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