View
220
Download
0
Category
Preview:
Citation preview
7/27/2019 Kuliah Bedah Oncology
1/39
Introduction to
SURGICAL ONCOLOGY
7/27/2019 Kuliah Bedah Oncology
2/39
ONCOLOGY
MULTIDISCIPLINARY FIELD OF
MEDICINE
Oncology ORCHESTRA
7/27/2019 Kuliah Bedah Oncology
3/39
Oncology Orchestra
General Physician
Radiology Specialist
Pathology Specialist
General Surgeon
Surgical Oncologist
Medical Oncologist
Radiotherapy Oncologist
Oncologic Nursing Specialist
Palliative Medicine
Medical Rehabilitation
Nutrition specialist
Psychologist etc..
7/27/2019 Kuliah Bedah Oncology
4/39
3 Factors
Tumour Factors
Patients Factors Doctor & Hospital Factors
7/27/2019 Kuliah Bedah Oncology
5/39
Tumour Factors
Clinical diagnosis
Microscopic diagnosis
Lymphatic metastase Hematogenic metastase
7/27/2019 Kuliah Bedah Oncology
6/39
Patient Factors
Physical General Status
Psychological Status
Socioeconomic Factors
7/27/2019 Kuliah Bedah Oncology
7/39
Doctor & Hospital factors
Competence of Doctors
Supporting Facilities
7/27/2019 Kuliah Bedah Oncology
8/39
Tumors
Clinical dx
Microscopic dx
Treatment Planning Curative treatment or non curative
Palliative treatment
Temporary or definitive
7/27/2019 Kuliah Bedah Oncology
9/39
Microscopic
Tumor type
Carcinoma, Sarcoma, Blastoma
(embryonal), Lymphoreticular
Histopathological grading
Extent of the disease to surounding tissue
7/27/2019 Kuliah Bedah Oncology
10/39
Microscopic Factors
Differentiation degree
Well, moderate, poorly differentiated
Undifferentiated With/without surrounding tumor invasion
Lymph node mets, is there any invasive
lymphnode capsule Distant metastase
7/27/2019 Kuliah Bedah Oncology
11/39
Grade of malignancy
Pleomorphic changes of the cell
Grade of differentiation
The number of mitosis Cells necrosis
7/27/2019 Kuliah Bedah Oncology
12/39
Natural History of Cancer
Dysplasia
Carcinoma (malignancy in situ)
Invasive type/ Infiltrating type
Local extension
Spreading lymphatic or haematogenic
Special: Basal cell carcinoma
Locally destruction
7/27/2019 Kuliah Bedah Oncology
13/39
TNM staging
Tumor
Node (Lymph node)
Metastase
To indicate treatment planning
To indicate prognosis
To facilitate evaluation and exchange oftreatment result
7/27/2019 Kuliah Bedah Oncology
14/39
SPREAD
Lymphatic spread
Extranodal growth
Haematogenic spread
7/27/2019 Kuliah Bedah Oncology
15/39
Tumor
The extent of primary tumor
T 0 : no evidence of primary tumour
Tis : insitu
T 1-4 (a, b, c) : increasing size T1 microscopic
7/27/2019 Kuliah Bedah Oncology
16/39
Lymph node
The absence or presence and
extent of regional lymph nodemetastase
N 0 : no evidence of regional lymph nodeinvolvement
N 1-3 : increasing involvement number
mobility/ fixation
connection to one another
7/27/2019 Kuliah Bedah Oncology
17/39
Metastase
The absence or presence of distant
metastase
Distant Metastase Haematogenic metastase
Lymph node metastses beyond the
regional lymph node area
7/27/2019 Kuliah Bedah Oncology
18/39
Clinical and Pathological
cTxNxMx (Clinical TNM)
pTxNxMx (Pathological)
Postoperative microscopic examination ofresected tissue
Exp: preop cT2N0M0 become pT2N2M0
Implications for treatment planning
7/27/2019 Kuliah Bedah Oncology
19/39
The Basic
No Cancer treatment may start before
there is microscopic evidence of a
malignant disesase
Plays a significant role in oncology
Cytology: FNAB/FNAC Exfoliative cytologyHistolgy: Thick needle biopsy/ core needle
biopsy, incisional biopsy, excisional biopsy
7/27/2019 Kuliah Bedah Oncology
20/39
Depends on the site and siize of tumour
The pathological information that is
needed for treatment planning
Bite punch biopsy
7/27/2019 Kuliah Bedah Oncology
21/39
FNAB FNAC
Easy, simple, quick
Hardly any complications
Disadvantages Histologic characteristics like invasive
growth are misssing
A possible false-negative result Bone?
