20th Group

Members: Nana Sri Rahayu Roberta Charles Sri Rahayu Nurul Fadila Firman Fajar Satria Pratama Mitra Nofembri Yenti Dian Arfan As Bahri Humaira Ulfa Herman Fitri Amelia Rizki

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Fitas Research
Fita is currently listed as a second-year student of the Faculty of Medicine, University of Andalas. She is confuse because her mother (46 years old) will undergo a total hysterectomy, with a diagnosis of endometrial cancer. Complaints of the mother's menstrual cycle disorders Fita was three years ago, according to a doctor who is medically called menorrhagia and metroragia. Although it has been getting therapy drugs, but there is no improvement. Therefore, doctors recommend to perform curettage. These actions were taken to reduce bleeding and also establish the diagnosis. Fita see anatomic pathology examination showed atypical cells of the uterine lining. Fitass family wonder why the mother could suffer from the disease, as far as they know Fitas mom is keeping health, food and exercising regularly. Fita looking for information about endometrial cancer in journals. Search results mentioning that in about 40% of patients did not show any risk factors. Premenopausal women, it may be difficult to distinguish between normal menstruation and abnormal bleeding. Further mentioned, other factors associated with endometrial cancer, including obesity, diabetes mellitus, and hypertension.

There are approximately 297 incident cases diagnosed each year, according to

the cancer registry 2005-2009. This is for the fourth most common cancer in women in
Indonesia. This disease has a case fatality rate is smaller than the cervical cancer in women, ie by 43%. Some journals mention that the survival rate of endometrial cancer is still at an early stage. Fita be interested in studying this disease in the department of dr. M.Djamil as thesis research topic. The purpose of research is to determine the other risk factor that associated with this cancer. Furthermore, the expected results of this study can be used as a promotive and preventive efforts for the community in order to reduce morbidity and mortality, as well as increase the life expectancy of patients with endometrial cancer. Fitas teacher support her plans and suggested to look for a good code of endometrial cancer in ICD-10 and ICD-O for the benefit of cancer registry. How do you help Fita explain the basic principles of Evidence Based Medicine Clinical Epidemiology for the endometrial cancer?

I. TERMINOLOGY
a. Total hysterectomy: surgical removal of the uterus and cervix, but without ovaries and fallopian tubes

b. ICD-10: Classification statistics consisting of alphanumeric

code that describes the entire disease c. ICD-O: Part of ICD specifically for neoplasm / tumor d. Cancer registry: collection, recording, and processing of data about cancer constantly based on demographic data,

diagnosis, disease, frequency of occurrence, and patient

survival were used as information for research and research

e. Incident: The description of the number of new cases of a

population at a particular period

f. CFR: Comparison of the number of deaths of a disease with the disease within a certain period

g. Survival rate: The number of people surviving cancer is

already at diagnosis h. Curettage: Medical action to clean up the rest of the pregnancy, fetal death less than 20 weeks, the fetus is not growing (only the placenta), and uterine bleeding

II.PROBLEM IDENTIFICATION
1. How can doctors diagnose endometrial cancer to Fitas mother? 2. Are there any consequences caused by a total hysterectomy?

3. Why endometrial cancer can cause menorrhagia and metroragia?

4. What therapy in endometrial cancer that can be given in addition to hysterectomy? 5. How the relationship of atypical cells were found with endometrial cancer?

6. What causes 40% of patients with endometrial cancer showed no

risk factors?

7. Why CFR endometrial cancer have a smaller value than cervical cancer? 8. Why obesity, diabetes mellitus, and hypertension can cause

endometrial cancer?
9. How calculate the value of the CFR? 10. How the role of ICD-O in the interest of cancer registration? 11. Why doctors do not recommend curettage from the beginning? 12. Why health promotion needs to be done for the community?

III. Analysis of the Problem

1. a. -of the complaint, namely metroragia and menorrhagia -Due to the growth of cancer cells, the growth of the cells and also occurs vascularization epitelnya -due to hormonal imbalance, leading to cancer cell growth b. -the lack of effect of drugs, so that the necessary anatomic pathology examination 2. If the uterus removed it can cause a woman can no longer menstruate, so it can be said to have a forced menopause 3. Occurs due to an imbalance of the hormones estrogen and progesterone. Increased estrogen but not accompanied by progesterone may lead to the decay of the uterine wall / bleeding

4. Endometrial cancer can be treated first with a total hysterectomy. However, if metastasis has occurred, given chemotherapy, radiotherapy, and hormonal therapy 5. Malignant tumors: a change in cell Atypical cells: indicate malignancy in the organ. Description of the cell is a cell different from each other, both in terms of size, shape,

and others are caused due to the imperfect differentiation

6. -Obesity: causes an increase in the hormone estrogen -hypertension: the amount of about 25-70% of cases -Diabetes Mellitus: due to an increase in insulin can also increase levels of the hormone estrogen

-Hormonal therapy: for example, tamoxifen

7. -research-based (epidemiological) existing

-cause of endometrial cancer based on environmental factors -due to chronic and degenerative diseases 8. -CFR goal is to know the disease that causes the most deaths. -Metastatic endometrial cancer is lower than cervical cancer -CFR: (The number of people died / number of people living)*100% 9. The same answer as number 6

10.The same answer as number 8

11. Role of ICD:

-ICD data have been obtained put cancer registration data,

then collected in a data bank. The goal is as a source of data for research in the field of epidemiology 12.because it feared the wall would be damaged endometrium 13. goals:

-memelihhara, improve, and protect public health

-reduce morbidity and mortality, as well as Enhancing quality of life

-Early detection of cancer, so that morbidity and mortality can

be reduced

IV. Systematics
Indicators and Measurement EPIDEMIOLOGY

Disease Research identify risk factors promotive and preventive

ICD-10

ICD-O

morbidity and mortality dropped

recording and reporting of disease

disease management

V. Learning Objective
1. Terminology in epidemiology 2. Indicators and measures used in epidemiology 3. Factors affecting the accuracy of the measurement of epidemiology 4. Epidemiological role in the management of the disease (chronic and degenerative) 5. Recording and reporting of disease (chronic and degenerative) 6. Health promotion and chronic degenerative diseases 7. Registration disease and IDC-10 8. Registration Disease and ICD-O