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Kanker Serviks - Via-Fk Unsoed 3 Mei 2017

The document discusses cervical cancer detection methods, specifically focusing on the IVA (Visual Inspection with Acetic Acid) technique as a viable early detection method in Indonesia. It highlights the prevalence of cervical cancer, barriers to screening, and the importance of awareness and training for healthcare providers. The document emphasizes the need for effective screening strategies due to the high mortality rates associated with cervical cancer, particularly in developing countries.

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0% found this document useful (0 votes)

17 views50 pages

Kanker Serviks - Via-Fk Unsoed 3 Mei 2017

Uploaded by

Adis Sahara

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KANKER SERVIKS

UPAYA DETEKSI DINI

(Mengenal Metode IVA )
Subbag. Ginekologi-Onkologi Dept. Obstetri dan Ginekologi
FK Universitas Jenderal Soedirman
RSUD Prof. Dr. Margono Soekarjo
Purwokerto
Deteksi Dini Kanker Serviks , IVA

OBJEKTIF :
1. Masalah Kanker serviks
2. Mengenal Metode Skrining Kanker Serviks
3. Apakah Metode IVA
4. Mengapa di Indonesia perlu skrining IVA
5. Teknik IVA
6. Interpretasi Temuan IVA
7. Alur Temuan IVA abnormal
8. Peran Spesialis OB-GYN dalam IVA
Cervical Cancer

Worldwide
▪ 231,000 women die of cervical cancer every year
▪ 12% of all cancers in women
▪ 80% from developing countries

World Health Organization : Cervical Cancer

Screening in Developing Countries. Report of a
WHO Consultation 2001 (unpublished)
INDONESIA
Masalah Kanker Serviks

• Geografi > 13.000 pulau

• Kendala fasilitas Sitologi di
daerah rural
• Kendala fasilitas TERAPI
• Kurangnya pemahaman dan
kepatuhan pasien ~ masalah
ekonomi
• “ Ignorancy” tentang Kanker
serviks
• Sikap “fatalistic” menghadapi
Penyakit Kanker secara Umum
10 Kanker tersering pada Laki-laki dan
Perempuan di Indonesia
1988-1994 (n=159.729)
Colon
Soft tissue
Thyroid
Rectum
Ovary
1
Lymphnode
Nasopharynx
Skin
Breast
- 5.00 10.00 15.00 20.00 Cervix
Skrining Kanker Serviks - IVA
10 Kanker tersering pada PEREMPUAN di
INDONESIA 1988-1994 (n=79798)
Data PATOLOGI
S oft tissue
Nasopharynx
Rectum
Uterus
1 Lymph node
Thyroid
S kin
Ovary
Breast
- 10.00 20.00 30.00 40.00 Cervix
EARLY DETECTION METHOD
on CERVICAL CANCER

SIMPLE :
• PAP’S SMEAR
• VISUAL INSPECTION with ACETIC ACID = VIA
• GYNESCOPY

SOPHISTICATED :
• CERVICOGRAPHY
• SPECULOSCOPY
• COLPOSCOPY
• PAPNET ( with COMPUTERISATION )
• THIN PREP
• HPV Testing
Reasons for Failure of
Cervical Cancer screening
Inadequate sampling
Inadequate screening
Interpretive errors
Inadequate follow-up
Exfoliating potential
CERVICAL CANCER SCREENING

Pap Smear
Sensitivity ( 70 – 80% )
Specificity ( 90 – 95 % )
“Cheap”
Easy
Acceptable
CERVICAL CANCER SCREENING

PAP SMEAR
Facility, Provider, Organization, Network

at DEVELOPING COUNTRY

ALTERNATIVE
SCREENING by VISUALISATION

Naked Eye Special Equipment

VIA COLPOSCOPY
( Visual Inspection with CERVICOGRAPHY
Acetic Acid )
GINESCOPY
AWARENES for doing INSPECULO on
CERVICAL CANCER PATIENT with SUBJECTIF COMPLAINT

PUSAT/PETUGAS MELAKUKAN PERIKSA DALM JUMLAH

KESEHATAN YA TIDAK

DOKTER AHLI 37 1 38
DOKTER UMUM 24 11 35
PUSKESMAS 19 10 29
BIDAN 3 11 14
TENAGA KESEHATAN
LAIN (a.l mantri - 1 1

JUMLAH 83 (70.9%) 34 (29.1%) 117 (100%)

CERVICAL CANCER

NATURAL HISTORY
PRA -CANCER CANCER
15 % 30 % 45 %

MILD MODERATE SEVERE CANCER CANCER

NORMAL
DISPLASIA DISPLASIA DISPLASIA IN SITU INVASIF

40 % 20 %

Low Grade Lesion High Grade Lesion

DETECTED by VIA
CAN WE PROVIDE CERVICAL CANCER
SCREENING by PAP’S SMEAR ?

