Karsinoma Sel Skuamosa

Karsinoma Sel Skuamosa
Credit: Alamy Stock Photo.

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Definisi

Karsinoma sel skuamosa (KSS) kulit merupakan jenis kanker kulit terbanyak kedua yang cukup sering ditemukan. Kanker ini ditandai dengan pertumbuhan sel skuamosa yang cepat dan tidak normal. Sel skuamosa adalah salah satu satu dari tiga jenis sel utama pada lapisan atas kulit (epidermis). Sel ini terletak dekat permukaan kulit yang senantiasa mengelupas seiring regenerasi sel kulit baru terjadi.

Kanker kulit ini sendiri walaupun umumnya tidak membahayakan nyawa, tetap bisa menjadi kanker yang agresif. Bila tidak ditangani, karsinoma sel skuamosa bisa menjadi semakin besar atau menyebar ke bagian tubuh lain, sehingga menyebabkan komplikasi yang serius. Jumlah kasus kanker kulit ini ditemukan meningkat dalam tiga dekade terakhir. Di Amerika Serikat contohnya, diestimasi terdapat 1,8 juta kasus karsinoma sel skuamosa yang didiagnosis setiap tahunnya.

 

Penyebab

KSS terjadi ketika terjadi DNA sel skuamosa kulit mengalami kerusakan atau bermutasi. DNA sel mengatur kehidupan sel tersebut. Kerusakan atau mutasi pada DNA sel skuamosa di kulit dapat menyebabkan sel tersebut bertumbuh dengan tidak terkontrol dan tidak mengalami kematian sel seperti sel normal lainnya.

Sebagian kerusakan DNA tersebut terjadi akibat kulit terpapar radiasi sinar ultraviolet atau zat merusak lainnya dalam jangka panjang. Paparan radiasi ultraviolet sendiri bisa didapatkan dari sinar matahari maupun tanning bed atau tanning lamp. Hal inilah yang mencetuskan perubahan abnormal dari sel skuamosa kulit.

Namun, teori ini tidak dapat menjelaskan adanya KSS yang timbul pada bagian kulit yang biasanya tidak terpapar sinar matahari. Hal ini menandakan bahwa terdapat faktor-faktor lain yang berkontribusi terhadap pembentukan kanker kulit, seperti kemungkinan adanya kondisi lain pada pasien yang menurunkan sistem kekebalan tubuhnya.

 

Faktor Risiko

KSS cukup sering ditemukan pada pria tua, sehingga diduga jenis kelamin pria yang sudah berumur menjadi salah satu faktor risiko terjadinya KSS. Walaupun kanker kulit ini juga bisa terjadi pada wanita dan orang-orang dewasa muda. Selain itu, kebiasaan merokok juga dapat meningkatkan risiko seseorang terkena karsinoma sel skuamosa.

Paparan sinar ultraviolet yang berlebihan juga menjadi faktor risiko dari KSS kulit. Sinar ultraviolet juga tidak hanya dari sinar matahari saja, namun juga dapat berasal dari tanning bed. Menghabiskan banyak waktu di bawah sinar matahari, terutama jika Anda tidak menutup kulit dengan pakaian atau tidak menggunakan tabir surya, meningkatkan risiko terkena kanker kulit ini. 

Faktor risiko lainnya adalah warna kulit yang terang. Semua orang dengan warna kulit apapun dapat menderita KSS. Namun, pada orang dengan kulit terang, pigmen kulitnya (melanin) lebih sedikit sehingga perlindungan terhadap radiasi ultraviolet juga lebih rendah. Jika Anda memiliki rambut pirang atau merah, warna iris mata yang terang, atau Anda mudah mengalami sunburn atau memiliki bintik-bintik freckles di wajah, maka Anda juga lebih rentan untuk terkena kanker kulit, termasuk KSS, jika dibandingkan dengan orang yang berkulit gelap.

