Prevalensi Karsinoma Serviks Di Rumah Sakit Hasan Sadikin Bandung Periode Januari - Desember 2009.
vi
ABSTRAK
PREVALENSI KARSINOMA SERVIKS DI RUMAH SAKIT HASAN
SADIKIN BANDUNG PERIODE JANUARI - DESEMBER 2009
Pitaria Rebecca, 2011
Pembimbing I : dr. July Ivone., MKK., M.Pd.Ked.
Pembimbing II: dr. Sri Nadya Saanin M.Kes
Karsinoma serviks adalah jenis penyakit ganas yang terjadi pada leher rahim,
merupakan penyebab kematian tertinggi pada wanita di negara-negara
berkembang. Menurut data, terdapat sekitar 500.000 kasus baru karsinoma serviks
per tahun di dunia dengan 250.000 ribu kematian setiap tahunnya.
Tujuan penelitian ini untuk mengetahui jumlah angka kejadian karsinoma
serviks yang terjadi di Rumah Sakit Hasan Sadikin Bandung periode Januari -
Desember 2009 dengan karakteristik distribusi menurut rentang usia, stadium, dan
gambaran histopatologis.
Metode penelitian dilakukan secara survei deskriptif dengan rancangan
penelitian retrospektif terhadap data rekam medis pasien rawat inap penderita
karsinoma serviks di Rumah Sakit Hasan Sadikin Bandung periode 1 Januari 2009
- 31 Desember 2009.
Hasil yang diperoleh menunjukkan bahwa pada tahun 2009 terdapat 226 kasus
karsinoma serviks dengan prevalensi usia tertinggi adalah golongan usia 46-50
tahun, atau sekitar 26,54% dari total observasi. Kemudian stadium yang paling
banyak ditemui adalah stadium III B sebanyak 41,59% dari total observasi dengan
gambaran histopatologis paling banyak adalah Non Keratinizing epidermoid
cancer cervix sebanyak 42,47% kasus.
Kata Kunci: karsinoma serviks, prevalensi
(2)
vi
ABSTRACT
CHARACTERISTICS OF CERVICAL CARCINOMA IN SADIKIN HASAN
HOSPITAL BANDUNG PERIOD JANUARY - DECEMBER 2009
Pitaria Rebecca, 2011
Supervisor I : dr. July Ivone., MKK., M.Pd.Ked
Supervisor II : dr. Sri Nadya Saanin., M. Kes
Cervical carcinoma or cervical cancer is a type of carcinoma that occurs in
the cervical region. Leading to be the highest death causes in women in
developing countries. According to the data, there are about 500.000 new cases
of cervical carcinoma in the world with 250.000 deaths annually.
The objective of this study is to determine the prevalence of cervical
carcinoma in Hasan Sadikin Hospital in period of January to December 2009 and
the characteristics of distribution according to age range, stage, and
histopathological picture.
This research is a retrospective descriptive study. The data was collected from
medical record of overnight staying cervical carcinoma patients in Hasan Sadikin
Hospital, Bandung at period 1 January 2009
–
31 December 2009
The result of study shows in 2009 there were 226 cases of cervical carcinoma
with the highest prevalence age ranging from until 46-50 years of age in 26,54%
of cases while the most commonly stage is III B obtained in 41,59% of cases with
the most commonly histopathologic picture of most of the Non Keratinizing
epidermoid cervical carcinoma in 42,47% of cases.
(3)
vi
DAFTAR ISI
Halaman
JUDUL ...
i
LEMBAR PERSETUJUAN ...
ii
SURAT PERNYATAAN ...
iii
PRAKATA ...
iv
ABSTRAK ...
vi
ABSTRACT ...
vii
DAFTAR ISI ...
viii
DAFTAR TABEL ...
xi
DAFTAR GAMBAR ...
xii
BAB I PENDAHULUAN ...
1
1.1 Latar Belakang ...
1
1.2 Identifikasi Masalah ...
2
1.3 Maksud dan Tujuan Penelitian ...
3
1.4 Manfaat Karya Tulis Ilmiah ...
3
1.5 Metode Penelitian ...
3
1.6 Lokasi dan Waktu Penelitian ...
4
BAB II TINJAUAN PUSTAKA ...
5
2.1 Genitalia Wanita ...
5
2.1.1 Anatomi ...
5
2.1.2 Histologi Serviks ...
8
2.1.3 Fisiologi Serviks ...
9
2.2 Karsinoma Serviks ...
10
2.2.1 Definisi ...
10
2.2.2 Epidemiologi ...
10
2.2.3 Faktor Etiologik ...
11
2.2.3.1 Virus...
11
(4)
vii
2.2.4 Faktor Resiko ...
13
2.2.4.1 Usia Reproduksi ...
13
2.2.4.2 Perilaku Seksual ...
14
2.2.4.3 Hubungan seks pada usia muda atau pernikahan
pada usia muda...
14
2.2.4.4 Jumlah Paritas ...
15
2.2.4.5 Tingkat Pendidikan ...
16
2.2.4.6 Penggunaan kontrasepsi oral jangka panjang...
18
2.2.4.7 Merokok ...
18
2.2.4.8 Nutrisi ...
19
2.2.4.9. Riwayat karsinoma serviks pada keluarga ...
19
2.2.5 Patogenesis dan Patofisiologi ...
20
2.2.6 Klasifikasi ...
22
2.2.6.1 Adenocarcinoma serviks ...
22
2.2.6.2 Squamous Cell Carcinoma ...
23
2.2.6.3 Klasifikasi secara klinis ...
25
2.2.7 Gejala Klinis ...
26
2.2.7.1 Leukore...
26
2.2.7.2 Perdarahan dari jalan lahir...
26
2.2.7.3 Nyeri...
26
2.2.7.4 Gejala umum lain ...
27
2.2.8 Diagnosis dan Pemeriksaan Penunjang Karsinoma Serviks
27
2.2.8.1 Pemeriksaan Inspeksi Visual Asetat ...
28
2.2.8.2 Pap Smear ...
29
2.2.8.3 Kolposkopi...
31
2.2.8.4 Servikografi ...
31
2.2.8.5. Pap Net...
31
2.2.8.6. Tes DNA - HPV ...
32
2.2.9 Komplikasi ...
32
2.2.10. Pencegahan ...
33
(5)
viii
BAB III METODE PENELITIAN ...
36
3.1 Rancangan Penelitian ...
36
3.2 Populasi dan sampel ... .
36
3.3 Teknik pengukuran ...
36
3.4 Lokasi dan Waktu Penelitian ...
36
3.5 Definisi Operasional...
37
3.6 Penyajian Data...
37
BAB IV HASIL DAN PEMBAHASAN ...
