Progressive infiltration, invasion, and Ill-defined and non-encapsuled The particular growth pattern of Be surgically enucleated difficultly Loosening up of tumor cells from each other: Attachment to matrix components: cancer Degradation of extra cellular

Symptom  Lung Metastasis  Nagging cough, dyspnea bulky metastasis. Pleural effusion  Liver Metastasis  Dyspepsia syndrome  Pain at epigastric  Hepatomegali  Bone metastasis  Bone pain, Pathologic fracture  Brain metastasis  Severe headache  Vertigo  Nausea and vomit Clinical Finding  Lymphadenopathy  Ascites fluid  Pleural Effusion  Hepatic nodule  Pathologic fracture  Krukenberg tumor Imaging  Chest X Ray  USG  Bone scan  CT Scan  MRI  Cytology  Pathology Lung Metastasis by Chest X Ray Metastatic Nodule in Lung CT Scan Colon Carcinoma Metastatic to Liver Breast Carcinoma Metastatic to Brain Fig. 2.2b and c Weinberg p. 27 Liver CT scan vs Liver Ultrasound Radioactive-Iodine SeeMets Arm MetnGlio Figure 14.1 The Biology of Cancer © Garland Science 2007. P. 588 Metastatic non-Hodgkins Lymphoma CT Scan and PET Scan positron emission tomography of incorporated radioactively- labelled deoxyfluoroglucose. Brain activity is normal, abdominal active is pathological Prognosis  Lung Liver metastasis : 8-12 months  Brain metastasis : 6 months  Bone metastasis : 2-4 years Treatment  Paliative treatment  Relieve of symptom : pain, dyspneu,severe headache,dyspepsia etc  Risk and benefit of treatment  Usually : chemotherapy hormonal radiotherapy  Surgery : depent on situation Prevention of Metastasis  Early Diagnosis  Prompt and Accurate Treatment  Depend of cancer type Thank You ADVERSE EVENT kejadian tidak diharapkan KTD Wirsma Arif Harahap Surgical Oncologist FIRST, DO NO HARM HIPPOCRATES’S TENET 460-335 BC What I want to talk about Freedom from accidental injury due to medical care, or medical errors – Institute of Medicine 1999 about  A story  How common is adverse event?  Why does it happen?  How should we think ?  How should we respond? Mistakes are a fact of life. It ’ s the response to the error that counts - Nikki Giovanni 2003 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 Medical Auto Workplace Air Deaths 5th leading cause 9th leading cause 1 10 100 1,000 10,000 100,000 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000 Number of encounters for each fatality T ot al liv es lo st p er y ear REGULATED DANGEROUS 11000 ULTRA-SAFE 1100K Health Care Mountain Climbing Bungee Jumping Driving Chemical Manufacturing Chartered Flights Scheduled Airlines European Railroads Nuclear Power Note: both dimensions are logarithmic 1. 12 -02-04 Alm. Lucy Maywati RS Bersalin YPK Jkt Meninggal saat melahirkan caecar Polda Metro Jaya Tgl Korban Terlapor Kasus Lapor

2. 23-04-04 Wulan Yulianti RSCM Jkt

Meninggal krn operasi pd usus Polda Metro Jaya

3. 28 -04-04 Alm Lucy Maywati RS Bersalin YPK Jkt Penggelapan MR

Polda Metro Jaya 4. 07-06-04 Jeremiah RS Budi Lestari Bks Operasi caecar mengakibatkan Polda Metro Jaya RS Hermina, Bekasi luka cacat 5. 11 -06-04 Mindo Sihombing RS Persahabatan Jkt Gagal operasi hernia Polda Metro Jaya 6. 15-06-04 Anissa Safitri RSCM Jkt Hidrocepalus Polda Metro Jaya 7. 24 -06-04 Alm. Jajang RSUD Sukabumi Jabar Wabah malaria di Sukabumi Polda Jawa Barat

8. 30-06-04 Alm. Lucy Maywati RS Bersalin YPK Jkt Meninggal saat melahirkan

Polda Metro Jaya 9. 07 -07-04 Robinson L. Tobing RS Kodam Bkt Barisan Vegetativ State akibat operasi Polda Sumatra Medan cacat permanen Utara

10. 12-07-04 Anissa Safitri Yayasan Amal Beduli

Perbuatan tdk menyenangkan Polda Metro Jaya Seribu, Jkt krn memulangkan pasien

11. 08 -07-04 Ngatmi RS Persahabatan Jkt

Operasi kanker payudara Polda Metro Jaya

12. 14-07-04 Rohati RS Darmais Jkt

Meninggal dunia akibat gagal Polda Metro Jaya operasi kanker payudara 13. 18 -07-04 Dr Jane P PT Newmont Minahasa Pencemaran limbah B3 Mabes Polri Raya, Sulawesi Utara 14. 18-07-04 Srifika Modeong RS CM RS MMC Jkt Keracunan mercury arsen Mabes Polri 15. 18 -07-04 Rasyid Rahman RS CM RS MMC Jkt Keracunan mercury arsen Mabes Polri 16. 18-07-04 Juhria Ratubahe RS CM RS MMC Jkt Keracunan Mercury arsen Mabes Polri

19. 09 -07-04 Revy Anastasia Apotik RS Cikini Jkt

Keracunan Obat Polda Metro Jaya

20. 12-08-04 Rasyid Rahman Menkes Ahmad Sujudi Pencemaran nama baik dgn

Mabes Polri Mentamben P Yusgiantoro menyatakan tdk ada pencemaran Men LH Nabiel Makarim 21. 18 -08-04 Fellina Azzahra RS Karya Medika Jkt Meninggal krn salah operasi usus Polda Metro Jaya 22. 31-08-04 Again Isna Nauli RS Islam Bogor Kelalaian medis yg berakibat SATGA OPS Polda cacat permanen Jawa Barat 23. 03 -09-04 Anggi Anggeli RSCM Jkt Membiarkan pasien yg hrs dirawat Polda Metro Jaya

24. 03-09-04 Andreas RS Pasar Rebo Jkt

Kelahiran yg mengakibatkan cacat Polda Metro Jaya 25. 03 -09-04 Maena Nurrocmah RS Setia Mitra Jkt Operasi usus Polda Metro Jaya

26. 15-09-04 Fellina Azzahra RS K Medika Cibitung Meninggal krn operasi usus

Polda Metro Jaya RSCM Jkt

27. 16-09-04 Leonardus W Pete RS Silom Gleaneglas Penyaderaan krn tdk mampu byr

Polda Metro Jaya 28. 27-09-04 Wino Polres Sorong Papua Penganiayaan mengakibatkan Mabers Polri Wiran mata dan dada rusak parah 29. 28-09-04 Lexyano Hamsalim RS Medistra Jkt Infeksi akibat operasi klip jantung Polda Metro Jaya 30. 28-09-04 Parrel Davin H.A RS Eva Sari Lalai mengakibtakan org lain Polda Metro Jaya Sinurat Rawamangun Jkt meninggal

31. 05-10-04 Rizka Hudha RS Harapan Bunda Jkt Lalai mengakibatkan kematian

Polda Metro Jaya 32. 05-10-04 Masita Ariani Klinik Bedah Plastik Kegagalan bedah plastik pd hidung Dit Reskrim Polda Annisa Bandung Jawa Barat 33. 07-10-04 Tyava Putra Juliarty Klinik Dharma Bakti 2 Keracunan obat mengakibatkan Polda Metro Jaya RS harapan Kita Jkt Steven Johnson Syndrom