PRINSIP-PRINSIP DASAR BEDAH ONKOLOGI
1.
Pendahuluan
Bedah onkologi adalah cabang ilmu kedokteran dalam hal ini ilmu bedah yang mempelajari penyakit akibat tumor. Dalam arti luas tumor berarti setiap benjolan abnormal pada tubuh tanpa melihat penyebabnya, misalnya benjolan pada dahi karena terbentur benda keras atau pembengkakan akibat infeksi. Tumor dalam arti sempit disebut juga neoplasma, yakni pertumbuhan sel atau jaringan baru di luar kendali [1] tubuh.[1] Onkologi Onkologi berasal dari bahasa unani, yaitu yaitu oncos yang oncos yang berarti massa atau
tumor, dan logos yang logos yang berarti ilmu. !eoplasma berasal dari kata bahasa unani, yaitu neos yang neos yang berarti baru dan plasein dan plasein yaitu yaitu jaringan bentukan yang abnormal.["] #rinsip$prinsip bedah onkologi meliputi epidemiologi tumor, biologi tumor yang terdiri dari karsinogenesis, genetik, etiologi kanker atau karsinogen, diagnosis dan dan stad stadiu ium m kank kanker er,, dan tera terapi pi kanke kanker. r.[%] &anker &anker merupak merupakan an ancaman ancaman serius serius kesehatan masyarakat kita karena insiden dan angka kematiannya terus merayap naik. Di a'al dasa'arsa 1()*$an, penyebab kematian utama di !egara kita adalah penyakit infeksi, infeksi, TB, dan penyakit neonatal. &anker hanya menduduki posisi ke$( atau ke$1* sebaga sebagaii penyeba penyebab b kemati kematian. an. +asil +asil surei surei dasa'a dasa'arsa rsa -*an menunj menunjukk ukkan an angka angka kematian akibat kanker telah menduduki posisi ke$%. +asil surei dasa'arsa *$an menunjukkan angka kematian kanker di /perkotaan sudah mencapai 1",*%01**.*** penduduk, menduduki "1, dari seluruh kematian, atau posisi teratas diantara berbagai penyebab kematian. 2edangkan angka kematian kanker di pedesaan adalah 11",%301**.*** 11",%301**.*** penduudk, atau 1-,4- dari seluruh seluruh kematian, kematian, menduduki menduduki posisi posisi kedua diantara berbagai penyebab kematian.[4]
2.
Epid Ep idem emio iolo logi gi u umo mo!!
5pidem 5pidemiol iologi ogi tumor tumor adalah adalah bidang bidang ilmu ilmu yang mempel mempelaja ajari ri aturan aturan tentan tentang g timbul, dan berkembangnya tumor dan distribusi tumor atau kanker dalam komunitas manusia, manusia, serta serta pencegahan pencegahan dan pengendalian pengendaliannya. nya.[4] Bebera Beberapa pa konsep konsep dasar dasar dalam dalam penelitian epidemiologis6[4,)] 1
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a7
#aparan #apara #aparan n yaitu yaitu faktor faktor yang yang berhubu berhubunga ngan n dengan dengan tumor tumor yang sedang sedang diteli diteliti. ti. 8isalnya dalam hubungan anatara infeksi irus hepatitis B dan hepatoma.
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Bias Bias Biasaa adala adalah h kekel kekelir irua uan n sist sistem em yang yang munc muncul ul dala dalam m pros proses es peran perancan canga gan, n, pelaksanaan, analisis, dan interpretasi suatu penelitian epidemiologis. &ekeliruan ini dapat melencengkan sifat maupun intensitas hubungan antara paparan dan penyakit, hingga terjadi kesimpulan yang salah.
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9onfounding 9onfou 9onfoundi nding ng menunj menunjukka ukkan n dalam dalam meneli meneliti ti hubunga hubungan n antara antara penyaki penyakitt dan paparan sering terdapat pengaruh dari faktor yang tidak diteliti. :aktor yang tida diteliti yang menimbulkan confounding disebut sebagai faktor confounding.
d7 2cre 2creen enin ing g ;pe ;pena napi pisa san7 n7 Dengan menggunakan suatu uji, pemeriksaan atau cara lain dari kelompok orang yang tampak sehat dipisahkan indiidu dengan risiko tinggi menderita kanker tert terten entu tu,, pemd pemder erit itaa tumo tumorr ataup ataupun un indi indii idu du yang yang dicur dicurig igai ai namu namun n belu belum m menamp menampakk akkan an gejala gejala.. Tujuann Tujuannya ya adalah adalah menemu menemukan kan secara secara dini dini penderi penderita, ta, pemberian terapi secara dini, agar penderita sembuh atau memperlambat progresifitas penyakitnya.
