Learning Objectives
http://www.webmd.com/a-to-z-guides/benign-tumors-causes-treatments
• Neoplasma: kumpulan sel abnormal yang terbentuk oleh sel-sel yang
tumbuh terus menerus secara tidak terbatas, tidak berkoordinasi dengan
jaringan sekitarnya dan tidak berguna bagi tubuh. –Patologi, FKUI
• Tumor : Pertumbuhan baru suatu jaringan dgn multiplikasi sel yg tdk
terkontrol dan progresif. – Dorland
In anatomy, soft tissues are the tissues that connect, support, or surround other
structures and organs of the body, not being hard tissue such as bone. Soft tissue includes
tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial
membranes (which are connective tissue), and muscles, nerves and blood
vessels (which are not connective tissue).
http://www.cancer.gov/publications/dictionaries/cancer-terms?CdrID=45882
• Tumor jaringan lunak terbentuk di jaringan lunak tubuh termasuk otot, tendo,
jaringan lemak, pembuluh darah, pembuluh limfe, saraf dan jaringan sekitar sendi.
http://www.cancer.gov/types/soft-tissue-sarcoma
Estimated Number* of New Cancer Cases and Deaths by Sex, US, 2016
American Cancer Society: Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer Society, 2016. Available online. Last accessed January 14,
2016.
Karakteristik Tumor Jinak dan Ganas
Karakteristik Tumor jinak Tumor ganas
Batas tumor Jelas Tidak jelas
Kapsul Jelas Tidak jelas / pseudokapsul
Tumor Grade T0
T1
T2
No evidence of primary tumor
Tumor <5 cm
Tumor >5 cm
Sumber: http://www.cancer.gov/types/soft-tissue-sarcoma/patient/adult-soft-tissue-treatment-pdq#section/_26
Stage I
• stage IA,
• the tumor is low-grade (likely to grow and spread slowly) and 5 centimeters or
smaller.
• It may be either superficial (in subcutaneous tissue with no spread into
connective tissue or muscle below) or deep (in the muscle and may be in
connective or subcutaneous tissue).
• stage IB,
• the tumor is low-grade (likely to grow and spread slowly) and larger than 5
centimeters.
• It may be either superficial (in subcutaneous tissue with no spread into
connective tissue or muscle below) or deep (in the muscle and may be in
connective or subcutaneous tissue).
Stage II
• In stage IIA,
• the tumor is mid-grade (somewhat likely to grow and spread quickly) or high-
grade (likely to grow and spread quickly) and 5 centimeters or smaller.
• It may be either superficial (in subcutaneous tissue with no spread into
connective tissue or muscle below) or deep (in the muscle and may be in
connective or subcutaneous tissue).
• In stage IIB,
• the tumor is mid-grade (somewhat likely to grow and spread quickly) and
larger than 5 centimeters.
• It may be either superficial (in subcutaneous tissue with no spread into
connective tissue or muscle below) or deep (in the muscle and may be in
connective or subcutaneous tissue).
Stage III
• In stage III, the tumor is either:
• high-grade (likely to grow and spread quickly),
• larger than 5 centimeters, and
• either superficial (in subcutaneous tissue with no spread into connective
tissue or muscle below) or deep (in the muscle and may be in connective or
subcutaneous tissue); or any grade, any size, and has spread to nearby lymph
nodes.
• Stage III cancer that has spread to the lymph nodes is advanced stage
III.
Stage IV
• In stage IV, the tumor is any grade, any size, and may have spread to
nearby lymph nodes.
• Cancer has spread to distant parts of the body, such as the lungs.
