PROJECT PROPOSAL

SEMINAR OF CERVICAL CANCER EXTENSION

Proposed

1. Annisyah Nuradabyah (21118005)

2. Aprelia (21118006)
3. Ayu Permata Sari (21118007)
4. Dandi Irawan (21118008)
5. Shinta Febrina (21117109)

Supervisor:
Dwi Maharrani,M.Pd

Nursing Science Study Program

STIKes MUHAMMADIYAH PALEMBANG
ACADEMIC YEAR 2019/2020
 CHAPTER 1
INRODUCTION

1. 1 Bacground
Cervical cancer ranks 7th in terms of case incidence rates and 8th as the cause of
global death in the world. In Indonesia, cervical cancer itself ranks second out of 10
cancers that cause death. According to the Republic of Indonesia's Health Ministry
estimates in 2013 the number of women with cervical cancer is 98,962 cases, and around
90-100 new cases of cervical cancer occur every year, it means every one or two days
there is always one case of cervical cancer occurs in women.Based on data from Global
Burden Cancer (Globocan) in 2018 the incidence of cervical cancer in Indonesia ranks
second at 10.7% and the death rate ranks third at 10.3%. around the world.
The condition of the patient with cervical cancer the diagnosis is indetified
including the fear of death.and feeling sorry for myself and not confident,cancer patients
need complementary treatment using content analysis.
Table 1.Numbers
Number of cervical cancer sufferers based on the results of the 2017,2018 and 2019 Riskesdas survey
No Region 2017 2018 2019
1. WIB 4508 5876 6980
2. WITA 536 687 701
3. WIT 34 44 57
TOTAL 5078 6607 7738

The data shows that there are a significance increase of the cervical cancer
patients in the last theree years in all region in Indonesia. in 2017, the women suffered
from cervical cancer are 5078. Which are 4508 women are from western region of
Indonesia, which are 536 women are from central region of Indonesia, and 34 women are
from eastern region of Indonesia. In 2018, the women the women suffered from cervical
cancer are 6607. Which are 5876 women are from western region Indonesia, which are
687 women are from central region of Indonesia, and 44 women are from eastern region
of Indonesia. In 2019, the women the women suffered from cervical cancer are 7738.
Which are 6980 women are from western region Indonesia, which are 701 women are
from central region of Indonesia, and 57 women are from eastern region of Indonesia.
Because cervical cancer in Indonesia is quite high, so people in Indonesia,
especially in the regions Central Java reach 23,6%, then we want to do a seminar on
cervical cancer. After a seminar on Cervical Cancer counseling, It is expected that the
incidence in the area can decrease. besides that the surrounding community can get
knowledge of the causes, how to prevent, handling, and natural medicines about cervical
cancer. So that the surrounding community is avoided or at least does not reduce cervical
cancer. Conside the improtance of this issue, we propose to make a seminar under the
theme of the Cervical Cancer

1.2 Purpose Of The Project

Preventing so that the people of Central Java avoid cervical cancer.
 CHAPTER 2
THE CONCEPT OF THE THEORY

2.1 Understanding Cervical Cancer

Cancer is a growth of abnormal cells or the proliferation of cells that can not be
arranged. The degree of poliferation between cancer cells differs from one another. The
difference between cancer cells and normal cells is in the nature of cancer cells that
never stop dividing. Cancer is a failure of normal morphogenesis and failure of normal
differentiation, meaning that the growth of the cancer can not be controlled and never get
the normal structure and function of the typical tissue where cancer cells grow.
According to Guyton, Arthur C., Cancer is a disease that attacks the basic processes of
cell life, which almost all add to the cell genome (the total genetic complement of cells)
and lead to wild growth and spread of cancer cells.
Cervical cancer is a malignant tumor that grows inside the cervix or the cervix
which is located at the lowest part of the uterus that attaches to the top of the vagina.
Cervical cancer is a disorder of cellular growth and is a group of diseases manifested by
failure to control cell proliferation and maturation in cervical tissue. Cervical cancer
usually attacks women aged 35 - 55 years, 90% of cervical cancer comes from mucous-
producing gland cells in the cervical canal that goes into the uterus. From some of the
opinions expressed by the authors the authors can conclude that cervical cancer is an
abnormal cell growth that is found in the female reproductive organs, namely the cervix
or the lowest part of the uterus attached to the top of the vagina.

2.2 Causes Of Cervical Cancer

The cause of the formation of cancer cells is caused by mutations from normal
cells so that they experience abnormal cell growth and differentiation of cell function.
Every human being continues to form cells that have a tendency to become cancerous but
the human immune system works like a vulture that will bite abnormal cells, to stop the
initial activities before they can start their activities as cancer cells.
Cell mutations that make up cancer cells, originate from a series of chromosomal
DNA in each cell that undergoes replication, beginning with the process of mitosis, and
because of the process of correcting the results of replication. This correction process
will cut and repair the abnormal DNA sequence system before the mitosis process
occurs. However, every action to protect abnormal cells, does not rule out the possibility
of one of every new cell formed has mutational properties which subsequently develop
into cancer, if the body's antibodies cannot prevent its development.

