BRCA

BAGIAN APA DARI CELL CYCLE YANG DIGANGGU SAAT RADIASI?

mengganggu g1 to s ada p53 terganggu, dan cell tumor supressor lain juga terganggu.

TREATMENT UNTUK BREAST CANCER

Chemotherapy
There are three main goals for chemotherapy (chemo) in cancer treatment:
1 Cure
If possible, chemo is used to cure cancer, meaning that the cancer is destroyed – it goes away and doesn’t
come back.
Most doctors don’t use the word “cure” except as a possibility or intention. So, when giving treatment that
has a chance of curing a person’s cancer, the doctor may describe it as treatment with curative intent.
There are no guarantees, and though cure may be the goal, it doesn’t always work out that way. It often takes
many years to know if a person’s cancer is really cured.
2 Control
If cure is not possible, the goal may be to control the disease. Chemo is used to shrink tumors and/or stop the
cancer from growing and spreading. This can help the person with cancer feel better and live longer.
In many cases, the cancer doesn’t completely go away, but is controlled and managed as a chronic disease,
much like heart disease or diabetes. In other cases, the cancer may even seem to have gone away for a while,
but it’s expected to come back. Then chemo can be given again.
3 Palliation
Chemo can also be used to ease symptoms caused by the cancer. This is called palliative chemotherapy or
palliation.
When the cancer is at an advanced stage, meaning it’s not under control and has spread from where it started
to other parts of the body, the goal may be to improve the quality of life or help the person feel better. For
instance, chemo may be used to help shrink a tumor that’s causing pain or pressure.

chemo is used with surgery or radiation therapy or both. Here’s why:

• Chemo may be used to shrink a tumor before surgery or radiation therapy. Chemo used in this way is
called neoadjuvant therapy.
• It may be used after surgery or radiation therapy to help kill any remaining cancer cells. Chemo used
in this way is called adjuvant therapy.
• It may be used with other treatments if your cancer comes back.

Kemoterapi dibedakan menjadi dua, yakni pertama, kemoterapi neoadjuvant. Kemoterapi ini diberikan
sebelum pengobatan primer (seperti pembedahan). Kemoterapi neuadjuvant berfungsi untuk menyusutkan
ukuran tumor. Terapi ini juga bisa diberikan sebelum pemberian radiasi.

Kedua, kemoterapi adjuvant. Pengobatan terapi yang digunakan setelah tumor diangkat melalui
pembedahan. Tujuannya untuk menghancurkan sel-sel kanker mikroskopik yang mungkin tertinggal.
Biasanya terapi ini diberikan kepada penderita kanker yang sudah dalam tahap IV (metastatis)

Mastectomy is the removal of the whole breast. There are five different types of mastectomy: "simple" or
"total" mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, and subcutaneous
(nipple-sparing) mastectomy.
"Simple" or "total" mastectomy
Simple or total mastectomy concentrates on the breast tissue itself:
• The surgeon removes the entire breast.
• The surgeon does not perform axillary lymph node dissection (removal of lymph nodes in the
underarm area). Sometimes, however, lymph nodes are occasionally removed because they happen
to be located within the breast tissue taken during surgery.
• No muscles are removed from beneath the breast.
Who usually gets simple or total mastectomy?
A simple or total mastectomy is appropriate for women with multiple or large areas of ductal carcinoma in
situ (DCIS) and for women seeking prophylactic mastectomies — that is, breast removal in order to prevent
any possibility of breast cancer occurring.

Modified radical mastectomy

Modified radical mastectomy involves the removal of both breast tissue and lymph nodes:
• The surgeon removes the entire breast.
• Axillary lymph node dissection is performed, during which levels I and II of underarm lymph nodes
are removed (B and C in illustration).
• No muscles are removed from beneath the breast.
Who usually gets a modified radical mastectomy?
Most people with invasive breast cancer who decide to have mastectomies will receive modified radical
mastectomies so that the lymph nodes can be examined. Examining the lymph nodes helps to identify
whether cancer cells may have spread beyond the breast

Radical mastectomy
Radical mastectomy is the most extensive type of mastectomy:
• The surgeon removes the entire breast.
• Levels I, II, and III of the underarm lymph nodes are removed (B, C, and D in illustration).
• The surgeon also removes the chest wall muscles under the breast.
Who usually gets a radical mastectomy?
Today, radical mastectomy is recommended only when the breast cancer has spread to the chest muscles
under the breast. Although common in the past, radical mastectomy is now rarely performed because in most
cases, modified radical mastectomy has proven to be just as effective and less disfiguring.

