5/25/2016

Leader
Secretary
Notulen
Member

: Esmeralda Bangun
: Theresia Anggriani
: Wisty Chintya Putri
: Widya Oktaviani Sinaga
Stevanie Liu
Novita Sari
Arta Liana
Kuning Eny Surya
Thipani Angela
Jonatan Yoseph
Novi Tamara
Safiran Nugraha Sahid
Tiara Malau
Harta Juliana Butar-butar
Ayu Bangun

CLARIFICATION OF TERM
1. Peau d'orange: a picture like an orange peel in
the breast
2. Painless: no pain
3. Superior lateral quadrant of the left: the upper
left hand side
4. Fixed to: can not be moved

ANALYSIS OF THE
PROBLEM

1. Their period of tumor

2. Has a high risk factor for suffering from breast tumors
3. - Signs of breast tumors
- Fixed to and painless: overview of malignancy
- Peau d'orange and uneven surfaces: for vasa vasa
lymphatic subcutaneous lymphatic congestion and
form metastases

SCENARIO

A 35-year-old woman complained of a lump in the left

breast, since one year ago. Her mother's sister also suffer
from breast tumors, has died at the age of 45 years. On
examination found a lump in the left lateral superior
quadrant, the size of a marble, uneven surfaces, fixed to,
painless, peau d'orange. What diseases suffered by this
patient?

IDENTIFICATION OF
PROBLEMS

1. A 35-year-old woman complained of a lump in the left

breast, since one year ago.
2. Her mother's sister also suffer from breast tumors, has
died at the age of 45 years.
3. On examination found a lump in the left lateral
superior quadrant, the size of a marble, uneven
surfaces, fixed to, painless, peau d'orange. From the
examination found a good general condition, vital
signs: Mon. CM, BP: 120/70mmHg, HR: 80x/min, RR:
20x/min, T:37C.

HYPOTHESIS

Women 35 years of suffering from Breast

Cancer

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Learning Objective

1.
2.
3.
4.
5.
6.
7.

1 Patofisiology Neoplasms

Pathophysiology Neoplasms
Classification, Etiology and Epidemiology of
Neoplasms
Definition, Etiology, Epidemiology and Risk
Factors of Breast Cancer
Pathophysiology and Clinical Symptoms of
Breast Cancer
Diagnosis and Differential Diagnosis of Breast
Cancer
Management and Prevention of Breast Cancer
Complications and Prognosis of Breast Cancer

2. Classification
Tumor diffirentiation

Benign Tumor

Malignant tumor

good

Bad

Growth pattern

exvansive

Invasive

Relation with another surrounded

tissue

pushed

Destroy

Capsul

With capsule

Without capsule

Secondary change

Rarely bleeding

Haemorrhage

limit

Strict line

Irregular

metastasis

Rarely found

Often metastasis

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Etiology

is consist of Exogenous & endogenous factor

1.Exogenous factor
Chemical factor such as nitrosamin, mitotoksin,hidrocarbon
poliaromatik,benzen.
Physics factor such as uranium, or radon radiation
Ultraviolet

Endogenous factor

Etiology

Carsinogenic virus (Hepatitis,EBV)

Immune system
Diet & life style factor

Epidemiology National Institute Cancer

Types of Cancer

New cases

Estimation of mortality

Skin

>1.000.000

<1.000

Lungs

215.020

161.840

Colorectal

148.810

49.960

Breast

182.460

40.480

Prostate

186.320

28.660

Leukemia

44.270

21.710

Etiology of breast cancer

Family history and gen

Reproduction
Abnormalities of mammary gland
Medication overuse
Radiation
Diet and nutrition

What is breast cancer??

Breast cancer occurs when the cells lining the breast

lobules or ducts grow abnormally and out of control. A
tumour can form in the lobules or ducts of the breast.

Epidemiology??

Although it can occur at any age, breast cancer is more

common in older women. More than two in three (69%) are
diagnosed in women aged 4069. About one in four (25%) are
diagnosed in women aged 70 and over.

