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KARAKTERISTIK PASIEN KARSINOMA NASOFARING DI RSUP SANGLAH DENPASAR TAHUN 2014-2016 I G A Wira Saraswati; I Gde Ardika Nuaba; I Ketut Suanda
E-Jurnal Medika Udayana Vol 8 No 1 (2019): Vol 8 No 1 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (162.828 KB)

Karsinoma nasofaring (KNF) merupakan kanker yang terdapat pada sel-sel epitel mukosa nasofaring. Penelitian ini dilakukan untuk mengetahui faktor-faktor apa saja yang berhubungan dengan kejadian KNF serta karakterstik pasien KNF di RSUP Sanglah Denpasar tahun 2014-2016. Penelitian ini bersifat deskriptif retrospektif dengan mengumpulkan data rekam medis pasien KNF di RSUP Sanglah Denpasar. Hasil penelitian ini, penderita awal terdiagnosis KNF tertinggi tahun 2016 sebanyak 114 orang. Berdasarkan umur dijumpai selama tiga periode tertinggi terdapat pada kelompok umur usia produktif (36-55 tahun). Jenis kelamin tertinggi pada laki-laki tahun 2016 sebanyak 75 orang (65,79%). Berdasarkan status pekerjaan paling tinggi pada pekerja aktif sebanyak 113 orang (66,08%). Stadium penyakit paling tinggi pada stadium IVA tahun 2016 sebanyak 46 orang (40,35%) dari total 69 orang (40,35%). Berdasarkan paparan asap rokok terbanyak di jumpai pada tahun 2016 sebanyak 58 orang (50,88%) dari total 90 orang (52,63%) yang mengenai laki-laki. Histopatolgi (WHO) paling banyak dijumpai selama tiga periode pada who tipe 3 sebanyak 163 orang (95,32%). Disimpulkan bahwa kejadian KNF di RSUP Sanglah Denpasar meningkat tiap tahunnya serta lebih sering diketahui pada stadium lanjut. Hasil penelitian ini diharapkan dapat digunakan sebagai dasar penelitian lebih lanjut untuk mengetahui karakterstik pasien KNF tiap tahunnya di RSUP Sanglah Denpasar. Kata Kunci: KNF, Karakteristik, RSUP Sanglah Denpasar

COMPARISON OF CYTHOCROME P450 FAMILY 2 SUBFAMILY A POLYPEPTYDE 6 (CYP2A6) GENE POLYMORPHISM PROPORTION ON EARLY AND ADVANCED STAGE OF UNDIFFERENTIATED TYPE NASOPHARYNGEAL CARCINOMA IN BALINESE I Gde Ardika Nuaba; Komang Andi Dwi Saputra; I Ketut Suanda; I Gusti Ayu Trisna Dewi
INTERNATIONAL JOURNAL OF NASOPHARYNGEAL CARCINOMA Vol. 1 No. 03 (2019): International Journal of Nasopharyngeal Carcinoma
Publisher : TALENTA PUBLISHER

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijnpc.v1i03.2066

Introduction Nasopharyngeal carcinoma (NPC) is a malignancy derived from epithelial cells lining the nasopharynx. The etiology of nasopharyngeal carcinoma is multifactorial. One of the risk factors is CYP2A6 gene polymorphism which causes nitrosamines are not metabolized, leading to DNA change that could trigger cancer. Objectives The purpose of this study is to know the association of CYP2A6 gene polymorphism and clinical stage of undifferentiated type of NPC Material and Method This is a cross sectional analytic study. The sample in this study were 80 nasopharyngeal carcinoma patients whose treated in ENT-HN department of Sanglah General Hospital between 2017 - 2018. The collected data consist of subject’s characteristic and CYP2A6 gene polymorphisms identified by the PCR-RFLP technique. Results The probability of CYP2A6 gene polymorphism in the undifferentiated type of NPC in the Balinese tribe is 3.125 times greater in advanced stage than early stage. Based on multivariate analysis, there was a statistically significant association between CYP2A6 gene polymorphism and clinical stage of undifferentiated type NPC in Balinese with p value = 0,0048 (p < 0,05). Conclusion There is association between CYP2A6 gene polymorphism and clinical stage of undifferentiated type NPC in Balinese tribe.

COMPARISON OF POLYMORPHISM rs2070672 CYP2E1 GENE PROPORTION IN EARLY AND ADVANCED STAGE OF UNDIFFERENTIATED TYPE NASOPHARYNGEAL CARCINOMA IN BALINESE I Ketut Suanda; I Gde Ardika Nuaba; Ni Putu Ayu Wiarni Susanthi
INTERNATIONAL JOURNAL OF NASOPHARYNGEAL CARCINOMA Vol. 2 No. 01 (2020): International Journal of Nasopharyngeal Carcinoma
Publisher : TALENTA PUBLISHER