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suatu kelompok pasien dengan suatu penyakit dan kelompok lain yang tidak diberi paparan penyakit.[3,-] #ada tahun "**%, diperkirakan 1.%%4.1** kasus baru kanker inasie yang terdiagnosis di
".
Biologi umo!
".1 Ka!# Ka!#ino inoge gene# ne#i# i#
a. #roliferas #roliferasii 2el, 2el, Transfor Transformasi masi 2el dan dan =nisias =nisiasii Tumor Tumor 2el tumo tumorr iala ialah h sel sel tubuh tubuh kita kita send sendir irii yang yang meng mengal alam amii tran transf sfor orma masi si ;perubahan7 sehingga tumbuhnya di dalam tubuh menjadi autonom yaitu tumbuhnya tersendiri, terlepas dari kendali pertumbuhan tubuh normal. 2el tumor terdiri dari 6 $
2el tumor jinak
$
2el 2el tum tumor or gana ganass ;se ;sell kan kanke ker7 r7 #erbe #erbedaa daan n sifa sifatt tumo tumorr jina jinak k denga dengan n sel sel ganas ganas terg tergan antu tung ng dari dari jauhn jauhnya ya
penyimpangan dari bentuk sel normal dalam hal derajat diferensiasinya, autonominya dan kemampuannya mengadakan infiltrasi dan metastasis.[",)] #ada sel yang normal, pertumbuhan pertumbuhan dan proliferas proliferasii sel diba'ah control yang
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abnormal biasanya terdiri dari beberapa abnormalitas. =ni termasuk hilangnya inhibisi kontak yaitu, sel terus berkembang biak setelah monolayer terbentuk, suatu keadaan berkurangnya ikatan antara sel$sel atau substrat. +ilangnya keterikatan untuk pertumbuhan sel, dan kemampuan untuk menimbulkan tumor saat disuntikkan ke host yang sesuai.[3,-] 2iklus pertumbuhan sel terdiri dari " fase yang terjadi secara bergantian, yaitu interfase dan mitosis. 17 2ikl 2iklus us per pertu tumb mbuh uhan an morf morfol ologi ogiss $
:ase 8itosis 6 8itosis adalah suatu proses pembentukan dari satu sel parental menjadi " sel
anakan yang identik termasuk jumlah kromosom dan informasi genetiknya. #ada mitosi mitosiss terdapa terdapatt " tahap tahap pembel pembelahan ahan yaitu yaitu karyoki karyokines nesis is ;pembe ;pembelah lahan an inti7 inti7 dan sitokinesis ;pembelahan sel7.
:ase #rofase #ada fase profase, kromosom tampak memendek ;terkondensasi7 dan telah
terdiri dari " kromatid serupa ; sister chromatid 7. 7. #ada fase ini nucleolus lenyap ;hilan ;hilang7, g7, membra membran n inti inti juga juga mengal mengalami ami disint disintegr egrasi asi ;hancur ;hancur7, 7, dan kompone komponen$ n$ komponen penyusun membran inti akan bercampur dengan sitoplasma. Di akhir fase ini benang$benang spindel terbentuk di dalam sitoplasma. :ase ini terjadi ± 1 jam.[",] $
:ase 8etafase :ase berikutnya dari mitosis yaitu fase metafase. #ada fase ini benang$benang
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2elanj 2elanjutn utnya ya pada pada fase fase anafase anafase,, sentro sentromer mer dari dari kromos kromosom om akan akan membela membelah h sepanj sepanjang ang lengan lengan kromos kromosom om dan tegak tegak lurus lurus benang benang spindel spindel,, sehing sehingga ga masing masing$$ masing kromatid serupa yang telah terpisah tersebut akan ditarik kearah kutub ;pada tumbuhan7 atau sentriol ;pada he'an7. :ase ini berlangsung $
± kurang
dari > jam.
