Kelainan dan perawatan kesehatan gigi dan mulut pada wanita hamil
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CURRICULUM VITAE Nama : DR. Poedjo hartono, dr.SpOG (K) Lahir : Probolinggo, 28 Maret 1955 Pekerjaan : Divisi onkologi ginekologi RSUD Dr. Soetomo Surabaya FK Univ. Airlangga Surabaya Alamat kantor : jl. Mayjen dr. Moestopo 6-8 Surabaya Telp. +62 31 5037732 Pendidikan : FKUA 1981 SpOG FKUA 1988 Konsultan Onkologi Ginekologi 2000 Doktor FKUA 2015 Riwayat Pekerjaan : Ka Puskesmas Dili Barat Timor Timur 1981 RSU Gianyar Bali 1989 RSUD DR. soetomo 1990 Organisasi : Ketua PG POGI 2015 Ketua MPPK IDI 2015 Ketua IDI cab. Surabaya 2012 HP, Email : +62 81 131 9905 [email protected] 1 PERAN PATOLOGI ANATOMI PADA KASUS GINEKOLOGI Poedjo Hartono SpOG 2 PEMERIKSAAN PATOLOGI ANATOMI DIAGNOSTIK (GOLDEN STANDARD) PROGNOSIS DERAJAT OPERASI PENGOBATAN TAMBAHAN ASPEK LEGAL SKRINING / CASE FINDING 3 SITUASI PENYAKIT KANKER DI INDONESIA Dir . PTM Prevalensi kanker 1, 4 per 1000 penduduk sekitar 330.000 orang Kasus baru Kanker tertinggi di Indonesia untuk wanita adalah Kanker Payudara 40 per 100.000 dengan angka kematian 21,5 per 100.000 Kanker leher rahim 17 per 100.000 dengan angka kematian 10 per 100.000 Kanker ovarium Lady Killer, kanker endometrium mulai meningkat Kasus baru kanker tertinggi pada pria adalah kasus kanker paru ( 26 per 100.000) dengan kematian 22 per 100.000 diikuti oleh kanker kolorektal 16 per 100.000 dengan kematian 10 per 100.000 penduduk Pasien kanker datang ke RS sudah dalam stadium lanjut CERVICAL CANCER DEVELOPING COUNTRY PREVENTABLE NATURAL HISTORY, HPV SCREENING 3%, CASE FINDING VIA, SEE AND TREAT VACCINE PROGRAM ADVANCED STAGE TREATMENT PROBLEM LESI PRA KANKER / SITOLOGI Standarisasi pemeriksa, pemeriksaan dasar ginekologi metode hasil / kesimpulan Sertifikasi Sering berdampak hukum 6 CERVICAL CANCER CELL TYPE RADICALITY NODAL INVASION PARAMETRIAL INVASION LVSI IMPORTANT PROGNOSTIC FACTORS AJUVANT TX 7 Squamous tumor and precursors Glandular tumor and precursors Endometrioid adenocarcinoma Other epithelial tumors Undifferentiated carcinoma HISTOPATOLOGICAL CLASSIFICATION 8 MICROINVASIVE CERVICAL CANCER / EARLY STAGE Stage Ia1 and Ia2 from CONIZATION : LVSI + LVSI - •Radical Hysterectomy •Pelvic lymphadenectomy •Conservative •Depends on the margin of the specimen ADJUVANT TREATMENT AFTER CERVICAL CANCER SURGERY (STAGE IA1 – STAGE IIA) Important Prognostic Factors : 1. Lymph node status 2. Radicality ( Vagina and parametrium) 3. Parametrial Involvement 4. LVSI PF Squamous + 1 PF Squamous + 2PF Adeno + PF Adenosquamous + PF • Just Follow Up • Adjuvant Radiation • Adjuvant chemoradiaton PF (PROGNOSTIC FACTOR) 1. Lymph node status 2. Radicality ( Vagina and parametrium) 3. Parametrial Involvement 4. LVSI ENDOMETRIAL CANCER ENDOMETRIAL CANCER CLINICAL -- SURGICAL STAGING GRADING CURRETAGE CELL TYPE GRADE NODAL INVASION CERVICAL INVOLVEMENT GETTING INCREASE ESTROGEN, PCOS 13 Hyperplasia : 1. Simple hyperplasia without atypia 2. Complex hyperplasia