BREAST DISORDER /DISEASES (KELAINAN PADA PAYUDARA

Kelainan pada payudara

I.          Pendahuluan

Dalam tulisan ini  saya Herry setya yudha utama akan membahas tentang  kelainan payudara ,baik lesi jinak maupun yang maligna walaupun secara umum. Insya Allah kedepan akan di bahas masing masing penyakit di payudara ini, Kelainan payudara seringkali memberi kesan menakutkan terutama bila ditemukan pada wanita berusia lebih dari 40 tahun. Bahkan banyak para onkologi berpendapat bahwa setiap tumor pada payudara dianggap karsinoma terutama pada wanita golongan risiko tinggi walaupun tumor jinak seperti fibroadenoma, displasia (fibrokistik, adenosis), mastitis dan nekrosis lemak tidak dapat diabaikan. Pendapat ini dapat dipahami, mengingat frekuensi karsinoma payudara yang relatif tinggi sehingga menimbulkan masalah dala kesehatan terutama bagi kaum wanita, tidak hanya di negara maju, tapi juga di negara sedang berkembang termasuk Indonesia. Frekuensi karsinoma payudara di negara maju merupakan yang terbanyak yaitu dengan rasio 5:1, dibandingkan dengan karsinoma serviks uteri, sedang di Indonesia neoplasma ini berada di ururtan kedua setelah karsinomaa serviks uteri.

BREAST CANCER AT AGLANCE

INTRODUCTION
1.1. Background
Breast cancer is a malignant tumor derived from cells located in the breast. -Lobular breast consists of lobules, ducts, fatty and connective tissue, blood and lymph vessels. In general, cancer originating from the cells contained in the ducts, some of which came from the lobular and other tissues.
Breast cancer is a malignancy that affects nearly one-third of all malignancy found in women. Breast cancer is also the second leading cause of death after cervical cancer in women as well as occupying the highest incidence of all malignancies. Each year, more than one million new cases of breast cancer are diagnosed worldwide, and nearly 400,000 people will die from the disease. By 2003, breast cancer is the cancer with the highest incidence of 2 in Indonesia and there is a trend from year to year, the incidence is increasing, and as well as in western countries. The incidence of breast cancer in the United States 92/100.000 women per year with a high mortality 27/100.000 or 18% of the deaths were found in women. In Indonesia by "Pathological Based Registration" relative incidence of breast cancer has 11.5%. Indonesia has the incidence is estimated at a minimum of 20,000 new cases per year; with the fact that over 50% of cases are still in the advanced stages.
There are so many risk factors that can lead to the development of breast cancer. Statistically the risk of breast cancer in women increased in nullipara, early menarche, late menopause and in women who are pregnant her first child at the age of 30 years. A total of less than 1% of breast cancers occur in less than 25 years of age, after the age of 39 years the incidence increased rapidly. The highest incidence is found in the age of 45-50 years. While breast cancer in men in the epidemiology of less than 1% of all breast cancers.

KANKER PAYUDARA DIAGNOSA DAN PENANGANAN / DIAGNOSIS AND MANAGEMENT OF BREAST CANCER

BAB I
PENDAHULUAN

Saya herry setya yudha utama mencoba memaparkan kanker payu dara ,mudah mudahan bermanfaat. Tumor payudara seringkali memberi kesan menakutkan terutama bila ditemukan pada wanita berusia lebih dari 40 tahun. Bahkan banyak para onkologi berpendapat bahwa setiap tumor pada payudara dianggap karsinoma terutama pada wanita golongan risiko tinggi walaupun tumor jinak seperti fibroadenoma, displasia (fibrokistik, adenosis), mastitis dan nekrosis lemak tidak dapat diabaikan. Pendapat ini dapat dipahami, mengingat frekuensi karsinoma payudara yang relatif tinggi sehingga menimbulkan masalah dala kesehatan terutama bagi kaum wanita, tidak hanya di negara maju, tapi juga di negara sedang berkembang termasuk Indonesia. Frekuensi karsinoma payudara di negara maju merupakan yang terbanyak yaitu dengan rasio 5:1, dibandingkan dengan karsinoma serviks uteri, sedang di Indonesia neoplasma ini berada di ururtan kedua setelah karsinomaa serviks uteri.

