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ONCOLOGY

UNIVERSITAS PALANGKA RAYA


Jumat 1 Januari 2016

ONCOLOGY

ONCOS = TUMOR
LOGOS = SCIENCE
TUMOR ABNORMAL
LUMP/BULKY/SWELLING
CERTAIN TERMINOLOGY:
TUMOR = NEOPLASMA
NEOPLASMA EXESSIVE AND
UNCONTROLE CELL GROWING

BENIGN
SARCOMA

NEOPLASM

MALIGNANT
CARCINOMA
TUMOR
CYST

NON NEOPLASM

INFLAMATION

HYPERTROPHY

BENIGN NEOPLASM

Consist of normal cells


No infiltration to adjacent tissue
Obvious/define border
Capsulated
No metastasis

MALIGNANT NEOPLASMA
(CANCER)

Consist of cells that have changed from


the origin cells, event entirely different
and can not distinguish the origin
(undifferentiated)
Uncontrolled and overgrowth
Uncapsulated
Adjacent tissues infiltration and far
metastasis
Cause mortality

CANCER PATHOGENESIS
1. STAGE INDUCTION
A. INITIATION
B. PROMOTION
C. PROGESSION
2 STAGE IN SITU CARSINOMA
3. STAGE INVASIVE CARSINOMA

1.

STAGE INDUCTION
A. INISIATION
- INISIATOR CARCINOGEN STIMULATE
CELL MUTATION
- INITIATED CELLS UNDERWENT
MULTIPLE MUTATION
- IRREVERSIBLE
- INITIATED CELLS IS NOT CANCER CELL
YET

B. PROMOTION
PROMOTOR
CARCINOGEN
STIMULATE
PROLIFERATION OF INITIATED
CELL
- PROMOTOR CARCINOGEN
COULD BE SAME OR
DIFFERENT WITH
INITIATOR
CARCINOGEN
- NEED YEARS BEFORE
BECOME
CANCER CELL
- REVERSIBLE

C. PROGRESSION
- CELLS BECOME
MALIGNANT
CELLS

2. STAGE CANCER IN SITU


- CELLS UNDERWENT
TRANSFORMATION
- CELLS HAVE MALIGNANT
MORPHOLOGY ANG BIOLOGIC
CHARACTERISTICS
- LIMITED AND LOCALIZED , NO
INFILTRATION, NOT
INVASIVENESS

3. STAGE CANCER
INVASIVE
- SIGNS AND SYMPTOMPS
APPEARANCES
- PATIENTS KNEW THE
TUMOR IN THEIR BODY

Etiology :

Certain etiology is unknown.


However there are many risk factor
(multifactorial)
1.

Chemical carcinogen

Carbon Ca scrotal carcinoma


Ter skin cancer
Aromatic amine (zat warna) Bladder
ca
Benzene leukemia
Tobacco Lung cancer
Sirih Lips cancer

Etiology(contd )
2. Physic :

Radiation Ca skin, thyroid, leukemia

Ultra Violet Ca skin


3. Virus :

Ebstein Barr Virus Burkittt lymphoma,


Nasopharyngeal Ca

Hepatitis B Hepatoma
4. Medication :

Hormon Ca mamma, Ca Ovarium

Melphalan, Cyclophosphamide Ca
bladder,
Leukemia

Dilantin Lymphoma maligna

ANOTHERS FACTOR THAT


INFLUENCES:

Hereditary Factor ( Ca Mammae, Ca Colon


familial poliposis, Retinoblastoma)
Geographic Factor (Ca Liver in Africa, Ca
Gaster in Japan, Ca Nasopharing in China)
Behaviour Factor ( have many children Ca
Cervix, no lactation Ca Mamma, no
circumcision Ca Penis, high fat diet Ca
Mamma)
Sosioeconomic Factor ( Ca Gaster, Ca Cervix
low social-economic; Ca Mamma, Leukemia
and Multiple Myeloma high social-economic)

Neoplasm Growth

Neoplasm cells continuously proliferated


achieve certain volume
Time that need to become twice volume
Doubling Time
Each neoplasm have different doubling
time weeks up to years
To become volume 1 cm3 spent 30X
doubling time ( if 1X doubling time 100
days, so 30X doubling time need 8 years)

CANCER SPREADING

PER-CONTINUITATUM (INFILTRATIIVE)
cancer cells free from primary tumor, moving
amoeboid enter and invade adjacent tissue
satellite nodule, infiltration and fixed to surround
tissue

LYMPHOGEN
cancer cells invade lymph vessel growing in
the lymph vessel (transit metastases) growing
in the regional lymph node (regional metastases)

HEMATOGEN
cancer cells invade blood vessel
enter blood stream, growing in
the far organs

TRANSLUMINAL
cancer cells grow intraluminar
organs spreading and follow
feces and urine growing in the
distal site of the lumen

CANCER SPREADING (CONTD)

TRANS SEROSAL
CANCER CELLS INVADE SEROSAL SITE
FREE FROM PRIMARY TUMOR
SPREADING AND GROWING IN THE
OTHER SEROSALS

IATROGENIC
MANIPULATION PRIMARY TUMOR
CANCER CELLS FREE AND SPREADING
CONTAMINATE SURGERY FIELDS
AND SPREAD TO OTHER SITES

Factors that influence cancer


growing:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Origin and type tumor


Behavior tumor
Differentiation grading
Tumor size
Ager
Immunology status
Organ sites tumor growing
Nutrition
Hormonal status

Early Detection
How to know earlier tumor
signs before the tumor growing
and spreading to far advanced,
faraway from primary tumor
Very important we have
chance to cure early stage
cancer decrease morbidity
and mortality

7 SIGN OF SUSPICIOUS
CANCER
1.
2.
3.
4.

5.
6.
7.

