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RPS. K65. Deteksi Dini KPD
RPS. K65. Deteksi Dini KPD
RPS. K65. Deteksi Dini KPD
Riahsyah Damanik,SpB(K)Onk
Insidens :
Urutan I di Eropa Barat & AS (32%)
Urutan II di Indonesia (12.6%)
RSK.Dharmais urutan I (2005)
Stadium Penanganan
Stadium Dini > 75% di AS & Jepang
Stadium Lanjut Lokal/Lanjut> 80%
di Indonesia
Klasifikasi Histopatologi
WHO
Japanese Breast Cancer Society (1984)
Malignant (Carcinoma)
1. Non Invasive
a. Non Invasive Ductal CA
b. Lobular CA Insitu
2. Invasive CA
a. Inv.Ductal CA
b. Special Type
c. Pagets Disease
STAGING (TNM)
Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage IIA T0 N1 M0
T1 N1 M0
T2 N0 M0
Stage IIB T2 N1 M0
T N0 M0
Stage IIIA T0 N2 M0
T1 N2 M0
T2 N2 M0
T N M0
T N1 M0
Stage IIIB T4 N0 M0
T4 N1 M0
T4 N2 M0
Stage IIIC Any T N3 M0
Stage IV Any T Any N M1
STADIUM PENEMUAN KPD
Stadium Tjindarbumi dkk Ramli dkk Sakamoto dkk Damanik dkk
I 2% 2.52% 35.6% 0%
I 95 85
II 80 65
III 30 20
IV 0 0
PENATALAKSANAAN KPD
KOMPREHENSIF
Pencegahan Primer
Pencegahan Sekunder / Deteksi Dini
(Skrining)
Diagnosis
Terapi
Rehabilitasi
PENCEGAHAN PRIMER
Faktor Resiko
Gender Previous Ca
Age Ionizing
Radiation Hormonal
Hereditary Fat
Oral Contraceptive
Alcohol
Faktor Resiko
SADARI
SKRINING KELOMPOK RESIKO
SARANIS
DIAGNOSA
BREAST CANCER
Screening
Posisi berdiri
Posisi berbaring
Posisi berbaring dengan bantal diletakan di punggung
Lokasi dominan tumor
Gejala klinis
LOKAL
- benjolan 36%
- benjolan dengan sakit 33%
- sakit 17,5 %
- sekret putting 5%
- tarikan putting 3%
Gejala Klinis
Tumor Jinak Payudara
Tumor Ganas Payudara
SARANIS (CBE)
Pemeriksaan oleh Klinisi (Dokter)
Meliputi
Kulit
Puting dan Areola
Tumor
Kelenjar Getah Bening Aksila
Metastasis
BREAST CANCER
Signs and symptoms at presentation
Mass or pain
in the axilla
Palpable mass
Thickening
Pain
Nipple discharge
Nipple retraction
Edema or erythema
of the skin
BREAST CANCER
Sites of distant
metastases
Brain
Lymph nodes
Pleura
Skin Lung
Liver
Bone
ULTRASONOGRAFI
Inflammatory carcinoma
Pagets disease Dollinger M, et al. Everyones Guide to Cancer Therapy. 1997;356-384.
BREAST CANCER
Pathology: Non-invasive DCIS & LCIS
DCIS LCIS
Harris J, et al. Cancer: Principles & Practice of Chemotherapy. 5th ed. 1997;1557-1616.
Love S, Barsky SH. Cancer Treatment. 4th ed. 1995;337-340.
BREAST CANCER
TNM stage grouping
Stage 0 Tis N0 M0
Stage I T1* N0 M0
Stage IIA T0 N1 M0
T1* N1** M0
T2 N0 M0
Stage IIB T2 N1 M0
T3 N0 M0
Stage IIIA T0, T1,* T2 N2 M0
T3 N1, N2 M0
Stage IIIB T4 Any N M0
Any T N3 M0
Stage IV Any T Any N
M1
* Note: T1 includes T1 mic.
** Note: The prognosis of patients with N1a is similar to that of patients with pN0.
Used with the permission of the American Joint Committee on Cancer (AJCC ), Chicago, Illinois.
The original source for this material is the AJCC Cancer Staging Manual, 5th edition (1997)
published by Lippincott-Raven Publishers, Philadelphia, Pennsylvania.
BREAST CANCER
Stage I
T1 N0 M0 T1a: T 0.5 cm
T1b: 0.5 cm < T 1 cm
T1c: 1 cm < T 2 cm
T1
T 2 cm
T0 No evidence
T2
of tumor
2 cm < T < 5 cm
T3
T > 5 cm
T4
Tumor of any size
with direct extension
to chest wall or skin
T4d = inflammatory
carcinoma
Operasi
Medikamentosa
Radioterapi
TABLET HORMONAL
IMUNOTERAPI
Sitokin
Interferon
Anti Angiogenesis