1. Deteksi Dini Knf - Dr
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Transcript of 1. Deteksi Dini Knf - Dr
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A R I E C A H YO N OE N T D E PA R T M E N T
D R . C I P TO M A N G U N K U S U M O G E N E R A L H O S P I TA LJA K A R TA
Detekasi Dini Karsinoma Nasofaring
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PREVALENSI / INSIDENS
CINA SELATAN30-50 kasus*
INDONESIA (NATIVE)
4.7/6.7 kasus*
MALAYSIAMALAY 1.1 kasusCHINESE 40.1(14.9) kasus
SINGAPURACANTONESE 18.2/7.5
HOKKIEN 12.3/3.7MALAY 4.3/1.5
THAILAND4.1/1.6
HONGKONG28.5/11.2
*per 100.000/tahun
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ETIOLOGI
Epstein-Barr virus
NPCEthnicity
Diet(smoke)
(Immuno)genetic factors
Gender
Herbal Drugs/
oils
Environmentalfactors
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KNF 1996-2005
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PATOLOGI ANATOMI
WHO; 1978:Type 1: Keratinizing SCCType 2: Non Keratinizing SCCType 3: Undifferentiated
WF: Working Formulation: degree of anaplasia and tumor cell1. High malignant degree SCC2. Type A: Anaplasia/obvious pleomorphic, Intermediate malignant
degree3. Type B: Anaplasia/ light pleomorphic, low malignant degree
Radiation response: Type B good, Type A: less
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KLASIFIKASI PATOLOGI ANATOMI
Classical scheme WHO Scheme Cologne modification WHO
SCC, keratinising SCC Type I
SCC Non Keratinisingtransisional cellIntermediate cell
Lymphoepithelial Ca(Regaud Type)
Non Keratinising Ca
Non-keratinising Ca
Type IIa ( NKC with no lymphoid infiltration)
Type IIb ( NKC with lymphoid infliltration)
Undifferentiated ( anaplastic)
Clear Cell Ca
Lymphoepithelial Ca(Schmincke type)
Undifferentiated Ca Type IIIa (Undifferentiated)
Ca with no lymphoid infiltration
Type IIIb ( undifferentiated Ca with lymphoid infiltration)
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ANATOMI
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ANATOMI
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ALIRAN KGB LEHER
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GEJALA KLINIS
Cefalgia
DiplopiaOphtalmoplegiaLagophtalmus
Obstruksi hidungSekret + darah
AnosmiaEpistaksis
PND Trismus Disfagia
Gangguan pengecapAtrofi palatum mole Parese parsial lidah
Limfadenopaticollie
Rasa penuh di telingaTinitusOtalgia
Tuli konduktif unilateral Perforasi
OME
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DIAGNOSIS
Anamnesis Pemeriksaan Fisik THT Rinoskopi Anterior & Posterior Endoskopi: Rigid/ Fiber
nasopharyngolaryngoscopy
BIOPSY
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Serology EBV
Serology Jakarta Singapore HongkongIgA anti VCASensitivity %Specificity %
IgA anti EASensitivity %Specificity%
73,33%83,33%
98,67% 63,67%
95,00%80-90%
>95%
93,00%
76,00%
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Diagnosis
CT Scan:* Perluasan tumor* Superior: destruksi tulang, densitas jaringan
lunak
MRI:* Resolusi tinggi* Superior: residual/reccurent, inflamasi, fibrosis* Keterlibatan sum tul,perineural, intracranial
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Primary Tumor
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor confined to the nasopharynx
T2 Tumor extends to soft tissuesT2a: Tumor extends to the oropharynxand/or nasal cavity without parapharyngealextension* T2b: Any tumor with parapharyngealextension*
T3 Tumor invades bony structures and/or paranasal sinuses
T4 Tumor with intracranial extension and/or involvement of cranial nerves, infratemporalfossa, hypopharynx, orbit, or masticator space
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T1: confined to the nasopharynx,causing thickening and asymmetry
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T2a: spread to the oropharynx or nasal cavity
