dr.

Riahsyah Damanik,SpB(K)Onk

RSUP H.ADAM MALIK / FK.USU

hope clinic
Medan
KPD STADIUM LANJUT
 KANKER PAYUDARA (KPD)

Insidens :
Urutan I di Eropa Barat & AS (32%)
Urutan II di Indonesia (12.6%)
RSK.Dharmais urutan I (2005)
Stadium Penanganan
Stadium Dini > 75% di AS & Jepang
Stadium Lanjut Lokal/Lanjut> 80%
di Indonesia
 Klasifikasi Histopatologi
WHO
Japanese Breast Cancer Society (1984)

Malignant (Carcinoma)
1. Non Invasive
a. Non Invasive Ductal CA
b. Lobular CA Insitu
2. Invasive CA
a. Inv.Ductal CA
b. Special Type
c. Pagets Disease
 STAGING (TNM)
Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage IIA T0 N1 M0
T1 N1 M0
T2 N0 M0
Stage IIB T2 N1 M0
T N0 M0
Stage IIIA T0 N2 M0
T1 N2 M0
T2 N2 M0
T N M0
T N1 M0
Stage IIIB T4 N0 M0
T4 N1 M0
T4 N2 M0
Stage IIIC Any T N3 M0
Stage IV Any T Any N M1
 STADIUM PENEMUAN KPD
Stadium Tjindarbumi dkk Ramli dkk Sakamoto dkk Damanik dkk

Tis 2% 1.26% 10.1% 0%

I 2% 2.52% 35.6% 0%

II 16% 12.26% 41.3% 2,5%

III 61% 69.4% 12.2% 80,2%

IV 19% 14.32% 0.8% 17,1%

 Harapan Hidup KPD

Stadium 5 Years (%) 10 Years (%)

I 95 85
II 80 65

III 30 20

IV 0 0
 PENATALAKSANAAN KPD
KOMPREHENSIF

Pencegahan Primer
Pencegahan Sekunder / Deteksi Dini
(Skrining)
Diagnosis
Terapi
Rehabilitasi
 PENCEGAHAN PRIMER

Insidens KPD Mortalitas & Morbiditas

Faktor Resiko

Gender Previous Ca
Age Ionizing
Radiation Hormonal
Hereditary Fat
Oral Contraceptive
Alcohol
Faktor Resiko

Hamil pada usia < 18 tahun

Physical Activity
Artificial Menopause < 35 tahun
Vitamin intake (vitamin A)
Diet (Phyto-estrogen, Soyabean)
Anatomi Payudara
 Deteksi Dini Kanker Payudara

Segala upaya yang dilakukan untuk

menemukan Kanker Payudara Stadium Dini
(STD I dan STD II) dan dilakukan penanganan
secara medis dan profesional untuk
mendapatkan hasil kuratif dan harapan
hidup yang panjang.
 UPAYA DETEKSI DINI

SADARI
SKRINING KELOMPOK RESIKO
SARANIS
DIAGNOSA
 BREAST CANCER
Screening

Breast self-examination Examination Mammographythe

by physician only modality shown
to decrease mortality
SADARI (SBE)

Posisi berdiri
Posisi berbaring
Posisi berbaring dengan bantal diletakan di punggung
Lokasi dominan tumor
 Gejala klinis
LOKAL
- benjolan 36%
- benjolan dengan sakit 33%
- sakit 17,5 %
- sekret putting 5%
- tarikan putting 3%
Gejala Klinis
Tumor Jinak Payudara
Tumor Ganas Payudara
 SARANIS (CBE)
Pemeriksaan oleh Klinisi (Dokter)

Meliputi

Kulit
Puting dan Areola
Tumor
Kelenjar Getah Bening Aksila
Metastasis
 BREAST CANCER
Signs and symptoms at presentation

Mass or pain
in the axilla

Palpable mass
Thickening
Pain

Nipple discharge
Nipple retraction

Edema or erythema
of the skin
 BREAST CANCER
Sites of distant
metastases

Brain
Lymph nodes
Pleura
Skin Lung

Liver

Bone
 ULTRASONOGRAFI

Hope clinic Klinik Bedah Tumor Medan

MAMMOGRAFI
BREAST CANCER
Horizontal mammography
BREAST CANCER
Vertical mammography
BREAST CANCER
Mammography
 BREAST CANCER
Biopsy techniques for palpable and
mammographically detected masses

