Organic Name Reactions for the students and aspirants of Chemistry12th.pptx
Sist.aliran limfe leher
1. SISTEM ALIRAN LIMF LEHER
Penting o/k hampir semua bentuk radang ,keganasan
bermanifetasi ke kelenjar limf leher
Setiap sisi leher 75 kelenjar limf
- >> rangkaian jugularis int & spinal asesorius
Rangkaian kel limf jugularis interna (profunda)
- clavicula dasar tengkorak
- Selalu terlibat metastasis tumor
2. Jugularis prof. superior.
Jugularis prof. medius
Jugularis prof. inferior
Submentalis
Submandibula
Servikal superfisial
Retrofaringeal
Paratrakeal
Spinal asesorius
Skalenius anterior
Kelompok kelenjar limf :
4. Nodus submental
Dagu, bibir bawah bgn tengah, cavum oris ant,
vestibulum nasi.
Eferen : nodus submandibula, jug.prof. superior
Nodus submandibula
Area submentalis, kel.liur submandibula,
bibir atas, lateral bibir bawah, rongga hidung,
kavum oris anterior, 2/3 ant. lidah
Nodus retrofaring
Nasofaring, cav.nasi post, telinga tengah,
tuba eustachius, orofaring, hipofaring, sinus
paranasalis
5. Nodus spinal asesorius
Kulit kepala bagian parietal, leher belakang,
Nodus retrofaring
Nodus paratrakea
Hipofaring, esofagus servikalis, trakea bgn atas, tiroid
Nodus supraklavikula
Paru, hepar, nodus spinal asesorius
Nodus servikalis superfisialis
Parotis, oksipitalis, retroaurikuker, terdapat vena
jugularis eksterna
6.
7.
8.
9.
10.
11.
12. What is head and neck cancer?
Head and Neck
Cancer is a group
of cancers that
includes tumors
in several areas
above the collar
bone.
13. Head and Neck Cancer has three major
subdivisions:
Oral Cancer
Laryngeal Cancer
Nasopharyngeal Cancer.
14. Head and Neck Cancer
Squamous cell carcinoma
of the head and neck
(SCCHN) occurs in
50,000 new cases
annually in the US,
resulting in over 13,000
deaths each year
15. Risk Factors for
Head and Neck Cancer
Tobacco Products:
Smoking Tobacco
Cigarettes
Cigars
Pipes
Chewing Tobacco
Snuff
Ethanol Products
Chemicals:
Asbestos
Chromium
Nickel
Arsenic
Formaldehyde
Other Factors:
Ionizing Radiation
Plummer-Vinson Syndrome
Epstein-Barr Virus
Human Papilloma Virus
16. Possible Occupational Risks
for Head and Neck Cancer
Woodworking
Leather manufacturing
Nickel refining
Textile industry
Radium dial painting
17. Warning Signs of Head and Neck Cancer
Hoarseness
Erythroplasia
Referred otalgia
Persistent sore throat
Epistaxis
Nasal obstruction
Serous otitis media
Neck mass
Non-healing ulcer
Dysphagia
Submucosal mass
Not all cancers present with symptoms at early stages!
