Q and A about Cervical Cancer

 Question and Answer about Cervical Cancer  

 Apa itu Kanker Serviks / Leher Rahim?

  Yaitu tumor ganas yang tumbuh di serviks (leher rahim)

l  Bagaimana seseorang bisa terjangkit kanker ini? 

 Kini sudah diketahui, penyebabya hampir 100% berkaitan dengan VIRUS yg disebut HPV (:Human papiloma Virus). Sebagian berkaitan dengan penularan melalui aktivitas seksual, tapi ada juga (sebagian kecil) dapat dengan kontak lain.

l  Adakah data  jumlah penderita, jumlah kasus baru, dan kematian akibat kanker serviks di Indonesia?

                    Di Indonesia. Setiap tahun diperkirakan 15.000 kasus baru dan lebih dari   

                     separonya (7800) meninggal pada tahun tersebut. 

         Jadi di Indonesia kira-kira 1 perempuan usia reproduktif meninggal setiap jam.

l  Berdasarkan informasi beberapa penyebab kanker serviks adalah akibat perawatan organ intim yang salah (air bilas yang tidak bersih, gaya bilas dr belakang ke depan, dan lainnya) Selain itu adakah pengaruh dari  tingkat cuaca di Indonesia yang cenderung lembab?

    Tingkat cuaca tidak berkaitan erat dg penyebaran

  pengaruh gaya hidup seperti pola makan?  

     Pengaruh gaya hidup pola makanan tak sangat terkait  secara khusus

  Apakah benar bahwa pemakaian sabun khusus organ intim tidak perlu? Dirawat secara baik, bersih dan benar perlu,   belum ada kajian Sabun khusus diperlukan utk perawatan vagina

l  Sebenarnya bolehkah wanita menggunakan pantyliner? karena ada informasi bahwa pemakaian pantyliner cenderung berpotensi menumbuhkan jamur dalam organ intim wanita.  

      Pemakaian pantyliner BOLEH

l  Apa saja langkah-langkah untuk mencegah kanker serviks?

               - Pencegahan primer:

    menghindari faktor risiko ( banyak pasangan, merokok, sering terpapar   

    IMS- infeksi menular seksual),

    vaksinasi

- Pencegahan sekunder dengan melakukan pemeriksaan  deteksi dini

        Paps Smir atau IVA atau tes HPV

l  Benarkah  masih  banyak wanita Indonesia yang enggan memeriksakan diri ke dokter karena terlanjur takut dengan hasil yang diterima? Bagaimana dengan pendapat dari para dokter? Apakah ada data mengenai hal ini?

Jawab: Di Indonesia masih banyak yang belum tahu, jika tahu masih enggan

Karena itu ayo kita saling mengingatkan:

Semua perempuan dewasa (yang sudah menikah, tepatnya yang sudah berhubungan seksual,

lakukan Pap's Smear  atau IVA

Pemeriksaan IVA dengan Dokumentasi

Haloo,

Saya ingin "share" dengan IVA dapat dengan Dokumentasi

Chemoradiation for Cervical Cancer

Chemoradiation for Locally Advanced Cervical Cancer
Dr Cipto Mangunkusumo Hospital Central General Hospital
Jakarta

Dewi Rochyantini, Laila Nuranna,
Sigit Purbadi, Gatot Purwoto

Abstract
Objective : To compare theraupetic respons and disease free survival for locally advanced cervical cancer patient in which treated with chemoradiation and radiation.
Setting : ERIA ward and Oncology Gynecology policlinic in Obstetrics and gynecology Departement dr. Cipto Mangunkusumo General Hospital.
Design : Retrospective Controlled Trial, observational study has been enrolled for 8 years.
Material and Method : 278 pts cervical cancer has been completed theraphy during 1997-2004. Divided into 2 theraupetic group, 199 pts (1997-2000) was radiation group, and 79 pts (2001-2004) was chemoradiation group. Each group has been followed for a year to find out theraupetic respons and recurrence effect, to count down disease free survival.
Result : Theraupetic respons based on each theraphy methods : Radiation group has completed respons 179 cases (89,95%), 14 cases parsial respons (7,04%), 4 cases nonrespons (2,01%) and 2 cases progresif (1,01%). Chemoradiation group has completed respons 73 cases (92,41%), 4 cases parsial respons (5,06%), 1 cases nonrespons (1,27%) and 1 cases progresif (1,27%), (p = 0,899). Theraupetic respons for locally advanced cervical cancer : radiation group has completed respons for 99 cases, parsial respons 8 cases, progresif 2 cases. chemoradiation group has completed respons 63 cases, parsial respons 3. and 1 progresif cases, (p > 0,05).
Disease Free Survival for each theraphy methods : one year DFS for radiation group is 87,07%, and chemoradiation group is 81,66%, two year DFS for radiation group is 79,81%, and chemoradiation group is 68,6%. (p = 0,405). Disease Free Survival for locally advanced cervical cancer : one year DFS for radiation group is 85% and 71,58% in 2nd year, two year DFS for chemoradiation group is 81%, and 66,77% in 2nd year, with recurrence probablility for chemoradiation is 1,09 times higher.
Conclusion : Theraupetic respons in chemoradiation group is not better than radiation group, but not statistically significant. Disease Free Survival and recurrence rate in chemoradiation group is not better than radiation group, but not statistically significant. Recurrence probablility for chemoradiation is 1,09 times higher.
Keywords: Cervical Cancer, Chemoradiation, Theraupetic respons, Disease free survival

