HUBUNGAN LOKASI TUMOR DENGAN DERAJAT ANEMIA PADA PENDERITA KANKER KOLOREKTAL DI RSU DR. SAIFUL ANWAR MALANG PERIODE 01 JANUARI 2009-31 DESEMBER 2010
BAB 1
PENDAHULUAN
1.1 Latar Belakang
Sampai saat ini, kanker kolorektal merupakan penyebab kematian akibat
kanker paling banyak nomor tiga di dunia dengan perkiraan lebih dari 500.000
pasien meninggal setiap tahunnya. Resiko untuk menderita kanker kolorektal
meningkat pada kelompok usia di atas 50 tahun. Pada tahun 2002, terdapat lebih
dari 1 juta insiden kanker kolorektal dengan tingkat mortalitas lebih dari 50%
(Bakta, 2006; Depkes, 2006).
Pada tahun 2004, terdapat 376.400 kasus baru di Uni Eropa dengan 149.400
kematian yang secara langsung disebabkan oleh penyakit kanker kolorektal. Pada
tahun 2003, terdapat 1.334.100 kasus dengan angka kematian sebanyak 556.500
orang di Amerika. Sedangkan di Indonesia, perkiraan insiden kanker kolorektal
adalah 100 per 100.000 penduduk. Berdasarkan data tersebut diatas, kanker
kolorektal menduduki peringkat ke-2 di Uni Eropa dan peringkat ke-3 di Amerika.
Sedangkan dari data yang dikumpulkan dari 13 pusat kanker menunjukkan bahwa
kanker kolorektal merupakan salah satu dari lima kanker paling sering terjadi di
Indonesia (Depkes, 2006; WHO, 2003; American Cancer Society, 2001).
Anemia merupakan salah satu gejala dari kanker kolorektal, baik lokasi
tumornya di kolon kanan maupun di kolon kiri dan atau rektum. Anemia pada
pasien keganasan secara umum memang sering terjadi terkait dengan penyebab
dan mekanisme yang kompleks dan multifaktor. Pada keganasan kolorektal
sebagaimana keganasan saluran cerna yang lain, anemia yang terjadi dikaitkan
1
2
dengan perdarahan akut ataupun kronik selain juga merupakan akibat reaksi sel
kanker dengan sistem imun dan sistem inflamasi (Kar, 2005).
Suatu penelitian yang dilakukan oleh Saidi HS dkk tahun 2008 di Nairobi
Kenya, melaporkan bahwa kadar Hb (hemoglobin) lebih rendah secara signifikan
terjadi pada keganasan di kolon kanan. Tanpa membedakan anemia menjadi
derajat ringan, sedang, dan berat, hasil serupa juga dilaporkan oleh Chao-Hung
Ho dkk tahun 2008, yang menggunakan kriteria anemia jika kadar Hb α).
Kesimpulan: Tidak terdapat hubungan lokasi tumor dengan derajat anemia pada
penderita kanker kolorektal.
Kata Kunci: Anemia, lokasi tumor kanker kolorektal
v
ABSTRACT
Islamia, Aqita. 2011. The Correlation between Tumor Location and Anemia
Degrees on Colorectal Cancer Patients in RSU Dr. Saiful Anwar Malang
Period January 1, 2009-December 31, 2010. Final Thesis, Medical Faculty
University of Muhammadiyah Malang. Tutor: (1) Mochamad Aleq Sander,
(2) Kusuma Andriana.
Background: Colorectal Cancer is one of five cancer diseases that often happens
in Indonesia. One of the symptoms of colorectal cancer is anemia. Anemia can
occur in colorectal cancer either on the right side or on the left side. In the
previous research, colorectal cancer patients that the location of the tumor was on
the left side often suffered light anemia and the patients that the location of the
tumor was on the right side mostly suffered heavy anemia.
Purpose: To prove that there is a correlation between tumor location and degrees
of anemia on patients who suffer colorectal cancer.
Method: Observational analytic with cross-sectional approach. Sample used to all
colorectal patients suitable with inclusion criteria (total sample), data analysis
using chi-square.