38
4.1 Distribusi Kasus Persentase Usia Penderita Karsinoma Serviks
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009
38
4.2 Distribusi Kasus Persentase Pendidikan Penderita Kanker Serviks
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009
39
4.3 Distribusi Kasus Persentase Pekerjaan Penderita Kanker Serviks
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009
40
4.4 Distribusi Kasus Persentase Status Ginekologis Kanker Serviks
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009
41
4.5 Distribusi Kasus Persentase Jenis Histopatologi Kanker Serviks
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009
43
4.6 Distribusi Kasus Persentase Stadium Kanker Serviks di RSHS
Bandung Periode 1 Januari 2009
–
31 Desember 2009
45
BAB V SIMPULAN DAN SARAN ...
47
5.1 Simpulan ...
47
5.2 Saran ...
47
DAFTAR PUSTAKA ...
49
LAMPIRAN ...
52
(6)
xi
DAFTAR TABEL
Halaman
Tabel 2.1 Jenis Kanker Serviks menurut Subtipe Histologi ...
24
Tabel 2.2 Stadium Kanker Serviks Menurut ACS
(American Cancer Society)... .
25
Tabel 2.3 Rekomendasi American Cancer Society untuk
melakukan Pap Smear... ....
30
Tabel 2.4 Hubungan stadium kanker serviks dengan Angka Harapan
Hidup 5 tahun ...
35
Tabel 4.1 Distribusi Kasus Kanker Serviks Menurut Usia Penderita
di RSHS Bandung Periode 1 Januari 2009-
31 Desember 2009...
....
38
Tabel 4.2 Distribusi Kasus Kanker Serviks Menurut Pendidikan
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009...
40
Tabel 4.3 Distribusi Kasus Kanker Serviks Menurut Pekerjaan
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009...
41
Tabel 4.4 Distribusi Kasus Kanker Serviks Menurut Jumlah Paritas
di RSHS Bandung Periode 1 Januari 2009
–
31 Desember 2009...
42
Tabel 4.5 Distribusi Kasus Kanker Serviks Menurut Jenis Histopatologi
di RSHS Bandung Periode 1 Januari 2009-
31 Desember 2009...
44
Tabel 4.6 Distribusi Kasus Kanker Serviks Menurut Stadium
di RSHS Bandung Periode 1 Januari 2009
–
(7)
xii
DAFTAR GAMBAR
Halaman
Gambar 2.1 Anatomi genitalia wanita tampak lateral...
7
Gambar 2.2 Anatomi Rahim ...
8
Gambar 2.3 Histologi serviks ...
9
Gambar 2.4 Neoplasia serviks intraepitel (CIN) ...
21
Gambar 2.5 Adenocarcinoma Cervix ...
22
Gambar 2.6 Squamous Cell Carcinoma ...
23
Gambar 2.7 Gambaran portio cerviks normal dan berpotensi
kanker ...
29
(8)
LAMPIRAN
No Jumlah
Pasien Paritas
1 454 51 P1A1 II A Non Keratinizing epidermoid cancer cervix well differentiated SMP IRT 2 165 55 P4A1 IIIB Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 3 889 38 P3A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SMEA IRT 4 764 57 P2A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 5 649 50 P3A0 II A Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 6 876 72 P7A1 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
7 526 65 P7A0 III B Adenocarcinoma cervix uteri well differentiated SD IRT
8 719 29 P2A0 II A Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 9 672 59 P4A1 III B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 10 717 29 P2A0 II A Non Keratinizing squamous cancer cervix moderately differentiated SD IRT
11 250 55 P5A0 IIA Adenocarcinoma cervix uteri poorly differentiated SMP Buruh
12 674 45 P3A0 III B Adenocarcinoma cervix uteri moderately differentiated SD IRT 13 659 39 P3A0 II B Non Keratinizing epidermoid cancer cervix moderately differentiated, large cell SMP IRT 14 359 47 P4A0 III B Non keratinizing squamous carcinoma cervix moderately differentiated SD Buruh 15 404 37 P4A0 IIA Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT
16 859 41 P0A0 I B Adenocarcinoma cervix uteri well differentiated SMP IRT
17 754 44 P0A0 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 18 531 47 P3A0 III A Non Keratinizing epidermoid cancer cervix poorly differentiated SMP Buruh
19 53 36 P6A0 IIA Mikroinvassif epidermoid carcinoma cervix uteri SMA IRT
20 811 46 P4A0 III B Non Keratinizing epidermoid cancer cervix well differentiated SMP IRT 21 822 61 P4A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 22 800 50 P3A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 23 771 30 P1A1 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 24 854 47 P3A1 III B Non Keratinizing squamous cancer cervix well differentiated SD IRT 25 184 38 P3A0 IIIB Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 26 192 50 P2A0 IIIB Keratinizing epidermoid cancer cervix moderately differentiated, large cell SD IRT 27 315 74 P9A1 II A Keratinizing epidermoid cancer cervix well differentiated SD IRT 28 844 59 P7A0 II B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 29 629 42 P3A1 I B Non Keratinizing squamous cancer cervix moderately differentiated SMA Swasta
30 215 56 P3A0 IIIB Adenocarcinoma cervix uteri well differentiated SD IRT
Pekerjaan
(9)
LAMPIRAN
31 286 35 P0A0 II B Keratinizing epidermoid cancer cervix moderately differentiated SMA Swasta 32 388 54 P6A2 III A Non keratinizing squamous carcinoma cervix poorly differentiated SD IRT
33 758 46 P3A0 I B Adenocarcinoma cervix uteri well differentiated SD IRT
34 358 55 P1A0 IV A Non keratinizing squamous carcinoma cervix poorly differentiated SMP IRT
35 263 55 P4A0 III B Adenosquamosa well differentiated a.r cervix uteri SD IRT
36 790 50 P5A0 III B Keratinizing epidermoid cancer cervix well differentiated SD IRT 37 10 60 P4A0 II A Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 38 378 42 P2A0 III B Non Keratinizing epidermoid cancer cervix well differentiated SMP IRT 39 2 46 P2 A1 II B Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 40 823 45 P4A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SMP IRT 41 774 26 P2A0 IV B Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 42 870 62 P10A1 III A Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 43 551 46 P3A1 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 44 614 49 P5A1 III A Adenocarcinoma cervix uteri moderately differentiated SD IRT 45 203 49 P5A0 IIIB Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 46 818 47 P2A0 I B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 47 528 29 P7A0 II A Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 48 466 65 P9A0 II B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 49 425 46 P3A0 II B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 50 248 42 P4A2 IIB Non keratinizing squamous carcinoma cervix well differentiated SD IRT
