BAB I PENDAHULUAN
I.1. Latar Belakang
Tumor adalah Pertumbuhan baru suatu jaringan dengan multiplikasi sel-sel yang tidak terkontrol dan progresif, disebut disebut juga neoplasma. neoplasma. (sumber: Dorland 2002, kamus kedokteran, Jakarta: EGC). Tumor adalah pembengkakan atau daging tumbuh (sumber: gayatri, arum 1990. kamus kesehat6an. Jakarta: Arcan). Ada dua jenis tumor yaitu tumor jinak dan tumor ganas. Masing-masing tumor memiliki ciri-ciri tertentu. Tumor jinak memiliki ciri-ciri, di antaranya timbulnya ekspansif, tumor jinak tidak menimbulkan residif (mendesak jaringan sehat di sekitar dan jaringan sehat yang terdesak), karena tumor jinak bersimpai maka mudah dikeluarkan seluruhnya, tumor jinak tidak mengadakan anak sebar, tumbuhmnya lambat, sehingga tidak cepat membesar dan pada pemeriksaan mikroskopik tidak ditemukan gambaran metosisi yang abnormal dan biasanya tidak menyebabkan kematian bila letaknya pada alat tubuh yang vital. Adapun ciri-ciri dari tumor ganas diantaranya tumbuhnya infiltratif, yaitu tumbuh bercabang-cabang menyembul kedalam jaringan sehat disekitarnya, menyerupai jari-jari kepiting (cancer), setelah di angkat atau diberi pengobatan dengan penyinaran sering tumor ganas tumbuh lagi, pada umumnya tumor ganas sanggup mengadakan anak sebar ditempat lain melalui pembuluh darah atau cairan getah bening, tumbuh cepat, maka secara klinik tumornya membesar dan mikroskopik, banyak ditemukan mitosis, baik mitosis normal (bipolar) maupun mitosis yang abnormal (atipik), terjadi pembelahan yang multiple, terdapat gambaran mikroskopik nitosis yang di atipik seperti mitosis tripolar atau multipolar, tumor ganas jika tidak diobati akan menimbulkan kematian pada penderita walaupun letaknya misalnya pada kaki dan tangan. Dalam makalah ini akan dibahas mengenai berbagai jenis tumor jinak dan ganas yang terdapat pada uterus, tuba dan ovarium baik dari segi penyebab, gejala klinis, manajemen asuhan, serta pendokumentasian pendokumentasian kasus tersebut.
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I.2. Tujuan 1.2.1 Tujuan Umum
Tujuan umum pembuatan makalah ini adalah untuk memenuhi salah satu tugas mata kulian Asuhan Kebidanan IV. 1.2.2 Tujuan Khusus
Adapun tujuan khusus dari pembuatan makalah ini:
Mengetahui pengertian, tanda gejala, jenis, penyebab, patofisiologi, detekksi dini, manajemen asuhan, dan rujukan dari penyakit tumor jinak dan tumor ganas pada tuba.
Mengetahui pengertian, tanda gejala, jenis, penyebab, patofisiologi, detekksi dini, manajemen asuhan, dan rujukan dari penyakit tumor jinak dan tumor ganas pada uterus.
Mengetahui pengertian, tanda gejala, jenis, penyebab, patofisiologi, detekksi dini, manajemen asuhan,dan rujukan dari penyakit tumor jinak dan tumor ganas pada ovarium.
Mempelajari cara mendokumentasikan kasus tersebut sesuai SOAP.
I.3. Sistematika Penulisan
Dalam pembuatan makalah ini, kami mencari sumber dari berbagai buku mengenai ilmu kandungan dan kebidanan serta memahami setiap penyakit tersebut untuk diaplikasikan ke dalam pendokumentasian kasus.
