Download - Breast Cancer Fk Rab
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May 18, 2016 Ca-Mamma 1
KANKERKANKER
PAYUDARA PAYUDARA
Dr Ramzi Asrial SpBDr Ramzi Asrial SpB
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PENDAHULUANPENDAHULUAN
Payudara : tempat terserinPayudara : tempat terserin
ter!adi "an"er pd #anitater!adi "an"er pd #anitaCa mamma : urutan "e-2 penye$a$Ca mamma : urutan "e-2 penye$a$
"ematian pada #anita "ematian pada #anita
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May 18, 2016 Ca-Mamma %
FAKTOR RESIKOFAKTOR RESIKO
FAKTOR RESIKOFAKTOR RESIKO KELOMPOK BERESIKO TINGGIKELOMPOK BERESIKO TINGGI
UsiaUsia ElderlyElderly
Lokasi geografisLokasi geografis Negara a!"Negara a!"
Usia #ada $ak%" e&ar'(eUsia #ada $ak%" e&ar'(e Se)el" "sia ** %a("&Se)el" "sia ** %a("&
Usia #ada $ak%" e&o#a"seUsia #ada $ak%" e&o#a"se Ses"da( "sia +, %a("&Ses"da( "sia +, %a("&
Usia #ada ke(aila& a%er IUsia #ada ke(aila& a%er I A&ak I la(ir di a$al "sia ,-.a&A&ak I la(ir di a$al "sia ,-.a&
Ri$aya% kel"argaRi$aya% kel"arga KPD #ada rea!a/ sa"dara ge&erasi IKPD #ada rea!a/ sa"dara ge&erasi I
Pe&yaki% !i&ak se)el"&yaPe&yaki% !i&ak se)el"&ya 0i#er#lasia a%i#ikal0i#er#lasia a%i#ikal
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May 18, 2016 Ca-Mamma &
FAKTOR RESIKOFAKTOR RESIKO
FAKTOR RESIKOFAKTOR RESIKO KELOMPOK BERESIKO TINGGIKELOMPOK BERESIKO TINGGI
'an"er pada payudara yan (ain'an"er pada payudara yan (ain ) * +) * +
DietDiet nta"e (ema" saturasi yan tininta"e (ema" saturasi yan tini
premen.pause premen.pause M / % M / %
p.stmen.pause p.stmen.pause M / % M / %
'.nsumsi a("..('.nsumsi a("..( nta"e yan $er(e$iannta"e yan $er(e$ian
Paparan radiasiPaparan radiasi 3erpapar di atas usia 10 taun3erpapar di atas usia 10 taun
H.rm.n E"s.en:H.rm.n E"s.en: '.ntrasepsi .ra('.ntrasepsi .ra(
Dieti(sti($estr.(Dieti(sti($estr.(
D.sis tini dan !an"a #a"tu (amaD.sis tini dan !an"a #a"tu (ama
4e(ama "eami(an4e(ama "eami(an
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TANDA.TANDA KLINISTANDA.TANDA KLINIS
Lokalisasi di #ay"dara1Lokalisasi di #ay"dara1
"#adran (atera( atas )&+"#adran (atera( atas )&+
area se"itar are.(ar mamma )2+area se"itar are.(ar mamma )2+ "#adran media( atas )1+"#adran media( atas )1+
"#adran (atera( $a#a )10+"#adran (atera( $a#a )10+
"#adran media( $a#a )+"#adran media( $a#a )+
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May 18, 2016 Ca-Mamma 6
Gejala klinisGejala klinis
KELU0ANKELU0AN en!.(an tanpa nyeri ) 50 +en!.(an tanpa nyeri ) 50 + payudara payudara
a"si(aa"si(a
U"uran 7 $entu" payudaraU"uran 7 $entu" payudara $eru$a $eru$a Penerutan "u(it payudaraPenerutan "u(it payudara
etra"si putinetra"si putin