18. Factors Delaying the Diagnosis of
Head and Neck Cancers
Patient procrastination in seeking medical
attention
Physician delay in diagnosis
Patient remains asymptomatic for a prolonged
period
25. N2c Bilateral or contralateral, < 6cm
ContralateralIpsilateral
< 6 cm
26. N3 Any LN > 6cm
ContralateralIpsilateral
> 6 cm
27. Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
Stage IVa T4a N0 M0
T4a N1 M0
T1 N2 M0
T2 N2 M0
T3 N2 M0
T4a N2 M0
Stage IVb T4b Any N M0
Any T N3 M0
Stage IVc Any T Any N M1
Staging
28. Resectability
Depends on T stage
T1, T2: resectable
T3: may be resectable
T4: mostly unresectable
Depends on surgical team
Wide excision reconstruction
ENT surgeon plastic surgeon
Depends on patients
Organ preservation
31. Incorporation of chemotherapy
Before definitive treatment:
Induction/neoadjuvant chemotherapy
After definitive treatment
Adjuvant/consolidation chemotherapy
Concurrent with radiotherapy
Concurrent chemoradiotherapy
32. KNF : Tumor ganas THT terbanyak
Urutan V di Indonesia
EPIDEMIOLOGI
Cina Selatan ( Guang Dong, Guang Xi)
- 38,84 / 100.000 penduduk
Asia Tenggara
- Ras Mongoloid
Eskimo
Sex Incidence Pria : Wanita ( Makassar 2,8 : 1 )
Age Incidence : 30 – 50 thn (44%)
KARSINOMA NASOFARING
33. ETIOLOGI
Multifaktor :
Genetik : HLA-A2, HLA-B.sin
Virus : Epstein Barr
- DNA pada epitel sel tumor
- Antibodi Anti EBV
Environment
- Nitrosamin
- Asap kayu bakar
- Herbal tea
- Higiena buruk
- Ventilasi buruk
34. HISTOPATOLOGI
KNF adalah tumor asal epidermoid
Kriteria WHO :
Tipe 1 : Keratinizing squamous cell carcinoma
(Karsinoma sel skuamosa berkeratin)
Tipe 2a : Non-keratinizing squamous cell carcinoma
(Karsinoma sel skuamosa tidak berkeratin)
Tipe 2b : Undifferentiated carcinoma
(Karsinoma tidak berdiffrensiasi)
35.
36. GEJALA KLINIK
Lokasi pertumbuhan di fossa Rossenmuleri
Stadium dini tidak khas
Diagnosis dini sulit ok :
- nasofaring tersembunyi
- creeping tumor
Tergantung lokasi tumor
Nasofaring : obstruksi nasi, epistaksis
Telinga : oklusi tuba, gangguan pendengaran,
otalgi, tinnitus
37. Mata dan syaraf : diplopia (N.VI) , parestesi muka (N.V)
Kadang ke N.III dan IV,
lebih lanjut dapat mengenai N.IX, X, XI,
sefalgia/hemisefalgia
Leher : Tumor koli lateral (nodus jug.prof.sup disebelah
bawah belakang m. sternokleidomastoideus)
Metastasis jauh : hepar, paru, tulang
40. ANGIOFIBROMA NASOFARING
( Angiofibroma nasasofaring juvenile )
- Tumor jinak jarang
- Mendapat perhatian gambaran klinis ganas
- Ekspansif
- Mudah berdarah
ETIOLOGI
Belum jelas, diduga faktor hormonal akibat gangguan
keseimbangan estrogen dan androgen
INSIDEN
- Anak atau dewasa muda ( 10-25 thn )
- Pria : Wanita = 10 : 1
41. HISTOPATOLOGI
- Angioma td tunika intima, tanpa muskular
- Fibroma
- Makro : soliter atau multipel, warna merah kebiruan ;
pucat
GEJALA
- Epistaksis banyak, sukar dihentikan
bila sering ANEMIA
- Obstruksi nasi
- FROG FACE : Prluasan ke arah wajah
- Mudah berdarah bila disentuh
Sebaiknya tidak dilakukan biopsi
42. PEMERIKSAAN
- Rinoskopi anterior / posterior
- CT- Scan
- Angiografi
TERAPI
1. Operasi Pendekatan transpalatal dan
Rinotomi lateral
1. Diperlukan darah yang cukup ( > 1 liter )
2. Radioterapi
3. Hormonal
PROGNOSIS
Umumnya baik
43. TUMOR GANAS SINUS MAKSILARIS
Tumor ganas sinus paranasalis paling sering
INSIDEN :
- Umur 50 – 59 tahun
- Pria : Wanita= 2 : 1
ETIOLOGI
- Belum diketahui
- Paling banyak menegenai pekerja kayu, tambang
- Thoratrast
- Sinusitis kronik
HISTOPATOLOGI
- Carsinoma Planoselulare paling sering
- Adenocarsinoma, Papillary carsinoma
- Silendroma
45. DIAGNOSIS
- Pemeriksaan Fisis : Rinoskopi anterior dan posterior
- Foto polos
- Ct-Scan perluasan tumor
- Biopsi
Maksilektomi merupakan terapi pilihan untuk tumor
ganas sinus maksila
- Radikal maksilektomi dengan eksentrasio orbita
- Partial maksilektomi biasanya untuk tumor jinak
-Inferior partial maksilektomi
-Superior partial maksilektomi
TERAPI
46.