Faktor-faktor lain yang dapat meningkatkan risiko seseorang terkena karsinoma sel skuamosa kulit adalah:

  • Riwayat memiliki kondisi kulit prekanker, seperti aktinik keratosis atau penyakit Bowen
  • Cedera pada kulit sebelumnya seperti luka bakar, ulkus atau tukak pada tungkai, lupus kutaneus
  • Riwayat kanker kulit sebelumnya, jika Anda sudah pernah menderita KSS atau kanker kulit lain seperti melanoma atau karsinoma sel basal kulit, maka Anda lebih mungkin untuk mengalami KSS 
  • Kelemahan sistem kekebalan tubuh dapat meningkatkan risiko terjadinya kanker kulit, contohnya pada:
    • Penderita leukemia atau limfoma
    • Sedang menggunakan obat-obatan penekan sistem imun
    • Orang yang telah melalui transplantasi organ
  • Terpapar dengan arsenik
  • Kelainan genetik tertentu, contohnya penderita xeroderma pigmentosum memiliki sensitivitas yang ekstrim terhadap sinar matahari, sehingga lebih rentan untuk terkena kanker kulit

 

Gejala

Sel skuamosa ditemukan pada banyak bagian tubuh, dan KSS dapat timbul di seluruh bagian tubuh yang terdapat sel skuamosa. KSS paling sering timbulnya di area tubuh yang terpapar sinar matahari seperti kulit kepala, punggung tangan, telinga, atau bibir. Namun, KSS juga dapat timbul pada area tubuh lain, termasuk mulut, kaki, dan area kelamin. KSS dapat menyebabkan gatal, berdarah, atau terbentuknya keropeng.

Pada setiap orang, gejala KSS kulit dapat berbeda-beda. KSS kulit dapat terlihat seperti bercak merah atau keropeng yang bersisik, luka terbuka, sampai benjolan keras kemerahan dengan cekungan di bagian tengahnya. Kelainan kulit yang tampak juga umumnya terasa nyeri dan bisa menjadi berdarah. Benjolan atau bercak bisa membesar dalam kurun waktu beberapa minggu sampai berbulan-bulan. Ukuran kelainan kulit bervariasi, dengan diameter dari beberapa milimeter sampai beberapa sentimeter.

 

Diagnosis

Ketika dokter melihat kelainan kulit pada Anda untuk pertama kalinya, dokter akan bertanya mengenai kelainan kulit tersebut secara detail, serta mencari tahu riwayat kesehatan Anda. Bila dokter curiga kelainan kulit yang Anda derita sepertinya mengarah ke keganasan atau kanker kulit, dokter akan menyarankan pemeriksaan penunjang untuk mengonfirmasi diagnosis.

Salah satu pemeriksaan penunjang yang bisa dilakukan adalah biopsi kulit. Biopsi kulit dilakukan dengan mengambil beberapa atau seluruh sampel daerah kulit yang dicurigai sebagai kanker. Sampel jaringan tersebut akan dikirim ke laboratorium untuk diperiksa dibawah mikroskop.

Pada pasien-pasien yang berisiko tinggi mengalami karsinoma sel skuamosa, dokter dapat menyarankan pemeriksaan lain untuk mencari tahu bila kanker sudah menyebar ke kelenjar getah bening atau ke bagian tubuh lain. Pemeriksaan yang bisa dilakukan antara lain:

  • Pemeriksaan pencitraan seperti ultrasound, rontgen dengan sinar X, CT scan, MRI
  • Biopsi kelenjar getah bening atau jaringan lainnya

 

Tata Laksana

Jika terdiagnosa dengan cepat, KSS dapat disembuhkan. Umumnya KSS dapat diangkat dengan prosedur bedah minor. Pilihan terapi bergantung pada ukuran, lokasi, agresivitas tumor, dan pilihan Anda.

