BAB I REKAM MEDIK I. IDENTIFIKASI B. Nama C. Umur E. Alama F. A$ama %. S a us '. Ban$sa I. &)S II. : Yurnaini : 28 Tahun : !

uar "# a : Islam : &eni"ah : In(#nesia : * A$us us 2++,

D. Jenis Kelamin : Perempuan

ANA&NESIS -au #anamnesis. Anamnesis Umum B. )i/a0a per"a/inan "a/in 1 "ali2meni"ah pa(a usia 18 ahun laman0a 1+ ahun. C. )i/a0a 34s e ri P1A5 Ana" per ama : Perempuan2 usia 6 ahun. D. )i/a0a hai( &enar7he umur 15 ahun. 'ai( era ur 28 hari2 laman0a 8 hari2 (arah hai( 4iasa2 sa"i /a" u hai( i(a" a(a. E. Na9su ma"an : menurun F. )i/a0a BAB suli se:a" 1 4ulan 0an$ lalu2 sempa BAB "eras 4er/arna hi am ; selama 5<6 hari2 (ii"u i (en$an per(arahan ne es2 api s #p sen(iri2 )= BAK suli 2 api masih 4isa BAK sen(iri %. )i/a0a pen0a"i 0an$ pernah (i(eri a D& i(a" a(a

Pen0a"i :an un$ i(a" a(a 'iper ensi i(a" a(a Anamnesis Khusus Keluhan u ama: Ba(an erasa lemas se elah "em# erapi )PP : Sa u ahun 0an$ lalu #s pernah men$alami per(arahan (ari "emaluann0a le4ih "uran$ sa u 4ulan. 3s "emu(ian 4er#4a "e (#" er (an (in0a a"an men(eri a pen0a"i "an"er leher rahim2 "emu(ian #s men:alani "em# erapi se4an0a" > "ali. Se elah "em# erapi era"hir -"e > (i )S&' 4ulan Juni 2++,. #s men$eluh 4a(an lemas (iser ai (en$an na9su ma"an (an minum menurun2 per(arahan (ari "emaluan -?. 4erupa 4er7a" pa(a pa"aian (alam2 "eluhan n0eri -<.2 #s lalu 4er#4a "em4ali "e (#" er spesialis "an(un$an "emu(ian (i"irim "e )S&' un u" (ira/a . )i/a0a BAB suli se:a" 1 4ulan 0an$ lalu2 sempa BAB "eras 4er/arna hi am ; selama 5<6 hari2 (ii"u i (en$an per(arahan ne es2 api s #p sen(iri2 )= BAK suli 2 api masih 4isa BAK sen(iri. III. PE&E)IKSAAN FISIK B. Status present Bera 4a(an 62 "$2 in$$i 4a(an 16+ 7m2 ipe 4a(an as heni7us. Kea(aan umum se(an$2 anemis -?.2 i" erus -<.2 "esa(aran "#mp#s men is2 e"anan (arah 1,+=11+ mm'$2 na(i 88 @=meni 2 pernapasan 22 @=meni 2 suhu 5, AC. 'a i (an limpa i(a" era4a2 e(ema<=<2 re9le"s 9isi#l#$is ?=?2 re9le"s pa #l#$is <=<2 pa0u(ara hiperpi$men asi <=<. Jan un$ : $all#p -<.2 murmur -<.. Paru<paru : 4isin$ na9as Besi"uler n#rmal2 r#n"hi <=<2 /heeCin$ <=<. Kea(aan $iCi se(an$. C. Status ginekologis

Pemeri"saan luar : A4(#menD (a ar2 lemas2 sime ris2 9un(us u eri a" era4a2 massa -<.2 n0eri e"an -<.2 an(a 7airan 4e4as -<.. Inspe"ul# : P#r i# 4er(un$"ul< (un$"ul e"s#9i i"2 rapuh2 mu(ah 4er(arah2 u"uran 6@ 6 7m2 in9il rasi -?. 1=5 (is al Ba$ina2 9l#ur -<.2 9lu"sus -?. (arah a" a" i9. Pemeri"saan (alam : SerBi"s : p#r i# 4er(un$"ul<(un$"ul2 e"s#9i i"2 u"uran 6@6@5 7m2 rapuh2 mu(ah 4er(arah2 CUT: En#rmal2 in9il rasi 1=5 (is al Ba$ina. A(ne@a parame rium "anan<"iri e$an$2 CaBum (#u$las a" men#n:#l. )e7 al #u7her : #nus sphin$ er ani 4ai"2 mu"#sa li7in2 ampula "#s#n$2 massa in ra lumen -<.2 CUT En#rmal2 CFS "anan +F2 (an CFS "iri +F. IG. PE&E)IKSAAN PENUNJAN% !a4#ra #rium : A. Darah 'ema #l#$i -Tanggal 6 Agustus 2007): '4 : 822 $=(!2 hema #"ri : 16F2 leu"#si :1*>++ mm 52 !ED 1582 r#m4#si 1*.>++=mm52 Di99. C#un : +=1=2=85=15=1 Kimia "lini" -Tanggal 8 Agustus 2007): BSS : ,8 m$=(l2 ureum : 515 m$=(!2 "rea inin : 252, m$=(!2 pr# ein # al : ,2* $=(!2 al4umin : 52> $=(!2 $l#4ulin : 52, m$=(!2 4iliru4in # al : +22, m$= (l2 4iliru4in (ire": +21+2 4iliru4in in(ire" : +21,2 S%3T : 18 U=I2 S%PT : * U=I2 Na rium 128 mm#l=!2 Kalium 822 mm#l= !. Tanggal 9 Agustus 2007 '4sA$=)P'A : -<. B. Pa #l#$i :arin$an Tanggal 1 Juli 2006 Kesan : a(en# 7ar7in#ma 7erBi@ 4er(i9erensiasi 4ai"

