tumor lambung - USU OCW

2 Des 2010 ... DR.ILHAMD SPPD. DIVISION OF GASTROENTERO-HEPATOLOGY. DEPARTEMENT OF INTERNAL MEDICINE FACULTY OF. MEDICINE / NORTH OF SUMATERA. H. ADAM...

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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)

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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

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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

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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)

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INVESTIGATION :  HISTORY  PHYSICAL EXAMINATION  BARIUM MEAL DOUBLE CONTRAST  ENDOSCOPY BIOPSY CONFIMATIVE DIAGNOSTIC  SCANNING

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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

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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%

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