C = Change in bowel or bladder habit


A = A sore that does not heal
U = Anusal bleeding or discharge
T = Thickening or lump in the breast or
elsewhere
I = Indigestion of difficulty in swallowing
O = Obvious change in wart or mole
N = Nagging cough or hoarseness
American Cancer Society

Signs of Malignant

Suspicious
:
Perdarahan atau keluarnya
lendir tidak wajar

Alat pencernaan yang terganggu


Tumor pada payudara/ tempat lain
Obstipasi atau perubahan kebiasaan BAK&
BAB

Koreng atau borok yang tidak sembuh-sembuh


Andeng-andeng yang makin besar, mudah
berdarah , tambah hitam

Nada suara serak, batuk tidak sembuh-sembuh


Yayasan kanker Wisnuwardhana Surabaya 1969

7 SIGN OF SUSPICIOUS
CANCER
1.

2.

3.
4.
5.

6.
7.

Waktu buang air besar atau kecil ada perubahan


kebiasaan atau gangguan
Alat pencernaan terganggu atau kesukaran
menelan
Suara serak atau batuk yang tidak sembuh
Payudara atau tempat lain ada benjolan
Andeng-andeng yang berubah sifatnya, menjadi
makin besar dan gatal
Darah dan lendir yang abnormal keluar dari tubuh
Adanya koreng atau borok yang tidak mau sembuh
YKI 1977

Early Detection:
1.
2.
3.

4.
5.
6.

Self examination
Physical examination by doctor
Sitology examination ( PAP smear,
secret bronchus, urine and other
bodies liquid)
Endoscopy
USG (ultrasonography)
Mammography

DIAGNOSIS
1.
2.
3.
4.

5.

Anamnesis
Physical examination
Laboratory
Imaging (USG, Endoscopy,
Radioisotope, CT- scan, MRI)
HystopathologyDefinitive
diagnosis

Pathology Evaluation:

INCISIONAL

BIOPSY

EXCISIONAL

Take out small part of


tumor

to cut pathology tissue


with normal tissue surrounded

Fine Needle Aspiration Biopsy


FNAB

STAGING/STADIUM
Cancer diagnosis must be follow by
staging TNM
show growing and spreading the
UICC : Union Internationale Contre
tumor
Cancer
International Standard Stadium
TNM system :
1. To plan the treatment
2. To know the prognosis
3. To evaluate treatment outcome
4. To make uniform definition staging

STAGING/STADIUM
Cancer diagnosis must be follow by staging
TNM show growing and spreading the
tumor
UICC : Union Internationale Contre Cancer
International Standard Stadium
TNM system :
1. To plan the treatment
2. To know the prognosis
3. To evaluate treatment outcome
4. To make uniform definition staging

CLASSIFICATION TNM
T Tumor size
N lymph Node metastasis
M far Metastasis

Example:
TNM system for Breast Cancer

T To : no evidence of primary tumor

T1 : diameter < 2 cm
T2 : diameter 2 - 5 cm
T3 : diameter > 5 cm
T4 : thoracic wall, skin, wall & skin, mastitis
carcinomatosa

N No : no regional lymph node metastasis


single

N1: to movable ipsi lateral lymph node metastasis,

N2: ipsi lateral lymph node metastasis fixed to


another to other
structure
N3 :axilla and infraclavicular or supraclavicular
lymph node
metastasis

Mo : no distant metastasis
M1 : distant metastasis

Stadium :

I T1NoMo
II T0N1M0,
T1N1M0,
T2NoMo,
T2N1M0
III T0N2M0,
T1-2N2M0,
T3N1M0,
T4NxMo
IV anyT anyN M1

Prognosis
1.
2.
3.
4.
5.
6.

Origin
Type
Grading
Staging
Immunology
Treatment adequacy
Prognosis: 5-year/10-year survival rate
example: Ca Mamma std III 5-ysr 30%,
10-ysr 17%

THERAPY
1.

SURGERY:
DEFINITIVE TREATMENT FOR
EARLY STAGING SOLID CANCER
(loco regional)
Decrease tumor mass (debulking)
Solitary localized metastases
Emergency purpose
Palliative treatment
Reconstruction

TERAPI
(cont)

2. RADIOTERAPHY
ADJUVANT, NEOADJUVANT
PALIATIVE
PRIMARY TREATMENT

3. CHEMOTERAPHY
- ADJUVANT, NEOADJUVANT
- PALIATIVE
- PRIMARY TREATMENT
4. HORMONAL TERAPHY
5. IMMUNOTERAPHY
6. TARGETED THERAPHY