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KANKER SERVIKS KANKER SERVIKS SKRINING, DIAGNOSA SKRINING, DIAGNOSA DAN PENATALAKSANAAN DAN PENATALAKSANAAN

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detiksi dini kanker serviks

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  • KANKER SERVIKS

    SKRINING, DIAGNOSA DAN PENATALAKSANAAN

  • Apa itu Kanker Serviks ?Kanker Leher Rahim :Adalah kanker yang terjadi pada leher rahim (serviks)Apa itu serviks ?Serviks adalah daerah yang menghubungkan rahim (uterus) dan vagina.

    1The Adam Health Illustrated Encyclopedia, A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission

  • Organ Genitalia PerempuanLeher rahim

  • 490,000 perempuan didiagnosa* menderita kanker serviks240,000 di antaranya MENINGGAL Seberapa sering Kanker Serviks ?Menurut WHO TIAP TAHUN, DI SELURUH DUNIA:*80% terjadi di negara berkembang

  • Bagaimana Terjadinya Kanker Serviks?Kanker serviks dapat berkembang ketika sel yang abnormal dalam serviks mulai membelah diri tanpa terkendaliSel yang abnormal pada serviks dapat berkumpul menjadi tumorTUMORGanas berbahaya , dapat menjadi kanker akan menyebar ke daerah lainJinak tidak berbahaya tetap pada daerah sumbernya, tidak menyebar

  • Cervical Cancer

  • Serviks Normal (Leher Rahim)

  • Lesi Pra Kanker

  • Apa penyebab Kanker Serviks?120 Tipe HPV telah diketahui30-40 Tipe HPV menyerang anogenital

    Low risk type ( HPV 6 & 11 )(tidak menyebabkan kanker)Menyebakan anogenital wartsHigh risk type ( HPV 16 & 18)Menyebabkan kanker serviksInfeksi dengan HPV seringkali TIDAK menimbulkan gejala Banyak orang TIDAK tidak tahu mereka terinfeksi HPVBanyak orang dapat menularkan HPV TANPA menyadarinyaAnogenital : area kelamin (termasuk kulit penis, mulut vagina & anus)KANKER SERVIKS DISEBABKAN OLEH HUMAN PAPILLOMIVARUSa,1,2

  • Cara Penularan

  • Pap Smears sebagai Deteksi DiniPap Smear : pengambilan sel dari serviks, diperiksa dengan mikroskop untuk mengetahui adanya kelainan pada serviksJIKA ANDA SUDAH MENIKAH / MELAKUKAN HUBUNGAN, LAKUKAN PAP SMEAR SECARA TERATUR

  • Skrining Kanker Serviks Pap SmearsRegular Pap smears untuk setiap wanita seksual aktif berapapun usianya. Batas umur ????

  • Penting untuk di-INGATKanker serviks adalah kanker yang banyak menyebabkan kematian pada wanita Kanker serviks dapat dicegah dengan cara :Deteksi sedini mungkin dengan PAP SMEAREdukasi mengenai kanker serviksVaksinasi HPV VAKSIN

    KONSULTASIKAN KEPADA DOKTER ANDA TENTANG KANKER SERVIKS & CARA PENCEGAHANNYA

  • Vaksin HPV diberikan kepada siapa ?????Pria usia 9 15 tahunPria usia diatas 15 tahun (On Going Study)Wanita usia 9 26 tahunWanita usia diatas 26 tahun ????

  • Bagaimana mendiagnosisnya ?

    Pap smear : Pengambilan sel sel serviks dengan spatula atau sitobrush, kemudian dioleskan di objek glas. Setelah itu diperiksa dengan mikroskop. Pemekrisaan Panggul : Vagina dan organ sekitar diperiksa secara visual dan bimanual (menggunakan dua tangan). Kemudian organ organ di raba dengan jari / tangan , dengan memakai sarung tangan dimasukkan ke dalam vagina dan tangan lain meraba perut.

  • Hasil temuan Pap Smir Slide di sebelah kiri menunjukkan sel-sel serviks yang normal diperbesar melalui mikroskop . Sel-sel normal yang seragam dalam ukuran dan bentuk .

    slide di sebelah kanan menunjukkan tidak teratur , sel-sel serviks cacat - khas kanker serviks

  • Source: EngenderHealth, Wright TC, 1996IVA images

  • http://www.brooksidepress.org/milddysp1.jpghttp://www.ykhoa.net/2.2.jpgIVAVILIMetoda melihat kelainan pada leher rahim dengan mengaplikasikanasam asetat atau lugol

  • Faktor Risiko Hubungan seksual pertama pada usia muda (sebelum usia 18) Pasien atau seksual partner mempunyai penyakit kondiloma genitalia (kutil). Tidak menggunakan kondom pada hubungan seksual dengan partner baru. Pasangan yang lalu dari partner seks menderita kanker serviks atau sel2 abnormal. Sexual partner menderita kanker penis.

