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Daftar Riwayat Hidup

STAF DEPARTEMEN ILMU BEDAH FK-UNHAS


DIVISI : Bedah Onkologi
Nama Dokter : Prof. Dr. dr. Daniel Sampepajung, Sp. B(K)
Alamat: : Jl. Baitul Rahman No. 65 A Makassar
NO. HP : 0811441291
Spesialis : Konsultan Bedah Onkologi
DATA PRIBADI
Tempat, Tanggal lahir : Tana Toraja, 20 Desember 1947
NIP : 194712201973021001
NIDN : 0020124701
Pangkat /Golongan : Pembina Utama Muda / IV c
Jenis kelamin : Laki- Laki
Status : Menikah
Nama Istri : Dra. Caroline Monica Wilhelmine Poli, MM
Jumlah Anak : 3 orang
Nama Anak 1. Mita Dathania Sampepajung, SE, MSc
2. dr. Elridho Sampepajung, Sp. B
3. Daniella Cynthia Sampepajung, SE
Hobby : Olahraga
Agama : Kristen
Email : onkologi_mks@yahoo.com
Alamat kantor : RS. Unhas Lt. 1 Dalam Poli
(Jl. P. Kemerdekaan Km. 11 Tamalanrea Makassar - 90245)
Telepon / Fax : 0411-587107
LATAR BELAKANG PENDIDIKAN
Tahun 1961 : SD Negeri I Makale Tana Toraja
Tahun 1964 : SMP Katolik Makale Tana Toraja
Tahun 1967 : SMA Katolik Makale Tana Toraja
Tahun 1975 : Dokter Umum FK-UNHAS Makassar .
Tahun 1981 : Ahli Bedah FK-UNHAS Makassar
Tahun 1996 : Ahli Bedah Onkologi dari PERABOI
Tahun 2003 : Program S3 Pasca Sarjana FK-UNHAS
PENGALAMAN KERJA
Asisten Luar Biasa Bagian Anatomi FK-UNHAS tahun 1970.
Dosen Bagian Anatomi FK-UNHAS tahun 1973 – 1981.
Asisten Bagian Bedah FK-UNHAS tahun 1976 – 1981.
Dosen tetap Bagian Bedah FK-UNHAS tahun 1981 sampai sekarang.
Ketua Program Studi PPDS I Ilmu Bedah FK-UNHAS Juli tahun 2002 - 2006.

PENGALAMAN ORGANISASI
Anggota Ikatan Dokter Indonesia (IDI)
Anggota Ikatan Ahli Bedah Indonesia (IKABI)
Anggota Perhimpunan Onkologi Indonesia (POI)
Anggota Perhimpunan Ahli Bedah Onkologi Indonesia (PERABOI)
Anggota World Federation of Surgical Oncologi Society (WFSOS)
TEMPAT PRAKTEK
No. STR : 7311101211048846
Berlaku sampai : 6 November 2016
Tempat Praktek / RS 1
Alamat : RS. Ibnu Sina
No. SIP : 446/164.10/DS-B/SIP.1/DKK/VI/2012
Masa berlaku : 6 November 2016
Tempat Praktek / RS 2
Alamat : RS. Akademis
No. SIP : 446/165.04/DS-B/SIP.2/DKK/VI/2012
Masa berlaku : 6 November 2016
Tempat Praktek / RS 3
Alamat : Jl. Jend. Urip Sumohardjo No. 119
No. SIP : 446/166.10/DS-B/SIP.3/DKK/VI/2012
Masa berlaku : 6 November 2016
PRINCIPLES OF SOLID CANCER
MANAGEMENT
Prof. Dr. dr. Daniel Sampepajung, Sp.B(K)Onk

MABI, 21 JULY 2018


CANCER STATISTICS

 32.5 million live with cancer worldwide


 14.1 million new cases each year worldwide
 Most Cancer:
1. Lungs cancer
2. Breast cancer
3. Colorectal cancer
4. Prostate cancer

 Indonesia ; incidence 1.4 ‰ in 2016


estimated 347,792 cases
 Solid Cancer : 70 % of all Neoplasms
PRINCIPLES OF CANCER MANAGEMENT

