23-May-13

CERVICAL CANCER

PENDAHULUAN
Pembunuh no 1 di dunia Setiap tahunnya terdapat 400 ribu kasus baru cervical cancer, sebanyak 80 persen terjadi pada wanita yang hidup di negara berkembang Penyebabnya minimnya akses screening dan pengobatan.

BY : TETTI SOLEHATI, S.KP.,M.KEP

1: fallopian tube, 2: bladder, 3: pubic bone, 4: g-spot, 5: clitoris, 6: urethra, 7: vagina, 8: ovary, 9: sigmoid colon, 10: uterus, 11: fornix, 12: cervix, 13: rectum, 14: anus

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STATISTICS
10,520 new

DEFINITION
Kanker

cases in the U.S. 3,900 will die 50% are diagnosed between ages 35 and 55. 20% at the age of 65 or over. Rarely occurs in women younger than 20

serviks adalah jenis kanker yang biasanya tumbuh lambat pada wanita dan mempengaruhi mulut rahim, yaitu bagian yang menyambungkan antara rahim dan vagina.

Perubahan

sel-sel serviks dinamakan proses metaplasia yang terjadi di daerah sambungan skuamosa kolumnar. Kanker ini dipengaruhi oleh aktivitas seksual.

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TYPES
Three Types :

Adenocarcinomas
Cancer arising from

glandular epithelium

Squamous cell Carcinomas

Cancer of 80%

10% -

20%

flat epithelial cell to 90%

Mixed carcinoma
Features both

types

KLASIFIKASI

STAGE

Klasifikasi kanker serviks menurut International Federation Of Gynaecology and Obstetric (FIGO) adalah terdiri dari stage 0 sampai stage IV

Stage 0 (Carcinoma in Situ) In stage 0, cancer is found only in the first layer of cells lining the cerviks and has not invaded the deepertissues of the cervix. Stage 0 is also called carcinoma in situ

Stage I cancer is found in the cerviks only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.

Stage IB:,

Stage 1A: A very small amount cancer that can only be seen with a microscope is found in the tissue of the cervix. Stage IA is divided into stages IA1 and IA2, based on the size of the tumor.
In stage

IA1, the cancer is not more than 3 millimeters deep and not more than 7 millimeters wide. In stage IA2, the cancer is more than 3 but not more than 5 millimeters deep, and not more than 7 millimeters wide.

cancer can only be seen with a microscope and is more than 5 millimeters deep or more than 7 millimeters wide, or can be seen without a microscope. Cancer that can be seen without a microscope is divided into stages IB1 and IB2, based on the size of the tumor stage 1B1, the cancer can be seen without a microscope and is not larger than 4 centimeters. stage 1B2, the cancer can be seen without a microscope and is larger than 4 centimeter

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Stage II cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.
Stage IIA:

Stage III cancer has spread to the lower third of the vagina, may have spread to the pelvic wall and/or has caused the kidney to stop working. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.
Stage IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall. Stage IIIB Cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis.

Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus. Stage IIB: Cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus.

Stage IV cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found. Stage IVA: Cancer has spread to the bladder or rectal wall and may have spread to lymphnodes in the pelvis. Stage IVB: Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver , intestinal tract, or lungs.

PATHOFISIOLOGY
Karsinoma serviks mulai timbul dibatas antara epitel yang melapisi ektoserviks dan endoserviks, kanalis serviks yang disebut sebagai scuamocolumnar junction Pada awal perkembangnnya kanker serviks tidak memberi tanda-tanda dan keluhan. Pada pemeriksaan dengan spekulum, tampak sebagai porsio yang mengalami peradangan

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Umumnya fase prainvasif berkisar antara 1015 tahun. Penyebaran terjadi secara limfogen yaitu melalui pembuluh getah bening. Meninggalnya penderita kanker serviks disebabkan oleh pendarahan yang eksesif dan gagal ginjal menahun akibat uremia oleh karena obstuksi ureter di tempat ureter masuk ke dalam kandung kemih

ETIOLOGI
human

papilloma virus (HPV) type 16, 18) mayoritas Other possible risk factor s include the following: Giving birth to many children. Having many sexual partners.

Having first

sexual intercourse at a young age. Smoking cigarettes. Oral contraceptive use ("the Pill"). Weakened immune system Defisiensi vit A,C, Beta caroten, as folat

MANIFESTASI KLINIK
Pra

ca tdk menimbulkan gejala

Low

socioeconomic status Diethylstilbestrol (DES) Family history

Ca

: Terdapat keputihan berlebihan, berbau busuk, dan tidak sembuhsembuh. Adanya pendarahan tidak normal, karena ca menyerang jaringanjaringan di sekitarnya.

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Meningkatnya

pendarahan selama

Nyeri

menstruasi. Terjadi pendarahan di luar siklus menstruasi dan setelah hubungan seks. Kesulitan atau nyeri dalam perkemihan

selama berhubungan seks. Nyeri di daerah panggul Pendarahan pada masa pra atau paska menopause

PREVENTION

Bila kanker sudah mencapai stadium 3 ke atas, maka akan terjadi pembengkakan di berbagai anggota tubuh, seperti di paha, betis, tangan dan sebagainya.

Avoiding the risk factors Especially HPV Help for low-income women Having the Pap Test 3 years after first vaginal intercourse or by age 21. Have test annually

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DIAGNOSIS
pap smear biopsi X-ray CT- scan USG MRI

Papsmear sebaiknya dilakukan setahun sekali bagi yang sudah melakukan hubungan seks. Bagi wanita yang berusia di atas 30 tahun dan telah melakukan Pap smear selama tiga kali berturut-turut dan hasil didapatkan normal, maka pap smear dapat dilakukan setiap dua atau tiga tahun sekali.

THREATMENT
Three types of standard treatment are used:
Invasive

Surgery Preinvasive cervical cancer Cryosurgery Laser surgery Conization

cervical cancer hysterectomy Removal of the body of the uterus and cervix. Radical hysterectomy and pelvic lymph node dissection Removal of entire uterus, surrounding tissue, upper part of the vagina, and lymph nodes from the cervix.
Simple

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Radiation therapy Chemotherapy

Penatalaksanaan medis terhadap klien kanker serviks tergantung dari stadium

Stadium Ib dan IIa - histerektomi radikal dengan limfadenektomi pelvis. Pasca bedah dilanjutkan dengan radiasi, tergantung ada tidaknya sel tumor dalam kelenjar limfe regional yang diangkat.

Stadium IIb dan III untuk terapi primer adalah radioterapi. Kombinasi dari kemoterapi dan radiasi sebagai upaya untuk memperbaiki laju penyembuhan, karena banyak klien mempunyai metastasis jauh yg tidak nampak.

Stadium IVa dan IVb radiasi untuk meredakan perdarahan dari vagina, kandung kemih, atau rektum. Karena terdapat metastasis yang jauh maka kemoterapi sering digunakan tetapi hanya bersifat paliatif.