:ase Telofase :ase :ase terakh terakhir ir dari dari mitosi mitosiss adalah adalah telofa telofase. se. #ada fase fase ini masing masing$ma $masi sing ng
kromatid yang telah menjadi kromosom tunggal telah berada di masing$masing kutub dan setiap kutub memiliki jumlah kromosom dan informasi genetik yang identik. 2elain itu pada fase ini inti sel, membrane inti dan nukleolus mulai terbentuk, benang$ benang spindel lenyap, dan kromosom membuka untuk membentuk kromatin yang kusut kembali. Diakhir fase ini kemudian terjadi sitokinesis sehingga akan terbentuk dua sel anakan yang identik. #roses sitokinesis pada sel tumbuhan dan sel he'an berbeda. &alau pada sel tumbuhan sitokinesis berlangsung dari arah tengah ke tepi, sedangkan pada sel he'an berlangsung dari arah tepi ke tengah. :ase ini berlangsung selama beberapa menit. $
=nt =nterf erfase ase 6 sel sel anak anak muda muda → de'asa #ada fase ini terjadi terjadi sintesa D!<, D!<, ?!<, 5n@im dan protein baru lainnya lainnya dan
duplikasi duplikasi rantai tunggal tunggal kromosom kromosom menjadi menjadi rantai rantai ganda. &romosom terdiri terdiri dari untaia untaian n rantai rantai ganda ganda D!< yang saling saling membeli membelit, t,
merupak merupakan an pasangan pasangan rantai rantai
nukleot nukleotida ida sebagai sebagai unit dari gen pemba' pemba'aa sifat sifat indiidu indiidu..
Aama Aama interf interfase ase dari
beberapa jam sampai bertahun$tahun. =nterfase merupakan fase terpanjang dalam siklus sel. #ada stadium ini inti sel dapat terlihat dengan jelas di dalam tiap$tiap selnya, namun kromosom masih berupa benang$benang kromatin yang memanjang sehingga tidak tampak dengan jelas.[",] "7 2ikl 2iklus us per pertu tumb mbuh uhan an biok biokim imia ia'i 'i $
:ase 1 ;Growth phase – 1)
→ beberapa
jam sampai beberapa tahun. 2el
anak membentuk ?!<, 5n@im dan protein lain untuk sintesa D!< dalam
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$
:ase / 2 ;Synthesa7 Synthesa7
→
jam → pembentukan rantai D!< baru. #ada fase ini
terjad terjadii replik replikasi asi D!< bersam bersamaan aan dengan dengan duplika duplikasi si kromos kromosom, om, sehing sehingga ga sebuah kromosom akan memiliki sepasang kromatid serupa ; sister chromatid sister chromatid 7 dengan satu sentromer. sentromer. :ase ini memakan memakan 'aktu %)$4) dari seluruh 'aktu interfase. $
:ase " ;Growth phase – 27 27 kira$kira 1 / " jam → pembentukan ?!<, 5n@im dan protein lainnya untuk persiapan fase mitosis berikutnya. #ada fase ini pembentukan D!< berlangsung cepat dan D!< bertambah kompleks. 2elain 2 elain itu pada fase ini juga masih berlangsung pembentukan protein kromosom dan ?!<.
