A. DEFINITIONS Cervical cancer is a disease caused by a malignant tumor on the cervix as a result of uncontrolled tissue growth and damage the surrounding normal tissue (Faculty of medicine, 1990; FKKP, 1997).
B. Etiology The cause of cervical cancer has not clearly known but there are some risks and predisposing factors that stand out, among others:
1. Age first had sexual intercourse Research shows that the more young women have sex more get cervical cancer. Married at age 20 is considered too young
2. The number of pregnancy and parturition Cervical cancer most often found in women who parturition. The more often partus more likely the risk of having cervical carcinoma.
3. Number of marriages Women who frequent sexual intercourse and multiple partners have a major risk factor of cervical kankers this.
4. Viral infections Infection with herpes simplex virus (HSV-2) and papilloma virus or condyloma viruses akuminata suspected as factor in cervical cancer
5. Social Economy Cervical carcinoma often found in lower socioeconomic groups may be socio-economic factors closely related to nutrition, immunity and personal hygiene. In the lower socioeconomic groups generally lack the quantity and quality of food does this affect the body's immunity.
6. Hygiene and circumcision Presumably the influence of easy occurrence of kankers cervix in women whose partners have not been circumcised. This is because the non sirkum male penile hygiene is not maintained so much a collection-a collection of smegma. 7. Smoking and the IUD (intrauterine device) Smoking will stimulate the formation of cancer cells, while the use of an IUD will have an effect on the cervix that is originated from the erosion diserviks who later became a strep infection that is continuous, as this can trigger the formation of cervical cancer.
C. Classification of cervical cell growth will kankers
Microscopic 1. Dysplasia Mild dysplasia occurred in one-third portions of the basal epidermis. Severe dysplasia occurred in two thirds epidermi hardly be distinguished from carcinoma in situ.
2. Stadium carcinoma in situ In situ carcinoma epithelial cell changes occur in all layers of the epidermis to squamous cell carcinoma. Carcinoma in situ ektoserviks growing area, transitional cell and squamous columnar endocervical reserve cells. 3. Karsionoma mikroinvasif Stadium. In karksinoma mikroinvasif, in addition to changes in the degree of increased cell growth of tumor cells also penetrate the basal membrane and invasion of the stoma so far no more than 5 mm from the basement membrane, these tumors are usually asymptomatic and are found only on cancer screening.
4. Stage invasive carcinoma In invasive carcinoma of the prominent changes in the degree of cell growth and cell shape varies. Petumbuhan invasive appear diarea posterior or anterior cervical lip and extends the three departments of the posterior or anterior fornix majors, majors parametrial and corpus uteri.
5. Shape abnormalities in the growth of cervical carcinoma Growth eksofilik, kool-shaped flowers, growing towards the vagina and can fill half of the vagina without infiltration into the vagina, growth form is easy to necrosis and hemorrhage.
Endofilik growth, usually in the form of ulcer lesions and progressive growth extends to the fornix, posterior and anterior to the corpus uteri and parametrial.
The growth of nodules, usually found on the lambatlaun endocervical lesions are turned into ulcers.
Markroskopis 1. Preclinical stage Indistinguishable from ordinary chronic cervicitis 2. Stadium beginning Lesions appear most often around osteum externum 3. Half-advanced stage It has been about the most or the entire lip porsio 4. Advanced Occurs destruction of cervical tissue, so it seems like ulcers with a network of fragile and bleed easily.
D. CLINICAL SYMPTOMS 1. Bleeding Nature can intermenstruit or contact bleeding, sometimes bleeding just happens on the next stage. On this kind of bleeding occurs intraservikal slow. 2.Biasanya like water, sometimes before the onset of bleeding. In more advanced stages of more bleeding and vaginal discharge accompanied by an infection so that the liquid that comes out smells.
E. Diagnostic tests 1. Cytology / Pap Smear Profits, cheap can check out the parts that are not visible. Weakness, can not determine the precise localization. 2. Schillentest Epithelial carcinoma of the cervix did not contain glycogen because it does not bind iodine. If porsio given iodine then normal epithelial carcinoma will be colored dark brown, being affected by carcinoma colorless. 3. Koloskopi Check by using a tool to view the cervix with light and raised 10-40 times. Advantages: can see clearly the areas concerned so easy to do a biopsy. Weaknesses: only can memeiksa area that looks just the porsio, being kelianan the squamous columnar junction and cervical intra invisible. 4. Kolpomikroskopi Seeing the vaginal smear (Pap smear) with magnification up to 200 times 5. Biopsy With a biopsy can be found or specified types karsinomanya. 6. Konisasi By way of remove tissue containing mucous membranes and cervical squamous epithelium and gland. Konisasi done when the results of cervical cytology in doubt and does not seem obvious abnormalities.
F. CLINICAL CLASSIFICATION • Stage 0: Ca.Pre invasive • Stage I: Ca. Confined to the cervix • Stage He; Accompanied by the invasion of the stroma which is known only by histopathologic • Stage Ib: All other cases of stage I • Stage II: It spreads out until the cervix but has not been on the vaginal wall kepanggul. But it does not exceed two-thirds of the proximal • Stage III: Are we there panggula wall and the lower third of the vagina • Stage IIIB: Already on other organs.
G. Therapy 1. Irradiation • Can be used for all stages • Can be used for older and obese women at medical risk • Does not cause the death of such an operation. Dosage: Radiation is aimed at network carcinoma located diserviks Complications of irradiation • Vulnerability content of urine • Diarrhea • rectal bleeding • Fistula vesico or rectovaginalis 2.Operasi • Operation limfadektomi for stage I and II • Operating a radical vaginal hysterectomy 3.Kombinasi • irradiation and surgery Not done as a matter of routine, because radiation causes increased vascularization, odema. So that subsequent surgery may have difficulty and often leads to fistula, as it also adds to the spread kesistem lymph and blood circulation. 4. Cytostatika: Bleomycin, therapeutic against a radio-resistant cervical carcinoma. 5% of cervical carcinomas are resistant to radiotherapy, considered resistant when 8-10 weeks post therapy still remains the same circumstances.
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