  • Penyakit HPV LainnyaKutil kelamin (genital warts)

    Sering kambuh

    Beban psikologis bagi penderitanya

    Tingkat kesembuhan bervariasi.4

  • Perdarahan per vaginam abnormal (e.g., spotting setelah hubungan seksual, perdarahan diantara periode menstruasi, jumlah darah menstruasi banyak). Abnormal (kuning putih, berbau) cairan vaginal, Low back pain Nyeri Cervical, noted ketika tampon , jari atau penis dimasukkan ke dalam vagina . Nyeri saat berhubungan seksual. Nyeri saat BAK pada keadaan yang lanjut. Manifestasi Klinik

  • Manifestasi KlinikJika kanker sudah metastasis :

    Sulit BAK dan mungkin gagal ginjal.Nyeri BAK dan kadang2 kencing darah . Bengkak di kaki . Diarrhea, atau nyeri di daerah anus atau BAB berdarah Mual, lemas, BB turun, nafsu makan turun, dan terasa nyeri. KonstipasiLubang Abnormal di leher rahim (fistula)pembesaran kelenjar limphe di leher atau ketiak. Penyebaran lanjut ke tulang , paru m usus atau otak memberikan tanda tanda abnormal.

  • Kanker Serviks

  • Stadium Kanker serviks

    Stage I tumors: sel sel kanker hanya terdapat dan terbatas pada leher rahim.

    Stage II tumors: sel tumor sudah menyebar di luar bagian dari leher rahim, sepert bagian atas dari vagina atau jaringan di sekitar leher rahim.

    Stage III tumors: tumor sudah menyebar di organ sekitar seperti bagian bawah dinding vagina, kelenjar getah bening terdekat atau jaringan lemak di sekitar leher rahim sampai mencapai dinding pelvis .

    Stage IV tumors: tumor menyebar ke organ organ di sekitar organ genitalia ( yaitu kandung kemih atau usus) atau ke organ organ di luar rongga pelvis . Meliputi penyebaran ke paru, hati atau tulang.

  • Stadium Klinis Kanker Leher Rahim

  • Pengobatan Kanker Serviks Surgery Radiation Therapy External Radiation Chemotherapy

  • Systemic Therapy and Radiation

    CisplatinBrachytherapyPelvic Radioterapi

  • SEKIAN &TERIMA KASIH

    *www.maketheconnection.orgGCF (Gynecologic Cancer Foundation) Presentation

    **www.maketheconnection.orgwww.cancer.org*1. Wright TC Jr, Cox JT, Massad LS, et al, for the ASCCP-Sponsored Consensus Congress. JAMA. 2002;287:21202129. 2. Bonnez W. In: Richman DD, Whitley RJ, Hayden FJ, eds. Washington, DC: American Society for Microbiology Press; 2002:557596. 3. Canadian Cancer Society. Cervical Cancer: What you need to know. Available at: http://www.cancer.ca/vgn/images/portal/cit_86751114/63/40/151140772cw_library_wyntk_cervical_en.pdf. Accessed March 13, 2006. 4. Reprinted with permission from Sellors JW, Sankaranarayanan R, eds. Colposcopy and Treatment of Cervical Intraepithelial Neoplasia. A Beginners Manual. Lyon, France: International Agency for Research on Cancer; 2003.

