252953510 Kanker Payudara Ppt

8/20/2019 252953510 Kanker Payudara Ppt

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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.

11


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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,……..

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252953510 Kanker Payudara Ppt