v
ABSTRACT
CHARACTERISTICS OF CERVICAL CARCINOMA AT HASAN SADIKIN HOSPITAL BANDUNG in 1 JANUARY 2010 -31 DECEMBER 2010
Fadhli Firman Fauzi, 2012 Tutor I : dr. Rimonta Gunanegara , Sp.OG
Tutor II : dr. Sri Nadya Saanin M. Kes
Cervical cancer is a type of cancer that usually found in Indonesian women compare from other types of cancers and causing a lot of deaths because of late detection and treatment.
The objective of this study is review the characteristic distribution of cervical carcinoma in Hasan Sadikin Hospital between of 1 January to 31 December 2010, primaryly to determine the prevalence of cervical cancer, most common location, type and stage of cancer that suffered by the patient of Hasan Sadikin Hospital.
This research is a retrospective descriptive study that collect data from medical record of patients with cervical cancer in a retrospective reviews of cases in Hasan Sadikin Hospital, Bandung between 1 January 2010 – 31 December 2010.
The result of study shows in 2010 there were 151 cases of cervical carcinoma with the highest prevalence age range from 46-50 years age in 19,87% of cases, mean while the most commonly stage is III B obtained in 41,73% of cases, the most commonly histopathologic picture of most of the Non Keratinizing epidermoid cervical carcinoma in 47,02% of cases, and the housewive is the most frequent type of job that patient have in 90,07% of cases.
iv ABSTRAK
Fadhli Firman Fauzi, 2011 Pembimbing I : dr. Rimonta Gunanegara , Sp.OG Pembimbing II: dr. Sri Nadya Saanin M.Kes
Kanker serviks merupakan jenis kanker yang paling banyak ditemukan pada wanita di Indonesia (diantara jenis kanker lainnya) dan banyak menyebabkan kematian karena terlambat dideteksi dan diobati. Frekuensi relatif di Indonesia adalah 27 % berdasarkan data patologik atau 16 % berdasarkan data rumah sakit. Insiden puncak pada usia 40–50 tahun.
Maksud penelitian ini adalah untuk mengetahui karakteristik kanker serviks di Rumah Sakit Hasan Sadikin, Bandung periode 1 Januari 2010 - 31 Desember 2010, terutama untuk mengetahui jumlah angka kejadian kanker serviks, lokasi tersering yang diderita pasien, jenis kanker dan stadium yang diderita oleh pasien kanker serviks di Rumah Sakit Hasan Sadikin, Bandung periode 1 Januari 2010 - 31 Desember 2010.
Penelitian ini dilakukan secara survey analitik dengan pengambilan data dari rekam medik pasien kanker serviks secara retrospektif terhadap kasus kanker serviks pasien rawat inap yang ada di Rumah Sakit Hasan Sadikin periode 1 Januari 2010 - 31 Desember 2010.
Hasil yang diperoleh menunjukkan bahwa pada tahun 2010 terdapat 151 kasus karsinoma serviks dengan prevalensi usia tertinggi adalah golongan usia 46-50 tahun, atau sekitar 19,87%. Stadium yang paling banyak ditemui adalah stadium III B sebanyak 41,73%. Gambaran histopatologis paling banyak adalah Non Keratinizing
epidermoid cancer cervix sebanyak 47,02% kasus, dan ibu rumah tangga adalah
pekerjaan yang paling banyak dilakukan oleh penderita sebanyak 90,07% kasus.