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BAB II TINJAUAN TEORI
II.1 TUMOR JINAK DAN TUMOR GANAS PADA TUBA FALLOPII
A. Tumor Jinak pada Tuba Fallopii Tumor tuba uterus dapat berupa neoplasma maupun non neoplasma. Tumor tuba uterine yang neoplastik jarang sekali ditemukan. Pernah dilaporkan dalam kepustakaan adanya adenoma, leiomioma, fibroma, kista dermoid dan lain-lainnya. Tumor neoplasmik jinak dekat tuba, kista parovarium (adalah sisa dari epoophoron), terletak diantara tuba bagian distal dan ovarium dengan diameter biasanya tidak mencapai 4 cm. dinding kista ini tipis terdapat epitel kuboid atau datar yang dikelilingi oleh jaringan pengikat dan lemak. Kista berisi cairan jernih. Genandri dkk. Melaporkan adanya adenokarsinoma serosum dengan derajat keganasan endah berasal berasal dari kista ini.
Tanda dan Gejala
Ketidaksuburan yang memperlihatkan tanda-tanda dan gejala bahwa masalah itu disebabkan berkenaan dgn kandungan atau tuba fallopi yang abnormal. Tuba fallopi yang mengalami penyumbatan atau menjadi rusak dapat mengurangi kesuburan dengan mencegah sperma mencapai telur atau mencegah telur mencapai rahim. Ketidaksuburan pada tuba fallopi juga dapat timbul setelah terjadinya infeksi keguguran, infeksi pada saat melahirkan anak, radang selaput perut atau operasi. Penyebab
Tumor-tumor ini disebabkan oleh radang dan beberapa penyakit pada alat genital, antara lain hidrosalping, pilosalping, dan kista tuboovarial.
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Penanganan
Ketidaksuburan pada tuba fallopi kadang-kadang dapat ditindak dengan melakukan operasi, operasi, tetapi jika hal ini tidak memungkinkan, atau jika operasi ini gagal, IVF (In Vitro Fertilisation) atau program bayi tabung mungkin merupakan sebuah solusi. Operasi tuba fallopi merupakan prosedur yang melibatkan anestesi secara umum dan seringkali berlangsung selama beberapa jam. Operasi biasanya dilakukan dilakukan dengan bantuan mikroskop. Keberhasilan Keberhasilan dari operasi sekitar 45% kalau masalahnya ada pada akhir saluran tuba, tetapi hanya 20-25% bila masalahnya pada penyumbatan fimbrial di ujung saluran tuba fallopi, dekat dengan ovaries.
B. Tumor Ganas pada Tuba Fallopii (ADNEKSA) Tumor ganas primer di tuba sangat jarang, lebih sering yang sekunder berasal dari tumor ganas ovarium, uterus, kolorektal, lambung dan payudara. Paling jarang diantara keganasan alat reproduksi wanita (<0,1%) diteemukan 1 : 1000 kasus operasi ginekologik abnormal, dapat dijumpai pada semua umur (dari 19-80 tahun), dengan rata-tara puncaknyapada usia 52 tahun. Kejadian paling sering ialah pada kelompok umur seperti pada karsinoma endometrium. Jenis-jenisnya Jenis-jenisnya
Hsu, Taymor dan Hertug membagi histologik tumor ini dalam 3 jenis menurut keganasannya. 1. Jenis papiler, tumor belum mencapai otot tuba dan diferensiasi selnya masih baik, batas daerah normal dengan tumormasih dapatditunjukan 2. Jenis papilo-alveoler (adenomatosa) tumor telah memasuki otot tuba dan memprihatikan gambaran kelejar. 3. Jenis alveo-meduler terlihat mitosis yang atipik dan terlihat invasi sel ganas ke dalam saluran limfa tuba.
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tuba fallopi yang menyebabkan berbagai gangguan dan terjadi pertumbuhan jaringan yang abnormal.
Patofisiologi
Pada umumnya terjadi secara langsung ke alat sekitarnya, kemudian mela lui pembuluh getah bening ke abdomen, leher, daerah inguinal, vaginal, tuba, ovarium dan uterus.
