PENATALAKSAN

AAN PERAWATAN
LUKA
KANKER
 Tujuan Pembelajaran

Memahami proses karsinogenesis

Memahami proses terjadinya luka kanker

Memahami tujuan perawatan luka kanker

Mengidentifikasi masalah yang terjadi pada luka kanker

Melakukan penatalaksanaan masalah pada luka kanker

LUKA
KANKER
ANATOMI KULIT

http://healthncare.info/wp-content/uploads/2014/07/Skin-Cancer-Sign-and-Symptoms.png
 PATHOPHYSIOLOG
Y

Cancer has a complex Pathophysiology. Pathologists are physicians who are concerned primarily with the study of disease in all
its aspects. This includes cause of the disease, diagnosis, how the disease develops (pathogenesis), mechanism and natural
course of the disease. They also deal with biochemical features, progression, and prognosis or outcome of the disease.

Tumor suppressor genes – these genes normally inhibit cell division and prevent survival of cells that have damaged DNA. In
patients with cancer these tumor suppressor genes are often disabled. This is caused by cancer-promoting genetic changes.
Typically, changes in many genes are required to transform a normal cell into a cancer cell.
 MEDICAL INTERVENTION
• Operative (SIDE EFFECT: surgical break down
– dehisence )
• Radiation (SIDE EFFECT: desquamation)
• Chemotherapy (SIDE EFFECT: extravasation)

• Hormonal therapy
• Antibiotic for infection
• Pain control
 LUKA
KANKER
fungating malignant wound
malignant cutaneous wound.

• Proliferasi sel ganas

• Bentuk menonjol ,
• Non mobile,
• Bentuknya menyerupai
jamur
 LUKA
KANKER
Malignant cutaneous wounds are a
metastatic complication arising from a
primary malignancy. (Goldberg & McGinn-Byer,
2000)

Their incidence is difficult to establish but has

been reported in up to 9% of patients
with
cancer. (Schwartz, 1995)

Approximately 5-10% of patients with

metastatic cancer will develop a
fungating
wound. (Dowsett, 2022)

LUKA KANKER yang paling umum

terdapat pada payudara 62%,
kepala dan wajah 24% dan
selangkangan dan alat kelamin 3%.
 KHARAKTERISTI
K
Luka kanker biasanya terjadi
polimikroba dengan biofilm tebal
- mengandung bakteri aerob
dan anaerob yang menyebabkan
bau busuk dan menghasilkan cairan
purulen akibat nekrosis jaringan.

Bakteri anaerob mengeluarkan putresin

dan kadaverin dan bakteri aerob seperti
Proteus dan Klebsiellacan. (Rupert KL., 2020)
 Certified
Wound Care MASALAH KHAS LUKA
Clinician
Associate
KANKER

1. Bau tidak sedap

2. Cairan yang berlebihan
3. Perdarahan
4. Nyeri
5. Maserasi kulit sekitar luka
6. Infeksi
7. Mengganggu penampilan
8. Psychological Issue

The main difficulties nurses experienced

in the management of patients related
to malodour, pain and difficulties in
applying the dressings to the wound.
(Probst S, Arber A, Faithfull S. 2009)
 PENATALAKSAN
AAN
PERAWATAN LUKA
PALIATIF DAN
SEMBUH
SUPPORTIF
LUKA ATAU
KANKE TIDAK PERAWATAN
R SEMBUH ? KURATI
F

Creative dressing techniques can help restore the look of symmetry to the patient's body. Effective
wound management, debridement, and antimicrobial therapy can reduce the risk of infection. Wound cleansing,
through irrigation or flushing, should not cause pain, further trauma or bleeding. Dressings should maintain a
moist wound environment and not traumatize the wound upon removal.

A protocol is included which can be individualized to the needs of each patient and addresses assessment,
interventions, patient teaching, documentation, and expected outcomes.
 Certified
Wound Care
Clinician
PERAWATAN
PALIATIF
Associate

TUJUAN :
•MENINGKATKAN RASA NYAMAN

•MENINGKATKAN RASA PERCAYA DIRI

•MEMPERTAHANKAN / MENINGKATKAN
KUALITAS HIDUP LAYAK

FOKUS PERAWATAN:
MENGONTROL / MENGHILANGKAN
GEJALA YANG DITIMBULKAN
LUKA KANKER
 Certified
Wound Care
Clinician
KANKER DAN PELAYANAN
Associate
PALIATIVE
Diperkirakan sekitar 7.2 sampai
7.5 juta individu di dunia meninggal
karena kanker setiap
tahunnya.