51 276 37 P3A0 II A Adenocarcinoma cervix uteri well differentiated SMP IRT
52 808 56 P5A1 III B Non Keratinizing squamous cancer cervix moderately differentiated SMP IRT 53 704 45 P3A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SMP IRT 54 825 33 P2A0 I B Non Keratinizing squamous cancer cervix well differentiated SD IRT 55 740 50 P5A0 IV A Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 56 476 40 P1A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 57 641 40 P1A0 II B Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 58 210 20 P0A0 Ca cervix reNon Keratinizing epidermoid cancer cervix moderately differentiated SMA IRT 59 662 41 P4A1 I B Adenocarcinoma cervix uteri moderately differentiated SMP IRT 60 509 48 P1A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
61 138 53 P3A0 IIIB Glassy cell carcinoma a.r carcinoma cervix SD IRT
62 405 50 P4A1 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 63 218 54 P2A1 IIIB Keratinizing epidermoid cancer cervix moderately differentiated SMA IRT
(10)
LAMPIRAN
64 605 40 P3A0 III B Non Keratinizing epidermoid cancer cervix poorly differentiated SMA IRT 65 707 45 P6A0 III B Non Keratinizing squamous cancer cervix well differentiated SD Buruh
66 144 58 P4A0 IIIB Squamous cell carcinoma cervix well diferentiated SD IRT
67 731 36 P4A0 III B Non Keratinizing squamous cancer cervix well differentiated SMA Buruh 68 429 53 P7A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 69 575 36 P2A1 II A Non Keratinizing squamous cancer cervix moderately differentiated SMP Buruh 70 156 52 P2A0 IIA Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
71 235 49 P2A0 IIA Glassy cell carcinoma a.r carcinoma cervix uteri SMP Swasta
72 35 48 P2A1 II A Suspect keratinizing epidermoid cancer cervix SD IRT
73 846 48 P2A0 III A Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 74 809 48 P2A0 IV B Non Keratinizing epidermoid cancer cervix poorly differentiated SMK IRT 75 677 42 P1A1 III B Non Keratinizing squamous cancer cervix moderately differentiated SMP IRT 76 801 53 P5A0 II B Non Keratinizing epidermoid cancer cervix poorly differentiated SD IRT 77 524 65 P5A0 III A Non Keratinizing epidermoid cancer cervix well differentiated IRT 78 100 44 P4A0 IIA Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 79 278 54 P3A1 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 80 632 60 P1A0 III B Non Keratinizing squamous cancer cervix well differentiated SD IRT
81 148 55 P3A0 IIIB Cancer cervix recidif SD IRT
82 500 39 P3A3 III B Non Keratinizing squamous cancer cervix well differentiated SD IRT 83 744 44 P1A0 II A Keratinizing epidermoid cancer cervix well differentiated SMP IRT 84 577 50 P2A0 IV B Non Keratinizing epidermoid cancer cervix poorly differentiated SD IRT 85 44 45 P1A0 IIIB Keratinizing squamous cell carcinoma cervix moderately differentiated SD IRT 86 185 55 P4A0 IVA Keratinizing squamous cancer cervix well differentiated SMP IRT 87 766 48 P4A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 88 340 49 P3A1 II B Non keratinizing squamous carcinoma cervix moderately differentiated SD IRT 89 842 51 P4A1 III B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 90 179 29 P2A0 IIB Non Keratinizing epidermoid cancer cervix moderately differentiated SMA IRT 91 162 37 P2A0 IIIB Adenocarcinoma cervix uteri moderately differentiated , clear cell SD IRT 92 90 80 P4A0 IIB Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
93 523 29 P1A0 III B Small cell epidermoid carcinoma cervix uteri SMP IRT
94 556 46 P2A0 I B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 95 188 56 P4A1 IIIB Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 96 858 54 P5A0 II A Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
(11)
LAMPIRAN
97 489 33 P1A0 I B Keratinizing squamous cancer cervix well differentiated SMA IRT 98 643 46 P3A0 II B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT
99 365 46 P4A0 II B Mucinous carcinoma SD IRT
100 372 46 P4A0 II B SD IRT
101 8 32 P0A0 II B Adenocarcinoma cervix uteri poorly differentiated SMP IRT
102 309 49 P3A0 III B Non Keratinizing epidermoid cancer cervix well differentiated SMP IRT 103 631 52 P3A0 Ca cervix reNon Keratinizing squamous cancer cervix well differentiated SMA IRT 104 491 52 P7A1 III B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 105 493 49 P4A0 II B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 106 832 60 P6A1 I B Non Keratinizing epidermoid cancer cervix well differentiated SMP IRT 107 564 58 P8A0 II A Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 108 366 53 P3A0 II A Adenocarcinoma cervix uteri well differentiated dengan displasia ringan ectocervixSMA Swasta 109 227 35 P2A0 IIA Non Keratinizing epidermoid cancer cervix moderately differentiated SMA PNS 110 369 45 P4A0 II B Keratinizing epidermoid cancer cervix poorly differentiated SD IRT
111 386 28 P2A0 III B Clear cell adenocarcinoma cervix Sarjana Swasta
112 34 44 P1A0 II B Non keratinizing squamous cell carcinoma cervix moderately diferentiated SD IRT 113 608 45 P5A0 IV A Non Keratinizing epidermoid cancer cervix poorly differentiated SD IRT
114 609 50 P2A1 III B Adenocarcinoma cervix uteri poorly differentiated SD IRT
115 485 68 P9A0 III A Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 116 41 47 P4A1 IIB Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 117 122 61 P5A1 IIIB Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 118 128 50 P1A0 IIIB Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 119 693 52 P4A1 I B Non Keratinizing squamous cancer cervix well differentiated SD IRT 120 565 67 P2A0 III B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 121 633 57 P1A0 IV A Non Keratinizing epidermoid cancer cervix poorly differentiated SD IRT 122 735 40 P3A0 II A Adenosquamosa cervix uteri moderately differentiated SD IRT 123 304 39 P3A0 III B Non Keratinizing epidermoid cancer cervix poorly differentiated SMP IRT 124 474 58 P5A1 II A Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 125 797 55 P2A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 126 360 34 P3A0 III B Non keratinizing squamous carcinoma cervix poorly differentiated SMP IRT 127 412 46 P2A0 III B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 128 660 57 P6A1 III B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT
