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
