TUMOR OTAK

RSU Haji Surabaya

Dr.Neimy Novitasari Sp.S
 Jaringan Otak
Neuron : transduksi  transmisi
 persepsi dan respons. :

Vasa : mendukung neuron

Glia : menyediakan nutrisi, perekat

 GLIA

Mikroglia Makroglia

Ependima

Oligodendrosit

Astrosit
 Fungsi Glia
Membentuk otak, memisah & membungkus neuron (sinap).

Menghasilkan mielin (Schwann & oligodendrosit).

Arah migrasi pertumbuhan neuron

Produksi sitokin & NGF (mikro) & astrosit.

Produksi & sirkulasi cairan otak & hormon (ependima)

Membersihkan debris (mikroglia)

Sawar drh otak : tight junction (astrosit).

Fasilitasi arus impuls : ion & NT (astrosit)

 Astrosit dan oligodendrosit
• Terbanyak bintang • Lebih kecil dp astrosit.
• Jonjot panjang : vasa dg • Mielin di otak 
neuron bungkus berlapis.
• penyangga NT dan ion • Schwann cell 
di sinap bungkus saraf tepi.
• Paling tahan -- hipoksia
• Gliosis
(hipertrofi/plasia)
Ependima
• Kubus  dinding rongga
ventrikel & kanalis sentralis.
• Plexus choroid  cairan otak.
Hipotalamus  hormon  hipofisa.
• Cilia (panjang) & villi (pendek)
 sirkulasi cairan otak & spinal.

6
Neuron
Badan sel dan tonjolan panjang &
bercabang (neurit).
Akson :
Tonjolan tabung.
Panjang 0,1 mm – 3 m.
Impuls menjauhi badan sel.
Dendrit :
Pendek
Cabang banyak seperti pohon.
Impuls ke badan sel.
Deff. Diagnosa
 Age Incidence
• Adults
– - Supratentorial: 80-85%
– - Intratentorial: 15-20%

• - Children
– - Intratentorial: 60%
– - Supratentorial: 40%
 Insiden
Supratentorial Dewasa Anak Infratentorial Dewasa Anak
Anaplastik 45 % 7% Neurinoma 6%
astrositoma ( akustikus
termasuk
Glioblastoma
multiforme)

Meningioma 15% - Mentastase 4%

Metastase 12% - Hemangioblast 2%
oma
Astrositoma 8% 7% Astrositoma 1% 27%
Pituitari 4% - Meningioma 1%
adenoma
Craniofaringioma 1% 13% Meduloblastom 1% 24%
a
Oligodendroglio 1% 1% Epidermoidf < 1% 1%
ma
Limfoma < 1% 9% Ependimoma 6%

- neurilemmoma
- meningioma
- epidermoid / dermoid cyst
- arachnoid cyst
- metastasis
- haemangioblastoma
- Medulloblastoma
- astrocytoma - cerebellum
brain stem
Based on tumor origine

Primary vs secondary

• Asal dari otak

Primary • >> anak

• Metastase dari organ lain ke

Secondary otak
Cell character

Benign Malignant

slow-growing Cancerous

Fast-growing and
Noncancerous
aggressive

do not spread to can invade nearby

surrounding tissue. tissue and also are
more likely to recur
after treatment.
Gen yang mengalami kerusakan dan dapat
menimbulkan kanker adalah :

1. ↑ protoonkogen

2. ↓ Tumor supressor dena

3. The genes that regulated programmed cell

death (apoptosis)

4. gangguan DNA repair

BASIC ONCOGENESIS

Molecular Carcinogenesis of Cancer (Kumar, et al., 2010)

Perjalanan klinis dan karakteristik GBM (Maher, et al.,2005)
 Permasalahan
• 18,400 tumor : otak primer maligna
(2004)  10,540 pria & 7,860 wanita.
• Diperkirakan 12,690 pasien meninggal
akibat tumor di tahun 2004.
• Sebesar 1.4% kematian semua kanker
• Accounts for 2.4% of all cancer
related deaths
 Insiden tumor otak
• Annual incidence ~15–20 cases per 100,000
people.
• Annual incidence primary brain cancer in
children is about 3 per 100,000.
• >35 thn.
• Primary brain tumors /secondary ~ 50/50
~17,000  tu otak primer.
• Secondary brain cancer ; 20–30% of patients
with metastatic disease.
 What is a Brain Tumor?

