Download - Imaging & Staging Carcinoma Cervix Fix
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Imaging & Staging CarcinomaCervix
Disusun oleh : Handini Rahmi Dewi /1061001!"#em$im$ing : dr% udiawan 'tmad(a) S*%Rad
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#endahuluan
+enurut ,H-Kanker seviks menempati urutan
kadua terbanyak menyerang kaumhawa. Dengan angka kejadian >
250.000 wanita meninggal akibatkanker serviks pada tahun 2005.
Data dari Sistem In.ormasiRumah Sait
Tahun 2008 menunjukkan kanker
payudara (8!"#$ menempatiurutan pertama pada pasien rawat
inap di seluruh rumah sakit di%nd&nesia! disusul kanker serviks
(0!'#$
+enurut D#S00 per 00.000 penduduk
pertahun! sedangkan dari data
ab&rat&rium )at&l&gi*nat&mi seluruh %nd&nesia!
+rekuensi kanker serviks palingtinggi diantara kanker yang
ada di %nd&nesia!penyebarannya terlihat bahwa
,2!"# terakumulasi di -awadan ali.
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2I34'5'3 #5S2''
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Denisi
Kanker serviks adalah penyakit akibat tum&r ganaspada daerah mulut rahim sebagai akibat dari adanya
pertumbuhan jaringan yang tidak terk&ntr&l danmerusak jaringan n&rmal di sekitarnya
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tiologi
/ubunganseksual
pertama kalipada usia dini(umur 1
tahun$.
anita yangmelahirkan
anak lebih dari' kali
(multiparitas$.
-arakpersalinan
terlalu dekat.
/ygieneseksual yang
jelek.
anitamer&k&k
%n+eksi /uman)apill&ma 3irus(/)3$ tipe 1
dan 8
4eringbergantiganti
pasangan(multipartner
se6$
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#atosiologi
7 k s & 8 t i k
• 9 u l a i d a r i 4 : - k e a r a h l u m e n v a g i n a s e b a g a i m a s s a p r & l i + e r a t i + y a n g m e n g a l a m i i n + e k s i s e k u n d e r d a n n e k r & s i s
7 n d & 8 t i k • 9 u l a i d a r i 4 : - t u m b u h k e d a l a m s t r & m a s e r v i k s d a n
; e n d e r u n g i n 8 t r a t i + m e m b e n t u k u l k u s
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Diagnosis
• e*utihan%Keputihan merupakan gejala yang paling sering ditemukan! berbaubusuk akibat in+eksi dan nekr&sis jaringan• #endarahan k&ntak merupakan 580# gejala karsin&ma serviks.)erdarahan timbul akibat terbukanya pembuluh darah! yang makinlama makin sering terjadi diluar senggama.• Rasa n7eri! terjadi akibat inltrasi sel tum&r ke serabut sara+. ?ejala lainnya adalah gejalagejala yang timbul akibat metastase jauh.
)*)497*@ %3*
%9*?%A?
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#em$ahasan
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*gar radi&gra terlihat! tum&r harus minimal tahap %batau di atas (lihat penyebaran$. 9@% adalah m&dalitas
pen;itraan pilihan untuk menggambarkan tum&r
primer dan menilai penyebaran l&kal. -auhnyametastasis baik dinilai dengan :T atau )7T! jikatersedia
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5S8
/yp&e;h&i;! massa heter&gen yangmelibatkan serviks mungkin
menunjukkan peningkatanvaskularisasi pada D&ppler warnameskipun klasikasi stadium padakanker serviks ditentukan jugase;ara
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C2 SC'3
:T pada umumnya tidak terlaluberguna dalam penilaian dari tum&r
primer! tetapi dapat berguna dalammenilai penyakit lanjut)ada :T! tum&r primer dapat
hyp&dens atau is&dens sama sepertiserviks n&rmal
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:T &+ ;lini;ally visible ;ar;in&ma ;&nned t& the ;ervi6(stage %$. The image sh&ws a mass with slightly
heter&gene&us attenuati&n that e6pands the ;ervi6 andis surr&unded by a thin rim &+ relatively preserved
str&ma. The ;ervi;al margins are sm&&th! well dened!and inta;t. )arametrial s&+ttissue stranding &r masses
are la;king! and the periureteral +at planes arepreserved
:T image thr&ugh the upper uterus sh&ws uidthat markedly distends the end&metrial ;avityse;&ndary t& &bstru;ti&n &+ the end&;ervi;al;anal by ;ervi;al ;an;er. * small submu;&sallei&my&ma pr&je;ts int& the right anteri&r aspe;t
&+ the end&metrial ;avity and has minute;al;i;ati&ns.