(12)
LAMPIRAN
130 126 41 P3A0 IB Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 131 542 56 P3A0 III A Non Keratinizing epidermoid cancer cervix well differentiated SD Buruh 132 750 49 P4A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 133 829 33 P1A0 I B Non Keratinizing squamous cancer cervix well differentiated Diploma-3 Perawat 134 695 40 P6A0 I B Non Keratinizing epidermoid cancer cervix poorly differentiated SMP Buruh 135 678 51 P5A0 II A Non Keratinizing squamous cancer cervix well differentiated SD IRT 136 333 45 P4A0 III B Keratinizing squamous carcinoma cervix well differentiated SMP Buruh 137 112 41 P8A0 IIA Non keratinizing squamous carcinoma cervix moderately differentiated SD IRT 138 761 49 P1A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 139 795 51 P5A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SMP IRT 140 9 55 P2 A1 II A Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 141 856 45 p5a0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 142 522 43 P4A0 II B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 143 22 53 P3A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
144 61 51 P3A0 IIB Adenocarcinoma cervix uteri moderately differentiated SD IRT
145 352 45 P5A0 II A Non keratinizing squamous carcinoma cervix poorly differentiated SD IRT
146 787 46 P3A2 II B Small cell epidermoid carcinoma cervix uteri Diploma-2 PNS
147 258 41 P2A1 III B Non keratinizing squamous carcinoma cervix well differentiated Sarjana PNS
148 558 44 P4A1 I B Adenocarcinoma cervix uteri well differentiated SMP IRT
149 305 36 P3A0 III B Clear cell carcinoma cervix SMA Buruh
150 193 49 P3A1 IIB Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 151 422 49 P6A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 152 710 37 P5A1 III B Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 153 441 57 P4A0 II B Adenocarcinoma cervix uteri well differentiated dengan displasia ringan ectocervixSD IRT 154 773 45 P2A1 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 155 621 50 P4A0 III B Keratinizing squamous cancer cervix moderately differentiated SD IRT 156 395 58 P6A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 157 767 43 P5A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 158 274 38 P2A0 II B Keratinizing squamous carcinoma cervix well differentiated Diploma-3 Guru 159 502 43 P4A1 III B Non Keratinizing squamous cancer cervix well differentiated SD IRT 160 590 35 P2A0 II A Non Keratinizing epidermoid cancer cervix poorly differentiated SMA Swasta 161 155 51 P1A0 IIIB Non Keratinizing epidermoid cancer cervix moderately differentiated, large cell SMA IRT 162 223 43 P5A0 IIIB Non Keratinizing epidermoid cancer cervix well differentiated SD IRT
(13)
LAMPIRAN
163 329 46 P4A0 III B Non Keratinizing epidermoid cancer cervix well differentiated SMP Swasta 164 452 65 P10A2 III B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 165 683 20 P0A0 II A Non Keratinizing squamous cancer cervix well differentiated SMA Buruh 166 804 53 P3A0 II A Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 167 620 61 P6A0 III A Non Keratinizing squamous cancer cervix well differentiated SD IRT 168 756 37 P4A0 II A Adenocarcinoma cervix uteri moderately differentiated SMP IRT 169 654 60 P2A0 II B Keratinizing squamous cancer cervix moderately differentiated SMP IRT 170 670 50 P2A0 II A Non Keratinizing squamous cancer cervix moderately differentiated SMP IRT 171 543 55 P5A0 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 172 785 50 P3A1 II A Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 173 270 51 P4A0 III B Keratinizing epidermoid cancer cervix well differentiated SMP Petani 174 847 32 P5A0 II B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT
175 812 38 P2A0 Sarjana PNS
176 279 46 P2A1 II A Non keratinizing squamous carcinoma cervix moderately differentiated SMA IRT 177 553 27 P5A1 III A Non Keratinizing squamous cancer cervix well differentiated SD IRT 178 871 53 P3A1 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 179 768 42 P3A0 IV B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
180 71 54 IB Squamous carcinoma cervix mocerately differentiated SD IRT
181 792 45 P4A0 I B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 182 272 44 P3A1 II A Non keratinizing squamous carcinoma cervix well differentiated SMA Swasta 183 437 60 P14A0 III B Non Keratinizing squamous cancer cervix well differentiated SD IRT 184 17 42 P3A1 II A Keratinizing squamous cell carcinoma well diferentiated SMP Buruh 185 401 46 P4A0 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT
186 806 47 P3A1 I B Adenocarcinoma cervix uteri well differentiated SMP BUMN
187 549 48 P5A0 I B Non Keratinizing squamous cancer cervix moderately differentiated SD IRT 188 836 48 P4A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 189 684 36 P2A1 II B Non Keratinizing squamous cancer cervix well differentiated SD IRT
190 612 31 P2A0 I B Neuroendokrin cancer a.r cervix SMA IRT
191 634 40 P4A0 III B Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 192 852 43 P2A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 193 760 46 P1A0 I B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 194 300 45 P5A1 II B Non keratinizing squamous carcinoma cervix moderately differentiated SD IRT 195 725 56 P5A1 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
(14)
LAMPIRAN
196 172 64 P7A1 IIIB Keratinizing epidermoid cancer cervix moderately differentiated SD IRT
197 228 58 P3A0 IIIB Adenocarcinoma cervix uteri poorly differentiated SMP Buruh
198 390 50 P3A1 I B Non Keratinizing epidermoid cancer cervix well differentiated Sarjana PNS
199 451 54 P3A0 III B Adenocarcinoma cervix uteri poorly differentiated SD IRT
200 534 56 P3A0 III B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 201 113 64 P11A0 IIB Keratinizing epidermoid cancer cervix poorly differentiated SD IRT 202 124 41 P3A0 IIIB Keratinizing epidermoid cancer cervix moderately differentiated SMA PNS
