COLORECTAL

CANCER
ARIANTI
Definisi Kanker
Kanker menurut WHO (2013) merupakan sekelompok penyakit yang dapat
mengenai seluruh bagian tubuh, atau sering juga dikenal dengan istilah tumor
ganas dan neoplasma.

Kanker menurut Merkle, di dalam Porth dan Gaffin (2009) bahwa kanker adalah
kondisi dimana terjadi gangguan pada diferensiasi dan pertumbuhan sel yang
juga disebut dengan istilah neoplasia.
Kanker Prevalensi
Diagnosa terbanyak di dunia:
1. Paru-paru
2. Payudara
3. Colorektal

Penyebab kematian
1. Paru-paru
2. Liver
3. Lambung
(International Agency for Research on Cancer, 2013)
Prevalensi Kanker Dunia
Peningkatan pada kanker yang berhubungan dengan reproduksi,
dietary, dan hormonal
Peningkatan insidensi hampir di seluruh dunia, highest developed
country
Kematian developed country

Kurangnya :
Deteksi dini
Akses ke pelayanan kesehatan
Kanker di Indonesia
Kanker serviks
Kanker payudara,
Kanker kolorektal.
Kanker Gastrointestinal
Esophagus
Stomach
Pancreas
Gallbladder
Liver
Small intestine
Large Intestine
Rectum
Colorectal
Epidemiology

The 3rd leading

cancer in Indonesia
(Globocan 2012)
The 3rd leading
cancer and death in
US (2014)

The 3rd leading

cancer in the world
What is colorectal cancer?
Colorectal cancer is a malignant tumor arising from the inner wall of
the large intestine, abnormal cells grow in the lining of the large
intestine
>50 year old
men> woman. Woman >> proximal colon
Normal Cell
Cancer Cell Growth
Cancerous Cells
Colorectal
Cancer
Risk
Factors
Colorectal Cancer Screening
Colorectal
Cancer
Screening
cont
Effective test for detecting cancer
Fecal occult blood test (FOBT)
- Cancerous tumors and some large polyps bleed intermittently into
the intestine
- This blood can be detected in stool by the FOBT kit
- Bleeding from colorectal cancer may be intermittent or undetectable
- Accurate test : collecting 1 to 3 samples from consecutive bowel
movements
FOBT
1. Guaiac-based test (detect blood form any sources)
2. Immunochemical-based test (detect blood only human blood from
large bowel)

Preparation for guaiac-based test:

- Avoid nonsteroidal anti-inflammatory drugs
- Avoid red meat for 3 days prior to the test false positive
- Avoid vitamin c and citrus juices false negative
- Six samples from 3 consecutibe bowel movementssmearing the
stool sample thinly on a special card
 (+) result is referred for a
colonoscopy to rule out the
presence of polyps or cancer
Patophysiology
STAGING
SIGNS
Bleeding from the rectum
Blood in the stool or in the toilet after having a bowel movement
Dark or black stools
A change in the shape of the stool (more narrow than usual)
Cramping or discomfort in the lower abdomen
An urge to have a bowel movement when the bowel is empty
Constipation or diarrhea that last for more than a few days
Decreased appetite
Unintentional wight loss
Symptoms
Blood loss leads to anemia
Weakness
Excessive fatigue
STAGING

TNM
Classification
STAGING,
cont
Assessment
History (personal and family medical history)
Physical examination : hepatomegaly, ascites, ymphadenopathy
Laboratory data: blood count, CEA, and liver chemistry
Intestinal evaluation: full colonoscopy, proctosigmoidoscopy and air-
contrast barium enema.
Instrumental work-up : pre-operative chest radiograph, live
ultrasonography, CT scan chest and abdomen, MRI
Surgical staging
TREATMENT
Adjuvant
A systemic treatment administer after primary tumour resection
Reducing the risk of relapse and death
Recommended for stage III and high risk stage II patients
Treatment Strategy
1. Complete endoscopic polypectomy
2. Surgical resection for a neoplastic polyp
3. Histological findings, lymphatic or venous invasion
4. Laparascopic colectomy vs conventional approach (pain, length of
stay and reduced duration of ileus)
Treatment based on Stages
Stages Treatment
I Wide surgical resection and anastomosis
(T2N0M0)
II Wide surgical resection and anastomosis
(T3N0M0) Adjuvant treatment
III Wide surgical resection and anastomosis
(anyT,N1,M Adjuvant treatment
0) Oxaliplatin, 5FU
 Proses Kanker
Fenotip
mematikan

Beban Kanker

Evolusi ?
progresi
Kematian
krn Kanker
Perubahan
menjadi ganas

kerentanan
Pre-initiation

Lahir Rentang Usia Kematian

Alami
 Kesempatan untuk Intervensi

Kuasai Kanker

Kematian
akibat
Deteksi dan Kanker
Eradikasi
Cegah atau
Perlambat

2010 2020

Lahir Rentang Usia Kematian

Alami
KESIMPULAN
Diperlukan waktu 15-20 tahun untuk menjadi kanker :
DAPAT DICEGAH dan DITEMUKAN SECARA DINI
Terapi Kanker bersifat Multi Modalitas
Pembedahan adalah terapi utama
Kemoterapi, Radioterapi , Target Terapi sudah amat maju
sehingga harapan hidup lebih baik
Perhatikan! Colostomy Care
Side effects of chemotherapy
drop in white blood cells: risk for infection
Anemia
Drop in platelets: Bruising more easily
Tiredness and fatigue
Mouth sores and ulcers
Diarrhea
Hair thinning
Nursing Diagnosis
Pain
Nutrition less than body requirement
Body image disturbances
Fatigue
Risk for infection
References
American Cancer Society (2014). Colorectal Cancer Facts & Figures
2014-2016. Di unduh dari
http://old.cancer.org/acs/groups/content/documents/document/acs
pc-042280.pdf
National Comprehensive Cancer Network.(2016). NCCN Guidelines for
patients: Colon Cancer. Diunduh dari
https://www.nccn.org/patients/guidelines/colon/files/assets/commo
n/downloads/files/colon.pdf