position of the uterus → normal
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Step 1 1. Adnexa : consist of tuba falopii and ovarium Parametrium : 2. Ante flexi position : position of the uterus normal. The normal uterus is anteflexi and anteversi. Anteflexi : Angle by corpus and cervix uteri. Anteversi :The angle that form by cervix uteri and vagina Step 2 1. Why the patient complained that she had the irregular menstruation cycle and sometimes twice in a month ? Why the patient complained about the longer period and bleeding large ? MENOMETRORRHAGIE Definisi Perdarahan yg tjd dlm masa antara 2 haid, karena kelainan organik atau kelainan fungsional. Perdarahan uterus yg berlebihan tjd selama menstruasi & pd interval yg tdk teratur. (Kamus Kedokteran Dorland) & (Hanifa W.2007.Ilmu Kandungan.Jakarta:YBP-SP) o Menometroragia Perdarahan uterus yang tidak teratur, interval non-siklik dan dengan darah yang berlebihan (>80 ml) dan atau dengan durasi yang panjang ( > 7 hari). Sebab-sebab Organik Etiologi Perdarahan dari uterus , tuba, dan ovarium disebabkan kelainan pada: serviks uteri polip servisis uteri, erosi porsionis uteri, ulkus pada porsio uteri, Ca servisis uteri korpus uteri polip endometrium, abortus imminens, abortus sedang berlangsung, abortus inkompletus, molahidatidosa, koriokarsinoma, subinvolusio uteri, Ca korporis uteri, sarkoma uteri, mioma uteri. tuba fallopi KET, radang tuba, tumor tuba. ovarium radang ovarium, tumor ovarium Sebab-sebab Fungsional Perdarahan ovulatoar Gangguan dianggap berasal dari faktor2 neuromuskular, vasomotorik, atau hematologik. Etiologinya: Korpus luteum persisten Insufisiensi korpus luteum Apopleksia uteri Kelainan darah Perdarahan anovulatoar Gangguan dianggap bersumber pada gangguan endokrin. Ilmu Kandungan,Yayasan Bian Pustaka Sarwono Prawirohardjo 2. Why the patient often accompanied a severe abdominal pain ? pain no distinctive symptoms. Can arise due to blood circulation disorders pd nest myomas, who accompanied the local necrosis and inflammation. In submukosum myomas who will be born, growth constringent cervical canal can cause dysmenorrhea Capita Selecta Kedokteran.FKUI.Jilid 1, Issue 3 3. 4. 5. 6. 7. What the correlation about the age and condition of the patient ? What is the correlation about the abdominal trauma was denied ? Why she had been married but never conceived? Why the size of uterus about swan egg ? Why there was frequent foul smelling vaginal discharge between mentrual cycle ? Symptoms often appear • Discharge: the longer, the more fetid, due to infection and tissue necrosis • Bleeding Contact: experienced bleeding after intercourse, is a symptom of cervical Ca (7580%) • Spontaneous bleeding: bleeding caused by the opening of the blood vessels and increasingly frequent, especially in tumors that are exophytic. • Anemia occurs due to recurrent vaginal bleeding. • Pain: caused by infiltration of tumor cells into nerve fibers. • Renal failure: the infiltration of tumor cells into the ureter that causes obstruction in total. Heavy periods with smelly discharge: You periods seem to be getting heavier by the month, there is bleeding in between periods, par- ticularly after sexual intercourse. There is a heavy, foul smelling discharge. Reviews These may be signs of early stages of cervical cancer, a condition called cervical dysplasia. Ask your doctor to perform a Pap smear test. Gray discharge Fishy, fishy smelling vaginal discharge that is worse after having sex or washing with soap. There may be itchiness or irritation Also in and around the vulva and vagina. You may have bacterial vaginosis, vaginitis see. Greenish discharge Gray / greenish discharge as well as itchiness around the vagina or vulva. There may be a burning sensation when urinating and discomfort during sex. You could have trichomoniasis, a type of vaginitis the which is sexually transmitted. Ask your doctor to perform an STD test. Trichomonas is treated with antibiotics; Also your partner will need to be tested. Thick white cottage cheese discharge discharge the which looks like cottage cheese, may yeasty smell like bread. Usually accompanied by itching and a burning sensation when urinating. The vulva