TREATMENT

AND
PROGNOSIS
Cancer is more than
“Just” imbalance between cell proliferation and cell death
Understanding cancer behavior
helps to cure
Triple Diagnosis
1. Klinis

2. Radiologi
• Butuh tambahan screening metastasis ke
organ lainya

3. Patologi anatomi
• Biopsi
In general, if a tumor is cancer, possible treatments
include:
• Chemotherapy
• Radiation
• Surgery
• A combination of these methods

In this case, curative surgery is not recommended

because of the cancer has metastasized to various
parts of the body.
Surgery or radiation may be done to ease the back
pain.
Analgesics
MORPHINE
• Strong opioid
• Not normally addictive
• Respiratory depression is not a problem 
usually used for reliefing dyspnea
• Not stupefying
• Initial sedation may occur but that it usually
settles within 48 hours.
Side Effect ....1
• Sedation - usually subsides within a few days.
• Nausea and vomiting - common in opioid-naive patients.
Usually settles within a few days but can be prevented by
access to an anti-emetic, eg metoclopramide 10 mg tds
or haloperidol 1.5 mg nocte.
• Constipation - very common and laxatives should be
prescribed prophylactically.
• Dry mouth - advise good mouth care: frequent sips of iced
drinks, dental floss, saliva replacements or stimulants.
Side Effect .... 2
• Pruritus - related to histamine release. Try oral antihistamine
to control itch.
• Bronchoconstriction - again related to histamine release. Use
IV/IM antihistamine and bronchodilators and switch to a
pharmacologically distinct opioid such as methadone.
• Toxicity - appears as agitation, hallucinations, confusion, vivid
dreams and myoclonic jerks. Worsening renal or hepatic
function will alter the metabolism of morphine and may cause
accumulation and toxicity.
Morphine intolerance

• Responsiveness of the pain to opioids.

• Previous exposure to opioids.
• Rate of dose titration.
• Additional medication.
• Concomitant disease.
• Genetic factors.
• Renal and hepatic function.
Alternative
Transdermal opioid : fentanyl or buprenorphine
Stronger than morphine
More expensive
Slower effect
Slower elimination
Radiation therapy
• Radiation akan membunuh jaringan apapun yang dilewatinya
• Kerusakan radiation = oxygen dependent
Jaringan yang ada oxygen saja yang bisa dirusak sedangkan
Jaringan hypoxemic itu resistant
Jaringan sudah mau mati otomatis dia hypoxemic dulu kan, saat
dia “sekarat” itu radiasi sudah tidak bisa bunuh dia lagi.
Ad 3 jenis:
(1) teletherapy, with beams of radiation generated at a distance
and aimed at the tumor within the patient;
(2) brachytherapy, with encapsulated sources of radiation
implanted directly into or adjacent to tumor tissues; and
(3) systemic therapy, with radionuclides targeted in some
fashion to a site of tumor. Teletherapy is the most commonly
used form of radiation therapy.
Surgery
• cancer prevention,
• diagnosis,
• staging,
• treatment (for both localized and metastatic
disease),
• palliation, and
• rehabilitation.
Palliation
Surgery is employed in a number of ways for
supportive care
En Bloc Resection and
Reconstruction of the Spine
• The term “vertebrectomy,” also termed “spondylectomy,” is
used to describe removal of the entire tumor in one piece
together with portions of the posterior elements.
• This approach is indicated if:
• tumor is confined to zones 4–8 or 5–9
• tumor is centrally located in the vertebral body
• at least one pedicle is free from tumor
Chemotherapy
Pada metastatic brain tumor, kemoterapi primer
yang digunakan adalah targeted therapy karena
kemoterapi tradisional tidak dapat menembus
blood brain barrier.
Obat: Erlotinib (Tarceva)
• merupakan epidermal growth factor receptor/human
epidermal growth factor type 1 (EGFR/HER1) tyrosin kinase
inhibitor
• menghambat aktivitas kinase EGFR secara reversible
• Mencegah autofosforilasi residu tyrosin
• Menghambat downstream signaling yang akan menyebabkan
kematian sel
• Indikasi: treatment non-small cell lung cancer lokal atau
metastasis
Klasifikasi metastatic spine tumor

1. Harrington’s Classification and treatment principle

2. Tomita’s Classification
• Tipe 1 : corpectomy atau laminectomy
• Tipe 2 : corpectomy atau total spondylectomy
• Tipe 3, 4, 5 : total spondylectomy dengan pendekatan dari
posterior
• Tipe 6, 7 : tidak diindikasikan pembedahan
Ommaya Reservoir
Cancer survival rate: What it
means for your prognosis

Your doctor can't predict the future, but can make

an estimate based on other people's experiences
with the same cancer.
 Lung Cancer (C33-C34): 2003-2006
Five-Year Relative Survival (%) by Stage, Adults 15-99, Former Anglia Cancer Network

Stage IV survival could not be calculated at five years due to the small number of people surviving more than two years.
• Stage 4 (Metastatic) Non-Small Cell - The overall 5-year
survival rate with stage 4 lung cancer is sadly only 1%. The
median survival time is about 8 months.