Lebih dari 70%

penderita Kanker di negara sedang
berkembang meninggal, karena sarana dan
prasarana tidak mencukupi/ tersedia untuk
pencegahan, diagnosis, dan pengobatan.
 Certified
Wound Care
Clinician
DEFINISI
PALIATIF
Associate

• Pelayanan paliatif adalah

pelayanan kesehatan yang
bertujuan untuk
meningkatkan atau
mempertahankan kualitas
hidup pasien (dan
keluarganya) yang terbaik.
 FILOSOFI PELAYANAN
Fi PALIATIF
l
• Setiap orang berhak akan pelayanan kesehatan fisik-
psiko-sosial-spiritual yang terbaik
 Certified
Wound Care
Clinician
FILOSOFI PELAYANAN
Associate
PALIATIF

• Setiap orang berhak untuk

terbebas dari rasa
tidak nyaman, baik fisik,
emosional, spiritual, dan sosial
• Pelayanan paliatif terbaik
adalah melibatkan tim
kesehatan multi disiplin,
termasuk anggota keluarganya
 Certified
Wound Care
Clinician
FILOSOFI PELAYANAN
Associate
PALIATIF

• Pemberi pelayanan paliatif harus sensitif terhadap kebutuhan pasien, budaya, agama,
kepercayaan yang dianut, dan komunikasi dipastikan terjadi secara efektif
 Certified
Wound Care
Clinician
TIM YANG
TERLIBAT
Associate

⚫Tim Kesehatan dari multidisiplin

⚫Tim memiliki beberapa keahlian yang berbeda :
⚫Dokter
⚫Perawat
⚫Ahli gizi
⚫Ahli fisioterapi
⚫Farmasi
⚫Pekerja sosial
 Certified
Wound Care
Clinician
PENDEKATAN DALAM
Associate
PALIATIF

• Tidak ada “satu pendekatan

untuk semua”
• Pelayanan yang diberikan disesuaikan
dengan kebutuhan masing-masing
pasien
• Karena pelayanan paliatif dipakai untuk
membantu pasien dengan berbagai latar
belakang penyakit, maka pelayanan HARUS
menyesuaikan gejala yang muncul.
 Certified
Wound Care
Clinician
DRESSING
Associate
CHALENGES

These patients usually are in the last few

months of their lives, and the presence of a
wound may be a constant reminder of their
disease.

In addition, patients may need to cope with

bleeding, exudates, odor, or infection. Caring
for these patients may be challenging but it can
be rewarding if the patients are able to
maintain or improve their
quality of life.
(Naylor, 2002)
 Certified
Wound Care
Clinician
PERDARAHA
Associate
N
Infiltrasi sel tumor ke sekitar pembuluh darah dan berkurangnya jumlah zat
pembeku darah dalam sel tumor menyebabkan luka kanker mudah berdarah

PASIEN RESPONS: BINGUNG; STRESS;

TAKUT

PENATALAKSANAAN:
• Meminimalisasi terjadinya perdarahan dan
trauma saat membuka balutan
• Hindari temperature yang ekstreem
• Tekan tempat perdarahan dg GENTLE
• Monitor adanya anemia dan kebutuhan
transfusi

Balutan hemostatik:ca.alginate,Spongostan® or Oxycell®,;lokal cauter: silver

nitrate; balut tekan / bandage OR Adrenalin ( dowset,2002 )
 EKSUDATIF – CAIRAN
BERLEBIHAN

PATIENT RESPONS :
BALUTAN CEPAT BASAH, MALU, JIJIK, RASA
BERSALAH, DEHIDRASI

TUJUAN: Efektifitas mengatasi cairan yang keluar

PENATALAKSANAAN:
• Cuci luka dan kulit sekitar luka dengan bersih – gentle
antiseptic
• Gunakan balutan menyerap cairan yang berlebihan (high
exudate: calsium alginate, padding or gamgee)
• Lindungi kulit sekitarnya dari iritasi akibat cairan yang
meleleh dengan zinc cream
• Monitor kebutuhan cairan dan elektrolit
 BAU TIDAK
SEDAP
PENYEBAB:

Bakteri aerob / anaerob pada jaringan

nekrotik

PATIENT RESPONS :

Menggunakan wewangian berlebihan;

Mengisolasi diri; Malu; Jijik; Depresi;
Mual – muntah

PENATALAKSANAAN :
• Mencuci luka dengan larutan gentle
antiseptik
•Mengontrol bau – menggunakan dressing
odor control/ Metronidazole bubuk
• Personal higine pasien
• Meningkatkan rasa percaya diri
 INFEKS
I
An infection occurs when the immune
system does not quickly destroy harmful
substances. Both cancer and cancer treatments
weaken the immune system.
This means that people with
cancer are more likely to develop
infections.

