Cervical Cancer (cont.

)
Tutor 23 Family Medicine – Fri, 09/10/2020
Nailatul Hana 130110170009
Managements of certain conditions in
cervical cancer
Skin Toxicity
 Radiation dermatitis
 Early: vascular dilatation, hyperemia, and
extravasation  small superficial blisters form,
coalesce, and rupture, resulting in moist
desquamation.
 Late: telangiectasis, pigmentation changes, hair loss,
atrophy, fibrosis, and ulceration.
 Most dermatitis are being treated with topical
steroids and dexpanthenol-containing emollients.
Lymphoedema
 Secondary lymphoedema
 Cancer or cancer treatment can damage or block the
lymphatic system, which can stop the lymphatic
system from working properly  swelling.
 Non-operative management: combined physical
therapy consists of,
 Exercise that stimulates lymph flow
 Compression with elastic garments and manual
LN drainage
 Operative management: when conservative therapy
has been unsuccessful.
NVR Symptom
 Nausea, Vomiting, and Retching. • Tab
- 4 mg, 8 mg
 Side effects of chemotherapy.
- Faskes tk. 2 & 3
 Combined radiotherapy and chemotherapy - Maks. 3 tab
experienced significantly higher level of pascakemoterapi / post
radioterapi
symptom occurrence than those receiving • Inj
chemotherapy only. - 2mg/ml
 Individual risk factors: age, anxiety, - Faskes tk. 2 & 3
- Maks. 1 amp sebelum
experience in motion sickness. kemoterapi
 Terapi antiemetik Ondansetron sebagai
Formulatorium Nasional, 2019.
pencegahan mual dan muntah pada
kemoterapi dan radioterapi.
 Dysphagia Fatigue
 Difficulty swallowing.  Fatigue: extreme body tiredness
 Side effect of treatment. that doesnt go away even after
Chemotherapy can affect a patient’s sleep and rest.
appetite and desire to eat, dry mouth,
mouth sore.
 May be caused by many factors.
 Treatment: oral health during cancer Exhaustion, the cancer itself, or
treatment. side effect of the treatments.
 Everyday oral care during  Treamtent  self-care methods.
chemoradiotherapy: hot water
brushing teeth with soft-bristle brush,
 In certain cases: medications or
antibacterial rinse, flossing, lip care medical procedures.
(cream with lanolin), denture care.
 Oral mucositis: mouth cleaning, and
topical medicies for pain.
Diarrhea
 Chemotherapy-Induced Diarrhea (CID)
 Types of drugs, and the nature of the chemotherapy drugs are
not associated with the incidence of diarrhea post chemotherapy.
Stress increases the incidence of diarrhea post chemotherapy.
 Treatment  modifying what to eat and drink: drink clear
liquids, eat low-fiber foods, eat five t six small meals a day,
avoid foods that can irritate the digestive tract, and try
probiotics.
 Medications (when diet aren’t helping): opioids, anti-secretory
agents.
Micturition Difficulty
 Can be caused by blockage of the genitouriary tract.
 Hydronephrosis: a frequetly observed complication
in patients with cervical cancer.
 Management consisted of stent placement,
nephrostomy tube, ureterostomy tube (Patel K,
2015).
BPJS dan Kanker Serviks
 “Gerakan Nasional Deteksi Dini Kanker Leher Rahim” bekerja sama dengan Yayasan
Kanker Indonesia, sejak Juni 2014.
 Optimalisasi program deteksi dini kanker serviks yang digagas Organisasi Aksi
Solidaritas Era (OASE) Kabinet Kerja.
 Beberapa program yang digalang:
 Pencegahan dan deteksi dini kanker terhadap puluhan ribu perempuan di Indonesia
mulai tahun 2015-2019.
 Pelatihan IVA dan Pap smear untuk 2.143 dokter umum dan bidan.
 Dalam pelaksanaannya, basis managed care pada BPJS Kesehatan terdiri dari empat
pilar prinsip dasar; promotif, preventif, kuratif, dan rehabilitatif.