C. )#n $en Th#ra"s Tanggal 27 Juni 2007 Kesan : me as ase "e paru D. S a$in$ Tanggal 6 Agustus 2007 D= Ca 7erBi"s s a(ium IGB ? hiper ensi ? C)F ? anemia 4era E. K#nsul PD! Tanggal 7 Agustus 2007 'asil: )enal Insu9isiensi e7 &e as ase Ca CerBi@ Saran: Fur#semi( 1@1 amp 'em#(ialisis 4ila 'B H8$rF (an '4SA$ -<. F. K#nsul Neur#l#$i Tanggal : 8 Agustus 2007 'asil: 'emiparese Sinis ra e7 CGD 'em#rrha$i7I G. DIA%N3SIS KE)JA Dia$n#sis "er:a : Karsin#ma serBi"s s a(ium IG B pas7a pa@us 7ar4#plas in > seri ? hiper ensi 4era ? anemia 4era ? suspe7 $a$al $in:al a"u GI. P)3%N3SIS B. Ju# a( Bi am C. Ju# a( 9un7 i#nam GII. PENATA!AKSANAAN Per4ai"an KU IGFD )! (an NaCl K 2 : 1 $ LL=m )= rans9usi hin$$a '4 H 1+ $r=(l Asam 9#la 5@1 a4 %raha4i#n 2@1 a4 )= 'em#(ialisis : malam : malam

)= US% $in:al )= C0s #s"#pi2 )= re7 #s"#pi K#nsul PD! ? Be(ah )= palia i9 GIII. F3!!3M UP Tan$$al +*<+8<2++, Keluhan S a us presen Ba(an lemas se elah "em# erapi KU:lemah2 sens: C&2 TD: 1,+=1++ mm'$2 N: 8+@=m2 )): 22 @=m2 T: 5*28#C.

S P!: a4(#men (a ar2 sime ris2 lemas2 9un(us u eri a" era4a2 $ine"#l#$i n0eri e"an -<.2 an(a 7airan 4e4as -<.2 massa -<. Dia$n#sis P: Karsin#ma serBi"s s a(ium IG B pas7a pa@us 7ar4#plas in > seri ? hiper ensi 4era ? anemia 4era ? suspe7 $a$al $in:al a"u o o o o o o o o o o Per4ai"i "ea(aan umum IGFD )! : NaCl 2:1 $ @B Trans9usi hin$$a '4 H 1+ $=(l !a4 D)2 U)2 (an KD )= 'em#(ialisis )= US% $in:al )= C0s #s"#pi (an re7 #s"#pi K#nsul PD! (an Be(ah Asam 9#la 2 @ 1 a4 %raha4i#n 2@1 a4

Tan$$al +,<+8<2++, Keluhan S a us presen Ba(an lemas se elah "em# erapi KU:lemah2 sens: C&2 TD: 18+=1++ mm'$2 N: ,*@=m2 )): 22 @=m2 T: 5*2,#C.

S P!: a4(#men (a ar2 sime ris2 lemas2 9un(us u eri a" era4a2 $ine"#l#$i n0eri e"an -<.2 an(a 7airan 4e4as -<.2 massa -<. Dia$n#sis Karsin#ma serBi"s s a(ium IG B pas7a pa@us 7ar4#plas in >

P:

seri ? hiper ensi 4era ? anemia 4era ? suspe7 $a$al $in:al a"u o Per4ai"i "ea(aan umum o IGFD )! : NaCl 2:1 $ @B o Trans9usi hin$$a '4 H 1+ $=(l o !a4 D)2 U)2 (an KD o )= 'em#(ialisis o )= US% $in:al o )= C0s #s"#pi (an re7 #s"#pi o K#nsul PD! (an Be(ah o Fur#semi(e 1@ 1 amp o Asam 9#la 2 @ 1 a4 o %raha4i#n 2@1 a4

Tan$$al +8<+8<2++, Keluhan S a us presen S $ine"#l#$i Dia$n#sis P: Ke:an$<"e:an$ KU:lemah2 sens: C&2 TD: 1*+=>+ mm'$2 N: *8@=m2 )): 22 @=m2 T: 5*28#C. P!: a4(#men (a ar2 sime ris2 lemas2 9un(us u eri a" era4a2 n0eri e"an -<.2 an(a 7airan 4e4as -<.2 massa -<. Karsin#ma serBi"s s a(ium IG B pas7a pa@us 7ar4#plas in > seri ? hiper ensi 4era ? anemia 4era ? suspe7 $a$al $in:al a"u o Per4ai"i "ea(aan umum o IGFD )! : NaCl 2:1 $ @B o Trans9usi hin$$a '4 H 1+ $=(l o !a4 D)2 U)2 (an KD o )= 'em#(ialisis o )= US% $in:al o )= C0s #s"#pi (an re7 #s"#pi o K#nsul PD! (an Be(ah o Fur#semi(e 1@1 amp o Asam 9#la 2 @ 1 a4 o %raha4i#n 2@1 a4

Tan$$al +><+8<2++, Keluhan Ba(an lemas se elah "em# erapi

S a us KU:lemah2 sens: C&2 TD: 1,+=>+ mm'$2 N: **@=m2 )): 22 presen @=m2 T: 5*28#C. S P!: a4(#men (a ar2 sime ris2 lemas2 9un(us u eri a" era4a2 $ine"#l#$i n0eri e"an -<.2 an(a 7airan 4e4as -<.2 massa -<. Dia$n#sis P: Karsin#ma serBi"s s a(ium IG B pas7a pa@us 7ar4#plas in > seri ? hiper ensi 4era ? anemia 4era ? suspe7 $a$al $in:al a"u o o o o o o o o o o o Per4ai"i "ea(aan umum IGFD )! : NaCl 2:1 $ @B Trans9usi hin$$a '4 H 1+ $=(l !a4 D)2 U)2 (an KD )= 'em#(ialisis )= US% $in:al )= C0s #s"#pi (an re7 #s"#pi K#nsul PD! (an Be(ah Fur#semi(e 1@1 amp Asam 9#la 2 @ 1 a4 %raha4i#n 2@1 a4

Tan$$al 1+<+8<2++, Keluhan S a us presen Ba(an lemas se elah "em# erapi KU: se(an$2 sense: C&2 TD: 1*+=1++ mm'$2 N: ,+ @=meni 2 )): 22 @= meni 2 T: 5*26+C

