ONCOLOGYONCOLOGYUNIVERSITAS PALANGKA RAYA

Sabtu 22 April 2023

ONCOLOGYONCOLOGY ONCOS = TUMORONCOS = TUMOR LOGOS = SCIENCELOGOS = SCIENCE TUMOR TUMOR ABNORMAL ABNORMAL

LUMP/BULKY/SWELLINGLUMP/BULKY/SWELLING CERTAIN TERMINOLOGY: CERTAIN TERMINOLOGY: TUMOR = NEOPLASMATUMOR = NEOPLASMA NEOPLASMA NEOPLASMA EXESSIVE AND EXESSIVE AND

UNCONTROLE CELL GROWINGUNCONTROLE CELL GROWING

TUMOR

NEOPLASM

NON NEOPLASM

BENIGN

MALIGNANT

SARCOMA

CARCINOMA

CYST

INFLAMATION

HYPERTROPHY

BENIGN NEOPLASMBENIGN NEOPLASM Consist of normal cellsConsist of normal cells No infiltration to adjacent tissueNo infiltration to adjacent tissue ObviousObvious/define/define border border CapsulatedCapsulated No metastasisNo metastasis

MALIGNANT NEOPLASMA MALIGNANT NEOPLASMA (CANCER)(CANCER) Consist of cells that have changed from Consist of cells that have changed from

the origin cells, event entirely different the origin cells, event entirely different and can not distinguish the origin and can not distinguish the origin (undifferentiated)(undifferentiated)

Uncontrolled and overgrowthUncontrolled and overgrowth UncapsulatedUncapsulated Adjacent tissues infiltration and far Adjacent tissues infiltration and far

metastasismetastasis Cause mortalityCause mortality

CANCER CANCER PATHOGENESIS PATHOGENESIS 1. STAGE INDUCTION1. STAGE INDUCTION

A. INITIATIONA. INITIATIONB. PROMOTIONB. PROMOTIONC. PROGESSIONC. PROGESSION

2 2 STAGE IN SITU CARSINOMA STAGE IN SITU CARSINOMA 3.3. STAGE INVASIVE CARSINOMASTAGE INVASIVE CARSINOMA

1.1. STAGESTAGE INDU INDUCCTITIONON

A. INISIAA. INISIATIONTION - INISIATOR CARCINOGEN STIMULATE- INISIATOR CARCINOGEN STIMULATE CELL MUTATIONCELL MUTATION - INITIATED CELLS UNDERWENT - INITIATED CELLS UNDERWENT MULTIPLE MUTATIONMULTIPLE MUTATION - IRREVERSIBLE- IRREVERSIBLE - INITIATED CELLS IS NOT CANCER CELL - INITIATED CELLS IS NOT CANCER CELL YET YET

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

C. PROGRESSC. PROGRESSIONION

- CELLS BECOME - CELLS BECOME MALIGNANT MALIGNANT CELLS CELLS

2. 2. STAGESTAGE CCANCER IN SITUANCER IN SITU

- CELLS UNDERWENT - CELLS UNDERWENT TRANSFORMATIONTRANSFORMATION- CELLS HAVE MALIGNANT - CELLS HAVE MALIGNANT MORPHOLOGY ANG BIOLOGIC MORPHOLOGY ANG BIOLOGIC CHARACTERISTICSCHARACTERISTICS- LIMITED AND LOCALIZED , NO - LIMITED AND LOCALIZED , NO INFILTRATION, NOT INFILTRATION, NOT INVASIVENESSINVASIVENESS

3. 3. STAGESTAGE CCANANCCER ER INVASIINVASIVEVE- SIGNS AND SYMPTOMPS - SIGNS AND SYMPTOMPS APPEARANCESAPPEARANCES- PATIENTS KNEW THE - PATIENTS KNEW THE TUMOR IN TUMOR IN THEIR BODYTHEIR BODY

Etiology :Etiology :Certain etiology is unknown. Certain etiology is unknown. However there are many risk factor However there are many risk factor (multifactorial)(multifactorial)1.1. Chemical carcinogenChemical carcinogen CarbonCarbon Ca s Ca sccrotrotal carcinomaal carcinoma Ter Ter skin cancerskin cancer Aromatic amine (zat warna)Aromatic amine (zat warna) Bladder Bladder

caca Benzene Benzene leuk leukeemiamia TTobaccoobacco Lung cancerLung cancer Sirih Sirih Lips cancerLips cancer