:T &+ ;lini;ally visible ;ar;in&ma ;&nned t& the ;ervi6(stage %$. The image sh&ws a mass with slightly
heter&gene&us attenuati&n that e6pands the ;ervi6 andis surr&unded by a thin rim &+ relatively preserved
str&ma. The ;ervi;al margins are sm&&th! well dened!
and inta;t. )arametrial s&+ttissue stranding &r massesare la;king! and the periureteral +at planes arepreserved
:T &+ ;lini;al stage %% ;ervi;al ;ar;in&ma. The parametrialinvasi&n is depi;ted with :T as l&ss &+ deniti&n &+ the
;ervi;al ;&nt&urs! a;;&mpanied by in;reased attenuati&nand pr&minent s&+ttissue stranding in the parametrial +at.
)arametritis ;an result in similar ndings. The ;ervi6
sh&ws illdened hyp&attenuati&n! but the tum&r is n&t;learly delineated.
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:T &+ ;lini;al stage %% ;ervi;al ;ar;in&ma. This imagesh&ws a hyp&attenuating tum&r &;;upying the entire;ervi6 and e6tending t& the &uter p&steri&r and right;ervi;al margins. This nding is ;&nsistent with +ull
thi;kness str&mal invasi&n. 9inimal air in the ;enter is
related t& the bi&psy. * vaginal tamp&n is present t&the right &+ the ;ervi6.
:T &+ parametrial and re;tal invasi&n by ;ervi;al;ar;in&ma. There is l&ss &+ deniti&n &+ the ;ervi;al
;&nt&urs! a;;&mpanied by masslike s&+t tissue whi;hrepla;es the parametrial +at &n the right and e6tends
int& the anteri&r and rightsided re;tal walls.
:T &+ a patient with stage %3 ;ervi;al ;ar;in&ma. This image &+ the mid abd&men sh&ws b&rderlineenlarged lymph n&de in the le+t paraa&rti; regi&n!
presumably se;&ndary t& metastasis! whi;h is;&nsistent with stage %3 disease. 9ultiple ndings
are visualiEed in this patient in &ther anat&mi;regi&ns (please see the images bel&w in;luded in4tage %3 :T ndings$.
:T &+ a patient with stage %3 ;ervi;al ;ar;in&ma(same patient as in the previ&us image$. The image atthe kidneys level sh&ws le+t hydr&nephr&sis whi;h is a+eature &+ stage %%% disease. The ndings &+ stage %3
disease in this patient are depi;ted &n the &therimages.
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:T &+ a patient with stage %3 ;ervi;al ;ar;in&ma (samepatient as in the previ&us image$. This image &+ the mid pelvis
sh&ws ;ervi;al tum&r e6tending int& the upper uterus!b&rderline enlarged lymph n&des! presumably se;&ndary t&
metastasis! and le+t hydr&ureter. The pelvi; lymph n&de
enlargement and le+t hydr&ureter are +eatures &+ stage %%%disease. The ndings &+ stage %3 disease in this patient are
depi;ted &n the &ther images
arge tum&ur in a barrelshaped ;ervi6appearing as an inh&m&gene&us mass
&wing t& ne;r&sis in ven&us and delayedphases. @ight adrenal n&dule is n&ted.
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+RI
)r&t&k&l 9@% sering bergunauntuk penilaian pen;itraan yang
&ptimal
)ed&man pelap&ran 9@% untuk kankerserviks ini membantu dalam menjagakeseragaman lap&ran dan penilaianterhadap pentingnya ;riteria pen;itraan
untuk menentukan stadium kanker.
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Stage 1 b
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Stage !
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Stage 9a
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Stage 9$
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Stage a
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Stage $
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2RI+''SIH