$
:ase :ase 8 ;8it ;8itos osis is77 kir kira$ a$ki kira ra 1 / " jam jam → 1 sel induk menjadi dua sel anak baru yang mempunyai struktur genetik sama dengan sel induk.[",]
ambar 1. 2iklus 2el ;dikutip dari kepustakaan 7
Tumo Tumori rige gene nesi siss
terb terbag agii
menj menjad adii
%
fase fase,,
yait yaitu u
insi insias asi, i, prom promos osi, i, dan dan
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cloning. &anker adalah penyakit perkembangan progresif klonal sebagai tumor yang muncul dari satu sel dan akumulasi mutasi yang memberikan sifar agresif pada tumor. &ebanyakan tumor yang berkembang dari lesi jinak pada tumor situ untuk menjadi kanker inasif ;misalnya, hiperplasia duktus atipikal menjadi karsinoma duktal in situ karsinoma duktal inasif pada payudara7.[(,1*] 8utasi 8utasi gen diperlu diperlukan kan minimal minimal terjadi terjadi pada empat atau atau lima lima gen
untuk untuk
pembentukan tumor ganas, meskipun hanya terjadi mutasi sedikit yang cukup untuk perkembangan menjadi tumor jinak. 8eskipun mutasi genetik sering terjadi, namun sifat biologis tumor ditentukan oleh total akumulasi perubahan gen etik.[1*]
2ifat$sifat sel kanker ["] $
Bent Bentuk uknya nya ber berma maca cam$ m$ma maca cam m ;pol ;polym ymor orph phi7 i7
$
Carnany Carnanyaa lebih gelap gelap ;hyperc ;hyperchro hromas masi7 i7 dan bermac bermacam$ am$mac macam am ;polychr ;polychroma omasi7 si7
$
=nt =nti sel sel rel relati atif bes besar ar
$
8itosis be bertambah
$
2usuna 2usunan n sel$s sel$sel el tidak tidak ter terat atur ur ;anap ;anapla last stik ik77
$
Tumb Tumbuh uh terus erus tanpa anpa bat batas as
$
Tidak Tidak menj menjal alan ankan kan fung fungsi si sel sel nor norma mall
$
8engada 8engadakan kan infi infiltr ltrasi asi ke sel$ sel$sel sel normal normal di seki sekitar tarnya nya
$
8engada 8engadakan kan metast metastasi asiss kebag kebagian ian$ba $bagia gian n tubuh tubuh lainnya lainnya
$
8eru 8erusa sak k bent bentuk uk dan dan fun fungs gsii orga organ n
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#ertumbuhan kanker cepat bila populasi sel yang dapat tumbuh lebih besar dan cepat. b. Disregulasi 2iklus 2el pada &anker &euntungan proliferasi sel tumor merupakan akibat langsung dari kemampuan sel untuk menjaga keadaan sel. 8utasi 8utasi atau perubahan perubahan dalam ekspresi ekspresi siklus protein protein sel, sel, faktor faktor pertum pertumbuha buhan, n, pertum pertumbuh buhan an faktor faktor resept reseptor, or, transd transduks uksii sinyal sinyal protei protein n intraseluler, dan faktor$faktor transkripsi nuklir. 2emua hal ini dapat menyebabkan gangguan mekanisme dasar yang mengontrol siklus sel, sehingga pertumbuhan dan proliferasi sel tidak teratur.[1*] 2ikl 2iklus us sel sel diba dibagi gi menj menjad adii empa empatt fase fase.. 2ela 2elama ma fase fase sint sintet etis is atau atau 2, sel sel menghasilkan satu generasi materi genetik, meskipun dalam mitosis atau fase 8, komp kompone onen n selu selule lerr yang yang dipa dipart rtis isii antar antaraa dua dua anak anak sel sel yang yang iden identi tik. k. 1 dan dan " merupakan fase antara selama sel mempersiapkan diri untuk menyelesaikan fase 2 dan 8 masing$masing sel. &etika sel$sel berhenti melakukan proliferasi, sel keluar dari siklus sel dan masuk ke fase diam yang disebut sebagai fase *. #erkembangan siklus sel diatur oleh serangkaian checkpoint yang yang mencegah sel memasuki fase baru tanpa menyelesaikan tahap sebelumnya.[(,1*] c. =nasi =nasi dan 8etast 8etastasi asiss 2el 2el &anker &anker #ertumbuhan kanker dibagi atas dua bagian, yaitu 6 17 #ertum #ertumbuh buhan an loka lokall yang yang terdir terdirii dari dari 6 $
Aokal in situ
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2uatu 2uatu tanda tanda dari dari sel$se sel$sell ganas ganas adalah adalah kemamp kemampuan uannya nya untuk untuk menyer menyerang ang jaringan normal di sekitarnya. #ertumbuhan tumor di mana sel$sel ganas muncul secara eksklusif pada membran basal disebut sebagai kanker in situ atau lokal in situ, sedangkan pertumbuhan tumor di dimana sel$sel ganas mele'ati membrane basalis dan dan menm menmbu buss stro stroma ma,, dise disebu butt seba sebaga gaii kank kanker er ina inasi sie e atau atau loka lokall ina inasi sif. f. &emampuan untuk melakukan inasi melibatkan perubahan dalam adhesi sel, inisiasi motilitas, dan proteolisis dari matriks ekstraselular ;5987.
