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PENDAHULUAN

ORAL CANCER AND PRECANCER


lrna Sufiarvati, drg., Sp.Pll
OrdLtfcitFD?dnll
Feltyol

. . . . . .

lndonesh: l6nkerRongga Mulut urubn

kell

lGnkerro4ga mulut5,6 % dad sduruh kanker Ush>,f0bhun,d: 9 =1,5"1 Lokasiteratug: Udah (57%) Histooatohoisbrbanvak; KarsinornSelSkuarroa (KSS)

% Oali Xeganasah mr6ga mulut, 3(D 000 kmus perbhun di sduruh dunia. Masalahubttta:
90

Kedar$ahnpaslenrBncadperdongannedis

mng@sbdiumlanjut
2

ArUka lwapan hklup 5 bhun < 50 % (tidak ada penimkalan pda lebih dai dua dekade ini)

ffitHlErrr

thi"ent

l-Kgonoson

I
akibot
konker

l50Trrrt

lit"s

K
I

5O % sekrrele

PRECANCER LESTONS g s

o
irfeksi
disfignrmsi wqioh

hilotgnya fungsi stormtognctik

wffiffi
A.lcnloplokic; B.Erirnoplokic; C.Eritrcla*oplokio
($ham
5,

plok rncnah/ prtih/ Diddrului oleh lari pnd<ordcr konbirrosi yorg tidok blso diorgkcr & fidok biso dikorotrteristiklcn secora klinis/palologik sebagoi pelrpkit/kondisi loin

LEUKOPLAKIA

. . . . .

Plak/bercakptih pd mukca mulutyg tidakdapatdiargkat

S@ian

besarlid pd gia, 45-65hn.

12-25%)dbplasia

Fmb

m,

TuloE E-

&rrfte

of

OFal

ilera)

$10%+

kasinoma

tcsi deryon konponen


Trsnsfornosi

sifilb, def. vibmin, ketidaladmbaryan

Eli&gi: mlciprobktif trp itihi kronb, bmbakau, alkotrol, hornol glmnbme,

r bsdf,

gesekan konb, virus dan lndk

bb.

Psneriksan dan Terapi lcukoplakia:


grbar4r klinh.

Sa|gdbsrlairilrid dflf,il, htq$,dan

. Hihngkanfakbnitihi & paryebab . Jikamer*p) bk4si . Tenapi:


frastrasanpaidr

. . .

strdarcoldd

Wana: leei grffi

l{bsiffka$(wtlo}: t('ltrogonelMtonpgen.
tnddd, iltdJar.

-Eksisi,lffi - Terap{ bpikal t adifasi bpikd vihmin Muthruhn - Ter4isislernik t Refinoid

A, Bborryin dl

ibn{omgn:siboffiia, bdc*,

ERITROPl.AKIA

Telah dikenal3 jenis Edtroplakia:

. .
.

Bercdt rnel.dt sepert bdrdu, amebp, yg trd( dapd digobngkansra il[nb sbg keerhan bh4agn
Secara

Benfuk homogen

merah memta

. .

Eri@hkia + bercak+ercak trerah bercampur


deqgan beberapa le{rkodakia Bercak tarltoplakia mengandurq bintik{intik atau grarrul+granula putih yg menyebar tli seluruh lesinya.

hisbhgb

lceUeruqmlehttr{$ {@ Tdak& prcdileldlttbkdil*n

di#asbepild

rnrqrrryai hdoftkia) rnnlrdi

Seiry rnngenaipa$en bensh>60tdun

Pemeriksan Eritro$akia:
Bi0p6i kehanrsan u/ sanualipeedEoplakia km 91% siboplakia mcnunjukkan displmia yg paah,

kaninoma in slfu, karcinoma selskuamosa yg


invasif.

