REFERAT

WASPADA DIARE KRONIK DENGAN

CURIGA KEGANASAN USUS BESAR
Disusun Oleh :
Vicky (406148030)

Pembimbing
dr. Andi Pohan, Sp. B

KEPANITERAAN ILMU BEDAH

RUMAH SAKIT PELABUHAN JAKARTA
PERIODE 18 JULI 2016 24 SEPTEMBER 2016
FAKULTAS KEDOKTERAN UNIVERSITAS
TARUMANAGARA

COLORECTAL CARCINOMA -

INCIDENCE

is the most common malignancy of the

gastrointestinal tract.
Over 140,000 new cases are diagnosed
annually in the United States,
and more than 50,000 patients die of this
disease each year, making colorectal
cancer the third most lethal cancer in the
United States.

RISK FACTORS

Aging > 50

th

Hereditary
contribute
20% of cases

chronic
inflammation

Other Risk
Factors.

Environment
al & Dietary
factors

EPIDEMIOLOGI

CLINICAL
PRESENTATION
The classic first
symptoms :

In advanced disease :

patients may be
asymptomatic and
present with
unexplained anemia,
weight loss, or poor
appetite.

change in bowel habits

and rectal bleeding.

Abdominal pain,
bloating,
and other signs of obstruction
left-sided tumors are more likely to cause obstruction
Rectal tumors may cause bleeding, tenesmus, and pain.

PATHOGENESIS OF
COLORECTAL CANCER

GENETIC PATHWAYS.

POLYPS

Familial juvenile polyposis

Unlike solitary juvenile polyps, these lesions may
degenerate into adenomas and eventually carcinoma.
Peutz-Jeghers syndrome
is characterized by polyposis of the small intestine and,
to a lesser extent, polyposis of the colon and rectum.
Characteristic melanin spots are often noted on the
buccal mucosa and lips of these patients.
considered to be hamartomas and are not thought to
be at significant risk for malignant degeneration.
surgery is reserved for symptoms such as obstruction
or bleeding or for patients in whom polyps develop
adenomatous features

Cronkite-Canada syndrome
is a disorder in which patients develop
gastrointestinal polyposis in association with
alopecia, cutaneous pigmentation, and atrophy of
the fingernails and toenails.
Diarrhea is a prominent symptom, and vomiting,
malabsorption, and protein-losing enteropathy may
occur.
Most patients die of this disease despite maximal
medical therapy, and surgery is reserved for
complications of polyposis such as obstruction.

INFLAMMATORY
POLYPS
(PSEUDOPOLYPS).

These lesions are not premalignant, but they cannot be distinguished from

FAMILIAL
This rare autosomal dominant
The genetic abnormality in FAP is a
condition accounts for only about ADENOMATOUS
1% mutation in the APC gene, located
of all colorectal adenocarcinomas.
on chromosome 5q
POLYPOSIS.

The lifetime risk of colorectal cancer in FAP patients approaches 100% by age

total proctocolectomy with an end (Brooke)

ileostomy;

total abdominal colectomy with ileorectal

anastomosis

restorative proctocolectomy with ileal

pouchanal anastomosis with or without
a temporary ileostomy.

Attenuated Familial Adenomatous Polyposis.

AFAP is a recognized variant of FAP.
Patients present later in life with fewer polyps (usually
10100) predominantly located in the right colon, when
compared to classic FAP.
Hereditary Nonpolyposis Colon Cancer (Lynchs
Syndrome).
HNPCC is inherited in an autosomal dominant pattern
and is characterized by the development of colorectal
carcinoma at an early age (average age, 4045 years).
Familial Colorectal Cancer.
accounts for 10% to 15% of patients with colorectal
cancer. The lifetime risk of developing colorectal cancer
increases with a family history of the disease.

DIAGNOSIS BANDING
Kolon

Kolon

Kolon Kiri

Rektum

Kanan

Tengah

Abses appendiks

Tukak peptik

Kolitis ulserosa

Polip

Massa appendiks

Karsinoma

Polip

Proktitis

Ca Appendiks

lambung
Abss hati

Divertikulitis

Fisura anus

Endometriosis

hemoroid
Karsinoma anus

Entritis regionalis

Karsinoma hati
Kolesistitis
Kelainan pankreas
Kelainan saluran
empedu

STAGING CLASSIFICATION

METASTASE

ANATOMY

PRINCIPLES OF
RESECTION
The objective in treatment of carcinoma of
the colon is to remove the primary tumor
along with its lymphovascular supply.
Because the lymphatics of the colon
accompany the main arterial supply, the
length of bowel resected depends on
which vessels are supplying the segment
involved with the cancer.

 Komplikasi :

Kebocoran anastomosis
Infeksi luka
Peritonitis
sepsis
Perdarahan

 MORTALITAS SAAT OPERASI

Angka kematian pada operasi kanker kolorektal berkisar
3,9% - 8,1 %.

PERAWATAN PASCA BEDAH

Pertahankan gastrik tube 1-3 hari
Diet peroral diberikan segera setelah saluran pencernaan
berfungsi, dimulai dengan diet cair dan bertahap
diberikan makanan lunak dan padat
Mobilisasi sedini mungkin

KEMOPREVENSI
Obat Anti Inflamasi Non-Steroid (OAIN)

termasuk aspirin dianggap berhubungan

dengan penurunan mortalitas kanker kolon.

Familial Adenomatous Polyposis (FAP) :

sulindac & celecoxib me insidens
berulang.
Kanker kolon sporadik : masih lemah (data
epidemiologi).

 FOLLOW UP
Untuk kasus karsinoma kolon:
Pemeriksaan fisik termasuk colok dubur setiap 3 bulan
dalam 2 tahun pertama, setiap 6 bulan dalam 5 tahun
berikutnya.
Pemeriksaan kadar CEA (Carcinoembryonig Antigen)
setiap 3 bulan untuk 2 tahun pertama dan setiap 6 bulan
untuk 5 tahun berikutnya.
Kolonoskopi 1 tahun pasca operasi, diulang 1 tahun
berikutnya bila ditemukan abnomalitas atau 3 tahun
berikutnya bila ditemukan normal.
Pemeriksaan lainnya seperti CT scan, pemeriksaan fungsi
liver dan Bone scan dilakukan bila ada indikasi.
Pemeriksaan Ro. Thoraks setiap tahun.

DAFTAR
PUSTAKA
Jong, Wim de & R. Syamsuhidajat : Buku Ajar Ilmu Bedah

ed. 3. Jakarta : EGC, 2005. 35:658-663.

Abdullah, Murdani. 2006. Tumor Kolorektal dalam Buku
Ajar Ilmu Penyakit Dalam edisi VI jilid III. FKUI : Jakarta hal:
3023-3031
Fleshman, James W : Schwartzs Principles of Surgery ed.
7th. New York : Mc. Graw-Hill, 1999. 26:1373-1374.
Mayer, Robert J : Harrisons Principles Of Internal Medicine
ed.15th. New York : Mc. Graw-Hill, 2001. 90:581-586.
Jones & Schofield. 1996. Neoplasia Kolorektal dalam
Petunjuk Penting Penyakit Kolorektal. EGC : Jakarta hal :5865
Roediger, WEW. 1994. Cancer of the Colon, Rectum and
Anus in Manual of Clinical Oncology Sixth edition. UICC :
Germany p:336-347