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Onkologi 2 (CA Mammae)
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Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
ONKOLOGI CARCINOMA MAMMAE
Ca mammae
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Payudara
Breasts - secondary sex characteristics – Physical characteristics besides genitals that distinguish
males from femalesIn physically mature women, breasts internally composed of fatty tissue and mammary (milk) glandsAreola – darker area of the external breastNipple – in center of areola
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Payudara
Kelenjar yang memproduksi susu– ditentukan ukuran jaringan lemak
payudara
daerah kehitaman areolaPutting (nipple) ditengah areola & berfungsi sbg saluran susu
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Payudara
Fig. 4.8 Cross-section front and side views of the female breast.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Payudara
Pemeriksaan – Pemeriksaan sendiri (self-exam) – Pemeriksaan rutin di RS– mammography
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Payudara
Breast lumps (bengkak)– cysts (fluid-filled sacs)– fibroadenomas (solid, round, benign tumors)– malignant tumor
Breast cancer– penanganan – Faktor risiko – Bedah rekonstruksi payudara– Keuntungan deteksi dini & penanganannya
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Payudara
Table 4.4 Risk Factors for Breast Cancer
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pemeriksaan sendiri
•Box on page 111:
HOW TO EXAMINE YOUR BREASTS
Pemeriksaan sendiriDeteksi apakah ada abnormalitas dari payudaraPemeriksaan bulanan, pada akhir menstruasiDilakukan di depan cermin
Melihat adanya
Perubahan kulitWarna kemerahanPembengkakan Puting yang kakuSimetris atau tidak
Angkat lengan ke atas
Payudara terlihat terangkatLihat adanya cekungan atau retraksi (tarikan)
Raba adanya benjolan
Angkat lenganRaba dengan lengan sebelahRasakan adanya kelereng dalam kantung beras “marble in a bag of rice”
Pergunakan bagian tengah jari
Ujung jari sangat sensitif (seluruh payudara terasa berbenjol)Telapak tangan juga sensitifBagian tengah jari adalah yang terbaik
Gerakkan tangan membentuk lingkaran kecil
Mulai dari satu kuadranTekan kemudian putar dg jari tanganRasakan penebalan ukuran seperti kelereng
Then move to another location
Dikerjakan seluruh kuadran payudara searah jarum jam dg menggunakan jari tanganMake sure the entire breast is felt.
The “Tail” of the Breast
Breast is not perfectly round.A “Tail” of breast tissue normally extends into the armpit.Make sure to feel for lumps in that portion of the breast.
Raba daerah ketiakGunakan putaran yg samaRasakan adanya benjolan payudara dan lymphonodiNormal lymphonodi tdk terabaPembesaran lymphonodi kira-kira seukuran penghapus pensil tetapi panjang dan tipis
Coba untuk menampilkan puting
Strip the ducts towards the nipple.Normal bila ada tetesan cairan berwarna susu atau hijauBukan darahShould not be bloody or in large quantity, squirting out or staining the inside of a bra.
Kemudian periksa sebelahnya
Lakukan urutan yang samaAngkat lengan melewati kepalaRasakan adanya benjolan atau massa
Periksakan ke spesialis tiap tahun
Dasar pemeriksaan payudaraTanya jawab
Mammograms
Usia 40-50 tahun: setiap tahun>50 tahun: berkalaLebih sering bila ada hal spesial seputar masalah payudara, misal riw.keluarga dg kanker payudara
If you find something in your breast...
Don’t panic. Most (90%) of breast lumps are benign.Do see a physician or other qualified health care provider right away.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
INCIDENCE
Fibroadenomas are the commonest benign tumors of teenage 10-15% have multiple & bilateral lumps Occur in the upper outer quadrantBlack women tend to develop fibroadenomas more frequently and at an earlier age than white women
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A new growth compose of both fibrous and glandular tissue. Lumps may be moveable, painless, firm, or rubbery, with well-defined bordersMost are smooth or slightly lobulated
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
PATHO-PHYSIOLOGY
Fibroadenomas are hormonally responsive - increases in size may occur during late phases of the menstrual cycleMay grow in size, especially during pregnancy Often get smaller after menopause (if not taking hormones)Unknown cause; possibly due to increased fat consumption
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
GROSS FEATURES
Grow as a spherical nodule which is usually well-circumscribed and freely movable (floating Mouse) Vary in size from less than 1 cm to giant forms 10 to 15 cm in diameterFeels like small, slipper marbles Mass more circumscribed and mobile than carcinoma
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Benign Conditions, continued
4. Tumors & cystsa. Fibroadenoma =
most common benign breast
tumor
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Tumors and Cysts, con’t…
b. Breast Cyst1. Benign2. May be aspirated
if large
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Benign conditions, continued …
c. Fibrocystic breast changes
1) 20%+ of premenopausal women 2) discomfort, cysts3) treatment rarely required 4) More likely to not detect a developing cancer
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Tumors & cysts, continued ….
d. Intraductal papilloma
- may produce “chocolate” or
bloody discharge from nipple
e. Lipoma: common
- fatty tumors
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
E. Carcinoma of the breast
1. Most common malignant tumor among women
2. 1/8 of women will develop breast cancera. 1/6 in Orange Countyb. 1/5 in San Francisco
3. Generally no discomfort
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Progression to Breast Cancer
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Carcinoma of breast, continued …
4. Physical signs:a. Slowly growing, painless massb. May demonstrate retracted nipplec. May be bleeding from nippled. May be distorted areola, or breast contoure. Skin dimpling in more advanced stages with retraction of
Cooper’s ligaments
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Physical signs, continued …
f. Attachment of mass
g. Edema of skin 1)with “orange skin” appearance
(peau d’orange) 2) due to blocked lymphatics
h. Enlarged axillary or deep cervical
lymph nodes
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Breast Cancer, con’t…
5. Common sites for metastasisa. Lungs & pleurab. Skeleton system (skull, vertebral column,
pelvis)c. Liver
6. Atypical carcinomasa. Inflammatory carcinoma (hormonal,
chemotherapy) b. Paget’s disease of the breast
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ultrasound
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Mammogram
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ultrasound
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Mammogram
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
ULTRASOUND
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
MRI
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