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KANKER

KANKER. PADA ANAK. 1. KEGANASAN PADA DEWASA DAN ANAK. PADA DEWASA: KANKER PARU, PAYUDARA, USUS BESAR, PROSTAT (JARANG PADA ANAK)  KLASIFIKASI BERDASAR LETAK/ASAL ORGAN PADA ANAK: BERVARIASI, TUMOR DAPAT BERASAL DARI LOKASI PRIMER YANG BERBEDA. *.

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KANKER

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  1. KANKER PADA ANAK 1

  2. KEGANASAN PADA DEWASA DAN ANAK PADA DEWASA: KANKER PARU, PAYUDARA, USUS BESAR, PROSTAT (JARANG PADA ANAK)  KLASIFIKASI BERDASAR LETAK/ASAL ORGAN PADA ANAK: BERVARIASI, TUMOR DAPAT BERASAL DARI LOKASI PRIMER YANG BERBEDA * * * *

  3. 12 DIAGNOSIS UTAMA KEGANASAN PADA ANAK ( I I C C ) I. LEUKEMIA VII. TUMOR HATI II. KEGANASAN LIMFOMA VIII. TUMOR TULANG & RES IX. SARKOMA JAR. III. TUMOR INTRAKRANIAL IKAT IV. TUMOR SARAF SIMPATIK X. TUMOR GERM CELL V. RETINOBLASTOMA XI. TUMOR EPITEL VI. TUMOR GINJAL XII. TUMOR LAIN

  4. DI DUNIA (1991) Epidemiologi Tu. Hati Lain-lain Leukemia Retinoblastoma Tu. Tulang Tu. Wilm’s Tu. Otak Tu. Jar. Ikat Neuroblastoma Limfoma Neuroblastoma Tu. Hati Lain-lain Tu. Tulang Leukemia Tu. Otak Tu. Jar. Ikat DI RSS. (1992-1998) Tu. Wilm’s Retinoblastoma Limfoma

  5. RADIASI: IONISASI, ULTRAVIOLET INFEKSI FAKTOR PRAKONSEPSI: ROKOK, RADIASI, SITOSTATIKA GENETIK KARSINOGENESIS LAIN-LAIN ETIOLOGI

  6. KELUHAN UTAMA PADA KEGANASAN KELUHAN UTAMA KEGANASAN PUCAT, LEMAH LEUKEMIA, LIMFOMA LEHER BENGKAK LIMPHOMA, LEUKEMIA DEMAM, NYERI TULANG EWING-CA, LEUKEMIA BINTIK PUTIH MATA RETINOBLASTOMA MASA ABDOMEN TUMOR WILM’S, HATI NEUROBLASTOMA NYERI KEPALA, MUNTAH TUMOR OTAK JATUH OSTEOSARKOMA

  7. DIAGNOSIS BANDING KELUHAN/GEJALADx. BANDINGKEGANASAN PANSITOPENIA INFEKSI LEUKEMIA PERDARAHAN KOAGULO/THROMBO LEUKEMIA LIMFADENOPATI INFEKSI LIMFOMA NYERI KEPALAMIGRAIN, SINUSITIS TUMOR OTAK NYERI TULANG INFEKSI TUMOR TULANG MASA ABDOMEN KISTE, INFEKSI TUMOR WILM’S, NEUROBLASTOMA

  8. LIMFOMA Limfadenopati TUMOR OTAK Nyeri kepala, muntah

  9. RETINOBLASTOMA Mata kucing Meluas ke orbita Tumor abdomen TUMOR WILM’S , NEUROBLASTOMA, TUMOR HATI

  10. PRINSIP DIAGNOSIS • ANAMNESIS • EVALUASI KLINIS • LABORATORIUM • PATOLOGI • PENCITRAAN • MARKER BIOLOGI

  11. PRINSIP TERAPI NON KAUSA • SUPORTIF • SIMPTOMATIK • KOMPLIKASI KAUSA • RADIASI • SITOSTATIKA • OPERASI

  12. CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA

  13. INTRODUCTIONLEUKEMIA: 25-35% CHILDHOOD CANCER (ALL: 80% & ANLL:20%) ALL: - MALIGNANT DISEASE - PROGRESSIVE INFILTRATION OF BONE MARROW & LYMPHATIC ORGANS BY IMMATURE LYMPHOID CEL/LYMPHOBLASTS UP TO 1970: AS INCURABLE DISEASECAN IT BE CURED ?

