KEMOTERAPI CA RECTUM Ol eh:dr .Ci t raLat i kaAgus t i a Pemb mbi mbi ng:dr .Gome meus,SpPD
DATA PASI EN
Nama:Tn.S
Je ni ske l:Laki l aki
Us i a :55t ahun
BB
:56kg
A gama :Kr i s t e n A l amat :Banyuwangi
St at us :Me ni kah
Tangg alMRS:26Okt o be r2015
KELUHAN UTAMA:
Pas i e ndat angkeUGD RSUD Ge nt e ngme mba wa r uj ukan dar idr .Go me us Effe ndy Sp. PD Pr o Ke mo t e r apiCaRe kt um ke 7 .
RI WAYATPENYAKI TDAHULU
2013
Ri wayatAt opi
:-
Ri wayatKel uar ga :Ti dakadar i way atkel uhan danpenyaki tyangs amadal am kel uar ga
Ri wayatGayaHi dup:Pe r o kokakt i fs e j akSMPdan b ar ub e r he nt i±1t a hunl a l u,j a r a ngme nko ns ums i buahdans ay ur .
PEMERI KSAAN FI SI K TD = 30/90 mmHg
N= 85x/min, regular, kuat
RR = 20 tpm,
Keadaan Umum: tampak sakit sedang
GCS 456
Kepala
Normocephal Pupil Isokor Releks Caha!a "#$
Kon%uncti&a pucat "'$ Sklera Ikterik "'$ ()( d*n
+eher
pem*esaran KG,"'$- .e&iasi trachea "'$
(hora/
Cor:
T : 36,8°
I c t usc o r di st i dakt e r l i hatdant e r abapadaI CS5 S1S2s i ng l e ,mur mur( ) ,g al l o p( ) Simetris
Pulmo:
s s & s s & s s &
& & &
Rh ' ' ' ' ' '
0*domen
(ampak Stoma ter*ungkus kantong- eses # )epar dan +ien tidak tera*a
1/tremitas
0kral hangat- edema "'$ crt 23 detik
PEMERI KSAAN PENUNJ ANG
Dar ahl e ngkap:
Hemogl obi n
12mg/ dl
Le uko s i t
4500mm3
He mat o kr i t
32%
Tr o mbo s i t
181r i bu
GDS
80mg/ dl
Fungs iGi nj al
Bun8, 4mg/ dl Cr e a t i ni n0, 9mg / dl
Fungs iHat i
SGOT30U/ L SGPT28U/ L
Hasil Pemeriksaan 23/6/14: Anorektal : 2 cm sampai 9 cm dari anal nampak masa tumor sirkuler berdungkul keras tapi skop masih dapat lewat. Biopsi 4x Kesimpulan : Keganasan rectum sepanjang 2 cm sampai 9 cm dari anal, sirkuler ada penempitan lumen tetapi skop masih dapat melewatina. Hasil Patologi Anatomi : Adenoca !ecti
Hasi lPemeri ks aan8/ 6/ 15: Nampakmas at umort el ahi nfil t r as i s ampaiSphi ngt erRec t um,s ehi ngga nampakme l e bardant umo rt e l ah menye babkanobs t r uks il umens ehi ngga s kophanyadapatmas ukse ki t ar8c m s a j a . Kes i mpul an: Mas at umo rRe c t um t e l ahme ny e babkan i nfil t r as ikeSphi nc t e rAnida nke pr o ksi malhanyas ampai8c ms aj amas a t umort el ahmenye babkanobs t r uks i ha mpe rt o t a ls e hi ng g as k o pt a kda pa t mas ukl a gi .Bi o ps it i da kdi l a kukanat a s per mi nt aanpas i en.
Di agnos a
TERAPI
I nfRL10t pm
Pr e me di kas i:I njRani t i di n1x 25mg,I nj Ondans e t r o n1x8mg,I njDe xame t has o n1x4mg
Le uc o v o r i n200mgdal am 200mlPZ50t pm dal am 2 j am,di l anj ut kanOxal i pl at i n100mgdal am 200ml D5% 50t pm dal am 2j am,di l anj ut kan5FU 100 0mg dal am 500mlPZ1014t pm dal am 22j am ( Se t e l ah 5FU t e r pas angber i5FU 750mgs e c ar aI Vpel an515 me ni t ) ,bi l a5FU dal am 500PZs udahhabi sber iRL 1 4t pm
I njOndanc e t r o n3x4mg( Si angMal am)
I njRa ni t i di n3 x2 5a mpul( Si a ng Ma l a m)
Tanggal26Okt ober2015
1. I nfRL10t pm 2. Pre medi kasi:I njRani t i di n
S:Kemot er apiCaRekt um O:TD:130/ 90mmHg,
1x25mg,I njOndans et r on1x8 mg,I njDexamet hason1x4mg. 3. Leucovor i n200mgdal am 200
nadi :85x/ meni t ,napas:20x/ meni t ,
mlPZ50t pm dal am 2j am,
suhu:36, 80C
di l anj ut kanOxal i pl at i n100mg
Abdomen:t er dapats t omapos t
dal am 200mlD5% 50t pm dal am 2j am,di l anj ut kan5FU
col os t omy,Labnormal A:CaRekt um Kemot er apike7
1000mgdal am 500mlPZ10 14 t pm dal am 22j am ( Set el ah5FU t er pas angberi5FU 750mg
Tanggal23November2015
secaraI V pel an515meni t ) , bi l a5FU dal am 500PZsudah
S:Kemot er apiCaRekt um O:TD:140/ 80mmHg,
4. I njOndance t r on3x4mg ( Si angMal am)
nadi :80x/ meni t ,napas:22x/ meni t , suhu:36, 50C