7/27/2019 Kuliah Bedah Oncology
22/39
A NEGATIVE RESULT MEANS:
NO TUMOUR CELLS ARE FOUND IN
THE SAMPLE
THIS DOES NOT MEAN THAT THIS
EXCLUDES A MALIGNANT TUMOUR
THE SAMPLE TOO SMALL TAKEN FROM ADJACENT TISSUE
7/27/2019 Kuliah Bedah Oncology
23/39
WHEM THERE IS CLINICAL
SUSPICION OF MALIGNANT
TUMOUR
SHOULD BE REPEATED OR ANOTHERBIOPSY METHOD
7/27/2019 Kuliah Bedah Oncology
24/39
TUMOUR SPILL IN BIOPSY
CONTAMINATION OF THE
SURROUNDING TISSUES WITH
TUMOUR CELLS
WHICH IN TURN CAN CAUSE
RECURRENT TUMOURS
7/27/2019 Kuliah Bedah Oncology
25/39
IN THE IMMEDIATE SURROUNDING OF
THE INVASIVE PROCEDURES
IN CAVITIES
SPONTANEOUSLY
IATROGENIC
7/27/2019 Kuliah Bedah Oncology
26/39
7/27/2019 Kuliah Bedah Oncology
27/39
Contaminated instrument
Must be replaced
From several lesions Use clean instrument for each new biopsy
May be One of the tumour malignant the
others are not
7/27/2019 Kuliah Bedah Oncology
28/39
Local anesthesia
Field block
Field wise at a distance around the lesion
NOT TO INFILTRATE UNDER OR IN THE
LESION
LOCAL NERVE BLOCK OR GENERAL
ANESTHESIA FNAC no need
Thick or Core biopsy only the skin area
7/27/2019 Kuliah Bedah Oncology
29/39
Treatment
Treatment Planning
WATCHFUL WAITING
Curative treatment or non curativePalliative treatment
Temporary or definitive
Locoregional treatment Systemic treatment
7/27/2019 Kuliah Bedah Oncology
30/39
Tumour type
Biological behavioour
Localization and the extent The Age and the general conditions
7/27/2019 Kuliah Bedah Oncology
31/39
Locoregional Treatment
Surgery
Radiation Therapy
Whether or not combined with cancer drug
treatment (aduvant treatment)
Curation can be obtained whom the the tumour is
restricted to the primary locoregional area and inthe whom locoregional lymph nodes do not
show extranodal growth
7/27/2019 Kuliah Bedah Oncology
32/39
SYSTEMIC
DISEASE
7/27/2019 Kuliah Bedah Oncology
33/39
Neoadjuvant treatment
Cancer drug treatment Radiation Therapy
Hormonal therapy
Immunotherapy Spesific Receptors therapy
7/27/2019 Kuliah Bedah Oncology
34/39
SURGERYThe most dramatic but not the only
Most tumours cancer surgery is usually
more extensive than non-oncological
surgery
Tumor characteristics
Biological behaviour
Possibilities of radiation therapy,
chemotherapy, hormonal therapy,
immunotherapy
7/27/2019 Kuliah Bedah Oncology
35/39
EVERY ONCOLOGICAL
SURGICAL TREATMENT
WITH CURATIVE INTENT IS AIMED TO
COMPLETE REMOVAL OF THETUMOUR AND POSSIBLY PRESENT
LYMPH NODE METASTASES
7/27/2019 Kuliah Bedah Oncology
36/39
7/27/2019 Kuliah Bedah Oncology
37/39
Enucleation (only in selected cases)
Tissue destructive methods
Isolated regional perfusion Excision of haematogenic metastases
7/27/2019 Kuliah Bedah Oncology
38/39
Follow up
IN ONCOLOGY FOLLOW UP IS ANIMPORTANT PART OF PATIENTMANAGEMENT
FOR SEVERAL TUMOURS FOLLOW UP ISALSO IMPORTANT IN THE ERALYDETECTION OF A SECOND PRIMARYTUMOUR
IN THE CASE OF LOCAL OR DISTANTRECURRENCES, TREATMENT WITHCURATIVE INTENT CAN STILL BE OFFEREDTO SEVERAL PATIENTS
7/27/2019 Kuliah Bedah Oncology
39/39
THANK YOU
TO SERVE AND TO PROTECT
PROTECT YOURSELF BY PROTECT
YOUR PATIENTs
PRIMUM NON NOCERE
Learn to communicate with patients and
their family
Learn to teach patients and their family
Balanced informations
Recommended