viii
1.2 Identifikasi Masalah………...………. 2
1.3 Maksud dan Tujuan penelitian…...………. 3
1.3.1. Maksud Penelitian……….. 3
1.3.2. Tujuan Penelitian……….. 3
1.4 Manfaat Karya Tulis ilmiah………... 4
1.4.1. Manfaat Akademis………. 4
1.4.2. Manfaat Praktis……….. 4
1.5 Kerangka Pemikiran dan Hipotesis………..……….. 4
1.5.1 Kerangka Pemikiran……… 4
1.5.2 Hipotesis………... 4
1.6 Metodologi………... 4
1.7 Bahan Penelitian... 4
BAB II. TINJAUAN PUSTAKA
2.2.4 Patogenesis dan Patofisiologi Kanker Serfiks... 16
ix
2.2.6 Gejala Klinis... 26
2.2.7 Diagnosis dan Pemeriksaan Penunjang Karsinoma Serviks... 27
2.2.8 Komplikasi... 37
2.2.9 Pencegahan ... 38
2.2.10 Terapi……… 41
2.2.11 Prognosis... 42
BAB III. METODE PENELITIAN 3.1 Rancangan Penelitian………. 44
3.2 Populasi dan sampel... 44
3.2.1 Populasi Penelitian... 44
3.2.2 Sampel Penelitian... 44
3.3 Teknik Pengukuran... 45
3.4 Lokasi dan waktu penelitian... 45
BAB IV. HASIL DAN PEMBAHASAN 4.1 Distribusi Kasus Berdasarkan Usia Penderita Kanker Serviks di RSHS Bandung Periode 1 Januari 2010 – 31 Desember 2010... 46 4.2 Distribusi Kasus Berdasarkan Pendidikan Penderita Kanker Serviks di RSHS Bandung Periode 1 Januari 2010 – 31 Desember 2010... 48
4.3 Distribusi Kasus Berdasarkan Pekerjaan Penderita Kanker Serviks di RSHS Bandung Periode 1 Januari 2010 – 31 Desember 2010... 49 4.4 Distribusi Kasus Kanker Serviks Berdasarkan Status Ginekologis di RSHS Bandung Periode 1 Januari 2010–31 Desember 2010...
49 4.5 Distribusi Kasus Berdasarkan Jenis Histopatologi Kanker Serviks di RSHS Bandung Periode 1 Januari 2010 – 31 Desember 2010...
52 4.6 Distribusi Kasus Berdasarkan Stadium Kanker Serviks di RSHS Bandung Periode 1 Januari 2010 – 31 Desember 2010...
x BAB V. SIMPULAN DAN SARAN
5.1 Simpulan... 55
5.2 Saran... 55
DAFTAR PUSTAKA ... 57
RIWAYAT PENULIS………... 60
xi
DAFTAR TABEL
Tabel 2.1 Human Papillomavirus... 17
Tabel 2.2 Perubahan genetik dalam kanker serviks... 22
Tabel 2.3 Jenis kanker serviks menurut subtipe histologi WHO tahun 1994... 23
Tabel 2.4 Stadium kanker serviks menurut ACS (American Cancer Society)... 24
Tabel 2.5 Rekomendasi American Cancer Society untuk melakukan Pap smear 30 Tabel 2.6 Hasil penelitian inspeksi visual dengan asam asetat... 33
Tabel 2.7 Indeks kolposkopi Reid... 35
Tabel 2.8 Terapi pada berbagai stadium kanker serviks... 41
Tabel 4.1 Distribusi kasus kanker serviks menurut usia penderita kanker serviks di RSHS Bandung periode 1 Januari 2010-31 Desember 2010... 47
Tabel 4.2 Distribusi kasus kanker serviks menurut pendidikan pasien di RSHS Bandung periode 1 Januari 2010-31 Desember 2010... 48
Tabel 4.3 Distribusi kasus kanker serviks menurut pekerjaan pasien di RSHS Bandung periode 1 Januari 2010-31 Desember 2010... 49
Tabel 4.4 Distribusi kasus kanker serviks menurut status geinekologis pasien di RSHS Bandung periode 1 Januari 2010-31 Desember 2010... 51
Tabel 4.5 Distribusi kasus kanker serviks menurut jenis histopatologi penyakit di RSHS Bandung periode 1 Januari 2010-31 Desember 2010... 53
xii
DAFTAR GAMBAR
Gambar 2.1 Organ reproduksi wanita... 5
Gambar 2.2 Organ reproduksi wanita potongan melintang... 7
Gambar 2.3 Histologi serviks... 9
Gambar 2.4 Genom Human Papillomavirus... 17
Gambar 2.5 Skema perubahan morfologi akibat infeksi HPV... 19
Gambar 2.6 Skema perjalanan infeksi HPV... 19
Gambar 2.7 Morfologi perubahan histologi serviks... 19
Gambar 2.8 Diagram ilustrasi pebentukan kanker serviks... 20
Gambar 2.9 Siklus Diagram onkoprotein E6 dan E7... 21
Gambar 2.10 Cervical intraepithelial neoplasma……... 25
Gambar 2.11 Konfensional Pap smear... 29
Gambar 2.12 Serviks setelah diaplikasi dengan asam asetat dan lugol... 32
Gambar 2.13 Gambaran portio serviks normal dan beerpotensi kanker... 32
Gambar 2.14 Kolposkopi... 33
Gambar 2.15 Kolposkopi dengan perubahan pembuluh darah... 34 Gambar 2.16 Cone biopsy...
