tumor kepala leher-edit - abl
DESCRIPTION
Tumor Kepala Leher-edit - ABLTRANSCRIPT
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Tumor THT/ Kepala Leher
Dr. Abla Ghanie Irwan, SpTHT-KL(K)
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Tumor THT :
–Karsinoma Nasofaring–Paranasal –Oropharynx –Larynx
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Karsinoma nasofaring
• Insidensi : Perbandingan penderita laki-laki : wanita : 3:1 China bag Selatan : 30-50 /100.000 populasi / tahun Indonesia ( 1977-1999) : 4.7 / 100.000 populasi/ tahun.
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Etiologi :
• Multifactor :–Genetik : HLA–Kebiasaan : • Cantonese Salted fish Nitrosamin. • Perokok.• Alkohol.
–Virus Epstein-Barr.
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Anatomi Nasofaring
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Gejala :
• Stadium awal :– Tidak khas :• Obstruksi Nasi• Rinorrhoe.• Epistaksis.• Tinitus / deafness.
Stadium Lanjut
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Stadium lanjut :
• Benjolan pada leher.• Mata juling / strabismus.• Cephalgia berat.
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Diagnosis :
• Pemeriksaan THT :– Rinoskopi anterior.– Rinoskopi posterior.
• Pemeriksaan Penunjang:– Nasofaringoskop.– Ct Scan.– Serologi
• Biopsi
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Terapi
• Stadium I : Radioterapi.• Stadium II : Radioterapi.• Stadium III : Kemoterapi dilanjutkan dengan
radio-terapi• Stadium IV : Kemoterapi dilanjutkan radio-
terapi.
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TUMOR SINUS PARANASALIS
• 4 sinus :– Sinus maksilaris : sepasang– Sinus ethmoidalis : sepasang - anterior / posterior.– Sinus frontalis– Sinus sphenoidalis.
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Gejala :
• Hidung buntu• Epistaksis berulang – menetap• Gigi goyang – mudah lepas• Sakit pada daerah yang diserang tumor.• Deformitas wajah / eksoptalmus.
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Terapi :
Operasi :• Ethmoidektomi.• Maksilektomi :– Parsial.– Total.
• Pan-sinektomi.Pendekatan : Intra nasal.
Rhinotomi lateralis.Radioterapi.
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Tumor rongga mulut
• Oral Cavity :– 2/3 bag depan lidah.– Dasar mulut.– Mucosa bucal– Palatum durum.– Gingiva– Retromolar.
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Insidensi dan etiologi
Netherland : 3 kasus / 100.000 penduduk. Asia : < tinggi. Penggunaan bahan makan/bahan yang mengiritasi
rongga mulut :TembakauAlkoholHygene mulut. Iritasi kronis : gigi palsu / caries.Defisiensi makanan.
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Leucoplakia• Bercak putih yang terlokalisasi pada
selaput lendir, tidak dapat diangkat dan tidak dapat didiagnosis sebagai penyakit lain.
• Iritasi kronis premaligna.• 5-7% mengalami maligna.• Banyak terjadi pada selaput lendir lidah ;
dasar mulut ; bibir bawah.
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Gejala :
Pada stadium awal : Nyeri (-). Sakit (-). Gangguan gerak lidah (-).
Stadium lanjut : Nyeri (+) Gangguan gerak (+)
Mengunyah Menelan.Bicara.Trismus.Prostesis gigi tidak pas / gigi goyang
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Terapi :
• Operasi• Radio-terapi .– Tergantung :
• Besar tumor ( T )• Lokasi tumor.• Umur & K U penderita.
Prognosis :• Stadium I: 5 years survival rate 70-80 %• Stadium III : 5 years survival rate : 20 %.
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Tumor oropharynx :
• Paling sering : Tumor tonsil.– Carcinoma tonsil.– Lymfoma maligna tonsil• Hodgkins• Non Hodgkins.
– Laki-laki >perempuan – Alkohol / tembakau
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GEJALA
• Nyeri tenggorok– Odinofagia– Disfagia– menyebar ke telinga.– Lendir berlebihan dan bercampur darah.– Suara sengau ( Hot potato chewing).– 60 % datang sudah terjadi metastasis di leher.
TERAPI• Operasi :
– Letaknya sulit / rumit.– Problem rekonstruksi.
• Radioterapi.
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Terapi :
• Operasi :– Letaknya sulit / rumit.– Problem rekonstruksi.
• Radioterapi.
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Tumor larynx
• Laki-laki >> perempuan.• 50thn-60thn• Eropa / Netherlands : rangking no 1.• Perokok berat ; alkoholisme.• HPV.
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Gejala :
• Supra glotis :– Gangguan menelan yang ringan.– Perasaan penuh pada tenggorok.– Nyeri telan , sering kali menyebar ke telinga.– Batuk ; tersedak.– Suara serak.– Benjolan leher.– Sesak nafas.
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Sub glotis :
• Batuk ringan• Suara serak• Sesak nafas.
Glotis :• Suara serak• Sesak nafas.
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Diagnosis
• Gejala.• Pemeriksaan :– Laryngoscopy indirect.– Laryngoscopy direct.• Biopsi.
– Stroboscopy.– CT scan / MRI
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Terapi :
• Stadium awal :– Radioterapi • 5 years survival rate 65 % - 85 %.• Fungsi suara baik.
• Stadium lanjut :– Operasi : Laryngectomy• Total..
– Suara hilang selamanya.– Nafas lewat stoma.– Protesis suara.; suara esophagus.
• Parsial– Suara berubah.