Result of the Research: The amount of colorectal cancer patients that the
location of the tumor was on the right side were 14 patients, 7 patients suffered
light anemia, 4 patients suffered medium anemia, and 3 patients suffered heavy
anemia. And colorectal cancer patients that the location of the tumor was on the
left side were 26 patients, 14 patients suffered light anemia, 5 patients suffered
medium anemia, and 7 patients suffered heavy anemia. The score was p=0,783
with α=0,05 (p> α).
Conclusion: There was no correlation between location of tumor and the degrees
of anemia in colorectal cancer patients.
Keywords: Anemia, Location of Colorectal Cancer
vi
DAFTAR ISI
Halaman
HALAMAN JUDUL........................................................................................ i
LEMBAR PENGESAHAN ............................................................................. ii
LEMBAR PENGUJI ........................................................................................ iii
KATA PENGANTAR ..................................................................................... iv
ABSTRAK ....................................................................................................... v
ABSTRACT ..................................................................................................... vi
DAFTAR ISI .................................................................................................... vii
DAFTAR TABEL ............................................................................................ xi
DAFTAR GAMBAR ....................................................................................... xii
DAFTAR SINGKATAN ................................................................................. xiii
DAFTAR LAMPIRAN .................................................................................... xiv
BAB 1 PENDAHULUAN ............................................................................... 1
1.1 Latar Belakang ............................................................................... 1
1.2 Rumusan Masalah .......................................................................... 3
1.3 Tujuan Penelitian ........................................................................... 3
1.3.1 Tujuan Umum ....................................................................... 3
1.3.2 Tujuan Khusus ...................................................................... 3
1.4 Manfaat Penelitian ......................................................................... 3
1.4.1 Manfaat Klinis....................................................................... 3
1.4.2 Manfaat Akademis ................................................................ 3
1.4.3 Manfaat Masyarakat .............................................................. 4
BAB 2 TINJAUAN PUSTAKA ...................................................................... 4
2.1 Kolon .............................................................................................. 5
2.1.1 Anatomi ................................................................................. 5
2.1.1.1 Caecum ...................................................................... 6
2.1.1.2 Appendix vermiformis ............................................... 7
2.1.1.3 Colon ascendens ........................................................ 9
2.1.1.4 Colon transversum .................................................... 11
2.1.1.5 Colon descendens ...................................................... 12
2.1.1.6 Colon sigmoid ........................................................... 14
vii
2.1.1.7 Rectum ....................................................................... 14
2.1.2 Fisiologi ................................................................................. 15
2.2 Kanker Kolorektal .......................................................................... 18
2.2.1 Definisi .................................................................................. 18
2.2.2 Etiologi .................................................................................. 19
2.2.3 Patofisiologi .......................................................................... 20
2.2.3.1 Kelainan Genetik ....................................................... 20
2.2.3.2 Faktor Lingkungan .................................................... 21
2.2.4 Gejala Klinis .......................................................................... 24
2.2.5 Stadium Kanker Kolorektal ................................................... 26
2.2.6 Pendekatan Diagnosis ........................................................... 27
2.2.6.1 Prosedur Diagnosis pada Pasien Dengan Gejala ....... 27
2.2.6.2 Laboratorium ............................................................. 27
2.2.6.3 Pemeriksaan Radiologi .............................................. 28
2.2.6.4 Kolonoskopi .............................................................. 28