Gambar 2.17 Alogaritma terapi kanker serviks... 36
lxxiv
DAFTAR RIWAYAT HIDUP
Nama lengkap : Fadhli Firman Fauzi
NRP : 0710149
Tempat dan tanggal lahir : Sumedang, 1 Februari 1990
Alamat : Jl. Sadang Sari No. 11 RT/RW 09/14
Kecamatan Coblong, Bandung
Riwayat Pendidikan
a. SD Negeri Merdeka V : Tahun 1995-2001
b. SMP Negeri 5 Bandung : Tahun 2001-2004
c. SMA Negeri 5 Bandung : Tahun 2004-2007
d. Mahasiswa Fakultas Kedokteran
lxxv
39 sd ibu rt p1a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
71 sd ibu rt p2a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
48 sd ibu rt p8a2 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated IV a
51 s1 pns p4a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
47
diplom
a guru p4a0
Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated I b
53 sd ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
59 sd ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
37 sd ibu rt p1a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
58 sma ibu rt p3a1 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
51 s1 pns p3a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
55 sd ibu rt p2a1
Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated I b
45 sd
pemba
ntu p4a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
48 sma ibu rt p5a4
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated II a
36 sd ibu rt p1a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
49 sd ibu rt p3a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated II a
50 sd ibu rt p3a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated I b
42 sd ibu rt p2a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
58 sd ibu rt p3a2
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated II b
76 sd ibu rt p12a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III a
45 s1 guru p3a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
41 sd ibu rt p1a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated I b
50 sd ibu rt p5a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
65 sma ibu rt p7a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
49 sd ibu rt p3a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated IV a
52 s1 pns p3a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated II a
62 sd ibu rt p8a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated I b
42 sd
pemba
lxxvi
41 sd ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated II b
50 sd ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
44 sd ibu rt p4a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
50 sd ibu rt p4a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
47 sd ibu rt p4a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III a
54 sd ibu rt p6a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
43 sd Ibu rt P3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated
58 sd ibu rt p4a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated I b
77 smp ibu rt p2a0 Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
52 smp ibu rt p9a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
40 sd ibu rt p8a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated I b
63 sd ibu rt p4a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
50 sd ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
47 sd ibu rt p4a1 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated I b
72 sd ibu rt p6a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
54 sd ibu rt p2a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated I b
45 sd ibu rt p5a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
50 sd ibu rt p4a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III a
52 smp ibu rt p2a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated II b
49 sd ibu rt p5a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated II a
38 sd ibu rt p3a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
28 sd ibu rt p3a1 Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
59 s1 guru p3a2 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
31 smp ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
44 sd ibu rt p3a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
27 sd ibu rt p4a0 Displasia berat cervix III b 42 sd ibu rt p1a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
63 sma ibu rt p5a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
34 sd ibu rt p0a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
lxxvii
50 s1 pns p2a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated I b
42 sd ibu rt p4a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
68 sd ibu rt p2a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III a
56 s1 pns p4a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
47 sd ibu rt p3a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
35 smp ibu rt p3a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
50 sma ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
59 sd ibu rt p4a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