47.
48.
49. TUMOR GANAS OROFARINGEAL
ETIOLOGI
- Belum jelas, diduga berhubungan dengan alkohol, tembakau
HISTOPATOLOGI
- Squamous cell carcinoma (paling sering)
- Lymfoma
GEJALA
- Disfagi, odinofagi, referred otalgia
- Sakit tenggorok, rasa benda asing
- Hot potato voice
- Trismus
- Hematemesis
50. Pada pemeriksaan ditemukan :
- Tonsil tampak membesar paling sering unilateral,
permukaan tidak rata, ulserasi
- Infiltrasi ke ruang parafaring trismus
- Pembesaran kel. Limf jugularis profunda superior
(Cepat mengadakan metastasis regional )
51. Many of the oral lesions may have had an initial
lesion that were potentially curable.
The cure could be predicted if the lesion is
diagnosed early and the appropriate therapy is given
before the disease reaches advance stages to
become incurable
55. Assessment
Complaint:
Vary widely and is often unreliable
Painless lump which persisted for a varying
period of time
Persistent ulceration
Difficulty of wearing denture
Later Symptoms:
Pain locally or referred to the jaw or ear
Difficulty with chewing food and swallowing
Altered speech and respiratory difficulty
Asymptomatic and noticed during routine
dental examination
56.
57. TUMOR LARING
JINAK :
- tidak banyak, sekitar 5 % dari tumor laring
- histopatologis : papilloma laring, adenoma,
kondroma, hemangioma, lipoma, neurofibroma
Papiloma Laring
paling sering
terdapat 2 jenis :
1. Papiloma laring juvenilis
- pada anak-anak
- multipel
- dapat mengalami regresi pd usia dewasa
- analog dengan verucca (o/k virus)
58. Makroskopis :
Seperti buah murbei, warna putih kelabu, rapuh,
tidak mudah berdarah
Gejala
- Disfonia
- Batuk
- Sesak
2. Pada orang dewasa
-Bentuk soliter
-Tidak mengalami regresi
- pre kanker
60. TUMOR GANAS LARING
tidak jarang
Etiologi :
- Risiko tinggi perokok, peminum alkohol
- Virus herpes
- Polusi udara
Patologi : 95 % Karsinoma sel skuamosa
Insidens :
- Luar negeri, Ca laring peringkat I
- Indonesia, Ca laring peringkat III (setelah tumor
nasofaring dan hidung/sinus paranasalis
Pria : Wanita = 7 : 1
Umur 51 – 60 tahun
61. KLASIFIKASI LETAK TUMOR
- Supraglotik : tepi bebas epiglotis sampai
plika ventrikularis
- Glotik : plika vocalis
- Infraglotik : > 1 cm dibawah plika vokalis sampai
tepi bawah krikoid
DIAGNOSIS
Gejala : suara serak, sesak napas, batuk (hemoptisis), BB
Pem. Fisis : Laringoskopi indirek/direk
Radiologik : X-Foto toraks/leher, CT-scan
Histopatologi : Ca. sel skuamosa (terbanyak)
Stadium tumor : Klasifikasi UICC
62. TERAPI
Pembedahan : Laringektomi total/parsial
Radioterapi : tergantung stadium dan KU
Sitostatik
Rehabilitasi suara :
- Esophageal speech
- Speech therapy