KANKER PADA ANAK 1.

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1 KANKER PADA ANAK 1

2 * * * * KEGANASAN PADA DEWASA DAN ANAK PADA DEWASA: PADA ANAK:
KANKER PARU, PAYUDARA, USUS BESAR, PROSTAT (JARANG PADA ANAK)  KLASIFIKASI BERDASAR LETAK/ASAL ORGAN PADA ANAK: BERVARIASI, TUMOR DAPAT BERASAL DARI LOKASI PRIMER YANG BERBEDA * * * *

3 12 DIAGNOSIS UTAMA KEGANASAN PADA ANAK
( I I C C ) I. LEUKEMIA VII. TUMOR HATI II. KEGANASAN LIMFOMA VIII. TUMOR TULANG & RES IX. SARKOMA JAR. III. TUMOR INTRAKRANIAL IKAT IV. TUMOR SARAF SIMPATIK X. TUMOR GERM CELL V. RETINOBLASTOMA XI. TUMOR EPITEL VI. TUMOR GINJAL XII. TUMOR LAIN

4 Epidemiologi DI DUNIA (1991) DI RSS. (1992-1998) Tu. Hati Lain-lain
Leukemia Retinoblastoma Tu. Tulang Tu. Wilm’s Tu. Otak Neuroblastoma Tu. Jar. Ikat Limfoma Neuroblastoma Tu. Hati Lain-lain Tu. Tulang Leukemia Tu. Otak Tu. Jar. Ikat DI RSS. ( ) Tu. Wilm’s Retinoblastoma Limfoma

5 ETIOLOGI RADIASI: IONISASI, ULTRAVIOLET INFEKSI
FAKTOR PRAKONSEPSI: ROKOK, RADIASI, SITOSTATIKA GENETIK KARSINOGENESIS LAIN-LAIN ETIOLOGI

6 KELUHAN UTAMA PADA KEGANASAN
KELUHAN UTAMA KEGANASAN PUCAT, LEMAH LEUKEMIA, LIMFOMA LEHER BENGKAK LIMPHOMA, LEUKEMIA DEMAM, NYERI TULANG EWING-CA, LEUKEMIA BINTIK PUTIH MATA RETINOBLASTOMA MASA ABDOMEN TUMOR WILM’S, HATI NEUROBLASTOMA NYERI KEPALA, MUNTAH TUMOR OTAK JATUH OSTEOSARKOMA

7 DIAGNOSIS BANDING PANSITOPENIA INFEKSI LEUKEMIA
KELUHAN/GEJALA Dx. BANDING KEGANASAN PANSITOPENIA INFEKSI LEUKEMIA PERDARAHAN KOAGULO/THROMBO LEUKEMIA LIMFADENOPATI INFEKSI LIMFOMA NYERI KEPALA MIGRAIN, SINUSITIS TUMOR OTAK NYERI TULANG INFEKSI TUMOR TULANG MASA ABDOMEN KISTE, INFEKSI TUMOR WILM’S, NEUROBLASTOMA

8 LIMFOMA Limfadenopati TUMOR OTAK Nyeri kepala, muntah

9 RETINOBLASTOMA Mata kucing Meluas ke orbita Tumor abdomen
TUMOR WILM’S , NEUROBLASTOMA, TUMOR HATI

10 PRINSIP DIAGNOSIS ANAMNESIS EVALUASI KLINIS LABORATORIUM PATOLOGI PENCITRAAN MARKER BIOLOGI

11 NON KAUSA PRINSIP TERAPI SUPORTIF KAUSA SIMPTOMATIK RADIASI KOMPLIKASI
SITOSTATIKA OPERASI

12 CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA 4/13/2018

13 INTRODUCTION. LEUKEMIA: 25-35% CHILDHOOD CANCER. (ALL: 80% & ANLL:20%)
INTRODUCTION LEUKEMIA: 25-35% CHILDHOOD CANCER (ALL: 80% & ANLL:20%) ALL: - MALIGNANT DISEASE - PROGRESSIVE INFILTRATION OF BONE MARROW & LYMPHATIC ORGANS BY IMMATURE LYMPHOID CEL/LYMPHOBLASTS UP TO 1970: AS INCURABLE DISEASE CAN IT BE CURED ? 4/13/2018