Perneriksaan yg cernddrslft p mulut) 10-'2ffi pasien memp. Bbrpdaedr eritopfd<iayg hebat

hnomena feU ca/rfirizdiwtl

Eritroleukoplakia dan Speckled Erihoplakia


Eddeul@kh + sadJbercak
ygHphdr-pirldr
merah dengar mrah W

daedrdardt tottoptdriir rrnOaduq


ttodder
dan 0H yg

Fokfor yorg rncnrpaporuhi rcsiko tnsntfot'nasi kcgnmson - Eritrcplokiapodo lcsi la*ophkio - Tompilon rcrukoso pnolifcrctif - Lokosi pada bogion deqon rcsiko titggi

er

SpeclGd E

graula{rfluh putih rnerda di sduruj lsi. tflkopl*ia rend(@ ptolivedif ) le$ merdrptih
tesiJesi inisahg dhrfifiUkar dgn perdoft berd,

i@*&r + $rfi berc*

Untik-ttntik

L.sl

nultlpel

Riwcyctmenolok

dlohdsrc,

lrkosi dsd lcsi proltanhcr


Bukol

h$dc Udah
Polsft^un

R iP
E

6iryiw
4
5

hbksi rtmur {Crrfe dbansJ serilul(di rffudrr$a d$t speckled leukod*ia. tithm hub. Seb$*ibdya$kdike&hui C. dtiodu &rninar dihruk* d Saghn b6ar k6t s.

durun
N

(ls|
%

50 82.5

I
10

10 12.5

10

Lesi pre-kanker lain:

. Lichen Planus . Syphilis . Submucous Fibrosis . OralHairy leukoplakia

ORAL CANCER

lfurhtqsnc,sls
Tirgkd insidasi kanks mulut berhuhngan dgn -U$a bedorangnya kekeHar tubuh - Wdrhr yg tlihr[rhkan u/ akumul*i perub$ar

&ltcl :

"pNoses

berbhap di mana teriadi drumulai keiadian genetlk diddam selyag menyebabkar bmpilar sel displmtik progrcsif, dercgulmi pefumhhar sd
& akhimya kasinoma'

gstdik

- Durai bekspmnya fip inisidor {pemicu) - ftorndor (fidftr2 yg madukung/runperoepat ka*er, tnsk fdrtor ilihi kimia & fisik, virus,
peruwuh fuxm(xr, p$uaan sd, dar menurunnya kdrebalar fu hrh)

dalnubi

bn nrton&ri penbdmfcmtip 4 gercrip nelipti inisiosi, prrornoci &

. Inlslsi t ikcton hngsurg & kerusokon


korsinogen

DNA oleh

Pathogenesis

. hvttwi

; menyebcbkon prokegonoson

irreversible.

. hwsit

disreaulasi vono rnenohosilkan se1 yorg'UeFsifqt-otonom akibot irbnormolitos genitllipodo onkogen

pefumbuhqn

ll\enahon

ll&furry

tahop lcrsinogenesis

menperlonbat perkemboryan

konker

Molecular

todel of Dysplasia and Carcinogenesis

*"-*l& &oHll
,r.,'r

+t
!s

tL

l *r'.,*t

illd

DrECili.

8ws

Pr!g[88lon ol Dysplaila

ktrr3s rds"lr

ffiffi__

rc
MEIANOMA
lll)

@E@E

k#ffieffiHffi
6{iq.'# @ cffiffiffi-,-'_hsffi M ffi tl* l*rdduhfff dl:w d0C rcqdzq ffilrlde

ffiffi-:-*ffi
Prooedur Diagnostik

Stadium Kanker Rongga Mulut

. ' . .

Anamnesis krngkp

Penerilcaan Fidkyang bliti

UkurnbJrorprnnet

KGByarlgHibet
EI(3Fi!{ dm

inneitrnc

k3

stddrskitar

TO

PrwedurBbpei - 8i0rE{ irlisi atil dlistr(ue tadlrrl llFM

- $Sris3kdiilBsetopre{
TnbJttr lnvad

r<td >3 -ar

dstrritT(etadium

Prosedurlrnging
dal ksb}si hrnor Trnl(srmetasbi3Fil.fi
B

Sebab keterlambatan:

-Ketidaktahuan pasien - Rendahnya kalaspadaan dokter

terhadap lesi prekankerdi rongga mulut Kebijakan pqnerintah yang longtgar (?)tentarg izin pengobatan altematif

tn
SqLoo. Et.ll|o

El*r

crlelrld

libt s

ORAL CAI{CER IS TREATED

WITII

How is oral cancer


treated

.
.

