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UPDATE ON COLORECTAL CANCER

AVIT SUCHITRA
PENDAHULUAN
Karsinoma kolorektal (KKR) merupakan
keganasan ke 4 terbanyak di dunia
Amerika Serikat penyebab kematian ke 2
terbanyak (terlepas dari gender)
Angka kematian 530.000 / tahun
Data Depkes : 1,8/100.000 penduduk
(Syamsuhidajat, 1986)
Indonesia 12,8 per 100.000 penduduk usia
dewasa dengan mortalitas 9,5% dari semua
kanker (Globocan 2012)
Diagnosis dini kunci utama keberhasilan
terapi
Estimated age-standardised rates (World)
per 100,000
Trends in incidence of colorectal cancer in selected countries: age-standardised
rate (W) per 100,000, ( men-left, women-right)

GLOBOCAN,IARC,2012
ETIOLOGY (KKR 2014)
Race
Physical activity for 30 minutes in 5 or more days
in a week incidence
Red meat consumption and long processed food
incidence eat more fruits and vegetables
Smoking
Alcohol abuse
Estrogen
INCIDENCE
http://paonessacrs.com/colon-and-rectal-cancer
PREDILEKSI TUMOR

http://www.aboutcancer.com/colon_mayo.
HISTOPATOLOGI

Adenocarcinoma : 90-95%
Musinous adenocarcinoma : 10 %
Signet ring cell Ca
Squomous cell Ca
Oat cell Ca
Undiferentiated cell Ca
Resiko sedang
Individu berusia 50 tahun atau lebih
Individu yang tidak mempunyai riwayat KKR
atau inflammatory bowel disease
Individu tanpa riwayat keluarga KKR
Individu yang terdiagnosis adenoma atau KKR
setelah berusia 60 tahun.
Resiko tinggi :
Individu dengan riwayat polip adenomatosa
Individu dengan reseksi kuratif KKR
Individu dengan riwayat keluarga tingkat
pertama KKR atau adenoma kolorektal
Individu dengan riwayat inflammatory bowel
disease yang lama
individu dengan diagnosis atau kecurigaan
sindrom hereditary non-polyposis colorectal
cancer (HNPCC) atau sindrom Lynch atau
familial adenomatous polyposis.
DETEKSI DINI

Tujuan : mencari lesi pra kanker terapi


kuratif

Indikasi : individu dengan resiko sedang /


tinggi
Metode :
Pemeriksaan untuk mendeteksi adanya kanker
(FOBT)
Pemeriksaan untuk mendeteksi kanker dan lesi
prakanker lanjut
Pada orang dewasa dengan resiko sedang,
skrining harus dimulai pada individu
berusia 50 tahun dengan pilihan berikut :

FOBT setiap 1 tahun


Sigmoidoskopi fleksibel setiap 5 tahun
Kolonoskopi setiap 10 tahun
Barium enema dengan kontras ganda setiap 5
tahun
CT colonografi setiap 5 tahun.
DIAGNOSE
Chief complaints and physical diagnosis:
Anal bleeding followed by increase defecation
frequention and/or diarrhea for at least 6 weeks
(every age)
Anal bleeding without other symptoms (over 60
years)
Increase defecation frequention and/or diarrhea for at
least 6 weeks (over 60 years)
Palpable mass at right iliac fossa (every age)
Intraluminal mass at rectum
Signs of bowel obstruction
Iron deficiency anemia
Digital rectal examination
Every patient with anorectal signs
Determine anal sphincter patency
Determine the size and the degree of tumor fixation
in patien with middle and lower rectal cancer
DIAGNOSIS
DIAGNOSE

History taking
Physical
examination
Laboratory
findings

Health and Medicine,2014


Diagnostic Imaging :
Colonoscopy
Barium Enema
CT Colonografi
ERUS
Virtual Endoscopy
CT Scan triple contrast
MRI
AJCC TNM STAGING,7 ED,2014
AJCC,7 Ed,2014
STAGING AJCC

AJCC,7 Ed,2014
Colorectal cancer management
Stadium 0 : local excision
Stadium I : wide surgical resection with
anastomosis without chemotherapy.
Stadium II : wide surgical resection with
anastomosis and chemotherapy (for
high risk)
Stadium III : wide surgical resection with
anastomosis and chemotherapy
Stadium IV :primary tumor resection with
metastasis that still resectable or
syst emic chemotherapy

Penatalaksanaan Kanker Kolorektal 2014


NCCN Guidelines Version 2.2016 Colon Cancer
NCCN Guidelines Version 2.2016 Colon Cancer
DECISIONAL ALGORITHM FOR URGENT TREATMENT OF
OBSTRUCTIVE COLON CANCER
RECTAL CANCER
Surgical resection is the one choiche of therapy and with chemoradiation will
increased 5 year survival rate depending on stage and location of the tumor
The tumor can managed
Local Resection
LAR
APR
Resection and anastomosis
Stage I, II and III
Stage IVA/IVB Resectable
Colostomy
Stage IVA/IVB Non Resectable

Maingots ABDOMINAL OPERATIONS 12th Edition,2013


Rectal Cancer

Penatalaksanaan Kanker Kolorektal 2014


NCCN Guidelines Version 2.2016 Rectal Cancer
NCCN Guidelines Version 2.2016 Rectal Cancer
COLOSTOMY FOR RECTAL CANCER

POOR GENERAL CONDITION


Hypotensive shock
Severe Comorbidity
Advance Age
LOCAL COMPLICATION
Perforation with peritonitis
History of radiation

Current Indication for Hartmann Procedure, Flumeraux, Barbieux, A. Hamy


Maingots ABDOMINAL OPERATIONS 12th Edition,2013
RECTAL CANCER
DIVERTING LOOP ILEOSTOMY
Low anastomosis < 5 cm
History of radiation, perioperative steroid use, malnutrition
Elderly patient with comorbid.
Ileostomy can be closed with in 8 weeks
HARTMAN PROCEDURE
poor general condition (hypotensive shock at the time of surgery, severe
comorbidity, and advanced age (mak-ing the likelihood of any eventual
reoperation for colectomy unlikely), or local complications (associated
peritonitis) may contribute to making the Hartmann procedure.
COLOSTOMY/ ILEOSTOMY PALLIATIVE
Permanent diversion followed by chemotherapy, Palliative resection with
permanent colostomy and Palliative resection with restoration of GI continuity.
STENTING

Current Indication for Hartmann Procedure, Flumeraux, Barbieux, A. Hamy


Maingots ABDOMINAL OPERATIONS 12th Edition,2013
TERAPI AJUVAN
Kemoterapi
Targetted therapy
Radioterapi
Mengurangi resiko kekambuhan lokal, terutama
pada pasien dengan histopatologi yang
berprognosis buruk
Meningkatkan kemungkinan prosedur preservasi
sfingter
Meningkatkan tingkat resektabilitas pada tumor
yang lokal jauh atau tidak resektabel.
Mengurangi jumlah sel tumor yang viable.
SURVEILENS
PROGNOSIS
SUMMARY

Kanker kolorektal bisa disembuhkan jika


ditemukan dalam stadium awal
Pentingnya skrining dan deteksi dini dari gejala-
gejala awal suatu keganasan yaitu dengan
anamnesa, pemeriksaan fisik dan pemeriksaan
penunjang
Faktor resiko kita kelompokan yaitu sedang dan
berat
Terapi tergantung dari stadium pasien
Terapi dapat berupa pembedahan, kemoterapi,
dan radioterapi