Discharge Discharge )*+)*+ Nyeri punun9tu(an, !aundie, Nyeri punun9tu(an, !aundie, ↓↓
!aran !aran
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TANDA.TANDA KLINISTANDA.TANDA KLINIS
Adanya $en!.(anAdanya $en!.(an 'eras'eras
rreu(er rreu(er
N.du( ;."a( N.du( ;."a( AsimetrisAsimetris
Immobile Immobile
Perubahan kontur payudara Perubahan kontur payudaraSkin tethering Skin tethering etra"si putinetra"si putin
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Di(atasi
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May 18, 2016 Ca-Mamma =
Pemeriksaan Fisik Pemeriksaan Fisik 3e"ni" Pemeri"saan :3e"ni" Pemeri"saan :
Penderita diperi"sa denan $adan $aian atas ter$u"aPenderita diperi"sa denan $adan $aian atas ter$u"a P.sisi 3ea" )dudu"+P.sisi 3ea" )dudu"+
>s dudu" d tanan $e$as "e sampin, pemeri"sa>s dudu" d tanan $e$as "e sampin, pemeri"sa $erdiri di depan d(m p.sisi sama tini? Pd $erdiri di depan d(m p.sisi sama tini? Pdinspe"si di(iat:inspe"si di(iat:
4imetris, (eta", $t" payudara "a9"i
'e(ainan putin, retra"si puttin *9-
'e(ainan "u(it 3anda2 radan
Peau [email protected], dimp(in 7 u(serasi
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P.sisi er$arinP.sisi er$arin
>s $er$arin, an!a( punun d>s $er$arin, an!a( punun d
$anta( $anta(
payudara terse$ar rata atas dada payudara terse$ar rata atas dadaLa"u"an pa(pasi, d ;a(an dista( 7La"u"an pa(pasi, d ;a(an dista( 7
media( !ari , , sr sistematis:media( !ari , , sr sistematis:
Dr rania( setini ia Dr rania( setini ia dista(dista(setini ia setini ia
4entri;ua( )dr tepi4entri;ua( )dr tepi sentra(+sentra(+
Pa(pasi area sentra( su$are.(ar 7Pa(pasi area sentra( su$are.(ar 7 papi( papi( airan "e(uar *9-airan "e(uar *9-
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Peni(aian pd pa(pasiPeni(aian pd pa(pasi
Menetap"an "eadaan tum.r Menetap"an "eadaan tum.r a?a? L."asi tum.r mnrt "#adran di payudara, tdd:L."asi tum.r mnrt "#adran di payudara, tdd:
'#adran (atera( atas'#adran (atera( atas
'#adran (atera( $a#a'#adran (atera( $a#a '#adran media( atas'#adran media( atas
'#adran media( $a#a'#adran media( $a#a
4atu daera sentra(4atu daera sentra(
$? $? U"uran tum.r, $atas2 tum.r teas *9-U"uran tum.r, $atas2 tum.r teas *9-
?? M.$i(itasnya td "u(it 7 m?pe"t.ra(is )dindinM.$i(itasnya td "u(it 7 m?pe"t.ra(is )dindin
dada+dada+
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MMemeri"sa 'B ei.na(emeri"sa 'B ei.na(a?a? AA"si(a"si(a
Harus d(m p.sisi dudu" s ;.ssa a"si(a !atuHarus d(m p.sisi dudu" s ;.ssa a"si(a !atu"e $#? Caranya :pd p a"si(a "anan, tanan "anan .s"e $#? Caranya :pd p a"si(a "anan, tanan "anan .s
di(eta""an (emas di $au pemeri"sa 7 tanan "iridi(eta""an (emas di $au pemeri"sa 7 tanan "iri
pemeri"sa pemeri"sa memeri"sa a"si(a?memeri"sa a"si(a?
