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BEDAH ONKOLOGI

dr. Kristanto Yuli Yarso, SpB(K)Onk


Bedah Onkologi

Head & Neck


Breast
Skin
Soft Tissue
Definitions

Oncology: Greek :
Oncos : Mass / Tumor
Logos : Science

Tumor: abnormal mass


Definitions

Tumor : Neoplasm
Non Neoplasm : Inflamatory Process

Neoplasia: new growth

Neoplasm : - Benign
- Malignant
Definitions

Benign neoplasm: a neoplasm that tends to grow


slowly, does not metastasize, and is usually non-life
threatening
Malignant neoplasm: a neoplasm that tends to grow
rapidly, uncontrolled, uncoordinated, often
metastasizes and frequently causes death of the host
Cancer: common term used for all malignant
neoplasms
Definitions

Metastasis: transfer of disease manifestations from


one organ to another. It is used mainly to refer to the
secondary growth of a malignant neoplasm in an
organ or site remote from the primary site
Hematogenous
Lymphogenous
How does Cancer Occur??

Normal tissue Cell growth Cells Death

Cancer Cell growth Cells Death

Multiple genetic abnormalities ( in Oncogen / Tumor


Suppresor gen)
Multi step
Initiation
Promotion
Progression
Cells premalignant

INITIATION PROMOTION

Cells still Expansion of


have normal premalignant
phenotype clone
Multistage
INITIATION Progression PROGRESSION

to Malignancy
Cells
malignant

Protooncogen
Further genetic
changes Expansion of
malignant clone

METASTASES
Causes of Cancer

External factors
Chemicals
Radiations
Viral Infection
Carcinogens PERSISTENT GEN ABNORMALITY
Carcinogens Abnormal cells growth

Internal factors
Repair failure
External factors

Chemicals Agents:
- Alkylating agent
- Polycyclic Hydrocarbon
- Aromatic Amin

Radiation:
- Ionization / X-ray Radiation
- UV Radiation

Viruses :
- Epstein Barr Virus (EBV)
- Human Papiloma virus (HPV)

Other Carcinogenic
- Alcohol
- Aflatoxin
- Tobacco
Treatment

1. Diagnosis
2. Staging
3. Performance States
4. Planning of Treatment
5. Implementation of treatment
6. Evaluation/ Follow up
1. Diagnosis

- Anamnesis
- Physical examination
- Other Instrumentation :
Laboratory examination : Tumor marker
Imaging : x-photo
USG
CT Scan
MRI

Patologi : Fine needle aspiration biopsy (FNAB)


Incision biopsy
Core Biopsy
Frozen section
2. Staging
Staging : T N M
T(tumor) N(nodule) M(metastais)

T : Tumor Size
N : Lymphenode
M : Metastases
3. Performance States
Scor KARNOFFSKY Scor
ECOG

100% Normal, no complain, no evidence of desease 0 Fully active, able to carry on all predesease
performance without restriction
90% Able to carry on normal activity, minor signs or symptom of desease

80% Normal activity with effort, some sign or symtomps of desease 1 Restricted in phisically strenuous activity but
ambulatory and able to carry out work of a light
or sedentary nature, e.g., light house work, office
70% Cares for self, unable to carry on normal activity or to do active work
work

60% Requires occasional assistance, is mostly able to care for himself 2 Ambulatory and capable of all self care but unable to
carry out any work activities, up and about more
than 50% of waking hours
50% Require considerable assistance and frequent medical care

40% Disabled, requires special care assistance 3 Capable of only limited self care and confined to bed
or chair more than 50% of waking hours
30% Severely disabled, hospitalization indicated, death not imminent

20% Very sick, hospitalization necessary, active supportive treatment 4 Completely disabled , cannot carry on any self-care,
necessary totally confined to bed or chair

10% Moribund, fatal processes progressing rapidly

0 Death 5 Death
4. Planning of Treatment

Therapy :
Curative : just for curable disease
Palliative: for non curable disease (ex: metastases disease)
Aim: Quality of Life

Modality of Treatment :
- Surgery/ Operation
- Radiotherapy
- Chemotherapy
- Hormonal therapy
- Immunology therapy
- Targeting cells therapy
- Gene therapy
5. Implementation of treatment
Application of planning therapy

6. Evaluation/ Follow up
- Evaluation of result treatment
- Evaluation of recurrency
Early Detection of the Cancer
is important

Why ??????

Early stage of the Cancer


- Prognosis
- Increase survival
- Reduce morbidity caused by cancer
- Reduce defect post treatment
Screening for early detection
Example

Breast :
- Breast self examination (BSE)
- Clinical Breast Examination (CBE)
- Mammography

pemerikSAan payuDAra sendiRI


Breast self examination (BSE)

SADARI
SADARI
SADARI
SADARI
SADARI
Clinical Breast Examination (CBE)
Mammography
Breast Ca Treatment

Surgery
- SM
- MRM
- Radical Mastectomy
- BCS / BCT
Chemotherapy
Radiotherapy
Targeting cell therapy
Hormonal Therapy
BCT on Breast Ca
Head and Neck
Anatomy
Anterior Triangle middle of
the neck, the
sternocleidomastoid muscle
and lower border of the
mandible
-submental triangle
-submandibular triangle

Posterior Triangle-
sternocleidomastoid, the
anterior border of the
trapezius, and the middle third
of the clavicle
Triangle Anatomy
Complex region

300/ 800 nodes located in


HAN region
Salivary glands
Thyroid gland
etc
Lymph Node Identification
Level 1 contains the submental
and submandibular nodes.

Level 2 is the upper third of the


jugular nodes medial to the SCM,
and the inferior boundary is the
plane of the hyoid bone (clinical)
or the bifurcation of the carotid
artery (surgical).

Level 3 describes the middle


jugular nodes and is bounded
inferiorly by the plane of the
cricoid cartilage (clinical) or the
omohyoid (surgical).

Level 4 is defined superiorly by


the omohyoid muscle and
inferiorly by the clavicle.

Level 5 contains the posterior


cervical triangle nodes.

Level 6 includes the paratracheal


and pretracheal nodes.
Neoplastic Masses

Primary
Secondary

Primary tumors
- Benign
- Malignant

Base on Lymph Node Level Identification


we can predict primary tumor that metastasis in the
neck Lymph Node
Thank You

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