Gis156 Slide Hepatomia
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HEPATOMA(Tumor Hati Primer)
Mabel HM Sihombing
DIVISI GASTROENTERO – HEPATOLOGIDEPARTEMEN ILMU PENYAKIT DALAM
FK. USU – RSUP. HAM
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ANATOMI HATI
���� T.D. 2 LOBUS : KANAN & KIRI.
LOBUS KIRI ���� SEG. LATERAL .
SEG. MEDIAL .
BATAS ���� LIG . FALSIFORMIS.
LOBUS KANAN ���� SEG. ANTERIOR .
SEG. POSTERIOR.
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EPIDEMIOLOGI
- TUMOR HATI PRIMER ( HEPATO CELLULAR
CARCINOMA ) ���� AS JARANG
- ANGKA KEMATIAN TERTINGGI.
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ETIOLOGI
- ADA HUBUNGAN DENGAN INFEKSI
- HEP. B KRONIS .
- HEP. C KRONIS .- HEP. C KRONIS .
- ALKOHOLIK .
- DIET AFLA TOKSIN.
- PENY. METABOLIK .
( HEMOCHROMATOSIS ) .
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PATOLOGI
MAYORITAS ���� HCC.
85 – 95 %
CHOLANGIO CA
ANGIOSARCOMA
HEPATOBLASTOMA
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METASTASE TUMOR HATI
DIAFRAGMA
PERI PORTAL LIMPH NODE
PARU - PARUPARU - PARU
TULANG
ADRENAL
OTAK
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GAMBARAN KLINIS
- RIWAYAT ALKOHOL ATAU SIROSIS
- RASA SAKIT ATAU TIDAK ENAK
- TERABA MASSA
- BERAT BADAN MENURUN
- ASITES
- JAUNDICE
PD : - HEPATOMEGALI.
- ARTERIAL BRUIT DI KWADRANT ATAS
KANAN.
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PARA NEOPLASTIC COMPLIKASI :PARA NEOPLASTIC COMPLIKASI :PARA NEOPLASTIC COMPLIKASI :PARA NEOPLASTIC COMPLIKASI :
HIPO GLISEMIA
HIPERKALSEMIA
ERITROSITOSIS
HIPERTROFI PULMONARI
OSTEOARTROPATI
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DIAGNOSA
- AFP MENINGGI ���� 50 – 90 % .
- TUMOR KECIL ���� BISA NORMAL / SDKT ���� .
- AFP JUGA BISA ME ���� PADA SIROSIS HATI .
���� TIDAK BERMAKNA.
MONITOR KEBERHASILAN RESEKSI
KURATIF.AFP
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USG DAN CTUSG DAN CTUSG DAN CTUSG DAN CT ....
- USG ���� KONFORMASI MASSA.
SKRINING .
- CT ���� - LEBIH SENSITIF & SPESIFIK.
- DETEKSI MASSA < 3 CM .
- MENCARI LESI EKSTRA HEPATIK
YANG LAIN.
CT ANGIOGRAFI ���� LEBIH SENSITIF.
LEBIH MAHAL.
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CTAP ( CT ARTERIAL PORTOGRAPHY )
- KONTRAS KE A. MESENTERIKA SUP.
ATAU A. SPLENIKA ���� KONTRAS MSK
KE SISTEM V.PORTA.
- PALING AKURAT .- PALING AKURAT .
- SENSITIFITAS ���� 97 %.
DI A.S. ���� PAKAI LIPIODOL.
- LEBIH SENSITIF .
- LESI TUMOR BBRP. MILIMETER.
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BIOPSI
- USG .
- STAGING .
STAGING SYSTEM HCC ( AJCC )’
KLASIFIKASI TNM
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STAGE GROUP
- STAGE I T 1 N0 M0
- STAGE II T2 N0 M0
- STAGE III T3 N0 M0- STAGE III T3 N0 M0
T 1-3 N1 M0
- STAGE IVa T4 Any N M0
- STAGE IVb Any T Any N M1
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PENATALAKSANAAN
KRITERIA CHILD PUGH
MENENTUKAN SIKAP OPERASI
- SAAT INI ���� MORTALITAS 20 %.