61 sd ibu rt p5a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
40 sd ibu rt p3a1 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated II b
25 sd ibu rt p6a1 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
38 smp ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated II a
43 sd ibu rt p1a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
41 sma
wirasw
asta p4a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
51 s1 guru p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
41 sd ibu rt p4a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
58 sd ibu rt p0a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
45 sd ibu rt p5a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
42 sd ibu rt p2a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
52 sd ibu rt p0a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b 50 sd ibu rt p3a0 Displasia berat cervix IV a 81 sd ibu rt p8a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
49 sd ibu rt p4a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated II b
59 sd ibu rt p7a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
50 sd ibu rt p9a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III a
57 smp ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
33 sd ibu rt p2a1 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III a
39 sma ibu rt p3a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
42 sd ibu rt p3a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
51 sd ibu rt p6a0
Non Keratinizing epidermoid cancer cervix well,
lxxviii
58 sd ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated II b
55 sd ibu rt p4a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II a
45 sd ibu rt p6a1
Adenocarcinoma cervix uteri well, moderately, poor
differentiated III b
65 sd ibu rt p9a1
Adenocarcinoma cervix uteri well, moderately, poor
differentiated II a
54 sd ibu rt p4a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated II b
33 sd ibu rt p1a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated II b
50 sd ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III a
46 sd ibu rt p0a0 Adenocarcinoma cervix uteri well, moderately, poor differentiated III b
39 sd ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
41 sd ibu rt p3a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III a
51 sd ibu rt p3a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
51 smp ibu rt p7a2 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
53 sd ibu rt p4a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
59 smp ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
51 smp ibu rt p3a0 Adenocarcinoma cervix uteri well, moderately, poor differentiated II b
65 sd ibu rt p12a1 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
34 sma ibu rt p3a0 Adenocarcinoma cervix uteri well, moderately, poor differentiated I b
60 sd ibu rt p7a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
39 sd ibu rt p0a2 Displasia berat cervix IV b
55 sd ibu rt p1a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated II b
43 sd ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
42 sd ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
46 sd ibu rt p4a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
43 sma ibu rt p3a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
40 sd ibu rt p0a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated I b
51 sd ibu rt p5a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
51 sd ibu rt p5a1 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated II b
44 sma ibu rt p1a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
47 sd ibu rt p2a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
lxxix
38 sd ibu rt p1a0 Adenosquamosa cervix uteri well, moderately, poor differentiated I b
53 sd ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
36 sd ibu rt p2a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated I b
39 sd ibu rt p3a1 Adenocarcinoma cervix uteri well, moderately, poor differentiated I b
71 sd ibu rt p3a0 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
44 sd ibu rt p3a0 Adenocarcinoma cervix uteri well, moderately, poor differentiated I b
41 sd ibu rt p3a2 Displasia berat cervix IV a
50 sd ibu rt p3a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
40 sd ibu rt p5a0 Adenocarcinoma cervix uteri well, moderately, poor differentiated I b
38 sma ibu rt p1a2 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
57 s1 ibu rt p2a1 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
51 sma ibu rt p3a4 Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated III b
54 sd ibu rt p5a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
40 sd ibu rt p3a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated II b
75 sd ibu rt p9a1
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated IV a
46 smp ibu rt p3a1 Adenocarcinoma cervix uteri well, moderately, poor differentiated I b
58 sd ibu rt p7a1 Adenocarcinoma cervix uteri well, moderately, poor differentiated II a
