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Transcript of 169658027 on k 17 Breast Cancer Blok Onk

  • Kanker Payudara

    Dr Emir T Pasaribu SpB(K)Onk

    Dr. Suyatno SpB(K)Onk

    Bagian Ilmu Bedah FK USU/

    RS H Adam Malik Medan

  • Kelenjar Getah Bening, tempat metastasis regional

  • BREAST CANCER Anatomical site

    RIGHT

    Upper inner Nipple Central portion Lower inner

    Upper outer Axillary tail Lower outer

  • KPD: karsinoma berasal dari epitel duktus atau

    lobulus

    Keganasan paling sering di negara maju

    Pria : wanita = 1 : 100

    Insiden meningkat dengan pertambahan

    usia,(setelah dekade ke 4)

    Penyebab kematian no.2 setelah ca.paru

    Di Indonesia

    No. 2 setelah Ca servik

    Kebanyakan datang std III & IV (M. Ramli, 43,9%)

    Epidemiologi

  • BREAST CANCER Worldwide incidence in females*

    *Incidence per 100,000 population.

    Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64.

    67.4

    36.0

    28.6

    71.7

    21.2

    25.0

    31.5

    25.5

    86.3

    Eastern Europe

    Japan

    Australia/ New Zealand

    South Central Asia

    Northern Africa

    Southern Africa

    Central America

    Western Europe

    North America

  • BREAST CANCER Age-specific incidence (per 100,000)

    Adapted from New Horizons in Cancer Management, SRI International, 1990.

    Inc

    ide

    nc

    e R

    ate

    s

    20 25 30 35 40 45 50 55 60 65 70 75 80 85+

    24 29 34 39 44 49 54 59 64 69 74 79 84

    420 400

    300

    200

    100

    0

    Age

    United

    States

    England

    and Wales

    Italy

    France

    Japan

  • BREAST CANCER Spread to lymph nodes

    Supraclavicular

    Subclavicular

    Distal (upper)

    axillary

    Central (middle)

    axillary

    Proximal (lower)

    axillary

    Mediastinal

    Internal mammary

    Interpectoral

    (Rotters)

  • BREAST CANCER Risk factors

    Age: setelah dekade 4

    Family history: mother, sister, dougther

    Prior personal history of breast cancer

    Increased estrogen exposure

    Early menarche ( 55 years)

    HRT ( > 5years)

    Oral contraceptives (> 8 years)

  • Risk factors

    Nulliparity

    1st pregnancy after age 30

    Diet and lifestyle (obesity, excessive alcohol consumption)

    Radiation exposure before age 30

    Mutation : BRCA1 and or BRCA 2

    Prior benign or premalignant breast changes

    In situ cancer

    Atypical hyperplasia

  • Diagnostik Klinis

    Anamnesis

    Keluhan utama

    Keluhan tambahan

    RPO & RPT

    Pemeriksaan fisik

    Inspeksi

    Palpasi

    Pememriksaan penunjang

    USG mammae

    Mamografi

    USG abdomen, F. Thorak, bone

    scann

    Biopsi

  • Tanda dan gejala :

    Benjolan yang keras dengan atau tanpa rasa sakit

    Bentuk puting berubah

    retraksi nipple

    putting mengeluarkan cairan /darah (nipple discharge)

    Perubahan pada kulit

    berkerut seperti kulit jeruk (peau dorange)

    melekuk ke dalam (dimpling)

    borok (ulcus)

    eritema, edema

  • benjolan kecil di kulit payudara (nodul satelit)

    luka puting dipayudara yang sulit sembuh/

    eczema (paget disease)

    payudara terasa panas, memerah dan

    bengkak

    benjolan awalnya biasanya hanya pada 1

    payudara

    ada benjolan di aksila dengan atau tanpa

    masa di payudara

  • Benjolan payudara kanan

  • Peau dorange Pembesaran kgb aksila

  • Retraksi Nipple (Puting)