an dira$a:an dira$a: Mammaria e"sterna : di$a? anteri.r 7 $# tepi
m?pe"t.ra(is a"si(a
4u$s"apu(aris di p.st?a"si(a
4entra( a"si(a Api"a( ;.ssa a"si(a
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May 18, 2016 Ca-Mamma 1%
$? 4upra9in;ra"(a
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Klasifikasi TNM Ka&ker Pay"daraKlasifikasi TNM Ka&ker Pay"dara
2A344 5 6--672A344 5 6--67
33 3um.r primer tida" dapat ditentu"an3um.r primer tida" dapat ditentu"an
3030 3ida" ter$u"ti adanya tum.r primer 3ida" ter$u"ti adanya tum.r primer
3is3is 'arsin.ma insitu,intradu"ta(, insitu (.$u(ar, atau'arsin.ma insitu,intradu"ta(, insitu (.$u(ar, atau
penya"it Paet dr puttin tanpa tera$a tum.r penya"it Paet dr puttin tanpa tera$a tum.r
3131 U"uran tum.r 2 mU"uran tum.r 2 m
31mi : mi"r.in
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May 18, 2016 Ca-Mamma 1
3232 U"uran tum.r 2 F mU"uran tum.r 2 F m
3%3% U"uran tum.r / mU"uran tum.r / m
3&3& 3um.r d sem$aran u"uran d penye$aran (ansun3um.r d sem$aran u"uran d penye$aran (ansun
"e )a+ dindin dada atau )$+ "u(it? 4pt y diam$ar"an"e )a+ dindin dada atau )$+ "u(it? 4pt y diam$ar"an
di$# inidi$# ini 3&a : me(e"at pd dindin dada, td" tms" m?pe"t.ra(is3&a : me(e"at pd dindin dada, td" tms" m?pe"t.ra(is
3&$ : edem,3&$ : edem, peau d’orange peau d’orange, u(serasi "u(it, n.du(, u(serasi "u(it, n.du(
sate(it pd daera payudara y samasate(it pd daera payudara y sama
3& : 3&a 7 3&$3& : 3&a 7 3&$
3&d : "arsin.ma in;(amat.ir )mastitis "arsin.mat.sis+3&d : "arsin.ma in;(amat.ir )mastitis "arsin.mat.sis+
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May 18, 2016 Ca-Mamma 16
Nod"s life regio&alNod"s life regio&al
N N Pem$esaran 'B rei.na( td" dpt ditentu"anPem$esaran 'B rei.na( td" dpt ditentu"an
)mis:te(a dian"at+)mis:te(a dian"at+
N0 N0 3d" tera$a metastase 'B3d" tera$a metastase 'B
N1 N1 3era$a pem$esaran "e(?(im;e a"si(a ipsi(atera( y3era$a pem$esaran "e(?(im;e a"si(a ipsi(atera( y
td" me(e"attd" me(e"at
N2 N2 Metastase "e "e(?(im;e a"si(a ipsi(at? y me(e"atMetastase "e "e(?(im;e a"si(a ipsi(at? y me(e"at
satu sama (ain atau me(e"at pd !arinan se"itarnya,satu sama (ain atau me(e"at pd !arinan se"itarnya,
atau pd penampa"an "(inis di!umpai n.dusatau pd penampa"an "(inis di!umpai n.dus
mammaria interna ipsi(at? tanpa adanya $u"ti srmammaria interna ipsi(at? tanpa adanya $u"ti sr
"(inis metastasis "e "e(?(im;e a"si(a"(inis metastasis "e "e(?(im;e a"si(a
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N2 N2 N2a: metastase "e "e(en!ar (im;e a"si(a yan N2a: metastase "e "e(en!ar (im;e a"si(a yan
me(e"at satu sama (ain atau "e !arinan se"itarnya?me(e"at satu sama (ain atau "e !arinan se"itarnya?
N2$: metastase anya pada penampa"an "(inis N2$: metastase anya pada penampa"an "(inis
n.dus "e(en!ar (im;e yan ipsi(atera(, tanpa adanyan.dus "e(en!ar (im;e yan ipsi(atera(, tanpa adanya $u"ti "(inis metastase "e "e(en!ar (im;e a"si(a $u"ti "(inis metastase "e "e(en!ar (im;e a"si(a
N% N% Metastase pada "e(en!ar (im;e in;ra"(a
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N8N8 N8a1 e%as%ase ke kele&ar life i&fra kla9ik"laN8a1 e%as%ase ke kele&ar life i&fra kla9ik"la
i#sila%erali#sila%eral
N8)1 e%as%ase ke kele&!ar life aariaN8)1 e%as%ase ke kele&!ar life aariai&%er&a da& aksila i#sila%erali&%er&a da& aksila i#sila%eral
N8'1 e%as%ase ke kele&!ar life s"#rakla9ik"laN8'1 e%as%ase ke kele&!ar life s"#rakla9ik"la
i#sila%erali#sila%eral
Me%as%ase 3a"( 2M7Me%as%ase 3a"( 2M7
M:M: Me%as%ase !a"( %idak da#a% di%e&%"ka&Me%as%ase !a"( %idak da#a% di%e&%"ka&
M-M- Tidak ada e%as%ase !a"(Tidak ada e%as%ase !a"(