EtiologEtiologyy(…(…cont’dcont’d ) )2. Physic :2. Physic : RadiaRadiationtion Ca Ca skinskin, thyroid, leuk, thyroid, leukeemiamia Ultra Violet Ultra Violet Ca Ca skinskin3. Virus :3. Virus : Ebstein Barr Virus Ebstein Barr Virus Burkittt lymphoma, Burkittt lymphoma,

Nasopharyngeal Ca Nasopharyngeal Ca Hepatitis B Hepatitis B Hepatoma Hepatoma4. 4. MedicationMedication : : Hormon Hormon Ca mamma, Ca Ovarium Ca mamma, Ca Ovarium Melphalan, Cyclophosphamide Melphalan, Cyclophosphamide Ca Ca

bladderbladder, , LeukLeukeemiamia

Dilantin Dilantin Lymphoma maligna Lymphoma maligna

ANOTHERS FACTOR THAT ANOTHERS FACTOR THAT INFLUENCES:INFLUENCES: Hereditary FaHereditary Facctor ( Ca Mammae, Ca Colon tor ( Ca Mammae, Ca Colon

familial poliposis, Retinoblastoma)familial poliposis, Retinoblastoma) GeograpGeographichic Fa Facctor (Ca Liver in Africa, Ca tor (Ca Liver in Africa, Ca

Gaster in Japan, Ca Nasopharing in China)Gaster in Japan, Ca Nasopharing in China) BehaviourBehaviour Fa Facctor ( have many children tor ( have many children Ca Ca

Cervix, no lactationCervix, no lactation Ca Mamma, no Ca Mamma, no circumcisioncircumcision Ca Penis, high fat diet Ca Penis, high fat diet Ca Ca Mamma)Mamma)

SosioSosioeconomiceconomic Fa Facctor ( Ca Gaster, Ca Cervix tor ( Ca Gaster, Ca Cervix low social-economic low social-economic;; Ca Mamma, Leukemia Ca Mamma, Leukemia and Multiple Myeloma and Multiple Myeloma high social-economic) high social-economic)

NeoplasmNeoplasm Growth Growth Neoplasm cells continuously proliferatedNeoplasm cells continuously proliferated

achieve certain volume achieve certain volume Time that need to become twice volume Time that need to become twice volume

““Doubling TimeDoubling Time”” Each neoplasm have different doubling Each neoplasm have different doubling

time time weeks up to years weeks up to years To become volume 1 cm3 To become volume 1 cm3 spent 30X spent 30X

doubling time ( if 1X doubling time 100 doubling time ( if 1X doubling time 100 days, so 30X doubling time need 8 years)days, so 30X doubling time need 8 years)

CANCER SPREADINGCANCER SPREADING PER-CONTINUITATUM (INFILTRATIPER-CONTINUITATUM (INFILTRATIIVEIVE)) cancer cells free from primary tumor, moving cancer cells free from primary tumor, moving

amoeboid enter and invade adjacent tissue amoeboid enter and invade adjacent tissue satellite nodule, infiltration and fixed to surround satellite nodule, infiltration and fixed to surround tissuetissue

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

HEMATOGENHEMATOGEN cancer cells invade blood vessel cancer cells invade blood vessel

enter blood stream, growing in the enter blood stream, growing in the far organsfar organs

TRANSLUMINALTRANSLUMINAL cancer cells grow cancer cells grow intraluminarintraluminar

organs organs spreading and follow spreading and follow feces and urine feces and urine growing in the growing in the distal site of the lumendistal site of the lumen

CANCER SPREADING (CONT’DCANCER SPREADING (CONT’D))

TRANS SEROSALTRANS SEROSAL CANCER CELLS INVADE SEROSAL SITE CANCER CELLS INVADE SEROSAL SITE

FREE FROM PRIMARY TUMOR FREE FROM PRIMARY TUMOR SPREADING AND GROWING IN THE SPREADING AND GROWING IN THE OTHER SEROSALSOTHER SEROSALS

IATROGENICIATROGENIC MANIPULATION PRIMARY TUMOR MANIPULATION PRIMARY TUMOR

CANCER CELLS FREE AND SPREADING CANCER CELLS FREE AND SPREADING CONTAMINATE SURGERY FIELDS CONTAMINATE SURGERY FIELDS AND SPREAD TO OTHER SITESAND SPREAD TO OTHER SITES

FaFacctortors that influence cancer s that influence cancer growinggrowing::