S P!: a4(#men (a ar2 sime ris2 lemas2 n0eri e"an -<.2 an(a 7airan $ine"#l#$i 4e4as -<.2 masssa -<. Dia$n#sis P: Karsin#ma serBi"s s a(ium IG B pas7a pa@us 7ar4#plas in > seri ? hiper ensi 4era ? anemia 4era ? suspe7 $a$al $in:al a"u o o o o o o o o Per4ai"i "ea(aan umum IGFD )! : NaCl 2:1 $ @B Trans9usi hin$$a '4 H 1+ $=(l !a4 D)2 U)2 (an KD )= US% $in:al C0s #s"#pi (an re7 #s"#pi K#nsul PD! (an Be(ah Fur#semi(e 1@1 amp

o Asam 9#la 2 @ 1 a4 o %raha4i#n 2@1 a4

BAB II PERMASALAHA 1. 2. 5. 6. Apa"ah (ia$n#sis pa(a pasien ini su(ah epa I Apa"ah pena ala"sanaan pa(a pasien ini su(ah epa I Apa"ah 9a" #r pre(isp#sisi "arsin#ma serBi"s pa(a pasien iniI Apa"ah pr#$n#sis pa(a pasien iniI

BAB III A ALISIS KASUS Diagnosis Kasus ini (i(ia$n#sis se4a$ai "arsin#ma serBi"s 4er(asar"an hasil anamnesis (an pemeri"saan 9isi" ser a (ari hasil pemeri"saan penun:an$ 4erupa hasil pemeri"saan pa #l#$i ana #mi. Dari anamnesis (i"e ahui 4ah/a pen(eri a mempun0ai "eluhan per(arahan (ari "emaluan merupa"an salah sa u $e:ala "has pa(a "arsin#ma serBi"s. Per(arahan pa(a umumn0a er:a(i se$era seha4is sen$$ama -per(arahan "#n a".2 namun pa(a in$"a "lini" 0an$ le4ih lan:u 2 per(arahan sp#n an (apa er:a(i seper i pa(a "asus ini. Dari hasil pemeri"saan 9isi" pa(a an$$al * A$us us 2++,2 (ari s a us $ine"#l#$is pen(eri a (i(apa "an Pemeriksaan luar ! A4(#menD (a ar2 lemas2 sime ris2 9un(us u eri a" era4a2 massa -<.2 n0eri e"an -<.2 an(a 7airan 4e4as -<.. Inspekulo ! P#r i# 4er(un$"ul< (un$"ul e"s#9i i"2 rapuh2 mu(ah 4er(arah2 u"uran 6@6 7m2 in9il rasi -?. 1=5 (is al Ba$ina2 9l#ur -<.2 9lu"sus -?. (arah a" a" i9. Pemeriksaan "alam ! SerBi"s : p#r i# 4er(un$"ul<(un$"ul2 e"s#9i i"2 u"uran 6@6@5 7m2 rapuh2 mu(ah 4er(arah2 CUT: En#rmal A(ne@a parame rium Re#tal tou#her ! "anan<"iri e$an$2 CaBum (#u$las a" men#n:#l2 in9il rasi 1=5 (is al Ba$ina.

>

#nus sphin$ er ani 4ai"2 mu"#sa li7in2 ampula "#s#n$2 massa in ra lumen -<.2 CUT En#rmal2 CFS "anan +F2 (an CFS "iri +F. Pemeriksaan Penun$ang La%oratorium ! A. Darah 'ema #l#$i -Tanggal 6 Agustus 2007): '4 : 822 $=(!2 hema #"ri : 16F2 leu"#si :1*>++ mm 52 !ED 1582 r#m4#si 1*.>++=mm52 Di99. C#un : +=1=2=85=15=1 Kimia "lini" -Tanggal 8 Agustus 2007): BSS : ,8 m$=(l2 ureum : 515 m$=(!2 "rea inin : 252, m$=(!2 pr# ein # al : ,2* $=(!2 al4umin : 52> $=(!2 $l#4ulin : 52, m$=(!2 4iliru4in # al : +22, m$= (l2 4iliru4in (ire": +21+2 4iliru4in in(ire" : +21,2 S%3T : 18 U=I2 S%PT : * U=I2 Na rium 128 mm#l=!2 Kalium 822 mm#l= !. Tanggal 9 Agustus 2007 '4sA$=)P'A : -<. B. Pa #l#$i :arin$an Tanggal 1 Juli 2006 Kesan : a(en# 7ar7in#ma 7erBi@ 4er(i9erensiasi 4ai" C. )#n $en Th#ra"s Tanggal 27 Juni 2007 Kesan : me as ase "e paru D. S a$in$ Tanggal 6 Agustus 2007 E. K#nsul PD! Tanggal 7 Agustus 2007 'asil: )enal Insu9isiensi e7 &e as ase Ca CerBi@ Saran: Fur#semi( 1@1 amp 'em#(ialisis 4ila 'B H8$rF (an '4SA$ -<.

1+

F. K#nsul Neur#l#$i Tanggal : 8 Agustus 2007 'asil: 'emiparese Sinis ra e7 CGD 'em#rrha$i7I D= Ca 7erBi"s s a(ium IGB ? hiper ensi ? C)F ? anemia 4era Ber(asar"an hasil pemeri"saan erse4u 2 ma"a (ia$n#sis pasien ini elah (i e$a""an (en$an epa . Penatalaksanaan Pena ala"sanaan 0an$ (i4eri"an 4a$i pen(eri a "arsin#ma serBi"s s a(ium IGB merupa"an sua u erapi palia i92 4erupa ra(iasi e"s erna - ele herap0. (an ra(iasi in erna -4ra7h0 herap0. (i am4ah (en$an 4ra"0 herap0 in ra"aBi er (en$an "#n"ruens "em# erapi. )a(iasi e"s erna (i u:u"an pa(a "elen:ar $e ah 4enin$ (an pen:alaran parame rium (in(in$ pan$$ul. Un u" men$uran$i e9e" sampin$2 (i$una"an sinar ener$i me$aB#l 2 misaln0a C# *+ (en$an (#sis 9ra"sinasi 2++7%0= hr. )a(iasi e"s ernal (i4eri"an (en$an ar$e primer 4erupa um#r (an u erus se(an$"an ar$e se"un(er 4erupa K%B pelBis (an K%B ilia"a "#munis. Tar$e B#lume pa(a erapi ini a(alah um#r primer2 "elen:ar lim9e pelBis (an ilia"a "#munis. )a(iasi in erna merupa"an ra(iasi (#sis in$$i 0an$ (i u:u"an pa(a um#r primer serBi"s. 'al ini (ila"u"an (en$an 7ara memasan$ sum4er ra(iasi erha(ap in rau erin (an Ba$ina -in ra"aBi er. (en$an e ap memper ahan"an ra(iasi pa(a re" um (an Besi"a urinaria (iper ahan"an (alam (#sis #leransi. Pemasan$an ra(iasi in erna (ila"sana"an (en$an 2 me #(e2 4erupa me #(e "#nBensi#nal -me #(e paris2 s#7"h#lm2 man7hes er (an implan asi in ers i iel. ser a me #(e a9 erl#a(in$. K#n"ruen "em#ra(iasi 0an$ (ila"sana"an 4erupa sisplas in (en$an (#sis 6+ m$ = m2 selama pem4erian ra(iasi e"s erna. &aktor Pre"isposisi