Gambaran Klinis
Pada awal penyakit ini tidak menimbulkan gejala, kalau sudah ada keluhan, biasanya sudah terlambat. Deteksi dini tumor ganas tuba Fallopii sukar diupayakan. Perlu dapat perhatian khusus bila wanita berusia 45-55 tahun, ditemukan tumor adneksa (tumor radang : hidrosalping, piosalping atau anses tubo-ovarial dan sebagainya) disertai rasa nyeri dan adanya getah vagina yang semula kekuningan yang bercampur darah, perlu dicurigai kemungkinan adanya tumor ganastubs terutama pada nulipara atau primipara. Perasaan nyeri ini dspst intermiten atau terus-menerus dan menjalar kepangkal paha dan punggung bagiuan bawah.
Pemeriksaan dan Deteksi Dini
a. Pemeriksaan pelvik Pemeriksaan ini digunakan untuk melihat perubahan pada vulva, vagina dan serviks dengan palpasi organ dalam khususnya ovarium dan permukaan uterus. b. Test papanicolau Merupakan pemeriksaan sistologis yang memungkinkan untuk mendeteksi adanya sel yang abnormal dan mendeteksi keganasan tumor pada tahap awal. c. Ultra sound / USG Digunakan untuk menentukan lokasi massa tumor
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1) Colposcopy : visualisasi vagina dan serviks dibawah kekuatan magnet yang rendah. 2) Culdoscopy : pemasukan culdoskop melalui vagina bagian belakang untuk melihat tuba fallopi dan ovarium. 3) Hysterescopy : pemasukan hyterescopy melalui servik untuk melihat bagian dalam uterus. 4) Biopsi : untuk mengetahui jenis dan keganasan keganasan sel. 5) Laboratorium : urine lengkap dan darah lengkap.
Penanganan
Penanganan utama yang dianjurkan adalah TAH + BSO + OM + APP (Total Abdominal Hysterectomi + Bilateral Salpingo-Oophorectomi + Omentectomy + Appendectomy). Dapat dipertimbangkan (optional) istilasi Phosphor 32 radioaktuf atau khemoterapi profilaksis. Radioterapi akhir-akhir ini tidak mendapat tempat dalam penanganan tumor ganas tuba dan ovarium karena sifat biologic tumor dan menyebar melalui selaput perut. Radiasi akan merusak alat-alat vital dalam rongga perut, khususnya usus hati dan ginjal. Dengan shielding (perlindungan) alat vital tersebut, akan menyebabkan kurangnya dosis radiasi. Radioterapi hanya dikerjakan pada tumor bed dan pada jenis histologik keganasan tertentu seperti disgerminoma.
II.2 TUMOR JINAK DAN TUMOR GANAS PADA UTERUS
A. Tumor Jinak pada Uterus Ektoserviks Kista sisa jaringan embrional : berasal dari saluran mesonefridikus Wolffi
terdapat pada dinding sampai ektoserviks
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ukuran besar berwarna putih mengkilap berisi cairan mucus. Kalau kista ini menjadi besar dapat menyebabkan perasaan nyeri. Papiloma :
dapat tunggal maupun multiple seperti kondiloma akuminata.
Kebanyakan papiloma ini adalah sisa epitel yang terlebih pada trauma bedah maupun persalinan. Hemangioma : jarang, biasanya terletak superficial, dapat membesar pada waktu
kehamilan, dapat menyebabkan metroragi Terapi tumor ektoseviks tergantung kepada kelainan atau pun potensi akan kelainan yang dapat disebabkannya. Umumnya bersifat ekspektatif saja. Kista nabothi dapat diinsisi, tumor-tumor lain dapat dilakukan ekstirpasi, kauterisasi dan krioterapi. Endoserviks Polip : sebetulnya adalah suatu adenoma maupun adenofibroma yang berasal dari
selaput lender endoserfiks. Tangkainya dapat panjang hingga keluar dari vulva. Epitel yang melapisi biasanya adalah epitel endoserviks yang dapat juga mengalami metaplasi menjadi lebih semakin kompleks. Bagian ujung polip dapat mengalami nekrosis, serta mudah berdarah. Polip ini berkembang karena pengaruh radang maupun virus. Harus ditegakkan apakah polip itu suatu adenoma, sarcoma botrioides, adenokarsima serviks atau mioma yang dilahirkan. Polip endoserviks diangkat dan perlu diperiksa secara histologik. Endometrium Polip endometrium : sering didapati, terutama dengan pemeriksaan histeroskop.
