TUMOR PAYUDARA

dr. Subianto, SpB(K)Onk

EPIDEMIOLOGI
URUTAN KE : 1 MAX USIA 40 50 TH [40-150/100.000 ] PRIA :1% SEMARANG : 2.559/100.000 EROPA -UTARA -BARAT 40/100.000 -AMERIKA EROPA -TIMUR -SELATAN -Amerika latin

20-40/100.000

- ASIA TENGGARA - AFRIKA

-

20/100.000 22-24/100.000/TH

ETIOLOGI
PASTI ? MULTI FAKTORIAL A. KONSTITUSI GENETIKA -BANGSA KANKER PAYUDARA -KELUARGA BANYAK -SYNDROMA KLINEFELTER 66 DARI N -KEMBAR MONOZYGOT B. HORMON C. VIRUS D. NUTRISI - LEMAK - KOLESTEROL E. KARSINOGEN F. RADIASI

Faktor Resiko
BANGSA OBESITAS RADIASI KANKER KONTRA LATERAL DYSPLASIA RIWAYAT KELUARGA MENARCHE < 13 TH ? 6.0 X 6.0 X 5.0 X 3.5 X 3.3 X 3.3 X

MENOPAUSE > 50 TH
TIDAK PUNYA ANAK > 35 TH TIDAK MENYUSUI MELAHIRKAN I > 30 TH

2.7 X
2.2 X 1.8 X 1.2 X

KLASIFIKASI PATOLOGI ATAU HISTOLOGI TUMOR PAYUDARA Menurut WHO, International Histological Classification Of Tumours 1978

A. Dysplasia mamma Benigna I. Kista : a. simple b. papiller II. Fibrocyctic disease III. Adenosis IV. Proliferasi ductus atau lobulus yang typis V. Ductal ectasis VI. Fibrosclerosis VII. Gynecomasty VIII. Lain lain lesi proliferasi non neoplastik

B. Tumor Mamma Benigna I. Adenoma mamma II. Adenoma papilla mamma III. Ductal papilloma IV.Fibroadenoma mammae: a. pericanaliculer b. intracanaliculer V. Kistosarkoma Pylloides benigna VI. Tumor jinak jaringan lunak.

C. Tumor Mamma Maligna I. Karsinoma mamma a. Non infiltrat carsinoma a.1. Intraductal carc. a.2. Intralobul carc. b. Infiltrating carcinoma b.1. ductal carc b.2. lobular carc. c. Special histological variants c.1. carc. Medullare c.2. carc. Inflamatory c.3. carc. Paget c.4. carc. Gelatinosum c.5. carc. Papiliferum c.6. carc. Cribriform c.7. carc. Scirrhosum c.8. carc. Epidermoid
II. Sarkoma a. Kistosarkoma phylloides maligna b. sarkoma, lain lain III. Karsinosarkoma IV. Tumor yang tidak dapat diklasifikasikan

Intraductal Papilloma

Mild Hyperplasia

Fibroadenoma

Florid Hyperplasia

Lobular atypia (low)

Lobular atypia (high)

Ductal atypia (low)

Ductal atypia (high)

DCIS Cribiform Type

DCIS micropapillary Type

DCIS Medullary Type

LCIS

Infiltrating ductal carcinoma well-differentiated (grade I)

Moderately differentiated (grade II)

Poorly differentiated (grade III)

Infiltrating lobular carcinoma (classical type)

Medullary carsinoma, low-power photomicrograph demonstrative circumscribed tumor border

Medullary carsinoma, high-power view demonstrates large, pleomorphic tumor cells and associated lymphocytes and plasma cells

Mucinous (colloid) carsinoma, lowpower view demonstrates islands of tumor cells within a sea of mucin.

Mucinous (colloid) carsinoma, higher mignification shows tumor cell nests.

Anatomi

PENYEBARAN
INFILTRATIF

PENYEBARAN
LYMPHOGEN

PENYEBARAN
HEMATOGEN

TULANG

HEPAR

PARU-PARU

Staging
pTN Pathological Classification
pT = Primary tumour (T)
The pathological classification requires the examination of the primary carcinoma, no gross tumour at the margin of resection. A case can be classified pT if there is only microscopic tumour in a margin. The pT categories correspond to the T categories. When classifiying pT the tumour size is a measurement of the invasive component. If there is a large in situ component (e.g. 4cm) and small invasive component (e.g. 0,5cm), the tumour is coded pT1a.

Staging

Staging

Staging

Staging

Staging

Inflamatory carcinoma

Staging
Regional Lymph Nodes (N)
The regional lymph nodes are : 1. Axyllary (ipsilateral) : interpectoral (Rotters) nodes and lymph nodes along the axyllary vein and its tributaries which may be devided into the following levels: i.Level 1 (low axilla) : lymph nodes lateral to the lateralborder of pectoralis minor muscle. ii.Level II (mid-axilla): lymph nodes between the medial and lateral borders of the pectoralis minor muscle and the interpectoral (Rotters) lymph nodes. iii.Level III (apical axilla) : lymph nodes medial to the medial margin of the pectoralis minor muscle including those designated as subclavicular, infraclavicular or apical 2. Internal mammary (ipsilateral) : Lymph nodes in the intercostal spaces along the edge of the sternum in the endithoracic fascia. Any other lymph node metastasis is coded as a distant metatasis (M1) including suprclavicular, cervical, or contralateral internal mammary lymph nodes.

