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KANKER PAYUDARAEpidemiologi Penyebab dan Faktor ResikoGejala dan TandaStadi mTindak !anj t
Rebecca N. Angka
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Penda" l an
• Profil Kesehatan Indonesia 2008 : – Urutan perta a !200"#200$% – 82$$ kasus !&'(8)*% – Insidens di Indonesia : +'(2 per &00.000
pr dengan angka ke atian : &8(' per
&00.000 pr. !20.0)2 kasus%. ,ata oleh-lobal urden of /ancer( 2008.
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• R /1 : – Penelitian terhadap +00 pasien bedah(
!& 8 #& 2% terban3ak : kanker pa3udara
lan4ut lokal !''*%. – & 8#2002 : 2$()*( tetapi stadiu I5
eningkat !"$("*%.
– U : KP66 7 )*
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10 KANKER TERBANYAK DIINDONESIA
Number ICD Location Relative Frequency
1.2.3.4.5.6.7.8.9.
10.
180174173147
183196154171193
CervixWomen's breast
SkinNasop ar!nx
"nkno#n$varies
%!mp oi& no&ese(t)m
So*t tiss)e+ !roi&
18,41 -11,57 -
8,24 -6,15 -5,16 -4,94 -4,91 -4,42 -3,50 -3,38 -
Source: Bulletin of Pathology Based Cancer Registry, BRK-IAP, No. 4, !"!.
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PERBANDINGAN INSIDENSKANKER DI INDONESIA
Padang Palembang Bandung Semarang Surabaya U. Pandang
1. reast Cervix Cervix Cervix Cervix reast2. So*t tiss)e Skin reast reast reast Skin3. "nkno#n reast Skin Skin %!mp no&es Cervix4. e(t)m "nkno#n Nasop ar!nx "nkno#n Skin "nkno#n5. $var! Nasop ar!nx %!mp no&es $var! Nasop ar!nx $var!6. Cervix / a(enta "nkno#n Nasop ar!nx $var! %!mp no&es7. Nasop ar!nx e(t)m e(t)m %!mp no&es So*t tiss)e + !roi&8. %!mp no&es $rop ar!nx $var! e(t)m + !roi& Nasop ar!nx
9. So*t tiss)e Co on So*t tiss)e + !roi& e(t)m So*t tiss)e10./rostate %!mp no&es + !roi& So*t tiss)e Co on e(t)m
Ra#li, $ICC !!%
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Anatomi
&Sa''y(s 'le)us * ly#'hatics under areolar co#'le)&+% of ly#'hatics flo to a)illa
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Payudara normal
reast profile
A ducts
B lobules
C dilated section of duct to hold milkD nipple
E fat
F pectoralis major muscle
G chest wall/rib ca e
nlarge ent
A normal duct cells
B basement membrane !duct wall"
C lumen !center of duct"
Illustration /ary K. Bryson
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Ductal Carcinoma in situ (DCIS)
0Illustration /ary K. Bryson
Ductalcancer cells
Normalductal cell
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Invasive Ductal Carcinoma (IDC –80% of breast cancer )
The cancer has spread to thesurrounding tissuesCarcinoma refers to anycancer that begins in theskin or other tissues thatcover internal organs 1Illustration /ary K. Bryson
Ductal cancercells breakingthrough thewall
Changes in genome o soma!i" "ells
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# l l u s
t r a
t i o n
$ % a r &
' (
B r & s o n
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#REAST $AN$ER %n&iden&e o' major "istologi& types
Percent of all Infiltrating /arcino as
$8*
*"* +* )* &*
,uctal 6obular 1edullar3 /olloid /o edo Papillar3
Adapted fro 1c,i9itt R et al( & '$.
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#REAST $AN$ER Age(spe&i'i& in&iden&e )per *++,+++-
UnitedUnitedtatestates
nglandngland
and alesand ales
Ital3Ital3
;rance;rance
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#REAST $AN$ER TN. stage gro ping
tage 0tage 0 >is.>is. N0N0 1010
tage Itage I >&>& N0N0 1010
tage IIAtage IIA >0( >&>0( >& N&N& 1010
>2>2 N0N0 1010tage IItage II >2>2 N&N& 1010
>+>+ N0N0 1010
tage IIIAtage IIIA >0( >&( >2>0( >&( >2 N2N2 1010
>+>+ N&( N2N&( N2 1010tage IIItage III An3 >An3 > N+N+ 1010
>">" An3 NAn3 N 1010
tage I5tage I5 An3 >An3 > An3 NAn3 N 1&1&
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#REAST $AN$ER S r/i/al by stage
Stage 0
Stage I
Stage IIA
Stage IIB
Stage IIIA
Stage IIIB
Stage IV
Percent surviving100
80
60
40
20
0
1 2 3 4 5 6
Years after diagnosis
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Pengar " gen dan lingk nganter"adap perkembangan kanker
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(source: Pharmaceutical Research,
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#REAST $AN$ER Risk 'a&tors
;e ale
?istor3 of breast cancer
;a il3 histor3 of breast cancer( especiall3 infirst#degree relati9es : &(8 @
enign breast cancerBC at3pical h3perplasia : ) @
arl3 enarche : &($#+(" @( late enopause : &() @
6ate first pregnanc3Cno pregnanc3 : &()#" @
@ogenous estrogens
Radiation
,iet( alcohol
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Adanya B !"#$A!Adanya B !"#$A!
