PATOFISIOLOGI KANKER

Dwi Novitasari, M.Sc

 Mekanisme
pertumbuhan
tumor
Perkembangan sel tumor
 Kegagalan pertahanan limfatik
menyebabkan perkembangan tumor
 The 7
warning
signs of
cancer
(American
Cancer
Society)
HOW DOES CANCER HAPPEN
 Initiation refers to
the damage of DNA

or mutation of
DNA chemical
Initiation
occurs when the
virus
cell is exposed by

during DNA
replication
radiation
(transcription)
CAUSES
GENETICS
VIRUSES
Immunosurveilance
 How the cell-mediated response occurs

tumor-associated antigens (TAAs) and tumor-specific antigens (TSAs)

How the humoral immune responseoccurs
How a disruption of the immune response occurs
Factors that disrupt immune response
 Factors that disrupt immune response
Extreme stress
Cytotoxic drugs
Aging cells. or steroids.
or certain viral
infections.
• errors in copying genetic • These agents • These
material during cell decrease conditions may
division may give rise to
mutations. antibody depress the
• If the aging immune production and immune
system doesn’t recognize destroy response, thus
these mutations as circulating allowing
foreign, the mutated lymphocytes. cancer cells to
cells may proliferate and
form a tumor.
proliferate.
 Factors that disrupt immune response
Acquired
Suppression of
Cancer. immunodeficiency
immune system.
syndrome.
• Radiation, cytotoxic • The disease it self is • This condition
drug therapy, and immunosuppressive. weakens the cell-
lymphoproliferative • Advanced disease mediated immune
and myelo exhausts the response.
proliferative immune system,
diseases (such as leading to anergy
lymphatic and (the absence of
myelocytic immune reactivity)
leukemia)
• will depress bone
marrow production
and impair leukocyte
function.
Risk factors
Risk factors
Risk factors
Risk factors
Risk factors
Risk factors
Risk factors
Risk factors
Risk factors
PATHOPHYSIOLOGIC CHANGES
Cancer cell characteristics
Cancer cell characteristics
 SIGNS AND SYMPTOMS CANCER
Fatigue

• Described as feeling of weakness

• Underlying mechanism unknown
• Believed to be the combined result of several
pathophysiologic mechanisms
• Existence of tumor may contribute to fatigue; a malignant
• tumor needs oxygen and nutrients to grow
• Pain can be physically and emotionally draining
• Stress, anxiety, lack of energy for daily life can cause
fatigue
 SIGNS AND SYMPTOMS CANCER
Cachexia
• Common in cancer patients
• Characterized by anorexia, taste perception alterations,
early satiety, weight loss, anemia, marked weakness,
altered metabolism
• May accompany pain or adverse reactions to
chemotherapy or radiation therapy
• Protein-calorie malnutrition may cause hypoalbuminemia,
edema, muscle wasting, and immunodeficiency
• Malignant tumor cells have high metabolic activity;
normal tissue becomes starved and depleted
 SIGNS AND SYMPTOMS CANCER
Pain
• Mild or absent in early stages of cancer
• Increases as cancer progresses
• Pressure on nerves, blood vessels, or tissue can
cause tissue death
• Occurs when viscera is stretched by a tumor
• Cancer cells release proteolytic enzymes that
destroy neighboring cells; inflammatory
response occurs
SIGNS AND SYMPTOMS CANCER

Anemia

•Caused by cancer of blood

forming cells, WBCs, or RBCs
•Common in metastatic cancer
 SIGNS AND SYMPTOMS CANCER
Leukopenia and thrombocytopenia

•Occur when cancer invades bone

marrow
•Can be caused by chemotherapy
and radiation therapy
•Greatly increases patient’s risk of
infection and hemorrhage
SIGNS AND SYMPTOMS CANCER
Infection

•Common in patients with advanced

cancer
•Malnutrition and anemia further
increase infection risk
•Obstructions, effusions, and
ulcerations may develop
Tumor effects
Host characteristics affecting tumors
Age
How cancer is spread
Dysplasia
Localized tumor
Invasive tumor
Invasive tumor
Metastatic tumor
Metastatic tumor
Metastatic tumor
Common site metastatis
Metastasis via pembuluh darah
Stase kanker
DIAGNOSIS BY IMAGING
DIAGNOSIS BY IMAGING
DIAGNOSIS BY IMAGING
DIAGNOSIS BY IMAGING
DIAGNOSIS BY IMAGING
DIAGNOSIS BY IMAGING
DIAGNOSIS
DIAGNOSIS
Common tumor cell markers
Common tumor cell markers
Common tumor cell markers
ACS guidelines: Early cancer detection
ACS guidelines: Early cancer detection
ACS guidelines: Early cancer detection
 TREATMENT
• Surgery
• Radiation therapy
• Chemotherapy
• Biotherapy
• Hormone therapy

• Each used alone or in combination

 Four goals
• cure and eradicate the cancer
• control or arrest tumor growth
• provide palliation to alleviate symptoms
• provide prophylaxis or treatment when no
tumor is detectible, but patient is at high risk
 Adverse effects to treatment include

• fluid and electrolyte imbalances,

• bone marrow suppression,
• hypercalcemia,
• pain
 Surgical
• Biopsy is diagnostic disfigurement and
surgery altered functioning
• Surgery as primary • Palliative surgery
treatment attempts to relieves complications
remove the entire tumor, • Prophylactic surgery
along with surrounding removes nonvital tissues
tissues and lymph nodes. or organs with high
• Radical or modified potential for developing
radical excision removes cancer
the primary tumor and
lymph nodes; results in
 Radiation therapy
• Uses high-energy • Normal and malignant
radiation cells respond to
• Aims to destroy dividing radiation differently
cancer cells while • Normal cells recover
minimizing damage to from radiation faster
normal cells than malignant cells
• Interacts with oxygen to • Protracted schedule
break strands of DNA allows time for normal
tissue to recover
between doses
 Chemotherapy
• Useful in controlling residual disease and as
adjunct to surgery or radiation therapy
• Can induce long remissions
• Each dose destroys only a percentage of tumor
cells; repeated doses are required
• Tumor cells in the growth fraction are the most
sensitive
• Nondividing cells must be destroyed to eradicate
a malignancy
 Adverse effects of chemotherapy
• Anemia
• Leukopenia
• Thrombocytopenia
• Vomiting
• Alopecia
• Dermatitis
• Venous sclerosis
• Pain
• Cutaneous necrosis
 Biotherapy
• Also known as immunotherapy
• Relies on biological response modifiers
• Main agent classifications include interferons,
interleukins, hemapoietic growth factors, and
monoclonal antibodies
• Adverse effects mimic the body’s normal
immune response; flulike symptoms are most
common