 The Principles management of cancer is different from the disease in general


 Appropriate cancer management may reduces morbidity and mortality
 Treatment of cancer ; personalized, multidisciplinary and multimodality 
Surgery, Chemo-tx, Radio-tx, hormone-tx, targeting-tx, Immuno-tx, gen-tx
 It is important to determine the purpose of care ; Curative or palliative
 The purpose of cancer management
 Cures
 Prolong life
 Improve quality of life
 Reduce symptoms
STEPS OF CANCER MANAGEMENT
Management of patients suspected of having malignant neoplasms:

I DIAGNOSIS
DISEASE IN GENERAL:
II STAGING I. DIAGNOSIS
II. THERAPY
III PERFORMANCE STATUS III.PROGNOSIS

IV PLANNING OF OPTIMAL THERAPY

V IMPLEMENTATION OF THERAPY
VI EVALUATION
d
I DIAGNOSIS
c

b
PATHOLOGY
a

IMAGING

CANCER MANAGEMENT
CLINICAL I. Diagnosis
II. Staging
EXAMINATION III. Performance Status
IV. Planning
ANAMNESIS V. Implementation
VI. Evaluation
I.a) ANAMNESIS

 CHIEF COMPLAINT
 ONSET
 ACCOMPANY SYMPTOMS
 METASTASIS SYMPTOMS
 RISK FACTORS
 PAST MEDICAL HISTORY
 FAMILY DISEASE HISTORY
 DIET
CANCER MANAGEMENT
I. Diagnosis
II. Staging
III. Performance Status
IV. Planning
V. Implementation
VI. Evaluation
I.b) CLINICAL EXAMINATION
STATUS GENERALIS
 GENERAL CONDITION
 VITAL STATUS

LOCAL STATUS
 LOCATION
 SIZE
 CONCISTENSY
 SURFACE
 MOBILE
 PAIN
REGIONAL STATUS CANCER MANAGEMENT
I. Diagnosis
 REGIONAL LYMPH NODE
II. Staging
III. Performance Status
IV. Planning
V. Implementation
VI. Evaluation
I.c) INVESTIGATION

 LABORATORY
 TUMOR MARKER
 X-RAY
 USG
 MAMMOGRAPHY
 CT SCAN
 MRI
 PET SCAN

CANCER MANAGEMENT
I. Diagnosis
II. Staging
III. Performance Status
IV. Planning
V. Implementation
VI. Evaluation
I.d) PATHOLOGY
 FNAB
Citology
Cancer Cell  Benign cell
 Malignant Cell

 CORE BIOPSY
HISTOPATHOLOGY
 INCISION BIOPSY
(GOLD STANDAR)
 EXCISION BIOPSY
Histopathology
 Type
 Grade CANCER MANAGEMENT
 LVI I. Diagnosis
II. Staging
III. Performance Status
 FROZEN SECTION IV. Planning
 IMMUNOHISTOCHEMISTRY V. Implementation
(ER,PR,HER2, Ki67) VI. Evaluation
II STAGING & STADIUM

AIM CLASSIFICATION
 DETERMINING TUMOR EXTENSION • STAGING DEPENDS TYPES OF CANCER
 DETERMINING TYPES OF THERAPY • TNM SYSTEM FOR SOLID TUMORS
 COMPARISON OF THERAPY RESULT • OTHER SYSTEM:
 AJCC
 KNOWING PROGNOSIS  UICC
 DUKE’S  Colorectal cancer
 FOLLOW UP  BRESLOW
 COMMUNICATIONS  CLARK Skin cancer
 FIGO  gynecology

CANCER MANAGEMENT
I. Diagnosis
II. Staging
III. Performance Status
IV. Planning
V. Implementation
VI. Evaluation
TNM CLASSIFICATION Ex. Breast Cancer

T = Tumour Extension
N = Invading regional lymph nodes

M = Metastasis
T N M STAGING
Ex. BREAST CANCER
T N M STAGE GROUP & FIVE YEARS SURVIVAL RATES
STAGE

I
S
IIA Early Breast cancer
T (EBC)
Ex. Ca Mammae IIB
A
IIIA
G Locally advanced
IIIB (LABC)
E
IV Metastatic
(MBC)
III PERFORMANCE STATUS