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Mioma submukosa sarang mioma dapat tumbuh bertangkai dan keluar dari uterus
menjadi mioma yang dilahirkan ( mioma geburt ). Tumor berkonsistensi kenyal berwarna putih. Miometrium
Neoplasma jinak ini berasal dari otot uterus dan jaringan ikat yang menumpangnya, sehingga dalam kepustakaan dikenal juga istilah fibromioma, leiomioma, atau pun fibroid. Berdasarkan otopsi, novak menemukan 27 % wanita berumur 25 tahun mempunyai sarang mioma, pada wanita yang berkulit hitam ditemukan lebih banyak. Mioma uterus belum pernah ( dilaporkan ) terjadi sebelum menars. Setelah menopause hanya kira-kira 10 % mioma yang masih bertumbuh. Di Indonesia mioma uteri ditemukan 2,39 – 11,7 % pada semua penderita ginekologi yang dirawat. Pathogenesis
Meyer dab de snoo mengajukan teori cell nest atau teori genitoblast. Percobaan Percobaan lipschutz l ipschutz yang memberikan estrogen kepada k epada kelinci percobaan ternyata menimbulkan tumor fibromatosa baik pada permukaan maupun pada tempat lain dalam abdomen. Efek fibromatosa ini dapat dicegah dengan pemberian preparat progesterone atau testosterone. Puuka dan kawan-kawan menyatakan bahwa reseptor estrogen pada mioma lebih banyak didapati daripada miometrium normal. Menurut Meyer asal mioma adalah sel imatur, bukan dari selaput otot yang matur. Patologi anatomi
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c. Mioma subserosum: apabila tumbuh keluar dinding uterus sehingga menonjol pada permukaan uterus, diliputi oleh serosa. Mioma subserosum dapat pula tumbuh menempel pada jaringan lain misalnya ke ligamentum atau omentum dan kemudian membebaskan diri dari uterus, sehingga disebut wandering / parasitic fibroid. Apabila mioma dibelah maka tampak bahwa mioma terdiri atas berkas otot polos dan jaringan ikat yang tersusun seperti konde / pesaran air ( whorl like pattern ), dengan pseudocapsule yang terdiri dari jaringan ikat longgar yang terdesak karena pertumbuhan sarang mioma ini. Pernah ditemukan 200 sarang mioma dalam satu uterus, namun biasanya hanya 5-20 sarang saja. Dengan pertumbuhan mioma dapat mencapai berat lebih dari 5 kg. Jarang sekali mioma ditemukan pada wanita berumur 20 tahun, paling banyak pada umur 35-45 tahun( kurang lebih 25 % ). Pertumbuhan mioma diperkirakan memerlukan waktu 3 tahun agar dapat mencapai ukuran sebesar tinju, akan tetapi beberapa kasus ternyata cepat. Setelah menopause banyak mioma menjadi lisut, hanya 10% saja yang masih dapat tumbuh lebih lanjut. Miom uteri ini lebih sering didapati pada wanita nulipara atau yang kurang subur. Faktor keturunan juga memegang peran .perubahan sekunder pada mioma uteri yang terjadi sebagian besar bersifat degenerasi. Hal ini oleh karena berkurangnya berkurangnya pemberian darah pada sarang mioma. Perubahan sekunder . 1. Atrofi : sesudah menopause ataupun sesudah kehamilan mioma uteri menjadi
kecil. 2. Degenerasi Degenerasi hialin : perubahan ini sering terjadi terutama pada penderita berusia
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4. Degenerasi Degenerasi membatu (calcareous degeneration) degeneration) : terutama terjadi terjadi pada wanita
berusia lanjut oleh karena adanya gangguan dalam sirkulasi. Dengan adanya pengendapan garam kapur pada sarang mioma maka miom akan menjadi keras dan memberikan bayangan pada foto rontgen. 5. Degenerasi merah (carneous degeneration) : perubahan ini biasanya terjadi
pada kehamilan dan nifas. Pathogenesis : diperkirakan karena suatu nekrosis subakut sebagai gangguan vaskularisasi. Pada pembelahan dapat dilihat sarang mioma seperti daging merah , berwarna merah disebabkan oleh pigmen hemosiderin dan hemofusin. Degenerasi merah tampak khas apabila terjadi pada kehamilan muda disertai emesis, haus, sedikit demam, kesakitan, tumor pada uterus membesar dan nyeri pada perabaan. Penampilan klinik ini seperti pada putaran tangkai tumor ovarium atau mioma bertangkai. 6. Degenerasi Degenerasi lemak : jarang terjadi, merupakan kelanjutan degenerasi hialin.