M*M* Me%as%ase !a"(Me%as%ase !a"(
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STADIUMSTADIUM
S%adi" -S%adi" - TisTis N-N- M-M-
S%adi" IS%adi" I T*T* N-N- M-M-
S%adi" II AS%adi" II A T-T-
T*T*
T6T6
N*N*
N*N*
N-N-
M-M-
M-M-
M-M-
S%adi" II BS%adi" II B T6T6T8T8
N*N*N-N-
M-M-M-M-
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STADIUMSTADIUM
S%adi" III AS%adi" III A T-T-T*T*
T6T6
T8T8T8T8
N6N6N6N6
N6N6
N*N*N6N6
M-M-M-M-
M-M-
M-M-M-M-
S%adi" III BS%adi" III B T,T,
T,T,T,T,
N-N-
N*N*N6N6
M-M-
M-M-M-M-
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STADIUMSTADIUM
S%adi" III 4S%adi" III 4 Se)ara&g TSe)ara&g T N8N8 M-M-
S%adi" I;S%adi" I; Se)ara&g TSe)ara&g T Se)ara&g NSe)ara&g N M*M*
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PENATALAKSANAANPENATALAKSANAAN
KPD DINIKPD DINI KPDKPD
LAN3UTLAN3UT
OPERABLEOPERABLE NON . OPERABLENON . OPERABLE
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May 18, 2016 Ca-Mamma 2%
STADIUM DINISTADIUM DINI
SISI Radikal as%ek%oiRadikal as%ek%oi KGB 2.7KGB 2.7 Follo$ U#Follo$ U#Modified radikalModified radikal
SIISII as%ek%oias%ek%oi KGB 2
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May 18, 2016 Ca-Mamma 2&
STADIUM LAN3UTSTADIUM LAN3UT Resid" 2.7Resid" 2.7 T"&gg" rela#s 1 0oro&al keo T(= T"&gg" rela#s 1 0oro&al keo T(=
S IIIBS IIIB
RadiasiRadiasi
0oro&al 1*? Pree&o#a"se0oro&al 1*? Pree&o#a"se )ila%eral oo#(ore'%oy)ila%eral oo#(ore'%oy
6? * 5 + %(6? * 5 + %( #eriksa efek es%roge& 1#eriksa efek es%roge& 1
. 2.@ gg
Resid" 2 sikl"s
8? Pos%e&o#a"se1 (oro&al i&(i)i%if=adi%if 8? Pos%e&o#a"se1 (oro&al i&(i)i%if=adi%if
O#erasiO#erasi
S I;?S I;?
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STADIUM LAN3UTSTADIUM LAN3UT
2*7 Pree&o#a"se 12*7 Pree&o#a"se 1
Res#o& 2
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Paet@s disease pada payudara
Ditemu"an .(e se.ran a(i $eda dari inrisDitemu"an .(e se.ran a(i $eda dari inris
sir !ames paets 185sir !ames paets 185
Merupa"an suatu am$aran "e(ainan padaMerupa"an suatu am$aran "e(ainan pada
putin payudara seperti u("us atau per(u"aan putin payudara seperti u("us atau per(u"aan
"u(it dise"itar putin?"u(it dise"itar putin? 4erin !ua di se$ut paets disease .; te nip(e?4erin !ua di se$ut paets disease .; te nip(e?
Du(u dianap $u"an ma(inansiDu(u dianap $u"an ma(inansi
4aat ini di ya"ini se$aai tanda-tanda yan4aat ini di ya"ini se$aai tanda-tanda yana"an men!adi "an"er payudaraa"an men!adi "an"er payudara
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4in and sympt.m
'u(it pada putin ter$e(a atau mere"a'u(it pada putin ter$e(a atau mere"a
'e(uar airan mera !am$u atau dara dari'e(uar airan mera !am$u atau dara dari
payudara payudara Putin sa(a satu payudara tertari" atau rataPutin sa(a satu payudara tertari" atau rata
asa nyeri pada putinasa nyeri pada putin
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dian.sa
Mamm.ra;iMamm.ra;i
i.psii.psi
it.pat.(.iyit.pat.(.iy
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terapy
4urya(4urya(
4eperti (umpet.my , Guadrantet.my atau4eperti (umpet.my , Guadrantet.my atau
mastet.mymastet.my Cem.terapyCem.terapy
adiasiadiasi
H.rm.na( terapyH.rm.na( terapy
imun.terapyimun.terapy
May 18, 2016 Ca-Mamma 2=
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eema
May 18, 2016 Ca-Mamma %0
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U(us dan (u"a pada nip(e
May 18, 2016 Ca-Mamma %1
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3ertari" atau retra"si
May 18, 2016 Ca-Mamma %2
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May 18 2016 Ca-Mamma %%