 Salah satu upaya optimalisasi promotif & preventif: sosialisasi pada masyarakat
mengenai pentingnya melalui deteksi dini kanker serviks.
 Layanan BPJS: Deteksi Dini
 Deteksi dini kanker serviks telah masuk dalam skema pembiayaan program JKN.
 Sasaran: peserta perempuan BPJS Kesehatan yang sudah menikah.
 Cara mendapatkan pelayanan: peserta mendapatkan rekomendasi atau pengantar dari
Faskes Tingkat Pertama, atau peserta mendaftar sendiri secara sukarela dengan mengisi
lembar kesediaan pada Formulir Permohonan.

Jangkauan peserta (2014): 81.000 peserta (IVA) dan 248.940 peserta (Pap smear)
Layanan BPJS: Tindak Lanjut
 Positif dari pemeriksaan IVA: tindakan krioterapi di FKTP yang memiliki
kompetensi.
 Bila pemeriksaan menunjukkan sel kankernya sudah ganas dan harus
mendapatkan pengobatan lebih lanjut di rumah sakit: BPJS Kesehatan juga akan
memberikan pelayanan kesehatan yg dibutuhkan, misalnya kemoterapi atau
radioterapi.
 BPJS juga menanggung biaya obat-obatan yang diperlukan pasien sesuai
dengan Formularium Nasional.
 Terapi sitotoksik jenis bleomisin inj. 15 mg, diberikan di faskes tk. 3 dg
peresepan maksimal 12x pemberian.
Sumber:
Info BPJS Kesehatan Edisi XVIII Tahun 2015. Diterbitkan oleh BPJS Kesehatan
Keputusan Menkes RI No. HK.01.07/MENKES/813/2019 ttg Formularium Nasional
Sources:
 Yazbeck, VY. 2016. Management of Normal Tissue Toxicity Associated with Chemoradiation (Primary Skin, Esophagus, and Lung). Accessed from https
://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836174/ on October 8th, 2020.
 Biglia, N. 2015. Lower Body Lymphedema in Patients with Gynecologic Cancer. Accessed from http://ar.iiarjournals.org/content/37/8/4005.full on October 8th, 2020.
 Cancer Council NSW. Lymphoedema. Accessed from https://www.cancercouncil.com.au/cancer-information/managing-cancer-side-effects/lymphoedema/ on October
8th, 2020.
 Prapti, NKG. 2012. Nausea, Vomiting, and Retching of Patients with Cervical Cancer Undergoing Chemotherapy in Bali, Indonesia. Accessed from https://
www.neliti.com/publications/155742/nausea-vomiting-and-retching-of-patients-with-cervical-cancer-undergoing-chemoth on October 8th, 2020.
 Menteri Kesehatan RI. Keputusan Menteri Kesehatan Republik Indonesia No. HK 01.07/MENKES/813/2019 tentang Formularium Nasional.
 Armini NKA, et. al. 2016. Diarrhea Incident in Cervical Cancer Patients Post Chemotherapy Treatment. Accessed from https://
www.neliti.com/publications/116183/diarrhea-incident-in-cervical-cancer-patients-post-chemotherapy-treatment on October 9th, 2020.
 Mayo Clinic. Diarrhea: Cancer-related causes and how to cope. Accessed from https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/diarrhea/art-20044799
on October 9th, 2020.
 MD Anderson Cancer Center. 2019. Dysphagia in Cancer Patients: What to Know. By Kate Hutcheson, Ph.D. Accessed from
https://www.mdanderson.org/cancerwise/dysphagia-in-cancer-patients--what-to-know-causes-diagnosis-prevention-treatment.h00-159305412.html on October 9th,
2020.
 Patel K. 2014. Hydronephrosis in Patients with Cervical Cancer: An Assessment of Morbidity and Survival. Accessed from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557876/ on October 9th, 2020.