ACKNOWLEDGEMNT

Fist of all, I’d like to introduce myself, My name’s Irfan Hidayatulloh, Please call me
Irfan I’m from Perumnas then, I’d like to thanks ALLAH SWT who has given health and
long life. My gratitud also goes to my English teacher, Ms Mulni, for her guidance and help
in making some corrections. And then, I’d like to convey my gratitude to the examiners who
has given me time to deliver a presentation about Cancer Cervix

I’v devided my presentation into five sections, First, I’m going to start by telling the
background of the problem. Second, I’ll turn to the definition and symptoms. Then, I’ll
concern on the aspects can cause Tetanus After that, I’ll move on to the medical treatments.
Finally, I’ll discuss about the preventions If you have any questions, I’ll do my best to answer
them at the end.

Karawang. 15 Maret 2017

i
TABLE OF CONTENTS

ii
1
 1. INTRODUCTION

1.1 Background of the problem

Cervical cancer (cervical cancer) is a malignant tumor that grows in the neck of
the uterus / cervix (the lowest part of the uterus attached to the top of the vagina.
Cervical cancer usually affects women aged 35-55 years. 90% of cervical cancers
derived from squamous cells lining the cervix and the remaining 10% comes from
mucus-producing gland cells in the cervical canal leading into the uterus, cervix
carcinoma usually occurs in the transitional zone which lies between squamous cell
epithelium and columnar epithelial cells.

Until now, cervical cancer is the leading cause of death from cancer in
developing countries. Indeed, this disease can be prevented if cytology screening
programs and improved health care. It is estimated that every year about 500,000 new
cases found worldwide and generally occur in developing countries.

This disease originated from a viral infection that stimulates changes in cervical
epithelial cell behavior. At the moment research is being conducted vaccination for
prevention and treatment of major diseases in the future.

Risk of infection with HPV virus and some other conditions such as sexual
behavior, contraception, or smoking will promote the occurrence of cervical cancer.
Mechanism incidence of cervical cancer is a complex process and so the variation that it
is difficult to understand.

The incidence and mortality of cervical cancer in the world second only to breast
cancer. meanwhile, in the developing world still ranks first as a cause of cancer deaths
in reproductive age. Almost 80% of cases are in developing countries. Prior to 1930,
cervical cancer is the leading cause of death of women and their cases dropped
drastically since the introduction of the pap smear screening technique by Papanikolau.
However, unfortunately until now have not been more popular in the community
screening programs in developing countries, to easy to understand why the incidence of
cervical cancer remains high.

The most important thing facing the cervical cancer is a diagnosis as early as
possible and provide effective therapy once predicted prognosis. Until now, therapeutic
options are still limited to surgery, radiation and chemotherapy, or a combination of
these treatment modalities. But, of course, this therapy is still a "symptomatic" because
they have not touched the bottom of the cause of cancer is a change in cell behavior.
More basic therapy or immunotherapy are still in the research stage.

2
 Currently, the choice of therapy depends on the extent of the spread of disease is
anatomically and constantly changing along with advances in medical technology.
Determining the choice of therapy and prediction of prognosis or to compare the
success rate of a new therapy should be based on the extent of disease. Universally
approved determination of the extent of the spread of disease through the staging
system.

1. DEFINITION AND SYMPTOMS

2.1. Definition

Cancer of the cervix (cervical) or carcinoma of the uterine cervix is the number
two cancer killer of women worldwide after breast cancer. In Indonesia, cervical cancer
even ranked first. Cervical cancer has entered advanced stage often leads to death within
a relatively quick period of time.

Uterine cervical cancer is the most common malignancy among women. This
disease is a process of change from a normal epithelium to become invasive Ca are on
symptoms and is a process that slowly and take many years.

Cervix or uterus / cervix is the lower end of the uterus that protrudes into
copulation canal (vagina). Cervical cancer develops gradually, but progressively. The
process begins with the occurrence of cancer cells that mutate and develop into
dysplastic cells, causing epithelial abnormalities called dysplasia. Starting from mild
dysplasia, moderate dysplasia, severe dysplasia, and finally became carcinoma in-situ
(KIS), then expand again to invasive carcinoma. Rate of dysplasia and KIS also known
as pre-cancer. Of dysplasia carcinoma in-situ takes 1-7 years, whereas carcinoma in situ
to invasive carcinoma ranges from 3-20 years.

