Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

ONKOLOGI CARCINOMA MAMMAE

Ca mammae

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Payudara

Breasts - secondary sex characteristics – Physical characteristics besides genitals that distinguish

males from femalesIn physically mature women, breasts internally composed of fatty tissue and mammary (milk) glandsAreola – darker area of the external breastNipple – in center of areola

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Payudara

Kelenjar yang memproduksi susu– ditentukan ukuran jaringan lemak

payudara

daerah kehitaman areolaPutting (nipple) ditengah areola & berfungsi sbg saluran susu

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Payudara

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

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Payudara

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

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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 & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Payudara

Table 4.4 Risk Factors for Breast Cancer

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pemeriksaan sendiri

•Box on page 111:

HOW TO EXAMINE YOUR BREASTS

Pemeriksaan sendiriDeteksi apakah ada abnormalitas dari payudaraPemeriksaan bulanan, pada akhir menstruasiDilakukan di depan cermin

Melihat adanya

Perubahan kulitWarna kemerahanPembengkakan Puting yang kakuSimetris atau tidak

Angkat lengan ke atas

Payudara terlihat terangkatLihat adanya cekungan atau retraksi (tarikan)

Raba adanya benjolan

Angkat lenganRaba dengan lengan sebelahRasakan 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 sensitifBagian tengah jari adalah yang terbaik

Gerakkan tangan membentuk lingkaran kecil

Mulai dari satu kuadranTekan kemudian putar dg jari tanganRasakan penebalan ukuran seperti kelereng

Then move to another location

Dikerjakan seluruh kuadran payudara searah jarum jam dg menggunakan jari tanganMake 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 ketiakGunakan putaran yg samaRasakan adanya benjolan payudara dan lymphonodiNormal lymphonodi tdk terabaPembesaran 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 hijauBukan darahShould not be bloody or in large quantity, squirting out or staining the inside of a bra.

Kemudian periksa sebelahnya

Lakukan urutan yang samaAngkat lengan melewati kepalaRasakan adanya benjolan atau massa

Periksakan ke spesialis tiap tahun

Dasar pemeriksaan payudaraTanya jawab

Mammograms

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

If you find something in your breast...

Don’t 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 & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

INCIDENCE

Fibroadenomas are the commonest benign tumors of teenage 10-15% have multiple & bilateral lumps Occur in the upper outer quadrantBlack women tend to develop fibroadenomas more frequently and at an earlier age than white women

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

A  new growth compose of both fibrous and glandular tissue. Lumps may be moveable, painless, firm, or rubbery, with well-defined bordersMost are smooth or slightly lobulated

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

PATHO-PHYSIOLOGY

Fibroadenomas are hormonally responsive - increases in size may occur during late phases of the menstrual cycleMay 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 & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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 diameterFeels like small, slipper marbles Mass more circumscribed and mobile than carcinoma

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Benign Conditions, continued

4. Tumors & cystsa. Fibroadenoma =

most common benign breast

tumor

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Tumors and Cysts, con’t…

b. Breast Cyst1. Benign2. May be aspirated

if large

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Benign conditions, continued …

c. Fibrocystic breast changes

1) 20%+ of premenopausal women 2) discomfort, cysts3) treatment rarely required 4) More likely to not detect a developing cancer

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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 & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

E. Carcinoma of the breast

1. Most common malignant tumor among women

2. 1/8 of women will develop breast cancera. 1/6 in Orange Countyb. 1/5 in San Francisco

3. Generally no discomfort

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Progression to Breast Cancer

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Carcinoma of breast, continued …

4. Physical signs:a. Slowly growing, painless massb. May demonstrate retracted nipplec. May be bleeding from nippled. May be distorted areola, or breast contoure. Skin dimpling in more advanced stages with retraction of

Cooper’s ligaments

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Physical signs, continued …

f. Attachment of mass

g. Edema of skin 1)with “orange skin” appearance

(peau d’orange) 2) due to blocked lymphatics

h. Enlarged axillary or deep cervical

lymph nodes

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Breast Cancer, con’t…

5. Common sites for metastasisa. Lungs & pleurab. Skeleton system (skull, vertebral column,

pelvis)c. Liver

6. Atypical carcinomasa. Inflammatory carcinoma (hormonal,

chemotherapy) b. Paget’s disease of the breast

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Ultrasound

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Mammogram

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Ultrasound

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Mammogram

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

ULTRASOUND

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

MRI