For NOW on still a lot of

handicap for this method as mass
screening method
Limitation of Provider
For doing PAP SMEAR
PROVIDER:
Obs – Gyn 1350
Pathologist/Cytologist 209 ( on 2003)
Screener < 100
Midwife ± 70.000

Can we do it as screening method

as mass screen in Indonesia ?
PAP SMEAR method
Is OK
but for NATIONAL PROGRAM
……………….. . . .

Is there any appropriate screening

method in Indonesia ?

14
VISUAL INSPECTION with
ACETIC ACID ( VIA )
Non-invasive
Easy - Cheap
At PRIMARY HEALTH CENTER
DIRECT RESULT
Sensitivity and specificity is good

Appropriate for INDONESIA

VIA
( Visual Inspection with Acetic Acid )
( Can be done at Primary Healht Center )
Equipment :
• Light resources
• Vaginal Speculum
• Gynecologic chair
• Acetic acid 3 - 5 %
• Cutten bud
• Gloves ( better steril )
PROVIDER
• Midwifes
• Nurse with training
• General Practitioners
• Med. Doctors : Ob Gyn
• Med. Doctors : Pathologist
VIA Result Criteria :
I. Normal
II. Inflammation = Atipic = Cervicitis
III. VIA positive : White Epithelium
IV. Cervical Cancer
Visual Inspection with
Acetic Acid
VIA finding :

Prior application
of acetic acid

White epithelium

Post application
of acetic acid
Criteria for positive or abnormal VIA test result

U. Zimbabwe/JHPIEGO Sankaranarayanan et al
Normal : smooth,pink,uniform,feature Negative : no acetowhite area, whitish
less ,faint,polyps,nabothian fol, grape like
glands or erosions in the endosx slig
htly paler than ectocx
Atypical : Cervicitis,discharge,ectropio --
n,polyp

Abnormal (positive) Abnormal

Cancer (positive) : Positive : Any distinct acetowhite

VIA
I FINDING

I. NORMAL

II
II. OVULA NABOTI

II. CERVIX ECTOPY

VIA FINDING

III.
PRA CANCER
LESION

LOW GRADE
Squamous cell
Intra Epithelial Lesion
~ CIN I
VIA FINDING

IV.
CERVICAL CANCER
VIA screening study finding (1)

First Author Country Nu. of Senstv. Specificity Level of Grade of

women Provider Dis Detected

Ottaviano et.al Italy 2400 Colposcopist CIN I-II and mo

(200!) 8 post grad traine re severe
d

Belinson et al. China 1,997 71% 74% Gynecologic CIN II and more
JHPIEGO (1999) 9 Oncologist severe

Univ.of Zimbabwe Zimbabwe 2,203 77% 64% Nurse Midwife HSIL and more
JHPIEGO severe

Denny et al. S.Africa 2,944 58,% 83,% Nurse HSIL and More
(2000) 10 severe

Denny et al. (2002) 11 S.Africa 2,754 58,3% 83,5% Nurse HSIL and More
severe
VIA screening study finding ( 2)
First Author Country Nu. of Specificity Level of Grade of
women Senstvty
Provider Displ. Detected

Sankaranarayanan et al India 3,000 90% 92% Cytotechnician Mod/severe dyspl and

(1998) More severe

Sankaranarayanan India 1,351 96% 68% Nurse Mod/severe dyspl and

et al (1999) More severe

Londhe et.al India 372 72% 54% Not specified Megavand et al

(1997)

Megevand et al Africa 2,426 65% 98% Nurse HSIL and more severe
(1996)

Cecchini at al Italy 2,105 88% 83% Midwives CIN II and more severe
(1993)

Slawson et. al USA 2,827 29% 97% Clinicians CIN II and more severe
(1992)
MAP
IVA guiding
VIA
Inspeculo on
CERVIX

Infection ? Suspect of CA
NORMAL finding SC J not satisfied
identify entirely
Treatment
VIA
Pap Smear Biopsy
Negative Positive

All of this procedure can be done by MIDWIFES/ TRAINED NURSE,

BIOPSY by PHYCISIAN
Management
VIA Positive
IVA Positive

Colposcopy

Lesion Negative Lesion Positive

Routine Target Biopsy

examination PA
VIA positive

Depends on Who is the provider

• Midwifes - Pap Smear

• Trained Nurse - Refer
• Physician

Pra Ca lesions

CRYO ??