gis-k15 tumor lambung pptocw.usu.ac.id/.../gis_20102011_slide_tumor_lambung.pdf · microsoft...
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DR. MABEL HM SIHOMBING, SPPD-KGEHDR.ILHAMD SPPD
DIVISION OF GASTROENTERO-HEPATOLOGY DEPARTEMENT OF INTERNAL MEDICINE FACULTY OF
MEDICINE / NORTH OF SUMATERA H. ADAM MALIK HOSPITAL
TUMOR LAMBUNGTUMOR LAMBUNGTUMOR LAMBUNGTUMOR LAMBUNG
TUMOR LAMBUNG
EPIDEMIOLOGY
INSIDENSI :
JAPAN :100/100000USA : 6 /100000
TYPE :
ADENO CARCINOMAGASTRIC LYMPHOMALEIOMYOSARCOMASCARCINOID TUMORS
SYMPTOM :
NOT SPECIFIC & FREQUENT VAGUE(EPIGASTRIC PAIN, HEARTBURN, ULCER PAIN, BB↓↓↓↓,MUAL, ANEMIA, HEMATEMESIS)
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RISK FACTORS FOR GASTRIC ADENOCARCINOMA
DEFENITE/SURVEILLANCE SUGGESTED
FAMILIAL ADENOMATOUS POLIPOSIS (FAP),GASTRIC ADENOMA DYSPLASIA
DEFENITE
HP INFECTION, CHRONIC ATROPHIC GASTRITIS,INTESTINAL METAPLASIA,HERED. NONPOLYPOSIS COLORECTAL CANCER (HNPCC)POSTGASTRECTOMY,FIRST-DEGREE RELATIVE WITH GASTRIC CANCER
PROBABLE
PEUTZ-JEGHERS SYNDROME, CIGARETTE SMOKING,LOW ASPIRIN INTAKE, HIGH SALT INTAKE,LOW INTAKE OF FRESH FRUITS AND VEGETABLES,PERNICIOUS ANEMIA, LOW ASCORBATE INTAKE
POSSIBLE
LOW SOCIOECONOMIC STATUSMENETRIER’S DISEASE, GASTRIC ULCER
QUESTIONABLE
HIGH INTAKE OF ALCOHOL HYPERPLASTIC/FUNDIC POLYPS
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HELICOBACTER PYLORI CARCINOGENIC NO. 1
PROPOSED MULTISTEP PATHWAY IN THE PATHOGENESIS OF GASTRIC CANCER
NORMAL
CHRONIC ACTIVE GASTRITIS
ATROPHIC GASTRITIS
INTESTINAL METAPLASIA
LOW – GRADE DYSPLASIA
HIGH - GRADE DYSPLASIA
GASTRIC CANCER
APC / ββββ = CATENIN
P53 MICROSATELLITE INSTABILITY
H PYLORI
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H. Pylori
AcquisitionAutoimmunity Normal Stomach
DGCA
Multifactorial
Cronic gastritisNaCl
Atropic gastritis Intestinal Metaplasia45 %
IGCA
Bacterial over growth/Inflammation
N-Nitroso-Compouns
Vitamin intake (c, carotene)
10 %
45 %
Dugaan : Pathogenesis of Gastric Carcinoma
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INVESTIGATION :
���� HISTORY
���� PHYSICAL EXAMINATION
���� BARIUM MEAL
DOUBLE CONTRAST
���� ENDOSCOPY����BIOPSY CONFIMATIVE
DIAGNOSTIC
���� SCANNING
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TREATMENT
���� CURATIVE (OPERATIVE) :
SUBTOTAL GASTRECTOMY
MORTALITAS ↓↓↓↓ & MORBIDITAS ↓↓↓↓
���� PALLIATIVE (OPERATIVE) :
SUBTOTAL GASTRECTOMY
BLEEDING ↓↓↓↓ & OBSTRUCTION ↓↓↓↓& QOL ↑↑↑↑ (QUALITY OF LIFE )
���� CHEMOTHERAPY :
PENGOBATANPENGOBATANPENGOBATANPENGOBATAN ::::
# DINI : MUNGKIN MASIH DAPAT DILAKUKAN MUCOSAL
RESECTION (EMR)
# BEDAH : - CURATIVE
- PALLIATIVE : - TANDA OBSTRUKSI
- TANDA PERDARAHAN
# KEMOTERAPI
# RADIASI
Prognosis :Prognosis :Prognosis :Prognosis :
Sangat ditentukan oleh :
1. Derajat invasi dinding lambung
2. Adanya penyebaran ke kelenjar lymph
3. Anak sebar di peritoneum dan tempat lain
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COMPLICATION POST OPERATIVE (SUBTOTAL GASTRECTOMY)
1. MEGALOBLASTIC ANEMIA ←←←← SUPP. VIT B 12
2. DUMPING SYNDROME : NAUSEA, VOMITING
ABD. FULLNESS, TACHYCARDIA,WEAKNESS, DIZZINESS
SMALL MEAL & LOW CHO
3. BUND LOOP SYNDROME
REFRACTORY DIARRHEA ←←←← BACTERIAL
OVER GROWTH ←←←← MALABSORBTION
ANTIBIOTICS
INTRA OPERATIVE STAGING
TUMOR 5 YEARS SURVIVAL
STAGE I MUCOSA-SUBMUCOSA 85 %
STAGE II PENETRASI���� SEROSA 45 – 55 %
STAGE III REGIONAL LYMPHNODE (+)
17 %
STAGE IV DISTAN METASTASIS < 5 %