program diploma iii keperawatan universitas muhammadiyah malang
DESCRIPTION
Keganasan Sistem Urogenital. Program Diploma III Keperawatan Universitas Muhammadiyah Malang. Kejadian. Keganasan prostat paling sering Keganasan buli-buli Keganasan testis, ginjal, penis. Stadium. Derajat diferensiasi (grade). Derajat diferensiasi sel-sel anaplastik Diferensiasi - PowerPoint PPT PresentationTRANSCRIPT
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Program Diploma III Keperawatan
Universitas Muhammadiyah Malang
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Kejadian Keganasan prostat paling sering Keganasan buli-buli Keganasan testis, ginjal, penis
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StadiumT
(tumor)Infiltrasi lokal ke organ sekitarnya
N(nodul)
Penyebaran limfogen Lnn inguinal, obturatoria, para aorta
M(metastasi
s)
Penyebaran secara hematogenHepar, paru-paru, tulang, otak
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Derajat diferensiasi (grade) Derajat diferensiasi sel-sel
anaplastik Diferensiasi baik – sedang – kurang –
jelek Mostofi : grade 1 s/ d 4 Gleason : grade 2 s/d 10 (CaP)
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Diagnosis Klinik : anamnesis pemeriksaan fisik Laboratorium Pencitraan Patologi anatomi (diagnosis
pasti)
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Staging T Infiltrasi lokal USG
CT scan /MRI
Pembedahan
N Lnn inguinal, obturator, para aorta,
CT scan /MRI
Pembedahan
M Hepar, paru-paru, tulang,
otak
USG / CT scan /MRI
Bone scan
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Karsinoma ginjal Tumor Grawitz Asal : tubulus proksimalis ginjal Gambaran PA: adeno karsinoma Bahan karsinogen ? DD : tumor jinak ginjal
(hamartoma) tumor retroperitoneal
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Klinik Trias tumor ginjal nyeri pinggang – hematuri –
massa Febris Hipertensi Anemia Sindroma paraneoplastik
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Stadium Robson
I
II
IIIIV
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Terapi Nefrektomi radikal – parsial - paliatif Hormonal ? Radiasi ? Sitostatika ? Imunoterapi dengan interferon
?
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Nefroblastoma Tumor ginjal pada anak-anak Tumor Wilm – karsinoma sel embrional Berasal dari blastema metanefrik Histopatologik favorable – unfavorable DD : neuroblastoma ( dari kelenjar
adrenal ) teratoma retroperitoneal hidronefrosis ?
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Diagnosis Klinik massa di perut sebelah atas hematuri – hipertensi Pencitraan : IVP - USG - CT scan DD neuroblastoma VMA urine Stadium NWTSG
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Terapi Nefrektomi dengan atau tanpa
didahului dengan sitostatika Sitostatika (aktinomisin +
vinkristin) Radiasi eksterna (radiosensitif)
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Karsinoma sel transisional Sel transisional: sistem pelvikalises – ureter – buli-
buli – uretra proksimal Paling sering: pada buli-buli Multifokal Klinik: hematuri – obstruksi (nyeri
pinggang)
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TCCmultifokal
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Diagnosis Klinik Pencitraan
IVP / RPG : filling defect
USG : massa
CT Scan : massa (T,N, dan M) Ureterorenoskopi biopsi
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Terapi Tergantung stadium: Pielum / ureter nefroureterektomi sampai dengan cuff pada buli-buli Radiasi ? Sitostatika ?
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Karsinoma buli-buli TCC paling sering dijumpai Faktor resiko Gambaran Histopatologi TCC – adenokarsinoma -
karsinoma
epidermoid Tumor primer / sekunder ?
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Diagnosis
Klinik anamnesis: hematuri – intermittent - painless fisik: massa di abdomen palpasi bimanual dengan narkose umum Laboratorium: BTA, sitologi urine, flowsitometri Pencitraan: IVP – USG – CT scan – MRI Sistoskopi - biopsi
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Terapi TUR Buli-buli dengan staging (T) Terapi selanjutnya tergantung stadium: radikal sistektomi radiasi eksterna sitostatika (CisCA) instilasi dengan sitostatika / imunoterapi
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Karsinoma prostat Keganasan urogenitalis paling banyak Insidens meningkat : usia harapan hidup
sarana diagnosis informasi Jenis histopatologi : adenokarsinoma Pada zona perifer kelenjar prostat
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Diagnosis Klinik :
Tanpa keluhan
Kluhan diluar sistem urinari (metastasis)
Keluhan miksi Fisik :
Fraktur patologik, kelainan nerologi
Colok dubur : teraba dungkul prostat Laboratorium : petanda tumor (PSA, PAP)
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Pencitraan :
TRUS (transrektal ultrasonografi)
Bone scan
Bone survey
MRI Biopsi transrektal (tuntunan USG)
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T Infiltrasi
lokalM
Hematogen pada tulang
(osteoblastik)
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Terapi
Tergantung usia dan stadium keganasan
Observasi (watchfull waiting) Prostatektomi radikal Radiasi eksterna Hormonal Terapi gen
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Hormonal Huygins androgen CaP Karsinoma prostat : androgen dependence androgen independence Menghilangkan sumber androgen : pembedahan (orkidektomi
subkapsuler) medikamentosa
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Karsinoma testis Dibedakan : seminoma non seminoma Usia : trimodal bayi – dewasa – orang tua Penyebaran sebagian besar limfogen, kecuali
korio karsinoma (hematogen) Stasiun kelenjar pertama : para aorta Predisposisi : kriptorkismus
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Diagnosis Klinik
massa pada testis, tidak nyeri
massa pada perut sebelah atas Petanda tumor : α feto protein, β HCG Pencitraan Histopatologi melalui orkidektomi
transinguinal
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Terapi
Tumor testis
orkidektomi
Histopatologi
Seminoma
Non-seminoma
RadiasiSitostatika
RPLND
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Karsinoma penis Karsinoma kulit Histopatologi : epidermoid karsinoma Hygiene penis yang kurang baik Pertahanan penyebarannya : fasia Buck Lesi berbau, ulkus, perdarahan Penyebaran limfogen ke kelenjar limfe
inguinal
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Terapi Lesi primer sirkumsisi penektomi : total / parsial laser Nd:YAG, kemoterapi topikal, radiasi Kelenjar inguinal diseksi Sistemik :
sitostatika bleomisin