Download - Ca mammae.pptx
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Ca MammaeMelissa Trixiana
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Diktum Tambunan
“ Suatu tumor payudara
dianggap ganas sampai terbukti
tidak”
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Breast Cancer
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Faktor Risiko
1. Umur >30 tahun , Bertambah tinggi risikonya hingga umur 50 tahun dan setelah menopause
2. Tidak kawin (2-4x)
3. Anak pertama lahir setelah usia 35 tahun (2x)
4. Menarche <12 tahun (1,7-3,4x)
5. Menopause >55 tahun (2,5-5x)
6. Riwayat infeksi, trauma, operasi tumor jinak payudara (3-9x)
7. Kanker payudara kontralateral (3-9x)
8. Riwayat operasi ginekologis, tumor ovarium (3-4x)
9. Riwayat radiasi dinding dada (2-3x)
10. Riwayat keluarga menderita kanker payudara (2-3x)
• Ibu • Saudara perempuan
ibu• Saudara perempuan
kandung (adik/kakak)
11. Kontrasepsi oral (11x)
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Erect
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Inspection
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Peau d’orange
obstruksi system limfatik dermis/kulit oleh sel tumor
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Satellite Nodule
Infiltrasi sel tumor ke lapisan kutis
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Dimpling
Infiltrasi sel tumor ke ligamentum Cooper
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Retraksi Puting Susu
Infiltrasi sel tumor ke duktus laktiferus
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Hiperemis
Venula tersumbat, tapi arteri belum
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Ulserasi
Sumbatan arteri oleh sel tumor tidak ada suplai O2 iskemik jaringan nekrotik
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Supine1. Lokasi2. Ukuran3. Konsistensi
• Keras• Padat• kistik
4. Permukaan• Licin• Kasar• Berlobus-lobus
5. Bentuk dan batas tumor• Tegas• Tidak tegas• Sebagian tidak tegas
6. Jumlah7. Mobilitas
• Kulit• Dinding dada
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Biopsy
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Mammography
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Mammography
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Mammography
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Mammography
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Ultrasound
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Mammography + Ultrasound
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Mammography + Ultrasound
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Lung Metastases
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Bone Metastases
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Liver Metastases
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Staging
• Tujuan: Pilihan modalitas terapiPrognosis, 5 years survival rate
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Stadium T N M Persentase Harapan Hidup 5 tahun
0
I
IIA
IIB
IIIA
TiS
T1
T0T1T2
T2T3
T0T1T2T3T3
N0
N0
N1N1N0
N1N0
N2N2N2N1N2
M0
M0
M0M0M0
M0M0
M0M0M0M0M0
100%
100%
92%
81%
67%
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Stadium T N M Persentase Harapan Hidup 5 tahun
IIIB T4T4T4
N0N1N2
M0M0M0
54%
IIIC T apapun N3 M0 ?
IV T apapun N apapun M1 20%
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Therapy
• Therapy modalities:• Mastectomy• Chemotherapy• Radiotherapy• Hormonal therapy• Targeting therapy
• Aim:• Curative• Palliative
• Type:• Adjuvant• Neoadjuvant
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Mastectomy
• Classic radical mastectomy: mengangkat seluruh tumor dengan jaringan payudara, nipple areolar complex, serta kulit diatas massa tumor hingga 2 cm disekelilingnya beserta pectoralis mayor dan pectoralis minor. Dilanjutkan diseksi KGB level I, II, III. Indikasi biasanya untuk T4a
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Mastectomy
• Modified radical mastectomy: mengangkat seluruh tumor dengan jaringan payudara, nipple areolar complex, serta kulit diatas massa tumor hingga 2 cm disekelilingnya beserta fascia pectoralis. Dilanjutkan diseksi KGB level I, II • Patey: pectoralis minor diangkat,
pectoralis mayor dipertahankan• Auchincloss and Madden: pectoralis
mayor dan pectoralis minor dipertahankan
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Mastectomy
• Supra radical mastectomy: seperti CRM plus diseksi KGB supraklavikula dan KGB mammaria interna
• Simple mastectomy: mengangkat seluruh tumor dengan jaringan payudara, nipple areolar complex, serta kulit diatas massa tumor hingga 2 cm disekelilingnya beserta beserta fascia pectoralis.
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Skin Incision
Stewart Willy Meier
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Mastectomy
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Thank You