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Keganasan Leher Dan Kepala
Keganasan Leher Dan Kepala
Oleh :
MUH. CHANDRA ALIM
10119210056
Jun Akizaki
The Power of PowerPoint | thepopp.com
Keganasan
1. Karsinoma Sinonasal
2. Kanker Nasofaring
5. Karsinoma Laring
Epidemiologi
Angiofibroma
Kanker
Nasofaring
Sinonasal
*3-5% kanker kepala *Paling banyak terjadi di
*Lebih banyak remaja laki-laki(4)
pria(1,2)
Ca Nasofaring Limfoma Hodgkin’s
*Endemik di Cina *2,6 kasus per 100.000 orang
*Lebih banyak pria(3) (5)
1. Chatelet F, Simon F, Bedarida V, Le Clerc N, Adle-Biassette H, Manivet P, Herman P, Verillaud B. Surgical Management of Sinonasal Cancers: A Comprehensive Review. Cancers. 2021, 13, 3995.
https://doi.org/10.3390/cancers13163995
2. Anttila S, Boffetta P. 2020. Occupational Cancers. Switzerland: Springer Nature. doi:10.1007/978-3-030-30766-0
3. Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
4. Kak I, Perez-Ordonez B, Sinonasal tract pathology: an updated review of select entities. Diagnostic Histopathology. 2019; 1-9. https://doi.org/10.1016/j.mpdhp.2019.04.007
Epidemiologi
Limfoma Non-
hodgkin’s Kanker Laring
*usia 65 hingga 74 tahun
dengan usia rata-rata 67 *1/3 dari semua kasus
tahun. kanker kepala
*Dapat terjadi pada usia 4- *Usia 65 tahun
7 tahun(5) *Lebih banyak pada
pria(6)
5. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
6. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK526076/
Kanker
Sinonasal
Hyperplasia abnormal pada cavum nasi
hingga sinusparanasal dengan
heterogenitas histologis yang tinggi(1)
7. Dean KE, Shatzkes D, Philips CD. Imaging Review of New and Emerging Sinonasal Tumors and Tumor-like Entities from the Fourth Edition of the World Health
Organization Classification of Head and Neck Tumors. AJNR Am J Neuroradiol. 2019; 1-7.
Patogenesis
Infeksi EBV dan HPV di sinus maksilaris
Gejala Umum
• Tekanan wajah
• Sesak Napas
• Hidung tersumbat yang memberat
seiring bertambahnya ukuran
tumor(4)
4. Kak I, Perez-Ordonez B, Sinonasal tract pathology: an updated review of select entities. Diagnostic
Histopathology. 2019; 1-9. https://doi.org/10.1016/j.mpdhp.2019.04.007
Diagnosis
• Berdasarkan histopatologi(8)
8. Weindorf SC, Noah A. Brown, Jonathan B. McHugh, Aaron M. Udager; Sinonasal Papillomas and Carcinomas: A Contemporary Update With
Review of an Emerging Molecular Classification. Arch Pathol Lab Med 1 November 2019; 143 (11): 1304–1316.
8. Weindorf SC, Noah A. Brown, Jonathan B. McHugh, Aaron M. Udager; Sinonasal Papillomas and Carcinomas: A Contemporary Update With
Review of an Emerging Molecular Classification. Arch Pathol Lab Med 1 November 2019; 143 (11): 1304–1316.
Tatalaksana
Beradaskan pada lokasi dan besar tumor
4. Kak I, Perez-Ordonez B, Sinonasal tract pathology: an updated review of select entities. Diagnostic Histopathology. 2019; 1-9.
https://doi.org/10.1016/j.mpdhp.2019.04.007
Komplikasi
Dengan ukuran massa yang kecil maka tidak dijumpai
komplikasi mengancam nyawa seperti sumbatan jalan nafas,
berbeda jika massa tumor sangat besar. Infasi tumor ke
anterior cenderung menyebabkan rasa penuh dan hidung
tersumbat yang mencul lebih awal (2,8)
Virk JS, Chan J, Dimitrov L, Williamson A, Sandison A, Weir J, Clarke P. Sinonasal cancer: an overview of the emerging
subtypes. The Journal of Laryngology & Otology, 2020; 1–6. doi:10.1017/s0022215120000146
Kanker
Nasofaring
Bentuk tidak terdiferensiasi
(undifferentiated) dari karsinoma sel
skuamosa yang timbul dari epitel
nasofaring(3)
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Etiologi
Ca Nasofaring
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Klasifikasi Histopatologi Ca Nasofaring (3)
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Patogenesis(10)
10.Chen YP, Chan AT, Le QT, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Nature. 2019; 1-17, http://dx.doi.org/10.1016/S0140-
6736(19)30956-0
• Manifestasi klinis beragam tergantunga rea yang
terlibat, paling sering di aspek lateral nasofaring Manifestasi
dan fossa Rosenmuller Klinis
• Gejala Nasal : hidung tersumbat, epistaksis,
post-nasal drip, suara hiponasal, cacosmia
• Otologis : gangguan pendengaran konduktif,
efusi telinga tengah, aural fullness
• Neurologis : keterlibatan nervus kranialis,
terutama nervus abducens.
