KANKER PAYUDARA

Epidemiologi
Penyebab dan Faktor Resiko
Gejala dan Tanda
Stadium
Tindak Lanjut

Rebecca N. Angka

Pendahuluan
Profil Kesehatan Indonesia 2008 :
Urutan pertama (2004-2007)
8277 kasus (16,85%)
Insidens di Indonesia : 36,2 per 100.000
pr dengan angka kematian : 18,6 per
100.000 pr. (20.052 kasus). Data oleh
Global Burden of Cancer, 2008.

 RSCM :
Penelitian terhadap 300 pasien bedah,
(1989-1992) terbanyak : kanker payudara
lanjut lokal (66%).
1998-2002 : 27,5%, tetapi stadium IV
meningkat (47,4%).
US : KPLL < 5%

10 KANKER TERBANYAK DI
INDONESIA
Number

ICD

Location

Relative Frequency

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

180
174
173
147

183
196
154
171
193

Cervix
Women'sbreast
Skin
Nasopharynx
Unknown
Ovaries
Lymphoidnodes
Rectum
Softtissue
Thyroid

18,41%
11,57%
8,24%
6,15%
5,16%
4,94%
4,91%
4,42%
3,50%
3,38%

Source: Bulletin of Pathology Based Cancer Registry, BRK-IAP, No. 4, 1989.

PERBANDINGAN INSIDENS
KANKER DI INDONESIA
Padang

Palembang

Bandung

Semarang

Surabaya

1.Breast
2.Softtissue
3.Unknown
4.Rectum
5.Ovary
6.Cervix
7.Nasopharynx
8.Lymphnodes
9.Softtissue
10.Prostate

Cervix
Skin
Breast
Unknown
Nasopharynx
Placenta
Rectum
Oropharynx
Colon
Lymphnodes

Cervix
Breast
Skin
Nasopharynx
Lymphnodes
Unknown
Rectum
Ovary
Softtissue
Thyroid

Cervix
Breast
Skin
Unknown
Ovary
Nasopharynx
Lymphnodes
Rectum
Thyroid
Softtissue

Cervix
Breast
Lymphnodes
Skin
Nasopharynx
Ovary
Softtissue
Thyroid
Rectum
Colon

Ramli, JICC 1995

U. Pandang

Breast
Skin
Cervix
Unknown
Ovary
Lymphnodes
Thyroid
Nasopharynx
Softtissue
Rectum

Anatomi

Sappys plexus lymphatics under areolar complex

75% of lymphatics flow to axilla

Payudara normal
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wall/rib cage
Enlargement
A

normal duct cells

basement membrane (duct wall)

C lumen (center of duct)

Illustration Mary K. Bryson

11

Ductal Carcinoma in situ (DCIS)

Ducta
l
cance
r cells

Illustration Mary K. Bryson

Norm
al
ducta
l cell

12

Invasive Ductal Carcinoma (IDC

80% of breast cancer)
Changes in genome
of somatic cells
Ductal cancer
cells breaking
through the
wall

Illustration Mary K. Bryson

The cancer has spread to the

surrounding tissues
Carcinoma refers to any
cancer that begins in the
skin or other tissues that
13
cover internal organs

Illustration Mary K. Bryson

BREAST CANCER
Incidence of major histologic types
Percent of all Infiltrating Carcinomas

78%

9%

Ductal

Lobular

4%
Medullary

3%
Colloid

5%

1%

Comedo

Papillary

Adapted from McDivitt R et al, 1967.

BREAST CANCER
Age-specific incidence (per 100,000)
Incidence rates
420
400

United
States
England
and Wales

300

Italy
200

France
Japan

100

0
20
24

25
29

30
34

35
39

40
44

45
49

50
54

55
59

60
64

65
69

70
74

75
79

80 85+
Age
84

Adapted from New Horizons in Cancer Management, SRI International, 1990.

BREAST CANCER
TNM stage grouping
Stage 0

Tis.