can also look swollen and afternoon. See: yeast infection symptoms (Candida). Watery discharge Bleeding between periods with abnormal vaginal discharges. Discharge may be watery, pinkish, foul smelling or blood tinged. The vulva may be persistently itchy (pruritic). Rule out: symptoms of vaginal cancer. Increased vaginal discharge Bleeding between periods or heavier periods than normal with Increased vaginal discharge. There may be a burning feeling in the vagina and the urethra the which could be mistaken for a urinary tract infection (cystitis). Also there may be irritation around the anus and a need to urinate frequently. These are symptoms of gonorrhea, a sexually transmitted disease. Discharge with burning pain Unusual vaginal discharge, burning pain when urinating, lower abdominal pain and a frequent need to urinate; These are all signs of a sexually transmitted disease calledchlamydia. Sometimes there may be no symptoms. Ask your doctor for a chlamydia screening. Treatment Consists of antibiotics with a follow-up test a few weeks later. Your partner will need to be tested Also. http://www.womens-health-advice.com/reproductive-disorders.html 8. Is there any correletion beetwen an anemic condition and obese condition in this patient with the disease? Explain it ! ANEMIA Menorrhagia is the most common cause of anemia (reduction in red blood cells) in premenopausal women. A blood loss of more than 80mL (around three tablespoons) per menstrual cycle can eventually lead to anemia. Most cases of anemia are mild. Nevertheless, even mild anemia can reduce oxygen transport in the blood, causing fatigue and a diminished physical capacity. Moderate-to-severe anemia can cause shortness of breath, rapid heart rate, lightheadedness, headaches, ringing in the ears (tinnitus), irritability, pale skin, restless legs syndrome, and mental confusion. Heart problems can occur in prolonged and severe anemia that is not treated. http://health.nytimes.com/health/guides/symptoms/menstrual-periods-heavy-prolongedor-irregular/print.html Obesity : obesity can make hormone estrogen and progesteron in body imbalance, because fatty contains androsterediol change to estradiol and make hormone estrogen increaed than progesteron,and if endometrium expose estrogen can make hiperplasi and make abdominal pain caused press the organns parametrium. . if estrogen decreased it can make descuamate stratum fungsional in endometrium. But usually unfollow ovulation. having too much estrogen and not enough progesterone. Women who have mentioned hormone imbalance over time may be more likely to get endometrial cancer after age 50. This hormone imbalance can happen if a woman: Is obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out. Takes estrogen without taking a progestin - Estrogen only hormone replacement therapy (HRT). Has polycystic ovary syndrome (PCOS) and chronic anovulation, which causes hormone imbalance. In general estrogens are responsible for the lining of the uterus (endometrium) grow thicker. Progesterone "opposes" estrogen - progesterone level goes up then drops at the end of each menstrual cycle, making the thick endometrium layer shed away. This is what we know as menstrual bleeding. When there is too much estrogen in the body, progesterone can't do its job. The endometrium gets thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow. Over time, the endometrium cells can become cancerous. http://www.women-health-info.com/272-Endometrial-cancer.html 9. Mention the forms/variations of uterus position in normal and abnormal patient! 10. What the imanging result the docter expect considered to USG and histopathology examination? Worldwide, approximately 500,000 new cases of cervical cancer and 274,000 deaths are attributable to cervical cancer yearly, making cervical cancer the second most common cause of death from cancer in women.[1] Fortunately, the incidence of cervical cancer has decreased by more than 50% in the past 30 years, largely due to the increasing use of cervical cancer screening with cervical cytology.[2] In fact, the incidence of cervical cancer in the United States has decreased from 14.8 cases per 100,000 women in 1975 to only 6.5 cases per 100,000 women in 2006.