Download - Carcinoma payudara pd kehamilan ppt
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Dr. Azis Aimaduddin AI
PPDS BEDAHFK UNS
RS DR MOEWARDI
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DefinisiDefinisi
didiagnosis selama kehamilan, atau dalam satu tahun setelah melahirkan
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Saunders CM,Baum M Breast cancer and pregnancy review .J R Soc Saunders CM,Baum M Breast cancer and pregnancy review .J R Soc
1 / 3000 kehamilan Incidence 0.76 – 3.8 % Median umur 33 ( 23 - 47 y)
EpidemiologiEpidemiologi
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Serupa dengan wanita tidak hamil
- Painless mass
- Nipple discharge
- Inflammatory breast
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Invasive ductal ca
Invasive lobular ca
Inflammatory breast ca
Middleton LP , et al. Breast carcinoma in pregnant women.Assissment of clinicopathologic & immunohistochemical features
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Serupa dengan wanita tidak hamil :
frekuensi histologi Grade
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Terlibat dalam 60 - 90% Sama dgn tidak hamil
Isaac J . Cancer of the breast in pregnancy. Surg clin North Am
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keterlambatan diagnostikRata-rata keterlambatan 8,2 bulan (2-15 bulan)Stadium lanjut '2,5 kali lipat'
Moore HCF, Foster Jr Rs. Breast cancer and pregnancy, Semin oncol
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FNABCore biopsi - Cost efektifSensitifity 60-70 %
Sorosky JI ,Scott-conner. Breast cancer complicating pregnancy.Obst Gynecol clin North Amer
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USG sensitivity 93 %
Mammogram: - 0.004 Gy - sensitivity 70%
Staging – Thoraks ro , USG
Nicklas A, Baker M. Imaging strategies in pregnant caner patients. Semin oncol 2000;27:623-32
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ManajemenManajemenTidak ada lagi penggunaan terapi aborsi.
Pendekatan therapeutik untuk wanita hamil dengan kanker payudara sama dengan wanita yang tidak hamil.
Pendekatan pasien harus dibedakan, mempertimbangkan umur kehamilan, tingkat penyakit pasien dan pilihan pasien.
Pendekatan multidisipliner, koordinasi antar oncology dan kebidanan
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Trimester ITrimester I
(Std I,II)Continuing pregnancy Mastectomy + Axilary staging adjuvant kemoterapi 2nd trimester ± Adjuvant radiasi post partum ± adjuvant endokrin terapi post partum
(Std III,IV)Discus termination adjuvant kemoterapi 2nd trimester ± Adjuvant radiasi post partum ± adjuvant endokrin terapi post partum
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Trimester IITrimester II(Std I,II)Mastektomy/BCS + Axilary
staging adjuvant kemoterapi ± Adjuvant radiasi post partum ± adjuvant endokrin terapi post partum
(Std III,IV) kemoterapi Adjuvant radiasi post partum ± adjuvant endokrin terapi post partum
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Trimester IIITrimester III(Std I,II)Mastectomy/BCS + Axilary
staging adjuvant kemoterapi ± Adjuvant radiasi post partum ± adjuvant endokrin terapi post partum
Std IV: Kemoterapi, Radiasi post partum ± adjuvant endokrin terapi post partum
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