Komplikasi
Degenerasi ganas Mioma uteri yang menjadi leimiosarkoma ditemukan hanya 0,32-0,6% dari seluruh mioma, serta merupakan 50-75% dari semua sarcoma uterus. Keganasan umumnya baru ditemukan pada pemeriksaan histology uterus yang telah diangkat. Kecurigaan akan keganasan uterus apabila mioma uteri cepat membesar dan apabila terjadi pembesaran sarang mioma mi oma dalam menopause. Torsi ( putaran tangkai ) Sarang mioma yang bertangkai dapat mengalami torsi, timbul gangguan
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Gejala dan tanda
Hampir separuh kasus mioma uteri ditemuka secara kebetulan pada pemeriksaan ginekologik karena tumor ini tidak mengganggu . gejala yang dikeluhkan sangat tergantung pada tempat sarang mioma ini berada ( serviks, intramural, submukus, subserus ) , besarnya tumor, perubahan dan komplikasi yang terjadi. Gejala tersebut dapat digolongkan sebagai berikut. Perdarahan abnormal Gangguan perdarahan yang terjadi umumnya adalah hipermenor, menoragi dan dapat juga terjadi metroragi. Beberapa factor yang mejadi penyebab perdarahan ini, antara lain adalah :
Pengaruh ovarium sehingga terjadilah hyperplasia endometrium sampai adenokarsinoma adenokarsinoma endometrium
Permukaan endometrium yang lebih luas daripada yang biasa
Atrofi endometrium diatas mioma submukosa
Miometrium tidak dapat berkontraksi optimal karena adanya sarang mioma diantara serabut miometrium, sehingga tidak dapat menjepit pembuluh darah yang melaluinya dengan baik
Rasa nyeri Rasa nyeri dapat timbul karena gangguan sirkulasi darah pada sarang mioma, yang disertai nekrosis setempat dan peradangan . pada pengeluaran mioma
submukosa
yang
akan
dilahirkan,
pula
pertumbuhannya
yang
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Infertilitas dan abortus Infertilitas dapat terjadi apabila sarang mioma menutup m enutup atau menekan pars intertitialis tuba, sedangkan mioma submukosa juga memudahkan terjadinya abortus oleh karena distorsi rongga uterus. Rubin ( 1958 ) menyatakan bahwa apabila penyebab lain infertilitas sudah disingkirkan, dan mioma merupakan penyebab infertilitas tersebut, maka merupakan suatu indikasi untuk dilakukan miomektomi.
Mioma uteri uteri dan kehamilan kehamilan Mioma uteri dapat mempengaruhi kehamilan, ,misalnya menyebabkan infertilitas, risiko terjadinya abortus bertambah karena distorsi rongga uteri khususnya pada mioma submukosa,, letak janin, menghalangi kemajuan persalinan karena letaknya pada serviks uteri, menyebabkan inersia maupun atonia uteri, sehingga menyebabkan perdarahan pasca persalinan karena adanya gangguan mekanik dalam fungsi miometrium, menyebabkan plasenta sukar lepas dari dasranya , dan mengganggu proses involusi dalam nifas.