2.2.6.5 Evaluasi Histologi ..................................................... 28
2.2.6.6 Macam Skrining Lainnya .......................................... 29
2.2.7 Penatalaksanaan .................................................................... 30
2.2.7.1 Pembedahan .............................................................. 30
2.2.7.2 Radioterapi ................................................................ 32
2.2.7.3 Kemoterapi ................................................................ 33
2.2.7.4 Moleculer Target Therapy ........................................ 34
2.2.8 Prognosis ............................................................................... 34
2.2.9 Pencegahan ............................................................................ 35
2.3 Anemia .......................................................................................... 36
2.3.1 Definisi ................................................................................. 36
2.3.2 Derajat Anemia..................................................................... 36
2.3.3 Etiologi dan Klasifikasi Anemia .......................................... 36
2.3.5 Gejala Klinis Anemia ........................................................... 39
2.3.6 Pemeriksaan Untuk Diagnosis Anemia ................................ 39
2.3.7 Terapi Anemia ...................................................................... 40
2.3.7.1 Defisiensi Nutrisional ............................................... 40
viii
2.3.7.2 Defisiensi Zat Besi ................................................... 41
2.3.7.3 Transfusi Eritrosit ..................................................... 41
2.4 Patofisiologi Anemia pada Kanker................................................ 41
2.4.1 Gangguan Pemakaian Besi ................................................... 43
2.4.2 Produksi Eritropoetin Tidak Memadai ................................. 43
2.4.3 Pemendekan Umur Eritrosit ................................................. 43
BAB 3 KERANGKA KONSEP DAN HIPOTESIS ........................................ 46
3.1 Kerangka Konsep .......................................................................... 46
3.2 Hipotesis ........................................................................................ 47
BAB 4 METODE PENELITIAN..................................................................... 48
4.1 Jenis Penelitian .............................................................................. 48
4.2 Lokasi dan Waktu Penelitian......................................................... 48
4.3 Populasi dan Sampel ..................................................................... 48
4.3.1 Populasi ................................................................................ 48
4.3.2 Sampel .................................................................................. 48
4.4 Kriteria Inklusi dan Eksklusi ......................................................... 48
4.4.1 Kriteria Inklusi ..................................................................... 48
4.4.2 Kriteria Eksklusi ................................................................... 48
4.5 Variabel Penelitian ........................................................................ 49
4.5.1 Variabel Bebas ..................................................................... 49
4.5.2 Variabel Tergantung ............................................................. 49
4.6 Definisi Operasional ...................................................................... 49
4.7 Teknik Pengumpulan Data ............................................................ 49
4.8 Analisis Data ................................................................................. 49
4.9 Alur Penelitian............................................................................... 50
BAB 5 HASIL PENELITIAN DAN ANALISIS DATA ................................ 51
5.1 Hasil Penelitian ............................................................................. 51
5.1.1 Karakteristik Penderita ......................................................... 51
5.1.1.1 Karakteristik Penderita Berdasarkan Umur.............. 51
5.1.1.2 Karakteristik Penderita Berdasarkan Jenis Kelamin 52
5.1.1.3 Karakteristik Penderita Berdasarkan Lokasi Tumor 53
5.1.2 Hasil Tabulasi Silang (Crosstabs) ........................................ 54
ix
5.2 Analisis Data ................................................................................. 55
BAB 6 PEMBAHASAN .................................................................................. 57
BAB 7 PENUTUP ........................................................................................... 62
7.1 Kesimpulan.................................................................................... 62
7.2 Saran .............................................................................................. 63
