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ONKOLOGI
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Incidence of primary Cancer in IndonesiaPathology Base 1990
Rank organ % N
1
2
3
4
5
6
7
89
10
11
Uterine Cervix
Breast
Skin
Nasopharynx
Ovary
Lymphatic gland
Rectum
UnknownThyroid
Soft tissue
Colon
19,18
11,52
8,64
6,23
4,95
4,74
4,62
4,413,26
2,75
2,72
3.817
2.293
1.719
1.240
985
944
920
878649
548
542
Total General 100,00 19.898
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Malignancy in the Head & Neck
Dept. OtorhinoLaryngology University of Indonesia
Site of
Malignancy
Number of case%
1980-1984
Number of case %
1988-1992
1. Nasopharynx
2. Sinonasal
3. Larynx
4. Oral cavity
5. Oropharynx6. Neck & Others
7. Ear
8. Oesophagus
9. Parotid gland
57,59
13,87
12,83
4,72
4,722,09
1.83
1,83
0,52
71,77
10,11
9,97
1,40
1,691,12
2,11
1,54
0,28
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Prevalence/ Incidence
Southern part of China : 30-50 case/100.000 population Indonesia (Native) : 4,7 Malaysia Malay : 1,1 Malaysia Chinese : 40,1 / 14,9 Singaporean Cantonese : 18,2 / 7,5 Singaporean Hokkien : 12,3 / 3,7
Singaporean Malay : 4,3 / 1,5 Thailand(Chiang mai) : 4,1 / 1,6 Hong Kong : 28,5 / 11,2
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Etiologi
UtamaVirus Epstein-barr
Faktor lain
Rasmongoloid
Cina,Hongkong,Vietnam,Taiwan,Thailand,Malaysia,SPore,Indonesia
Genetik
Dietmakanan yg diawetkan
Eskimofrek.tinggi
Ikan AsinHongkong,Cina selatan
dll.Sex,sosial-budaya,higiene,infeksi
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Genetik was detected by HLAdifferent part among :
Chinese : A2-CW11-BW46-DR9AW33-C3-BW58-DR3
Malaysian : A2&A9-B17&18-BW35 Indonesia :A2-A11-B18-BW6-CW(-)
A11-A24-B13-B35-BW4,BW6,CW(-)
Others country in Asia
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Gejala KNF
Gejala dinigejala Telinga
gejala Hidung Gejala Lanjutgejala leher
gejala paresis saraf
kranial
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Gejala mata (KNF)
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Knfmetastasis ke kgb leher (N)
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Gejala dini knf
Gejala Telingatinnitus, rasa penuh,OME
tuli konduktif unilateral
Gejala hidungtersumbat,epistaksis
riak berdarah
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Gejala Lanjut knf
Leherpembesaran kgb leher
Paresis saraf kranialdiplopia,ptosis,baal di wajah
Gejala metastasis jauhnyeri di tl.belakang,batuk
darah
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Deteksi dini&Anjuran pemeriksaan
CT Scanhrs utk tumorkepala &leher
Tumor marker/serologiIgA EBV anti VCAIgA EBV anti EA
IgG EBV anti EA
dpt di Labcheck up/mass screening
Biopsidokter THT
Akurat : Endoskopi
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Level Kgb Leher
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Serology EBV
Serology Jakarta
Singapore
Hongkong
IgA antiVCA
Sensitivity 73,33
95,00%
80-90% 93,00%
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Histopathology
Type
(WHO)
Jakarta
%
Malaysia
%
Hong kong
%
I
2
3
12,25
5,22
82,53
35
15
50
2,7
6,9
90,4
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Treatment
Radiasi Kemoradiasi(sensitisizer)
Ajuvan/neoajuvan kemoterapi Pembedahan
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Prognosis(li et al in Guang Zhou,1983/radiotherapy alone)
5 years survival rate
Stage I : 79,6%
Stage II : 56,0%
Stage III : 38,4%
Stage IV : 16,4%
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Pencegahan
Vaksinasi(vaksin virus EBV) Screening massserologis,nasofaringoskopi Migrasi penduduk
Peningkatan status sosial ekonomi Pendidikan kes.masyarakat Kampanye melalui media massa
Peningkatan higiene Perlindungan pekerjaan obat2an
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Karsinoma Sinonasal
Epidemiologi
Terbanyak ke 2 dr seluruh keganasan THT(10%) 1% dr keganasan seluruh tubuh Tertinggi di Jepang2/100.000 pddk/thn
:= 2 : 1 Tersering pada usia > 40thn
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Karsinoma SinonasalEtiologi
Belum diketahui Diduga akibat iritasi bahan Industri/kimia
Nikel, debu/serbuk kayu,kulit,formalinKromium, terpentin dsb.