1.1. Origin and type tumorOrigin and type tumor2.2. Behavior tumorBehavior tumor3.3. Differentiation grading Differentiation grading 4.4. Tumor sizeTumor size5.5. AgerAger6.6. Immunology statusImmunology status7.7. Organ sites tumor growingOrgan sites tumor growing8.8. NutritionNutrition9.9. Hormonal statusHormonal status

Early Early DeteDetectionction How to know earlier tumor How to know earlier tumor

signs before the tumor growing signs before the tumor growing and spreading to far advanced, and spreading to far advanced, faraway from primary tumorfaraway from primary tumor

Very important Very important we have we have chance to cure early stage chance to cure early stage cancer cancer decrease morbidity decrease morbidity and mortalityand mortality

7 SIGN OF SUSPICIOUS 7 SIGN OF SUSPICIOUS CANCERCANCER

1.1. CC = Change in bowel or bladder habit = Change in bowel or bladder habit2.2. AA = A sore that does not heal = A sore that does not heal3.3. UU = Anusal bleeding or discharge = Anusal bleeding or discharge4.4. TT = Thickening or lump in the breast or = Thickening or lump in the breast or

elsewhere elsewhere5.5. II = Indigestion of difficulty in swallowing= Indigestion of difficulty in swallowing6.6. OO = Obvious change in wart or mole = Obvious change in wart or mole7.7. NN = Nagging cough or hoarseness = Nagging cough or hoarseness

American Cancer Society

Signs of Malignant Signs of Malignant SuspiciousSuspicious:: PPerdarahan atau keluarnya lendir tidak wajarerdarahan atau keluarnya lendir tidak wajar AAlat pencernaan yang terganggulat pencernaan yang terganggu TTumor pada payudara/ tempat lainumor pada payudara/ tempat lain OObstipasi atau perubahan kebiasaan BAK& bstipasi atau perubahan kebiasaan BAK&

BABBAB KKoreng atau borok yang tidak sembuh-sembuhoreng atau borok yang tidak sembuh-sembuh AAndeng-andeng yang makin besar, mudah ndeng-andeng yang makin besar, mudah

berdarah ,berdarah , tambah hitamtambah hitam NNada suara serak, batuk tidak sembuh-sembuhada suara serak, batuk tidak sembuh-sembuh

Yayasan kanker Wisnuwardhana Surabaya 1969

1.1. WWaktu buang air besar atau kecil ada perubahan aktu buang air besar atau kecil ada perubahan kebiasaan atau gangguankebiasaan atau gangguan

2.2. AAlat pencernaan terganggu atau kesukaran lat pencernaan terganggu atau kesukaran menelanmenelan

3.3. SSuara serak atau batuk yang tidak sembuhuara serak atau batuk yang tidak sembuh4.4. PPayudara atau tempat lain ada benjolanayudara atau tempat lain ada benjolan5.5. AAndeng-andeng yang berubah sifatnya, menjadi ndeng-andeng yang berubah sifatnya, menjadi

makin besar dan gatalmakin besar dan gatal6.6. DDarah dan lendir yang abnormal keluar dari tubuharah dan lendir yang abnormal keluar dari tubuh7.7. AAdanya koreng atau borok yang tidak mau sembuh danya koreng atau borok yang tidak mau sembuh

7 SIGN OF SUSPICIOUS 7 SIGN OF SUSPICIOUS CANCERCANCER

YKI 1977

Early DetectionEarly Detection::

1.1. Self examinationSelf examination2.2. Physical examination by doctorPhysical examination by doctor3.3. Sitology examination Sitology examination ( PAP smear, ( PAP smear,

secret bronchus, urine and other secret bronchus, urine and other bodies liquid)bodies liquid)

4.4. EndosEndoscopycopy5.5. USG (ultrasonography)USG (ultrasonography)6.6. MammograMammographyphy

DIAGNOSISDIAGNOSIS1.1. AnamnesisAnamnesis2.2. Physical examinationPhysical examination3.3. LaboratoryLaboratory4.4. Imaging Imaging (USG, Endoscopy, (USG, Endoscopy,

Radioisotope, CT- scan, MRI)Radioisotope, CT- scan, MRI)5.5. HystopathologyHystopathologyDefinitiveDefinitive

diagnosisdiagnosis

Pathology Pathology EvaluationEvaluation::

BIOPSY

INCISIONAL

EXCISIONAL

FNAB

Take out small part of tumor

to cut pathology tissue with normal tissue surrounded

Fine Needle Aspiration Biopsy

STAGING/STADIUMSTAGING/STADIUMCancer diagnosis must be follow by Cancer diagnosis must be follow by staging TNMstaging TNM show growing and spreading the show growing and spreading the tumortumor UICC : Union Internationale Contre UICC : Union Internationale Contre