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Ke:a(ian "arsin#ma serBi"s 4erhu4un$an era

(en$an se:umlah 9a" #r

e"s rinsi"2 4erupa usia "#i us 0an$ san$a mu(a -"uran$ (ari 1* ahun.. Insi(enn0a menin$"a (en$an in$$in0a pari as2 s#si#e"#n#mi ren(ah2 hi$iene se"sual :ele"2 a" i9i as se"sual 0an$ serin$ 4er$an i pasan$an (an "e4iasaan mer#"#". Fa" #r<9a" #r pre(isp#sisi 0an$ mun$"in an ara lain a(alah : 1. C#i us per ama usia san$a mu(a 0ai u 18 ahunD 2. Asap r#"#" se4a$ai sum4er ra(i"al 4e4as men0e4a4"an menurunn0a :umlah an i #"si(an 0an$ erse(ia (alam u4uh un u" mem4an u menan$$ulan$i "elainan<"elainan (alam u4uhD 5. S#sial e"#n#mi 0an$ ren(ah -pasien (an "eluar$a 4erpr#9esi se4a$ai pe ani=4er"e4un. se(i"i 4an0a" 4erpen$aruh erha(ap pen$e ahuan mas0ara"a en an$ pen0a"i menular se@ualD (an 6. 'i$iene (aerah "emaluan "uran$. Prognosis Five years survival rates pa(a pen(eri a Ca.CerBi@ s a(ium IGB a(alah 4er"isar an ara +<12' sehin$$a pa(a pasien ini pr#$n#sis 4ai" un u" Nu# a( Bi am maupun un u" Nu# a( 9un7 i#namn0a a(alah malam, "arena se elah in(a"an 0an$ elah (ila"u"an2 i(a" a(a "emun$"inan "em4alin0a 9un$si #r$an seper i semula.

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BAB I( KESIMPULA 1. Dia$n#sis "arsin#ma serBi"s s a(ium IGB su(ah epa 4er(asar"an hasil anamnesis2 pemeri"saan 9isi" (an pemeri"saan penun:an$ -Pa #l#$i Ana #mi (an 7lini7al s a$in$. (an pena ala"sanaan 0an$ elah (ila"u"an. 2. Pena ala"sanaan pen(eri a pa(a "asus ini su(ah epa 2 0ai u per4ai"an "ea(aan umum se4a$ai persiapan un u" mela"sana"an ra(i# erapi in erna (an e"s erna. 5. Fa" #r pre(isp#sisi "arsin#ma serBi"s pa(a "asus ini a(alah 7#i us per ama pa(a usia mu(a 0ai u 18 ahun2 $#l#n$an s#sial e"#n#mi ren(ah (an hi$iene (aerah "emaluan i(a" 4ai"2 ser a #s merupa"an per#"#" pasi9. 6. Pr#$n#sis pa(a pasien ini a(alah malam 4ai" un u" Nu# a( Bi am maupun un u" Nu# a( 9un7 i#nam.

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BAB ( )I *AUA PUS)AKA

A. EPIDEMI+L+,I Kan"er 7erBi"s u eri merupa"an "an"er pa(a /ani a n#m#r (ua erserin$ (iseluruh (unia2 0ai u 18F (ari semua "an"er pa(a /ani a. Dine$ara 4er"em4an$ merupa"an "an"er 0an$ er4an0a" 0ai u 2+<5>F (ari semua "an"er pa(a /ani a. Dine$ara ma:u 9re"uensin0a han0a 4er"isar an ara 6<*F. Di In(#nesia2 (ian ara um#r $anas $ine"#l#$i"2 "an"er serBi"s masih men(u(u"i in$"a per ama. PreBalensi umur pen(eri a 4er"isar an ara 5+<*+ ahun2 er4an0a" umur 68<8+ ahun. Peri#(e la en pa(a 9ase prainBasiBe men:a(i inBasiBe se"i ar 1+ ahun2 han0a >F (ari pen(eri a 4erumur 58 ahun 0an$ menun:u"an "e$anasan serBi"s u eri pa(a saa er(ia$n#sis2 se(an$"an 85F (ari "arsin#ma insi u er(apa pa(a /ani a (i4a/ah umur 58 ahun. B. E)I+L+,I Ke:a(iann0a 4erhu4un$an era (en$an se:umlah 9a" #r e"s rinsi"2 (ia aran0a : :aran$ (i emu"an pa(a pera/an2 7#i ar7he (iusia san$a mu(a -1* ahun.2 mul i pari as (en$an :ara" persalinan erlalu (e"a 2 s#se" ren(ah2 hi$ien se"sual :ele"2 mer#"#"2 pr#mis"ui as ser a :aran$ (i emu"an pa(a /ani a 0an$ suamin0a (isir"umsisi.

