ONKOLOGI

CARCINOMA MAMMAE
Ca mammae

Bledsoe et al., Paramedic Care Principles &

Payudara

Breasts - secondary sex characteristics

Physical characteristics besides genitals that distinguish
males from females

In physically mature women, breasts internally

composed of fatty tissue and mammary (milk)
glands

Areola darker area of the external breast

Nipple in center of areola
Bledsoe et al., Paramedic Care Principles &

Payudara
Kelenjar yang memproduksi susu
ditentukan ukuran jaringan lemak
payudara

daerah kehitaman areola

Putting (nipple) ditengah areola &
berfungsi sbg saluran susu

Bledsoe et al., Paramedic Care Principles &

Payudara

Fig. 4.8 Cross-section front and side views of the female breast.

Bledsoe et al., Paramedic Care Principles &

Payudara
Pemeriksaan
Pemeriksaan sendiri (self-exam)
Pemeriksaan rutin di RS
mammography

Bledsoe et al., Paramedic Care Principles &

Payudara
Breast lumps (bengkak)
cysts (fluid-filled sacs)
fibroadenomas (solid, round, benign tumors)
malignant tumor

Breast cancer

penanganan
Faktor risiko
Bedah rekonstruksi payudara
Keuntungan deteksi dini & penanganannya

Bledsoe et al., Paramedic Care Principles &

Payudara

Table 4.4 Risk Factors for Breast Cancer

Bledsoe et al., Paramedic Care Principles &

Pemeriksaan sendiri

Box on page 111:

HOW TO EXAMINE
YOUR
BREASTS
Bledsoe et
al., Paramedic
Care Principles &

Pemeriksaan sendiri
Deteksi apakah ada
abnormalitas dari
payudara
Pemeriksaan
bulanan, pada akhir
menstruasi
Dilakukan di depan
cermin

Melihat adanya
Perubahan kulit
Warna kemerahan
Pembengkakan
Puting yang kaku
Simetris atau tidak

Angkat lengan ke atas

Payudara terlihat
terangkat
Lihat adanya
cekungan atau
retraksi (tarikan)

Raba adanya benjolan

Angkat lengan
Raba dengan lengan
sebelah
Rasakan adanya
kelereng dalam
kantung beras
marble in a bag of
rice

Pergunakan bagian tengah jari

Ujung jari sangat
sensitif (seluruh
payudara terasa
berbenjol)
Telapak tangan juga
sensitif
Bagian tengah jari
adalah yang terbaik

Gerakkan tangan membentuk

lingkaran kecil
Mulai dari satu
kuadran
Tekan kemudian putar
dg jari tangan
Rasakan penebalan
ukuran seperti
kelereng

Then move to another location

Dikerjakan seluruh
kuadran payudara
searah jarum jam dg
menggunakan jari
tangan
Make sure the entire
breast is felt.

The Tail of the Breast

Breast is not
perfectly round.
A Tail of breast
tissue normally
extends into the
armpit.
Make sure to feel for
lumps in that portion
of the breast.

Raba daerah ketiak

Gunakan putaran yg
sama
Rasakan adanya
benjolan payudara dan
lymphonodi
Normal lymphonodi tdk
teraba
Pembesaran lymphonodi
kira-kira seukuran
penghapus pensil tetapi
panjang dan tipis

Coba untuk menampilkan

puting
Strip the ducts towards
the nipple.
Normal bila ada tetesan
cairan berwarna susu
atau hijau
Bukan darahShould not
be bloody or in large
quantity, squirting out or
staining the inside of a
bra.

Kemudian periksa sebelahnya

Lakukan urutan
yang sama
Angkat lengan
melewati kepala
Rasakan adanya
benjolan atau
massa

Periksakan ke spesialis tiap

tahun
Dasar
pemeriksaan
payudara
Tanya jawab

Mammograms
Usia 40-50 tahun:
setiap tahun
>50 tahun: berkala
Lebih sering bila ada
hal spesial seputar
masalah payudara,
misal riw.keluarga dg
kanker payudara

If you find something in your

breast...
Dont panic.
Most (90%) of breast
lumps are benign.
Do see a physician or
other qualified health
care provider right
away.

