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7/22/2019 Kapita Selekta Onkologi THT

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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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