99.7% of this cancer is caused by human papilloma virus (HPV) oncogenic,

which attacks the cervix. Starting occur in the cervix, if it has entered the stage, this
cancer can spread to other organs throughout the body.

2.2 The Symptoms

Not typical at an early stage. Often just as fluos with a bit of blood, bleeding or
bleeding pastkoital pervagina suspected of being an extension of the time period. In
later stages the new signs are more typical, either in the form of massive bleeding
(mainly in the form eksofitik), fluor albus smelled and the pain is very great.

In the pre-cancerous phase, often there are no symptoms or signs typical.

However, sometimes the symptoms can be found as follows:

3
 Whitish or watery discharge from the vagina. Sap coming out of the vagina is
the longer will stink due to infection and tissue necrosis

Bleeding after sexual intercourse (post-coital bleeding) then progress to

abnormal bleeding. Incidence of bleeding after menopause. In the liquid phase out
invasive yellowish, odorless and can be mixed with blood.Symptoms occur when
bleeding occurs chronic anemia.

Arising pelvic pain (pelvic) or in the lower abdomen when pelvic inflammation.
When pain occurs in the lumbar region down, the possibility of hydronephrosis. In
addition, it could also be pain in other places. In later stages, the body was emaciated
due to malnutrition, edema leg, bladder irritation arises and shaft bottom of the large
intestine (rectum), the formation of vesicovaginal or rectovaginal fistulas, or symptoms
occur as a result of distant metastases

2. ASPECTS THAT CAN CAUSE

3.1. Aspects can cause

 Causative factor

HPV (Human Papilloma Virus) is the cause. In addition to cigarette smokers

have been found to cause too. Women smokers nicotine-containing concentrates and
kotinin in their cervix that damage cells. Male smokers also are konsetrat this material
in genital secretions, and can meet the cervix for some nutritional intercourse.Defisiensi
can also cause cervical displasia.National Cancer Institute recommends that women
should consume five times the fresh fruits and vegetables every day. If you can not do
this, consider a multivitamin with antioxidants such as vitamin E or beta carotene every
day.

 Risk factor

Patterns of sexual intercourse

Epidemiological studies revealed that the risk of contracting cervical cancer

increases with increasing number of sexual pasangan.aktifitas started at an early age,
which is less than 20 years, also can dijadkan as faktr Resko kanke servks occurrence. It
diuga nothing to do with yet matannya derah transformas on the drain tesebut when
serine exposed. The frequency of sexual hubungna also affects the higher risk in that
age, yeyapitidak in older age groups. (Schiffman, 1996).

4
 1) parity

Cervical cancer often found in women often give birth yan. The more often give
birth, the greater the risk terjamgkit semain cervical cancer. Pemelitian in Latin America
shows the relationship between risk with multiparity after controlling for HPV
infection.

2) Smoke

Some peneitian menunukan strong relationship between smoking and cervical

cancer, even after controlling for confounding variables sepert sexual hubungna pattern.
Another discovery mempekhatkan ditemkanna paa cervical fluid nicotine smoker
woman this material bersifata sebaai kokassnoen and co-sma with no further pretext yan
kasinoge mendoron growth toward cancer.

3) oral contraceptives

Research into perspective conducted by Vessey et al 1983 (Schiffman, 1996)

found that an increase in the incidence of cervical cancer is influenced by the duration
of use of oral contraceptives. The study also found that the incidence of invasive
cervical cancer all contained in oral contraceptive users. Another study found that the
incidence of cancer after 10 years of service 4 times higher than non-users of oral
contraceptives. However, a similar study conducted by peritz et al concluded that sexual
activity is confounding that is closely related to it.