Pene%a&an 'u&itPene%a&an 'u&it
!yeri!yeri
Ben(o&an diBen(o&an di
'etia' 'etia'
)airan *uting sui'su)airan *uting sui'su
Putting tertari' 'eda&a+Putting tertari' 'eda&a+
,u&it +era- atau &u'a,u&it +era- atau &u'a
$esung 'u&it$esung 'u&it
Gejala dan tanda Kanker Pay dara
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0akt terjadinya kanker
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Detection
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Ameri&an $an&er So&iety
• krining kanker pa3udara sediniungkin :
– Pr D 20 thn : sadari tiap bulan – Pr D 20#"0 thn : e eriksakan diri ke
dokter tiap + tahun
– Pr D "0 thn : e eriksakan diri ke doktertiap tahun
– Pr +)#"0 thn : base line a ografi – Pr D )0 thn : a ografi tiap tahun.
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!R"#S$ %#N%"R!reast inspection
S#in dim$ling
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!R"#S$ %#N%"R!reast palpation
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!R"#S$ %#N%"RRegional nodes assessment
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Waktu mamograf Sebaikn&a diker'akan pada :
)anita usia diatas *+ -0 tahunsebagai baseline)anita dengan .aktor risiko tinggi
/ 10 hari masa haid
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What ammo!rams Sho"
#"o of the most im$ortant mammo!ra$hicindicators of breat cancers
– asses– icrocalcifications : Tiny flecks of calcium – like
grains of salt – in the soft tissue of the breastthat can sometimes indicate an early cancer.
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Detection of ali!nant asses
Malignant masses have a more spiculated
appearance
14
mali nant
beni n
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ammo!ram – Difficult Case
1%
• Heterogeneously dense breast• Cancer can be difficult to
detect with this type ofbreast tissue
• The fibroglandular tissuewhite areas! may hide the
tumor• The breasts of younger
women contain more glandsand ligaments resulting indense breast tissue
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ammo!ram – asier Case
12
• "ith age# breast tissue
becomes fattier and hasfewer glands• Cancer is relatively easy
to detect in this type ofbreast tissue
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Biops
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!enanganan Kanker!a u"ara
Surger&
Radiotherap&
%hemotherap&
ormonal therap&
New therapies
Supporti3e care
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#REAST $AN$ER S$REEN%NG PAT1
;ine#needle aspirationbiops3
reast self#e@a ination
Palpableass
!not c3st%
,iagnostic i aging# a ogra# ultrasound# co pression agnification filNor al
Ph3sical e@a ination!3earl3%
creening a ogra!guidelines%
uspicious Eui9ocal
Eui9ocal or suspicious
Probabl3benign /3st
hort#terfolloF#up Aspiration
Nor al
G =
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#REAST $AN$ER D%AGN2S%S PAT1
9aluationfor
biops3
/3staspiration
;ine#needle aspirationbiops3
NeedlelocaliHation
Palpableass
,uctalcarcino a
in situ
In9asi9ecancer
6obular carcino a
in situenign
Insufficiente9aluation(
rebiops3
If persistent(short#terfolloF#up
Fith surgeon
/ontinuedappropriatescreening
/3st Nor al
Nonpalpableass
>reat ent Path
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#REAST $AN$ER T"erape ti& options
)ur er&)ur er&
*adiotherap&*adiotherap&
Chemotherap&Chemotherap&
ormonal therap&ormonal therap&
#mmunotherap&#mmunotherap&
0ew therapies0ew therapies
)upporti1e care)upporti1e care
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#REAST $AN$ER S rgi&al options %
6ocal e@cision6ocal e@cision
+ass
+ass
ide e@cisionide e@cision
...... Juadrantecto 3Juadrantecto 3
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#REAST $AN$ER S rgi&al options %%
1odified radical astecto 31odified radical astecto 3 Radical astecto 3 Radical astecto 3 IncisionIncision
@cised area@cised area
+ass+ass
nodes
nodes
@cised area@cised area
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TERI#A KASI$““ HEALTH IS NOTHEALTH IS NOTEVERYTHING, BUT ……………EVERYTHING, BUT ……………WITHOUT HEALTH,……..WITHOUT HEALTH,……..