COD - PERI OPERATIF :COD - PERI OPERATIF :
- GAGAL HATI
- PERDARAHAN
- SEPSIS
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PENATALAKSANAAN :
- TERAPI DEFINITIF ���� OPERASI
- HANYA 10 – 30 % ���� MASIH OPERABLE
���� HANYA 50 – 70 % YANG CURATIVE
KRITERIA NON OPERATIF :KRITERIA NON OPERATIF :
- ADA PENYAKIT EKTRA HEPATIK
- GANGGUAN FUNGSI HATI BERAT
- MASA TUMOR YANG MASIF
- V. PORTA ATAU V. CAVA SUDAH TERLIBAT
���� KONTRA INDIKASI RELATIF
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TINDAKAN NON BEDAH :
1. HEPATIC ARTERY LIGATION / OCCLUSION
���� TERAPI PALIATIF ���� UNRESECTABLE
2. TAE
���� INTRA ARTERIAL OCCLUSION CHEMOTHERAPY ���� INTRA ARTERIAL OCCLUSION CHEMOTHERAPY
+ HEPATIC ARTERY OCCLUSION
3. PEIT
���� PADA HCC + SIROSIS
ETHANOL ABSOLUT ( 95 % )
DILAKUKAN 1 – 2 KALI SEMINGGU
MASSA TUMOR KECIL < 3 CM
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LESI METASTASE ���� TERGANTUNG VASKULARISASI.
- HIPERVASKULAR ���� TACI .
TUMOR BESAR ���� CHILD B / C
TIDAK EMBOLISASI.
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TUJUAN TERAPI EMBOLISASI
- MENGECILKAN MASA TUMOR.
- HILANGKAN SAKIT.
���� KWALITAS HIDUP.
- TUMOR KECIL ���� RESEKSI.
TRANSPLANTASI.
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RADIO TERAPI .
- UN OPERABLE .
- MAKSIMAL TERAPI ���� GAGAL .
RADIO TERAPI 3 DCRT RADIO TERAPI 3 DCRT
“ 3 DIMENTIONAL CONFORMAL RADIOTHERAPY “
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TUMOR HATI SEKUNDER
- GASTROINTESTINAL TUMOR ���� KOLON & REKTUM
GEJALA KLINIS :
- SERING SUDAH LANJUT ���� ASITES, JAUNDICE, - SERING SUDAH LANJUT ���� ASITES, JAUNDICE,
SAKIT PERUT KANAN ATAS, FAAL HATI ���� , AFP SEDIKIT MENINGGI.
PROGNOSA JELEK
DIAGNOSA USG
CT SCAN / CTAP
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This is the external surface of a normal liver.This is the external surface of a normal liver.The color is brown and the surface is smooth. The color is brown and the surface is smooth. A normal liver is about 1200 to 1600 grams.A normal liver is about 1200 to 1600 grams.
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Kanker HatiKanker Hati�� 20% infeksi kronis 80% 20% infeksi kronis 80%
Infeksi HCV: kronisInfeksi HCV: kronis
�� berakhir dengan sirosisberakhir dengan sirosis
�� 25% sirosis berakhir 25% sirosis berakhir
dengan kanker hati dengan kanker hati
atau gagal hatiatau gagal hati
Kelompok Risiko Tinggi HCV:
•Pengguna Narkoba Suntik
•Penerima Transfusi
•Pasien terpapar alat medis
yang tak steril
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Here is another example of macronodular cirrhosis. Viral hepatitis Here is another example of macronodular cirrhosis. Viral hepatitis (B or C) is the most common cause for macronodular cirrhosis. (B or C) is the most common cause for macronodular cirrhosis. Wilson's disease and alphaWilson's disease and alpha--11--antitrypsin deficiency also can antitrypsin deficiency also can produce a macronodular cirrhosis.produce a macronodular cirrhosis.
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