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membran$ter membran$terikat ikat ?eck ;reersi$i ;reersi$inducin nducing g sistein sistein kaya protein protein dengan domain ka@al7, ka@al7, dan inhibitor jaringan 88#s ;T=8#$1, $", $%, dan $47. Dengan demikian regulasi 88#s terjadi pada tiga tingkat6 perubahan ekspresi gen, aktiasi @ymogens laten, dan penghambatan oleh inhibitor endogen. #erubahan dari ketiga tingkat kontrol telah dikaitkan dengan perkembangan tumor.[1*] "7 #ertum #ertumbuh buhan an 0 penyeb penyebara aran n ke organ organ lain lain 0 metas metastas tasis is 6 $
&e kele kelenj njar ar limf limfee regi region onal al
$
&e organ ja jauh 8eta 8etast stas asis is timb timbul ul dari dari penye penyeba bara ran n sel$ sel$se sell kanke kankerr dari dari primary site site dan
pembentukan tumor baru di tempat yang jauh. #roses metastasis terdiri dari serangkaian fase yang membutuhkan penyelesain dengan lengkap. #ertama, tumor primer harus mengembangkan akses ke sirkulasi baik melalui sistem peredaran darah atau sistem limfatik. 2etelah sel$sel kanker masuk ke sirkulasi, sel tersebut harus bertahan di sirkulasi. 2elanjutnya, sel$sel beredar ke organ baru dan eGtraasasi ke jaringan baru. 2elanjutnya, sel$sel harus memulai pertumbuhan di jaringan baru dan akhirn akhirnya ya memben membentuk tuk askul askulari arisas sasii untuk untuk memper mempertah tahanka ankan n tumor tumor baru. baru. 2ecara 2ecara keseluruhan, metastasis adalah proses yang tidak efisien, meskipun langkah$langkah a'al hematogenous metastasis ;penangkapan sel tumor pada organ dan ekstraasasi7 diyakini dilakukan secara efisien. 8etastasi 8etastasiss kadang$kadang kadang$kadang bisa timbul beberapa beberapa tahun setelah pengobatan pengobatan tumor primer. :enomena ini disebut sebagai dormansi, dan itu tetap menjadi salah
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Bebe Bebera rapa pa jeni jeniss tumo tumorr berm bermet etas asta tasi siss dala dalam m pola$ pola$or orga gan n tert terten entu tu.. 2uat 2uatu u penjelasan untuk hal ini adalah mekanik dan didasarkan pada drainase peredaran darah yang berbeda berbeda dari tumor. #enjelasan #enjelasan lain untuk metastasis metastasis preferensi preferensial al adalah adalah apa yang disebut disebut sebagai teori Hbenih dan tanahI, ketergantungan ketergantungan benih ;sel kanker7 pada tanah ;organ sekunder7. 8enurut teori ini, sekali sel telah mencapai organ sekunder, efisiensi pertumbuhannya dalam organ yang berdasarkan kompatibilitas biologi sel kanker dengan microenvironment . &emamp &emampuan uan sel$se sel$sell kanker kanker untuk untuk tumbuh tumbuh pada pada lokasi lokasi terten tertentu tu mungki mungkin n tergant tergantung ung pada pada substa substansi nsi$su $subst bstans ansii yang melekat ke sel kanker, substansi yang melekat pada organ, dan interaksi antara sel kanker dan microenvironment .[",1*]
Banyak onkogen ditemukan sampai saat ini, seperti +5?" 0 neu, ras, dan myc, diperkirakan berpotensi tidak hanya sebagai transformasi ganas tapi juga dalam satu atau lebih fase$fase fase$fase yang diperlukan diperlukan dalam proses metastasis. metastasis. 8etastasis 8etastasis juga dapat melibatkan hilangnya metastasis gen supresor.[",1*] 9ara #enyebaran sel kanker secara umum yaitu6["] $
#erkont #erkontinu inuit itatum atum 6 #ertum #ertumbuha buhan n ke ke sekita sekitarny rnyaa
$
2ecar 2ecaraa limfo limfoge gen n 6 2el$s 2el$sel el mengi menginf nfil iltr tras asii salur saluran an limf limfee regional
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kelenjar limfe
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Berdasarkan asal, sifat, dan pola kerjanya, faktor terkait dengan timbulnya kanker dapat digolongkan menjadi faktor endogenik dan faktor eksogenik. :aktor eksogenik berasala dari d ari lingkungan luar, berkaitan erat dengan d engan lingkungan alamiah dan kondisi kehidupan, meliputi faktor kimia'i, fisika dan biologis. :aktor endogenik meliputi kondisi kondisi imunit imunitas, as, konstit konstitusi usi genetik genetik,, kadar kadar hormon hormon,, dan kemamp kemampuan uan repara reparasi si kerusakan D!<.[(,1*] a.