2.3 Anatomy of Physiolog

The anatomy of the uterine device was differentiated into 2 namely external and
internal genetalia. 1. External genetalia
a. Monsveneris c. Himen
b. Vulva d. Perinium
2. Internal genetalia
a. Uterus
b. Ovarium
c. Tuba Fallopi
2.4 Etiologi
Cervical cancer occurs if cervical cells become abnormal and divide
uncontrollably, if cervical cells continue to divide, a mass of tissue called a tumor that
can be benign or malignant will form, if the tumor is malignant then the condition is
called cervical cancer. The cause of abnormalities in cervical cells is not known with
certainty, but there are several risk factors that influence cancer.
Causes of cancer from the outside:
 Smoking
 First sexual intercourse is done at an early age (less than 17 years) and changing
sexual partners
 husband or sexual partner first sexual intercourse at the age of 18 years, changing -
changing partners and never married a woman suffering from cervical cancer
 Use of DES (Diethilstilbestrol) in pregnant women to prevent miscarriage
 Use of birth control pills
 Genital herpes infection or chronic chlamydal infection
 Nutrition Deficiency
 The economy is weak

2.5 Clinical Manifestations / Signs of Cervical Cancer

1. Leucorrhoea that is increasingly smelly due to infection and tissue necrosis.
2. Bleeding experienced immediately after intercourse (75% - 80%).
3. Bleeding that occurs outside of intercourse.
4. Spontaneous bleeding during defecation.
5. Bleeding between menstruation.
6. The feeling of heaviness below and the dry feeling of divagina.
7. Anemia due to recurrent bleeding.
8. Pain due to infiltration of tumor cells into nerve fibers.

2.6 Prevention of Cervical Cancer

1. Primary prevention
Primary prevention of cervical cancer is an activity that can be done by
everyone to avoid themselves from the factors that can cause cancer. Communities
that carry out prevention at this level will be free from suffering, productivity goes on,
does not require costs for examination, treatment, rehabilitation and further care. One
part of primary prevention is to provide a Human Papilloma Virus (HPV) vaccine,
administering an HPV vaccine will eliminate HPV infection.
2. Secondary Prevention
Early detection and screening are secondary prevention of cervical cancer. The
purpose of secondary prevention is to find cases early so that the possibility of cure
can be increased. In addition, it aims to slow down or stop the disease at an early
 stage. Secondary prevention through early diagnosis of dysplasia in various clinical
and laboratory ways. Secondary prevention has disadvantages, including:
 Secondary prevention does not prevent the occurrence of NIS (CIN)
 But new precancerous lesions detected in secondary prevention often cause
morbidity to the patient's fertility function
 Secondary prevention or will experience obstacles in developing human resources
and tools.
3. Tertiary Prevention
The purpose of tertiary prevention is to prevent disease complications and
treatment, after clinical symptoms develop and the diagnosis has been established.
There are two treatments for tertiary prevention, namely:
a. Prevention of Pre-cancer
 cautery is to electrically burn the cervix
 Cryosurgery ie the cervix is frozen to minus 80-180 degrees Celsius using CO2 or
N2O gas
 Konisasi is to cut a portion of the cervix that is representative enough with an
ordinary knife or electric knife
 Surgery (hysterectomy) if the patient does not want to have another child
 Laser beams used under the supervision of a kalposcope, radium heating radium
needles are used if an elderly patient is afraid of surgery
b. Treatment for Invasiv e Cancer
Treatment of invasive cancer in the form of radiation, surgery or a combination of
surgery and radiation.

2.7 Classification
1. Dysplasia
Dysplasia is an active growth accompanied by disruption of the squamous
epithelial maturation process which starts in the basal part to the superficial layer.
Based on the degree of change in epithelial cells that clearly change. Dysplasia is
divided into three degrees of growth, namely:
 Mild dysplasia: changes occur in the basal third of the epidermis
 Moderate dysplasia: when changes occur in half the epidermis
2. Carcinoma In Situ (KIS)
Changes in epithelial cells found in carcinoma in situ occur in all layers of the
epidermis into squamous carcinoma but the basement membrane is intact.
3. Microinvasive carcinoma
The scope of the others is from dysplasia to neoplasia. In microinvasive
carcinomas, changes in the degree of cells increases tumor cells through the
membrane of the catalyst. Usually the tumor is asymptomatic and is only found in
cancer screening or is found to coincide with the examination of other diseases in the
cervix. On physical examination, there are no changes in the portion, but with a
Kalposcopy examination, it can be predicted that there is a pre-carcinoma.
4. Invasive carcinoma
 The degree of cell growth is prominent, the size and shape of cells from cells
varies, the nucleus is dark, chromatin is grouped unevenly, and the cell structure is
increasingly irregular. A group or more tumor cells invade the basement membrane
and infiltrative plants into the stroma. Invasive carcinoma is divided into 3 subtypes
namely squamous cell carcinoma with creatine, squamous cell carcinoma without
creatine and small cell carcinoma. At this stage the cancer has become so widespread
that healing is difficult.