BAB II
ANATOMI dan FISIOLOGI

I. ANATOMI PAYUDARA
Payudara adalah massa stroma dan parenkim payudara yang terletak di dinding torak anterior antara ICS II dan VI dan parasternal sampai dengan garis axilaris medius. Payudara terdiri dari alveolus, duktus laktiferus, sinus laktiferus, ampulla, pori pailla, dan tepi alveola. Payudara mendapat vaskularisasi utama dari cabang a. mammaria interna, a. torakoakromialis dan cabang a. Interkostalis.
Payudara terletak pada hemitoraks kanan-kiri dengan batas-batas sebagai berikut :
1. Batas-batas payudara yang tampak dari luar :
a. Superior : iga II atau III
b. Inferior : iga VI atau VII
c. Medial : pinggir sternum
d. Lateral : garis aksilaris anterior
2. Batas-batas payudara sesungguhnya :
a. Superior : hampir sampai klavikula
b. Medial : garis tengah
c. Lateral : m. latissimus dorsi

Gambar 1. Anatomi payudara

Phylloid Tumor (Mamae) / Cystosarcoma phylloides Mamae ( etiology,sign, symptoms,diagnosis and management)

                                                                     CHAPTER I

                                                                INTRODUCTION

It is a benign neoplasm that is locally infiltrate and possibly malignant (10-15%). Used to be called Cystosarcoma phyllodes are benign tumors that occur almost exclusively on women's breasts. Its name comes from the Greek word sarcoma, which means the fleshy tumor, and phyllo, meaning leaf. So called because the tumors display characteristics of a large, malignant sarcomas, such as display-leaves when cut, and the epithelium, cyst-like space when viewed histologically. Because most of the tumor was benign tumor is also called filoides.

Although metastatic tumors are not benign, but they have a tendency to grow locally aggressive and recurrent. Similar to sarcoma, malignant tumor hematogenous metastasis. Filoides tumor pathological picture is not always predict the clinical behavior of neoplasms, hence in some cases there is uncertainty about the classification level of the lesion.

The characteristics of malignant tumor filoides are as follows:

· Recurrent malignant tumors are more aggressive look than the original tumor.

· Pulmonary metastasis is the place most frequently, followed by bone, heart, and liver.

· The symptoms for metastatic involvement can occur immediately, until a few months and no later than 12 years after initial therapy.

· Most patients with metastases died within 3 years of initial therapy.

· There is no treatment for systemic metastases occurred.

· Roughly 30% of patients with malignant tumors filoides died of the disease.

            Filoides tumor etiology is not known, it is estimated associated with fibroadenoma in some cases, because patients may possibly have a second histological lesions in the same tumor. However, if the tumor develops filoides of developing fibroadenoma or both together, or whether the tumor can arise de novo filoides, is still unclear

This tumor has a smooth texture, sharply bounded and usually move freely. This tumor is relatively large tumor, with an average size of 5 cm. However, lesions> 30 cm have been reported.

Haagensen reported roughly one for every 40 filodes tumor fibroadenoma. Distribution of age according to Haagensen majority occur between the ages of 35 and 55 years.Bilateral tumors are very rare and rarely also occur in patients under age 20, first appeared benign react.

Mammography and ultrasound examination (Figure II.03) are generally important in the diagnosis of breast lesions, but they are notoriously unreliable in differentiating benign tumor from filoides malignant form of the condition or of fibroadenoma. Thus, the findings on imaging studies is not a definite diagnosis. Open excision biopsy of breast lesions smaller or incisional biopsy for larger lesions is a surefire method for diagnosing tumor filoides.

 image 03. Mammography image of the tumor filoides