• The World Health Organization (WHO)

recognizes 120+ different types of brain
tumors
• 3 Basic types (N. Vick):
– Tumors of the Brain – Gliomas –
– Tumors to the Brain – Metastases
– Tumors on the Brain – Meningiomas,
Pituitary Tumors, Acoustic Neuromas,
etc.
 Tumor otak yang sering dijumpai
• The most common childhood tumors are:
– 1. Astrocytoma
– 2. Medulloblastoma
– 3. Ependymoma
• The most common adult tumors are:
– 1. Metastatic brain tumors from lung, breast,
melanoma, and other cancers
– 2. Glioblastoma Multiforme
– 3. Anaplastic (Malignant) Astrocytoma
– 4. Meningioma
Klasifikasi Histologi Tumor Otak
Primer
• Tumor otak primer
– (bermeta-stase keluar otak)
• Grading tumor otak primer
– Klasifikasi WHO yang umum dipakai
• Derajat keparahan : I-IV
• Morfologi sel tumor
 Faktor Risiko
• Sindroma Genetik
– Neurofibromatosis 1neurofibromatosis multipel, malignant
peripheral nerve sheath tumors,dll.
– Neurofibromatosis 2 schwannoma, meningioma, glioma
– Retinoblastoma
– Li-Faumeni [TPS3]osteosarkoma, breast cancer
• Polimorfism genetik
• Ionisasi radiasi
• Nonionizing radiation exposure
• Virus
 What is the Cause of a Brain Tumor?
“Where facts are few, speculation flourishes”
1. Genetic – Altered genome – cancer genome-
Microarray Glioma Microarray NIH Study (Dr. H.
Fine) – REMBRANDT Data Base
– Personalized medicine
– Pharmacogenomics
– Total Cancer Care
2. Dietary
– 30% of cancers, in general, linked to diet
– Obesity promotes tumor growth
– Little is known about brain tumors
– Carcinogens or additives in diet???
 What is the Cause of a Brain Tumor?

3. VIRUS
– HPV , Vaccine
– Epstein-Barr Virus - PCNS Lymphoma
4. HORMONES
_ KB

5. PEPTISIDA
– Meningiomas – 3: 1 in females
– Incidence higher with Hormone Replacement
Therapy
– Tumors pregnancy
– Estrogen receptors targets for RU 486
 What is the Cause of a Brain Tumor?

5. Ionizing Radiation
Israeli immigrant children treated with
scalp RT for fungus developed gliomas,
meningiomas
Gliomas have developed years later at
radiation-sites for other tumors
Laboratory models support ionizing
radiation which causes misrepair of
DNA, and damage to DNA
?? CT Scans – 2% of cancer
incidence??????
 What is the Cause of a Brain Tumor?

7. Cell Phones
– Electromagnetic fields can induce mutations and DNA
damage in cell cultures
– Reports of higher incidence of brain tumors and leukemia
in children living near high energy towers and lines
– Epidemiological data to support this hypothesis is not
conclusive and the preponderance of data currently is that
cell phones do not contribute to brain cancer burden
 Tipe Tumor

1. Tumor Glia
– Astrositoma difus
– Glioma batang otak
– Astrositoma pilositik
– Astrositoma pilositik serebeler
– Astrositoma giant cell subependymal
– Glioblastoma Multiforme (GBM)
– Oligodendroglioma
– Ependymoma
– Myxopapillary Ependymoma
2. Primitive Neuroectodermal Neoplasms
– Medulloblastoma
 Tipe Tumor

