Payudara dan kelainanya

Benny Kusuma, dr., SpB (K) Onk.MARS

BAG/SMF ILMU BEDAH
FK UNSRI / RSMH PALEMBANG
4 Maret 2019
Setelah mengikuti pembelajaran ini peserta mampu :
• Melakukan pemeriksaan fisik payudara
• Membuat diagnosis kelainan payudara
• Menjelaskan terapi kelainan payudara
ANATOMI
EPIDEMIOLOGI
 Cancer statistics, 2015

CA: A Cancer Journal for Clinicians

Volume 65, Issue 1, pages 5-29, 5 JAN 2015 DOI: 10.3322/caac.21254
http://onlinelibrary.wiley.com/doi/10.3322/caac.21254/full#caac21254-fig-0001
 Epidemiologi kanker
Negara yang sedang
berkembang
Perkiraan Kasus Baru Perkiraan Kematian

Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69-90
Breast cancer is the most common cancer in
women worldwide.
 Stage distribusi of breast cancer arround the world
Centre Is To T1 T2 T3 T4

UK 10 % 2% 36 % 44 % 8% 0%
Australia 0% 0% 52 % 36% 12 % 0%

Hungaria 9% 0% 56 % 32% 6% 2%

Turkey 0% 4% 26 % 48% 14 % 8%
Mexico 0% 1% 14 % 35% 20 % 30 %
Oman 0% 0% 10 % 45% 14 % 31 %
Pakistan 0% 0% 4% 68% 24 % 4%

Bangladesh 0% 0% 6% 32 % 53 % 9%
Kenya 0% 0% 0% 0% 76 % 34 %
Brazil - - 20 % 48 % 26 % 6%
Uganda 3% - - 5% 35 % 59 %

EBCC 9. 21 maret 2014 International prevention Reseach Intitutr

Epidemiologi BC di Asia

The burden of cancer in Asia. Pfizer facts.

Diagnosed with Breast Cancer1
 Breast Cancer Facts in Indonesia
• Breast Cancer – Most Common Cancer Affecting
Indonesian Women1
• 0.5 % prevalence
• 61,682 estimation absolute number

• Leading Cause of Cancer Death among

Indonesian Women1
• 19,750 Indonesian women die from breast cancer
each year – That is 54 women each day – at least
11 were HER2-positive breast cancer2

• 22.8% of Indonesian Women are diagnosed with

HER2-positive breast bancer in 20163
• HER2-positive is a marker of aggressive breast cancer

References:
1. Infodatin Kemenkes 2015.
2. International Agency for Reasearch on Cancer. 2016. ” GLOBOCAN 2012 : Estimated Cancer Incidence, M
3. ortality and Prevalence Worldwide in 2012.” Web. 30 November 2016. <http://globocan.iarc.fr/Pages/fact_sheets_population.aspx>
4. N Pathmanathan et al Asia-Pac J Clin Oncol 2016
Angka kejadian dan kematian Kanker (Sumber: Global Cancer Statistic, 2019)
 Genomics of Breast Cancer:
Breast Cancer is NOT One Disease!

Sorlie et al, Proc Natl Acad Sci 100:8418, 2003

Subtipe Kecenderungan tumor* Prevalensi

Luminal A ER(+) dan/atau PR(+), HER2 (-), Ki67 40%

rendah

Luminal B ER(+) dan/atau PR(+), HER2 (+). Ki67 20%

tinggi

Triple negative/basal-like ER(-), PR (-), HER2(-) 15-20%

Tipe HER2 ER(-), PR(-), HER2 (+) 10-15%

* = Gambaran umum untuk tiap subtipe. Namun, tidak semua tumor pada subtipe tersebut selalu memiliki sifat atau

kecenderungan seperti yang disebutkan pada tabel.

soal
 DX

Natural History
Cancer treatment

Natural History DX

Therapy
•Surgery
•Systemic therapy
•Endocrine therapy
•Chemotherapy
•Biologic therapy
SISTEM LIMFATIK

1Snell, Richard A. 2011. Anatomi Klinis. Jakarta : Penerbit Kedokteran EGC

7 Schwartz, et al, Intisari Prinsip-prinsip Ilmu Bedah, Edisi Keenam, EGC, Jakarta: EGC, 2015.
 Keluhan utama
Status tumor terakhir