CancerCancer InternaInternattional Standard ional Standard Stadium Stadium TNM system :TNM system :1.1. To plan the treatmentTo plan the treatment2.2. To know the prognosisTo know the prognosis3.3. To evaluate treatment outcomeTo evaluate treatment outcome4.4. To make uniform definition stagingTo make uniform definition staging

STAGING/STADIUMSTAGING/STADIUM Cancer diagnosis must be follow by staging Cancer diagnosis must be follow by staging

TNM TNM show growing and spreading the show growing and spreading the tumortumor

UICC : Union Internationale Contre CancerUICC : Union Internationale Contre Cancer InternaInternattional Standard ional Standard Stadium Stadium TNM system :TNM system :1.1. To plan the treatmentTo plan the treatment2.2. To know the prognosisTo know the prognosis3.3. To evaluate treatment outcomeTo evaluate treatment outcome4.4. To make uniform definition stagingTo make uniform definition staging

CLASSIFICATIONCLASSIFICATION TNM TNM

T T TTumor umor ssizeize N N lymphlymph NNode metastasisode metastasis M M far far MMetastasetastasisis

Example: Example: TNM system for Breast CancerTNM system for Breast Cancer TT To : no evidence of primary tumor To : no evidence of primary tumor T1 : diameter < 2 cmT1 : diameter < 2 cm

T2 : diameter 2 - 5 cmT2 : diameter 2 - 5 cm T3 : diameter > 5 cmT3 : diameter > 5 cm

T4 : thoracic wall, skin, wall & skin, mastitis T4 : thoracic wall, skin, wall & skin, mastitis carcinomatosacarcinomatosa

NN No : no regional lymph node metastasis No : no regional lymph node metastasis N1: to movable ipsi lateral lymph node N1: to movable ipsi lateral lymph node

metastasis, singlemetastasis, single N2: ipsi lateral lymph node metastasis fixed to N2: ipsi lateral lymph node metastasis fixed to

another to other another to other structure structure N3 :axilla and infraclavicular or supraclavicular N3 :axilla and infraclavicular or supraclavicular

lymph node lymph node metastasis metastasis MM Mo : no distant metastasis Mo : no distant metastasis M1 : distant metastasis M1 : distant metastasis

Stadium :Stadium : I I T1NoMo T1NoMo II II T0N1M0, T0N1M0,

T1N1M0, T1N1M0, T2NoMo, T2NoMo, T2N1M0T2N1M0

III III T0N2M0, T0N2M0, T1-2N2M0, T1-2N2M0, T3N1M0, T3N1M0, T4NxMoT4NxMo

IV IV anyT anyN M1 anyT anyN M1

PrognosisPrognosis1.1. Origin Origin 2.2. Type Type 3.3. GradingGrading4.4. StagingStaging5.5. Immunology Immunology 6.6. Treatment adequacyTreatment adequacy Prognosis: 5-year/10-year survival ratePrognosis: 5-year/10-year survival rate

example: Ca Mamma std III example: Ca Mamma std III 5-ysr 30%, 5-ysr 30%, 10-ysr 17%10-ysr 17%

TTHHERAPERAPYY1.1. SURGERY:SURGERY: DEFINITIVE TREATMENT FOR DEFINITIVE TREATMENT FOR

EARLY STAGING SOLID CANCER EARLY STAGING SOLID CANCER (loco regional)(loco regional)

Decrease tumor mass (debulking)Decrease tumor mass (debulking) Solitary localized metastasesSolitary localized metastases Emergency purposeEmergency purpose Palliative treatmentPalliative treatment ReconstructionReconstruction

TERAPITERAPI(…con’t)(…con’t)

2. RADIOTERAPHY2. RADIOTERAPHY ADJUVANT, NEOADJUVANTADJUVANT, NEOADJUVANT PALIATIVEPALIATIVE PRIMARY TREATMENTPRIMARY TREATMENT

3. CHEMOTERAPHY3. CHEMOTERAPHY- ADJUVANT, NEOADJUVANT- ADJUVANT, NEOADJUVANT- PALIATIVE- PALIATIVE- PRIMARY TREATMENT- PRIMARY TREATMENT

4. HORMONAL TERAPHY4. HORMONAL TERAPHY5. IMMUNOTERAPHY5. IMMUNOTERAPHY6. TARGETED THERAPHY6. TARGETED THERAPHY