16

Seirin$ (en$an 4er"em4an$an 4i#m#le"uler2 ampa" 4ah/a 'PG an#$eni al 4eperan pen in$ (alam pa #$enesis "an"er serBi"s. Pa(a >+<>8 F "an"er serBi"s elah (i4u" i"an a(an0a hu4un$an (en$an 'PG resi"# in$$i. Pa(a saa ini (i"e ahui er(apa ,+ ma7am ipe 'PG. Yan$ (ima"su( (en$an 'PG ipe Ohi$h ris"P a(alah 'PG ipe 1*2182512 552 5>2 682 812 822 8* (an 88. Tipe 1* (an 18 merupa"an ipe 'PG #n"#$en 0an$ (apa men0e4a4"an ins a4ili as "r#m#s#mal2 er:a(in0a mu asi (alam DNA (an $an$$uan re$ulasi per um4uhan. Se(an$"an 'PG ipe *2 112 622 65 (an 66 (ise4u Ol#/ ris"P 0an$ merupa"an ipe n#n<#n"#$en. C. PA)+L+,I Karsin#ma serBi"s im4ul (i4a asi an ara epi el 0an$ melapisi e" #serBi"s -p#r i#. (an en(#serBi"s "analis serBi"s 0an$ (ise4u s"uam# "#lumnar :un7 i#n -SCJ.. Pa(a /ani a mu(a SCJ erle a" (iluar 3UE2 se(an$ pa(a /ani a (ia as 58 ahun2 (i(alam "analis serBi"s. Tum#r (apa um4uh : 1. 2 2. E"s#9i i". &ulai (ari SCJ "earah lumen Ba$ina se4a$ai massa pr#li9era i9 0an$ men$alami in9e"si se"un(er (an ne"r#sis. En(#9i i". &ulai (ari SCJ um4uh "e(alam s r#ma serBi"s (an 7en(erun$ in9i ra i9 mem4en u" ul"us Ulsera i9. &ulai (ari SCJ (an 7en(erun$ merusa" s ru" ur :arin$an pelBis (en$an meli4a "an 9#rni7es Ba$ina un u" men:a(i ul"us 0an$ luas. SerBi"s n#rmal se7ara alami men$alami me aplasi=er#si a"i4a salin$ (esa" "e(ua :enis epi el 0an$ melapisin0a. Den$an masu"n0a mu a$en2 p#r i# 0an$ err#si9 -me aplasia s"uam#s. 0an$ semula 9aali 4eru4ah men:a(i pa #l#$i" -(ipla i"< (is"ari# i". melalui in$"a an NIS<I2 II2 III (an KIS un u" a"hirn0a men:a(i "arsin#ma inBasiBe. Se"ali men:a(i mi"r#inBasiBe. Pr#ses "e$anasan a"an 4er:alan erus. D.PE -EBARA

18

Pen0e4aran "arsin#ma serBi"s er:a(i melalui 5 :alan 0ai u per"#n inui a um "e (alam Ba$ina2 sep um re" #Ba$inal (an (asar "an(un$ "emih. Pen0e4aran se7ara lim9#$en er:a(i eru ama paraserBi"al (alam parame rium (an s asiun s asiun "elen:ar (i pelBis min#r2 4aru "emu(ian men$enai "elen:ar para a#r ae er"ena (an 4aru er:a(i pen0e4aran hema #$en -hepar2 ulan$.. Se7ara lim9#$en melalui pem4uluh $e ah 4enin$ menu:u 5 arah : 1. 9#rni7es (an (in(in$ Ba$ina 2. "#rpus u eri 5. parame rium (an (alam in$"a an le4ih lan:u men$in9il rasi sep um re" #Ba$ina (an "an(un$ "emih. Pen0e4aran lim9#$en "e parame rium a"an menu:u "elen:ar "elen:ar lim9e re$i#nal melalui li$amen um la um2 "elen:ar ilia"a2 #4 ura #r2 hip#$as ri"a2 parasa"ral2 paraa#r a2 (an se erusn0a "e run"us lim9a i" (i "anan (an Bena su4"lBia (i "iri men7apai paru2 ha i2 $in:al2 ulan$ ser a # a". E. DIA, +SIS Dia$n#sis "an"er serBi"s i(a"lah suli apala$i in$"a ann0a su(ah lan:u . Yan$ men:a(i masalah a(alah 4a$aimana mela"u"an s"rinin$ un u" men7e$ah "an"er serBi"s2 (ila"u"an (en$an (e e"si2 era(i"asi2 (an pen$ama an erha(ap lesi pra"an"er serBi"s. Kemampuan un u" men(e e"si (ini "an"er serBi"s (iser ai (en$an "emampuan (alam pena ala"sanaan 0an$ epa a"an (apa menurun"an an$"a "ema ian a"i4a "an"er serBi"s. a. Kepu ihan. Kepu ihan merupa"an $e:ala 0an$ palin$ serin$ (i emu"an2 4er4au 4usu" a"i4a in9e"si (an ne"r#sis :arin$an.

1*

4. Pen(arahan "#n a" merupa"an ,8<8+F $e:ala "arsin#ma serBi"s. Per(arahan im4ul a"i4a er4u"an0a pem4uluh (arah2 0an$ ma"in lama ma"in serin$ er:a(i (iluar sen$$ama. 4. 7. )asa n0eri2 er:a(i a"i4a in9il rsi sel um#r "esera4u sara9. %e:ala lainn0a a(alah $e:ala<$e:ala 0an$ im4ul a"i4a me as ase :auh. Ti$a "#mp#nen u ama 0an$ salin$ men(u"un$ (alam mene$a""an (ia$n#sa "an"er serBi"s a(alah : 1. Si #l#$i. Bila (ila"u"an (en$an 4ai" "e eli ian mele4ihi >+F. Tes Pap san$a 4erman9aa 2. un u" men(e e"si lesi se7ara (ini. Se(iaan si #l#$i harus K#lp#s"#pi. K#lp#s"#pi a(alah pemeri"saan (en$an men$$una"an "#lp#s"#p2 0ai u sua u ala seper i mi"r#s"#p 4er ena$a ren(ah (en$an sum4er 7aha0a (i(alam0a. Pemeri"saan "#lp#s"#pi merupa"an pemeri"saan s an(ar 4ila (i emu"an pap smear 0an$ a4n#rmal. Pemeri"saan (en$an "#lp#s"#p2 merupa"an pemeri"saan (en$an pem4esaran2 meliha "elainan epi el seBi"2 pem4uluh (arah se elah pem4erian asam ase a . Pemeri"saan "#lp#s"#pi i(a" han0a er4a as paa(a serBi"s2 e api pemeri"saan melipu i BulBa (an Ba$ina. Tu:uan pemeri"saan "#lp#s"#pi 4u"an un u" mem4ua (ia$n#sa his #l#$i"2 e api un u" menen u"an "apan (an (imana 4i#psi harus (ila"u"an. 5. Bi#psi. Bi#psi (ila"u"an (i(aerah a4n#rmal (i 4a$ian 0an$ "#nisasi. &. PE A)ALAKSA AA elah (ila"u"an "#lp#s"#pi. Ji"a "analis serBi"alis suli (inilai2 sampel (iam4il se7ara men$an(un$ "#mp#nen e" #serBi"s (an en(#serBi"s.

1,

1. 2. 5. 6. 8. erapi *.

