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GEN
ABNORMAL
YANG MENETAP
What is the Structure of the
Breast?
• The breast is composed mainly of fatty
tissue, which contains a network of
lobes made up of tiny, tube-like
structures called lobules that contain
milk glands
Tis - - 1.3 % - - - -
Unclas-
- 0.8 % - 2.9 % - - -
sified
Adopted from Ramli M. Epidemiological Review of Breast Cancer in Indonesia, 1995
Picture 1. Distribution of locally
advanced breast tumor in cipto
mangunkusumo hospital (2008 – 2012)
FAKTOR RESIKO
1. Haid pertama < 16 tahun
2. Menopause > 50 tahun
3. Tidak pernah menyusui anak
4. Melahirkan anak I : > 35 tahun
5. Pernah ada tumor jinak mammae
6. Usia > 30 tahun
7. Riwayat keluarga : (+)
8. Terapi hormon yang lama
9. Obesitas
10. Radiasi
Faktor resiko
Benjolan di payudara
Penebalan
Nyeri
Oedema kulit
Kanker Payudara
Skin dimpling
Nipple discharge
Paget`s disesase
Early detection is the best
protection
HAMBATAN PROGRAM DETEKSI DINI
• PENGOBATAN ALTERNATIF
• PENDIDIKAN MASYARAKAT
• SDM TENAGA MEDIS
• PERALATAN
• SOSIAL EKONOMI
• KEADAAN GEOGRAFIS
KEUNTUNGAN DETEKSI DINI
Screening
Mammography
21
Pemeriksaan Payudara
• Breast Self Examination (SADARI)
• Clinical Breast Examination (Pemeriksaan
Dokter)
• Pemeriksaan Penunjang: Mamografi
- ultrasonografi
- MRI, dll
BREAST SELF EXAMINATION
(SADARI)
• Tujuan: Mampu mengenal topografi
•Clustered
microcalcification
•Masses
•Architectural distortion
and asymmetries
BIRAD (Breast Imaging Reporting and
Data System)
1.Normal
2.Benign
3.Suspicious benign, follow up
4.Suspicious malignant, should be biopsy
5.Malignant, biopsy
AMERICAN CANCER SOCIETY
1. Wanita >20th SADARI tiap bulan
2. Wanita 20-40th, tiap 3th periksa ke dokter
3. Wanita>40th, tiap th periksa ke dokter
4. Wanita 35-40th, base line mammografi
5. Wanita<50 th, konsultasi ke dokter utk
mammografi
6. Wanita >50th, tiap th mammografi
7. Wanita dg riwayat keluarga (+),
mammografi dini
Summary of American Cancer Society
Breast Cancer Screening Guidelines
• Annual mammogram starting at age 40
• Breast clinical exam age 20-40 every 3 years,
annual clinical exam beginning at age 40
• Optional breast self-exam beginning at age 20
• Women to be informed of the benefits and
harms of mammographic screening
• High-risk women: additional annual breast MRI
as adjunctive to mammography
Ultrasound
Biopsi
CHARUSHEELA ANDAZ, MD
Associate Director
Division of Breast Surgery
Treatment of breast cancer depends on:
– Size of the tumor (T)
– Invasive or in situ
– Lymphnode (N)
– Metastase (M)
STAGING
• Surgery
• Radiation therapy
• Chemotherapy
• Hormonal therapy
• Targetted therapy
Beberapa tehnik pembedahan
pada keganasan payudara
• BCT
• Skin sparing mastektomi & nipple sparing
• Klasik mastektomi, MRM
• Semua tindakan diatas dengan rekontruksi segera/
ditunda
- LD
- TRAM
- SILIKON
- BCT dgn reduksi payudara
- graft lemak / dermal fat graft
Definisi BCT
• Tumorektomi / lumpektomi
• Segmentektomi/quadrantektomi
• Diseksi aksila
• Radioterapi
syarat
• Margin –
• Kosmetik Skin sparing
• radiasi Modified BCT
Breast conserving treatment(BCT)
Mastektomi Radikal Modifikasi
Rekonstruksi Payudara dengan
TRAM
• Radiation
- Adjuvant therapy
- Syarat ??
• Chemotherapy
- Neoadjuvant ( LABC)
- Adjuvant
• Hormonal therapy
- Hormonal Reseptor ( ER/PR)
• Targetted Therapy
- Her-2Neu