STJRGERY

RADIOTTIERAPY

CHEMOTHERAPY

-_L. t..!.'a#'

. !

,-!i/

Terapi Kanker Rongga Mulut

. .

PondekatanMldttdisidinr

e .
.

STRGERY

lhdalitae traft:

Aims to rcmovc the cmcerous growth aompletely md to maintain reasonable 4pecmco md

. .

- Bdafr - FladiderQi - Klmdrpi - Kofl*fnsi


Di Divisi Bdah Turpr, paeem yang menFbn harya 50% dad yarp didiagnetue

fimctim
Cm affect eating swatlon'ing md cmtrol of saliva
becane the

brapi

alter*im to stnrchnes inlhemordt

harrye 3E% yang dioper4t, skrarva Stadium hniut rediotar8pi, kemtrrapi atau komum$ ked.Enya

Credeproblems wih diet mdfmd intalc, leading to weighloss mdsuscepfibility to infectim

Terapi Operatif

.
' .

lndikasioperasi: - I(8ll3 oporbd

/
.

crrEMorr{ERAPY

pada rEla rru(b tg|pa

ko{no.bidi6 bret

Use of cell toxic drugs to reduce or stop the

Hal yang han s dipfiatikan:

growfi cancercells

Pgrtah.Io

acpk l(osntis dan nrEFi(rnal

Sdama operari: - Prnbrfil hrae tntl* mdtrd *#r8l tlrDr - Eibta.p invadtdag, rsseksi ft.Es (l-2crn bpi saydr b6bas
Bile d{rgfli invaBitdslgf rEsdqri lsas + rurd{$ tuldfgyilg - tnnvEat - Dir6lG$KGB Ggional Hhts.libat - Rd(o.l!ftIqfd*kyruwi

tfllor)

Can not distinguish normal cells of the body which are actively dividing; including cells liningthe rnoutlq bone mmow, mucosa ofthe GIT, hair follicles

Kemoterapi

RADIOTIIERAPY

xemaeraplpnmer

- k

ka$ sta&m Irt'.d d.rgan fit@$ jartt

'
. .
lrgpi

. l

n&rapi

Use of a beam of high ener$/ x-rays to stop cancercells firom growing and multiplying

neoaiuvan Dib.ik'rs.tftrn tind{fiierapi(ffitit1{opre{) Tquen: molEpdfidt rnosaa trrprdan mongtar'rgi


mitroanetartalis saat oprsri YdE brs6rirE: Regfutsr cispldindm

lncalisedtreatuent only tissues in dfuct


path of the beam, including normel tissues

.lGrderafi4wan

trU

Oral problems occurred in radiotherapy on

theheadand neck
gbegei

- Db.il(grsdebhffiil opdsi d{t - Tuirraft nrargfitgi ri8il(oflr'kflle@aE Aftafidlpa(blarsil pcit'f - negintn Cilpletdil 54U

Radioterapi

. .
.

lndikasi:

- Ksl3inopdbd - Ldeits.t6nbr - Uliiatue, mstold(opaad, koflrortidit$bri


Cara: - Radia{l(8tille

What are some

onl problems

caused by

chemothenly and mdiation?

- Rdi$iirtuna

\l\laktupemberian:

Pa'c*a(bh: lu&ft T3 *, T4 yilg retsnr3 opr*i a.{it rnilr( dielisirdild, at4r bibad.l@ntflniDa{ rd l(gl(srdi l+ng
oporasi

mdah: wnd(kas.E yangQar&ltttasryaOlagr*st

ORALCOMPLICdTIONOF
CHEMOTHEN.AXY AND RADIOTHERAPT
ORALSEQUEIAE CI{EMOTTIENAPY RAI}IOTEENAFT

Follow Up

Tujuan:

Xcrmir
Mumiria
Infccrioos

x
x x x

- lbrfhi reopotbrapi - Deteksi dini lekuensi

x x x
x

'