Excisional biopsy (usually outpatient)

Tumor size and histologic diagnosis

Core-cutting needle biopsy (in-office)

Histologic diagnosis

Fine-needle aspiration (in-office)

Cytologic diagnosisHarris J, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1557-1616.
BAJAH (FNAB)
BIOPSI CORE
 DIAGNOSA
KANKER PAYUDARA

Ukuran Tumor/Kelenjar Getah

Bening/Metastasis
Jenis kanker
 BREAST CANCER
Pathology
Non-invasive carcinoma in situ

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)
Invasive carcinoma

Infiltrating ductal or lobular carcinoma

Medullary, mucinous, and tubular carcinomas
Uncommon tumors

Inflammatory carcinoma
Pagets disease Dollinger M, et al. Everyones Guide to Cancer Therapy. 1997;356-384.
 BREAST CANCER
Pathology: Non-invasive DCIS & LCIS

DCIS LCIS

Abnormal mammogram Microscopic characterization

on biopsy

Clustered microcalcifications Solid proliferation of small

or non-palpable masses cells with uniform round to
oval nuclei

30% risk of invasive cancer 37% chance of subsequent

at 10 years at or near invasive cancer
original biopsy site

DCIS ductal carcinoma in situ.

LCIS lobular carcinoma in situ.

Harris J, et al. Cancer: Principles & Practice of Chemotherapy. 5th ed. 1997;1557-1616.
Love S, Barsky SH. Cancer Treatment. 4th ed. 1995;337-340.
 BREAST CANCER
TNM stage grouping
Stage 0 Tis N0 M0
Stage I T1* N0 M0
Stage IIA T0 N1 M0
T1* N1** M0
T2 N0 M0
Stage IIB T2 N1 M0
T3 N0 M0
Stage IIIA T0, T1,* T2 N2 M0
T3 N1, N2 M0
Stage IIIB T4 Any N M0
Any T N3 M0
Stage IV Any T Any N
M1
* Note: T1 includes T1 mic.
** Note: The prognosis of patients with N1a is similar to that of patients with pN0.

Used with the permission of the American Joint Committee on Cancer (AJCC ), Chicago, Illinois.
The original source for this material is the AJCC Cancer Staging Manual, 5th edition (1997)
published by Lippincott-Raven Publishers, Philadelphia, Pennsylvania.
 BREAST CANCER
Stage I
T1 N0 M0 T1a: T 0.5 cm
T1b: 0.5 cm < T 1 cm
T1c: 1 cm < T 2 cm

T1

T 2 cm

N0 = no regional lymph node metastasis

M0 = no distant metastasis
 BREAST CANCER
Stage IIA
T0
T1} N1 M0 T2 N0 M0

T0 No evidence
T2
of tumor

2 cm < T < 5 cm

N1 = metastasis to movable ipsilateral axillary lymph node(s)

M0 = no distant metastasis
 BREAST CANCER
Stage IIB
T2 N1 M0 T3 N0 M0

T3

T > 5 cm

N1 = metastasis to movable ipsilateral axillary lymph node(s) (p) N1a, N1b

M0 = no distant metastasis
 BREAST CANCER
Stage IIIA T0
T1
N2 M0
T3 N1 M0 T2
T3

Metastasis to ipsilateral axillary lymph node(s)

N1 = movable
N2 = fixed to one another or to other structures
M0 = no distant metastasis
 BREAST CANCER
Stage IIIB
T4 any N M0 Any T N3 M0

T4
Tumor of any size
with direct extension
to chest wall or skin

T4d = inflammatory
carcinoma

N3 = metastasis to ipsilateral internal mammary lymph node(s)

M0 = no distant metastasis
 BREAST CANCER
Stage IV
Any T any N M1

M1 = distant metastasis (including metastases to ipsilateral supraclavicular,

cervical, or contralateral internal mammary lymph nodes)
 Pengobatan
BEDAH
RADIASI
HORMONAL
SITOSTATIKA
BIOLOGI / MOLECULAR TARGETING THERAPY
TERAPI BEDAH
RADIOTERAPI
KEMOTERAPI
HORMONAL TERAPI

Operasi
Medikamentosa
Radioterapi
TABLET HORMONAL
 IMUNOTERAPI

Meningkatkan daya tahan tubuh

Biobran, Sanotake
 BIOTERAPI

Sitokin
Interferon
Anti Angiogenesis