4. Pemeriksaan Tumor Jinak
Pemeriksaan klinik
• Anamnesa
• Pemeriksaan fisik:
Inspeksi
Palpasi
Perkusi
Auskultasi
Rectal toucher
Pemeriksaan laboratorium
• Tujuan:
Mengetahui keadaan penderita apakah ada penyulit kanker atau
penyakit sekunder
Persiapan terapi yang akan dilakukan
• Pemeriksaan yang dilakukan:
Darah lengkap
Urin lengkap
Tes fungsi hati
Tes fungsi ginjal
Gula darah
Faal hemostatik
Protein serum
Alkali fosfatase
Elektrolit serum
LDH
Asam urat
Serum imunoglobin
Pemeriksaan patologi anatomi
• Digunakan untuk menentukan:
Diagnosis patologi atau morfologi dan menentukan jaringan asal tumor padat
Sifat tumor
Derajat diferensiasi sel
• Bahan diperoleh dari biopsi tumor padat atau spesimen operasi
• Terdiri dari biopsi tertutup dan biopsi terbuka
Biopsi tertutup
• Biopsi aspirasi dengan jarum • Keuntungan:
(Needle Aspiration Biopsy): Sedikit invasif
mengambil sebagian kecil Tidak meninggalkan scar
jaringan tumor padat dengan Bisa dilakukan di tempat praktek
cara disedot menggunakan dokter jika tidak membutuhkan
jarum yang ditusukkan kedalam guiding imaging
jaringan tumor • Kerugian:
Fine Needle Aspiration Biopsy Sampel yang diambil biasanya
Core Biopsy sedikit
• Biopsi endoskopi: mengambil
sebagian kecil jaringan tumor
dengan alat endoskopi
http://www.thyroidmanager.org/wp-content/uploads/2015/04/fig2.png
Biopsi terbuka
• Biopsi insisi • Biopsi eksisi (biopsi in toto)
Mengambil sebagian kecil jaringan Mengambil seluruh tumor secara
tumor padat dengan pisau bedah eksisi
Keuntungan: jaringan diambil Keuntungan: dapat dijadikan
lebih banyak sebagai terapi untuk tumor jinak
Kerugian: lebih invasif, menyisakan Kerugian: lebih invasif, menyisakan
scar, butuh waktu untuk recovery scar, butuh waktu untuk recovery,
ada jaringan sehat yang terangkat
5. Penanganan dan Penatalaksanaan
Tumor Jinak
Apley’s System of Orthopaedics and Fractures Ninth Edition
Renal
http://www.intechopen.com/source/html/42749/media/image3.jpeg
Apley’s System of Orthopaedics and Fractures Ninth Edition
Apley’s System of Orthopaedics and Fractures Ninth Edition
Pharmacological Treatment
• Cosmegen (Dactinomycin)
• Dactinomycin
• Doxorubicin Hydrochloride
• Eribulin Mesylate
• Gleevec (Imatinib Mesylate)
• Halaven (Eribulin Mesylate)
• Imatinib Mesylate
• Pazopanib Hydrochloride
• Trabectedin
• Votrient (Pazopanib Hydrochloride)
• Yondelis (Trabectedin)
• Drugs Combination: VAC
Non-Pharmacological Treatment
• Surgery
• Surgery (wide local excision) followed by radiation therapy.
• Surgery (amputation; rarely done).
• Surgery to remove cancer that has recurred in the lungs.
• Chemotherapy
• Radiation Therapy
• Follow up test
Surgery
Mohs Surgery
• This type of surgery removes as
little normal tissue as possible and
is often used where appearance is
important, such as on the skin.
Surgery
• Wide local excision: Removal of the tumor along with some normal tissue around
it. For tumors of the head, neck, abdomen, and trunk, as little normal tissue as
possible is removed.
• Limb-sparing surgery: Removal of the tumor in an arm or leg without
amputation, so the use and appearance of the limb is saved. Radiation therapy or
chemotherapy may be given first to shrink the tumor. The tumor is then removed
in a wide local excision. Tissue and bone that are removed may be replaced with
a graft using tissue and bone taken from another part of the patient's body, or
with an implant such as artificial bone.
• Amputation: Surgery to remove part or all of a limb or appendage, such as an
arm or leg. Amputation is rarely used to treat soft tissue sarcoma of the arm or
leg.
• Lymphadenectomy: A surgical procedure in which lymph nodes are removed and
a sample of tissue is checked under a microscope for signs of cancer. This
procedure is also called a lymph node dissection
Liposarcoma Surgery
Radiation therapy or chemotherapy may be given before or after
surgery to remove the tumor.
Ulkus diabetik
Kadar glukosa darah Penimbunan sorbitol
tdk terkendali & fruktosa
• http://www.cancer.gov/types/soft-tissue-sarcoma
• http://www.thyroidmanager.org/wp-content/uploads/2015/04/fig2.png
• http://medicalpicturesinfo.com/wp-content/uploads/2011/10/Leiomyoma-1.jpg