  • Terapi untuk KSS yang sangat kecil dan berisiko rendah untuk menyebar adalah:
    • Kuretase dan elektrodesikasi (bedah listrik)
    • Terapi laser
    • Bedah beku
    • Terapi fotodinamik
  • Terapi untuk KSS yang besar:
    • Pembedahan untuk membuang kanker
    • PembedahanvMohs
    • Terapi radiasi
  • Terapi untuk KSS yang sudah menyebar:
    • Kemoterapi
    • Targeted drug therapy
    • Imunoterapi

 

Komplikasi

Sebagian besar KSS dapat diterapi dengan mudah dengan tingkat keberhasilan yang tinggi. KSS yang tidak diterapi dapat menjadi agresif dan menyebar ke bagian tubuh yang lain seperti kelenjar getah bening atau organ lain. KSS yang seperti ini dapat mengganggu bentuk tubuh, merusak jaringan sehat di sekitarnya, serta dapat bersifat fatal atau mengancam nyawa.

Risiko KSS yang agresif meningkat ketika:

  • Ukuran kanker besar atau terletak sampai ke dalam
  • Kanker melibatkan selaput lendir seperti bibir
  • Kanker terjadi pada orang dengan kelemahan sistem kekebalan tubuh

 

Pencegahan

Kebanyakan KSS kulit dapat dicegah dengan cara:

  • Menghindari sinar matahari saat tengah hari. Sinar matahari paling kuat pada jam 10 pagi sampai 3 sore, sehingga Anda tidak dianjurkan untuk beraktivitas di luar ruangan pada waktu tersebut.
  • Memakai tabir surya sepanjang musim. Pemakaian tabir surya spektrum luas dengan minimal SPF 30 sangat disarankan, termasuk saat cuaca mendung atau berawan. Pakailah tabir surya dengan banyak dan ulangi pemakaian setiap dua jam atau lebih jika Anda beraktivitas di air atau berkeringat.
  • Memakai pakaian pelindung. Tutup kulit Anda dengan pakaian bertenun rapat dan gelap. Tutup bagian lengan dan tungkai, serta pakai topi yang lebar yang dapat memberi perlindungan terhadap kulit kepala dan wajah. Jangan lupa untuk memakai kacamata gelap anti UVA dan UVB.
  • Hindari tanning bed. Tanning bed memancarkan gelombang ultraviolet.
  • Lakukan pemeriksaan kulit secara teratur dan konsultasi ke dokter jika ada perubahan pada kulit Anda. Periksa kulit Anda dan cari adanya benjolan atau perubahan yang tidak biasanya pada tahi lalat, freckles, dan kondisi kulit lainnya.

 

Kapan Harus ke Dokter?

Anda sebaiknya berkonsultasi ke dokter atau dokter spesialis kulit jika Anda memiliki luka atau keropeng yang tidak kunjung sembuh dalam dua bulan, atau memiliki bercak bersisik yang tidak kunjung hilang.

 

Mau tahu informasi seputar penyakit lainnya? Cek di sini, ya!

 

 

Writer : dr Tea Karina Sudharso
Editor :
  • dr Hanifa Rahma
Last Updated : Senin, 29 April 2024 | 07:43

Squamous Cell Carcinoma. The Skin Cancer Foundation. (2022). Retrieved 24 May 2022, from https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/.

Squamous cell carcinoma of the skin - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. (2022). Retrieved 24 May 2022, from https://www.mayoclinic.org/diseases-conditions/squamous-cell-carcinoma/diagnosis-treatment/drc-20352486.

Cutaneous squamous cell carcinoma: Symptoms, Causes, and Treatment — DermNet. Dermnetnz.org. (2022). Retrieved 24 May 2022, from https://dermnetnz.org/topics/cutaneous-squamous-cell-carcinoma.