Karsin#ma serBi"s mi"r#inBasiBe 'is ere" #mi # alis S a(ium IA1 TA'=TG'. Bila (iser ai GAIN (ila"u"an pen$an$"a an Ba$inal 7u99. S a(ium IA2 'is ere" #mi ra(i"al ipe 2 (an lim9e a(ene" #mi pelBis Ca inBasiBe Bi#psi un u" "#n9irmasi (ia$n#sis S a(ium IB1 Q IIA R 67m Ji"a mempun0ai pr#$n#sis 4ai" (apa (i"#n r#l (en$an #perasi (an ra(i# S a(ium IB2 Q IIA H67m Kem#ra(iasi primer 'is ere" #mi ra(i"al primer ? lim9a(ene" #mi ? ra(iasi ne#a(:uBan Kem# erapi ne# a(:uBan

,.

Ca serBi"s s a(ium lan:u melipu i s a(ium IIB2 III2 IG A Pen$#4a an erpilih a(alah ra(i# erapi len$"ap 0ai u ra(iasi e"s erna (i4eri"an (ilan:u "an in ra"aBi er ra(i# erapi. Terapi Bariasi 0an$ serin$ pa7hi a@el2 (#7e a@el2 9lu#r#urasil2 $em7i a4ine

"hem#ra(iasi2 "hem# erapi 0an$ serin$ (i4eri"an an ara lain 7ispla inum2 8. S a(ium IG B Pen$#4a an 0an$ (i4eri"an 4ersi9a palia i92 ra(i# erapi palia i9 0an$ (i4eri"an Ra"ioterapi. Kemoterapi. "an Ra"ikal Histerektomi A(apun alasan un u" memilih salah sa u erapi (ia as a(alah 4er(asar"an "eun un$an (an "eru$ian masin$<masin$ erapi. KEM+)ERAPI

18

&erupa"an 4en u" pen$#4a an "an"er (en$an men$$una"an #4a si #s a i"a 0ai u sua u Ca <Ca 0an$ (apa men$ham4a pr#li9erasi sel<sel "an"er. Prinsip kerja obat kemoterapi sitostatika) ter!a"ap kanker # Se4a$ian 4esar #4a "em# erapi -si #s a i"a. 0an$ (i$una"an saa ini 4e"er:a eru ama erha(ap sel<sel "an"er 0an$ se(an$ 4erpr#li9erasi2 sema"in a" i9 sel<sel "an"er erse4u 4erpr#li9erasi ma"a sema"in pe"a erha(ap si #s a i"a hal ini (ise4u Kemoresponsif, se4ali"n0a sema"in lam4a sema"in ren(ah. 'al ini (ise4u Kemoresisten. 34a "em# erapi a(a 4e4erapa ma7am2 (ian aran0a a(alah : 1. 34a $#l#n$an Alkylating agent, platinum Compouns, (an Anti iotik Ant!rasiklin #4s $#l#n$sn ini 4e"er:a (en$an an ara lain men$i"a DNA (i in i sel2 sehin$$a sel<sel erse4u i(a" 4isa mela"u"an repli"asi. 2. 34a $#l#n$an Antimeta olit2 4e"er:a lan$sun$ pa(a m#le"ul 4asa in i sel2 0an$ 4era"i4a men$ham4a sin esis DNA. 5. 34a $#l#n$an Topoisomerase"in!i itor, #in$a Alkaloi%2 (an Ta&anes 4e"er:a pa(a $an$$uan pem4en u"an u4ulin2 sehin$$a er:a(i ham4a an mi #sis sel. 6. 34a $#l#n$an 'n(im seper i2 )"Asparaginase 4e"er:a (en$an men$ham4a sin esis pr# ein2 sehin$$a im4ul ham4a an (alam sin esis DNA (an )NA (ari sel<sel "an"er erse4u . *ola pem erian kemoterapi : 1. Kem# erapi In(u"si Di u:u"an un u" se7epa mun$"in men$e7il"an massa um#r a au :umlah sel "an"er2 7#n #h pa(a #mur $anas 0an$ 4eru"uran 4esar -Bul"0 &ass Tum#r. a au pa(a "e$anasan (arah seper i leu"emia a au lim9#ma2 (ise4u pen$#4a an pen0elama an. 2. Kem# erapi A(:uBan :u$a (en$an pr#li9erasin0a ma"a "epe"aann0a

1>

Biasan0a (i4eri"an sesu(ah pen$#4a an 0an$ lain seper i pem4e(ahan a au ra(iasi2 u:uann0a a(alah un u" memusnah"an sel<sel "an"er 0an$ masih ersisa a au me as ase "e7il 0an$ a(a -mi7r# me as asis.. 5. Kem# erapi Primer Dima"su("an se4a$ai pen$#4a an u ama pa(a um#r $anas2 (i4eri"an pa(a "an"er 0an$ 4ersi9a "em#sensi i92 4iasan0a (i4eri"an (ahulu se4elum pen$#4a an 0an$ lain misaln0a 4e(ah a au ra(iasi. 6. Kem# erapi Ne#<A(:uBan Di4eri"an men(ahului=se4elum pen$#4a an= in(a"an 0an$ lain seper i pem4e(ahan a au pen0inaran "emu(ian (ilan:u "an (en$an "em# erapi la$i. Tu:uann0a a(alah un u" men$e7il"an massa um#r 0an$ 4esar sehin$$a #perasi a au ra(iasi a"an le4ih 4erhasil $una. $ara pemberian obat kemoterapi 1. In ra Bena -IG. Ke4an0a"an si #s a i"a (i4eri"an (en$an 7ara ini2 (apa 4erupa 4#lus IG pelan<pelan se"i ar 2 meni 2 (apa pula per (rip IG se"i ar 5+ Q 12+ meni 2 a au (en$an 7#n in#us (rip se"i ar 26 :am (en$an in9usi#n pump upa0a le4ih a"ura e esann0a. 2. In ra e"al -IT. Di4eri"an "e (alam 7analis me(ulla spinalis un u" memusnah"an um#r (alam 7airan # a" -liNu#r 7ere4r#spinalis. an ara lain &TL2 Ara.C. 5. )a(i#sensi iCer2 0ai u :enis "em# erapi 0an$ (i4eri"an se4elum ra(iasi2 u:uann0a un u" memper"ua e9e" ra(iasi2 :enis #4a un u"l "em# erapi ini an ara lain Flu#ru#ra7il2 Cisplas in2 Ta@#l2 Ta@# ere2 '0(rea. 6. 3ral Pem4erian per #ral 4iasan0a a(alah #4a !eu"eran, Al"eranS2 &0leranS2 Na ulanS2 Puri<ne #lS2 h0(reaS2 Te$a9urS2 Lel#(aS2 %leeBe7S.

