Carcinoma Carcinoma PancreasPancreasOleh :Oleh :

NurbaitiNurbaiti

PendahuluanPendahuluan

Berasal dari kelenjar Berasal dari kelenjar eksokrineksokrin Penyebab ke 5 kematian (USA)Penyebab ke 5 kematian (USA) 5 YSR: < 5%5 YSR: < 5% Perokok > beresikoPerokok > beresiko Dekade 6-8Dekade 6-8

Lanjutan Lanjutan

Mutasi gen K-ras, p16 (CDKN2A), p53, Mutasi gen K-ras, p16 (CDKN2A), p53, DPC4 (deleted in pancreatic cancer 4), DPC4 (deleted in pancreatic cancer 4), HER-2/NEU, BRCA2, MLH1.HER-2/NEU, BRCA2, MLH1.

Head (70%), corpus (5-10%0, caudal Head (70%), corpus (5-10%0, caudal (10-15%), seluruh area (20%)(10-15%), seluruh area (20%)

Anatomi Anatomi

Gejala KlinisGejala Klinis

Obstruktiv jaundice, phlebotrombitisObstruktiv jaundice, phlebotrombitis Nyeri pada bagian atas abdomen Nyeri pada bagian atas abdomen Nafsu makan dan berat badan Nafsu makan dan berat badan Dark urine,Dark urine, clay-coloredclay-colored stoolsstools Lemah, lesu, mual, muntah Lemah, lesu, mual, muntah CEA CEA ↑, CA-19 ↑↑, CA-19 ↑ CT scanCT scan

Laboratorium Laboratorium

Peningkatan :Peningkatan : Albumin Albumin Alpha-1 antitrypsin Alpha-1 antitrypsin ALP ALP ALT ALT AST AST Gamma-glutamyl transpeptidase (GGT) Gamma-glutamyl transpeptidase (GGT) Prothrombin time Prothrombin time Serum bilirubin Serum bilirubin Urine bilirubin Urine bilirubin CBC (complete boold count?)CBC (complete boold count?)

Klasifikasi WHO:Klasifikasi WHO:

AdenocarcinomaAdenocarcinoma Adenosquamous carcinomaAdenosquamous carcinoma Mucinous (colloid) adenocarcinomaMucinous (colloid) adenocarcinoma Signet ring cell carcinomaSignet ring cell carcinoma Small cell carcinoma (oat cell)Small cell carcinoma (oat cell) Squamous cell carcinomaSquamous cell carcinoma Undifferentiated carcinomaUndifferentiated carcinoma Medullary carcinomaMedullary carcinoma OtherOther

Klasifikasi Klasifikasi MalignantMalignant

  Carcinoma in situ (PanIn III; pancreatic intraepithelial neoplasia)Carcinoma in situ (PanIn III; pancreatic intraepithelial neoplasia)

  Ductal adenocarcinomaDuctal adenocarcinoma

  Intraductal papillary mucinous carcinoma (invasive IPMN)Intraductal papillary mucinous carcinoma (invasive IPMN)

  Mucinous cystadenocarcinomaMucinous cystadenocarcinoma

  Acinar cell carcinomaAcinar cell carcinoma

  PancreatoblastomaPancreatoblastoma

PremalignantPremalignant

  Intraductal papillary-mucinous neoplasm (noninvasive IPMN)Intraductal papillary-mucinous neoplasm (noninvasive IPMN)

  Mucinous cystadenomaMucinous cystadenoma

Uncertain malignant potentialUncertain malignant potential

  Solid pseudopapillary tumorSolid pseudopapillary tumor

BenignBenign

  Serous cystadenomaSerous cystadenomacc

GrossGross

Mikroskopik 10XMikroskopik 10X

Mikroskopik 40XMikroskopik 40X

Perineural invasion Perineural invasion

Asinar CaAsinar Ca

Anaplastik CaAnaplastik Ca

Ductal AdenocarcinomaDuctal Adenocarcinoma

Terima kasihTerima kasih