Neutropenia, chemotherapy, or radiation

therapy may place you at a higher risk of
infection.

If you develop neutropenia with a fever, you

may need to stay in the hospital until the infection
is gone.
 Certified
Wound Care
Clinician
NYER
Associate
I
Pertumbuhan tumor yang menekan saraf dan
pembuluh darah dapat menyebabkan rasa
tidak nyaman sampai dengan nyeri pada luka
kanker.

PASIEN RESPON :
• Takut ganti balutan
• Mudah marah - Menangis
• Frustasi - kesakitan

PENATALAKSANAAN:
• Hati-hati saat membuka balutan
• Hindari perlakuan secara kasar
• Mencuci luka dengan lembut
• Hindari menggosok luka hingga berdarah.
• Kolaborasi obat nyeri pada dokter/ minum obat
nyeri sesaat sebelum dilakukan penggantian
balutan
 MASERAS
I
Prolonged exposure to moisture may remove the protective barrier
causing more damage.
PENATALAKSANAAN:

Be easy to apply in a variety of situations; Not

cause further trauma on application or removal;
Not interact with existing dressings or continence
products; Not increase the risk of bacterial
contamination of wounds; Effectively
protect tissues from moisture/chemical
attack; Be non- sensitizing.

Oil-based creams and zinc paste as SKIN

PROTECTION are effective in preventing over-
hydration. Creams may be replaced by liquid
film dressings, in which the solvent evaporates
leaving the polymer film.
 Certified
Wound Care
Clinician
Associate
Case Report

Menurunkan segala
keluhan pasien,
masalah sosial
dan spiritual
dengan meningkatkan
atau mempertahankan
wellbeing
pasien.

Doc. WOCARE CENTER

Case Report
Case Report
Case Report
Case Report
 Case Report
Certified
Wound Care
Clinician
Associate
 KESIMPULAN
Luka kanker adalah mimpi buruk - Assessment of malignant
wounds, selection of appropriate dressings, related symptom
management, and patient and family support are vital aspects of
cutaneous wound management in advanced cancer.

Klien harus sadar bahwa hidup yang akan ia jalani telah

berubah untuk jangka waktu yang lama - Hindari
kesedihan yang berlarut-larut

Sokongan keluarga dan PETUGAS KESEHATAN terhadap

perawatan luka kanker sejak awal pertemuan.
 REFERENCES
• Haisfield-Wolfe ME, Rund C. Malignant cutaneous wounds: a management protocol. Ostomy Wound Manage. 1997 Jan-Feb;43(1):56-60, 62, 64-6.
PMID: 9087066.
• Schiech L. Malignant cutaneous wounds. Clin J Oncol Nurs. 2002 Sep-Oct;6(5):305-9. doi: 10.1188/02.CJON. 305-309. PMID: 12240496.

• Probst S, Arber A, Faithfull S. Malignant fungating wounds: a survey of nurses' clinical practice in Switzerland. Eur J Oncol Nurs. 2009
Sep;13(4):295-8. doi: 10.1016/j.ejon.2009.03.008. Epub 2009 Apr 21. PMID: 19386546.

• Seaman S. Management of malignant fungating wounds in advanced cancer. Semin Oncol Nurs. 2006 Aug;22(3):
• 185-93. doi: 10.1016/j.soncn.2006.04.006. PMID: 16893748.

• McNees P. Skin and wound assessment and care in oncology. Semin Oncol Nurs. 2006 Aug;22(3):130-43. doi: 10.1016/j.soncn.2006.04.003.
PMID: 16893742.
• Dowsett C. Malignant fungating wounds: assessment and management. Br J Community Nurs. 2002 Aug;7(8): 394-400. doi:
10.12968/bjcn.2002.7.8.10641. PMID: 12192342.
• Grocott P. The palliative management of fungating malignant wounds. J Wound Care. 2000 Jan;9(1):4-9. doi: 10.12968/jowc.2000.9.1.25942.
PMID: 10827661.

• Bergstrom, K.Assessment and Management of FungatingWounds.Source:Journal of Wound, Ostomy and Continence Nursing. 38 (1): 31-
37, 2011 Jan/Feb

• Rupert KL, Fehl AJ. A Patient-Centered Approach for the Treatment of Fungating Breast Wounds. J Adv Pract

• Oncol. 2020 Jul;11(5):503-510. doi: 10.6004/jadpro.2020.11.5.6. Epub 2020 Jul 1. PMID: 32974074; PMCID: PMC7508249.