203 563 40 P3A0 III B Adenocarcinoma cervix uteri well differentiated SMP IRT
204 628 55 P2A0 II B Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 205 20 52 P1A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 206 18 52 P1A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SMA PNS 207 297 50 P5A1 II B Keratinizing squamous carcinoma cervix well differentiated SD IRT 208 512 56 P3A1 III B Non Keratinizing epidermoid cancer cervix well differentiated SMA IRT 209 865 58 P4A0 III B Non Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 210 232 49 P2A0 IIIB Non keratinizing squamous carcinoma cervix moderately differentiated SMA IRT 211 560 51 P4A0 II A Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 212 127 49 P3A0 IB Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 213 334 50 P3A1 III A Dysplasia berat cervix dengan tanda-tanda infeksi HPV SD IRT
214 31 50 P1A1 III A Squamous cell carcinoma carcinoma well diferentiated SD IRT
215 861 50 P9A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SMP Petani
216 261 47 P2A1 IV A CIN 3 dengan efek HPV SMA BUMN
217 848 46 P2A0 I B Non Keratinizing epidermoid cancer cervix well differentiated SD IRT 218 424 25 P0A0 II A Non Keratinizing squamous cancer cervix well differentiated Diploma- 3 Swasta
219 813 44 P1A0 III B Adenocarcinoma cervix uteri well differentiated SD IRT
220 882 54 P3A1 II B Non Keratinizing epidermoid cancer cervix moderately differentiated SMP IRT 221 788 42 P3A1 II B Non Keratinizing epidermoid cancer cervix well differentiated SMP IRT 222 838 49 P1A0 III B Non Keratinizing squamous cancer cervix moderately differentiated SMA IRT
223 506 32 P3A0 I B Adenocarcinoma cervix uteri well differentiated Sarjana Swasta
224 559 55 P1A1 I B Adenocarcinoma cervix uteri well differentiated SD IRT
225 711 43 P5A0 III B Keratinizing epidermoid cancer cervix moderately differentiated SD IRT 226 406 39 P2A1 III A Adenocarcinoma cervix uteri well differentiated dengan displasia ringan ectocervixDiploma -3 Swasta
(15)
vi
RIWAYAT PENULIS
Nama
: Pitaria Rebecca
NRP
: 0710045
Tempat, tanggal lahir
: Bandung, 8 Agustus 1990
Alamat
: Jl.Melong Asih dalam 176 Cimahi
Riwayat Pendidikan
:
1994-1995
: TKK Bethel Cimahi
1995-2001
: SDK Pelita Bandung
2001-2004
: SMP Negeri 5 Bandung
2004-2007
: SMA Negeri 17 Bandung
2007-sekarang
: Mahasiswa Fakultas Kedokteran Universitas
Kristen Maranatha
(16)
1
BAB I
PENDAHULUAN
1.1 Latar belakang
Karsinoma serviks merupakan penyebab kematian akibat kanker yang tertinggi
pada wanita di negara-negara berkembang. Angka prevalensi karsinoma serviks di
dunia, termasuk di kawasan Asia Tenggara, masih sangat tinggi. Menurut data,
ada sekitar 500.000 kasus baru karsinoma serviks di dunia dengan 250.000
kematian setiap tahunnya (Globocan, 2002). 80% penderita kanker serviks hidup
di negara-negara dengan pendapatan penduduk yang rendah atau sedang (WHO,
2002).
Dalam beberapa dekade angka penderita karsinoma serviks di negara-negara
maju mengalami penurunan yang tajam. Di Amerika Serikat, dalam 50 tahun
terakhir insidensi karsinoma serviks turun sekitar 70%. Hal tersebut
dimungkinkan karena adanya program deteksi dini dan tatalaksana yang baik.
Sebaliknya di negara-negara berkembang, angka penderita penyakit ini tidak
mengalami penurunan, bahkna justru meningkat seperti yang terjadi di
negara-negara Afrika akibat jumlah populasi yang meningkat. Kalaupun ada sedikit
penurunan hal tersebut lebih banyak disebabkan karena perubahan sosial
demografi bukan karena usaha pencegahan atau deteksi dini (Sankaranarayaan R,
2001. Saslow D, 2002).
Perkembangan sampai terjadinya karsinoma ini juga memerlukan waktu yang
panjang yaitu 5-20 tahun. Perubahan morfologi ini pada epitel serviks sebelum
menjadi kanker dapat dideteksi dengan pemeriksaan Pap Smear yang teratur
(Elizabeth. R. Unger. Eliav Barr, 2004).
Di Indonesia sendiri setiap tahun terdapat lebih dari 15.000 kasus karsinoma
serviks baru dan kurang lebih 8.000 kematian. Sedangkan setiap hari sekitar 40
–
45 kasus baru ditemukan dan 20
–
25 perempuan meninggal dunia akibat penyakit
tersebut. Tingginya angka ini terutama disebabkan oleh rendahnya pengetahuan
dan kesadaran akan bahaya karsinoma serviks. Karsinoma serviks merupakan
penyakit yang telah diketahui penyebab dan perjalanan penyakitnya. Dengan ada
(17)
2
metode deteksi dini dan adanya pencegahan dengan vaksinasi, seharusnya angka
kejadian dan kematian akibat penyakit ini dapat diturunkan. Karsinoma serviks
cenderung muncul pada perempuan berusia 35-55 tahun, namun dapat pula
muncul pada perempuan dengan usia yang lebih muda. (Laras L, 2009).
Diagnosis karsinoma serviks uteri masih sering terlambat dan penanganannya
pun ternyata tidak memberikan hasil yang baik. Mengusahakan mengatasi sendiri
dengan minum jamu, atau pergi ke dukun, hal tersebut sebenarnya disebabkan
kurangnya pengertian mengenai bahaya karsinoma, karena pendidikan yang
kurang atau kurangnya penerapan karsinoma pada umumnya, ada juga pendapat
umum bahwa karsinoma tidak dapat diobati dan selalu dihubungkan dengan
kematian (KTI Kebidanan, 2010).
Berdasarkan latar belakang di atas, untuk itulah penulis ingin mengetahui
prevalensi karsinoma serviks di Rumah Sakit Hasan Sadikin Bandung selama
periode Januari - Desember 2009.
1.1.
Identifikasi masalah
Dari latar belakang penelitian tersebut maka dilakukan penelitian di Rumah
Sakit Hasan Sadikin selama periode Januari - Desember 2009, sehingga dapat
diidentifikasikan beberapa masalah kanker sebagai berikut:
1. Bagaimana prevalensi karsinoma serviks di Rumah Sakit Hasan Sadikin
selama periode Januari - Desember 2009
2. Bagaimana distribusi karsinoma serviks menurut rentang usia
3. Bagaimana distribusi karsinoma serviks menurut pendidikan
4. Bagaimana distribusi karsinoma serviks menurut pekerjaan
5. Bagaimana distribusi karsinoma serviks menurut jumlah paritas
6. Bagaimana distribusi karsinoma serviks menurut gambaran histopatologi
7. Bagaimana distribusi karsinoma serviks menurut stadium
(18)
3
1.3. Maksud dan Tujuan penelitian
Maksud penelitian:
o
Untuk mengetahui prevalensi karsinoma serviks di Rumah Sakit Hasan
Sadikin, Bandung periode Januari - Desember 2009.
