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