WHO is reviewing various other research linking oral contraceptive use with the
risks of cervical cancer, concludes that it is difficult to interpret these relationships
given that the duration of use of oral kontraseps interact with other factors, especially
the pattern of sexual habits in influencing the risk of cervical cancer. In addition, the
possibility that women who use oral contraceptives other more often Smera cervical
examination, so dysplasia and carcinoma in situ seems more frekuen in the group.
Necessary caution in interpreting the association between duration of oral contraceptive
use with the risk of cervical cancer because of their bias and confounding factors.

4) nutritional deficiency

Some studies indicate that a deficiency of certain nutrients such as beta-carotene

and vitamin A and folic acid, berhubungna with an increased risk for mild and moderate
dysplasia sampasaat .. But this is never any indication that improvements will be
enurunkan defisensi nutritional risk.

5) socioeconomic

Is descriptive and analytic studies show a strong relationship between the

incidence of cervical cancer with a low socioeconomic level. This is also confirmed by
studies showing that HPV infection is more prevalent in women with low levels of

5
education and income. Factor nutritional deficiencies, and the cleanliness of the
genitalia multilaritas dduga also associated with the problem.

6) sexual partners

The role of the sexual partners of patients with cervical cancer starts to become
interesting material for research. Condom use frekuen it gives a lower risk of the
occurrence of cervical cancer. Low hygiene genitalia associated with circumcision is
also a long discussion on the incidence of cervical cancer. The number doubles partner
other than his wife is also another risk factor.

7) Epidemiology of Cervical Cancer

Distribution by Age

The occurrence of cervical cancer starts from cells that mutate and develop into
dysplastic cells, causing epithelial abnormalities called dysplasia. Starting from mild
dysplasia, moderate, severe dysplasia and carcinoma eventually become the In-Situ
(KIS), then develop into invasive carcinoma. Rate of dysplasia and carcinoma in-situ,
also known as pre-cancerous stage. The latest classification uses the name of cervical
intraepithelial neoplasm (NIS). NIS 1 for mild dysplasia, NIS 2 for dysplasia and NIS 3
for severe dysplasia and carcinoma in-situ.

According to Snyder (1976), NIS is commonly found in young age after first
sexual intercourse occurred. The time interval between first intercourse with NIS
discovered is 2-33 years. For a distance of first intercourse with NIS 1 interval average
is 12.2 years, NIS 1 to NIS 2 Average rata13,9 year and NIS 2 samppai NIS 3 on
average 11.7 years old. Sedanhkan according Cuppleson LW and Brown B (1975)
mentions that the NIS will be developed in accordance with age, so the NIS at the age
of over 50 years has been a little bit and infiltrative cancer increased by 2 times.

From the report of FIGO (International Federation Of Gynecology and

Obstetrics) in 1988, the age group 30-39 years and 60-69 years age group seen as much.
In general, stage IA is more common in the age group 30-39 years, while for stage IB
and II are often found in the age group 40-49 years, stage III and IV are often found in
the age group 60-69 years.

Inseden larim neck cancer (Age Standarized Cancer Incidence Rate / ASR)
residents of the city, recorded in the year 1980 to 1981 showed 27.9 ASR and ASR Data
for 1985-1989 24.4. Is compared with various overseas regions this figure is slightly
different, as in Thailand (Chiang Mai) reported ASR 1983-1987 was 33.2 and 13.2
years in South Korea from 1982 to 1983. India showed higher at 41.7 in 1982.

6
 Based on research conducted in RSCM Jakarta in 1997-1998 ditmukan that
stage IB-IIB are often found in the age group 35-44 years, while stage IIIB frequent in
the age group 45-54 years. Research conducted by Litaay, et al in several hospitals in
Ujung Pandang (1994-1999) found that most patients with ovarian cancer are in the age
group 46-50 years is 17.4%.

8) According Distribution Points

The frequency of cervical cancer most common in developing countries such as

Indonesia, India, Bangladesh, Thailand, Vietnam and the Philippines. In Latin America
and South Africa frequency of uterine cancer is also the most malignant disease of all
other existing malignant disease.

Research conducted by the American Cancer Society (2000) proved that cervical
cancer is more common in women of minority groups such as Vietnamese immigrants,
African and Indian women. This relates to their assumption that women who do not
carry out mutually couple (promikuitas) do not need to do a Pap smear.