Tujuan penelitian:
o
Untuk mengetahui distribusi karsinoma serviks menurut rentang usia.
o
Untuk mengetahui distribusi karsinoma serviks menurut pendidikan.
o
Untuk mengetahui distribusi karsinoma serviks menurut pekerjaan.
o
Untuk mengetahui distribusi karsinoma serviks menurut jumlah paritas.
o
Untuk mengetahui distribusi karsinoma serviks menurut gambaran
histopatologi.
o
Untuk mengetahui distribusi karsinoma serviks menurut stadium.
1.4. Manfaat Karya Tulis Ilmiah
Manfaat penelitian ini di bidang akademik adalah untuk menambah wawasan
tentang penyakit karsinoma serviks dan memberikan data tentang kejadian
karsinoma serviks di Rumah Sakit Hasan Sadikin, Bandung periode Januari -
Desember 2009.
Manfaat penelitian ini secara praktis adalah agar masyarakat pada umumnya
dan paramedis pada khususnya, diharapkan dapat memotivasi usaha untuk
pencegahan dan deteksi dini karsinoma serviks.
1.5. Metode penelitian
Penelitian ini dilakukan secara retrospektif deskriptif dengan pengambilan data
secara retrospektif terhadap kasus karsinoma serviks yang telah didokumentasikan
di bagian Rekam Medik Rumah Sakit Hasan Sadikin, Bandung periode Januari -
Desember 2009.
(19)
4
1.6. Lokasi dan waktu penelitian
Penelitian dilakukan di bagian Rekam Medik Rumah Sakit Hasan Sadikin.
Penelitian ini dilaksanakan dari tanggal 20 Januari 2010
–
31 Januari 2011.
(20)
47
BAB V
SIMPULAN DAN SARAN
5.1 Simpulan
Dari hasil penelitian disimpulkan bahwa:
o
Prevalensi karsinoma serviks di Rumah Sakit Hasan Sadikin pada periode
1 Januari 2009 - 31 Desember 2009 adalah 226 kasus.
o
Kejadian dari karsinoma serviks yang paling banyak didapatkan pada
kelompok usia 46-50 tahun, yaitu sebanyak 26,54%.
o
Pendidikan tertinggi dari penderita karsinoma serviks adalah SD (Sekolah
Dasar) yaitu 61,50%.
o
Pekerjaan terbanyak dari penderita karsinoma serviks adalah IRT (Ibu
Rumah Tangga) yaitu 83,62%.
o
Jumlah paritas dari karsinoma serviks yang paling banyak didapatkan
G3A0 (gestasional 3 dan abortus 0) yaitu sebanyak 15,92% dan
didapatkan jumlah paritas terbanyak yaitu G14A0 (gestasional 14 abortus
4) atau paritas lebih dari empat belas sebanyak 0,44%.
o
Gambaran jenis histopatologi yang paling banyak ditemukan adalah Non
Keratinizing epidermoid cancer cervix well, moderately, poor
differentiated yaitu 42,47%.
o
Stadium dari karsinoma serviks yang paling banyak didapatkan pada
stadium III B yaitu sebanyak 41,59%.
5.2 Saran
o
Untuk Bagian Rekam Medis Rumah Sakit Hasan Sadikin agar data pasien
dibuat lebih lengkap dan tepat sehingga data tersebut dapat digunakan
sebagai sumber pengetahuan bagi tenaga medis dan paramedik.
(21)
48
o
Meningkatkan pengetahuan masyarakat tentang karsinoma serviks
melalui penyuluhan dan penerangan sehingga dapat mengetahui
gejala dini serta meningkatkan kesadaran masyarakat untuk berobat
dan melakukan pemeriksaan dini Pap Smear terutama untuk wanita
usia reproduktif.
o
Disarankan pada wanita yang memiliki risiko tinggi terkena
karsinoma serviks sebaiknya melakukan pemeriksaan yang rutin dan
pencegahan dengan vaksin sehingga dapat terhindar dari karsinoma
serviks dan menurunkan angka mortalitas akibat karsinoma serviks.
(22)
49
DAFTAR PUSTAKA
Anonim. 2006. Bahaya Kanker Serviks bagi wanita, www.kespro.info.
Aziz F., Nugroho K., Ratna SS. 1985. Karsinoma Serviks Uterus. Bagian / SMF
Obstetri dan Ginekologi Fakultas Kedokteran UI
–
dr.Ciptomangunkusumo
Jakarta.
Aziz, M. Farid. 2001. Masalah pada Kanker Serviks. Cermin Dunia Kedokteran :
133: 5-7
Berek, Jonathan S. 2007.
Novak’s Gynecology
14th Edition. Philadelphia :
Lippincott Williams & Wilkins
Berkowitz RS, Goldstein DP Department of Obstetrics, Gynecology, and
Reproductive Biology, Brigham and Women's Hospital, Boston.
DEPKES RI, 2005, Penanggulangan Kanker Serviks dengan Vaksin HPV,
Departemen Kesehatan RI; 2005.
Elizabeth R., Unger., Eliav., B. 2004. Human papilomavirus and cervical cancer.
http://www.familydoctor.org/
Fujita, Megumi., Tase, Toru., Kakugawa, Yoichiro., Hoshi, Shigeko., Nishino,
Yoshikazu., Nagase, Satoru., et al. 2008. Smoking, Earlier menarche and Low
Parity as Independent Risk Factors for Gynecologic Cancers inn Japanese:
Tohoku J. Exp. Med, 216: 297-307
Ferlay J, Bray P, Pizani P, Parkin DM. 2004. GLOBOCAN 2002: Cancer
incidence, mortality and prevalence worldwide. IARC CancerBase
.IARCPress, Lyon, 5.
I Ketut Suwiyoga.2006. Tes Human Papillomavirus sebagai Skrining Alternatif
Kanker Serviks. http://www. 12_151_TestHumanPapillomavirus.html 20
Januari 2010
Kumar, Vinay., Abul K. Abbas., Nelson Fausto. 2005. Robbins and Cotran
pathologic Basis of Disease 7th ed. Philadelphia : Elsevier Saunders
Krivak TC, McBroom JW Elkas JC. Cervical and vaginal cancer. In: Berek JS,
Adashi EY, Hillard PA, (editor). 2002.
Novak’s ginecology
. Edisi 13.
Baltimore: Lippincot Williams & Wilkin; p. 1199-244.
Laras Lembahmanah. 2009. Analisa faktor pendidikan pada wanita peserta
program penapisan kanker leher rahim dengan p
endekatan “See & Treat”:
(23)
50
untuk deteksi lesi prakanker dan pengobatan dengan terapi beku. Fakultas
Kedokteran UI.