  • Masa menonjol dengan eritema dan retraksi

    nipple

  • Masa keras, terfiksir dgn eritema dan retraksi nipple

  • Nipple discharge/ Keluar cairan puting

  • SKIN DIMPLING

    Pagets Disease

  • No

    du

    le

    Sa

    te

    lit

    Ulkus dengan retraksi nipple

  • Ulkus yang meluas mengenai kedua

    payudara

  • BREAST CANCER Sites of distant metastases

    Skin

    Liver

    Bone

    Pleura

    Lung

    Lymph nodes

    Brain

  • Gejala Klinis Metastasis Jauh

    Paru/ pleura: batuk, sesak nafas , efusi pleura

    Tulang: sakit pada tulang dan patah tulang

    Otak: nyeri kepala hebat, muntah proyektil,

    kesadarn menurun

    Liver: hepatomegali, ikterus, sakit perut,

    perut gembung, mual

  • BREAST CANCER Screening

    Breast self-examination Examination Mammographythe

    by physician only modality shown

    to decrease mortality

  • SADARI (SBE)

    Posisi berdiri

  • Posisi berbaring

  • Posisi berbaring dengan bantal diletakan di punggung

  • BREAST CANCER Examination by physician

    Breast inspection

    Skin dimpling

  • BREAST CANCER Breast palpation

  • BREAST CANCER Regional node assessment

  • BREAST CANCER Screening mammography

    Reduces mortality by 26% in women

    aged 50-74

    ACS recommends

    1st screening mammography by

    age 40

    Mammography every 1 to 2 years

    between the ages of 40 and 49

    Mammography annually thereafter

    Harris J, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1557-1616.

    Fink DJ, Mettlin CJ. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;128-193.

  • BREAST CANCER Screening (high-risk)

    Annual mammogram, beginning 5 yrs

    before age of youngest affected

    relative at time of diagnosis

    High familial risk

    BRCA 1/2-positive

    Tripathy D, Henderson IC. Current Cancer Therapeutics. 3rd ed. 1999;123-129.

  • BREAST CANCER Horizontal mammography

  • BREAST CANCER Vertical mammography

  • BREAST CANCER Mammography

  • B I R A D S

    Kategori

    BIRADS Deskripsi

    Resiko

    Malignansi

    Perencanaan

    Tindakan

    1 Negative 5 in 10,000 Continue annual

    mammograpy

    2 Benign finding,

    noncancerous

    5 in 10,000 Continue annual

    mammograpy

    3 Probably benign

    finding

  • USG Payudara

    USG merupakan metode terpilih untuk membedakan kistik dengan solid sebagai guide untuk biopsi

    Gambaran maligna: lesi hipoechoic dgn margin irregular

  • BREAST CANCER Biopsy

    Excisional biopsy

    Size < 3 cm

    Incisional biopsy

    Size > 3 cm & operable

    inoperable

    Core needle biopsy

    Histologic diagnosis

    Fine-needle aspiration

    Cytologic diagnosis

    Harris J, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1557-1616.

  • FNAB CORE BIOPSY

  • BREAST CANCER Pathology

    Non-invasive carcinoma in situ

    Ductal carcinoma in situ (DCIS)

    Lobular carcinoma in situ (LCIS)

    Invasive carcinoma

    Infiltrating ductal or lobular carcinoma

    Medullary, mucinous, and tubular carcinomas

    Uncommon tumors

    Inflammatory carcinoma

    Pagets disease

    Dollinger M, et al. Everyones Guide to Cancer Therapy. 1997;356-384.

  • BREAST CANCER Tumor definitions

    TX Primary tumor cannot be assessed

    T0 No evidence of primary tumor

    Tis Carcinoma in situ: Intraductal carcinoma, lobular carcinoma in situ,

    or Pagets disease of the nipple with no tumor

    T1 Tumor 2 cm or less in greatest dimension

    T1mic Microinvasion more than 0.1 cm or less in greatest dimension

    T1a Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension

    T1b Tumor more than 0.5 cm but not more than 1 cm in greatest dimension

    T1c Tumor more than 1 cm but not more than 2 cm in greatest dimension

    T2 Tumor more than 2 cm but not more than 5 cm in greatest dimension

    T3 Tumor more than 5 cm in greatest dimension

    T4 Tumor of any size with direct extension to (a) chest wall or (b) skin, only as described below

    T4a Extension to chest wall

    T4b Edema (including peau dorange) or ulceration of the skin of the breast

    or satellite skin nodules confined to the same breast

    T4c Both (T4a and T4b)

    T4d Inflammatory carcinoma

    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 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