DAFTAR PUSTAKA ...................................................................................... 64
x
DAFTAR TABEL
Halaman
Tabel 2.1 Stadium Kanker Kolorektal Berdasarkan Kriteria TNM ................. 26
Tabel 2.2 Stadium Kanker Kolorektal Berdasarkan Kriteria Dukes
Modifikasi Astler Coller ................................................................... 27
Tabel 2.3 Derajat Anemia Menurut WHO dan NCI ........................................ 36
Tabel 2.4 Klasifikasi Anemia Menurut Etiopatogenesis.................................. 37
Tabel 2.5 Klasifikasi Anemia Berdasarkan Morfologi dan Etiologi................ 38
Tabel 2.6 Anemia pada Kanker: Efek Langsung Dari Keganasan................... 45
Tabel 5.1 Karakteristik Penderita Berdasarkan Usia ....................................... 52
Tabel 5.2 Karakteristik Penderita Berdasrkan Jenis Kelamin .......................... 53
Tabel 5.3 Karakteristik Penderita Berdasarkan Lokasi Tumor ........................ 54
Tabel 5.4 Crosstabs Hubungan Lokasi Tumor dengan Derajat Anemia Pada
Penderita Kanker Kolorektal ........................................................... 55
Tabel 5.5 Hasil Analisis Chi-square ................................................................ 55
xi
DAFTAR GAMBAR
Halaman
Gambar 2.1 Anatomi Colon Ascendens, Colon descendens, Colon transversum,
Colon sigmoid,dan Rectum ........................................................... 5
Gambar 2.2 Caecum tampak ventral, Appendix vermiformis di titik
pertemuan taenia omentalis, taenia libera, dan taenia
mesocolica ....................................................................................... 6
Gambar 2.3 Colon ascendens, Ileum, Caecum dan Appendix vermiformis ........ 10
Gambar 2.4 Colon transversum; Omentum majus dilipat ke atas untuk
memperlihatkan Taenia libera; lipatan selaput lendir di dalam
bagian usus yang tampak terbuka; tampak ventral kaudal .............. 11
Gambar 2.5 Stadium I, II, dan III Kanker Kolorektal ......................................... 24
Gambar 2.6 Stadium Kanker Kolorektal ............................................................. 27
Gambar 2.7 Pathophysiology of Anemia in Cancer ............................................ 42
Gambar 3.1 Kerangka Konsep ............................................................................ 46
Gambar 4.1 Alur Penelitian................................................................................. 50
Gambar 5.1 Diagram Batang Karakteristik Berdasarkan Usia ........................... 52
Gambar 5.2 Diagram Batang Karakteristik Berdasarkan Jenis Kelamin ............ 53
Gambar 5.3 Diagram Batang Karakteristik Berdasarkan Lokasi Tumor ............ 54
xii
DAFTAR SINGKATAN
5FU
: 5-flurourasil
AIDS
: Acquired Immunodeficiency Syndrome
AIS
: Anemia Induced Substance
APC
: Agent Presenting Cell
APR
: Abdomino Perineal Resection
ATP
: Adenosine Tri Phosphate
BFU-E
: Burst Forming Unit-Erythroid
CEA
: Carcinoembryonic Antigen
CFU-E
: Colony Forming Unit-Erythroid
DNA
: Deoxyribonucleic Acid
DRE
: Digital Rectal Examination
Epo
: Eritropoetin
FAP
: Familial Adenomatous Polyposis
FOBT
: Fecal Occult Blood Test
Hb
: Hemoglobin
HNPCC : Hereditary Nonpolyposis Colorectal Cancer
INF
: Interferon
IL
: Interleukin
LAR
: Low Anterior Resection
LED
: Laju Endap Darah
MMR
: Mismatch Repair
PET
: Positron Emission Tomography
RS
: Rumah Sakit
RSU
: Rumah Sakit Umum
RSUP
: Rumah Sakit Umum Pusat
SPSS
: Statistical Product and Solution Services
TIBC
: Total Iron Binding Capacity
TNF
: Tumor Necrosis Factor
xiii
DAFTAR LAMPIRAN
Halaman
Lampiran 1 Data Penelitian ............................................................................. 66
Lampiran 2 Hasil Analisis................................................................................ 67
xiv
DAFTAR PUSTAKA
Abdullah Murdani, 2006, Tumor Kolorektal, In: Sudoyo AW, Setyohadi B, Alwi
I, Simadibrata M, Setiati S (eds). Buku Ajar Ilmu Penyakit Dalam, 4th ed
Vol II, Pusat Penerbitan Departemen Ilmu Penyakit Dalam FK UI, Jakarta,
p.375-382.
Arief, 2008, Mengenal Kanker Kolorektal [online], (cited November 17 2010),
available from:
Bakta IM, 2006, Pendekatan terhadap pasien anemia, In: Sudoyo AW, Setiyohadi
B, Alwi I, Simadibrata M, Setiati S (eds). Buku Ajar Ilmu Penyakit Dalam
4th ed Vol II, Pusat Penerbitan Departemen Ilmu Penyakit Dalam FK UI,
Jakarta, p.622-625.
Dinkes Gorontalo, 2007, Mengenal Kanker [online], (cited November 17 2010),
available from:
Harahap, A. Ikhsanuddin 2004, Perawatan Pasien Dengan Kolostomi Pada
Penderita Kanker Kolorektal [online], cited 10 December 2010, available
from:
Kar AS, 2005, Pengaruh Anemia Pada Kanker Terhadap Kualitas Hidup Dan
Hasil Pengobatan [online], (cited February 04 2011), available from:
Koswara Sutrisno, 2008, Serat Makanan, Membuat Usus Nyaman [online], (cited
November 17 2010), available from: < www.eBookpangan.com>
xv
Price AS, Lorraine MW, 2006, Patofisiologi Konsep Klinis Proses-Proses
Penyakit, 6th ed Vol. 1, EGC, Jakarta, p.465-466.