Laila N. 2001. Skrining Kanker Serviks dengan Metode Skrining Alternatif: IVA.
Cermin Dunia Kedokteran, 133: 22-5
Morrow CP., Curtin JP., Townsend DE. 1987. Synopsis of Gynecologic Oncology.
New York: Churchill Livingstone.
Nuranna, L. 2005. Penanggulangan Kanker Serviks yang Sahih dan Andal dengan
metode Proaktif-VO (Proaktif, koordinatif dengan skrining IVA dan terapi
krio). Disertasi program Doktor FKUI. Jakarta
Ocviyanti, Dwiana. 2007. Berbagai Teknik Deteksi Dini kanker Leher Rahim dan
Payudara. Departemen Obstetri dan Ginekologi FKUI/RSCM
Petignat P, Roy M. 2007. Diagnosis and management of cervical cancer. Br Med
J; 335:765-8.
Ramli, Muchlis dr., Umbas, Rainy., Panigoro, Sonar S., 2002. Deteksi Dini
Kanker. Edisi 1. Jakarta: Balai Penerbit FK UI.
Rasjidi, Imam. 2008.Manual Prakanker Serviks. Jakarta: Sagung Seto
Rasjidi, Imam. 2009. Deteksi Dini & Pencegahan Kanker pada Wanita. Jakarta :
Sagung Seto
Robbins dan Kumar. 1995. Buku ajar patologi II.Edisi 4., WB Saunders
Company: 378-382.
Sankaranarayanan R., Budukh AM., Rajkumar R. 2001. Effective Screening
programmes for cervical cancer in low and middle-income developing
countries. Bull WHO; 79:954-62.
Saslow D, et al. 2002. American Cancer Society Guideline for the Early Detection
of Cervical Neoplasia and Cancer. CA Cancer J Clin; 52:342.
Sjamsuddin S. 2001. Pencegahan dan deteksi dini kanker serviks. Cermin Dunia
Kedokteran; 133:9-14.
Soegiyanto H. 2008. Paritas Penduduk di Daerah Pedesaan Kabupaten Klaten
Jawa Tengah. Surakarta: Disertasi Pengukuhan Guru Besar UNS
(24)
51
Snell, Richard S.2006. Anatomi Klinik untuk Mahasiswa Kedokteran. Edisi 6.
EGC:356-359
Wawang Setiawan Sukarya. 2000. Perjalanan timbulnya penyakit kanker leher
rahim dan faktor risikonya. Simposium Mengenal dan mencegah kanker Leher
Rahim. Bandung: Yayasan Kanker Indonesia Wilayah Jawa Barat.
Wiyono, Sapto. 2004. Inspeksi Visual Asam Asetat (IVA) Untuk Deteksi Dini Lesi
Prakanker Serviks. Fakultas Kedokteran Universitas Diponegoro Semarang.
Kampanye bantu cegah kanker serviks. Yayasan Kanker Indonesia. 2007.
http://www.cegahkankerserviks.org.
Adenocarcinoma Cervix.
http://www.eurocytology.eu. 2 Oktober 2010
Anatomi Rahim.
http://cancerhelps.net/kanker-serviks.htm.
3 Oktober 2010
Anatomi serviks
http://www.google.co.id/imglanding?q=anatomi+serviks.. 12
Oktober 2010
Gambaran
portio
cerviks
normal
dan
berpotensi
kanker.
http://www.google.co.id/images. 1 Desember 2010
Histologi serviks.
http://www.google.co.id/imglanding?q=histology+servix.. 12
Oktober 2010
Kolposkopi. http://www.sripoku.com/view/13286. 1 Desember 2010
KTI Kebidanan Ibu yang memeriksakan Pap Smear di Rumah Sakit.
http://www.kti-kebidanan.co. ____. 2010. 2 November 2010
Neoplasia serviks intraepitel (CIN).
http://www.google.co.id/imglanding?q=cervix+intraepitelial+neoplasia&hl. 7
Desember 2010
Squamous Cell Carcinoma.
http://radiology.uchc.edu/eAtlas/Images/ 2 Oktober
2010
(1)
4
1.6. Lokasi dan waktu penelitian
Penelitian dilakukan di bagian Rekam Medik Rumah Sakit Hasan Sadikin. Penelitian ini dilaksanakan dari tanggal 20 Januari 2010 – 31 Januari 2011.
(2)
47 BAB V
SIMPULAN DAN SARAN
5.1 Simpulan
Dari hasil penelitian disimpulkan bahwa:
o Prevalensi karsinoma serviks di Rumah Sakit Hasan Sadikin pada periode 1 Januari 2009 - 31 Desember 2009 adalah 226 kasus.
o Kejadian dari karsinoma serviks yang paling banyak didapatkan pada kelompok usia 46-50 tahun, yaitu sebanyak 26,54%.
o Pendidikan tertinggi dari penderita karsinoma serviks adalah SD (Sekolah Dasar) yaitu 61,50%.
o Pekerjaan terbanyak dari penderita karsinoma serviks adalah IRT (Ibu Rumah Tangga) yaitu 83,62%.
o Jumlah paritas dari karsinoma serviks yang paling banyak didapatkan G3A0 (gestasional 3 dan abortus 0) yaitu sebanyak 15,92% dan didapatkan jumlah paritas terbanyak yaitu G14A0 (gestasional 14 abortus 4) atau paritas lebih dari empat belas sebanyak 0,44%.
o Gambaran jenis histopatologi yang paling banyak ditemukan adalah Non Keratinizing epidermoid cancer cervix well, moderately, poor differentiated yaitu 42,47%.
o Stadium dari karsinoma serviks yang paling banyak didapatkan pada stadium III B yaitu sebanyak 41,59%.
5.2 Saran
o Untuk Bagian Rekam Medis Rumah Sakit Hasan Sadikin agar data pasien dibuat lebih lengkap dan tepat sehingga data tersebut dapat digunakan sebagai sumber pengetahuan bagi tenaga medis dan paramedik.
(3)
48
o Meningkatkan pengetahuan masyarakat tentang karsinoma serviks melalui penyuluhan dan penerangan sehingga dapat mengetahui gejala dini serta meningkatkan kesadaran masyarakat untuk berobat dan melakukan pemeriksaan dini Pap Smear terutama untuk wanita usia reproduktif.
o Disarankan pada wanita yang memiliki risiko tinggi terkena karsinoma serviks sebaiknya melakukan pemeriksaan yang rutin dan pencegahan dengan vaksin sehingga dapat terhindar dari karsinoma serviks dan menurunkan angka mortalitas akibat karsinoma serviks.