Partial mastectomy
Partial mastectomy is the removal of the cancerous part of the breast tissue and some normal tissue around it.
While lumpectomy is technically a form of partial mastectomy, more tissue is removed in partial mastectomy
than in lumpectomy.

Nipple-sparing mastectomy
During nipple-sparing mastectomy, all of the breast tissue is removed, but the nipple is left alone.

The surgery is often followed by radiation therapy to the remaining breast tissue. With radiation therapy,
powerful X-rays target the breast tissue. The radiation kills cancer cells and prevents them from spreading, or
reoccurring.

A mastectomy is an umbrella term used for several techniques to remove one or both breasts. In addition, the
surgeon may also remove nearby lymph nodes to determine whether the cancer has spread.
During an axillary node dissection, the surgeon removes a number of lymph nodes from your armpit on the
side of the tumor.
In a sentinel lymph node biopsy, your surgeon removes only the first few nodes into which a tumor drains
(sentinel nodes).
Lymph nodes removed during a mastectomy are then tested for cancer. If no cancer is present, no further
lymph nodes need be removed. If cancer is present, the surgeon will discuss options, such as radiation to
your armpit. If this is what you decide to do, no further lymph nodes will need to be removed.
Removing all of the breast tissue and most of the lymph nodes is called a modified radical mastectomy.
Newer mastectomy techniques remove less tissue and fewer lymph nodes.
Other types of mastectomy include:
• Total mastectomy. A total mastectomy, also known as a simple mastectomy, involves removal of the
entire breast, including the breast tissue, areola and nipple. A sentinel lymph node biopsy may be
done at the time of a total mastectomy.
• Skin-sparing mastectomy. A skin-sparing mastectomy involves removal of all the breast tissue,
nipple and areola, but not the breast skin. A sentinel lymph node biopsy also may be done. Breast
reconstruction can be performed immediately after the mastectomy.

A skin-sparing mastectomy may not be suitable for larger tumors.
 • Nipple-sparing mastectomy. A nipple- or areola-sparing mastectomy involves removal of only
breast tissue, sparing the skin, nipple and areola. A sentinel lymph node biopsy also may be done.
Breast reconstruction is performed immediately afterward.

Well-differentiated cancer cells look more like normal cells and tend to grow and spread more slowly than
poorly differentiated or undifferentiated cancer cells -> doesnt look like normal cell and grow RAPIDLY

EDUKASI KE KELUARGA ?
Berdasarkan hasil pemeriksaan ini ini, ibu di diagnosis ca payudara, menurut pemeriksaan ca payudara nya
stadium sekian sekian,
jangan khawatir bu, pilihan terapi nya ini ini, saya sarankan agar ibu terapi yang dianjurkan karena semakin
awal terapinya hasilnya akan semakin baik, kemungkinan penyakitnya ada hubungannya dengan keturunan,
jadi keluarga ibu jg berisiko, sehingga akan baik jika dilakukan pemeriksaan payudara, seperti sadari atau
melakukan pemeriksaan ke dokter
Terdapat 5 hingga 10% kejadian kanker payudara yang disebabkan oleh keturunan.
WO

HUBUNGAN NEGATIVE STATUS ESTEROGEN RECEPTOR DENGAN HER2 OVER EXPRESSION

Berdasarkan penelitian yang telah
dilakukan didapatkan hasil bahwa hubungan
status HER2 dengan derajat keganasan
bersifat lurus yaitu bila status HER2+ maka
akan terjadi peningkatan derajat keganasan
pada penderita kanker payudara, begitupula
sebaliknya jika status HER2 ‒ maka akan
terjadi penurunan dari derajat keganasan dari
pasien kanker payudara,