Anumberoftumormarkersarecurrentlybeingusedforawiderangeofcancertypes.

Althoughmostofthesecanbetestedinlaboratoriesthatmeetstandardssetbythe
ClinicalLaboratoryImprovementAmendments,somecannotbeandmaythereforebe
consideredexperimental.Tumormarkersthatarecurrentlyincommonusearelisted
below.
ALKgenerearrangements

Cancertypes:Nonsmallcelllungcancerandanaplasticlargecelllymphoma

Tissueanalyzed:Tumor

Howused:Tohelpdeterminetreatmentandprognosis

Alphafetoprotein(AFP)

Cancertypes:Livercancerandgermcelltumors

Tissueanalyzed:Blood

Howused:Tohelpdiagnoselivercancerandfollowresponsetotreatment;to
assessstage,prognosis,andresponsetotreatmentofgermcelltumors

Beta2microglobulin(B2M)

Cancertypes:Multiplemyeloma,chroniclymphocyticleukemia,andsome
lymphomas

Tissueanalyzed:Blood,urine,orcerebrospinalfluid

Howused:Todetermineprognosisandfollowresponsetotreatment

Betahumanchorionicgonadotropin(BetahCG)

Cancertypes:Choriocarcinomaandtesticularcancer

Tissueanalyzed:Urineorblood

Howused:Toassessstage,prognosis,andresponsetotreatment

BCRABLfusiongene

Cancertype:Chronicmyeloidleukemia

Tissueanalyzed:Bloodand/orbonemarrow

Howused:Toconfirmdiagnosisandmonitordiseasestatus

BRAFmutationV600E

Cancertypes:Cutaneousmelanomaandcolorectalcancer

Tissueanalyzed:Tumor

Howused:Topredictresponsetotargetedtherapies

CA153/CA27.29

Cancertype:Breastcancer

Tissueanalyzed:Blood

Howused:Toassesswhethertreatmentisworkingordiseasehasrecurred

CA199

Cancertypes:Pancreaticcancer,gallbladdercancer,bileductcancer,and
gastriccancer

Tissueanalyzed:Blood

Howused:Toassesswhethertreatmentisworking

CA125

Cancertype:Ovariancancer

Tissueanalyzed:Blood

Howused:Tohelpindiagnosis,assessmentofresponsetotreatment,and
evaluationofrecurrence

Calcitonin

Cancertype:Medullarythyroidcancer

Tissueanalyzed:Blood

Howused:Toaidindiagnosis,checkwhethertreatmentisworking,and
assessrecurrence

Carcinoembryonicantigen(CEA)

Cancertypes:Colorectalcancerandbreastcancer

Tissueanalyzed:Blood

Howused:Tocheckwhethercolorectalcancerhasspread;tolookforbreast
cancerrecurrenceandassessresponsetotreatment

CD20

Cancertype:NonHodgkinlymphoma

Tissueanalyzed:Blood

Howused:Todeterminewhethertreatmentwithatargetedtherapyis
appropriate

ChromograninA(CgA)

Cancertype:Neuroendocrinetumors

Tissueanalyzed:Blood

Howused:Tohelpindiagnosis,assessmentoftreatmentresponse,and
evaluationofrecurrence

Chromosomes3,7,17,and9p21

Cancertype:Bladdercancer

Tissueanalyzed:Urine

Howused:Tohelpinmonitoringfortumorrecurrence

Cytokeratinfragments211

Cancertype:Lungcancer

Tissueanalyzed:Blood

Howused:Tohelpinmonitoringforrecurrence

EGFRmutationanalysis

Cancertype:Nonsmallcelllungcancer

Tissueanalyzed:Tumor

Howused:Tohelpdeterminetreatmentandprognosis

Estrogenreceptor(ER)/progesteronereceptor(PR)

Cancertype:Breastcancer

Tissueanalyzed:Tumor

Howused:Todeterminewhethertreatmentwithhormonaltherapy(suchas
tamoxifen)isappropriate

Fibrin/fibrinogen

Cancertype:Bladdercancer

Tissueanalyzed:Urine

Howused:Tomonitorprogressionandresponsetotreatment

HE4

Cancertype:Ovariancancer

Tissueanalyzed:Blood

Howused:Toassessdiseaseprogressionandmonitorforrecurrence

HER2/neu

Cancertypes:Breastcancer,gastriccancer,andesophagealcancer

Tissueanalyzed:Tumor

Howused:Todeterminewhethertreatmentwithtrastuzumabisappropriate

Immunoglobulins

Cancertypes:MultiplemyelomaandWaldenstrmmacroglobulinemia

Tissueanalyzed:Bloodandurine

Howused:Tohelpdiagnosedisease,assessresponsetotreatment,andlook
forrecurrence

KIT

Cancertypes:Gastrointestinalstromaltumorandmucosalmelanoma

Tissueanalyzed:Tumor

Howused:Tohelpindiagnosinganddeterminingtreatment

KRASmutationanalysis

Cancertypes:Colorectalcancerandnonsmallcelllungcancer

Tissueanalyzed:Tumor

Howused:Todeterminewhethertreatmentwithaparticulartypeoftargeted
therapyisappropriate