51 sma ibu rt p3a2 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
27 smp ibu rt p2a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated II a
26 sma ibu rt p0a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
48 smp ibu rt p7a1
Adenocarcinoma cervix uteri well, moderately, poor
differentiated I b
57 sd ibu rt p3a1
Adenocarcinoma cervix uteri well, moderately, poor
differentiated I b
50
diplom
a pns p2a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated I a
57 smp ibu rt p2a0
Adenocarcinoma cervix uteri well, moderately, poor
differentiated I b
56 sd ibu rt p2a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated III b
36 sma ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
59 sma ibu rt p3a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
70 s1 pns p7a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
28 smp ibu rt p2a0 Non Keratinizing squamous cancer cervix well, moderately, poor differentiated III b
lxxx
a differentiated
57 sd ibu rt p4a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated I b
25 sd ibu rt p1a0
Mikroinvassif epidermoid carcinoma
cervix uteri III b
58 sd ibu rt p5a0
Non Keratinizing epidermoid cancer cervix well,
moderately, poor differentiated II a
45 sd ibu rt p5a0
Non Keratinizing epidermoid cancer cervix well,
xiii
BAB I PENDAHULUAN
1.1. Latar Belakang
Insidensi dan mortalitas kanker serviks masih menempati urutan kedua
terbanyak di dunia setelah kanker payudara, dimana setiap tahunnya terdapat 600.000 kanker serviks invasive baru dan 300.000 kematian. Sementara itu, di negara
berkembang masih menempati urutan pertama sebagai penyebab kematian akibat kanker pada wanita usia reproduktif. Kebanyakan penyebab kanker ini adalah infeksi
Human Papillomavirus (HPV), meskipun faktor-faktor penjamu lainnya berhubungan
dengan progresi dari infeksi awal. (Bidus A.M.,2007)
Pada tahun 1998, sekitar 12,800 wanita di Amerika menderita kanker serviks, dan 4,800 diantaranya meninggal dunia. Kanker serviks ini jarang ditemukan pada stadium dini pada negara-negara berkembang, hal ini disebakan oleh karena tidak optimalnya skrining pada penyakit tersebut. Sekitar 80% penderita kanker serviks hidup di negara-negara dengan pendapatan penduduk yang rendah atau sedang. (WHO, 2002)
Di Indonesia, kanker serviks masih merupakan masalah kesehatan wanita sehubungan dengan angka kejadian dan angka kematiannya yang tinggi. Keterlambatan diagnosis pada stadium lanjut, keadaan umum yang lemah, status ekonomi yang rendah, keterbatasan sumber daya, sarana, dan prasarana, jenis histopatologi, dan derajat pendidikan ikut serta dalam menentukan prognosis penderita. Dibandingkan dengan keganasan ginekologis lainnya, kanker serviks lebih sering menyerang wanita muda. Maka dari itu, skrining kanker serviks dengan Pap smear dimulai ketika masa remaja atau dewasa muda. Menurut data Departemen Kesehatan RI (2005), penyakit kanker serviks menempati urutan pertama daftar kanker yang diderita wanita Indonesia, saat ini ada sekitar 100 kasus per 100 ribu penduduk atau 200 ribu kasus setiap tahunnya. Diperkirakan setiap harinya terjadi 41 kasus baru kanker serviks dan 20 wanita meninggal dunia karena penyakit tersebut. Kanker serviks yang sudah masuk ke stadium lanjut sering menyebabkan kematian
xiv
dalam jangka waktu relatif cepat. Selain itu, lebih dari 70 persen kasus yang datang ke rumah sakit ditemukan dalam keadaan stadium lanjut. (DEPKES RI.2005)
(Laras L, 2009).
Angka kejadian kanker serviks turun secara drastis semenjak diperkenalkannya teknik skrining Pap Smear oleh Papanicolaou di negara maju. Berbeda dengan negara maju, di negara berkembang skrining dengan Pap Smear tidak terbukti mampu menurunkan insidensi dan angka kematian akibat kanker serviks. Program skrining yang belum memasyarakat di negara berkembang dan kanker serviks sendiri belum merupakan program pemerintah sehingga ditangani oleh perorangan, perkumpulan, dan lembaga swadaya masyarakat, sehingga mudah dimengerti mengapa insidensi kanker serviks masih tetap tinggi. Selain itu, keterbatasan pengetahuan, status sosial ekonomi, kebudayaan dan politik, geografi, demografi juga berpengaruh dalam tidak optimalnya skrining penyakit kanker serviks. ( Bristow R, 2002).
Berdasarkan latar belakang di atas, untuk itulah penulis ingin mengetahui
gambaran kanker serviks di Rumah Sakit Hasan Sadikin Bandung selama periode 1 Januari – 31 Desember 2010.
1.2. Identifikasi masalah
Berdasarkan uraian latar belakang penelitian tersebut di atas, maka dapat dirumuskan penelitian sebagai berikut:
Berapakah prevalensi penyakit kanker serviks di Rumah Sakit Hasan Sadikin periode 1 Januari 2010 - 31 Desember 2010.
Bagaimana pola usia penderita kanker serviks di Rumah Sakit Hasan Sadikin periode Januari 1 Januari 2010 - 31 Desember 2010.
Bagaimana pola pendidikan penderita kanker serviks di Rumah Sakit Hasan Sadikin periode Januari 1 Januari 2010 - 31 Desember 2010.
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Sadikin periode Januari 1 Januari 2010 - 31 Desember 2010.