5. I njRani t i di n3x25mg( Si angMal am)
Abdomen:t er dapats t omapos t K
t
6. ObatOr al:Sanmaags i rup 3xI C,Ul si dexsi rup3x1C,
col os t omy, Labnormal A C R kt
habi sberiRL14t pm
ik 9
Domper i dont abl et3x10mg,
Tanggal7Des ember2015
1. I nfRL10t pm 2. Pr emedi kas i:I njRani t i di n
S:Kemot er apiCaRekt um
1x25mg,I njOndans et r on1x8
O:TD:140/90mmHg,nadi :88x/ meni t , napas:20x/ meni t ,suhu:36, 7C 0
Abdomen:t er dapats t omapos tcol os t omy, Labnormal A:CaRekt um Kemot er apike10
mg,I njDexamet hason1x4mg. 3. Leucovor i n200mgdal am 200 mlPZ50t pm dal am 2j am, di l anj ut kanOxal i pl at i n100mg dal am 200mlD5% 50t pm dal am 2j am,di l anj ut kan5FU 1000mg
Tanggal21Des ember20 15
dal am 500mlPZ1014t pm dal am 22j am ( Set el ah5FU
S:Kemot er apiCaRekt um
t er pas angber i5FU 750mg
O:TD:120/70mmHg,nadi :82x/ meni t ,
secaraI V pel an515meni t ) ,bi l a
napas:22x/ meni t ,suhu:36, 50C
5FU dal am 50 0PZsudahhabi s
Abdomen:t er dapats t omapos t col os t omy, Labnormal A:CaRekt um Kemot er apike11 Tanggal4Januari2016 S:Kemot er apiCaRekt um O:TD:140/80mmHg,nadi :83x/ meni t , napas:22x/ meni t ,suhu:36, 50C
beriRL14t pm 4. I njOndance t r on3x4mg( Si angMal am) 5. I njRani t i di n3x25mg( Si angMal am) 6. ObatOr al:Sanmaags i rup 3xI C,Ul si dexsi rup3x1C, Domper i dont abl et3x10mg,
TI NJ AUAN PUSTAKA CAREKTUM 940
De fini s i Ca Rekt i adal ah kanke r y ang t e r j adi padar e kt um.Re kt um t e r l e t ak di ant e r i o r s akr um and c o c c yx panj ang ny a ki r a ki r a 15c m.
Ge j al aKl i ni s P e r ubahanpol a danbe nt uk de f e kas i B Bme nur unt anpa s e babj e l as Mu almunt ah L e t uh,l e s u
Di a gno s i s
CEA( Car c i nomaEmbr i oni kAnt i ge n)
Di gi t alr e c t ale x ami nat i o n( DRE)
Bar i um Ene ma
Si gmoi dosc opy
Co l o no s c o p y
Bi o ps y
STADI UM THEAMERI CAN JOI NTCOMMI TTEEON CANCER ( AJCC) TNM STAGI NG SYSTEM
St adi um o
TNM Stadium
Modiied !eskripsi !ukes Stadium
T1 N" M"
A
Tumor ter#atas pada su#mu$osa
T2 N" M"
%1
Tumor ter#atas pada mus$ularis propria
T3 N" M"
%2
Pen&e#aran transmural
T2 N1 M"
'1
T2( pem#esaran kelen)ar mesenteri$
T3 N1 M"
'2
T3( pem#esaran kelen)ar mesenteri$
T4
'2
Pen&e#aran ke organ &ang #erdekatan
An& T( M1
!
Metastasis )au*
Ta t al aks a na: Pe mbe dahan R adi as i Ke mo t e r api
Pr o gno s i s
5y e ars ur v i v al r at e s:
St adi um I-72% S t adi um I I-54% S t adi um I I I-39% S t adi um I V-7%
DAFTARPUSTAKA 1.
Ha s s a n,I s a a c .Re c t a lCa r s i no ma .2 00 6.Av a i l a bl ef r o m:www. e me d i c i ne . c o m. ( Do wnl oad:25Des ember2015)
2.
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5.
ManuabaTW.Panduaanpenat al aks anaankankers ol i dper aboi2010.Jakar t a: Sa g ungs e t o ,2 01 0.
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8.
Sc hwar t zSI .Sc hwar t z ’ spr i nc i pl e so fs ur g e r y .9t he d.Uni t e dSt at e so fAme r i c a : TheMc Gr awHi l lc ompani es ,2010.
9.
Cagi rB.Rect alcancer. 2012.Avai l abl ef rom: ht t p: / / emedi ci ne. medscape. com/ art i cl e/ 281237overvi ew Downl oad30Apri l2015)
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abdomi naloper at i ons .TheUni t edSt at esofAmeri ca:TheMcGra wHi l lcompani es :2007 . P.6 93 7 25 . 11 .S abi s t on DC.Sabi s t onbukuaj arbedah( Ess ent i al sofsurgery) .19t hed.Jakart a:EGC.
2 01 2. 12.Eng st rom
FP,Arnol et t iPJ.Rect alCancer .JNat lComprCancNet w 2009; 7: 838881. Avai l abl ef r om:ht t p: / / www. j nccn. or g/ cont ent / 7/ 8/ 838. f ul l . pdf +ht ml( Downl oad30 Des ember20 15)
13.Cut se m1EV,Di cat oM.Thedi agnosi sandmanagementofr ect alcancer :expert
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