Transcript

Gejala dan cara diagnosis tumor ginjal

Dr. Titiek Sunaryati, M.Ked

• Tumor ginjal merupakan tumor saluran kencing terbanyak ketiga setelah tumor prostat dan tumor kandung kencing. Semakin meluasnya penggunanaan ultrasonografi (USG) di poliklinik rawat jalan mempermudah deteksi dini kasus-kasus tumor ginjal.

• Banyak faktor yang diduga menjadi penyebab timbulnya tumor ginjal. Merokok merupakan salah satu faktor resiko yang menyebabkan tumor ginjal. Semakin lama merokok dan semakin muda seseorang mulai merokok semakin besar kemungkinan menderita tumor ginjal.

• Gejala khas tumor ginjal berupa tiga tanda trias klasik yaitu: nyeri pinggang, kencing berdarah dan benjolan atau massa pada pinggang atau perut yang merupakan tanda tumor dalam stadium lanjut. Hipertensi (tekanan darah tinggi) dan anemia (kurang darah) tanpa sebab yang jelas terutama di usia muda juga merupakan gejala yang penting untuk dicurigai sebagai tanda adanya tumor ginjal.

• Terapi tumor ginjal yang masih dalam stadium dini dilakukan nefrektomi radikal yaitu mengambil organ ginjal. Terapi lain berupa hormon, radiasi dan kemoterapi.

Tumor ginjalTumor jinak• Renal papillary adenoma• Renal fibroma/hamartoma• Angiomyolipoma• Oncocytoma

Tumor ganas• Renal cell carcinoma• Urothelial carcinomas of

the renal pelvis

Gejala tumor ginjal• Abdominal mass• Abdominal swelling• Fever• Abdominal pain• Nausea• Vomiting• Apetite loss• Weigth loss• Blood in urine

• High blood pressure• Usually only one kidney affected• Palpable upper abdominal mass• Anemia• Heart murmur• Ascites• Prominent veins• Pallor• Mild fever• Lethargy• Pain• Hemihypertrophy• Genitourinary defects

• Physical exam: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors.

• Urine tests: Urine is checked for blood and other signs of disease. • Blood tests: The lab checks the blood to see how well the kidneys are

working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job.

• Intravenous pyelogram (IVP): The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems.

• CT scan (CAT scan): An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.

• Ultrasound test: The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram.

• Biopsy: In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.

• Surgery: In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or all of the kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Wilms’tumor=nephroblastoma=embryonal mixed tumor• Biasa pada anak < 10tahun (tut <3)• 25% tumor ganas pada anak• Merupakan tumor campur shg td bermacam

komponen,

tetapi asalnya dari 1 germ layer yaitu mesodermal

Gros:o Tumor btk bola sangat besar,shg ginjal jadi kerdilo Berat bisa mencapai 15 kgo Pada irisan td macam-macam komponen

Antara lain: Jar.miksomatik Jar.sarkomatik spt daging ikan Konsistensi lunak/padat Jar.tulang rawan Daerah nekrosis+perdarahanPA:1.Glomerulus abortif/primitif

dg ruang bowman yg terbentuk kurang baik2.Tubulus abortif

seluruhnya terkurung dalam stroma sel spindel3.Blastem

sel-sel ginjal yg masih primitif4.Otot bergaris, tulang rawan dll

Klinis:

px anak2 dgn tumor yang besar sekali

Prog:

sangat baik

Tx:

surgical, nefrektomi

radioterapi

chemoterapi


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