- Benjolan
- Nyeri
- Krusta Nipple
- Nipple Discharge
(Ackerman, del Regato)
 STADIUM KLINIS

Klasifikasi Kanker Payudara berdasarkan Sistem TNM

(UICC/AJCC)

STADIUM T N M
0 Tis No Mo
I T1 No Mo
II A To N1 Mo
T1 N1 Mo
T2 No Mo
T2 No Mo
II B T2 N1 Mo
T3 No Mo
STADIUM T N M

III A To N2 Mo

T1 N2 Mo

T2 N2 Mo

T3 N1-N2 Mo

III B T4 Tiap N Mo

Tiap T N3 Mo

IV Tiap T Tiap N M1
T : tumor primer
Tis : karsinoma in situ
T1 : diameter tumor < 2 cm
T2 : diameter tumor 2-5 c
T3 : diameter tumor > 5 cm
T4 : tumor telah menginvasi jar. diluar
mamma
T4a : dinding dada
T4b : kulit mama
T4c : dinding dada dan kulit
T4d : tumor dg inflamasi

Tx : tumor primer tdk dpt dievaluasi

N : metastase KGB regional
No : tdk terdapat metastase KGB reg.
N1 : ada metastase KGB axilla yg mobile
N2 : ada metastase KGB axilla yg melekat
N3 : metastase KGB mammaria interna
Nx : metastase axilla tdk dpt dievaluasi

M : metastase jauh
Mo : tdk ditemukan metastase jauh
M1 : ada metastase jauh
Mx : metastase jauh tdk dpt dievaluasi
 FAKTOR RESIKO

Radiasi

Familial

Hormonal

Diet dan “Life Style”

Lesi Benigna Payudara

Wood WC, 2005
 KARSINOGENESIS

11 Stricker TP, Kumar V. Neoplasia. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbins and
Cotran Pathologic Basis of Disease, Eighth Edition. Philadelphia: Saunders; 2010.
Karsinogenesis (Sumber: Kumar, 2010)
DIAGNOSIS KLINIS KANKER PAYUDARA

 Anamnesis T N M

 Pemeriksaan Fisik

 Pemeriksaan Penunjang
Sederhana
(Martatko)
 Anamnesis

TUMOR
–Tumor saat datang
–TDT kasar
–Tanda keganasan
NODUL

Metastasis
 Pemeriksaan Fisik

Inspeksi

Palpasi
Konsistensi
Permukaan
Terfiksasi ; + / -
Ukuran
 Pemeriksaan Penunjang

1. Darah rutin
2. Thorax photo
3. USG
4. Mammografi
Mammography
Detection of Malignant Masses

Malignant masses have a more spiculated appearance

benign malignant
 Diagnosa Klinis

• Tumor Payudara Suspek Jinak

- DD : FAM dll
• Tumor Payudara Suspek Ganas
» DD : IDCM T.. Nx Mx Stadium xxxx
ILCM T ..Nx Mx Stadium xxxx
 TERAPI KANKER PAYUDARA

OPERASI
HORMON
KEMOTERAPI
RADIASI
TARGETING TERAPI
 OSCE
Education
 TERAPI KANKER PAYUDARA

Farmakologi
SIMTOMATIS
obatan 2an ( kemoterapi, hormonal,
targeting terapi)
Non Farmakologi
operasi
Radiasi
 DIAGNOSIS PASTI

Renca Tindakan
A. STd I. II. IIIA.
Biopsi + persiapan Operasi Mastektomi

B. STd IIIB . IV
Kemoterapi
 Ductal Carcinoma in situ
(DCIS)

Ductal
cancer cells

Normal
Carcinoma refers to any ductal cell
cancer that begins in
the skin or other
tissues that cover
37 internal organs
llustration  Mary . Bryson
 Invasive Ductal Carcinoma

Ductal cancer cells

breaking through the
wall

• The cancer has spread to the

surrounding tissues

38
llustration  Mary . Bryson
Range of Ductal Carcinoma in situ

llustration  Mary . Bryson

 Invasive Lobular Carcinoma (ILC)

Lobular cancer
cells breaking
through the wall

llustration  Mary . Bryson