without atypia 3. Simple atypical hyperplasia 4. Complex atypical hyperplasia Risk of Malignancy : Simple hyperplasia without atypia – 1 of 93 patients (1 %) Complex hyperplasia without atypia – 1 of 29 patients (3 %) Simple atypical hyperplasia – 1 of 13 patients (8 %) Complex atypical hyperplasia – 10 of 35 patients (29 %) CURRETAGE SPECIMEN : HYPERPLASIA CURRETAGE SPECIMEN : CELL TYPE Adenocarcinoma? Clear Cell? Papillary serous adenocarcinoma Clear cell and Papillary serous adenocarcinoma Poor prognosis Extensive surgery CURRETAGE SPECIMEN : GRADE Grade is important Grade of endometrial cancer : Grade I Grade II Grade III Grade I Simple hysterectomy Grade III Very extensive surgery : Hysterectomy + Pelvic node + Paraaortic node ENDOMETRIAL CANCER SURGICAL SPECIMEN What is important 1. Histological type 2. Grade 3. Myometrial invasion 4. Node status (if lymphadenectomy is done) 5. Cervical Involvement These factors determine the adjuvant treatment after surgery ADJUVANT TREATMENT Low risk Just follow up Grade I-II Invasion less than 50% No cervical involvement Intermediate risk Vaginal Brachytherapy Grade III + invasion < 50% Grade I-II + invasion > 50% • High Risk Vaginal brachytherapy + External Radiation Grade III Invasion > 50% • Lymph nodes + External Radiation OVARIAN CANCER OVARIAN, TUBE AND PERITONEAL CANCER SURGICAL STAGING FROZEN SECTION CYTOLOGY CELL TYPE CELL DIFFERETIATION RESIDUAL MASS FNAB 20 OVARIAN CANCER Cell types 1. “Borderline” 2. Epithelial 3. Germ Cell 4. Sex cord stromal tumor Clinical consequences : Borderline Just Tumor Extirpation Germ Cell Conservative surgery Early stage : Cell differentiation Advance stage : Residual mass after surgery PROGNOSTIC FACTOR IN OVARIAN CANCER FROZEN SECTION IN OVARIAN CANCER Determine the extensiveness of surgery At least VC can differenciate : - Benign - Borderline - Epithelial ovarian cancer - Non-epithelial ovarian cancer Chemosensitive Conservative surgery All germ cell tumors need chemotherapy, except : 1. Dysgerminoma Stage IA 2. Immature Teratoma Stage IA, Grade 1 Grade is vey important in Immature Teratoma Stage Ia grade 1 No Chemotherapy Stage Ia grade 2-3 Chemotherapy GERM CELL TUMOUR TANTANGAN KEDEPAN INDUSTRIALISASI KESEHATAN GLOBALISASI SJKN / BPJS PROFESSIONAL TRUST 25 FAKTA YANG ADA MASYARAKAT BELUM TERLALU PERCAYA HASIL KADANG DIPERTANYAKAN SERING TERPAKSA DILAKUKAN REVIEW BELUM ADA KESERAGAMAN ADA KESENJANGAN KOMUNIKASI ANTAR PROFESI KURANG BAIK KESEJAHTERAAN ANGGOTA TIDAK DIPERIKSAKAN PA 26 USULAN SOLUSI Team working internal / eksternal Tumor board / up dating Komunikasi Standarisasi permintaan Standarisasi pelaksanaan skrining / case finding Standarisasi pembacaan Standarisasi hasil Peningkatan kualitas 27 KESIMPULAN PERAN PA SANGAT PENTING KERJASAMA / TEAM WORKING KOMUNIKASI RUJUKAN, HELP, FOLLOW UP MEETING / TUMOR BOARD RUJUK BALIK , KONFIRMASI HASIL PELATIHAN NO SHAME, NO BLAME 28 THERE IS NO BEST DOCTOR FOR CANCER MANAGEMENT, BUT THERE IS ONLY THE BEST TEAM MATURNUWUN, TERIMA KASIH 29