3. Neoplasma of Meningeal Differentiation

• Meningioma
4. Tumors of Nerve Roots and Peripheral Nerves
• Schwannoma
• Intracranial Schwannoma
• Intraspinal Schwannoma
• Peripheral Schwannoma
• Neurofibroma
5. Primary Tumor arising from Cranium/Spinal
Cavity aren’t from Neural Tube/Crest
 Tipe Tumor

5. Primary Tumor arising from Cranium/Spinal

Cavity aren’t from Neural Tube/Crest
• Capillaray Hemangioma
• Primary Sarcoma
• Primary Lymphomas
• Pituatary Adenoma
6. Tumors of Maldevelopment
• Craniopharyngioma
• Germ Cell Neoplasms
• Epidermoid and Dermoid cysts
 Kenaikan Tekanan Intrakranial
• Sakit Kepala kronik progresif
• Mual / Muntah proyektil
• Mata kabur
• Lemah separuh badan, afasia
• Kesadaran menurun
• Gg kognitif
• Lethargi
• Kejang
• Papilledema, bradikardi, bradipnea
 Diagnosa Radiologi
1. Photo polos X ray :
1. Calsifikasi : meningioma ( hiperostosis ),
oligodendroglioma
2. Osteolitik : Primary / secondary boe
tumor, chordoma, nasopharyngeal ca.
3. TIK ↑ :sutura separasi ( bayi)
2. CT scan kepala
3. MRI
 Pemeriksaan
• Laboratorium • USG
– DL, LED
• Petanda tumor :
CEA, PSA, AFP
• Reseptor
progesteron
 Diagnosa Radiologis
Imaging
CT scan (plain + contrast)

MRI with Contrast (Gd) MRI preferred

sensitivity
resolution
three planer views

INTP - PPO, PHO, IAP.

P2 – 10/27
 Diagnosa Radiologi
• MRI dengan gadolinium merupakan pilihan
diagnosa tumor otak primer
– Imajing perlu untuk: diagnosa, perencanaan
operasi, imajing intraoperatif,
postoeperative care dan respons
pengobatan
– Gambaran bervariasi  histologinya
– Imajing tidak dapat mengganti diagnosa
jaringan; karena tidak dapat membedakan
histologi glioma
 MENINGIOMA
• Banyak pada dekade 6-7
• Female: Male :3:2 to 2:1
• Multiple in 5-15% (NF-2)
• 90% intracranial
• 10% intraspinal
• Spinal meningioma: 10x in women
• All familial meningiomas occur with NF-2
• Rare in children (more in boys)
– - Rare with dural attachments
– - Usually Intraventricular or posterior fossa
– - Commonly with sarcomatous changes
– - Frequently with NF-2
 Astrocytoma

• Dari sel glia

 Glioblastoma
• 23% of primary brain tumors
• most common age 45 - 64
• Grade III/III or IV/IV
• Malignant astrocytoma
• Invasive
 Medulloblastoma
• Sering dijumpai : anak usia 5 tahun, remaja
dan dewasa muda
• Dari vermis cerebelum  meluas ke ventrikel
4
• Highly malignant
• Asal primitive embrionic cell
• Klinis : beb minggu  trunkal & gait ataxia
berat gg visual loss
• Lokasi: Anak  midline (75% vermis)
Dewasa muda  hemisfere lateral
serebelum
 Nerve sheath tumors
• 6.9%
• Vestibular schwannoma/acoustic neuroma
• Asal : nerve sheath nerve cranial vestibular
• >> wanita
• 6% dari primer tumor intrakranial
• Keluhan : gg pendengaran, nigtagmus
• Neurofibromatosis Type II
• Benign, slow growing tumor
• Pemeriksaan : Audiometri, BERA, calori tes,
• Ct : Area kontras enhanced
 Management
• Tatalaksana Medik
• Tatalaksana Pembedahan
• Kemoterap
• Radioterapi
 Pembedahan
Prinsip Umum

Surgery
• Diagnosis
• Tumor burden is decreased/reduced
• CT/MRI Guided STB
• Open biopsy / extensive microsurgical
resection
INTP - PPO, PHO, IAP.
P2 – 21/27