Gejala dan cara diagnosis tumor

ginjal
Dr. Titiek Sunaryati, M.Ked
• Tumor ginjal merupakan tumor saluran kencing terbanyak ketiga setelah
tumor prostat dan tumor kandung kencing. Semakin meluasnya
penggunanaan ultrasonografi (USG) di poliklinik rawat jalan
mempermudah deteksi dini kasus-kasus tumor ginjal.
• Banyak faktor yang diduga menjadi penyebab timbulnya tumor ginjal.
Merokok merupakan salah satu faktor resiko yang menyebabkan tumor
ginjal. Semakin lama merokok dan semakin muda seseorang mulai
merokok semakin besar kemungkinan menderita tumor ginjal.
• Gejala khas tumor ginjal berupa tiga tanda trias klasik yaitu: nyeri
pinggang, kencing berdarah dan benjolan atau massa pada pinggang atau
perut yang merupakan tanda tumor dalam stadium lanjut. Hipertensi
(tekanan darah tinggi) dan anemia (kurang darah) tanpa sebab yang jelas
terutama di usia muda juga merupakan gejala yang penting untuk dicurigai
sebagai tanda adanya tumor ginjal.
• Terapi tumor ginjal yang masih dalam stadium dini dilakukan nefrektomi
radikal yaitu mengambil organ ginjal. Terapi lain berupa hormon, radiasi
dan kemoterapi.
•
 Tumor ginjal
Tumor jinak Tumor ganas
• Renal papillary adenoma • Renal cell carcinoma
• Renal fibroma/hamartoma • Urothelial carcinomas of the
• Angiomyolipoma renal pelvis
• Oncocytoma
 Gejala tumor ginjal
• Abdominal mass
• Abdominal swelling
• Fever
• Abdominal pain
• Nausea
• Vomiting
• Apetite loss
• Weigth loss
• Blood in urine
• High blood pressure
• Usually only one kidney affected
• Palpable upper abdominal mass
• Anemia
• Heart murmur
• Ascites
• Prominent veins
• Pallor
• Mild fever
• Lethargy
• Pain
• Hemihypertrophy
• Genitourinary defects
• Physical exam: The doctor checks general signs of health and tests for
fever and high blood pressure. The doctor also feels the abdomen and side
for tumors.
• Urine tests: Urine is checked for blood and other signs of disease.
• Blood tests: The lab checks the blood to see how well the kidneys are
working. The lab may check the level of several substances, such as
creatinine. A high level of creatinine may mean the kidneys are not doing
their job.
• Intravenous pyelogram (IVP): The doctor injects dye into a vein in the
arm. The dye travels through the body and collects in the kidneys. The dye
makes them show up on x-rays. A series of x-rays then tracks the dye as it
moves through the kidneys to the ureters and bladder. The x-rays can
show a kidney tumor or other problems.
• CT scan (CAT scan): An x-ray machine linked to a computer takes a series
of detailed pictures of the kidneys. The patient may receive an injection of
dye so the kidneys show up clearly in the pictures. A CT scan can show a
kidney tumor.
• Ultrasound test: The ultrasound device uses sound waves that
people cannot hear. The waves bounce off the kidneys, and a
computer uses the echoes to create a picture called a
sonogram. A solid tumor or cyst shows up on a sonogram.
• Biopsy: In some cases, the doctor may do a biopsy. A biopsy is
the removal of tissue to look for cancer cells. The doctor
inserts a thin needle through the skin into the kidney to
remove a small amount of tissue. The doctor may use
ultrasound or x-rays to guide the needle. A pathologist uses a
microscope to look for cancer cells in the tissue.
• Surgery: In most cases, based on the results of the CT scan,
ultrasound, and x-rays, the doctor has enough information to
recommend surgery to remove part or all of the kidney. A
pathologist makes the final diagnosis by examining the tissue
under a microscope.
Wilms’tumor=nephroblastoma=embryonal mixed tumor
• Biasa pada anak < 10tahun (tut <3)
• 25% tumor ganas pada anak
• Merupakan tumor campur shg td bermacam
komponen,
tetapi asalnya dari 1 germ layer yaitu mesodermal
Gros:
o Tumor btk bola sangat besar,shg ginjal jadi kerdil
o Berat bisa mencapai 15 kg
o Pada irisan td macam-macam komponen
Antara lain:
 Jar.miksomatik
 Jar.sarkomatik spt daging ikan
 Konsistensi lunak/padat
 Jar.tulang rawan
 Daerah nekrosis+perdarahan
PA:
1.Glomerulus abortif/primitif
dg ruang bowman yg terbentuk kurang baik
2.Tubulus abortif
seluruhnya terkurung dalam stroma sel spindel
3.Blastem
sel-sel ginjal yg masih primitif
4.Otot bergaris, tulang rawan dll
Klinis:
px anak2 dgn tumor yang besar sekali
Prog:
sangat baik
Tx:
surgical, nefrektomi
radioterapi
chemoterapi