• Keterlibatan kelenjar getah bening(3)
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554588/
Diagnosis
• Berdasarkan Laboratorium
pemeriksaan darah lengkap, tes fungsi ginjal dan hepar jika diduga
terdapat metastasis atau sindrom paraneoplastik. Selain itu
pemerksaan kadar IgA serum Epstein Barr virus dapat membawa
signifikansi diagnostik dan prognostik, terutama pada populasi
endemik
• Berdasarkan Radiologi
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Tatalaksana
Beradaskan pada lokasi dan besar tumor
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Komplikasi(3)
• Otitis Media Efusi akibat sumbatan tuba
eustachius
• Obstruksi hidung persisten
• Obstruksi jalan napas area orofaring
• Pelemahan nervus cranialis
Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554588/
Prognosis
Li J, Chen S, Peng S, Liu Y, Xing S, He X, Chen H. Prognostic nomogram for patients with Nasopharyngeal
Carcinoma incorporating hematological biomarkers and clinical characteristics. Int J Biol Sci. 2018;14(5):549-
Juvenile
nasopharyngeal
angiofibroma
lesi jinak dan sangat vaskular dengan satu atau
lebih pedikel vaskular arteri yang sering
menunjukkan gambaran agresif dengan invasi lokal
ke konka nasi, septum nasi, dan lamina pterigoid
medial(12).
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK545240/
Etiologi
• Sisa arkus faring pertama
• Ekspresi reseptor pertumbuhan
vascular VEGFR-2(12)
Histopatologi
massa polipoid yang tidak berkapsul dan
berbatas tegas yang terdiri dari jaringan
stroma vaskular dan fibrosa
Patogenesis
Terdapatnya faktor risiko (hormonal, kelainan kromosom, dan
ekspresi VEGFR-2 berlebihan) angiogenesis dan proliferasi
vaskuler di rongga hidung posterior, foramen sphenopalatine,
dan nasofaring(12)
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
• Terdapat pada rongga hidung
Manifestasi
• Sumbatan hidung unilateral kronis Klinis
• epistaksis tanpa rasa nyeri dan terjadi tiba-tiba
• nyeri kepala
• rinore.
• Bila massa besar dan invasif dapat muncul
proptosis, gangguan penglihatan, kelumpuhan
nervus kranialis, disfungsi tuba Eustachius, dan
kelainan bentuk wajah.
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
Diagnosis
• Endoskopi hidung
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
Tatalaksana
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
Komplikasi (12)
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
Prognosis
12. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
Limfoma
Hodgkin & Non
Hodgkin
Neoplasma jaringan limfoid yang berasal
dari prekursor sel B, sel B matur,
prekursor sel T, dan sel T matur(13)
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK559328/
Etiologi
• Infeksi Epstein-Barr (EBV)
• penyakit autoimun
• imunosupresi
Histopatologi
• Limfoma Hodgin : Terdapat • Limfoma Non-Hodgin : kelenjar getah
sel reedstenberg, dengan bening sepenuhnya tertutupi infiltrasi
dikelilingi banyak limfosit limfosit monomorfik
Patogenesis
*Limfoma Hodgkin : Memiliki sel Reed-Stenberg (RS) mengeluarkan
sitokin IL-5 dan merubah TGF beta menyebabkan pertumbuhan sel kanker
*Limfoma Non-Hodgkin : Translokasi, mutase, dan delesi kromosom
Translokasi t14;18 ekspresi cyclin D1 berlebihan siklus sel tidak
terkendali pertumbuhan sel kanker (13)
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
• Limfoma Hodgkin’s & Non-Hodgkins
• Limfadenopati supra-diafragma yang tidak nyeri
Manifestasi
• Penurunan BB tanpa sebab Klinis
• Demam tinggi
• Keringat malam basah kuyup
• Pruritus kronis
• Gastrointestinal : mual-muntah, anoreksia, perdarahan
GI
• Sesak napas jika massa besar (13)
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK559328/
Diagnosis(13)
• Limfoma Hodgkin Histopatologi
• Staging
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
Diagnosis Limfoma Nonhodgkin(13)
• Darah Lengkap
peningkatan LDH oleh beban tumor yang tinggi atau infiltrasi luas
pada hepar.
