Carcinoma Mammae

Disusun oleh:
Jefferson Nicklaus (1015170)
Maria Florensia Delong (1015155)
Selfa (1015059)
Virgina Destiana Suhendar (1015038)

Pembimbing : dr. Danny Ganiarto Sugandi, SpB

Anatomy of Breast

 Mammae  perm. ant thorax  dpn

M. pectoralis major, M. serratus
anterior, M. obliquus externus
abdominis.
 Mammae  glandula mammaria +
jaringan lemak
 Kuadran lateral atas mammae  >>>
Gld. Mammaria.
Definisi
Tumor payudara adalah benjolan tidak normal akibat
pertumbuhan sel yang terjadi secara terus menerus. Dalam
klinik, istilah tumor sering digunakan untuk semua tonjolan dan
diartikan sebagai pembengkakan yang dapat disebabkan baik
oleh neoplasma maupun oleh radang, atau perdarahan.
Neoplasma membentuk tonjolan, tetapi tidak semua tonjolan
disebabkan oleh neoplasma.
 KLASIFIKASI TUMOR PAYUDARA
Berdasarkan WHO 2003
 Epithelial tumors ● Metaplastic carcinomas
● Invasive ductal carcinoma, not otherwise specified (NOS) ● Pure epithelial metaplastic carcinomas
● Mixed type carcinoma ● Squamous cell carcinoma
● Pleomorphic carcinoma ● Adenocarcinoma with spindle cell metaplasia
● Carcinoma with osteoclastic giant cells ● Adenosquamous carcinoma
● Carcinoma with choriocarcinomatous features ● Mucoepidermoid carcinoma
● Carcinoma with melanotic features ● Mixed epithelial/mesenchymal metaplastic carcinomas
● Invasive lobular carcinoma ● Lipid-rich carcinoma
● Tubular carcinoma ● Secretory carcinoma
● Invasive cribriform carcinoma ● Oncocytic carcinoma
● Medullary carcinoma ● Adenoid cystic carcinoma
● Mucinous carcinoma and other tumours with abundant mucin ● Acinic cell carcinoma
● Mucinous carcinoma ● Glycogen-rich clear cell carcinoma
● Cystadenocarcinoma and columnar cell mucinous ● Sebaceous carcinoma
carcinoma ● Inflammatory carcinoma
● Signet ring cell carcinoma ● Lobular neoplasia
● Neuroendocrine tumours ● Lobular carcinoma in situ
● Solid neuroendocrine carcinoma ● Intraductal proliferative lesions
● Atypical carcinoid tumour ● Usual ductal hyperplasia
● Small cell / oat cell carcinoma ● Flat epithelial atypia
● Large cell neuroendocrine carcinoma ● Atypical ductal hyperplasia
● Invasive papillary carcinoma ● Ductal carcinoma in situ
● Invasive micropapillary carcinoma ● Microinvasive carcinoma
● Apocrine carcinoma
 KLASIFIKASI TUMOR PAYUDARA
Berdasarkan WHO 2003
Intraductal papillary neoplasms Myoepithelial lesions
● Central papilloma ● Myoepitheliosis
● Adenomyoepithelial adenosis
● Peripheral papilloma ● Adenomyoepithelioma
● Atypical papilloma ● Malignant myoepithelioma
● Intraductal papillary carcinoma Mesenchymal Tumors
● Intracystic papillary carcinoma ● Hemangioma
● Benign epithelial proliferations ● Angiomatosis
● Haemangiopericytoma
● Adenosis including variants: sclerosing ● Pseudoangiomatous stromal hyperplasia
adenosis, apocrine adenosis, blunt duct ● Myofibroblastoma
● Fibromatosis (aggressive)
adenosis, microglandular adenosis, ● Inflammatory myofibroblastic tumour
adenomyoepithelial adenosis ● Lipoma
● Radial scar / complex sclerosing lesion ● Angiolipoma
● Granular cell tumour
● Adenomas ● Neurofibroma
●Tubular adenoma ● Schwannoma
● Angiosarcoma
● Lactating adenoma ● Liposarcoma
● Apocrine adenoma ● Rhabdomyosarcoma
● Osteosarcoma
● Pleomorphic adenoma ● Leiomyoma
● Ductal adenoma ● Leiomyosarcoma
KLASIFIKASI TUMOR PAYUDARA
Berdasarkan WHO 2003
Fibroepithelial Tumors
● Fibroadenoma
● Phyllodes tumour
● Benign
● Borderline
● Malignant
● Periductal stromal
sarcoma, low grade
● Mammary hamartoma
Tumors of the nipple
● Nipple adenoma
● Syringomatous adenoma
● Paget disease of the nipple
Malignant lymphoma
● Diffuse large B cell lymphoma
● Burkitt lymphoma
● Extranodal marginal-zone
B-cell lymphoma of MALT
type
● Follicular lymphoma
Metastatic tumors - Tumors
of the male breast
● Gynaecomastia
● Carcinoma
● Invasive
● In situ
T – Tumor Primer
Tx : Tumor primer belum dapat dievaluasi
T0 : Tidak ditemukan tumor primer
Tis : Karsinoma in situ
T1 : Tumor dengan ukuran diameter terbesar ≤2 cm
T2 : Tumor dengan ukuran diameter terbesar 2-5 cm
T3 : Tumor dengan ukuran diameter terbesar >5 cm
T4 : Tumor telah menginvasi jaringan di luar mamma
T4a : dinding dada
T4b : kulit mamma
T4c : dinding dada dan kulit
T4d : tumor dengan inflamasi
N – Kelenjar getah bening regional
 Nx : Kelenjar getah bening regional belum dapat dievaluasi
 N0 : Tidak terdapat metastasis kelenjar getah bening regional
 N1 : Terdapat metastasis kelenjar getah bening axilla yang
mobile
 N2 : Terdapat metastase KGB axilla yang melekat
 N3 : Metastase KGB mammaria interna
 N4 : metastase axilla tidak dapat dievaluasi
M – Metastasis jauh
Mx : Metastasis jauh belum dapat dievaluasi
M0 : Tidak ada metastasis jauh
M1 : Terdapat metastasis jauh
Dasar Diagnosis
 Anamnesis
 Pemeriksaan Fisik
 Inspeksi
 Palpasi
 Teknik SADARI dapat diajarkan ke pasien
 Pemeriksaan Penunjang
 Mammografi
 USG
 Tumor marker :CEA, CA153
 Pemeriksaan PA ;
 Biopsi jarum
 Biopsi eksisi ( excisional biopsy )
Penatalaksanaan
 Berdasarkan Stadium
 In Situ Breast Cancer (Stadium 0)
 Early Invasive Breast Cancer (Stadium I, IIA, atau IIB)
 Advanced Local-Regional Breast Cancer (Stadium IIIA atau IIIB)
 Metastase Jauh (Stadium IV)
 Teknik Pembedahan
 Biopsi Eksisi dengan Lokalisasi Jarum
 Diseksi Sentinel Lymph Node
 Breast Conservation
 Modified Radical Mastectomy
 Rekonstruksi Payudara dan Dinding dada
Teknik Pembedahan