badan turuntapi belum ada diagnosis pasti
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Bukan GRT dengan gejala batuk kronik, sesak nafas
batuk darah, berat badan turuntapi belum ada diagnosis pasti
DETEKSI DINI KANKER PARU(SKRINING)
GRT dengan gejala batuk kronik, sesak nafas
batuk darah, berat badan turuntapi belum ada diagnosis pasti
Golongan Risiko Tinggi (GRT) Tanpa Gejala
Foto Toraks setiap 6 bulanCT-Scan Toraks
(Sebaiknya Spiral CT)
Curiga Kanker Paru
Teruskan Prosedur Diagnostik Kanker Paru
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Golongan Resiko Tinggi (GRT) Tanpa Gejala
Bukan GRT dengan gejala batuk kronik, sesak nafas
batuk darah, berat badan turuntapi belum ada diagnosis pasti
DETEKSI DINI KANKER PARU(SKRINING)
GRT dengan gejala batuk kronik, sesak napas
batuk darah, berat badan turuntapi belum ada diagnosis pasti
Foto toraksSitologi sputumBronkoskopi
CT-scan toraks
Curiga kanker paru
Teruskan prosedur diagnostik kanker paru
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Golongan Resiko Tinggi (GRT) Tanpa Gejala
DETEKSI DINI KANKER PARU(SKRINING)
GRT dengan gejala batuk kronik, sesak nafas
batuk darah, berat badan turuntapi belum ada diagnosis pastiBukan GRT dengan gejala
batuk kronik, sesak napasbatuk darah, berat badan turuntapi belum ada diagnosis pasti
* Diagnostik umum & terapi penyakit paru* Prosedur diagnostik kanker paru bila curiga keganasan
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The benefits of team work
• Better diagnosis & staging • Better choice of treatment modalities and their sequences• Better management in difficult cases, more professional support • Collective responsibility
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