Oattcmontegc

Yang dinilai selama follor up: - StilIsumum, koluhan pesion - tema hilup &n larrE bbas pnyakit

nedftruseis
Irirrnus

x
4t

- Stafrspenyakjt (Bebaskanker, - R6po.tbrepi - l(omplik*[bnapi - Timbulnyakankerbaru

rcek*f,

rffi#*D

STAGES OF CAI\ICER

THENAPT

SIAGES OF CANCER ITIEX,APT

Prcfefrnelrt
indu6 fie priod lirnefom medftrel drgnob ard hcpitd dndlciot b tp initbtion
Thb psiod

Dudnsbeattte|rt
Thb pqiod dfind by nignincant nryehsupprsbn and innruncupgession fiat is a cmsequence of aqgrcssitte

of

cancerbednent
Maintenance-of good oralhyglene

fierapy.

bnnhitU

2{g!f

utitt

lf

cfuamtanoesalhr, ftb b fte optimaltime to institute an

softbrush,flcoiry
Use of oommm oral dnrec (lsotottic saline, sodium

dfficdoradtuna

onl hygi,endand orfruori& rqim, reEtoND or l"mo\ro dlseed dentitsrand eliminab pobntial onl sources

trftHbonab), drlodp&tine

Stegcr of canccr therepy

Strg6of c$ccrtrnpy PoctTna8nent


This pe*iod

desease he risk, mntinue pescribed oralhygiene regimen, avoid ahohol based moutlnmdr,M lhuids, smoldng, ding had or rough fioods, plateld hanfinrion, ltcrtootaftic agent (ilunexanic acid, topical
Oral

hemsrfiee

@to

inddee long

raryes fiom

I yrarb

bm ftllo*np

of the

paiiat and

llfu-tim.
mually begin

thruntt'n)

Vltpn

Mnentomphbd, ord omflications

resdve Patienb

.
.

lnfedion e4' {epsventusetodcalantisepdc agen6, anffi rngal, antivird Tdsmus er*pssiveiawopening exercice

theMr ad
fiChwup

stul6

continue to fullow a

selfsrc qimen

to

teep

gumc lml$y and facili@the rcpair of residual oral darmge, mainbin integdty d befi, freqtent

utTffidft"&ttrTflI
ll*naqrner olplim*rhdild md en9g' bconiln

$FmRI$l0sBljtcts

@rrHdft#tFlhil
tp*tnrtildHl*{F

enpd gati*dr$fr$slks*S xpntblrthc nqcrt.rlef prta6rrl h*d dru* cr*cbopfu

At,

trfirotr4ub.ltru& hftdlrc*npahorfolheldadnxk sel T:x mm$cettd rd ild ad anry FlhG mt hfihGdr* b&*rq:
Ftrm*n
0f

tult*ttf $od h fcftmd

U r plryrithn

r$q

taii $

ffiW{

sd

rF$eGryrEnrnNngcmit
rlfulirirtttd*opcrl

.Cl*id$ili*frd( d{rdadrdruryry rRr*duuelgy rtr*linsrpct rlqlE*tfi@t rP*ffill' rP*rdrwrmdi*xrpy rtliqno{krddog r$ilHindnsciqnn .l*rrt. mriiss rDE*bttJlnffintcs r tarmngrl f{*dd+lrad r0flHrdog rdffif,l .P{dirll rs*dgdffff*ri{trTl ;.ldqiiltffiiGr

.h*dcnltrllrldr
rXlo*nnEfiEtqnud

; Edsr.dhcinn . CrduplflEilB

'3n*htesraisn
N@{ .9rlFo{Y*

rt*$ahrycxr r$odm*adGmffir!flnfft
Cn

KESIMPUTAN

.
A

Perauntan gimud satgat

pafiry ddam rnnua frre

di,agncb

&

lenpf pcbn kanku mngga rrulut

cans bednentban

derffi,

nuredffi
in

indrtr oncdogistr, lrytenirtr' nubi&nkilr yylto


ehould seqUdae

l&ntfililldan

ae knodedgede

tn

dcarcer tnrryy

dlagnocbdini penlfig untuk menirukaten tirykat kesdarnbn dan mencegdt,insttabsi komlikasi bnpi.

ard ord hedh mainhnance ild aile b coilerdhdy b feat patienb lmlisticdly

wt

mee,ygbarpngshmn.