enetik 8ekanisme pasti herediter atau genetik dengan timbulnya penyakit tumor
belum diketahui secara pasti. !amun, belakangan ini perkembangan onkogen dan supr supres esor or onko onkogen gen,, lebi lebih h jauh jauh dapa dapatt dije dijela lask skan an hubun hubunga gan n antar antaraa here heredi dita tass dan dan tumorigenesis. #roduk ekspresi onkogen berefek regulasi positif terhadap proliferasi sel. Bila mengalami mutasi atau oereskpresi, dapat menyebabkan sel berproliferasi berlebihan, sedangkan supresor onkogen mengekspresikan produk yang berefek regulasi negatif terhadap proliferasi sel. Bila struktur atau fungsi supresor onkogen berubah atau supresor onkogen hilang, regulasi negatif terhadap proliferasi sel hilang,
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astric cancer '*1
13J""
+ereditary diffuse gastric cancer Ai$:raumeni and hereditary breast cancer +ereditary nonpolyposis colorectal cancer
h*(2
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h"+*1& h"S*2& h"S*%& hP"S1& hP"S2
%p"1K "p""$ "1K "p13K "J%1$ %%K -p""
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8ultiple endocrine neoplasia type 1
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+ereditary papillary renal cell carcinoma !eurofibromatosis !eurofibromatosis type 1
/2
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!eurofibromatosis !eurofibromatosis type "
b.
&arsinogen &imia'i
Breast cancer, soft$tissue sarcoma, brain tumors 9olorectal cancer, endometrial cancer, transitional cell carcinoma of the ureter and renal pelis, and carcinomas of of the stomach, small bo'el, oary, and pancreas #ancreatic islet cell cancer, parathyroid hyperplasia, hyperplasia, pituitary adenomas ?enal cancer !eurofibroma, neurofibrosarcoma, acute myelogenous leukemia, brain tumors
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karsin karsinoge ogen. n. &arsin &arsinogen ogen jenis jenis ini luas luas terseb tersebar ar di lingku lingkungan ngan luar, luar, yang yang sering sering ditemukan adalah hidrokarbon aromatic polisiklik, golongan amin aromatic, golongan nitrosami nitrosamin, n, dan aflatoksin. aflatoksin. Berdasarkan Berdasarkan tingkat tingkat aktiasi aktiasi metabolic metabolic @at karsinogen karsinogen tida tidak k lang langsu sung ng ini, ini, umum umumny nyaa bent bentuk uk yang yang belum belum tera terakt kti ias asii dise disebut but seba sebagai gai prekarsinogen. Bentuk yang telah mengalami metabolism tubuh berubah menjadi karsinogen aktif dengan umur sangat singkat disebut sebagai karsinogen proksimat. &arsinogen proksimat yang bertransformasi selangkah lagi menjadi @at elektrofilik bermuatan positif disebut sebagai karsinogen ultimat. &arsinogen ultimat ini berikatan koalen dengan D!<, ?!<, protein dan makromolekuler biologis lain sehingga mereka mengalami kerusakan dan menjadi ganas.[4,1*] Lat pemacu kanker disebut juga sebagai agen promosi tumor. Lat pemacu tumor secara tersendiri di dalam tubuh tidak dapat menimbulkan kanker, tapi dapat memacu memacu karsin karsinogen ogen lain lain menimb menimbulk ulkan an kanker. kanker. Lat pemacu pemacu kanker kanker yang sering sering ditemukan adalah minyak kroton, sakarin, dan fenobarbital.[4] Berdasarkan hubungannya dengan kanker pada manusia, karsinogen kimia'i
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Ben@ene
!itrosourea
&admium dan senya'anya
&romium dan senya'anya
Dimetilsulfat
&arbon tetraklorida
"$naftilamin
!ikel dan senya'anya
Dimetilhidra@ina
Minilklorida
&lormetin0mostar nitrogen
9o, 2e, #b, +g
4$aminodifenil
Berilium dan sneya'anya
+idra@ina
:enasetin c.
