Patogenesis Kanker Paru &

Penatalaksanaannya

MUHAMMAD ZULHUSNI BIN NGALI

102012495
A4

SKENARIO 1
Seorang perempuan berusia 55 tahun datang ke
poliklinik dengan keluhan batuk darah sejak 4 bulan
yang lalu. Pasien telah menjalani pengobatan TB
sebelumnya selama 2 bulan, tapi keluhan batuk
darah tersebut belum berkurang. Selain itu, selama
1 bulan ini pasien mengeluh sering sakit pada
punggung di sekitar tulang belakangnya. Pasien
pernah menjalani operasi pengangkatan payudara 1
tahun yang lalu setelah didiagnosis terkena kanker
payudara. Riwayat merokok 10 tahun.

HIPOTESIS
Keluhan batuk darah diduga penyebabnya
adalah kanker paru.

Definisi

Anamnesis

Prognosis

Periksa Fisik

Pemeriksaan
Penunjang

Penatalaksanaan

Kanker Paru
Diagnosis Utama (WD)

Diagnosis Banding
(DD)

Patofisiologi
Etiologi

ANAMNESIS
Identitas pasien
Keluhan utama
Keluhan penyerta
(tambahan)
Riwayat penyakit
sekarang
Riwayat penyakit
dahulu
Riwayat penyakit
keluarga
Riwayat sosial terkait.
Riwayat pengobatan

DEFINISI
Kanker Paru
Keganasan/
Abnormalitas
proliferasi sel

Gangguan fisiologis
paru

Organ Paru
(lobus/segmen)

PEMERIKSAAN FISIK UMUM

& LOKAL
Wajib: TTV, Tingkat Kesadaran, Tingkat Kesakitan
PF:
1. Kalau ada efusi pleura pada perkusi bunyi pekak
2. Suara nafas wheezing / stridor
3. Suara serak (hoarseness)
4. Penurunan BB

PEMERIKSAAN PENUNJANG (LAB &

RADIO)
Pemeriksaan
laboratorium
Menilai kerusakan yg
ditimbulkan kanker paru.
Menilai seberapa jauh
kerusakan pada organ
lainnya
Menilai kerusakan yg
ditimbulkan oleh tumor
primer atau dari hasil
metastasis.
NSCLC Cyfra 21 1
(primer), CEA (sekunder)
SCLC NSE (primer),
Cyfra 21 1 (sekunder)

Hasil Px
laboratorium
LED: 100 mm/jam
Hb: 7 mg/dL
Leu: 4000 uL

 Pemeriksaan
radiologi
Foto toraks PA
CT-Scan
MRI
Pemeriksaan Lain:
Sitologi
Bronkoskopi
Biopsi transtorakal
Torakoskopi

DIAGNOSIS UTAMA (WORKING

DIAGNOSIS)
Kanker Paru
Jinak
Fibroma,
adenoma,lipoma
, tuberkuloma
dsb
Ganas
Primer
Sekunder (Ca
mammae, ginjal,
ovarium, tulang,
hati dsb)

Two main Types of Lung Cancer:

Small Cell Lung Cancer

(20-25% of all lung

cancers)

Non Small Cell Lung Cancer (most common

~80%)

1. Squamous cell carcinoma

2. Adenocarcinoma
3. Large cell carcinomas

SMALL CELL LUNG CANCER (SCLC)

NON SMALL CELL LUNG CANCER

(NSCLC)
1. SQUAMOUS CELL CARCINOMA

Moderate to poor differentiation

makes up 30-40% of all lung cancers
more common in males
most occur centrally in the large bronchi
Uncommon metastasis that is slow effects the
liver, adrenal glands and lymph nodes.
Associated with smoking
Not easily visualized on x-ray (may delay dx)
Most likely presents as a Pancoasts tumor

NON SMALL CELL LUNG CANCER

(NSCLC)
2. ADENOCARCINOMA
Increasing in frequency. Most common type of
Lung cancer (40-50% of all lung cancers).
Clearly defined peripheral lesions
Glandular appearance under a microscope
Easily seen on a CXR
Can occur in non-smokers
Highly metastatic in nature
Pts present with or develop brain, liver,
adrenal or bone metastasis

NON SMALL CELL LUNG CANCER

(NSCLC)
2. LARGE CELL CARCINOMAS
makes up 15-20% of all lung cancers
Poorly differentiated cells
Tends to occur in the outer part (periphery) of
lung, invading sub-segmental bronchi or larger
airways
Metastasis is slow BUT
Early metastasis occurs to the kidney, liver
organs as well as the adrenal glands
.

DIAGNOSIS BANDING (DIFFERENTIAL

DIAGNOSIS)

GEJALA KLINIS
Early Signs

Late signs

Cough/chronic cough

Bone pain, spinal cord

compression

Dyspnea

Chest pain/tightness

Hemoptysis

Dysphagia

Chest/shoulder pain

Head and neck edema

Recurring temperature

Blurred vision, headaches

Recurring respiratory infections

Weakness, anorexia, weight-loss,

cachexia
Pleural effusion
Liver metastasis/regional spread

ETIOLOGI
Merokok
Perokok pasif
Polusi udara
Paparan zat karsinogen
Penyakit paru

PATOFISIOLOGI
Berdasarkan kasus:
Merokok
Metastasis

Teori Onkogenesis

Gen supressor tumor

Predisposisi
Inisiator

Delesi/Insersi

Promotor

Tumor/Otonomi
Progresor

Ekspansi/metastasis

TMN STAGING SYSTEM FOR

LUNG CANCER
T= Tumors : tumor size,
(local invasion)
N= Node : node
involvement (size and
type)
M= Metastasis : general
involvement in organs
and tissues

LUNG CANCER STAGING

CONTINUED.
T: Tx, T0, Tis, T1-T4
(T3-tumors greater
than 7cm, T4 is a
tumor of any size)
N: N0, N1, N2, N3
M: M0, M1a, M1b

PENATALAKSANAAN
The three main cancer treatments are:
*surgery (lung resections)
*radiation therapy
*chemotherapy
Other types of treatment that are used
to treat certain cancers are hormonal
therapy, biological therapy or stem cell
transplant.

LUNG RESECTIONS
Lobectomy: a single lobe of lung is removed
Bilobectomy: 2 lobes of the lung are removed (only on R
side)
Sleeve resection: cancerous lobe is removed and
segment of the main bronchus is resected
Pneumonectomy: removal of entire lung
Segmentectomy: a segment of the lung is removed
Wedge resection: removal of a small, pie-shaped area
of the segment
Chest wall resection with removal of cancerous
lung tissue: for cancers that have invaded the chest wall

COMPLEMENTARY THERAPIES
Includes acupuncture and massage and
pharmacological approaches such as vitamins
and herbal medicine.
One study showed that herbal medicine is used
by approximately 48% of lung cancer patients in
China.
These herbal therapies combined with
chemotherapy increases survival in non-smallcell lung cancer by up to 42%, compared with
chemotherapy alone.

PROGNOSIS
The best estimate on how a patient will do
based on:
*type of cancer cells
*grade of the cancer
*size or location of the tumor
*stage of the cancer at the time of diagnosis
*age of the person
*gender
*results of blood or other tests
*a persons specific response to treatment
*overall health and physical condition

TERIMA KASIH