PERTEMUAN III

TREATMENT ORAL
NEOPLASMA MALIGNA
• TUMOR JINAK: ENUCLEASI
EKSISI MARGINAL
GOAL TREATMENT: CURATIVE

TREATMENT OF
NEOPLASMA
• TUMOR GANAS/CANCER?
FACTORS RELATED TREATMENT CHOICE
GOALS of TREATMENT of CANCER

• A. CURATIVE
• B. PALLIATIVE CARE
• C. HOSPICE CARE
TREATMENT MODALITIES OF CANCER

• SURGERY (wide excisi,en block,2-5 cm margin bebas sel tumor)

• RADIASI (loco regional treatment)
• CHEMOTHERAPI (metastase treatment)

• TARGET THERAPI
• GEN THERAPY
• IMUNOTHERAPI
• PDT (PHOTODYNAMIC THERAPI)

COMBINASI (adjuvant / neo adjuvant radioterapi/chemoterapi

combined with surgery) depend on indication
PEMBEDAHAN ORAL
NEOPLASMA MALIGNA
• CURATIVE SURGERY
– WIDE EXSICI(1-2CM MARGIN)
– RADICAL EXSICI(3-4 CM MARGIN)
– EN BLOCK RESEKSI
• PREVENTIVE SURGERY
– EXCISI PADA EUKOPLAKIA/ERITROPLAKIA
• PALLIATIVE SURGERY
– LIGASI ARTERI,NEURECTOMY,DLL
• DIAGNOSTIC SURGERY
– BIOPSI
 RADIOTERAPI

• CAUSE: DNA damage (normal tissue, tumor

cell), G1,G2, M phase.
• RESULT IN :Apoptosis atau necrosis
• PEMBERIAN: external,brachyterapi
• TUJUAN: curative, paliative
• URGENT RADIOTERAPI: superior vena cava
sindrom, spinal cord compression, brain
metas, uncontrolled bleeding
 SENSITIVITY MALIGNANT TUMORS TO RADIATION

Moderately
Very Responsive Poorly Responsive
Responsive
Hodgkin lymphoma Head and neck cancer Melanoma

Non-Hodgkin lymphoma Breast cancer Glioblastoma

Seminoma,dysgerminoma Prostate cancer Renal cancer

Neuroblastoma Cervical cancer Pancreatic cancer

Small-cell cancers Esophageal cancer Sarcoma

Retinoblastoma Rectal cancer

Lung cancer
 KEMOTERAPI

• Sebagai palliative,curative treatment

• untuk: cancer systemic (leukemia,limfoma
dll),cancer solid dengan metastase
klinis/subklinis,cancer stadium lanjut
• Destroy dividing abnormal cancer cell
• Manage spread and metastasis
• Cara pemberian : induksi ( sebelum
pembedahan,neo-ajuvant),bersamaan dg
radioterapi,ajuvant CT( setelah pembedahan)
 KEMOTERAPI

• KASIFIKASI KEMOTERAPI
– PLATINUM COMPOUNDS(CISPLANTIN,CARBIPLANTIN)
– ANTIMETABOLITES (METHOTREXATE,5-FLUOROURACIL
– TAXANES (DOCETAXEL)
– ANTIBIOTIK ( AKTINOMISIN D,EPIRUBISIN)
– ALKILATOR (MOSTAR NITROGEN,SIKLOFOSFAMIN)

• TARGET TERAPI (CETUXIMAB-BLOCK EGRF)

• EFEK: TOKSIS
CANCERS CURABLE OR OCCASIONALLY CURABLE WITH
CHEMOTHERAPY ALONE
Curable with chemotherapy alone
 Gestational choriocarcinoma
 Hodgkin lymphoma
 Germ cell cancer of the testis
 Acute lymphoid leukemia
 Non-Hondgkin lymphoma (some subtypes)
 Hairy cell leukemia

Occasionally curable with chemotherapy alone

 Acute myeloid leukemia
 Ovarian cancer
 Small-cell lung cancer
 PROGNOSIS

Factor
• Site
• Size (diameter, thickness , invasion)
• Degree of histologic differentiation
• Lymph node metastasis (Level, number)
• Extranodal spread
• Distant metastasis
 Tatalaksana oral cancer

IV. Biopsi

I. Diagnosa Grading patologis

TIM RS
1. Anamnesa
2. Pemeriksaan
fisik V. Terapi
a. Inspeksi
b. Palpasi

II. Staging Operasi Radioterapi Kemoterapi

TNM
H
III. Pemeriksaan A Residif
radiologis S
1. Waters I
2. Hap L
3. Lateral
4. Tomografi Metastas
5. CT Scan e jauh
Ilustrasi kasus
1.ADENOMA
ADENOMA
ADENOMA
ADENOMA
ADENOMA
2.Carcinoma ginggiva
Carsinoma pangkal lidah
ODONTOGENIC TUMORS
 Ameloblastoma