Staging

Staging
N = Regional lymph nodes NX = Regional lymph nodes cannot be assessed (e.g. previously remove) N0 = No regional lymph node metatasis N1 = Metastasis to moveble ipsilateral axillary nodes N2 = Metastasis to ipsilateral axillaryt nodes fixed to one another or to other structures N3 = Metastasis to ipsilateral internal mammary lymph nodes

Staging

Staging

Staging

Staging
M = Metastasis MX = Metastasis cannot be assessed M0 = No distant metatasis M1 = Distant metastasis

Staging
Metastasis

Tulang
Nnll kontralateral (Osteolitik)

Paru-paru (Coin lession)

Hepar (Nodul)

Staging
TNM menurut UICC
Stadium 0 Stadium I Stadium IIa IIb Stadium IIIa IIIb Stadium IV : : : : : : : Tis N0 M0 T1 N0 M0 T0-1 N1 M0 atau T2 N0 M0 T2 N2 M0 atau T3 N0 M0 T1-2 N2 M0 atau T3 N1 M0 T4 N0-3 M0 atau T1-4 N3 M0 T0-4 N0-3 M1

Diagnosis
DX : Anamnesa
: - kecepatan - resiko tinggi

PD

: - Tumor : - lokasi - diameter - konsistensi - permukaan - batas --- perlekatan - KGB : - diameter - jumlah - perlekatan : - fisik - penunjang

-M

Mammografi:
- skrining wanita resiko tinggi - payudara sudah involusi - non palpable

Mammogram. Tumour with irregular outline and no calcifications, representing ductal carcinoma in situ.

Mammogram, mediolateral, oblique view. Ductal breast cancer with productive fibrosis and retraction of the nippleareolar complex, as well as the major pectoral muscle

MAMMOGRAPH BENIGN LESIONS

MAMMOGRAPH MALIGNANT Multiple Lesions

USG

: - Wanita muda - Tumor solid / kistik

- hepar ------------ nodul

USG Payudara

USG Hepar Normal

USG Hepar dg Nodul

STEREOTACTIC PROCEDURE

X Foto
- Paru : - coin lession - efusi pleura

- Tulang : - osteolitik - fraktur

Bone scan

 CT scan Lab : alkali phospatase Terapi: - operasi - radiasi - sitostatika - hormonal - monoclonal targeting therapy

OPERASI
- ST : I, II, IIIA - ST : - IIIB SOSIAL - IV PALIATIF - MACAM : - SIMPLE MASTEKTOMI - RADICAL MASTEKTOMI - MODIFIED RADIKAL MASTEKTOMI - BCT

Mastektomi

Mastektomi

BCT

BCT

BCT

BCT

 RADIASI - ST IIIB, IV - ADJUVANT : ST IIIA, POST SM - POST : - BCT - RM ------- KGB (+)

Bad cosmetic ~ Radio-therapy reaction

SITOSTATIKA
-ADJUVANT : ST IIIA, POST SM, VI SERI -ST IV ----------- 12 SERI

PALIATIF
- ST IV - MENJAGA KUALITAS HIDUP - MENGURANGI RASA SAKIT

HORMONAL
- HORMONAL DEPENDENT - OBAT ANTI ESTROGEN - OOPHOREKTOMI : - OPERASI - RADIASI

PROGNOSIS
STADIUM
I II III IV

5 THN
90% 70% 20% 0%

10THN
80% 50% 11% 0%

PROBLEM: 75 80% DATANG PADA STAD LANJUT

SEBAB: - PENDERITA : - TIDAK MENGERTI 47% - TAKUT OPERASI 14,5% - TUMOR TAK NYERI 12,5% - KURANG BIAYA 9,4% - LAIN LAIN 10,2% - SEGERA DATANG 6,4% - DOKTER - RUMAH SAKIT ---------PKM-----------SARARI ---------PKP

Pencegahan :
1. Primer
- usaha supaya tumor tidak timbul - cara hidup sehat : - hindari kegemukan - banyak makan berserat, mengandung vit A dan C - hindari makanan yang terlalu banyak diasinkan dan dibakar - hindari rokok

2. SekundeR Deteksi dini - W waktu buang air besar atau kecil ada perubahan kebiasaan atau gangguan A alat pencernaan terganggu atau susah menelan S suara serak dan batuk batuk yang tak kunjung sembuh P payudara atau tempat lain ada benjolan A andeng andeng yang berubah sifatnya, menjadi besar dan gatal D darah dan lendir yang abnormal keluar dari tubuh A adanya koreng atau borok yang tak kunjung sembuh - sadari / sarari - Pap smear - mammografi - pemeriksaan darah samar - endoskopi - foto rontgen - USG

Tips SADARI

Arah gerakan

TIDAK AKAN BISA KALIAN MEMBAYAR LUNAS AIR SUSU IBUMU