Lactatedehydrogenase

Cancertype:Germcelltumors

Tissueanalyzed:Blood

Howused:Toassessstage,prognosis,andresponsetotreatment

Nuclearmatrixprotein22

Cancertype:Bladdercancer

Tissueanalyzed:Urine

Howused:Tomonitorresponsetotreatment

Prostatespecificantigen(PSA)

Cancertype:Prostatecancer

Tissueanalyzed:Blood

Howused:Tohelpindiagnosis,assessresponsetotreatment,andlookfor
recurrence

Thyroglobulin

Cancertype:Thyroidcancer

Tissueanalyzed:Blood

Howused:Toevaluateresponsetotreatmentandlookforrecurrence

Urokinaseplasminogenactivator(uPA)andplasminogenactivatorinhibitor(PAI1)

Cancertype:Breastcancer

Tissueanalyzed:Tumor

Howused:Todetermineaggressivenessofcancerandguidetreatment

5Proteinsignature(Ova1)

Cancertype:Ovariancancer

Tissueanalyzed:Blood

Howused:Topreoperativelyassesspelvicmassforsuspectedovariancancer

21Genesignature(OncotypeDX)

Cancertype:Breastcancer

Tissueanalyzed:Tumor

Howused:Toevaluateriskofrecurrence

70Genesignature(Mammaprint)

Cancertype:Breastcancer

Tissueanalyzed:Tumor

Howused:Toevaluateriskofrecurrence

Faseabdominal

Desinfeksilapanganoperasidenganantiseptikjugadilakukanirigasirektum
denganbahanantiseptik.

Lapanganoperasidipersempitdenganlinen/doeksteril.

Insisimidlineduajaridiatasumbilikussampaidiatassymphisispubis
diperdalamlapisdemilapissampaiperitoneum.Peritoneumdibukasecara
tajam.

Identifikasirektumdanditentukanresektabilitastumor.

Identifikasilesiataukelainanpadarektum,kelenjarmesorektum,hepar
(stagingtumor)

Mobilisasirektumdenganmelakukaninsisipadalateralrefleksiperitoneal
sambilmengidentifikasivasaspermatikaatauovarisertaureterdiisolasi.

A.mesenterikainferiordiikatdandipotongpadadistaldaripercabangana.
kolikamedia.

Mobilisasirektumposteriordenganmelakukandiseksisecaratajam,sehingga
sisiretrorektaldapatdicapai.Fasciarektorektaldipotong,setelahmemotong
fasciarektosakralberartisudahmencapaicoccygeus.

Mobilisasianteriordimulaidenganinsisirefleksirektovesikalpadalaki2dan
antararektumdanuteruspadawanita.Diseksidilanjutkandengan

memisahkanrektumdenganvesicaseminalispadalaki2danrektumdengan
vaginapadawanita.

Setelahmobilisasisisiposteriordananteriordilakukanidentifikasifascia
pelvis(ligamentumlateral),dipisahkan,dipotongdandiikat.

Karsinomarektumharusdieksisibersamamesorektumsecarautuh(Total
MesorectalExcision)

Dilanjutkandengantranseksirektumdiataslesi/tumordenganbatassesuai
kaidahonkologi.

Stumpproksimalrektumdimobilisasikeluardindingabdomendandibuat
permanentendcolostomy.

Dilakukanpenjahitansisaperitoneumuntukmenutupdasarpanggul.

Perdarahandirawatdanlukaoperasiditutuplapisdemilapis.

Faseperineal

Insisiellipssekelilinganussampaibatasm.sfingteranus.

Insisidiperdalamdenganinsisisirkumferensialmengelilingirektumdengan
memotongm.levatorani.Insisiterusdiperdalamsampaistumpdistalrektum
dicapaidandapatdikeluarkanmelaluiperineum.

Perdarahandirawatdanlukaoperasiditutuplapisdemilapisdengan
meninggalkandrainperineal(drainRedon).

Jaringantumorbesertarektumyangdireseksidandiperiksapatologi
anatominya.