Robbins, Kumar, Buku Ajar Patologi 7th ed Vol II, 2007, Karsinoma Kolorektar,
EGC, Jakarta, p.291.
Saba HI, 2008, Anemia in cancer patient [online], (cited January 30 2011),
available from:
Schofield PF, DJ Jones, 1996, Petunjuk Penting Penyakit Kolorektal, EGC,
Jakarta
Scottish Intercollegiate Guidelines, 2003, Network: Management of Colorectal
Cancer, A National Clinical Guidline
Sorra Toomas, 2008, Kanker Kolorektal [online], (cited November 17 2010),
available from:
Ward J, Robert C, Roger L, 2009, At a Glance Fisiologi, Erlangga, Jakarta, p.8283.
Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, et al.,
1997, Colorectal Cancer Screening: Clinical Guidelines And Rationale,
Gastroenterology, p. 112:594-642.
xvi
PENDAHULUAN
1.1 Latar Belakang
Sampai saat ini, kanker kolorektal merupakan penyebab kematian akibat
kanker paling banyak nomor tiga di dunia dengan perkiraan lebih dari 500.000
pasien meninggal setiap tahunnya. Resiko untuk menderita kanker kolorektal
meningkat pada kelompok usia di atas 50 tahun. Pada tahun 2002, terdapat lebih
dari 1 juta insiden kanker kolorektal dengan tingkat mortalitas lebih dari 50%
(Bakta, 2006; Depkes, 2006).
Pada tahun 2004, terdapat 376.400 kasus baru di Uni Eropa dengan 149.400
kematian yang secara langsung disebabkan oleh penyakit kanker kolorektal. Pada
tahun 2003, terdapat 1.334.100 kasus dengan angka kematian sebanyak 556.500
orang di Amerika. Sedangkan di Indonesia, perkiraan insiden kanker kolorektal
adalah 100 per 100.000 penduduk. Berdasarkan data tersebut diatas, kanker
kolorektal menduduki peringkat ke-2 di Uni Eropa dan peringkat ke-3 di Amerika.
Sedangkan dari data yang dikumpulkan dari 13 pusat kanker menunjukkan bahwa
kanker kolorektal merupakan salah satu dari lima kanker paling sering terjadi di
Indonesia (Depkes, 2006; WHO, 2003; American Cancer Society, 2001).
Anemia merupakan salah satu gejala dari kanker kolorektal, baik lokasi
tumornya di kolon kanan maupun di kolon kiri dan atau rektum. Anemia pada
pasien keganasan secara umum memang sering terjadi terkait dengan penyebab
dan mekanisme yang kompleks dan multifaktor. Pada keganasan kolorektal
sebagaimana keganasan saluran cerna yang lain, anemia yang terjadi dikaitkan
1
2
dengan perdarahan akut ataupun kronik selain juga merupakan akibat reaksi sel
kanker dengan sistem imun dan sistem inflamasi (Kar, 2005).
Suatu penelitian yang dilakukan oleh Saidi HS dkk tahun 2008 di Nairobi
Kenya, melaporkan bahwa kadar Hb (hemoglobin) lebih rendah secara signifikan
terjadi pada keganasan di kolon kanan. Tanpa membedakan anemia menjadi
derajat ringan, sedang, dan berat, hasil serupa juga dilaporkan oleh Chao-Hung
Ho dkk tahun 2008, yang menggunakan kriteria anemia jika kadar Hb α).
Kesimpulan: Tidak terdapat hubungan lokasi tumor dengan derajat anemia pada
penderita kanker kolorektal.
Kata Kunci: Anemia, lokasi tumor kanker kolorektal
v
ABSTRACT
Islamia, Aqita. 2011. The Correlation between Tumor Location and Anemia
Degrees on Colorectal Cancer Patients in RSU Dr. Saiful Anwar Malang
Period January 1, 2009-December 31, 2010. Final Thesis, Medical Faculty
University of Muhammadiyah Malang. Tutor: (1) Mochamad Aleq Sander,
(2) Kusuma Andriana.