Bagaimana pola riwayat persalinan penderita kanker serviks di Rumah Sakit Hasan Sadikin periode Januari 1 Januari 2010 - 31 Desember 2010.
Bagaimana jenis histopatologis penyakit kanker serviks di Rumah Sakit Hasan Sadikin periode Januari 1 Januari 2010 - 31 Desember 2010.
Bagaimana pola stadium penyakit kanker serviks di Rumah Sakit Hasan Sadikin periode 1 Januari 2010 - 31 Desember 2010.
1.3.Maksud dan tujuan
1.3.1.maksud penelitian :
Mengetahui jumlah angka kejadian kanker serviks yang terjadi di Rumah Sakit Hasan Sadikin, Bandung periode 1 Januari 2010 - 31 Desember 2010.
1.3.2.tujuan penelitian :
Mengetahui distribusi umur, jenis pekerjaan, pendidikan, riwayat persalinan, jenis histopatologis dan stadium penyakit pada penderita serviks.
1.4. Manfaat Karya Tulis Ilmiah
1.4.1.Manfaat akademik
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Data yang didapat pada penelitian ini dapat bermanfaat untuk penelitian selanjutnya.
1.4.2.Manfaat praktis
Agar masyarakat pada umumnya dan paramedis pada khususnya, diharapkan dapat memotivasi usaha untuk mewaspadai kanker serviks sedini mungkin.
1.5. Metodologi
Penelitian ini dilakukan secara survei analitik dengan pengambilan data dari rekam medik pasien kanker leher rahim secara retrospektif terhadap semua kasus kanker rawat inap yang ada di Rumah Sakit Hasan Sadikin periode 1 Januari 2010 - 31 Desember 2010.
1.6. Waktu dan Tempat Penelitian
Penelitian ini dilakukan pada bulan November 2011-Januari 2012 di Bagian Rekam Medik Rumah Sakit Hasan Sadikin kota Bandung.
1.7. Bahan Penelitian
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BAB V
SIMPULAN DAN SARAN
5.1 Simpulan
Dari hasil penelitian disimpulkan bahwa:
o Prevalensi kanker serviks di Rumah Sakit Hasan Sadikin pada periode 1 Januari 2010 - 31 Desember 2010 adalah 151 kasus.
o Kejadian dari kanker serviks yang paling banyak didapatkan pada kelompok usia 46-50 tahun, yaitu sebanyak 19,87%.
o Pendidikan yang paling banyak dimiliki oleh penderita kanker serviks adalah SD (Sekolah Dasar) yaitu 70,87%.
o Pekerjaan terbanyak dari penderita kanker serviks adalah IRT (Ibu Rumah Tangga) yaitu 90,07%.
o Riwayat persalinandari kanker serviks yang paling banyak didapatkan P3A0 (partus 3 dan abortus 0) yaitu sebanyak 18,55% dan didapatkan jumlah paritas terbanyak yaitu P12A1 (partus 12 abortus 1) atau paritas lebih dari dua belas sebanyak 1,33%.
IV B 1 0,67
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o Gambaran jenis histopatologi yang paling banyak ditemukan adalah Non
Keratinizing epidermoid cancer cervix well, moderately, poor differentiated
yaitu 47,02%.
o Stadum dari kanker serviks yang paling banyak didapatkan pada stadium III B yaitu sebanyak 41,73%.
5.2 Saran
o Untuk yang dokter yang bertugas untuk mencatat rekam medis dihimbau agar data pasien dibuat lebih lengkap dan tepat.
o Meningkatkan pengetahuan dan kesadaran masyarakat tentang kanker serviks melalui penyuluhan dan penerangan terutama pada masyarakat dengan latar belakang pendidikan yang rendah sehingga dapat mengetahui gejala dini serta meningkatkan kesadaran masyarakat untuk berobat dan melakukan pemeriksaan dini Pap Smear terutama untuk wanita usia reproduktif.
o Disarankan kepada wanita dengan usia reproduktif atau yang mempunyai resiko tinggi agar melakukan pemeriksaan yang rutin dan pencegahan dengan vaksin sehingga dapat terhindar dari kanker serviks dan menurunkan angka mortalitas akibat kanker serviks.
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