    1/Sellors/Ch. 7/p. 1/ 1; p. 6/ 3, Figure 7.12.1/Sellors/Ch. 7/p. 1/ 1; p. 6/3,4; p. 8/ Figure 7.20; p.9/Figure 7.23.2/Bonnez/p. 576/Figure 12; p. 578/col 1/21/Wright/p.2120/abstract conclusions3/CCS/p 6/24/Sellors/Ch. 7/p.9/Figure 7.23.1/Sellors/Ch. 4/p. 1/ 1; p.5/ 2*www.maketheconnection.orgwww.cdc.gov/std/HPV/STDFcat-HPV.htm*1. Hewitt M, Devesa SS, Breen N. Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey. Prev Med. 2004;39:270-278.2. Crum CP, Rivera MN. Vaccines for cervical cancer. Cancer J. 2003;9:368376.3. Sung HY, Kearney KA, Miller M, Kinney W, Sawaya GF, Hiatt RA. Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan. Cancer. 2000;88:22832289.4. Schink JC. Strategies for detecting cervical dysplasia: Visual inspection, spectroscopy, and speculoscopy. OBG Manag. 2003;(suppl):58.5. Selvaggi SM. Implications of low diagnostic reproducibility of cervical cytologic and histologic diagnoses. JAMA. 2001;285:15061508.6. Chacho MS, Mattie ME, Schwartz PE. Cytohistologic correlation rates between conventional Papanicolaou smears and ThinPrep cervical cytology: A comparison. Cancer. 2003;99:135140.7. Saslow D, Runowicz CD, Solomon D, et al. American Cancer Society Guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin. 2002;52:342362.8. Uyar DS, Eltabbakh GH, Mount SL. Positive predictive value of liquid-based and conventional cervical Papanicolaou smears reported as malignant. Gynecol Oncol. 2003;89:227232.9. Kulasingam SL, Hughes JP, Kiviat NB, et al. Evaluation of human papillomIVArus testing in primary screening for cervical abnormalities: Comparison of sensitivity, specificity, and frequency of referral. JAMA. 2002;288:17491757.5/Selvaggi/ p. 1506/col 1/34/Schink/ p. 5/ col 2/1.5/Selvaggi/ p. 1506/col 1/1, 3.6/Chacho/ p. 137/col 2/58/Uyar/p. 227/abstract7/Saslow/p. 352/col 2/2.8/Uyar/ p. 227/abstract5/Selvaggi/ p. 1506/col 2/1.9/Kulasingam / p.1754/Table 3; p. 1749/abstract3/Sung/p. 2285/col 2/3, 42/Crum/p. 368/col 1/2; col 2/11/Hewitt/p. 270/ col 1/11/Parham/p. S14/Table 1.2/Schink/p. 5/ col 2/2.3/Uyar/p. 227/abstract.4/Kulasingam/p. 1754/Table 3.2/Schink/p. 5/col 2/1.5/Selvaggi/ p. 1506/col 1/1, 3.6/Chacho/p. 137/col 2/5*American Cancer Detailed Guide. American Cancer Society Online Publication. http://www.cancer.org*The picture on your left is the magnified image of a normal cervix after the application of Acetic acid.

    The picture to your right is the magnified image of a cervix with an abnormal Aceto white lesion- ie a Positive tests. *References1. Wiley DJ, Douglas J, Beutner K, et al. External genital warts: Diagnosis, treatment, and prevention. Clin Infect Dis. 2002;35(suppl 2):S210S224.2. Maw RD, Reitano M, Roy M. An international survey of patients with genital warts: Perceptions regarding treatment and impact on lifestyle. Int J STD AIDS. 1998;9:571578.3. Soper DE. Genitourinary infections and sexually transmitted diseases. In: Berek JS, ed. Novaks Gynecology. 13th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2002:453470. 4. Kodner CM, Nasraty S. Management of genital warts. Am Fam Physician. 2004;70:23352342, 23452346. 1/Soper/p. 465/43/Maw/p. 574/col 2/5; p. 574/Table 4; p. 575/ Table 52/Wiley/p. S211/col 2/14/Kodner/p. 2339/Table 33/Soper/p. 465/42/Maw/p. 574/col 2/5; p. 574/Table 4; p. 575/Table 5; p. 571/ abstract /31/Wiley/p. S211/col 2/14/Kodner/p. 2339/Table 34/Kodner/p. 2336/col 2/4,5; p. 2337/col 1/ 2/col 2/2; p. 2338/col 1/2,3/col 2/2,3 4/Kodner/p.2339/Table 3*1. Reprinted with permission from Sellors JW, Sankaranarayanan R, eds. Colposcopy and Treatment of Cervical Intraepithelial Neoplasia. A Beginners Manual. Lyon, France: International Agency for Research on Cancer; 2003.

    1/Sellors/Ch. 8/p. 4/ Figures 3.5 and 8.81/Sellors/Ch. 8/p. 2/ 5,6. Photos courtesy of Dr. J. Monsonego.*Stage I is carcinoma strictly confined to the cervix; extension to the uterine corpus should be disregarded. Stage IA: Invasive cancer identified only microscopically. All gross lesions even with superficial invasion are stage Ib cancers. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm* and no wider than 7 mm.[Note: *The depth of invasion should not be more than 5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. Vascular space involvement, either venous or lymphatic, should not alter the staging.]Stage IA1: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter. Stage IA2: Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter. Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than stage IA.Stage IB1: Clinical lesions no greater than 4 cm in size. Stage IB2: Clinical lesions greater than 4 cm in size.Stage II is carcinoma that extends beyond the cervix but has not extended onto the pelvic wall. The carcinoma involves the vagina, but not as far as the lower third. Stage IIA: No obvious parametrial involvement. Involvement of up to the upper two thirds of the vagina.Stage IIB: Obvious parametrial involvement, but not onto the pelvic sidewall. Stage III is carcinoma that has extended onto the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumor and the pelvic sidewall. The tumor involves the lower third of the vagina. All cases with a hydronephrosis or nonfunctioning kidney should be included, unless they are known to be due to other causes. Stage IIIA: No extension onto the pelvic sidewall but involvement of the lower third of the vagina. Stage IIIB: Extension onto the pelvic sidewall or hydronephrosis or nonfunctioning kidney.Stage IV is carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum. Stage IVA: Spread of the tumor onto adjacent pelvic organs. Stage IVB: Spread to distant organs.