According to estimates by the Ministry of Health in 1988-1994 the incidence of

cervical cancer reached 100 / 100,000 population per year, while the proportion of
cervical cancer of all types of cancer in some parts of anatomical pathology in 2000,
such as Surabaya found 24.3%, 25.7% Yogyakarta Bandung 25.1%, 28.2% Surakarta
and Medan by 16.9%.

3. THE MEDICAL TREATMENTS

4.1. The Medical Treatments

Selection of treatment for cervical cancer depends on the location and size of the
tumor, disease stage, age, general condition of the patient and the patient plans to
become pregnant again.

1. Surgery

In carcinoma in situ (cancer confined to the outermost layer of the cervix), all
cancers can often be removed with the aid of a scalpel or via LEEP. With such
treatment, the patient is still able to have children. Because cancer can recur, it is
recommended to undergo re-examination and Pap smear every 3 months for 1 year first
and then every 6 months. If the patient does not have a plan to get pregnant again, it is
recommended to undergo a hysterectomy. In invasive cancer, a hysterectomy and
removal of surrounding structures (the procedure is called a radical hysterectomy) as
well as lymph nodes. In young women, the ovaries (ovarian) were normal and still
serves not lifted.

7
 2. radiation therapy

Radiation therapy (radiotherapy) is effective for treating invasive cancer that is still
confined to the pelvic area. In radiotherapy used high-energy rays to damage cancer
cells and stop the growth. There are 2 kinds of radiotherapy, namely:

3. External radiation: berasar rays from a large machine Patients do not need to be
hospitalized, irradiation is usually performed 5 days / week for 5-6 weeks.

4. Internal radiation: the radioactive substance contained in a capsule inserted

directly into the cervix.This capsule is left for 1-3 days during which patients are
hospitalized. This treatment can be repeated several times for 1-2 weeks.

The side effects of radiation therapy are:

 Irritation of the rectum and vagina Damage to the bladder and rectum Ovaries
stop functioning.

5. chemotherapy

If the cancer has spread beyond the pelvis, sometimes recommended to undergo
chemotherapy. In the chemotherapy drugs used to kill cancer cells. Anti-cancer drugs
can be administered by intravenous injection or by mouth. Chemotherapy is given in
cycles, meaning a treatment period interspersed with recovery periods, and then do the
treatment, recovery interspersed premises, and so on.

6. biological therapies

In biological therapy used substances to improve the immune system to fight

disease. Biological therapy do to cancer that has spread to other body parts. The most
commonly used are interferon, which can be combined with chemotherapy.

4. THE PREVENTIONS

5.1. The Preventions

A. Prevention and Treatment of Cervical Cancer

Control of Cervical kinder to prevention can be divided into three parts, namely
prmer prevention, secondary prevention and tertiary prevention public health strategy in
preventing deaths from cervical cancer include primary prevention and secondary
pencegaan.

8
 B. Primary prevention

Primary prevention is an activity of money can be made by any person to avoid

themselves from the factors that can cause cervical cancer. This can be done by
emphasizing hdup healthy behaviors to reduce or avoid risk factors such as early
marriage, multiple sexual partners and others. In addition, primary prevention can be
done with HPV imuisasi in community groups.

C. secondary prevention

Secondary prevention of cervical cancer done with early detection and cervical
cancer screening aims to find cases of cervical cancer dibni so the chances of cure can
be improved. The development of cervical cancer takes a long time. Of invasive
prainvasif to take about 10 years or more. Cytology is a simple and sensitive method for
pre-invasive mwndeteksi karsinoa. When treated properly, pre-invasive carcinomas
have a cure rate approaching 100%. Diagnosis of invasive cases in phase only has a
resistance level of about 35%. With cytology screening program known as the Pap test
mear and has been done in the developed countries. Prevention Pap smears
terbukimampu lowering the death rate from cervical cancer is 50-60% dalamkurun 20
years (WHO, 1986).