2+

8. Su4"u an (an in ramus"ular Pem4erian su4 "u an su(ah san$a :aran$ (ila"u"an2 4iasan0a a(alah !< Aspara$inase2 hal ini serin$ (ihin(ari "arena resi"# s0#" ana9ila"sis. Pem4erian per I& :u$a su(ah :aran$ (ila"u"an2 4iasan0a pem4erian Ble#m07in. *. T#pi"al ,. In ra ar erial 8. In ra7aBi 0 >. In raperi #neal=In rapleural In raperi #neal (i4eri"an 4ila pr#(u"si 7airan a7i es hem#ra$is 0an$ 4an0a" pa(a "an"er $anas in ra<a4(#men2 an ara lain Cisplas in. Pem4erian in rapleural 0ai u (i4eri"an "e(alam 7aBum pleuralis un u" memusnah"an sel<sel "an"er (alam 7airan pleura a au un u" men$ehn i"an pr#(u"si e9usi pleura hem#ra$is 0an$ ama 4an0a" 2 7#n #hn0a Ble#7in Tujuan pemberian kemoterapi% 1. Pen$#4a an. 2. &en$uran$i massa um#r selain pem4e(ahan a au ra(iasi. 5. &enin$"a "an "elan$sun$an hi(up (an memper4ai"i "uali as hi(up. 6. &en$uran$i "#mpli"asi a"i4a me as ase. 'fek samping kemoterapi. Umumn0a e9e" sampin$ "em# erapi er4a$i a as : 1. 2. E9e" sampin$ se$era er:a(i -Imme(ia e Si(e E99e7 s. 0an$ im4ul (alam 26 :am per ama pem4erian2 misaln0a mual (an mun ah. E9e" sampin$ 0an$ a/al er:a(i -Earl0 Si(e E99e7 s. 0an$ im4ul (alam 4e4erapa hari sampai 4e4erapa min$$u "emu(ian2 misaln0a ne ripenia (an s #ma i is.

21

5.

E9e" sampin$ 0an$ er:a(i 4ela"an$an -Dela0e( Si(e E99e7 s. 0an$ im4ul (alam 4e4erapa hari sampai 4e4erapa 4ulan2 misaln0a neur#pa i peri9er2 neur#pa i.

6.

E9e" sampin$ 0an$ er:a(i "emu(ian - !a e Si(e E99e7 s. 0an$ im4ul (alam 4e4erapa 4ulan sampai ahun2 misaln0a "e$anasan se"un(er. In ensi as e9e" sampin$ er$an un$ (ari "ara" eris i" #4a 2 (#sis pa(a se iap

pem4erian2 maupun (#sis "umula i92 selain i u e9e" sampin$ 0an$ im4ul pa(a se iap pen(eri a 4er4e(a /alaupun (en$an (#sis (an #4a 0an$ sama2 9a" #r nu risi (an psi"#l#$is :u$a mempun0ai pen$aruh 4erma"na. E9e" sampin$ 0an$ selalu hampir (i:umpai a(alah $e:ala $as r#in es inal2 supresi sumsum ulan$2 "er#n #"an ram4u . %e:ala $as r#in es inal 0an$ palin$ u ama a(alah mual2 mun ah2 (iare2 "#ns ipasi2 9arin$i is2 es#pha$i is (an mu"#si is2 mual (an mun ah 4iasan0a im4ul selan$ 4e4erapa lama se elah pem4erian si #s a i"a (a4 4erlan$sun$ i(a" mele4ihi 26 :am. %e:ala supresi sumsum ulan$ eru ama er:a(in0a penurunan :umlah sel (arah pu ih -leu"#penia.2 sel r#m4#si - r#m4#si #penia.2 (an sel (arah merah -anemia.2 supresi sumsum ulan$ 4ela"an$ a"i4a pem4erian si is a i"a (apa er:a(i se$era a au "emu(ian2 pa(a supresi sumsum ulan$ 0an$ er:a(i se$era2 penurunan "a(ar leu"#si men7apai nilai eren(ah pa(a hari "e<8 sampai hari "e<162 se elah i u (iperlu"an /a" u se"i ar 2 hari un u" menai"an "a(ar lau"#si n0a "em4ali. Pa(a supresi sumsum ulan$ 0an$ er:a(i "emu(ian penurunan "a(ar leu"#si er:a(i (ua "ali 0ai u per ama< ama pa(a min$$u "e(ua (an pa(a se"i ar min$$u "e empa (an "elima. Ka(ar leu"#si "emu(ian nai" la$i (an a"an men7apai nilai men(e"a i n#rmal pa(a min$$u "eenam. !eu"#penia (apa menurun"an (a0a u4uh2 r#m4#si #penia (apa men$a"i4a "an per(arahan 0an$ erus<menerus= 4erla4ihan 4ila er:a(i er#si pa(a ra" us $as r#in es inal. Ker#n #"an ram4u (apa 4erBariasi (ari "er#n #"an rin$an (ampai pa(a "e4# a"an. e9e" sampin$ 0an$ :aran$ er:a(i e api i(a" "alah pen in$ a(alah