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seringkali teraba terbenjol-benjol. Mioma subserosum dapat mempunyai tangkai yang berhubungan dengan uterus. Mioma intramular akan menyebabkan kavum uteri menjadi luas, yang ditegakkan dengan pemeriksaan dengan uterus sonde. Mioma submukosum kadang-kala dapat teraba dengan jari yang masuk kedalam kanalis servikalis, dan terasanya benjolan pada permukaan kavum uteri. Diagnosis banding yang perlu kita pikirkan tumor abdomen dibagian
bawah atau panggul ialah mioma subserosum dan kehamilan, mioma submukosum yang dilahirkan harus dibedakan dengan inversio uteri, mioma intramular harus dibedakan dengan suatu adenomiosis, khoriokarsinoma, karsinoma korporis uteri atau suatu sarcoma uteri . USG abdominal dan transvaginal dapat membantu dan menegakkan dugaan klinis.
Pengobatan
Tidak semua mioma uteri memerlukan pengobatan bedah, 55 % dari semua mioma uteri tidak membutuhkan suatu pengobatan dalam bentuk apapun, terutama apabila mioma itu masih kecil dan tidak menimbulkan gangguan atau keluhan. Walaupun demikian mioma uteri memerlukan pengamatan setiap 3-6 bulan. Dalam menopause dapat terhenti pertumbuhannya menjadi lisut. Apabila terlihat adanya suatu perubahan yang berbahaya dapat terdeteksi dengan cepat
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Pengobatan Operatif
Miomektomi adalah pengambilan sarang mioma saja tanpa pengangkatan uterus. Tindakan ini dapat dikerjakan misalnya pada mioma submukosum pada myom geburt dengan cara ekstirpasi lewat vagina. Pengambilan sarang mioma
subserosus dapat mudak dilaksanakan apabila tumor bertangkai. Apabila miomektomi ini dikerjakan dikerjakan
karena ingin memperoleh memperoleh keinginan keinginan memperoleh
anak, maka kemungkinan kemungkinan akan terjadi terjadi kehamilan adalah 30-50 %. Perlu disadari bahwa 25 – 35 % dari penderita tersebut akan masih memerlukan histerektomi. Histerektomi adalah pengangkatan uterus, yang umumnya merupakan tindakan terpilih. histerektomi dapat dilaksanakan per abdominam atau per vaginam. Yang akhir ini jarang dilakukan karena uterus harus lebih kecil dari telor angsa dan tidak ada perlekatan dengan sekitarnya. Adanya prolapsus uteri akan mempermudah proses pembedahan. Histerektomi total umumnya dilakukan dengan alas an mencegah akan timbulnya karsinoma servisis uteri. Histerektomi supravaginal hanya dilakukan apabila terdapat kesukaran teknis dalam mengangkat mengangkat uterus keseluruhannya. keseluruhannya.
Radioterapi Tindakan ini bertujuan agar ovarium tidak berfungsi lagi sehingga penderita mengalami menopause. Radioterapi ini umumnya hanya dikerjakan
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B. Tumor Ganas pada Uterus Serviks Uterus (Leher Rahim)
Diagnosis tumor ganas pada serviks uterus tidaklah sulit, apa lagi kalau tingkatannya sudah agak lanjut. Dengan memperhatikan perubahan displastik dari epitel serviks (NIS I,II,III, dan KIS), penangananyang sederhana sederhana tetapi benar akan menghindarkan wanita itu dari karsinoma serviks (pencegahan sekunder). Memang pencegahan pencegahan masih selalu lebih murah dari pada pengobatan kanker yang sudah ada. Pencegahan primer tampaknya sulit dikerjakan, karena sebab biologic kanker serviks belum diketahui yang dapat disarankan ialah menghindari factor eksogen/ekstrinsik yang