[3, 4] This corresponds to approximately 10,000 new diagnoses and 4,000 deaths attributable to the disease annually in this country.[4] Although worldwide cervical cancer rates have decreased dramatically with the increase in screening efforts, incidence and prevalence in developing countries remains high due to lack of screening programs, with approximately 80% of all cervical cancer deaths occurring in the developing world.[1] The mainstay of cervical cancer screening for the last 60 years has been the Papanicolaou test. The Papanicolaou test, also known as the Pap test or the Pap smear, was developed in the 1940s by Georgios Papanikolaou. It involves exfoliating cells from the transformation zone of the cervix to enable examination of these cells microscopically for detection of cancerous or precancerous lesions. An image depicting a Pap smear can be seen below. Pap smear. Pap smear. In one newer technique, liquid-based cytology, these cells are released into a vial of liquid preservative that is then used in the cytology lab to produce a slide for microscopic evaluation of the cells. The older, traditional Pap technique involves direct transfer of the cervical cells to a microscope slide for evaluation. Although the traditional method may introduce confounders such as blood and other debris to the slide, which may make interpretation more difficult, both conventional cytology and liquid-based cytology have been shown to have similar sensitivity and specificity for moderate dysplasia or worse lesions when using a threshold of LSIL or higher. In addition, both types of cytological screening are considered acceptable by the American College of Obstetricians and Gynecologists.[2] When abnormal cells are detected on the Pap Test, diagnostic testing in the form of colposcopy is often indicated. This testing may be followed by diagnosis of dysplasia via colposcopic biopsies. Subsequent cervical cancer may be prevented through the diagnosis and treatment of these cervical cancer precursors. Evidence shows that approximately 99-100% of cervical cancers are attributable to infection by high-risk types of the human papillomavirus (HPV). HPV represents a family of doublestranded, circular DNA viruses that can infect skin or mucosal cells, including the anogenital region and the oral cavity, and may be transmitted easily via sexual intercourse or direct contact.[5, 6] More than 100 types of HPV exist, 12 of which can involve the anogenital region and are considered "high risk" or oncogenic in nature. These include HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. Of these, HPV 16 is responsible for the largest number of CIN 3 and cervical cancer cases.[5] Although HPV is a necessary factor in the development of cervical dysplasia that can eventually lead to cervical cancer, most women infected with HPV will not develop cervical dysplasia.[7] The presence of high-risk HPV DNA is accompanied by cytologic abnormalities approximately one third of the time. Whether an HPV infection will progress relates to the persistence of the infection and also possibly to the immune response and smoking status of the woman.[8] Relevant Anatomy The female reproductive organs can be subdivided into the internal and external genitalia. The internal genitalia are those organs that are within the true pelvis. These include the vagina, uterus, cervix, uterine tubes (oviducts or fallopian tubes), and ovaries. The external genitalia lie outside the true pelvis. These include the perineum, mons pubis, clitoris, urethral (urinary) meatus, labia majora and minora, vestibule, greater vestibular (Bartholin) glands, Skene glands, and periurethral area. The cervix is the inferior portion of the uterus, separating the body of the uterus from the vagina. The cervix is cylindrical in shape, with an endocervical canal located in the midline, allowing passage of semen into the uterus. The external opening into the vagina is termed the external os, and the internal opening into the endometrial cavity is termed the internal os. The internal os is the portion of a female cervix that dilates to allow delivery of the fetus during labor. The