Bledsoe et al., Paramedic Care Principles &

INCIDENCE
Fibroadenomas are the commonest
benign tumors of teenage
10-15% have multiple & bilateral
lumps
Occur in the upper outer quadrant
Black women tend to develop
fibroadenomas more frequently and at
an earlier age than white women
Bledsoe et al., Paramedic Care Principles &

A new growth compose of both

fibrous and glandular tissue.
Lumps may be moveable,
painless, firm, or rubbery, with
well-defined borders
Most are smooth or slightly
lobulated

Bledsoe et al., Paramedic Care Principles &

Bledsoe et al., Paramedic Care Principles &

PATHO-PHYSIOLOGY
Fibroadenomas are hormonally
responsive - increases in size may
occur during late phases of the
menstrual cycle
May grow in size, especially during
pregnancy
Often get smaller after menopause (if
not taking hormones)
Unknown cause; possibly due to
increased fat consumption
Bledsoe et al., Paramedic Care Principles &

GROSS FEATURES
Grow as a spherical nodule which is
usually well-circumscribed and freely
movable (floating Mouse)
Vary in size from less than 1 cm to
giant forms 10 to 15 cm in diameter
Feels like small, slipper marbles Mass
more circumscribed and mobile than
carcinoma
Bledsoe et al., Paramedic Care Principles &

Bledsoe et al., Paramedic Care Principles &

Benign Conditions, continued

4.

Tumors & cysts

a. Fibroadenoma =
most common
benign breast
tumor

Bledsoe et al., Paramedic Care Principles &

Tumors and Cysts, cont

b. Breast Cyst
1. Benign
2. May be
aspirated if
large

Bledsoe et al., Paramedic Care Principles &

Benign conditions, continued

c. Fibrocystic breast
changes
1) 20%+ of premenopausal
women
2) discomfort, cysts
3) treatment rarely required
4) More likely to not detect a
developing cancer

Bledsoe et al., Paramedic Care Principles &

Tumors & cysts, continued .

d. Intraductal papilloma
- may produce
chocolate or
bloody discharge from
nipple
e. Lipoma: common
- fatty tumors

Bledsoe et al., Paramedic Care Principles &

E. Carcinoma of the breast

1. Most common malignant tumor among
women
2. 1/8 of women will develop breast cancer
a. 1/6 in Orange County
b. 1/5 in San Francisco

3. Generally no discomfort

Bledsoe et al., Paramedic Care Principles &

Progression to Breast Cancer

Bledsoe et al., Paramedic Care Principles &

Carcinoma of breast, continued

4. Physical signs:
a.
b.
c.
d.

Slowly growing, painless mass

May demonstrate retracted nipple
May be bleeding from nipple
May be distorted areola, or breast
contour
e. Skin dimpling in more advanced
stages with retraction of Coopers
ligaments
Bledsoe et al., Paramedic Care Principles &

Physical signs, continued

f. Attachment of mass
g. Edema of skin
1)with orange skin appearance
(peau dorange)
2) due to blocked lymphatics
h. Enlarged axillary or deep cervical
lymph nodes
Bledsoe et al., Paramedic Care Principles &

Breast Cancer, cont

5. Common sites for metastasis

a. Lungs & pleura
b. Skeleton system (skull, vertebral column,
pelvis)
c. Liver

6. Atypical carcinomas
a. Inflammatory carcinoma (hormonal,
chemotherapy)
b. Pagets disease of the breast
Bledsoe et al., Paramedic Care Principles &

Bledsoe et al., Paramedic Care Principles &

Ultrasound

Bledsoe et al., Paramedic Care Principles &

Mammogram

Bledsoe et al., Paramedic Care Principles &

Ultrasound

Bledsoe et al., Paramedic Care Principles &

Mammogram

Bledsoe et al., Paramedic Care Principles &

Bledsoe et al., Paramedic Care Principles &

ULTRASOUND

Bledsoe et al., Paramedic Care Principles &

MRI

Bledsoe et al., Paramedic Care Principles &