memberi resiko untuk mengidap kanker leher rahim. Upaya pencegahan skunder melalui usapan servikovaginal berkala dengan pengecatan Papanicolaou, biopsy terarah dengan sebelumnya memulas portio dengan sol. Lugoli dibawah bimbingan kolposkop, atau kuretase endoserviks sangat penting dan perlu dikuasai oleh setiap dokter puskesmas dan mereka yang berkerja dirumah sakit. Bilamana deteksi dini dapat diupayakan, sebenarnya tidak perlu wanita itu mati akibat kanker leher rahim. Karsinoma serviks uterus Etiologi
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Patologi
Karsinoma serviks timbul di batas antara epitel yang melapisi ektoserviks (porsio) dan endoserviks kanalis seriks yang disebut sebagai squamo-columnar junction (SCJ). Histologik antar epitel gepeng berlapis bersilia dari endoserviks kanalis serviks. Pada wanita muda SCJ ini berada diluar ostiumuteri eksternum, sedang pada wanita berumur >35 tahun, SCJ berada di dalam kanalis serviks. Maka untuk melakukan Pap Smear yang efektif yang dapat mengusapzona transformasi, harus dikerjakan dengan skraper dari ayre atau cytubrush sikat khusus. Pada awal perkembangannya kanker serviks tak member tanda-tanda dan keluhan. Pada pemeriksaan dengan speculum, tampak sebagai sebagai porsio yang erosive (metaplasi skuamosa)yang fisiologik atau patologik.tumor yang dapat tumbuh: 1) Eksofitik mulai dari SCJ kearah lumen vagina sebagai masa proliferative yang mengalami infeksi skunder dan nekrosis; 2) Endofitik mulai dari SCJ tumbuh kedalam stroma serviks dan cenderung untuk mengadakan infiltrasi menjadi ulkus; 3) Ulseratif mulai dari SCJ dan cenderung merusak struktur jaringan serviks dengan melibatkan awal fornises vagina untuk menjadi ulkus yang luas. Serviks yang normal, secara alami mengalami proses metaplasi (erosi) akibat
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Penyebaran
Pada umumnya melalui pembuluh getah bening menuju 3 arah: a) Ke arah fornises dan dinding vagina b) Ke arah korpus uterus c) Ke arah perimetrium dan dalam tingkatan yang lanjut menginfiltrasi septum retrovaginal dan kandung kemih. Tergantung dari kondisi imunologik tubuh penderita KIS akan berkembang menjadi mikro invasive dengan menembus membrana basalis dengan kedalaman invasi <1 mm dan sel tumor belum terlihat dalam pembuluh limfa atau darah. Jika sel tumor sudah terdapat >1mm dari membrana basalis, atau <1 mm tapi sudah tampak berada dalam pembuluh limfe atau darah, maka prosesnya sudah invasive. Tumor mungkin telah menginfiltrasi stroma serviks, akan tetapi secara klinis
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Ia
Karsinoma mikro invasive;bila membrane basalis sudah rusak dan sel tumor sudah memasuki stroma tak>3 mm, dan sel tumor tidak terdapat dalam pembuluh limfa atau pembuluh darah.
Ibo cc:
Kedalam invasi 3 mm sebaiknya diganti dengan tak >1 mm.
(I b occult = Ib yang tersembunyi);secara tersembunyi);secara klinis tumor tidak tampak sebagai karsinoma, tetapi pada pemeriksaan histologik ternyata sel tumor telah mengadakan invasi stroma melebihi I a.
Ib:
Secara kinis sudah diduga adanya tumor yang histologikmenunjukkan histologikmenunjukkan invasi kedalam stroma serviks uteri.
II
Proses keganasan sudah keluar dari serviks dan menjalar ke 2/3 bagian atas vagina dan/ke parametrium, tetapi tidak sampai dinding panggul.
