PEMERIKSAAN RADIOLOGI

KEGANASAN PARU

Mashuri, dr. Sp.Rad(K)., M.Kes

Departemen Radiologi Fakultas Kedokteran

Universitas Lambung Mangkurat
RSUD Ulin, Banjarmasin
 Pendahuluan
• Data epidemiologi menunjukkan bahwa faktor resiko
utama penyebab kanker paru adalah merokok.
• Faktor resiko lain adalah hidrokarbon, polusi industry,
radon, asbestos, uranium chromium, COPD dan fibrosis
paru.
• Mayoritas pasien datang dalam stadium lanjut.
• Kanker paru stadium dini dapat diterapi dengan
penatalaksanaan yang optimal.
• Penting untuk diagnosis dini dan staging secara radiologi
untuk pemilihan terapi kuratif dan penatalaksanaan
selanjutnya.
Epidemiologi
4
 Gejala
• Local effect: batuk, haemoptysis, nafas
pendek, nyeri dada dan infeksi yang
persisten
• Distant metastases: nyeri tulang
• Non-specific constitutional symptoms:
malaise,weight loss and weakness.
• Kurang dari 10% pasien adalah
asimtomatik dan terdeteksi secara
insidental.
 Klasifikasi

Histologi Inidens Gambaran radiologi

SCLC 25% Hilar/mediastinal mass
NSCLC
Adeno Ca 35% Peripheral nodul/mass
Squamous cell 25% Hilar mass
Large cell 15% Large peripheral mass
 Pemeriksaan Radiologi
1. Menentukan lokasi massa
2. Membedakan benign dan malignant lessions
3. Staging / penderajatan penyakit
4. Membedakan keganasan yang rekuren dengan
perubahan yang diinduksi terapi
5. Monitoring terhadap respon terapi
 Diagnosis

• Gejala klinik
• Pemeriksaan PA
• Imaging:
– Chest x-ray (Foto Toraks)
– Computed tomography scan
– Magnetic resounce imaging (MRI)
– PET
 Modalitas Radiologi
Foto toraks :
Investigasi awal curiga kanker paru.

CT scan :
• Lebih detail untuk karakteristik lesi
• Dapat mendeteksi lesi 3 – 5 mm.
• CT scan dengan kontras, meningkatkan akurasi
diagnosis membedakan lesi jinak dan ganas
( sensitivitas 98%, spesifisitas 58%, akurasi 77% ).
• Guiding trans thoracal Biopsy ( TTB ).
 Lung Tumour
– Benign
– Malignant
• Primary
– Small cell
– Non-Small cell
» Adeno
» Squamous
» Large cell
• Secondary (Metastatic)
 Small cell lung cancer
• SCLC = oatcell
• Small-cell carcinomas most commonly
arise from the main airways, but rapidly
invade the submucosal tissues.
• It arises from endocrine cells (kulchitisky
cells) where many hormones are secreted
• Spread to lymph nodes and other organs
more quickly than NSCLC .
• More likely to respond to chemotherapy.
• Small cell cell tumours are located
centrally in the vast majority of cases
(90%).
• They  arise from main-stem of lobar
bronchi, and thus appear as hilar or
perihilar masses.
• They frequently have mediastinal lymph
node involvement at presentation.
 CXR
• Appearances on chest x-rays are non-
specific.
• They may be seen as a hilar/perihilar
mass usually with mediastinal widening
due to lymph node enlargement.
• Mediastinal involvement is often the most
striking feature and the primary mass
may be inapparent.
CXR
Superior Vena Cava Syndrome
CT
 Adenocarcinoma
• It arises from the submucosal
glands,located in peripheral airways and
alveoli.
• Adenocarcinomas present as a nodule or
mass:
– periphery of the lung (50%),
– hilar mass (15%), and
– a combination of mass and hilar/mediastinal
lymphadenopathy (35%).
CT
 Squamous (Epidermoid)
cell carcinoma
• Squamous cell carcinoma most commonly
arises in a lobar or segmental bronchus,
occluding the lumen and causing distal
collapse or consolidation.
• Rapid growth, late metastatic
• When it arises peripherally it may grow
large before presentation
 CXR
• The appearance depends on the location
of the lesion. The more central lesions
may merely appear as a bulky hilum,
representing the tumour and local nodal
involvement.
• Lobar collapse may be seen due to
obstruction of a bronchus.
• When the right upper lobe is collapsed
and a hilar mass is present, this is known
as the Golden S sign. 
• A more peripheral location may appear as
a rounded or spiculated mass.
• Cavitation may be seen as an air-fluid
level.
• Chest wall invasion is difficult to identify
on plain films unless there is destruction
of the adjacent rib or evidence of soft
tissue growing into the soft tissues
superficial to the ribs. 
• A pleural effusion may also be seen, and
although it is associated with a poor
prognosis
• Some are due to venous obstruction or
represent a parapneumonic effusion
 CXR

• 3 cm
cavitated
lesion left
mid-lung
• Lymp node
hilar (left)
 CT
• CT is the modality of choice for the
evaluation of possible lung cancer. 
• Certain morphological features can be
suggestive of squamous cell carcinoma of
the lung (SCC), but these are by no
means definitive, with significant overlap
with other histological types.
• More importantly, cross-sectional imaging
enables staging of the disease and
together with the histological grading and
clinical performance status will dictate
the prognosis and treatment.  
• Central SCC often results in
intraluminal obstruction and causes
lung collapse and/or obstructive
pneumonitis.
• Peripheral SCC may be seen as a solid
nodule/mass with or without an irregular
border
• The irregular margin can be attributed to
a desmoplastic reaction or infiltrative
growth
• Similar to central lung cancer, peripheral
cancer can also result in obstructive
changes such as a mucocele. 
• Cavitation is a frequent finding in primary
lung SCC but can also be encountered in
metastatic SCC.
• Cavitation is secondary to tumoral
necrosis. In other instances, SCC can have
a central scar with peripheral growth of
tumor.
• When SCC presents as a peripheral solid
nodule, follow-up is as per the Fleischner
Society guidelines.
 Large cell carcinoma

• Most typically they are large peripheral

masses (>4 cm)
• Histologically, the cells in large cell
carcinoma neoplasms show no
differentiation into glandular or
squamous cells.
 Metastatic Lung Cancer

• Dissemination is hematogenously
• Brain
• Liver
• Adrenals
• Bone
 43
154 slides 43
Multiple pulmonary nodules
METASTATIC
Terapi
 Simpulan

• Pada kanker paru, pemeriksaan radiologi ( foto torak

dan CT scan ) diperlukan untuk karakteristik nodul
apakah jinak atau ke arah maligna.
• Indikasi pemeriksaan PET/ CT scan dapat dilakukan
pada kasus sulit yang belum tegak pada pemeriksaan
radiologi konvensional, kasus unknown primary,
penentuan stadium atau evaluasi terapi.

20XX presentation title 51

Terima Kasih