In addition, there are also three levels of prevention and treatment of cervical cancer,
namely:

 Prevention First Level

Community Health Promotion for example:

1) public awareness campaign

2) public health education programs

3) Health promotion

 Special precautions, for example:

1) Interference sources of exposure

2) chemopreventive

9
 Second-level prevention

Early diagnosis, for example screening

Medicine, for example:

1) Chemotherapy

2) Surgery

 Third-level prevention

Rehabilitation, such as home care while cancer treatment generally is in

multidiscipline approach. Results of treatment of radiotherapy and radical
surgery is more or less the same, although it is actually difficult to compare
because of general surgery patients who are young and generally good.

Although cervical cancer is scary, but we all can prevent it. You can do a lot of
precautions before HPV infection and ultimately develop cervical cancer. Some
practical ways that you can do in everyday life include:

Have a healthy diet, rich in vegetables, fruit and cereals to stimulate the immune
system. For example consuming various carotene, vitamin A, C, and E, and folic
acid can reduce the risk of cervical cancer.

Avoid smoking. Much evidence suggests tobacco use can increase the risk of
cervical cancer.Avoid sex before marriage or at a very young age or a dozen
years. Avoid having sex during menstrual period proved to be effective to
prevent and inhibit the formation and development of cervical cancer. Avoid
having sex with many partners. Routinely undergo regular Pap smear tests.
Currently Pap test can be done even at the health center at an affordable price.
Alternative tests Pap smear is a test IVA with a cheaper cost of Pap smear. The
goal for the early detection of HPV infection. Vaccine or HPV vaccination to
prevent HPV infection. Perform an intimate organs or vagina known as a toilet.
This can be done alone or also with the help of medical experts. The goal is to
clean the female sex organs of filth and disease.

10
5. CONCLUSION

Uterine cervical cancer is the most common malignancy among women.

This disease is a process of change from a normal epithelium to become
invasive Ca are on symptoms and is a process that slowly and take many
years. There are several classifications but the most predominant is created
by IFGO (International Federation of Ginekoloi and Obstetrics), ie Stage 0,
1, 1 a, 1 b, 2, 3, and 4. Clinical symptoms of cervical cancer at an advanced
stage new look signs more typical, either in the form of massive bleeding
(mainly in the form eksofitik), fluor albus smelled and the pain is very great.

HPV (Human Papilloma Virus) is the most common cause of

cervical cancer. In addition to cigarette smokers have been found to cause
too. As for risk factors, namely: Patterns of sexual intercourse, parity,
smoking, oral contraceptives, nutritional deficiency, Socio-economic, and
sexual partner.

From the report of FIGO (International Federation Of Gynecology

and Obstetrics) in 1988, the age group 30-39 years and 60-69 years age
group seen as much. In general, stage IA is more common in the age group
30-39 years, while for stage IB and II are often found in the age group 40-49
years, stage III and IV are often found in the age group 60-69 years. The
frequency of cervical cancer most common in developing countries such as
Indonesia, India, Bangladesh, Thailand, Vietnam and the Philippines. In
Latin America and South Africa frequency of uterine cancer is also the most
malignant disease of all other existing malignant disease.

Cervical carcinoma arising confined between the epithelium lining

the ectocervix (portio) and endocervical canal of the cervix called skuamo
columnar junction (SCJ). In young women SCJ is located outside the OUE,
while in women over 35 years, in the cervical canal. The spread of cervical
cancer in general is limfogen through the lymph vessels to the three
directions: a) toward the fornices and vaginal walls, b) towards the uterine
corpus, and c) to the parametrial and in advanced stages infiltrating
rectovaginal septum and bladder. The diagnosis of cervical cancer is not
difficult especially advanced level. The problem is how do to prevent
cervical cancer screening, conducted with the detection, eradication, and
observation of cervical precancerous lesions.

Treatment of cervical cancer that can be done, yiatu: surgery,

radiation therapy, chemotherapy, and biological therapy. While some
practical ways you can do in our daily lives to prevent cervical cancer, ie:
have a healthy diet, rich in vegetables, fruit and cereals to stimulate the
immune system, avoid smoking, avoid sex before marriage or at a very

11
young age or a dozen years, vaccine or HPV vaccination to prevent HPV
infection, perform an intimate organs or vagina known as a toilet, avoid
having sex with many partners, routinely undergo regular Pap smear tests,
and so on.

12
REFERENCES

13