N0

M0

Stage I

T1

N0

M0

T0, T1

N1

M0

T2

N0

M0

T2

N1

M0

T3

N0

M0

T0, T1, T2

N2

M0

T3

N1, N2

M0

Any T

N3

M0

T4

Any N

M0

Any T

Any N

M1

Stage IIA
Stage IIB
Stage IIIA
Stage IIIB
Stage IV

BREAST CANCER
Survival by stage
Percent surviving
100

Stage 0

80

Stage I

60

Stage IIA
Stage IIB

40

Stage IIIA
20

Stage IIIB

Stage IV
1

Years after diagnosis

Pengaruh gen dan lingkungan

terhadap perkembangan kanker

(source: Pharmaceutical Research,

BREAST CANCER
Risk factors
Female
History of breast cancer
Family history of breast cancer, especially in
first-degree relatives : 1,8 x
Benign breast cancer/ atypical hyperplasia : 5 x
Early menarche : 1,7-3,4 x, late menopause : 1,5 x
Late first pregnancy/no pregnancy : 1,5-4 x
Exogenous estrogens
Radiation
Diet, alcohol

Gejala dan tanda Kanker Payudara

Adanya BENJOLAN
Penebalan kulit
Nyeri

Benjolan di
ketiak
Cairan puting suiksu
Putting tertarik kedalam

Kulit merah atau luka

Lesung kulit

Penyebaran jauh(metastasis) kanker

payudara
Otak
Kelenjar getah
bening
Kulit

Paru

Hati
Ginjal

Tulang

Waktu terjadinya kanker

Detection

American Cancer Society

Skrining kanker payudara sedini
mungkin :
Pr > 20 thn : sadari tiap bulan
Pr > 20-40 thn : memeriksakan diri ke
dokter tiap 3 tahun
Pr > 40 thn : memeriksakan diri ke dokter
tiap tahun
Pr 35-40 thn : base line mammografi
Pr > 50 thn : mammografi tiap tahun.

BREAST CANCER
Breast inspection

Skin dimpling

BREAST CANCER
Breast palpation

BREAST CANCER

Regional nodes assessment

Waktu mamograf
Sebaiknya dikerjakan pada :
Wanita usia diatas 35/40 tahun
sebagai baseline
Wanita dengan faktor risiko tinggi
7-10 hari masa haid

What Mammograms Show

Two of the most important mammographic
indicators of breat cancers
Masses
Microcalcifications: Tiny flecks of calcium like
grains of salt in the soft tissue of the breast
that can sometimes indicate an early cancer.

33

Detection of Malignant Masses

Malignant masses have a more spiculated
appearance
benign
malignant

34

Mammogram Difficult Case

Heterogeneously dense breast
Cancer can be difficult to
detect with this type of
breast tissue
The fibroglandular tissue
(white areas) may hide the
tumor
The breasts of younger
women contain more glands
and ligaments resulting in
dense breast tissue

35

Mammogram Easier Case

With age, breast tissue

becomes fattier and has
fewer glands
Cancer is relatively easy
to detect in this type of
breast tissue

36

Biopsy

Penanganan Kanker
Payudara
Surgery
Radiotherapy
Chemotherapy
Hormonal therapy
New therapies
Supportive care

BREAST CANCER SCREENING PATH

Breast self-examination
Physical examination
(yearly)

Screening mammogram
(guidelines)

Normal

Suspicious

Diagnostic imaging
Equivocal

Palpable
mass
(not cyst)

Fine-needle aspiration
biopsy

- mammogram
- ultrasound
- compression magnification film

Equivocal or
suspicious

Probably
benign

Short-term
follow-up

Cyst

Aspiration

Normal

BREAST CANCER DIAGNOSIS PATH

Evaluation
for
biopsy

Palpable
mass

Cyst

Normal

Nonpalpable
mass
Cyst
aspiration

Needle
localization

Fine-needle aspiration
biopsy

Insufficient
evaluation,
rebiopsy

Ductal
carcinoma
in situ

Invasive
cancer

Treatment Path

Lobular
carcinoma
in situ

Benign

If persistent,
short-term
follow-up
with surgeon

Continued
appropriate
screening

BREAST CANCER
Therapeutic options
Surgery
Radiotherapy
Chemotherapy
Hormonal therapy
Immunotherapy
New therapies
Supportive care

BREAST CANCER
Surgical options I

mass
mass

Local excision
Wide excision

...

Quadrantectomy

BREAST CANCER
Surgical options II
nodes
nodes

mass

mass

Modified radical mastectomy

Excised area

Radical mastectomy
Incision
Excised area

TERIMA KASIH
HEALTH IS NOT
EVERYTHING, BUT
WITHOUT HEALTH,..
EVERYTHING IS NOTHING !