IIa
Penyebaran Penyebaran hanya ke vagina, parametrium masih bebas dari infiltrate tumor,
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Gambaran klinik dan diagnosis
Keputihan merupakan gejala yang sering ditemukan. Getah yang keluar dari vagina ini makin lama akan berbau busuk akibat infeksi dan nikrosis jaringan. Dalam hal demikian, pertumbuhan tumor menjadi ulseratif. Perdarahan yang dialami segera sehabis senggama (disebut sebagai perdarahan kontak) merupakan gejala karsinoma serviks (75-80%). Perdarahan yang timbul akibat terbukanya pembuluh darah makin lama akan lebih sering terjadi, jika diluar senggama (perdarahan spontan). Perdarah spontan saat defekasi akibat tergesernya tumor eksofitik dari serviks oleh skibala, memaksa mereka dating ke dokter. Adanya perdarahan spontan pervaginam saat berdefekasi, berdefekasi, perlu dicurigai kemungkinan adanya karsinoma serviks tingkat lanjut adanya bau busuk yang khas memperkuat dugaan adanya karsinoma. Anemia akan menyertai sebagai akibat perdarahan pervaginam yang berulang. Rasa nyeri
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Bila penderita telah cukuptua, atau sudah mempunyai cukup anak, uterus tidak perlu ditinggalkan, agar penyakit tidak kambuh (relapse) dapat dilakukan histerektomi sederhana (simple vaginal hysterectomy). Pada kasus tertentu dimana operasi merupakan suatu kontraindikasi aplikasi radium dengan dosis 6500-7000 rads/cGy dititik A tanpa penambahan penyinaran luar, dapat dilakukan. Gambaran klinik dan penanganan adenokarsinoma serviks uterus pada umumnya tidak berbeda dengan karsinoma epidermoid. Karsinoma serviks uterus dalam kehamilan
Tumor ganas diserviks tidak menghalangi untuk adanya kehamilan. Terdapat kira-kira 1 di antara 3000 kehamilan. Tidak ada perbedaan antara karsinoma serviks dalam dan diluar kehamilan, mengenai perjalanan penyakitnya, dalam
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Prognosis
Faktor-faktor yang menentukan prognosis: 1) Umur penderita 2) Keadaan umum 3) Tingkat klinik keganasan 4) Cirri-ciri histologik sel tumor 5) Kemampuan ahli atau tim ahli yang menangani menangani 6) Sarana pengobatan yang ada
Sarcoma
Sarcoma serviks uterus, jarang sekali ditemukan. Yang terbanyak ialah
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mioma uterus. Perlu diingatkan, pembesaran cepat dari uterus pada wanita yang mioma uterus dalam masa menopause, perlu dicurigai akan kemungkinan pertumbuhan maligna (degenerasi sarkomatosa). Penanganan pada dasarnya adalah TAH + BSO dilanjutkan dengan tambahan/adjuvans khemoterapi.
Khoriokarsinoma
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Pengobatan
Khorio-karsinoma merupakan keganasan pertama yang dapat diobati dengan kemoterapidan merupakan merupakan contoh yang nyata dari tumor ganas yang dapat disembuhkan dengan obat-obatan. Bilamana tidak ada penyebaran, 90% dapat Methotrxate). Sisanya yang 10% bilamana titer Betadisembuhkan dengan MTX ( Methotrxate).
HCG
terus
menerus
tinggi,
yang
menunjukan
adanya
penyakit
yang
peristen/menetap, perlu dilakukan histerektomi. Bilamana titer Beta-HCA turun
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2.4 kista endometrium 2.5 kista Stein-Leventhal Tumor Neoplastik Jinak
1. Kistik a. Kistoma ovarii simpleks b. Kistadenoma ovarii serosum
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pembicaraan tumor ganas, sebuah tumor sel granulosa dapat menimbulkan hipermenorea, dan arhenoblastoma dapat menyebabkan amenore. Akibat komplikasi komplikasi
Perdarahan ke dalam kista biasanya terjadi sedikit – sedikit, sehingga berangsur – angsur menyebabkan pembesaran kista, dan hanya menimbulkan gejala – gejala klinis yang minimal. Akan tetapi , kalau kalau perdarahan perdarahan terjadi tiba –
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Robekan dinding pada kistadenoma musinosum dapat mengakibatkan implantasi sel – sel kista pada peritoneum. Sel – sel tersebut mengeluarkan cairan musim yang mengisi rongga perut dan menyebabkan perlekatan – perlekatan dalam rongga perut. Keadaan ini dikenal dengan nama pseudomiksoma peritonei. Perubahan keganasan dapat terjadi pada beberapa kista jinak, seperti jistadenoma ovarii serosum, kistadenoma ovarii musinosum, dan kista dermoid. Oleh sebab itu, setelah tumor – tumor tersebut diangkat pada operasi, perlu
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anamnesis yang cermat dan disertai pemeriksaan tambahan, kemungkinan –
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2) Ultrasonografi
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terjadinya kista, berisi cairan yang berwarna merah coklat karena darah tua.
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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Trusted by over 1 million members
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