• Radilogi
CT scan,Thoraks, Abdomen, dan Pelvis menyingkirkan diagnosis
banding
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
Tatalaksana
Limfoma Hodgkin’s
• Stadium awal (I – IIA) kemoterapi jangka pendek
• Stadium awal + penyakit mediastinum yang besar kemoterapi
lebih lama (4-6 siklus)
• Stadium lanjut (IIB-IV) kemoterapi dan ABVD
Limfoma Non-Hodgkin’s
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
Komplikasi(13)
• Penyakit janting akibat radioterapi : pericarditis,
penyakit katup jantung, arteri coroner
• Sindrom lisis tumor : kelelahan, mual, muntah,
mati rasa, kesemutan, nyeri sendi
• Hiperleukositosis
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
Prognosis Limfoma
Hodgkin’s
13. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
Prognosis Limfoma Non-
Hodgkin’s
14. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK526076/
Etiologi
Kanker Laring
• Merokok
• Usia Lanjut
• Diet rendah sayur daun hijau
• Infeksi HPV
• Paparan asbes, radiasi, dan asap bensin(14)
14. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526076/
Histopatologi
Sebagian besar merupakan kanker sel
skuamosa, namun ada bentuk adenokarsinoma,
sarcoma, limfoma, dan tumor neuroendokrin
Patogenesis
• Supraglotis : tumbuh secara eksofitik dan superior menyebar ke
tingkat II, II, dan IV dari rantai kelenjar serviks
• Glotis : apeks ventrikel merupakan transisi dari supraglotis ke glottis
• Subglotis : area ini juga memiliki suplai limfatik yang jarang, dengan
drainase terkumpul ke tingkat IV dan VI dari rantai nodal serviks
14. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526076/
Manifestasi
• Kanker Glotis : suara serak, nyeri tekan, nyeri
Klinis(14)
telinga
• Kanker Supraglotis : nyeri telan, serak
• Penurunan BB
• Disfagia
• Aspirasi
14. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526076/
Diagnosis(14)
• Biopsi
14. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526076/
Tatalaksana
Karsinoma Laring
14. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526076/
DAFTAR PUSTAKA
1. Chatelet F, Simon F, Bedarida V, Le Clerc N, Adle-Biassette H, Manivet P, Herman P, Verillaud B. Surgical Management of
Sinonasal Cancers: A Comprehensive Review. Cancers. 2021, 13, 3995. https://doi.org/10.3390/cancers13163995
2. Anttila S, Boffetta P. 2020. Occupational Cancers. Switzerland: Springer Nature. doi:10.1007/978-3-030-30766-0
Chen YP, Chan AT, Le QT, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Nature. 2019; 1-17,
http://dx.doi.org/10.1016/S0140-6736(19)30956-0
3. Dean KE, Shatzkes D, Philips CD. Imaging Review of New and Emerging Sinonasal Tumors and Tumor-like Entities from the
Fourth Edition of the World Health Organization Classification of Head and Neck Tumors. AJNR Am J Neuroradiol. 2019;
1-7.
4. Gołąbek W, Szymańska A, Morshed K. Transnasal microscopic approach for juvenile nasopharyngeal angiofibroma.
Otolaryngol Pol. 2018;72(5):31-36.
5. Jiang L, Li N. B-cell non-Hodgkin lymphoma: importance of angiogenesis and antiangiogenic therapy. Angiogenesis.
2020;23(4):515-529.
Daftar Pustaka
6. Kak I, Perez-Ordonez B, Sinonasal tract pathology: an updated review of select entities. Diagnostic Histopathology. 2019; 1-9.
https://doi.org/10.1016/j.mpdhp.2019.04.007
7. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2022 Mar 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526076/
8. Li J, Chen S, Peng S, Liu Y, Xing S, He X, Chen H. Prognostic nomogram for patients with Nasopharyngeal Carcinoma incorporating
hematological biomarkers and clinical characteristics. Int J Biol Sci. 2018;14(5):549-556.
9. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2022 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
10. Shah AB, Nagalli S. Nasopharyngeal Carcinoma. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554588/
11. Tork CA, Simpson DL. Nasopharyngeal Angiofibroma. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545240/
12. Weindorf SC, Noah A. Brown, Jonathan B. McHugh, Aaron M. Udager; Sinonasal Papillomas and Carcinomas: A Contemporary Update
With Review of an Emerging Molecular Classification. Arch Pathol Lab Med 1 November 2019; 143 (11): 1304–1316.
Thank you