Strategi Penanggulangan

Kanker Servik
dr. Yahya Irwanto
Sp.OG(K)Onk
Divisi Onkologi Ginekologi
RSSA/FKUB
RS Melati Husada
081334508205
 OUTLINE

1. Histology
2. Causes
3. HPV
4. Pathophysiology
5. Sign and Symptoms
6. Diagnosis
7. Treatment

MOGU, Malang 05-02-2017

Histology
Risk Factors

Immunosuppr
Sex at young
esion : HIV

LKB1
HPV Smoking

Multiple
History of
Sexual
STDs
Partners
 HPV
Low risk (6,11)

Condyloma

High risk (16,18)

CIN

(Sakaguchi 2001)
Outcome of Genital HPV
Infection
 Cervical
Cancer Types Squamous cell
carcinoma (75%, most
common).

Adenocarcinomas & mixed

adenosquamouscarcinoma
(20%)
Small cell
neuroendocrine
carcinoma (<5%)
 Cervical Carcinoma

Squamous cell carcinoma

Signs and Symptoms :
- Metrorrhagia
- Vaginal bleeding
- Discharge
- Cervical ulceration
Complications
 Screening Diagnosis

Pap smea is the gold standart for screening

cells are scraped from the transformation
zone
screning starts at 21 or 3 years after first
sexual activity
then anually until age 30, then every 2-3
years if 3 normals
if abnormal result are found --> Colposcopy
and biopsy
 10 Kasus Kanker Terbanyak
Tahun 2014
No. Diagnosa Jumlah Kasus Jumlah Biaya

1 breast 60.097 175.185.828.302

2 ca-cervix 19.229 67.515.289.020

3 Nasopharynx 9.806 37.945.425.500

4 lung 8.922 59.781.758.391

5 ovary 8.836 46.114.457.729

6 rectum 7.804 50.265.558.480

7 colon 5.608 40.028.979.310

8 thyroid 5.607 20.017.042.114

9 skin 5.231 15.481.152.912

10 prostate 4.108 16.227.319.152

Grand Total 135.248 528.562.810.910

www.bpjs-kesehatan.go.id 1-500-400
 SEROKONVERSI
7-8 TAHUN
INFEKSI INFEKSI RATA-RATA KLASIK 15 TH
AWAL 9 BULAN
RESPON IMUN

Sustained clinical
remission 8-30 M
9,8 months
75-90%
Incubation Active growth Host DNA-ve
(16 months) (36 months) containment
(36 months) Re-infeksi
10-25%

DNA-ve DNA+ve PERSISTEN

INFEKSI BERULANG

8,9-14,8 months 4,5

2,3

4 TH

High grade lesion

PERJALANAN KANKER SERVIKS
2 TH

KANKER SERVIKS
Modified from Stanley M. Vaccine 2006;24S1:S1/1622.
(2). Molden T, et al. Int J Cancer.2005:973-6. (3) Rozendaal L, etal. Int J Cancer 1996;68:766-9 (
4).Franco EL, etal. J Infect Dis 1999;180:1415-23. (5)Munoz N, etal. J Infect Dis 2004;190:234-42
Cervical Cancer Management:
Back to Basic Concept
NETWORK Surveillance

Improved
PRIMARY SECONDARY TERTIARY Screening
PREVENTION PREVENTION PREVENTION Coverage
Prevent contact Screening, Treatment (70-80%)
with carcinogen early detection & of positive cancer,
(HPV) treat precancer or rehabilitation &
early invasive palliative care
HPV Vaccine
lesions Coverage

Pap-Smear Reduced
Promotion VIA screening
Treatment advanced
HPV Vaccine Treatment stage Ca.

Training
Reduced
Training Training mortality rate
STRATEGI
IVA
SKRINING PAP SMEAR
HPV-DNA TEST

VAKSINASI
 SCREENING METHODS FOR
CERVICAL CANCER
IVA
Konsep Sistem Rujukan
Kanker Mulut Rahim

110 RS
Rujukan
Regional

14 RS
PALIATIF Rujukan
CARE Nasional &
20 RS
Rujukan
Propinsi
RUJUKAN
PEMERIKSAAN IVA

IVA POSITIF CURIGA KANKER

LGSIL BIOPSI
HGSIL SpOG

K.Onk POSITIF KANKER

PERANAN PROFESI (BIDAN)

PELAKSANA SKRINING, EDUKASI

PERANAN PROFESI
(DOKTER UMUM)
PELATIHAN SKRINING
SUPERVISI
KONSULTASI
PELAKSANA PROGRAM
EDUKASI
BIDAN

PENATALAKSANAAN IVA POSITIF

TERAPI KRIO
PERANAN PROFESI (POGI)
PELATIHAN SKRINING
SUPERVISI
KONSULTASI
PELAKSANA PROGRAM
EDUKASI
BIDAN
DOKTER UMUM

PENATALAKSANAAN IVA POSITIF

KRIO,LEEP, LLETZ, KAUTERISASI
 Skrining Kesehatan
IVA & Papsmear
PMK No.
Pelayanan skrining kesehatan tertentu merupakan 28 Th
pelayanan yang termasuk dalam lingkup non-kapitasi, yang 2014
dilaksanakan sesuai dengan ketentuan peraturan
perundang-undangan.
Pelayanan pemeriksaan penunjang diberikan kepada peserta BPJS Kesehatan yang
telah mendapatkan analisis riwayat kesehatan dengan hasil teridentifikasi
mempunyai resiko penyakit tertentu
Pelayanan pemeriksaan penunjang skrining kesehatan yang dijamin oleh BPJS
Kesehatan adalah:
1. Pemeriksaan IVA
2. Pemeriksaan Pap smear
3. Pemeriksaan Gula Darah Puasa
4. Pemeriksaan Gula Darah Post Prandial
Tarif pemeriksaan :
1. Pemeriksaan IVA Maksimal Rp 25.000,00
2. Pemeriksaan Pap Smear Maksimal Rp. 125.000,00
3. Pemeriksaan Gula Darah Rp 10.000,00 sd Rp 20.000,00
Khusus untuk kasus dengan pemeriksaan IVA positif dapat dilakukan
pelayanan terapi Krio Rp. 150.000,00
www.bpjs-kesehatan.go.id
021 500 400 1-500-400
www.bpjs-
PROGRAM VAKSINASI

VAKSINASI NASIONAL
PROPINSI/KABUPATEN

DUA DOSIS USIA 9-14 TAHUN

( 12 TAHUN )
PROGRAM VAKSINASI

VAKSINASI
NON PROGRAM

TIGA DOSIS
USIA > 14 TAHUN
CERVICAL CANCER

1. Bisa dicegah

2. Temukan sedini mungkin

 5 Years Survival in Cervical Cancer according
to FIGO Staging

Stage Cases 5 year survival

rate
I 33.179 97,4%
IA 9.528 99,3%
IB 15.084 99,2%

II 3.475 80,2%
III 2.651 59,6%
IV 3.284 28,6%

SEER data, 1988-2001. note figure are for the old staging system