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      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • CategoryHealtTopics.php#11aicare_prod_new1.39msselect * from `categories` where (`slug` != 'penyakit-a-z' and `slug` != 'obat-a-z' and `slug` != 'pemeriksaan-a-z' and `parent_id` = '0') and `categories`.`deleted_at` is null order by `order` asc
      Bindings
      • 0: penyakit-a-z
      • 1: obat-a-z
      • 2: pemeriksaan-a-z
      • 3: 0
      Hints
      • Use SELECT * only if you need all columns from table
      • The != operator is not standard. Use the <> operator to test for inequality instead.
      Backtrace
      • app/Repositories/Categories/CategoryHealtTopics.php:11
      • app/Http/Controllers/WebController.php:376
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • WebController.php#377aicare_prod_new148msselect * from `posts` where `status` = 1 and `publish_date` <= '2025-01-13 09:15:32' and `content_type` = 'article' order by RAND() limit 7
      Bindings
      • 0: 1
      • 1: 2025-01-13 09:15:32
      • 2: article
      Hints
      • Use SELECT * only if you need all columns from table
      • ORDER BY RAND() is slow, try to avoid if you can. You can read this or this
      Backtrace
      • app/Http/Controllers/WebController.php:377
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • WebController.php#391aicare_prod_new13.49msupdate `posts` set `views_count` = 1133 where `id` = 3679
      Bindings
      • 0: 1133
      • 1: 3679
      Backtrace
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • ActivityLogger.php#174aicare_prod_new9.09msinsert into `activity_log` (`log_name`, `properties`, `batch_uuid`, `event`, `subject_id`, `subject_type`, `description`, `updated_at`, `created_at`) values ('default', '[]', null, 'updated', 3679, 'App\\Models\\Admin\\Post', 'updated', '2025-01-13 09:15:32', '2025-01-13 09:15:32')
      Bindings
      • 0: default
      • 1: []
      • 2: 
      • 3: updated
      • 4: 3679
      • 5: App\Models\Admin\Post
      • 6: updated
      • 7: 2025-01-13 09:15:32
      • 8: 2025-01-13 09:15:32
      Backtrace
      • vendor/spatie/laravel-activitylog/src/ActivityLogger.php:174
      • vendor/spatie/laravel-activitylog/src/Traits/LogsActivity.php:88
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
    • single-post-healthpedia.blade.php#37aicare_prod_new960μsselect * from `users` where `users`.`id` = 31 limit 1
      Bindings
      • 0: 31
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.single-post-healthpedia:37
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.12msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8508 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8508
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.01msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8851 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8851
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.9msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4811 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4811
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.83msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 9979 and `categories`.`deleted_at` is null
      Bindings
      • 0: 9979
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new11.11msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4111 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4111
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new15.63msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 7137 and `categories`.`deleted_at` is null
      Bindings
      • 0: 7137
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new11.24msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3751 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3751
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new13.75msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3080 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3080
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.33msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3145 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3145
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new10.22msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3581 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3581
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.55msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2142 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2142
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new6.54msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4469 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4469
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#122aicare_prod_new830μsselect * from `pages` where `slug` = 'about-us' limit 1
      Bindings
      • 0: about-us
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:122
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#547aicare_prod_new590μsselect * from `faqs` limit 1
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:547
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#551aicare_prod_new990μsselect * from `term_policies`
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      Backtrace
      • view::layouts.v2.web_layout:551
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    App\Models\Admin\Post
    136Post.php#?
    App\Models\Admin\Category
    25Category.php#?
    App\User
    4User.php#?
    App\Models\Admin\Tag
    3Tag.php#?
    App\Models\TermPolicy
    3TermPolicy.php#?
    App\Models\Admin\Page
    1Page.php#?
    App\Models\Admin\Faq
    1Faq.php#?
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        7pq12bYMqdEgaLj7Vh8FkOIij3YyAVHQqtV8OUb2
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        array:1 [ "url" => "https://ai-care.atmatech.id/healthpedia-penyakit/karsinoma-sel-skuamosa" ]
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        /healthpedia-penyakit/karsinoma-sel-skuamosa
        status_code
        200
        
        status_text
        OK
        format
        html
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        request_request
        []
        
        request_headers
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        request_cookies
        0 of 0
        array:2 [ "XSRF-TOKEN" => "7pq12bYMqdEgaLj7Vh8FkOIij3YyAVHQqtV8OUb2" "laravel_session" => "M343OjZvnso90kYIl0CTEO9fYymP1R5d3ZgSTgPz" ]
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