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4. Patophysiology of Breast Cancer

Cell Hyperplasia
Development of atypical cells

Invaded the stroma

View the exchange rate and it looks like eczema

Breast carcinoma

Malignant cells
Invaded the nipple epidermis

Metastasize
Dissemination via lymphatics and blood

3. Changes in the mammary papilla

a. Retraction
b. Secret papiler
c. Changes eksematoid
4. Enlargement of regional lymph nodes

2. Physical examination
A. Inspection
Observe the size, symmetrical both mammary, note whether there is a lump or tumor,
pathological changes in skin. Then note the mammary papilla is symmetrical.
- Tumor mass. If no value:
Location
Size
Consistency
The shape and boundaries of a tumor
- Changes in skin
redness, dimpling, edema / satellite nodules
Peau de orange, ulceration
- Changes in the nipple / nipple
Interested
Erosion
crusting
Discharge

Clinical Symptoms of Breast Cancer

1. Tumor mass : consistency rahter loud, ill defined, the surface is

not slippery, etc.
2. Skin changes :
a. Mark dimples
b. Peau d orange
c. Satellite skin nodules
d. invasion ulcerated skin, when the tumor invaded visible
discoloration of red or dark red
e. Inflamatory

5. Diagnosis and Differential diagnosis of breast

cancer

A.Diagnosis
1.Anamnesis
Main complaint
A lump in the breast
The speed grows with / without pain
Nipple discharge, nipple retraction, and crusting
Abnormal skin, dimpling, peau d'orange, ulceration, venektasi
Lump armpit and arm edema
Additional complaints
Pain in the bones (vertebrae, femur)
Shortness etc.

B. palpation
Check whether a tumor is attached to the bottom, must ask for the patient's
arm akimbo side of the lesion, major m.pektoralis wrinkled. If the tumor and
attached to the skin or basic, unfettered mobility, the possibility of very large
tumor. For the examination of the lymph nodes most excellent seating
position.
- The status of lymph nodes (the value of the number, size, consistency, fixed
to the neighbor or surrounding tissues)
axillary lymph nodes
infraclavicular lymph nodes
supraclavicular lymph node
- Examination of the regional metastases
Location: bone, liver, lung, brain
Form
Complaints

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3. Laboratorium examination
- Mammography
Imaging Test
Ultrasound (USG)
Magnetic Resonance Imaging (MRI)
-Test Surgery
Biopsy
- Blood test
B. Differetial Diagnosis
1. mammary fibroadenoma
2. cystic hyperplasia of the mammary gland
3. Tumor papiliform large intraductal
4. Cyst retention of Lactasi
5. Tuberculosis mammary gland

Divided into:
1. Stage 0 (T0,N0,M0) : histopathology test, radiology test
2. Early stage / operable : Mastectomy & Breast Conserving Therapy
3. Locally advance stage :
a. Operable (III A) :
i.

ii.
iii.

Simple Mastectomy + radiation with adjuvant chemotherapy with or without hormonal, with or
without target therapy
Modification of radical Mastectomy +radiation with adjuvant chemotherapy, with or without
hormonal, with or without target therapy
Pre-operation chemo radiation continue with or without breast conserving therapy or simple
mastectomy, with or without hormonal, with or without target therapy

b. Non-operable (III B):

i.
ii.

iii.

Pre-operation radiation with or without operation + chemotherapy +hormonal therapy

Pre-operation chemotherapy/neoadjuvant with or without operation + chemotherapy + radiation
+ hormonal therapy + with or without target therapy
Pre-operation chemo radiation with or without operation, radiation, adjuvant radiation,
chemotherapy + with or without target therapy

4. End stage :

Palliative therapy , for reduce pain

Systemic therapy for primer therapy : chemotherapy and hormonal therapy
Loco regional therapy : radiation and operation (if needed)
Hospice home care

7. COMPLICATIONS AND PROGNOSIS

BREAST CANCER

COMPLICATIONS
1. Lymphoedema
2. Hyperglycemic syndrome

PROGNOSIS
Many factors affect prognosis. But clearly the biggest
influence on prognosis and is the condition of the lymph nodes
and stage.
therefore in the current condition to increase the cure rate of
cancer of the mammary key is early detection, early diagnosis,
dissemination of knowledge about mammary cancer, women's
education to examine your own breasts is an eminently
practical actions