&arsinog nogen :is :isika &arsin &arsinoge ogen n fisika fisika terdir terdirii atas atas dua jenis, jenis, yaitu yaitu radias radiasii pengion pengion dan sinar sinar
ultraiolet. 5fek karsinogen kedua jenis tersebut memiliki masa laten yang sangat panjang. :aktor fisika dapat menyebabkan berbagai jaringan dan sel tubuh berubah sensitifi sensitifitasnya tasnya terhadap karsinogen karsinogen dan penunjang penunjang karsinogen karsinogen endogenik endogenik maupun eksogenik hingga timbul kanker, juga dapat mencederai sel reproduksi hingga timbul kanker pada generasi selanjutnya.[4]
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#aparan #aparan radias radiasii sinar sinar matahar mataharii atau atau sinar sinar ultra ultraiol iolet et dalam dalam jangka jangka 'aktu 'aktu panjang bersifat karsinogenik bagi kulit. ku lit. &anker kulit akibat sinar ultraiolet dengan terben terbentuk tuknya nya pirimi pirimidin din dimer dimer pada D!<. D!<. Dalam Dalam keadaan keadaan normal normal,, di dalam dalam sel terdapat sistem reparasi D!< yang dapat membersihkan pirimidin dimer tersebut. ika ika terjad terjadii defisi defisiens ensii en@im en@im repara reparasi si dapat dapat menyeba menyebabkan bkan dimer dimer terseb tersebut ut tidak tidak tereliminasi sehingga terjadi perubahan struktur gen dan kekeliruan replikasi D!<.[4,3]
d.
&arsinog nogen Mir Mirus
#engaruh irus dalam etiologi tumor telah diteliti sejak (* tahun yang lalu. Calaupun hubunga hubungan n irus irus dan kanker kanker pada manusi manusiaa belum belum diketa diketahui hui secara secara pasti pasti,, namun namun beberapa penelitian menunjukkan irus tertentu berkaitan dengan kanker pada manusia. manusia. Mirus tumor adalah jenis irus yang dapat menimbulkan menimbulkan tumor pada tubuh atau membuat sel berubah menjadi ganas. =nteraksi antara irus tumor dan sel hospes menyeb menyebabka abkan n transf transform ormasi asi ganas ganas sel, sel, kunciny kuncinyaa adalah adalah adanya adanya gen irus irus yang onkogenik berintegrasi dengan D!< sel sehingga D!< irus menjadi bagian dari
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poksirus. Mirus ?!< yang berkaitan dengan tumor pada manusia terutama adalah retroirus.[4]
.
Diagno gno#i# #i# umo!
Diagnosis tumor ditegakkan berdasarkan 6 .1 Lo%a#i $umo! $umo! p!ime! p!ime! #e#uai dengan dengan %!i$e!ia %!i$e!ia I+D &In$e!na &In$e!na$ional $ional +ode +ode o $he Di#ea#e#' 1 da!i 3HO.
&lasifikasi Tumor berdasarkan =9D 1* dari C+O, yaitu6[11] $
9**$914 9**$914 8align 8alignant ant neop neoplas lasms ms of lip, lip, oral oral cai caity ty and and phary pharynG nG
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$
D%-$D4 D%-$D4 !eopla !eoplasms sms of uncerta uncertain in or unkno'n unkno'n behaio behaiour ur
.2 Diagn Diagno#i o#i## %lini %lini## .2.1 Anamne#i#
Diagnosis segala penyakit harus dimulai dari anamnesis termasuk untuk kasus tumor. tumor.
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".