Background: Colorectal Cancer is one of five cancer diseases that often happens
in Indonesia. One of the symptoms of colorectal cancer is anemia. Anemia can
occur in colorectal cancer either on the right side or on the left side. In the
previous research, colorectal cancer patients that the location of the tumor was on
the left side often suffered light anemia and the patients that the location of the
tumor was on the right side mostly suffered heavy anemia.
Purpose: To prove that there is a correlation between tumor location and degrees
of anemia on patients who suffer colorectal cancer.
Method: Observational analytic with cross-sectional approach. Sample used to all
colorectal patients suitable with inclusion criteria (total sample), data analysis
using chi-square.
Result of the Research: The amount of colorectal cancer patients that the
location of the tumor was on the right side were 14 patients, 7 patients suffered
light anemia, 4 patients suffered medium anemia, and 3 patients suffered heavy
anemia. And colorectal cancer patients that the location of the tumor was on the
left side were 26 patients, 14 patients suffered light anemia, 5 patients suffered
medium anemia, and 7 patients suffered heavy anemia. The score was p=0,783
with α=0,05 (p> α).
Conclusion: There was no correlation between location of tumor and the degrees
of anemia in colorectal cancer patients.
Keywords: Anemia, Location of Colorectal Cancer
vi
DAFTAR ISI
Halaman
HALAMAN JUDUL........................................................................................ i
LEMBAR PENGESAHAN ............................................................................. ii
LEMBAR PENGUJI ........................................................................................ iii
KATA PENGANTAR ..................................................................................... iv
ABSTRAK ....................................................................................................... v
ABSTRACT ..................................................................................................... vi
DAFTAR ISI .................................................................................................... vii
DAFTAR TABEL ............................................................................................ xi
DAFTAR GAMBAR ....................................................................................... xii
DAFTAR SINGKATAN ................................................................................. xiii
DAFTAR LAMPIRAN .................................................................................... xiv
BAB 1 PENDAHULUAN ............................................................................... 1
1.1 Latar Belakang ............................................................................... 1
1.2 Rumusan Masalah .......................................................................... 3
1.3 Tujuan Penelitian ........................................................................... 3
1.3.1 Tujuan Umum ....................................................................... 3
1.3.2 Tujuan Khusus ...................................................................... 3
1.4 Manfaat Penelitian ......................................................................... 3
1.4.1 Manfaat Klinis....................................................................... 3
1.4.2 Manfaat Akademis ................................................................ 3
1.4.3 Manfaat Masyarakat .............................................................. 4
BAB 2 TINJAUAN PUSTAKA ...................................................................... 4
2.1 Kolon .............................................................................................. 5
2.1.1 Anatomi ................................................................................. 5
2.1.1.1 Caecum ...................................................................... 6
2.1.1.2 Appendix vermiformis ............................................... 7
2.1.1.3 Colon ascendens ........................................................ 9
2.1.1.4 Colon transversum .................................................... 11
2.1.1.5 Colon descendens ...................................................... 12
2.1.1.6 Colon sigmoid ........................................................... 14
vii
2.1.1.7 Rectum ....................................................................... 14
2.1.2 Fisiologi ................................................................................. 15
2.2 Kanker Kolorektal .......................................................................... 18
2.2.1 Definisi .................................................................................. 18
2.2.2 Etiologi .................................................................................. 19
2.2.3 Patofisiologi .......................................................................... 20
2.2.3.1 Kelainan Genetik ....................................................... 20
2.2.3.2 Faktor Lingkungan .................................................... 21
2.2.4 Gejala Klinis .......................................................................... 24
