Peran Bedah Pada Solid Tumorocw.usu.ac.id/.../elo173_slide_peran_bedah_pada_solid_tumor.pdf ·...
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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
TypeType Tissue originTissue origin
So
lid
SarcomaSarcoma MesenchymalMesenchymal
BlastomaBlastoma EmbryonalEmbryonal
LymphomaLymphoma Lymphoreticular Lymphoreticular
LeucaemiaLeucaemia Blood cellsBlood cells
So
lid
Th
e 1
2 m
ajo
r ca
nce
rsT
he
12
maj
or
can
cers
Causes o
f cancer
Causes o
f cancer
�� 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
Causes o
f cancer
Causes o
f cancer
•• 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
IncidenceIncidence
% ���� Rank ����%
41 Prostate 1 Breast 3113 Lung 2 Lung 13
9 Colon 3 Colon 12
The Netherlands
9 Colon 3 Colon 12
7 Bladder 4 System 6
6 System 5 Uterus 6
3 Mouth 6 Ovary 4
3 Melanoma 7 Bladder 4
2 Stomach 8 Cervix 3
2 Pancreas 9 Melanoma 3
14 Other 10 Mouth 2
MortalityMortality
% ���� Rank ����%
32 Lung 1 Lung 25
14 Prostate 2 Breast 17
9 Colon 3 Colon 10
The Netherlands
9 Colon 3 Colon 10
9 Systemic 4 Systemic 8
5 Bladder 5 Ovary 6
5 Pancreas 6 Pancreas 5
3 Stomach 7 Bladder 3
2 Melanoma 8 Cervix 2
2 Oral 9 Uterus 2
19 Overig 10 Melanoma 1
Pathology
Radiology
Nuclear Medicine
Nurse
Psychology
DieticianDietician
Oral care
Lab physician
Etc
Peran bedahPeran bedah
�� PreventionPrevention
�� DiagnosticDiagnostic
�� TreatmentTreatment
Rehabilitation.Rehabilitation.�� Rehabilitation.Rehabilitation.
Prevention. Prevention.
�� PrimerPrimer
�� SekunderSekunder
�� Tertier. Tertier.
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 ColectomyColectomyFamilial 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�� Insisi biopsiInsisi biopsi
�� Eksisi biopsiEksisi biopsi
Strategy in OncologyStrategy in Oncology
Clinical diagnosisClinical diagnosis
Microscopic diagnosis and stagingMicroscopic diagnosis and stagingMicroscopic diagnosis and stagingMicroscopic diagnosis and staging
Treatment planningTreatment planning( curative or palliative )( curative or palliative )
Diagnosis and stage first !Diagnosis and stage first !
PhysicalPhysical
ExaminationExamination
Biopsy setBiopsy set
Tumor
Node
Metastasis
cTNM = clinical stage
pTNM = pathological stage
Staging Gastric CancerStaging Gastric Cancer
Treatment modalitiesTreatment modalities
locoregional treatmentlocoregional treatment
surgerysurgery
radiotherapyradiotherapy
systemic treatmentsystemic treatmentsystemic 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
TherapyTherapy
�� Curative Curative
�� PalliativePalliative
TreatmentTreatment
-- definitive surgicaldefinitive surgical
- reduce the bulk of residual disease
- resection of metastatic disease with curative- resection of metastatic disease with curative
- onkologic emergecies
- palliation
- reconstruction and rehabilitation
Rehabilitation Rehabilitation
�� RekontruksiRekontruksi
�� Protesa Protesa
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 metsCRC with liver mets
SummarySummaryCancer 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
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 Every cancer should be TNM staged Every cancer should be TNM staged
Early detection is more effective than intensive treatmentEarly detection is more effective than intensive treatment