8ani 8anife fest stas asii sist sistem emik ik Tumor pada stadium a'al belum menunjukkan gejala sistemik yang jelas,
denga dengan n berke berkemb mban angny gnyaa tumo tumorr dapat dapat timb timbul ul gejal gejalaa sist sistem emik ik sepe sepert rtii dema demam, m, penurunan berat badan, anemia, asthenia progresif, dan ikterus. %.
2ind 2indro rom m par paran aneo eopl plas asti tik k 8anifestasi klinis tumor ganas selain ditimbulkan oleh tumor primer dan atau
metast metastasi asisny snyaa akibat akibat @at aktif aktif biolog biologis is abnorma abnormall yang disebu disebutt sebagai sebagai sindro sindrom m paraneoplastik, atau efek ajuh tumor. 2indrom paraneoplastik bisa terjadi pada kulit dan jaringan penunjang, sistem saraf, sistem kardioaskuler, sistem endokrin dan
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mengukur panjang dan lebar tumor. Bentuk tumor, tumor jinak umumnya bentuknya bulat atau lonjong sedangkan tumor ganas bentuknya tidak teratur. Batas tumor, tumo tumorr jina jinak k bias biasan anya ya memi memili liki ki kapsu kapsull utuh utuh,, batas batas tega tegas, s, tumo tumorr gana ganass tumb tumbuh uh infiltrate, batas tidak jelas. &onsistensi tumor apakah padat kenyal, padat kistik, atau lunak. #emeriksaan permukaan tumor dilakukan dengan memperhatikan 'arna kulit disekitar normal atau merah, ada tidak nodul, rata atau berbenjol$benjol, tumor dan kulit atau dasarnya beradhesi, pelebaran ena subkutis, dan ulserasi. #emeriksaan mobilitas tumor, biasanya tumor jinak beradhesi dengan jaringan di sekitarnya, mobilitasnya baik, tumor ganas pada stadium dini umumnya dapat
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8agnetic ?esonance =maging ;8?=7 adalah suatu teknologi menggunakan resonansi inti atom dan gelombang frekuensi radio di dalam medan magnet untuk menghasilkan sinyal dan rekonstruksi gambar.[",4] .2.5 .2.5
Peme Peme!i !i%#a %#aaan aan Hi#$o Hi#$opa pa$ol $ologi ogi##
Aangkah / langkah umum teknik +istopatologi[",4] $
:iksasi jaringan #enga'etan #enga'etan jaringan jaringan agar substansi substansi jaringan tetap seperti seperti keadaan semula
;bentu ;bentuk k maupun maupun lokali lokalisas sasii @at kimia kimia yg ada dlm jaring jaringan an terseb tersebut7 ut7.. pembusukan jaringan. :iksasi merupakan langkah yg sangat penting.
8encegah
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organ / organ dalam seperti hati, prostat, prostat, dsb. ;jaringan7. ;jaringan7. =mplantasi =mplantasi sel / sel tumor dapat terjadi sehingga jangan memakai jarum dgn ukuran yang besar ;!o. "*7, dan belum dapat mengganti pemeriksaan histopathologi.
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o
$
#embuatan sel blok
:iksasi spesimen #ul
sim
tin ;#ap ;#ap 2tain 2tain atau atau ?o
ky$ie ky$ie
7
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"6 Aemah, tidak dapat bekerja,tapi dapat jalan Q mera'at mera'at diri sendiri )* dari 'aktu sadar. %6 elek, tidak tidak dapat jalan,dapat jalan,dapat bangun Qra'at Qra'at diri sendiri,pe sendiri,perlu rlu tiduran tiduran R )*
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6.
e!api um umo o! So Solid
6.1 P!in#ip P!in#ip Pena$al Pena$ala%#a a%#anaa naan n umo! Solid Solid
1.
8ene 8enega gakk kkan an di diagno agnosi siss
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Dilaku Dilakukan kan setela setelah h pelaks pelaksana anaan an terapi terapi dan ditinj ditinjau au apakah apakah stadiu stadium m klinis klinis sesu sesuai ai
deng dengan an
stad stadiu ium m
pato patolo logi gi
sesu sesuda dah h
oper operas asi. i.
Bila Bila
dipertimbangkan pemberian terapi adjuant atau terapi tambahan.
berb berbed edaa
mung mungki kin n
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