Patut dicurigaiinfeksi kronis/berulang
di sinonasal.
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Gejala keganasan di Sinonasal (1)
Gejala Hidung-Obstruksi & Rinore campurdarah (spt
Epistaksis)-Ingus berbau krn terdapatJaringan nekrotik
Gejala Mata-Diplopia
-Proptosis-Optalmoplegia-Epifora-Gangguan Visus
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Gejala Keganasan Sinonasal
Gejala Rongga mulutpenonjolan Palatum
durum
gigi goyahgigi palsu tak pas lagi
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Gejala Karsinoma Sinonasal (2)
Gejala Wajah-deformitas pipi/ hidung
/gigi akibat
desakan/infitrasi tumor. Gejala Intrakranial
-sakit kepala hebat
-gangguan visus
-kebocoran Likuor
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Pemeriksaan keganasan Sinonasal
Tampak massa tumor dirongga hidung
CT Scan
perluasantumor
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Diteksi dini keganasan Sinonasal
Sulit dilakukan Diketahui stlh tumor meluas deformitas wajah D/ dinibiopsirinitis/sinusitis Operasi Sinusitispem. PA
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Treatment
Surgery Radiotherapy Combination of its Chemotherapy : - Adjuvant
- In distant metastasisNot suitable for surgery :
Old age
Poor general condition
Refusal
Massive local disease
Involvement of skull base
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Surgery
Maksilektomi :-Partial- Total/radikal dgn/tanpa
eksentrasi orbita
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Tumor ganas Laring
Di Sub.dept.Onkologi THTNomor 3 Di Amerika & EropaKeganasan No.1
Data WHO
35 Negara : 1,2/100.000/tahunEtiologi ?
Perokok & Alkoholik
- Risiko tinggi
- : = 11 : 1
- Usia > 60 thn.
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Laryngeal Cancer
Mostly- Squamous Cell Carcinoma
- 10% of Head & Neck Cancer
(Indonesia)
- 1% of all cancer in Men (Western country)
- Men : Women = 5 : 1
- over 7 th decade
Predisposing factorsSmoking & Alcohol
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Incidence Cancer of Larynx
per 100.000 Population/year
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Laryngeal Cancer
(primary tumor)
Suplraglottic Gottic
Subglottic
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Gejala dini karsinoma Laring
Suara serak terutama Glotiktergantung lokasi awal Tumor primer(T),
dpt merpk gejala lanjut.
Sesak nafas (Sub dan Supraglotik) Rasa tak nyaman(disfagia)/Nyeri(odinofagi)/
gangguan proses menelan.
Gejala lanjutbatuk2,sesak,stridor,hemoptisis.
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Pemeriksaan Karsinoma Laring
CT Scan Endoskopi/Laringoskopi
langsung
-menilai tumor primer :Lokasi & perluasan
-ada/tidaknya paresis pitasuara
-melalui monitor(pasien dptmelihat sendiri)
-Biopsi laring
Mikroskop(microlaryngoscopy)
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Treatment
(laryngeal cancer)
1. Currative - surgery- Radiotherapy
- or combination two modalitiesGlottic tumor T1 & T2 : Radiotherapy
Small one vocal cord : Cordectomy
T3 : Radiotherapy + surgery
T4 dgn N : Total Laryngectomy + RND
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Laryngectomy
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Juvenile Angiofibroma Nasopharynx
Histologically benign-Fibrous tissue
-vascular tissue Unknown etiology Postero-lateral of nasal cavity or superolateral
of nasopharynx wall. Male, young adult.Hormonal dependent
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Angifibroma
Symptoms : -severe epistaxis-progressive nasal obstruction
Signs : smooth reddish or bluiesh mass in thenasopharynx.
Investigation:- Should not as a rule be biopsied- CT Scandefine the extent of
tumor - MRIinvestigation of choice
to define extent &
vascularity - Angiographyfeeding
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Juvenile Angiofibroma Nasopharynx
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Angiofibroma
Treatment :-SurgeryTh/ of choice-Poorly radioth/changes tomalignancy.
-Embolization of feeding artery
1-2 days pre operatively-Hormonal Th/
Surgical Approach : - Transpalatal
- Lateral Rhinotomy- Midfacial degloving-craniofacial approach, if cribriform plate
involved.
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Oral cavity cancer
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Oral cavity cancer
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Keganasan Lidah (oral tongue cancer)
Sariawan yg tak sembuh Painless, kecuali bila sudah infiltrasi ke otot lidah Std.diniberupa Leukoplakia, Eritroplakia.
Paling sering KSS >50%metastasis ke Kgb dalam std awal.
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Oral tongue cancer
(worldwide incidence)
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Oral tongue cancer
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Keganasan di Telinga & kel.Parotis
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