average length of the cervix is 3-5 cm. For more information about the relevant anatomy, see Female Reproductive Organ Anatomy. Also see Uterus Anatomy and Vaginal Anatomy. https://www.cancer.ca/en/cancer-information/cancer-type/cervical/cervicalcancer/?region=on Di seluruh dunia, sekitar 500.000 kasus baru kanker serviks dan 274.000 kematian yang disebabkan kanker serviks setiap tahun, membuat kanker serviks penyebab paling umum kedua kematian akibat kanker pada wanita. [1] Untungnya, kejadian kanker serviks telah menurun lebih dari 50 % dalam 30 tahun terakhir, sebagian besar disebabkan oleh meningkatnya penggunaan skrining kanker serviks dengan sitologi serviks. [2] Bahkan, angka kejadian kanker serviks di Amerika Serikat telah menurun dari 14,8 kasus per 100.000 perempuan pada tahun 1975 menjadi hanya 6,5 kasus per 100.000 perempuan pada tahun 2006. [3, 4] Hal ini sesuai dengan sekitar 10.000 diagnosis baru dan 4.000 kematian disebabkan oleh penyakit setiap tahun di negeri ini. [4] Meskipun tingkat kanker serviks di seluruh dunia telah menurun secara dramatis dengan peningkatan upaya pemeriksaan, insiden dan prevalensi di negara-negara berkembang tetap tinggi karena kurangnya program skrining, dengan sekitar 80% dari semua kematian akibat kanker serviks terjadi di negara berkembang. [1] The andalan skrining kanker serviks selama 60 tahun terakhir telah menjadi tes Papanicolaou. Tes Papanicolaou, juga dikenal sebagai tes Pap atau Pap smear, dikembangkan pada tahun 1940-an oleh Georgios Papanikolaou. Ini melibatkan pengelupasan sel-sel dari zona transformasi serviks untuk memungkinkan pemeriksaan sel-sel ini secara mikroskopis untuk mendeteksi lesi kanker atau prakanker. Sebuah gambar yang menggambarkan Pap smear dapat dilihat di bawah ini. Pap smear. Pap smear. Dalam satu teknik baru, sitologi berbasis cairan, sel-sel ini dilepaskan ke dalam botol cairan pengawet yang kemudian digunakan di laboratorium sitologi untuk menghasilkan slide untuk evaluasi mikroskopis dari sel. Semakin tua, teknik Pap tradisional melibatkan transfer langsung dari sel-sel leher rahim ke slide mikroskop untuk evaluasi. Meskipun metode tradisional dapat memperkenalkan pembaur seperti darah dan puing-puing lainnya ke slide, yang dapat membuat interpretasi yang lebih sulit, baik sitologi konvensional dan sitologi berbasis cairan telah terbukti memiliki sensitivitas dan spesifisitas yang sama untuk displasia sedang atau lesi lebih buruk ketika menggunakan ambang LSIL atau lebih tinggi. Selain itu, kedua jenis skrining sitologi dianggap dapat diterima oleh American College of Obstetricians dan Gynecologists. [2] Ketika sel-sel abnormal terdeteksi pada tes Pap, tes diagnostik dalam bentuk kolposkopi sering ditunjukkan. Pengujian ini dapat diikuti oleh diagnosis displasia melalui biopsi kolposkopi. Kanker serviks berikutnya dapat dicegah melalui diagnosis dan pengobatan ini prekursor kanker serviks. Bukti menunjukkan bahwa sekitar 99-100% dari kanker serviks yang disebabkan infeksi oleh jenis risiko tinggi dari human papillomavirus (HPV). HPV merupakan keluarga, virus DNA sirkular untai ganda yang dapat menginfeksi kulit atau mukosa sel, termasuk daerah anogenital dan rongga mulut, dan dapat ditularkan dengan mudah melalui hubungan seksual atau kontak langsung. [5, 6] Lebih dari 100 jenis HPV yang ada, 12 di antaranya dapat melibatkan daerah anogenital dan dianggap "berisiko tinggi" atau onkogenik di alam. Ini termasuk HPV tipe 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, dan 59. Dari jumlah tersebut, HPV 16 bertanggung jawab untuk jumlah terbesar dari CIN 3 dan kasus kanker serviks. [5 ] Meskipun HPV merupakan faktor penting dalam pengembangan displasia serviks yang akhirnya dapat menyebabkan kanker serviks, kebanyakan wanita yang terinfeksi HPV tidak akan mengembangkan displasia serviks. [7] kehadiran risiko tinggi HPV DNA disertai dengan kelainan sitologi sekitar satu sepertiga dari waktu. Apakah infeksi HPV akan maju berkaitan dengan kegigihan infeksi dan juga kemungkinan untuk respon dan merokok status kekebalan wanita. [8] Anatomi relevan Organ reproduksi wanita dapat dibagi lagi menjadi alat kelamin internal dan eksternal. Genitalia interna adalah