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17 ETIOLOGY& EPIDEMIOLOGY RADIATION, CHEMICALS, DRUGS, VIRUSES
ETIOLOGY& EPIDEMIOLOGY RADIATION, CHEMICALS, DRUGS, VIRUSES and GENETIC ABNORMALITIES INCIDENCE: 3 per CHILDREN PEAK: 2-6 YEARS SARDJITO ( ) LEUKEMIA: 48% INDONESIA PROBLEMS: REGISTRATION, PROTOCOL, SPECIFIC DIAGNOSIS, COST (DRUGS & SUPORTIVE) 4/13/2018

18 75 Intensive Tx 1980’s CNS Prophylaxis 1970’s
EFS (%) TREATMENT OUTCOME Intensive Tx 1980’s CNS Prophylaxis 1970’s Combination Agent 1960’s 0 Single Agent 1950’S (YEARS) 4/13/2018

19 CLINICAL SIGN SYMPTOMS:. Malaise, Fatique. Bleeding, Bruising. Fever
CLINICAL SIGN SYMPTOMS: Malaise, Fatique Bleeding, Bruising Fever Bony pain, Lymphadenophaty (80%) Splenomegali & Hepatomegaly (70%-75%) Enlargement of the TESTES CNS: (Intracranial pressure> & cranial nerve palsies) 4/13/2018

20 LABORATORY & RADIOLOGY Peripheral blood: Anemia, Thrombocytopenia, Neutropenia Bone Marrow Aspirate: > 25% leukemic lymphoblasts Special stains: Biochemical, immunologic, cytogenetic Radiographic: Mediastinal mass (5-10%) 5%-10%: Diagnostically chalenging   4/13/2018 ALL 1.flv

21 BMP 4/13/2018

22 FAB CLASSIFICATION Morphological CLASSIFICATION: French-American-British (FAB)  L1, L2, and L L1: 80% L3: < 2% The remainder: L L1: Higher remission Prolonged survival than L2 and L3, L3: The worst prognosis 4/13/2018

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26 ALL MANAGEMENT in childhood. Four COMPONENTS. - REMISSION INDUCTION
ALL MANAGEMENT in childhood Four COMPONENTS - REMISSION INDUCTION - INTENSIFICATION - CNS TREATMENT - CONTINUATION The purpose: Eradicate leukemic cells/their progenitors Preserving normal progenitors 4/13/2018

27 Disease Clin. Dx of ALL Made: Detectable Tx Started A D Relapse B Compl. Remission Achieve C Tx Stopped/Ineffective One Malignant Cell Patient Cured E (WEEKS) Number of Leukemic Cell 4/13/2018

28 video csf.CSF REMISSION INDUCTION Reduce the LEUKEMIC CELL BURDEN  CLINICALLY/HEMATOLOGICALLY UNDETECTABLE LEVEL Regimens: VCR, DEXA, L-ASP, DNR & MTx intrathecally PROBLEMS: DIFFICULT DIAGNOSIS EDUCATION/INFORMATION NO COST, NO DELAY COMPLICATIONS/FAILURE 4/13/2018

29 CNS TREATMENT. Prolonged disease free survival
CNS TREATMENT Prolonged disease free survival Protect against late bone marrow relapse CNS Tx REGIMENS: - INTRATHECAL drugs - Systemically administered drugs - Craniospinal irradiation (Now: Avoided) video.LP3 schem.flv video.lp1 tech.flv 4/13/2018 video lp.flv.flp

30 CESSATION THERAPY IN GENERAL: STOP 2-5 YEARS AFTER Dx
CURRENT Tx: AFTER 2 YEARS OF Tx REDUCTION TO 18 MONTHS: INCREASE RELAPSE RATE RELAPSE: IN THE FIRST 12 MONTHS HIGHER THAN IN SUBSEQUENT YEARS 4-6 YEARS AFTER CESSATION Tx: RARE 4/13/2018

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32 Complications: - Infection - Bleeding - Stomatitis - Moon face - Striae - Alopecia - Malnutrition - Psychologic ALL.flv 4/13/2018

33 SUPPORTIVE CARE MORTALITY << & SURVIVAL >> NURSES: AWARE & OPTIMAL CARE HEMORRHAGE: Transfusions Nutrition INFECTION: - ANTIBIOTIC - SEMISTERILE ROOM - ASEPTIC CARE 4/13/2018 ALL.flv

34 SUPPORTIVE CARE - Asscociation of leukemia family - Education - Fund rising - Psychologic support - Drug discount 4/13/2018

35 INDUCTION 4/13/2018

36 CONSOLIDATION MAINTANANCE 4/13/2018