• The ameloblastoma is the most common

clinically significant (not the most common)
odontogenic tumor.
• It may develop from cell rests of the enamel
organ; from the developing enamel organ;
from the lining of odontogenic cysts or from
the basal cells of the oral mucosa.
 Ameloblastoma

• Ameloblastomas occur in 3 different clinico-

radiographic situations requiring different
therapeutic considerations and having
different prognoses.
– Conventional Solid/Multicystic (86 % of all cases)
– Unicystic (13 % of all cases)
– Peripheral or Extraosseous (1 % of all cases)
Solid or Multicystic Ameloblastoma:
Clinical Features
• Patient Age: Approximately equal frequency from
the third through the seventh decades.
• Sex Predilection: Approximately equal.
• Location: 80 % in mandible; 70 % in posterior
regions.
• Radiographic Appearance: Radiolucent lesion which
is usually well-circumscribed; it may be unilocular or
multilocular (soap-bubble, honeycomb); occasionally
an ameloblastoma will be ill-defined with a ragged
border.
Solid or Multicystic Ameloblastoma:
Histologic Features
• There are several microscopic subtypes but
these generally have little bearing on the
behavior of the tumor.
• The follicular and plexiform types are the most
common.
• The follicular type is composed of islands of
epithelium which resemble the enamel organ
in a mature fibrous connective tissue stoma.
Solid or Multicystic Ameloblastoma:
Histologic Features
• The plexiform type is composed of long,
anastomosing cords or larger sheets of
odontogenic epithelium. Its stroma tends to
be loose and more vascular.
• The acanthomatous type shows evidence of
extensive squamous metaplasia with keratin
formation in the island of odontogenic
epithelium.
Solid or Multicystic Ameloblastoma:
Histologic Features
• In the granular cell type there is
transformation of groups of epithelial cells to
granular cells; the nature of the granular
change is unknown. This type is more
common in young patients and has been
shown to be clinically aggressive.
Solid or Multicystic Ameloblastoma:
Histologic Features
• The desmoplastic form is composed of
islands/cords of odontogenic epithelium in a
very dense collagenous stroma. It has a
predilection for the anterior maxilla and
because of the dense connective tissue may
appear as a radiolucent-radiopaque lesion.
• The basaloid type is the least common and is
composed of uniform basaloid cells with no
stellate reticulum.
Solid or Multicystic Ameloblastoma:
Additional Features

• In some studies solid/multicystic

ameloblastomas are reported to be more
common in Blacks.
• While lesions are generally asymptomatic,
ameloblastomas may cause paresthesia, pain
particularly if infected and they can erode the
cortical palates.
Solid or Multicystic Ameloblastoma:
Treatment
• Treatments have ranged from simple
enucleation and curettage to en bloc
resection.
• Marginal resection is the most widely used
method of treatment with the least
recurrences reported (up to 15 %).
• Most surgeons advocate a margin of at least
1.0 cm beyond the radiographic limits of the
tumor as the tumor often extends beyond the
apparent radiologic/clinical margins.
AMELOBLASTOMA
 Unicystic Ameloblastoma:
Clinical Features
• Patient Age: The patients are younger than
those with the solid/multicystic form. 50% are
diagnosed during the second decade of life.
• Sex Predilection: ? Same as for the solid??
• Location: 90 % occur in the mandible usually
in the posterior region.
• Radiographic Appearance: Typically appears
as a RL around the crown of an unerupted
tooth (most commonly a mandibular third
molar).
 Unicystic Ameloblastoma:
Histologic Features
• Three histopathologic variants are recognized:
– Luminal: the tumor is confined to the luminal
surface of the cyst.
– Intraluminal/plexiform: the tumor projects from
the cystic lining; sometimes resembles the
plexiform type of solid/multicystic
ameloblastoma.
– Mural: the tumor infiltrates the fibrous cystic
wall.
UNICYSTIC AMELOBLASTOMA
 Odontoma

• The odontoma is the most common odontogenic

tumor.
• It is not a true neoplasm but rather is considered to
be a developmental anomaly (hamartoma).
• Two types of odontomas are recognized:
– Compound: this type of odontoma is composed of
multiple small tooth-like structures.
– Complex: this lesion is composed of a conglomerate mass
of enamel and dentin, which bears no anatomic
resemblance to a tooth.
COMPOUND ODONTOMA
COMPLEX ODONTOMA
Terima Kasih