Doa yang Dikabulkan

Menjadi kelompok Orang-orang yang Didoakan Malaikat.

Saudaraku, inginkah kita termasuk orang-orang yang didoakan oleh malaikat, karena doa para malaikat, insya Allah besar kemungkinannya dikabulkan oleh Sang Maha, yaitu Allah. Dan salah satunya adalah ketika:
Kita mendoakan saudara kita tanpa sepengetahuan orang yang kita doakan dengan tulus ikhlas. "Doa seseorang untuk saudaranya yang dilakukan tanpa sepengetahuan orang yang didoakannya adalah doa yang makbul. Pada kepalanya ada seorang malaikat yang menjadi wakil baginya, setiap kali dia mendoakan kebaikan bagi saudaranya, maka malaikat tersebut berkata: ”Amiin dan engkaupun mendapatkan kebaikan yang saudaramu dapatkan"
Saudaraku,
Dari beberapa kelompok yang didoakan malaikat seperti disebut di atas, ingin kami mengajak untuk membangun suatu suasana beratmosfer SALING MENDOAKAN KEBAIKAN di antara kita di lingkungan masyarakat Indonesia. Andai masing –masing kita mendoakan kebaikan untuk sejawatnya secara diam-diam dengan tulus ihlas, betapa keberkahan yang akan berlimpah bagi diri kita SEMUANYA. Ternyata doa yang dilantunkan bagi saudara lain dengan diam-diam dengan tulus ikhlas,
Doa tersebut akan lebih makbul untuk dikabulkan,
Dapat menjadi JEJARING SILATURAHMI BATIN di antara kita.

Saudaraku,
Memang hal tersebut tampaknya ringan, tapi kenyataannya berat, karena dituntut ketulus ikhlasan kita, menembus dinding EGO diri kita yang lebih sering berdoa untuk diri sendiri. Mari kita latih, dan betapa rasa bahagia akan mengalir melalui sendi-sendi dan urat nadi kita, menjadi ringan kala kita biasakan ketika diri kita mengikhlaskan DOAnya bagi SAUDARAnya. Misalnya ada saudara kita sedang terkena ujian apakah sedang di uji terkena penyakit, atau sedang terkena ujian masalah keluarga, atau terlilit masalah keuangan, MARI kita doakan diam-diam dengan tulus ikhlas agar ujiannya teratasi. InsyaAllah, boleh kita berharap:
• doa kita nilainya tinggi untuk dikabulkan bagi saudara kita itu,
• secara tidak langsung malaikat mendoakan hal kebaikan yang sama bagi diri kita,
• tersambung silaturahmi batin di antara sesama sejawat.
Maka akan terwujudlah wadah masayarakat Indonesia yang saling mengasihi dan saling menyayangi serta saling mendukung, bukan saling ’menohok’. Akan terjadi rasa persaudaraan yangg akrab tidak saja secara fisik persaudaraan, tetapi juga rasa persaudaraan akan terwujud secara batiniah. Amin
Masalahnya, BAGAIMANA KITA MENDOAKAN KEBAIKAN BAGI ORANG LAIN dengan TULUS IKHLAS. Kita berusaha.


Laila N

DISCOVER THE MOST FREQUENT
CAUSE OF VAGINAL BLEEDING

Laila Nuranna

Division of Oncology Gynecology, Department of Obstetrics and Gynecology
Faculty of Medicine, University of Indonesia