 PHYSICAL CAPACITY
 RELATED TO COMORBID DISEASES
- Hypertension, DM, Kidney, Heart, etc -
 SCALE
 KARNOFSKY ( 100 – 0 )
 WHO / ZUBROD ( 0 – 4 )
 ECOG ( EASTERN COOPERATIVE ONCO-LOGY GROUP )
CANCER MANAGEMENT
I. Diagnosis
II. Staging
III. Performance Status
IV. Planning
V. Implementation
VI. Evaluation
III PERFORMANCE STATUS
IV PLANNING
 DIAGNOSIS
 STAGING TUMOR PURPOSE OF THERAPY

 PERFORMANCE STATUS

CANCER MANAGEMENT
I. Diagnosis CURATIVE PALLIATIVE
II. Staging
III. Performance Status
IV. Planning
V. Implementation
VI. Evaluation
OBJECTIVES OF CANCER THERAPY
1. CURATIVE
Eradicating cancer, clinically and pathologically cancer-free, returns
the life expectancy of patients like healthy individuals of the same
age and gender

2. PALLIATIVE
If curative goals can not be achieved, cancer treatment goals shift
to palliative, maintain functional status, Relieve symptoms, improve
quality of life, and strive to extend life.
NCI, 2017
De Vita, 2017
Harrison’s, 2018
TYPES OF THERAPY

NEOADJUVANT PRIMARY THERAPY ADJUVANT

OPERATION
• CHEMOTERAPY • CHEMOTHERAPY
RESECTABLE • HORMONAL
• RADIOTHERAPY
• RADIOTHERAPY
• HORMONE THERAPY
UNRESECTABLE • TARGETING THERAPY
• IMMUNOTHERAPY

• AIMS :
 DOWNSIZING
 RESPONSE THERAPY 70% Malignant Neoplasms  Solid Cancer
 SURGERY OPTIONS
OPERATION

THE BASICS OF CANCER SURGERY


1. The removal of the tumor must be sharp
2. Healthy tissue around the tumor should be removed
3. Adequate Safety Margin  types tumor, location
4. Blood less –operations fieldshould be clean
5. En block excision – removal of the tumor & metastasis in one unit
6. No Touch Technic
7. The biopsy field should be large enough
8. Previous operations or FNAs should be included in the next operation
9. Curative Operation 1x  Re-operation is less likely to be curative
enbloc Include previous operation Safety Margin
Extremity Longitudinal Incision
OPERATION
Ex. Ca Mammae

 Curative Operation
 Nipple / Skin Sparring Mastectomy
 Breast conserving Surgery
 Modified Radical Mastectomy
 Radical Mastectomy
 Paliative Operation
 Excision
 Debulking
 Simple Mastectomy
 Metastasectomy
 Breast Reconstruction
RADIOTHERAPY

 Radiotherapy uses radiation from radioactive or electromagnetic energy


 Radiation destroys the cell's genetic material so that the cell can not divide and grow again
 Direct and indirect effect
CHEMOTHERAPY

 The use of cytotoxic drugs


 Neoadjuvant Therapy  3 – 6 cycles
 Adjuvant therapy  3 weeks after surgery
 Palliative
HORMONAL THERAPY

Ex. Breast Cancer

 75% of Breast Cancer Patients


 IHC ER / PR positive  "hormonal therapy"
 Surgical Ablation: Bilateral Salphingo Ovarectomy
 Medical Ablation: Goserelin
 SERM: Tamoxifen
 Aromatase Inhibitor: Anastrozole, Letrozole

Ex. Thyroid Cancer


 Papillary/follicular Thyroid cancer
 Substitusion & supression Levothyrosin
TARGETING THERAPY
Ex. Ca Mammae

 25% of HER2 positive breast cancer patients

 IHC HER2 positive

 Can be given targeting therapy  Trastuzumab


V IMPLEMENTATION
DEPENDS ON:
 TUMOR FACTORS
DIAGNOSIS : TYPES OF TUMOR, GRADING
STAGE : SPREAD OF TUMOR

 PATIENT FACTORS
PERFORMANCE STATUS : PHYSICAL CAPACITY
PATIENT PREFERENCE, INFORMED CONSENT
CANCER MANAGEMENT
 MODALITY FACTORS I. Diagnosis
II. Staging
FACILITY III. Performance Status
IV. Planning
COMPETENCY
V. Implementation
VI. Evaluation
V IMPLEMENTATION
Ex. Breast cancer