(4)
49
DAFTAR PUSTAKA
Anonim. 2006. Bahaya Kanker Serviks bagi wanita, www.kespro.info.
Aziz F., Nugroho K., Ratna SS. 1985. Karsinoma Serviks Uterus. Bagian / SMF Obstetri dan Ginekologi Fakultas Kedokteran UI – dr.Ciptomangunkusumo Jakarta.
Aziz, M. Farid. 2001. Masalah pada Kanker Serviks. Cermin Dunia Kedokteran : 133: 5-7
Berek, Jonathan S. 2007. Novak’s Gynecology 14th Edition. Philadelphia : Lippincott Williams & Wilkins
Berkowitz RS, Goldstein DP Department of Obstetrics, Gynecology, and
Reproductive Biology, Brigham and Women's Hospital, Boston.
DEPKES RI, 2005, Penanggulangan Kanker Serviks dengan Vaksin HPV, Departemen Kesehatan RI; 2005.
Elizabeth R., Unger., Eliav., B. 2004. Human papilomavirus and cervical cancer. http://www.familydoctor.org/
Fujita, Megumi., Tase, Toru., Kakugawa, Yoichiro., Hoshi, Shigeko., Nishino, Yoshikazu., Nagase, Satoru., et al. 2008. Smoking, Earlier menarche and Low Parity as Independent Risk Factors for Gynecologic Cancers inn Japanese: Tohoku J. Exp. Med, 216: 297-307
Ferlay J, Bray P, Pizani P, Parkin DM. 2004. GLOBOCAN 2002: Cancer incidence, mortality and prevalence worldwide. IARC CancerBase .IARCPress, Lyon, 5.
I Ketut Suwiyoga.2006. Tes Human Papillomavirus sebagai Skrining Alternatif Kanker Serviks. http://www. 12_151_TestHumanPapillomavirus.html 20 Januari 2010
Kumar, Vinay., Abul K. Abbas., Nelson Fausto. 2005. Robbins and Cotran pathologic Basis of Disease 7th ed. Philadelphia : Elsevier Saunders
Krivak TC, McBroom JW Elkas JC. Cervical and vaginal cancer. In: Berek JS, Adashi EY, Hillard PA, (editor). 2002. Novak’s ginecology. Edisi 13. Baltimore: Lippincot Williams & Wilkin; p. 1199-244.
Laras Lembahmanah. 2009. Analisa faktor pendidikan pada wanita peserta program penapisan kanker leher rahim dengan pendekatan “See & Treat”:
(5)
50
untuk deteksi lesi prakanker dan pengobatan dengan terapi beku. Fakultas Kedokteran UI.
Laila N. 2001. Skrining Kanker Serviks dengan Metode Skrining Alternatif: IVA. Cermin Dunia Kedokteran, 133: 22-5
Morrow CP., Curtin JP., Townsend DE. 1987. Synopsis of Gynecologic Oncology. New York: Churchill Livingstone.
Nuranna, L. 2005. Penanggulangan Kanker Serviks yang Sahih dan Andal dengan metode Proaktif-VO (Proaktif, koordinatif dengan skrining IVA dan terapi krio). Disertasi program Doktor FKUI. Jakarta
Ocviyanti, Dwiana. 2007. Berbagai Teknik Deteksi Dini kanker Leher Rahim dan Payudara. Departemen Obstetri dan Ginekologi FKUI/RSCM
Petignat P, Roy M. 2007. Diagnosis and management of cervical cancer. Br Med J; 335:765-8.
Ramli, Muchlis dr., Umbas, Rainy., Panigoro, Sonar S., 2002. Deteksi Dini Kanker. Edisi 1. Jakarta: Balai Penerbit FK UI.
Rasjidi, Imam. 2008.Manual Prakanker Serviks. Jakarta: Sagung Seto
Rasjidi, Imam. 2009. Deteksi Dini & Pencegahan Kanker pada Wanita. Jakarta : Sagung Seto
Robbins dan Kumar. 1995. Buku ajar patologi II.Edisi 4., WB Saunders Company: 378-382.
Sankaranarayanan R., Budukh AM., Rajkumar R. 2001. Effective Screening programmes for cervical cancer in low and middle-income developing countries. Bull WHO; 79:954-62.
Saslow D, et al. 2002. American Cancer Society Guideline for the Early Detection of Cervical Neoplasia and Cancer. CA Cancer J Clin; 52:342.
Sjamsuddin S. 2001. Pencegahan dan deteksi dini kanker serviks. Cermin Dunia Kedokteran; 133:9-14.
Soegiyanto H. 2008. Paritas Penduduk di Daerah Pedesaan Kabupaten Klaten Jawa Tengah. Surakarta: Disertasi Pengukuhan Guru Besar UNS
(6)
51
Snell, Richard S.2006. Anatomi Klinik untuk Mahasiswa Kedokteran. Edisi 6. EGC:356-359
Wawang Setiawan Sukarya. 2000. Perjalanan timbulnya penyakit kanker leher rahim dan faktor risikonya. Simposium Mengenal dan mencegah kanker Leher Rahim. Bandung: Yayasan Kanker Indonesia Wilayah Jawa Barat.
Wiyono, Sapto. 2004. Inspeksi Visual Asam Asetat (IVA) Untuk Deteksi Dini Lesi Prakanker Serviks. Fakultas Kedokteran Universitas Diponegoro Semarang. Kampanye bantu cegah kanker serviks. Yayasan Kanker Indonesia. 2007.
http://www.cegahkankerserviks.org.
Adenocarcinoma Cervix. http://www.eurocytology.eu. 2 Oktober 2010
Anatomi Rahim. http://cancerhelps.net/kanker-serviks.htm. 3 Oktober 2010
Anatomi serviks http://www.google.co.id/imglanding?q=anatomi+serviks.. 12
Oktober 2010
Gambaran portio cerviks normal dan berpotensi kanker.
http://www.google.co.id/images. 1 Desember 2010
Histologi serviks. http://www.google.co.id/imglanding?q=histology+servix.. 12 Oktober 2010
Kolposkopi. http://www.sripoku.com/view/13286. 1 Desember 2010
KTI Kebidanan Ibu yang memeriksakan Pap Smear di Rumah Sakit.
http://www.kti-kebidanan.co. ____. 2010. 2 November 2010
Neoplasia serviks intraepitel (CIN).
http://www.google.co.id/imglanding?q=cervix+intraepitelial+neoplasia&hl. 7 Desember 2010
Squamous Cell Carcinoma. http://radiology.uchc.edu/eAtlas/Images/ 2 Oktober 2010