KANKER Leher Rahim

bisakah dicegah ??
mochamad maroef

RS Universitas Muhamadiyah Malang

28 Desember 2013

Organ Genitalia Perempuan

Leher rahim

Kanker Cervix di Indonesia

Jumlah kasus baru : 40/hari

Jumlah kematian
: 20/hari

Epidemiologi

Epidemiologi
NA + Europe
75,000
Asia

36,000

266,000
Latin
72,000
33,000

Africa

143,000

79,000
62,000

Ferlay J et al. Globocan 2002. IARC 2004.

PEMBUNUH WANITA no. 1

PENYEBAB CA CERVIX

HPV
Kanker Serviks disebabkan oleh HPV
Kanker Serviks bukan penyakit keturunan

HPV

HUMAN PAPILOMA VIRUS

HPV
Kanker Serviks disebabkan oleh HPV
Kanker Serviks bukan penyakit keturunan

Histolopathology:

1
CIN

CIN 1: Mild dysplasia; includes condyloma (anogenital warts)2

CIN 2: Moderate dysplasia2
CIN 3: Severe dysplasia; CIS; FIGO stage 02,3
Normal
CIN 1
CIN 2
CIN 3

Basal
cell layer

All figures reprinted with permission from Frappart, et al. Histopathology and Cytopathology of the Uterine Cervix. Digital Atlas, Lyon, France: IARC Press, 2004.

LESI
CERVIX

Normal
Cervix

HPV Infection /
CIN* 1

CIN 2 / CIN 3 /
Cervical Cancer

Natural History of
Cervical Cancer
Pracancer Lesion
HPV

Cancer

------------------ 3-17 year--------------

Mild
Dysplasia

CIN I

Moderate
Dysplasia

Severe
Dysplasia

CIN II

Screening

CIN III

Ca CA
Insitu

Invasive
Cancer

Progression
Normal

99,7 %
infeksi
HPV

>>>
CIN I

CIN II
>>

CIN III
>

Ca. Cervix
Stage I - IV

GAMBARAN PAP SMEAR Normal

GAMBARAN PAP SMEAR CIN

KANKER Serviks

GENITAL
WARTS
Disebabkan HPV
Type 6 dan 11
HPV Type 6 & 11
Penyebab > 90 %
anogenital warts
Beban Psikologis
Bagi Penderitanya.
Sering Kambuh

Presentation of Genital Warts: Penile

Gardasil is indicated for the prevention of high-grade cervical dysplasia (CIN 2/3), cervical carcinoma, high-grade vulvar
dysplastic lesions (VIN 2/3), and external genital warts (condyloma acuminata) causally related to Human Papillomavirus
(HPV) types 6, 11, 16 and 18. The indication is based on the demonstration of efficacy of Gardasil in adult females 16 to 26
years of age and on the demonstration of immunogenicity of Gardasil in 9- to 15-year old children and adolescents.
Protective efficacy has not been evaluated in males. The use of Gardasil should be in accordance with official
recommendations.

Presentation of Genital Warts:

Vulvar

Reprinted with permission from NZ DermNet

(www.dermnetnz.org)

Recurrent Respiratory Papillomatosis

(RRP)
Age distribution is bimodal with peaks at1:
2 to 4 years of age (childhood-onset)
20 to 40 years of age (adult-onset)

Usually caused by HPV types 6 or 112

Papillomas are stratified squamous
epithelial masses that can obstruct the airway
if not removed.2
Although histologically benign, RRP causes significant
morbidity and mortality due to recurrent nature.2
Could require surgery under general anesthesia as
frequently as every few weeks
Possible causative role of RRP in head and neck cancers2-4

RRP
PAPILOMAS

Setiap perempuan
berisiko terkena
HPV penyebab kanker serviks
dalam masa hidupnya
tanpa memandang usia dan
gaya hidup

INSIDENSI
20

Oncogenic HPV (%)

Peak 1

18
16

15

14
12

10

10
8
6

4
2

0
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Age (years)

Age-standardised incidence
rate for cervical cancer (per
100,000)

20

PENULARAN HPV

Setiap wanita yang aktif secara seksual beresiko

terkena HPV onkogenik
Infeksi HPV dapat ditularkan melalui sexual intercouse,
skin-to-skin genital contact, manual to genital, oral to
genital,
Penetrasi seksual tidak selalu diperlukan untuk
terjadinya infeksi
Penggunaan kondom dapat mengurangi resiko infeksi,
namun tidak memberikan proteksi penuh dari infeksi
HPV
Ibu dapat menularkan HPV pada bayi baru lahir saat
proses persalinan transmisi vertikal

Beberapa faktor mempermudah infeksi HPV

Usia muda (puncak infeksi usia 2029 )1
Berganti pasangan2
Memulai hubungan di usia muda*,3
Merokok*,4
dll

Kebanyakan
infeksi HPV
berlangsung tanpa
gejala

Penanganan Kanker Serviks

PENCEGAHAN

DETEKSI DINI

PENGOBATAN

EDUKASI

PAP SMEAR

KONDOM

VIA

Kemoterapi
Radioterapi
Pembedahan
atau
Konsultasi
kepada dokter
anda

VAKSINASI

Manfaat Vaksinasi
Penyakit Menular

VIRUS

BAKTERI

Vaksin HPV
Vaksin HPV tipe 6, 11, 16 & 18
berpotensi mencegah lebih dari
70% kasus kanker serviks dan 90%
kasus Genital Warts
Vaksin HPV ditujukan untuk
perempuan usia 10 55 (panduan
HOGI)
Jadwal pemberian: 3 dosis
(bulan ke-0, ke-2 dan ke-6)

Penting untuk di-INGAT!!!

Kanker serviks adalah kanker yang banyak
menyebabkan kematian pada perempuan
Kanker serviks dapat dicegah :
Deteksi sedini mungkin
Edukasi mengenai kanker serviks
Vaksinasi HPV VAKSIN

KONSULTASIKAN KEPADA DOKTER ANDA

TENTANG KANKER SERVIKS & CARA PENCEGAHANNYA