Early Stage Advanced Stage


 Aim: Curative  Aim: Palliative
 Primary Therapy: Operation  Primary Therapy: Systemic Therapy
 Adjuvant: Chemotherapy Chemotherapy
Hormonal therapy Hormonal therapy
Radiotherapy  Adjuvant: Operation
Targeting Therapy Chemotherapy
Immunotherapy Hormonal therapy
Radiotherapy
Targeting Therapy
Immunotherapy
VI EVALUATION

 EVALUATION
RESPONSE THERAPY
RECURRENT
METASTASIS
 RECONSTRUCTION
 REHABILITATION
 FOLLOW UP
 3 month, 6 month CANCER MANAGEMENT
I. Diagnosis
 1, 3, 5 years
II. Staging
 till 20 years III. Performance Status
IV. Planning
V. Implementation
VI. Evaluation
CASE REPORT

Mrs. KS, 56 th, Wajo I. Diagnosis : Adenocarcinoma Mammae Dextra


• Anamnesis: Lump in the right breast, since II. Stage : cT3N0M0, stadium IIB
1 year ago, quickly enlarged III. Performance Status : Karnofsky 80%
• General Status: Good, normal activity IV. Planning:
• PE : Right Breast mass Ø 4 cm  Aim: Curative
 Primary Therapy: Operasi
Axilla : Lymph Node (-)
 Adjuvant Therapy: chemotherapy, hormonal
• USG : right breast mass Ø 4 cm targeting therapy
• Biopsy: Adenocarsinoma Mammae V. Implementation:
• IHC : ER/PR +ive, Her2 +ive, Ki67 +ive  Curative Surgery : Modified Radical Mastectomy
 Adjuvant : Chemoterapy : CAF Regiment 6x
• Ro thorax : no metastasis
Hormonal : Tamoxifen 2 years
• USG Abdominal : metastasis hepar (-) Targeting : Trastuzumab while recurrent
V. Follow Up
CASE REPORT

Mrs. S, 41 th  International Hospital 15/11/2017 Tumor enlarged, Ulcus


31/02/2015 Lump in the right breast Ø 8 cm Consult to Surgical Oncologist
FNA : Adenoma Mammae
Excision  No pathology examined
06/04/2015 Appear Lump in right breast Ø 3 cm
FNA  IDC Mammae
MRM PA : IDC, Moderate Grade
11/08/2015 Residif Ø 3 cm
Excision  PA : IDC Moderate grade
20/10/2015 Residif Ø 6 cm  Incision
IHC : ER/PR - , HER-2 +
10/11/2015 Consult to HOM  Initial treatment are Important
Chemotx Herceptin + Paclitaxel 8 cycles Re-operation have small chance to be curative
Chemotx Brexel + Doxo + Cyclophosphamide
CASE REPORT

Mr. M, 60 th I. Diagnosis : Papillary Thyroid Cancinoma


• Anamnesis: Lump in the Neck, since 1 year II. Stage : cT3N1bM0, stadium IVA
ago, quickly enlarged III. Performance Status : Karnofsky 80%
• General Status: Good, normal activity IV. Planning:
• PE : Thyroid mass Ø 8 cm  Aim: Curative
 Primary Therapy: Operation
Lymph Node mass Level 2,3,4
 Adjuvant Therapy: RAI, hormonal therapy
• CT Scan : Thyroid mass Ø 8 cm, multiple targeting therapy
Lymph node mass level 2,3,4 V. Implementation:
• FNA: Papillary Thyroid Cancer, Infiltrating  Surgery : Total Thyroidectomy + MRND type III
Lymph Node  Adjuvant : Hormone therapy : Levothyrosin
• Ro thorax : no metastasis  Substitusion + Supression
RAI
• USG Abdominal : No metastasis
V. Follow Up
SUMMARY

1. THERE ARE SIX CANCER MANAGEMENT STEPS


2. OBJECTIVES OF CANCER THERAPY: CURATIVE OR PALIATIF
3. SELECTION OF THERAPY MODALITY
 TUMOR FACTORS - TUMOR TYPES, STADIUM & GRADING
 PATIENT FACTORS - PERFORMANCE STATUS, PATIENTS PREFERENCE, INFORMED CONSENT
 THERAPY FACTORS - AVAILABILITY OF FACILITIES, FUNDS, COMPETENCIES
THANK YOU!