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijnpc.v2i01.2652

Introduction: Nasopharyngeal carcinoma is the most common malignancy in the ENT field. The cause of nasopharyngeal carcinoma is multifactorial. One of the risk factors for an increase in nasopharyngeal carcinoma is the rs2070672 polymorphism of the CYP2E1gene. Purpose: To determine the rs2070672 CYP2E1gene polymorphism proportion in early and advanced stage undifferentiated type NPC subjects in Balinese. Method: This research is a cross sectional comparative study. The case population were all subjects with undifferentiated type NPC in the ENT outpatient clinic at Sanglah General Hospital Denpasar. This study uses 65 samples. Data collected in the form of subject characteristics and rs2070672 CYP2E1gene polymorphisms which examined by ARMS-PCR technique. Results: The average age of the sample was 48.1 years, the most were male as many as 48 subjects (73.8%), and the highest was advanced stage as many as 56 subjects (86.2%). In the chi square test the proportion of polymorphisms in the advanced stage was 2.357 times higher than the early stages. The results of multivariate analysis using logistic regression proved that the rs2070672 CYP2E1gene polymorphism at advanced stage was 7.469 times higher than early stage. Conclusion: There is a difference in the proportion of rs2070672 CYP2E1gene polymorphism in undifferentiated type NPC of Balinese, where advanced stage is higher than early stage.

Head and Neck Cancer in Bali: A Retrospective Study on Patient Characteristics, Predominant Sites, and Histopathology at a Tertiary Referral Hospital Komang Soniananda Pradnyana Putri; I Gde Ardika Nuaba; I Ketut Suanda
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.757

Head and neck cancers (HNCs) represent a significant global health burden, with distinct epidemiological patterns observed across different geographical regions. In Indonesia, HNCs are among the leading malignancies, yet detailed regional data, particularly from areas like Bali, remain limited. This study aimed to delineate the characteristics of HNC patients at a tertiary referral hospital in Denpasar, Bali. A retrospective descriptive study was conducted using medical records of patients diagnosed with head and neck malignancies at Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar, between January 1st, 2021, and December 31st, 2023. Data collected included age, gender, occupation, primary tumor site, and histopathological findings. A total sampling method was employed. Descriptive statistics were used for analysis. A total of 290 patient records were analyzed. Males comprised 69% (n=201) of cases, and females 31% (n=89). The predominant age group was 45–65 years (63%, n=183). Farmers were the most common occupational group (27%, n=77). Nasopharyngeal cancer was the most prevalent malignancy, accounting for 80% (n=232) of cases. Nonkeratinizing squamous cell carcinoma was the most frequent histopathological diagnosis (80%, n=231). In conclusion, head and neck malignancies in this Balinese cohort predominantly affected middle-aged to elderly males, with farming being a common occupation. The strikingly high prevalence of nasopharyngeal cancer, primarily nonkeratinizing squamous cell carcinoma, underscores a significant regional health concern that warrants further etiological investigation and targeted public health strategies.

Reconstructive Challenges and Outcomes Following Radical Resection of Sinonasal Squamous Cell Carcinoma via Weber-Ferguson Approach: A Case Study Ni Putu Deby Rathasari; I Gde Ardika Nuaba; I Ketut Suanda
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.749

Sinonasal squamous cell carcinoma (SCC) is an uncommon malignancy characterized by diagnostic delays and complex management. Advanced-stage disease often necessitates radical surgical resection, leading to significant anatomical defects and formidable reconstructive challenges. The Weber-Ferguson approach provides wide surgical exposure for extensive tumors but results in considerable midfacial defects requiring meticulous reconstruction to restore function and aesthetics. This case study details the reconstructive challenges and outcomes following total maxillectomy with this approach for an advanced sinonasal SCC. A 53-year-old male presented with a one-month history of right cheek pain and swelling, preceded by a year of right upper molar pain and progressive facial masses. Clinical and radiological evaluations revealed an extensive mass originating from the right maxillary sinus, destructing surrounding bony structures and involving regional lymph nodes. Biopsy confirmed poorly differentiated keratinizing squamous cell carcinoma. The patient underwent a right total maxillectomy via a Weber-Ferguson approach with Lynch modification, extended to involve the mandible, along with reconstruction. The final staging was T4aN3M0. Postoperatively, the patient experienced minor wound dehiscence, which was managed conservatively. He was planned for an obturator and adjuvant radiochemotherapy, but he declined further oncological treatment. Radical resection of advanced sinonasal SCC using the Weber-Ferguson approach, while oncologically necessary, presents substantial reconstructive dilemmas. Addressing these defects is crucial for functional rehabilitation, including speech, deglutition, and acceptable cosmesis. This case underscores the complexity of managing such extensive defects and the importance of a multidisciplinary approach, even when patients decline standard adjuvant therapies. The long-term prognosis in such cases remains guarded, particularly without adjuvant treatment.