2.8 Diagnosis
1. Sitologi
Cytology examination is known as pap smear examination. Cytology is useful for
detecting cervical cells that show no symptoms, with a level of accuracy reaching
90%.
2. Kalposcopy
Kalposcopy is a cervical examination using a calposcopy device, a device that is
likened to a low-powered microscope with magnification between 6-40 times and
there is a light source in it. Kalposcopy can increase the accuracy of cytology to 95%.
3. Biopsy
Biopsy is carried out in an abnormal area if the squamous-columnar (SSC)
junction is seen entirely using a kalposcopy. Biopsy must be done properly and the
biopsy tool must be sharp and must be preserved in 10% formalin solution so that it
does not damage the epithelium.
4. Conization
 The process is suspected to be in the endocervix
 The lesion was not completely seen with a kalposcopy examination
 There is a gap between cytologic and histopathological outcomes

CHAPTER 3
METHOD OF THE PROJECT

3.1 Participant
a. Location : Central java health center
 b. Target : 40 people
c. Target : Women of childbearing age of 20-40 years
d. Time : 08-00 WIB - Done
e. Day : Sunday
f. Date : 23 March 2020
g. Place of execution : Public health center
h. Presenter 1 : Dandi Irawan
i. Presenter 2 : Annisyah Nuradabyah

3.2 Trem of Reference

1. Definition or understanding of cervical cancer
2. Difference between tumor and cancer
3. Factors that cause cervical cancer
4. Signs and symptoms of cervical cancer
5. Risk factors for cervical cancer
6. Prevention of cervical cancer
7. Diagnosis of cervical cancer
8. Management of cervical cancer

3.3 Schedule of Activities

Time Activity
08.00 - 08.10 Registration
08.10 - 08.30 Opening and greeting
08.30 - 08.40 Snack distribution
08.40 - 09.30 Providing material (Sesion 1 )
09.30 - 09.40 Asking questions
09.40 - 10.00 Answer the question
10.00 - 10.50 Providing material (Sesion 2 )
10.50 - 11.10 Asking questions
11.10 - 11.30 Answer the question
11.30 - 11.40 Giving souvenirss
11.40 - 12.00 Closing ceremony

3.4 Term of References

Presenter Material
Dandi Irawan -Definition or understanding of cervical cancer
-Difference between tumor and cancer
-Factors that cause cervical cancer
-Signs and symptoms of cervical cancer
Annisyah Nuradabyah -Risk factors for cervical cancer
-Prevention of cervical cancer
-Diagnosis of cervical cancer
-Management of cervical cancer
Appendix
List of Budget
 No Description Quantit Unit Unit Price Amount
y
1 Secretariat
- Proposal and LPJ 2 Pcs Rp 40.000 Rp 80.000
2 Consumtion
- Snack 50 Wrab Rp 5.000 Rp 250.000
3 Souvenirss
-spoon 50 Wrab Rp 3.000 Rp 150.000
4 Equipment
-Banner 1 2x1 Rp 85.000 Rp 85.000
-Peminjaman tenda 2 Pole Rp 750.000 Rp 1.500.000
-Brosur & pamphlet 50 Pcs Rp 3.000 Rp 150.000
5 Transportation
-Transportation 1 Bus Rp 300.000 Rp 300.000
-Highway 1 Pcs Rp 150.000 Rp 150.000
6 Health
-P3K 1 Pack Rp 50.000 Rp 50.000
Total : Rp 1.216.500

CHAPTER 4
CONCLUSION AND RECOMENDATION

Considering that cervical cancer in Indonesia is still at the top, efforts should be
made to overcome or at least reduce the incidence of cervical cancer . Noting the importance
of education about this, we recommend that counseling activities about cervical cancer at
least 2 times a year . The goal is to be born women who understand the dangers of cervical
cancer and are able to socialize its prevention to the wider community , and be able to make
women aware of the importance of preventing an illness early on with a good pattern of
prevention and being able to anticipate other life risks.

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Dr.Makasari,D.(2016).Sebaran Kanker di indonesia,Riset Kesehatan dasar.Indonesian jurnal
of cancer Vol.11.no.1.Retrive from http://indonesianjournalofcancer.or.id/ejournal/
index.php/ijoc/atricel/view/494