Clinical Aspect of Cervical Cancer

Dr. I Putu Fery Immanuel W, SpOG

DEPARTMENT OF OBSTETRICS & GYNECOLOGY

MEDICAL FACULTY UNIVERSITAS TADULAKO – TADULAKO EDUCATIONAL HOSPITAL
2019
 Uncontrol
INTRODUCTION Cell
Proliferation

Invation &
Metastases

Malignancy

• American Cancer Society 2012:

12.170 new cases, & 4.220
deaths/year
• Indonesia: ± 40.000 new cases/year,
50% death rate
Definition Primary malignant
tumor of
Cancer on uterine
scuamocolumnar
cervix
junction
metaplasia

Cervical
Cancer

Etiology
• HPV Infection on 99,7% kanker Cervical Cancer

Order Type of HPV

High Risk 16,18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59
Possible High Risk 26, 53, 66, 68, 73, 82
Low Risk 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81
 HPV Infection

Oral
Age
Contraception

Risk
Facto
Multiparity r Sexual
Behaviour

Socio-econom
Smoking
ic Status
Patofisiologi

http://www.intechopen.com/source/html/30755/media/image2.png
 Natural Course Of Cervical Cancer

Pre Cancerous Lesion Cancer

------------------- 3-17 tahun

-------------------------

Mild Karsinoma Cervical

Moderate Severe Insitu
Displasia Displasia Displasia Cancer
 Papanicolaou
Smear Test

Pap-Net

Early Detection
IVA

Kolposkopi

Thin-prep/LBC

HC (Hybrid
Capture)

Genotyping

Oncoprotein Test
Precancer Lesion Classification System
WHO Bethesda System

Normal Within Normal Limit

Atipic Within normal limits cell changes, ASC(US,H),

AGCUS/AGUS/ASCNOS/AGC

Mild Displasia Lesi intraepitel derajat rendah (LGSIL)

Moderate Displasia Lesi intraepitel derajar berat (HGSIL)

Severe Displasia Lesi intraepitel derajar berat (HGSIL)

Karsinoma insitu Lesi intraepitel derajar berat (HGSIL)

Squamous Cell Carcinoma Karsinoma sel skuamosa (≈ HPV 16)

Adenokarsinoma Adenokarsinoma (≈ HPV 18)

http://classconnection.s3.amazonaws.com/33/flashcards/602033/jpg/pap_test_results1338504648293.jpg
Algoritme Skrining PAP Smear dan Tes HPV
Diagnosis

• Biopsy – Hstopatology 🡪 Gold Standard

• Additional Examination:
– USG
– Radiologi
– Sistoskopi
– Rektoskopi
 Cryotherapy

Cold Knife Ablation

Conization Therapy
Pre-Cancerou
s Lesion
Management

LEEP (Loop
Laser Electrical
Vaporization Excision
Procedure)
1. Penanganan kanker serviks uteri stadium IA1
Pap Smear 4,
Fertilitas 10 bulan, dan
Konisasi
dipertahankan rutin apabila
kedua hasil
negatif

Kanker
serviks uteri
stadium IA1

Fertilitas tidak Histerektomi Totalis atau

dipertahankan Histerektomi vaginal
2. Penanganan kanker serviks uteri stadium IA2
Trakhelektomi +
Fertilitas diseksi kelenjar
dipertahankan getah bening

Kanker serviks
uteri stadium
IA2

Invasi pembuluh Histerektomi

darah / limfe (-) Radikal

Fertilitas tidak
Histerektomi
dipertahankan
Radikal +
Invasi pembuluh Limfadenek-to
darah / limfe (+) mi KGB pelvis
3. Penanganan kanker serviks uteri stadium IB1
Trakhelektomi +
Fertilitas diseksi kelenjar
dipertahankan getah bening

Kanker serviks
uteri stadium
IB1

Histerektomi Radikal +
Fertilitas tidak
limfadenektomi KBG pelvis
dipertahankan
dengan/tanpa KGB paraaorta
4. Penanganan kanker serviks uteri stadium IB2 dan IIA

Radiasi
praoperasi
Histerektomi
Radikal +
limfadenektomi
Kekambuhan
KBG pelvis
dengan KGB
paraaorta
Kanker Kemoterapi
serviks uteri neoadjuvan Kemoterapi Kemoradiasi
stadium IB2, adjuvan adjuvan
IIA

Kontraindikasi Radiasi eksterna &

operasi radiasi interna
5. Penanganan kanker serviks uteri stadium IIB, III, dan IVA
Radiasi KGB pelvis +
Radiasi paraaorta konkuren,
praoperasi kemoterapi berbasis
cisplatin + brakhiterapi

Kanker serviks
CT Toraks,
uteri stadium
PET scan
IIB, III, IVA

Kontraindikasi Pertimbangkan biopsi pada

operasi jaringan yang dicurigai

(-) (+)

Terapi sistemik /
Radiasi individual
6. Penanganan kanker serviks uteri stadium IVB

Pengobatan yang diberikan bersifat paliatif,

radioterapi yang diberikan bersifat radioterapi paliatif
Prognosis
Stage 5-Year Survival Rate

0 100%
IA 93%

IB 80%

IIA 63%
IIB 58%
IIIA 35%

IIIB 32%

IVA 16%

IVB 15%
Pencegahan
Vaksinasi

Penggunaan
Nutrisi
Kondom

Tidak Perilaku
Merokok Seks

Sirkumsisi
Deteksi Dini
pada pria
Thank You