organ-organ yang berada dalam panggul sejati. Ini termasuk vagina, rahim, leher rahim, tabung rahim (saluran telur atau tuba falopi), dan ovarium. Genitalia eksterna berada di luar panggul sejati. Ini termasuk perineum, mons pubis, klitoris, uretra (saluran kemih) meatus, labia majora dan minora, vestibulum, vestibular yang lebih besar (Bartholin) kelenjar, Skene kelenjar, dan daerah periuretra. Leher rahim adalah bagian inferior rahim, memisahkan tubuh rahim dari vagina. Serviks berbentuk silinder, dengan kanal endoserviks yang terletak di garis tengah, yang memungkinkan bagian dari air mani ke dalam rahim. Pembukaan eksternal ke dalam vagina disebut os eksternal, dan pembukaan internal ke dalam rongga endometrium disebut os internal. Os internal bagian dari leher rahim perempuan yang berdilatasi untuk memungkinkan pengiriman janin selama persalinan. Rata-rata lama serviks 3-5 cm. Untuk informasi lebih lanjut tentang anatomi yang relevan, lihat Reproduksi Perempuan Organ Anatomi. Juga lihat Rahim Anatomi dan vagina Anatomi. 11. What the relation with the mother died because cervical cancer? This answer about her genetic Everyone should care about the potential for genetic discrimination. Every person has dozens of DNA differences that could increase or decrease his or her chance of getting a disease such as diabetes, heart disease, cancer or Alzheimer's disease. It's important to remember that these DNA differences don't always mean someone will develop a disease, just that the risk to get the disease may be greater. http://www.genome.gov/page.cfm?pageID=10002328 12. If the doctor discover in the patient there is a mass in adnexa and parametrium, what the the doctor supposed to think ? ULTRASOUND Imaging techniques are often used to detect certain conditions that may be causing menstrual disorders. Imaging can help diagnose fibroids, endometriosis, or structural abnormalities of the reproductive organs. Ultrasound and Sonohysterography. Ultrasound is the standard imaging technique for evaluating the uterus and ovaries, detecting fibroids, ovarian cysts and tumors, and finding obstructions in the urinary tract. It uses sound waves to produce an image of the organs. Ultrasound carries no risk and causes very little discomfort. http://health.nytimes.com/health/guides/symptoms/menstrual-periods-heavy-prolongedor-irregular/print.html Histopathology is the microscopic examination of biological tissues to observe the appearance of diseased cells and tissues in very fine detail. The main use of histopathology is in clinical medicine where it typically involves the examination of a biopsy (i.e. a surgically removed sample or specimen taken from a patient for the purposes of detailed study) by a specialist physician called a pathologist. http://www.ivy-rose.co.uk/HumanBody/Histology/What-is-Histopathology.php 13. DD ? Cervical cancer is the third most common malignancy in women worldwide, and it remains a leading cause of cancer-related death for women in developing countries. In the United States, cervical cancer is relatively uncommon. Essential update: FDA approves bevacizumab for late-stage cervical cancer In August 2014, the US Food and Drug Administration (FDA) approved bevacizumab (Avastin) for the management of persistent, recurrent or late-stage (metastatic) carcinoma of the cervix.[1, 2] This agent is approved for combination chemotherapy with paclitaxel and cisplatin or with paclitaxel and topotecan.[1, 2] Approval was based on the GOG-0240 study (n = 452) that assessed the efficacy and safety of bevacizumab plus chemotherapy (paclitaxel and cisplatin or paclitaxel and topotecan) in women with persistent, recurrent or metastatic carcinoma of the cervix.