Abstract
This topic shows the various causes of vaginal bleeding, and how common these diseases or conditions are in the general population. This is not a direct indication as to how commonly these diseases are the actual cause of Vaginal bleeding, but gives a relative idea as to how frequent these diseases are seen overall
Bleeding from the vagina may be abnormal when menstrual periods are too heavy or too light, last too long, occur too frequently, or are irregular. Any vaginal bleeding that occurs before puberty or after menopause is abnormal. Some causes are more common among certain age groups.
In children, vaginal bleeding is rare. The most common cause is injury to the vulva or vagina (sometimes due to insertion of an object, such as a toy), bleeding in children may also result from puberty that starts very early (precocious puberty).
In reproductive age, vaginal bleeding may be caused by birth control methods, such as oral contraceptives (a combination of a progestin and estrogen or a progestin alone) or an intrauterine device (IUD). Abnormal bleeding may also be caused by complications of pregnancy, such as an ectopic pregnancy, or by infections of the uterus, usually after delivery of a baby or an abortion. Other causes of bleeding include blood disorders involving abnormal clotting (such as leukemia or a low platelet count), a hydatidiform mole, endometriosis, and noncancerous growths (such as adenomyosis, fibroids, cysts, and polyps). Cancer may cause bleeding in women of reproductive age. Bleeding from the vulva is usually due to injury. Thyroid disorders can cause menstrual periods to be irregular.
In postmenopausal women, vaginal bleeding may be due to atrophic vaginitis, thinning or thickening (hyperplasia) of the lining of the uterus, or polyps in the uterus. Cancer, such as cancer of the cervix, vagina, or endometrial can also cause bleeding and should be excluded by proper diagnosis procedure.
By knowing the most frequent cause of vaginal bleeding gives a relative idea as to how frequent these diseases are seen overall, and then more important is to develop appropriate diagnosis. How to diagnose? Identify the age, the type of bleeding, during pregnant or not, is there any organ abnormality or related with hormonal imbalance.
Further procedure may support the diagnosis, identify the symptoms and the results of a physical examination (including a pelvic examination). And additional procedures may be needed. Procedures may include a Papanicolaou (Pap) test, a biopsy of the cervix, and dilation and curettage (D and C). Ultrasonography using an ultrasound device inserted through the vagina into the uterus (transvaginal ultrasonography) can determine whether the uterine lining is thickened. A biopsy of cells obtained during dilation and curettage can determine if the thickening is due to cancer.

SEE AND TREAT IN PROACTIVE-VO MODEL
OF CERVICAL CANCER PREVENTION IN DEVELOPING COUNTRY
(Indonesian Perspective)

Laila Nuranna,1 M Farid Aziz1, Santoso Cornain,2 Setyawati Budiningsih,3
Gatot Purwoto,1 Yunita Indarti,1 Budiningsih Siregar2
1Department of Obstetrics and Gynecology,
2 Department of Pathologic Anatomy,
3 Department of Community Medicine
Faculty of Medicine, University of Indonesia


Abstract
Objective: to obtain a model for the cervical cancer prevention which appropriate for country with low resource setting.

Methods: Research design is an interventional study in community setting for cervical cancer control. This study was conducted in Pademangan Sub-district, North Jakarta, in the study was conducted from 2003 to 2004. And the other study was done in Jakarta, Tasikmalaya, and Bali with 22.035 respondents from 2004 to 2006

Results:
Cervical cancer is a leading cancer in Indonesian women. Indonesia as developing country has major problem of cervical cancer because most of the cases (< 65%) were diagnosed at the advanced stage.
Screening programme based on Pap test was difficult to be applied in low resource setting, the alternative methods is Visual Inspection with Acetic Acid (VIA).We should anticipate high number cases of loss of follow up for further treatment, and the alternative is cryotherapy in one single visit or we call SEE and TREAT.
We need supporting of political will, women empowerment, community education, appropriate screening method. We combined the See and Treat and how to implement at the community in comprehensive approach, we call it PROACTIVE-VO model, which constituted a series of proactive and coordinated activity, and was consists of five pillars of area preparation, training for provider, promotion and education, see and treat by VIA and cryotherapy, and referral for invasive cases.
In Indonesia, one study in Pademangan, North Jakarta, on 6.293 respondents. It was study in community setting with model named Proactive-VO (Proactive, Coordinative with VIA, and Cryotherapy). Community counseling was performed by PKK (Pendidikan Kesejahteraan Keluarga = Family Welfare Empowerment) health cadres. And the other study was done in Jakarta, Tasikmalaya, and Bali with 22.035 respondents.
From the first study the accuracy of VIA compared with Pap test, in the case of CIN, VIA sensitivity was 92.82% with specificity of 98.97%. Kappa of 0.52. Effectivity of cryotherapy, which evaluated after 6 months, on LSIL was cured 88, 1% and on HSIL was 74.2%. Follow up at the first phase was 48.3% and at the second phase after 6 months was 65.2%
Conclusions: VIA is a good alternative screening method, and cryotherapy is a promising way to treat pracancer lesions in this low resource setting. This model is recommended for cervical cancer prevention with wider coverage to identify precancerous lesions of the cervix. The method should apply in comprehensive approach, we call it PROACTIVE-VO Model.

Key words: Cervical cancer, cancer screening, VIA, pap test, cryotherapy, see and treat, screening coverage, cervical cancer prevention model.