2.2.5 Stadium Kanker Kolorektal ................................................... 26
2.2.6 Pendekatan Diagnosis ........................................................... 27
2.2.6.1 Prosedur Diagnosis pada Pasien Dengan Gejala ....... 27
2.2.6.2 Laboratorium ............................................................. 27
2.2.6.3 Pemeriksaan Radiologi .............................................. 28
2.2.6.4 Kolonoskopi .............................................................. 28
2.2.6.5 Evaluasi Histologi ..................................................... 28
2.2.6.6 Macam Skrining Lainnya .......................................... 29
2.2.7 Penatalaksanaan .................................................................... 30
2.2.7.1 Pembedahan .............................................................. 30
2.2.7.2 Radioterapi ................................................................ 32
2.2.7.3 Kemoterapi ................................................................ 33
2.2.7.4 Moleculer Target Therapy ........................................ 34
2.2.8 Prognosis ............................................................................... 34
2.2.9 Pencegahan ............................................................................ 35
2.3 Anemia .......................................................................................... 36
2.3.1 Definisi ................................................................................. 36
2.3.2 Derajat Anemia..................................................................... 36
2.3.3 Etiologi dan Klasifikasi Anemia .......................................... 36
2.3.5 Gejala Klinis Anemia ........................................................... 39
2.3.6 Pemeriksaan Untuk Diagnosis Anemia ................................ 39
2.3.7 Terapi Anemia ...................................................................... 40
2.3.7.1 Defisiensi Nutrisional ............................................... 40
viii
2.3.7.2 Defisiensi Zat Besi ................................................... 41
2.3.7.3 Transfusi Eritrosit ..................................................... 41
2.4 Patofisiologi Anemia pada Kanker................................................ 41
2.4.1 Gangguan Pemakaian Besi ................................................... 43
2.4.2 Produksi Eritropoetin Tidak Memadai ................................. 43
2.4.3 Pemendekan Umur Eritrosit ................................................. 43
BAB 3 KERANGKA KONSEP DAN HIPOTESIS ........................................ 46
3.1 Kerangka Konsep .......................................................................... 46
3.2 Hipotesis ........................................................................................ 47
BAB 4 METODE PENELITIAN..................................................................... 48
4.1 Jenis Penelitian .............................................................................. 48
4.2 Lokasi dan Waktu Penelitian......................................................... 48
4.3 Populasi dan Sampel ..................................................................... 48
4.3.1 Populasi ................................................................................ 48
4.3.2 Sampel .................................................................................. 48
4.4 Kriteria Inklusi dan Eksklusi ......................................................... 48
4.4.1 Kriteria Inklusi ..................................................................... 48
4.4.2 Kriteria Eksklusi ................................................................... 48
4.5 Variabel Penelitian ........................................................................ 49
4.5.1 Variabel Bebas ..................................................................... 49
4.5.2 Variabel Tergantung ............................................................. 49
4.6 Definisi Operasional ...................................................................... 49
4.7 Teknik Pengumpulan Data ............................................................ 49
4.8 Analisis Data ................................................................................. 49
4.9 Alur Penelitian............................................................................... 50
BAB 5 HASIL PENELITIAN DAN ANALISIS DATA ................................ 51
5.1 Hasil Penelitian ............................................................................. 51
5.1.1 Karakteristik Penderita ......................................................... 51
5.1.1.1 Karakteristik Penderita Berdasarkan Umur.............. 51
5.1.1.2 Karakteristik Penderita Berdasarkan Jenis Kelamin 52
5.1.1.3 Karakteristik Penderita Berdasarkan Lokasi Tumor 53
5.1.2 Hasil Tabulasi Silang (Crosstabs) ........................................ 54
ix
5.2 Analisis Data ................................................................................. 55
BAB 6 PEMBAHASAN .................................................................................. 57
BAB 7 PENUTUP ........................................................................................... 62
7.1 Kesimpulan.................................................................................... 62