[1, 3] A statistically significant improvement in overall survival (OS) and an increase in the rate of tumor shrinkage was shown in women treated with bevacizumab plus chemotherapy compared with chemotherapy alone. However, hypertension, thromboembolic events, and gastrointestinal fistulas were higher in the bevacizumab group. [1, 3] Signs and symptoms The most common finding in patients with cervical cancer is an abnormal Papanicolaou (Pap) test result. Physical symptoms of cervical cancer may include the following: Abnormal vaginal bleeding Vaginal discomfort Malodorous discharge Dysuria See Clinical Presentation for more detail. Diagnosis Human papillomavirus (HPV) infection must be present for cervical cancer to occur. Complete evaluation starts with Papanicolaou (Pap) testing. Screening recommendations Current screening recommendations for specific age groups, based on guidelines from the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), the American Society for Clinical Pathology (ASCP), the US Preventive Services Task Force (USPSTF), and the American College of Obstetricians and Gynecologists (ACOG), are as follows [4, 5, 6, 7] : < 21 years: No screening recommended 21-29 years: Cytology (Pap smear) alone every 3 years 30-65 years: Human papillomavirus (HPV) and cytology cotesting every 5 years (preferred) or cytology alone every 3 years (acceptable) >65 years: No screening recommended if adequate prior screening has been negative and high risk is not present See Workup for more detail. Management Immunization Evidence suggests that HPV vaccines prevent HPV infection.[8] The following 2 HPV vaccines are approved by the FDA: Gardasil (Merck, Whitehouse Station, NJ): This quadrivalent vaccine is approved for girls and women 9-26 years of age to prevent cervical cancer (and also genital warts and anal cancer) caused by HPV types 6, 11, 16, and 18; it is also approved for males 9-26 years of age[9] Cervarix (GlaxoSmithKline, Research Triangle Park, NC): This bivalent vaccine is approved for girls and women 9-25 years of age to prevent cervical cancer caused by HPV types 16 and 18 [10] The Advisory Committee on Immunization Practices (ACIP) recommendations for vaccination are as follows: Routine vaccination of females aged 11-12 years of age with 3 doses of either HPV2 or HPV4 Routine vaccination with HPV4 for boys aged 11-12 years of age, as well as males aged 13-21 years of age who have not been vaccinated previously Vaccination with HPV4 in males aged 9-26 years of age for prevention of genital warts; routine use not recommended Stage-based treatment The treatment of cervical cancer varies with the stage of the disease, as follows: Stage 0: Carcinoma in situ (stage 0) is treated with local ablative or excisional measures such as cryosurgery, laser ablation, and loop excision; surgical removal is preferred Stage IA1: The treatment of choice for stage IA1 disease is surgery; total hysterectomy, radical hysterectomy, and conization are accepted procedures Stage IA2, IB, or IIA: Combined external beam radiation with brachytherapy and radical hysterectomy with bilateral pelvic lymphadenectomy for patients with stage IB or IIA disease; radical vaginal trachelectomy with pelvic lymph node dissection is appropriate for fertility preservation in women with stage IA2 disease and those with stage IB1 disease whose lesions are 2 cm or smaller Stage IIB, III, or IVA: Cisplatin-based chemotherapy with radiation is the standard of care[11] Stage IVB and recurrent cancer: Individualized therapy is used on a palliative basis; radiation therapy is used alone for control of bleeding and pain; systemic chemotherapy is used for disseminated disease[11] http://emedicine.medscape.com/article/253513-overview Kanker serviks merupakan kanker yang paling umum ketiga pada wanita di seluruh dunia, dan itu tetap menjadi penyebab utama kematian terkait kanker bagi perempuan di negara berkembang. Di Amerika Serikat, kanker serviks relatif jarang. Penting update: FDA menyetujui bevacizumab untuk stadium akhir kanker serviks Pada bulan Agustus 2014, US Food and Drug Administration (FDA) menyetujui bevacizumab (Avastin) untuk pengelolaan persisten, berulang atau tahap akhir (metastasis) kanker leher rahim. [1, 2] Agen ini disetujui untuk kemoterapi kombinasi dengan paclitaxel dan cisplatin atau dengan paclitaxel dan topotecan. [1, 2] Persetujuan didasarkan pada studi GOG-0240 (n = 452) yang menilai efikasi dan keamanan bevacizumab plus kemoterapi (paclitaxel dan cisplatin atau paclitaxel dan topotecan) pada wanita dengan gigih, berulang atau karsinoma metastasis serviks. [1, 3 ] sebuah peningkatan yang signifikan secara statistik