UNPREDICTABLE

CANCER

ANDRIJONO
MANAJEMEN KANKER GINEKOLOGI
ADALAH MANAJEMEN YANG SESUAI
PANDUAN PRAKTEK KLINIK KANKER
GINEKOLOGI

PERAWATAN PRAPEMBEDAHAN,
INTRAPEMBEDAHAN DAN PASCAPEM-
BEDAHAN
KANKER
SERVIKS UTERI
KANKER SERVIKS

HISTEREKTOMI
RIW PERDARAHAN
FLUOR ALBUS
NYERI PELVIK
KANKER SERVIKS

HISTEREKTOMI
RIW PERDARAHAN
FLUOR ALBUS
NYERI PELVIK
KASUS
KANKER SERVIKS YANG TIDAK
TERDIAGNOSIS

PASIEN DENGAN KELUHAN PERDARAHAN

PEMERIKSAAN KLINIS, USG : MIOMA UTERI
DENGAN DD ADENOMIOSIS

LAPARATOMI (RENCANA HISTEREKTOMI)

PADA LAPARATOMI TIDAK DAPAT DILAKUKAN
HISTEREKTOMI TOTAL
PERDARAHAN DAN JARINGAN RAPUH

HISTEREKTOMI SUBTOTAL
ANALISA KASUS

TIDAK DIPERIKSA DALAM

TERLALU MENGANDALKAN USG

TIDAK DILAKUKAN EKSPLORASI

HISTEREKTOMI ATAU TIDAK

DILANJUTKAN
In a study reported in The American Journal of Surgical
Pathology, the clinical features of 42
LEIOMYOSARCOMAS were analyzed. " In a univariate
analysis age >62 years, size >4 cm, extensive necrosis,
modified updated French Federation of Cancer Centers
(FFCC) grade, and whether the tumor had been
"disrupted" by a previous incisional biopsy or incomplete
excision were significantly correlated with metastasis....
Disruption was the only significant risk factor for
metastasis in a multivariate analysis (relative risk 2.70; p =
0.0001) but was strongly correlated with large size and
deep location ."
BELUM ADA REJIMEN KEMOTERAPI
YANG MEMBERI RESPON OPTIMAL
PADA KANKER SERVIKS UTERUS

JANGAN MEMOTONG JARINGAN TUMOR

KANKER SERVIKS
STOP SURGERY
MANAGEMENT BASE ON
GUIDELINE
KANKER
OVARIUM
PERAWATAN PRABEDAH
TUMOR OVARIUM
TUMOR OVARIUM

PEMERIKSAAN TUMOR MARKER

TUMOR OVARIUM (GANAS)

MEMBUTUHKAN
FUNGSI REPRODUKSI
EPITHELIAL OVARIAN
CANCER

Women who still wish to still have children if :

1. The tumor is confined

2. Wedge biopsy of the opposite ovary
shows no evidence of disease involvement.

This procedure carries an increased risk of relapse

therefore, total hysterectomy and salpingo-oophorectomy
should be performed immediately after childbearing is
complete.
SOLID OVARIAN
TUMOR

GERM CELL TUMOR

Chemosensitive
Young women
Tumor marker
TUMOR OVARIUM (GANAS)

TAK MEMBUTUHKAN
FUNGSI REPRODUKSI
INTRA-OPERATIVE

Bila kita menemukan tumor yang

makroskopik nya mencurigai ganas
maka sebaiknya dilakukan pembedahan
KONSERVATIF
INTRA-OPERATIVE

Bila kita menemukan tumor yang

makroskopik nya mencurigai ganas
maka dapat pula dilakukan
HISTEREKTOMI TOTAL DAN
SALPINGO-OOVOREKTOMI BILATERAL
OMENTEKTOMI
LYMPHADENECTOMY

Systematic lymphadenectomy has a clear

diagnostic value in early-stage ovarian cancer
In a consecutive Charite cohort of 88 patients
having stage I or II, lymph node metastasis was
found in 14 cases ( 15.9% ) , whereby in 14
cases pelvic (15.9% ) and in 10 cases (11.4% )
para-aortic metastases were documented.

Crouet H, De Ranieri J, Heron JF, Couette JE and Brune D: Para-aortic

lymphadenectomy in the surgical evaluation of
ovarian cancer. Presse Med 15(2): 61-64, 1986.
Petru E, Lahousen M, Tamussino K, Pickel H, Stranzl H,
Stettner H et al: in stage I ovarian cancer. Am J Obstet Gynecol
170(2): 656-662, 1994.
LYMPHADENECTOMY

Five-year progression-free survival

for the control group and the SL
group was 71.3 and 78.3%
respectively, and 5-year overall
survival was 81.3 and 84.2%

Maggioni A, Benedetti Panici P, Dell'Anna T, Landoni F, Lissoni A,

Pellegrino A et al: Randomised study of systematic
lymphadenectomy in patients with epithelial ovarian cancer
macroscopically confined to the pelvis. Br J Cancer 95(6): 699-
704, 2006.
EARLY STAGE

Overall, 6,686 patients with stage I ovarian

cancer were included in this analysis.
The 5-year survival was significantly better in
the group of patients with lymphadenectomy
(92.6% compared to 87%,p<0.001)

Chan JK, Munro EG, Cheung MK, Husain A, Teng NN, Berek JS
et al: Association of lymphadenectomy and survival in stage I
ovarian cancer patients. Obstet Gynecol 109(1): 12-19, 2007.
ADVANCE STAGE

61 cases as systematic lymphadenectomy (LND) and

in 32 as sampling (LNS).
Overall 5-year survival was 26%.
In patients with optimal cytoreduction with more
systematic lymphadenectomy, the 5-year overall
survival was 50% in contrast to 33% in the sampling
collective, and only 29% in patients without any
lymphadenectomy.

Aletti GD, Dowdy S, Podratz KC and Cliby WA: Role of

lymphadenectomy in the management of grossly apparent
advanced stage epithelial ovarian cancer. Am J Obstet Gynecol
195(6): 1862-1868, 2006.
LYMPHADENECTOMY IN
RECURRENT OC
The adjusted risk for progression and death were not
statistically different (hazard ratio (HR) for
progression=1.18
5-year progression-free survival (PFS)=40.9% and
53.8%; HR for death=1.04, 95% CI=0.7331.49; P=0.81;
5-year OS=63.5% and 67.4%, in the SAPL and in the
control arm, respectively).

Conclusion:
SAPL in second-look surgery for advanced ovarian
cancer did not improve PFS and OS.
British Journal of Cancer (2012) 107, 785792.
INTRAOPERATIVE

Bila dijumpai tumor yang makroskopik

ganas dengan penyebaran yang
tidak operabel, maka perlu pertimbangan
melakukan pembedahan yang minimal