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T2b: Parapharyngeal space involvement
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T3: paranasal sinus andbony involvement
Tumor eroding and widening right pterygopalatine fossa (thick arrow)
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T4: Intracranial hypopharyngeal, orbital, maxillary sinus or cranial nerve involvement tumours
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Lymph Node
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Unilateral metastasis in lymph node(s), not more than 6 cm in greatest dimension, above the supraclavicular fossa*
N2 Bilateral metastasis in lymph node(s), not more than 6 cm in greatest dimension, above the supraclavicular fossa*
N3 Metastasis in a lymph node(s)* larger than 6 cm and/or to supraclavicular fossa N3a: Larger than 6 cm N3b: Extension to the supraclavicularfossa**
* [Note: Midline nodes are considered ipsilateral nodes.]** [Note: Supraclavicular zone or fossa is relevant to the staging of nasopharyngeal carcinoma and is the triangular region originally described in the Ho-stage classification for nasopharyngeal cancer. It is defined by three points: (1) the superior margin of the sternal end of the clavicle; (2) the superior margin of the lateral end of the clavicle; and, (3) the point where the neck meets the shoulder. Note that this would include caudal portions of Levels IV and V. All cases with lymph nodes (whole or part) in the fossa are considered N3b.]
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Distant Metastasis
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
AJCC Stage Grouping
Stage 0 Tis, N0, M0
Stage I T1, N0, M0
Stage IIA T2a, N0, M0
Stage IIB T1, N1, M0 T2, N1, M0 T2a, N1, M0 T2b, N0, M0 T2b, N1, M0
Stage III T1, N2, M0 T2a, N2, M0 T2b, N2, M0 T3, N0, M0 T3, N1, M0 T3, N2, M0
Stage IV A T4, N0, M0 T4, N1, M0 T4, N2, M0
Stage IV B Any T, N3, M0
Stage IV C Any T, any N, M1
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Types of Nasopharyngeal Carcinoma
Three microscopic subtypes of NPC: Well-differentiated keratinizing (type 1) Moderately-differentiated nonkeratinizing (type 2) Undifferentiated (type 3), which typically contains large numbers
of non-cancerous lymphocytes (lymphoepithelioma)
Stage Relative Survival Rates
5-year 10-year
I 78% 62%
II 64% 52%
III 60% 46%
IV 47% 37%
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Survival Rates
Stage Relative Survival Rates
5-year 10-year
I 78% 62%
II 64% 52%
III 60% 46%
IV 47% 37%
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PENATALAKSANAAN
Sesuai dengan staging tumor yang telah dibuat:
RadioterapiStadium 1
KemoradiasiStadium 2 & 3
KemoradiasiStadium 4a & b
KemoterapiStadium 4 c
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Pasien dengangejala dini
Dokter umum Tidak berobat Pengobatan Alternatif
Rujuk ke Spesialis THT setelah 6 mg keluhan
Misdiagnosis karenarendahnya pengetahuan
Pasien memasuki stadium lanjut KNF Tidak dapat diterapi
Pasien dengan KNF
Pasien dapatditerapi
Edukasi
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Deteksi dan terapi dini akan menyelamatkanbanyak nyawa!
Angka ketahanan hidup 5 tahun:Stadium 1: 78%Stadium 4: 47%
Deteksi & terapi dini: angka keberhasilan
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UPAYA PENCEGAHAN
Jaga daya tahan tubuh
Cegah ISPA
Skrining pasien risiko tinggi
Kurangi makanan dengan pengawet
Kurangi pemakaian alat rumah tangga yang mengandung karsinogen
Hindari rokok (aktif + pasif), terutama di sekitaranak-anak
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KEYPOINTS
KNF kasus terbanyak di kepala leher
Stadium dini prognosis lebih baik
Skrining pasien risiko tinggi
Rekuren terjadi < 1 tahun
Follow up rutin: KEHARUSAN
Program kewaspadaan