pada kelangsungan hidup secara keseluruhan (OS) dan peningkatan laju penyusutan tumor ditunjukkan pada wanita yang diobati dengan bevacizumab plus kemoterapi dibandingkan dengan kemoterapi saja. Namun, hipertensi, peristiwa tromboemboli, dan fistula gastrointestinal yang lebih tinggi pada kelompok bevacizumab. [1, 3] Tanda dan gejala Temuan yang paling umum pada pasien dengan kanker serviks adalah Papanicolaou (Pap) hasil tes yang abnormal. Gejala fisik kanker serviks mungkin termasuk yang berikut: Perdarahan vagina abnormal ketidaknyamanan vagina debit berbau busuk disuria Lihat Presentasi klinis untuk detail lebih lanjut. diagnosa Human papillomavirus (HPV) infeksi harus hadir untuk kanker serviks terjadi. Evaluasi lengkap dimulai dengan Papanicolaou (Pap) pengujian. rekomendasi skrining Rekomendasi saat skrining untuk kelompok usia tertentu, berdasarkan pedoman dari American Cancer Society (ACS), American Society for Kolposkopi dan Serviks Patologi (ASCCP), American Society for Patologi Klinik (ASCP), US Preventive Services Task Force (USPSTF ), dan American College of Obstetricians dan Gynecologists (ACOG), adalah sebagai berikut [4, 5, 6, 7]: <21 tahun: Tidak ada skrining dianjurkan 21-29 tahun: Sitologi (Pap smear) saja setiap 3 tahun 30-65 tahun: Human papillomavirus (HPV) dan sitologi cotesting setiap 5 tahun (lebih disukai) atau sitologi saja setiap 3 tahun (diterima) > 65 tahun: Tidak ada skrining dianjurkan jika pemeriksaan sebelumnya yang memadai telah negatif dan berisiko tinggi tidak hadir Lihat hasil pemeriksaan untuk detail lebih lanjut. pengelolaan imunisasi Bukti menunjukkan bahwa vaksin HPV mencegah infeksi HPV [8] 2 vaksin HPV berikut disetujui oleh FDA.: Gardasil (Merck, Whitehouse Station, NJ): Vaksin quadrivalent ini disetujui untuk anak perempuan dan wanita 9-26 tahun untuk mencegah kanker serviks (dan juga kutil kelamin dan kanker anal) yang disebabkan oleh HPV tipe 6, 11, 16, dan 18 ; itu juga disetujui untuk laki-laki 9-26 tahun [9] Cervarix (GlaxoSmithKline, Research Triangle Park, NC): Vaksin bivalen ini disetujui untuk anak perempuan dan wanita 9-25 tahun untuk mencegah kanker serviks disebabkan oleh HPV tipe 16 dan 18 [10] Komite Penasehat Praktek Imunisasi (ACIP) rekomendasi untuk vaksinasi adalah sebagai berikut: Vaksinasi rutin dari perempuan berusia 11-12 tahun dengan 3 dosis baik HPV2 atau HPV4 Vaksinasi rutin dengan HPV4 untuk anak laki-laki berusia 11-12 tahun, serta laki-laki berusia 13-21 tahun yang belum divaksinasi sebelumnya Vaksinasi dengan HPV4 pada laki-laki berusia 9-26 tahun untuk pencegahan kutil kelamin; penggunaan rutin tidak dianjurkan Pengobatan berbasis tahap Pengobatan kanker serviks bervariasi dengan tahap penyakit, sebagai berikut: Tahap 0: Karsinoma in situ (stadium 0) diperlakukan dengan tindakan ablatif atau eksisi lokal seperti cryosurgery, ablasi laser, dan loop eksisi; operasi pengangkatan lebih disukai Tahap IA1: Pengobatan pilihan untuk stadium IA1 penyakit adalah operasi; histerektomi total, histerektomi radikal, dan konisasi diterima prosedur Tahap IA2, IB, atau IIA: Gabungan radiasi sinar eksternal dengan brachytherapy dan histerektomi radikal dengan limfadenektomi panggul bilateral untuk pasien dengan stadium IB atau penyakit IIA; trachelectomy vagina radikal dengan diseksi kelenjar getah bening panggul cocok untuk pelestarian kesuburan pada wanita dengan stadium IA2 penyakit dan orang-orang dengan penyakit stadium IB1 yang lesi 2 cm atau lebih kecil Tahap IIB, III, atau IVA: kemoterapi Cisplatin berbasis dengan radiasi standar perawatan [11] Tahap IVB dan kanker berulang: Terapi Individual digunakan secara paliatif; terapi radiasi digunakan sendiri untuk mengontrol perdarahan dan nyeri; kemoterapi sistemik digunakan untuk penyakit disebarluaskan [11] 14. Theraphy of the scenario Step 3 1. Why the patient complained that she had the irregular menstruation cycle and sometimes twice in a month ? The cycle of menstruation and can find about the disorders. 