Esophageal Squamous Cell Carcinoma Masquerading as Achalasia: A Case Report on Diagnostic Pitfalls and Therapeutic Strategies Renata Timoty Pasaribu; I Gde Ardika Nuaba; I Ketut Suanda; Ida Ayu Alit Widiantari; I Wayan Lolik Lesmana
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.760

Esophageal squamous cell carcinoma (SCC) is an aggressive malignancy often diagnosed at an advanced stage, leading to a poor prognosis. Its initial symptoms can be nonspecific, occasionally mimicking benign esophageal disorders such as achalasia, thereby posing significant diagnostic challenges. This report details such a case, emphasizing the diagnostic pitfalls and discussing therapeutic approaches. A 43-year-old male presented with a 5-month history of progressive dysphagia and odynophagia, initially suspected to be achalasia. Clinical findings, including significant weight loss and specific laboratory abnormalities, are detailed. Esophagogastroduodenoscopy revealed an obstructing tumor, confirmed as esophageal SCC by biopsy. Staging investigations, including Multi-Slice Computed Tomography (MSCT), characterized the disease as Stage IVA (T4N1M0). The patient underwent feeding gastrostomy for nutritional support and commenced systemic chemotherapy with docetaxel, carboplatin, and cetuximab. The treatment course and initial follow-up are described. In conclusion, this case underscores the critical importance of maintaining a high index of suspicion for malignancy in patients presenting with symptoms suggestive of achalasia, especially if accompanied by atypical features or risk factors. A meticulous and timely diagnostic evaluation, incorporating early endoscopy and biopsy, is paramount for accurate diagnosis and staging. Multidisciplinary management, including robust nutritional support and carefully selected systemic therapy, remains central to addressing advanced esophageal SCC.

Salvage Total Laryngectomy with Bilateral Deltopectoral Flap Reconstruction for Metastatic (Stage IVC) Laryngeal Carcinoma: A Case Report Steven Yohanis Latupeirissa; I Wayan Lolik Lesmana; Eka Putra Setiawan; I Gde Ardika Nuaba; Made Lely Rahayu; I Ketut Suanda
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.781

The management of advanced laryngeal squamous cell carcinoma (SCC) that persists or recurs after definitive chemoradiotherapy presents a significant clinical challenge. This challenge is profoundly amplified in the setting of distant metastatic disease (Stage IVC), where the goals of treatment shift from curative intent to palliation and quality of life preservation. Surgical salvage in this context is controversial and reserved for highly selected cases with severe, unmanageable local symptoms. We present the case of a 58-year-old male, a long-term smoker, with Stage IVC (T3N2cM1) laryngeal SCC, complicated by bone metastases. He initially underwent definitive chemoradiotherapy. Ten months later, he presented with progressive local disease, including a fungating cervical mass and impending airway compromise. A palliative salvage total laryngectomy with bilateral Modified Radical Neck Dissection (MRND) was performed to control severe local symptoms. The extensive pharyngocutaneous defect was reconstructed using bilateral pedicled deltopectoral fasciocutaneous flaps. The final histopathology confirmed viable, moderately differentiated SCC with extensive cartilage invasion and, critically, a positive deep resection margin. The postoperative course was managed successfully, with the patient showing significant improvement in local symptoms and quality of life at short-term follow-up. This case highlights the complex decision-making required for palliative surgery in metastatic head and neck cancer. The discussion focuses on the justification for aggressive local intervention to palliate debilitating symptoms, the rationale for selecting the robust bilateral deltopectoral flap for reconstruction in a hostile, irradiated field, and the profound prognostic implications of a positive surgical margin in the salvage setting. In conclusion, palliative salvage total laryngectomy can be a viable strategy to improve quality of life in selected patients with Stage IVC laryngeal cancer and overwhelming local disease. However, achieving complete oncologic clearance is a formidable challenge, and management must be tailored within a multidisciplinary framework.

Solitary Sinonasal Neurofibroma in an Elderly Male: A Rare Presentation and Surgical Management Jessica Filbertine; I Gde Ardika Nuaba; I Ketut Suanda; Ida Ayu Alit Widiantari; I Wayan Lolik Lesmana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.794

Solitary sinonasal neurofibromas are rare peripheral nerve sheath tumors whose diagnosis is frequently confounded by non-specific symptoms and radiological features that mimic common inflammatory conditions. In the elderly, a unilateral sinonasal mass necessitates a high index of suspicion for neoplasia, yet diagnostic pitfalls remain a significant clinical challenge. A 65-year-old male with no stigmata of neurofibromatosis type 1 presented with a three-year history of progressively worsening unilateral nasal obstruction. Endoscopy revealed a large, pale, firm, non-friable mass. Computed tomography (CT) demonstrated an extensive, non-enhancing soft tissue mass originating in the left maxillary sinus, causing significant expansile bone remodeling and extending into multiple adjacent sinuses. The initial radiological impression was extensive sinonasal polyposis. However, an incisional biopsy followed by a comprehensive morphological analysis confirmed the diagnosis of a benign spindle cell tumor consistent with neurofibroma. The patient underwent complete tumor excision via a left lateral rhinotomy. The postoperative course was uneventful, with no recurrence at 12-month follow-up. In conclusion, this case underscores the critical importance of a thorough diagnostic workup for unilateral sinonasal masses in the elderly, where radiological findings can be misleading. Histopathological analysis is indispensable for the definitive diagnosis of spindle cell tumors in this location. For massive, maxillary-based neurofibromas with extensive lateral and anterior involvement, the lateral rhinotomy remains a vital and superior surgical approach, providing the necessary exposure to uphold the fundamental principle of complete oncologic resection and maximize the probability of a curative outcome.

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