7.2 Saran .............................................................................................. 63
DAFTAR PUSTAKA ...................................................................................... 64
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DAFTAR TABEL
Halaman
Tabel 2.1 Stadium Kanker Kolorektal Berdasarkan Kriteria TNM ................. 26
Tabel 2.2 Stadium Kanker Kolorektal Berdasarkan Kriteria Dukes
Modifikasi Astler Coller ................................................................... 27
Tabel 2.3 Derajat Anemia Menurut WHO dan NCI ........................................ 36
Tabel 2.4 Klasifikasi Anemia Menurut Etiopatogenesis.................................. 37
Tabel 2.5 Klasifikasi Anemia Berdasarkan Morfologi dan Etiologi................ 38
Tabel 2.6 Anemia pada Kanker: Efek Langsung Dari Keganasan................... 45
Tabel 5.1 Karakteristik Penderita Berdasarkan Usia ....................................... 52
Tabel 5.2 Karakteristik Penderita Berdasrkan Jenis Kelamin .......................... 53
Tabel 5.3 Karakteristik Penderita Berdasarkan Lokasi Tumor ........................ 54
Tabel 5.4 Crosstabs Hubungan Lokasi Tumor dengan Derajat Anemia Pada
Penderita Kanker Kolorektal ........................................................... 55
Tabel 5.5 Hasil Analisis Chi-square ................................................................ 55
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DAFTAR GAMBAR
Halaman
Gambar 2.1 Anatomi Colon Ascendens, Colon descendens, Colon transversum,
Colon sigmoid,dan Rectum ........................................................... 5
Gambar 2.2 Caecum tampak ventral, Appendix vermiformis di titik
pertemuan taenia omentalis, taenia libera, dan taenia
mesocolica ....................................................................................... 6
Gambar 2.3 Colon ascendens, Ileum, Caecum dan Appendix vermiformis ........ 10
Gambar 2.4 Colon transversum; Omentum majus dilipat ke atas untuk
memperlihatkan Taenia libera; lipatan selaput lendir di dalam
bagian usus yang tampak terbuka; tampak ventral kaudal .............. 11
Gambar 2.5 Stadium I, II, dan III Kanker Kolorektal ......................................... 24
Gambar 2.6 Stadium Kanker Kolorektal ............................................................. 27
Gambar 2.7 Pathophysiology of Anemia in Cancer ............................................ 42
Gambar 3.1 Kerangka Konsep ............................................................................ 46
Gambar 4.1 Alur Penelitian................................................................................. 50
Gambar 5.1 Diagram Batang Karakteristik Berdasarkan Usia ........................... 52
Gambar 5.2 Diagram Batang Karakteristik Berdasarkan Jenis Kelamin ............ 53
Gambar 5.3 Diagram Batang Karakteristik Berdasarkan Lokasi Tumor ............ 54
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DAFTAR SINGKATAN
5FU
: 5-flurourasil
AIDS
: Acquired Immunodeficiency Syndrome
AIS
: Anemia Induced Substance
APC
: Agent Presenting Cell
APR
: Abdomino Perineal Resection
ATP
: Adenosine Tri Phosphate
BFU-E
: Burst Forming Unit-Erythroid
CEA
: Carcinoembryonic Antigen
CFU-E
: Colony Forming Unit-Erythroid
DNA
: Deoxyribonucleic Acid
DRE
: Digital Rectal Examination
Epo
: Eritropoetin
FAP
: Familial Adenomatous Polyposis
FOBT
: Fecal Occult Blood Test
Hb
: Hemoglobin
HNPCC : Hereditary Nonpolyposis Colorectal Cancer
INF
: Interferon
IL
: Interleukin
LAR
: Low Anterior Resection
LED
: Laju Endap Darah
MMR
: Mismatch Repair
PET
: Positron Emission Tomography
RS
: Rumah Sakit
RSU
: Rumah Sakit Umum
RSUP
: Rumah Sakit Umum Pusat
SPSS
: Statistical Product and Solution Services
TIBC
: Total Iron Binding Capacity
TNF
: Tumor Necrosis Factor
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DAFTAR LAMPIRAN
Halaman
Lampiran 1 Data Penelitian ............................................................................. 66
Lampiran 2 Hasil Analisis................................................................................ 67
xiv
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Arief, 2008, Mengenal Kanker Kolorektal [online], (cited November 17 2010),
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Bakta IM, 2006, Pendekatan terhadap pasien anemia, In: Sudoyo AW, Setiyohadi
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Harahap, A. Ikhsanuddin 2004, Perawatan Pasien Dengan Kolostomi Pada
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Koswara Sutrisno, 2008, Serat Makanan, Membuat Usus Nyaman [online], (cited
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Robbins, Kumar, Buku Ajar Patologi 7th ed Vol II, 2007, Karsinoma Kolorektar,
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Saba HI, 2008, Anemia in cancer patient [online], (cited January 30 2011),
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Jakarta
Scottish Intercollegiate Guidelines, 2003, Network: Management of Colorectal
Cancer, A National Clinical Guidline
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Ward J, Robert C, Roger L, 2009, At a Glance Fisiologi, Erlangga, Jakarta, p.8283.
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