1. Disorder of duration of cycle , normally is 21 until 35 days. - Polimenore when its happpen less than 21 days. Shortness term of fase luteal cycle - Oligomenorrhe : more than 35 days, follicular phase is disfunction - Ammenorhea if the menstruatin cant happen in 3 months 2. Disorder of amount of blood, normally more or less 80 ml -hypermenorrhe : more than 80 ml. It can because of mioma and infection -hypomenorrhe : less than 80 ml 3. disorder of the duration of time , normally 3-7 days - menorhagi : if the menstruation more than 7 days, it can occur because loss of local endometrial haemostasis. Mioma, uterus hyperplasi - brachymenorrhe : if the menstruaution happen less than 3 days Why the the estrogen up regulate ? In this scenarion the patient is obesity --> fatty make hormon estrogen estradiol and make the estrogen There is neovascularisation that is supply the abnormal tissue. Tumor is have a neovascularization. In normal woman , there is contraction on menstration cycle ? Why the patient complained about the longer period and large amounts of bleeding? Estrogen is vital in regulation of the menstruation cycle. During proliferation influence smooth muscle overstimulation of estrogen makes the size of uterine lining increase and further develop to afibroid During menstruation the thickned that cant be descuamated prolonged and excessive menstrual bleeding Perdarahan vagina di luar fase menstruasi 2. Why the patient often accompanied a severe abdominal pain ? There is correlation with the obesity. Fatty contain changes into estradiol and there is much of Hormone estrogen abdominal pain there is an hyperplasia in parametrium when the parametrium pressure severe abdominal pain. Many of Reseptor taktil makes the abdominal pain when the tissue invasive to . Normally mens cycle dismenorrhea. Devided by 2 : primer normal. Uterus contraction in mesntruation. But abdominal pain can feel in that mens Sekunder : abdnormal abdominal painalways feel the pain. Have an ethiology -- > intrauterion : IUD , infection, mioma Extrauterine : endometriosis tumor , inflamation Uterine fibroid (other name of mioma) disminore menghambat aliran menstruation 3. What the correlation about the age (32 yo) and condition of the patient ? Epidemiology Usually happen in old age. (geriatri) For today, it changes. More fast. Often happen in America. Because of the lifestyle. Kalangan mid to end. There is no correlation about the age because the patient have the symtoms from young. Any Endometrium disorder releted of the age? 4. What is the correlation about the abdominal trauma was denied ? To eliminated the DD (ruptur uterine and disorder of endomertium) What is the difference about the trauma bleeding and the bledding disorder? In conclude it can be collect from the anamnesis. 5. Why she had been married but never conceived? The patient complained about the menstruation cyclesiklus terganggu(in all phase) Or maybe in the uterine wall there is a tumor. 6. Why the size of uterus about swan egg ? In normally, in pregnant on 3 mo Maybe there is a mass in intrauterine. 7. Why there was frequent foul smelling vaginal discharge between mentrual cycle ? Discharge in the pattient because there is a mass which obstruct the menstrual flow there will be acumulate and stimulate the flora normal infection foul smelling Normal vaginal discharge may appear clear cold white and yellow Menstrual cycle, nutrional status, usage og medication affect the vaginal environment. Increase wetness and clear foul smelling 8. Is there any correletion beetwen an anemic condition and obese condition in this patient with the disease? Explain it ! Fatty estradiol estrogen much There are new vascularization metabolisme digunakan untuk pertumbahan jaringan baru weakness Bleeding occur in the patien, because more than 80 mlanemic condition 9. Mention the forms/variations of uterus position in normal and abnormal patient! 10. What the imanging result the docter expect considered to USG and histopathology examination? There is any other supporting examination ? mention it! 11. What the relation with the mother died because cervical cancer? 12. If the doctor discover in the patient there is a mass in adnexa and parametrium, what the the doctor supposed to think ? 13. DD ? Any endometrial disorder (kelainan perdarahan, benigna and maligna) Mioma uteri 14. Theraphy of the scenario HOW THE NEOPLASIA HAPPEN ?