  14. ETIOLOGY& EPIDEMIOLOGYRADIATION, CHEMICALS, DRUGS, VIRUSES and GENETIC ABNORMALITIESINCIDENCE: 3 per 100.000 CHILDREN PEAK: 2-6 YEARSSARDJITO (1992- 1998) LEUKEMIA: 48% INDONESIA PROBLEMS: REGISTRATION, PROTOCOL, SPECIFIC DIAGNOSIS, COST (DRUGS & SUPORTIVE)

  15. EFS(%) • 100 TREATMENT OUTCOME • 75 Intensive Tx 1980’s • CNS Prophylaxis 1970’s • 25 Combination Agent 1960’s • 0 Single Agent 1950’S • 1 2 3 4 5 6 10 15 20 (YEARS)

  16. CLINICAL SIGNSYMPTOMS: Malaise, Fatique Bleeding, Bruising Fever Bony pain, Lymphadenophaty (80%)Splenomegali & Hepatomegaly (70%-75%) Enlargement of the TESTES CNS:(Intracranial pressure> & cranial nerve palsies)

  17. LABORATORY & RADIOLOGYPeripheral blood:Anemia, Thrombocytopenia, Neutropenia Bone Marrow Aspirate: > 25% leukemic lymphoblastsSpecial stains: Biochemical, immunologic, cytogeneticRadiographic: Mediastinal mass (5-10%) 5%-10%: Diagnostically chalenging ALL 1.flv

  18. BMP

  19. FAB CLASSIFICATIONMorphological CLASSIFICATION: French-American-British (FAB) L1, L2, and L3L1: 80% L3: < 2% The remainder: L2 L1: Higher remission Prolonged survival than L2 and L3, L3: The worst prognosis

  20. ALL MANAGEMENT in childhoodFour COMPONENTS - REMISSION INDUCTION - INTENSIFICATION - CNS TREATMENT - CONTINUATIONThe purpose: Eradicate leukemic cells/their progenitors Preserving normal progenitors

  21. Disease Clin. Dx of ALL Made: Detectable Tx Started1012 - A D Relapse1010 - B108 - Compl. Remission Achieve106 -104 - C Tx Stopped/Ineffective 102 - 100 -One Malignant Cell Patient Cured 10-1 - E 2 4 6 8 10 12 16 18 20 22 24 (WEEKS)Number of Leukemic Cell

  22. REMISSION INDUCTIONReduce the LEUKEMIC CELL BURDEN CLINICALLY/HEMATOLOGICALLY UNDETECTABLE LEVELRegimens: VCR, DEXA, L-ASP, DNR & MTx intrathecallyPROBLEMS:DIFFICULT DIAGNOSIS EDUCATION/INFORMATION NO COST, NO DELAY COMPLICATIONS/FAILURE video csf.CSF

  23. CNS TREATMENT Prolonged disease free survival Protect against late bone marrow relapseCNS Tx REGIMENS: - INTRATHECAL drugs - Systemically administered drugs - Craniospinal irradiation (Now: Avoided) video.LP3 schem.flv video.lp1 tech.flv video lp.flv.flp

  24. CESSATION THERAPY IN GENERAL: STOP 2-5 YEARS AFTER Dx CURRENT Tx: AFTER 2 YEARS OF Tx REDUCTION TO 18 MONTHS: INCREASE RELAPSE RATE RELAPSE: IN THE FIRST 12 MONTHS HIGHER THAN IN SUBSEQUENT YEARS 4-6 YEARS AFTER CESSATION Tx: RARE

  25. Complications:- Infection- Bleeding- Stomatitis- Moon face- Striae- Alopecia- Malnutrition- Psychologic ALL.flv

  26. SUPPORTIVE CAREMORTALITY << & SURVIVAL >>NURSES: AWARE & OPTIMAL CAREHEMORRHAGE: Transfusions Nutrition INFECTION: - ANTIBIOTIC - SEMISTERILE ROOM- ASEPTIC CARE ALL.flv

  27. SUPPORTIVE CARE- Asscociation of leukemia family- Education- Fund rising- Psychologic support- Drug discount

  28. INDUCTION

  29. CONSOLIDATION MAINTANANCE

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