TUMOR LAMBUNG

12/2/2010
TUMOR LAMBUNG
DR. MABEL HM SIHOMBING, SPPD-KGEH
DR.ILHAMD SPPD
DIVISION OF GASTROENTERO-HEPATOLOGY
DEPARTEMENT OF INTERNAL MEDICINE FACULTY OF
MEDICINE / NORTH OF SUMATERA
H. ADAM MALIK HOSPITAL
TUMOR LAMBUNG
EPIDEMIOLOGY
INSIDENSI :
JAPAN :100/100000
USA : 6 /100000
TYPE :
ADENO CARCINOMA
GASTRIC LYMPHOMA
LEIOMYOSARCOMAS
CARCINOID TUMORS
SYMPTOM :
NOT SPECIFIC & FREQUENT VAGUE
(EPIGASTRIC PAIN, HEARTBURN, ULCER PAIN, BB↓
↓,
MUAL, ANEMIA, HEMATEMESIS)
1
12/2/2010
2
12/2/2010
RISK FACTORS FOR GASTRIC ADENOCARCINOMA
DEFENITE/SURVEILLANCE SUGGESTED
FAMILIAL ADENOMATOUS POLIPOSIS (FAP),
GASTRIC ADENOMA DYSPLASIA
DEFENITE
HP INFECTION, CHRONIC ATROPHIC GASTRITIS,
INTESTINAL METAPLASIA,
HERED. NONPOLYPOSIS COLORECTAL CANCER (HNPCC)
POSTGASTRECTOMY,
FIRST-DEGREE RELATIVE WITH GASTRIC CANCER
PROBABLE
PEUTZ-JEGHERS SYNDROME, CIGARETTE SMOKING,
LOW ASPIRIN INTAKE, HIGH SALT INTAKE,
LOW INTAKE OF FRESH FRUITS AND VEGETABLES,
PERNICIOUS ANEMIA, LOW ASCORBATE INTAKE
POSSIBLE
LOW SOCIOECONOMIC STATUS
MENETRIER’S DISEASE, GASTRIC ULCER
QUESTIONABLE
HIGH INTAKE OF ALCOHOL
HYPERPLASTIC/FUNDIC POLYPS
3
12/2/2010
HELICOBACTER PYLORI
CARCINOGENIC NO. 1
NORMAL
H PYLORI
CHRONIC ACTIVE GASTRITIS
ATROPHIC GASTRITIS
P53
MICROSATELLITE INSTABILITY
INTESTINAL METAPLASIA
LOW – GRADE DYSPLASIA
HIGH - GRADE DYSPLASIA
APC / β = CATENIN
GASTRIC CANCER
PROPOSED MULTISTEP PATHWAY IN THE
PATHOGENESIS OF GASTRIC CANCER
4
12/2/2010
Dugaan : Pathogenesis of Gastric Carcinoma
H. Pylori
Acquisition
Normal Stomach
Autoimmunity
10 %
45 %
NaCl
Cronic gastritis
DGCA
Multifactorial
45 %
Atropic gastritis
Intestinal Metaplasia
IGCA
Bacterial over growth/Inflammation
N-Nitroso-Compouns
Vitamin intake (c, carotene)
5
12/2/2010
INVESTIGATION :
HISTORY
PHYSICAL EXAMINATION
BARIUM MEAL
DOUBLE CONTRAST
ENDOSCOPY
BIOPSY CONFIMATIVE
DIAGNOSTIC
SCANNING
6
12/2/2010
TREATMENT
CURATIVE (OPERATIVE) :
SUBTOTAL GASTRECTOMY
MORTALITAS ↓ & MORBIDITAS ↓
PALLIATIVE (OPERATIVE) :
SUBTOTAL GASTRECTOMY
BLEEDING ↓ & OBSTRUCTION ↓
& QOL ↑ (QUALITY OF LIFE )
CHEMOTHERAPY :
PENGOBATAN :
# DINI : MUNGKIN MASIH DAPAT DILAKUKAN MUCOSAL
RESECTION (EMR)
# BEDAH : - CURATIVE
- PALLIATIVE :
- TANDA OBSTRUKSI
- TANDA PERDARAHAN
# KEMOTERAPI
# RADIASI
Prognosis :
Sangat ditentukan oleh :
1.
Derajat invasi dinding lambung
2.
Adanya penyebaran ke kelenjar lymph
3.
Anak sebar di peritoneum dan tempat lain
7
12/2/2010
COMPLICATION POST OPERATIVE
(SUBTOTAL GASTRECTOMY)
1. MEGALOBLASTIC ANEMIA ← SUPP. VIT B 12
2. DUMPING SYNDROME : NAUSEA, VOMITING
ABD. FULLNESS, TACHYCARDIA,
WEAKNESS, DIZZINESS
SMALL MEAL & LOW CHO
3. BUND LOOP SYNDROME
REFRACTORY DIARRHEA ← BACTERIAL
OVER GROWTH ← MALABSORBTION
ANTIBIOTICS
INTRA OPERATIVE STAGING
TUMOR
5 YEARS SURVIVAL
STAGE I
MUCOSA-SUBMUCOSA
85 %
STAGE II
PENETRASI
SEROSA
45 – 55 %
STAGE III
REGIONAL LYMPH
NODE (+)
DISTAN METASTASIS
17 %
STAGE IV
<5%
8