22

"erusa"an # # :an un$2 s erili as2 9i4r#sis paru2 "erusa"an $in:al2 "erusa"an ha i2 s"ler#sis "uli 2 rea"si ana9ila"sis2 $an$$uan s0ara92 $an$$uan h#rm#nal2 (an peru4ahan $ene i" 0an$ (apa men$a"i4a "an er:a(in0a "an"er 4aru. Kar(i#mi#pa i a"i4a (#"s#ru4in (an (aun#ru4isin umumn0a suli (ia asi2 se4a$ian 4esar pen(eri a menin$$al "arena Opump 9ailureP2 9i4r#sis paru umumn0a irreBersi4el2 "elainan ha i er:a(i 4iasan0a men0uli "an pem4erian si is a i"a selan:u n0a "arena 4an0a" (ian aran0a 0an$ (ime a4#lisir (alam ha i2 e9e" sampin$ pa(a "uli 2 sara92 u erus (an saluran "en7in$ rela i9 "e7il (an le4ih mu(ah (ia asi. RADI+)ERAPI Dalam menen u"an e"ni" (an (#sis ra(iasi pa(a pen$#4a an "arsin#ma serBi"s u eri perlu (iper im4an$"an 9a" #r (a0a #leransi (ari :arin$an<:arin$an (i (alam r#n$$a pelBis. Te"ni" ra(iasi K#m4inasi an ara ra(iasi l#"al (an ra(iasi e"s ernal merupa"an #ilihan 0an$ umumn0a (i4eri"an (en$an ma"su(: )a(iasi l#"al -in ra"aBi er. (apa mem4eri"an (#sis in$$i pa(a serBi"s (an "#rpus u eri e api (#sis 7epa menurun pa(a :arin$an (i se"i arn0a2 sehin$$a (#sis "e re" um2 si$m#i(2 "an(un$ "en7in$ (an ure er (apa (i4a asi sampai 4a as<4a as #leransi. Kemun$"inan im4uln0a me as ase lim9#$en pa(a "arsin#ma serBi"s u eri 7u"up in$$i. 3leh "arena i u "elen:ar<"elen:ar (alam pan$$ul "e7il harus men(apa pen0inaran :u$a. D#sis ra(iasi l#"al 7epa menurun (iluar u erus2 sehin$$a (#sis 0an$ sampai pa(a "elen:ar lim9e san$a ren(ah. Un u" men7apai (#sis 0an$ (apa men$aman"an me as asis "elen:ar lim9e ini (iperlu"an pen0inaran luar 0an$ (apa mem4eri"an (is ri4usi (#sis 0an$ mera a pa(a (aerah 0an$ le4ih luas. K#mpli"asi<"#mpli"asi sesu(ah erapi ra(i#l#$i" an ara lainD

25

a. K#mpli"asi umum %e:ala umum 0an$ serin$ im4ul a(alah na9su ma"an menurun2 rasa mual2 lesu2 (an i(a" a(a $airah "er:a. Pa(a "ea(aan 0an$ le4ih 4era empa er(apa mun ah<mun ah2 i(a" 4isa ma"an2 lemah2 sampai i(a" 4isa 4an$un (ari i(ur. Bera rin$ann0a $e:ala<$e:ala san$an (ipen$aruhi #leh s a us 9isi" (an psi"#l#$i pen(eri a. 4. K#mpli"asi l#"al %e:ala<$e:ala 0an$ im4ul ialah $e:ala<$e:ala (ari ala <ala u4uh 0an$ er"ena ra(iasi se7ara lan$sun$2 0ai u: Pr#4lema "#i us -pen$"eru an Ba$ina. Fis el ra(i#l#$i" %e:ala sis i is Pr#" i is hem#ra$i" Fi4r#sis (aerah pelBis (emi"ian luas eru ama pa(a pen0inaran 0an$ luas (en$an (#sis 0an$ in$$i sehin$$a im4ul &ro'en pelvis (en$an "emun$"inan pen0empi an Ba$ina2 re7 um2 "an(un$ "en7in$ a au ure er. A r#pi mu7#sa re7 um 0an$ (iser ai elean$ie" asi 0an$ se/a" u</a" u 4ila (e9e"asi "eras (apa menim4ul"an per(arahan Ne"r#sis pa(a (in(in$ Ba$ina (en$an "emun$"inan im4uln0a 9is ula re7 #Ba$inalis a au 9is ula Besi"#Ba$inalis. HIS)EREK)+MI RADIKAL 'is ere" #mi ra(i"al primer men$un un$"an "arena (apa (ila"u"an surgi(al staging% 3perasi ra(i"al 0an$ memerlu"an /a" u 0an$ 7u"up lama2 i(a" mun$"in anpa er:a(i "#mpli"asi. 3leh "arena i u2 persiapan #perasi perlu (ila"u"an (en$an

26

7erma sehin$$a (apa men$uran$i "#mpli"asi seper i laCimn0a "#mpli"asi #perasi2 0ai u : 1. Trias p#"#" "#mpli"asi -per(arahan2 in9e"si (an rauma in(a"an #perasi.. 2. K#mpli"asi em4#li -"ar(i#Bas"ular (an paru.. 5. K#mpli"asi lainn0a Em%oli "an em%oli paru /ang %erat Fa" #r 0an$ (apa menim4ul"an er:a(in0a em4#li paru2 0ai u : 1. 2. 3perasi 0an$ lama saa men$an$"a :arin$an lema" (i pelBis. InBasi sel "arsin#ma 0an$ (apa menim4ul"an em4#li melalui pr#ses O hiper"#a$ulasiP Komplikasi alat perkemihan &anipulasi 0an$ 7u"up lama (an 4erBariasi se"i ar pelBis men0e4a4"an "emun$"inan er:a(i "#mpli"asi ala per"emihan pa(a : 1. Dis9un$si Besi"#u erina Ke:a(ian ini 4er"ai an (en$an upa0a pen0isihan (an upa0a pem# #n$an li$amen um "ar(inale 0an$ erlalu "e la eral (an pem# #n$an li$amen um sa"r#u erinum erlalu (e"a (en$an re" um. 2. Fis ula &anipulasi 0an$ 4era (i se"i ar Besi"a urinaria In0eksi pas#aoperati0 In9e"si 0an$ 4era (apa menim4ul"an "#mpli"asi 4eran ai2 seper i : Sepsis menin$"a "an m#r4i(i as (an m#r ali as. &emperpan:an$ h#spi alisasi Ter:a(i )oun" "e!i(ense Pem4en u"an a4ses se"i ar pelBis.

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,. &+LL+1 UP Tiap 5 4ulan selama 2 ahun per ama2 "emu(ian iap * 4ulan2 er$an un$ "ea(aan. Jan$an lupa mera4a "elen:ar in$uinal (an supra7laBi"la2 a4(#men2 a4(#minal Ba$inal2 (an a4(#minalre" al2 pemeri"san si #l#$i" pun7a" Ba$ina2 (an 9# # r#n $en h#ra"s - se iap * 4ulan. K#lp#s"#pi un u" meneli i pun7a" Ba$ina2 ser a 4en u"<4en u" pra$anas. )e" #s"#pi2 sis #s"#pi2 ren#$ram2 IGP2 (an CT s7an pan$$ul2 han0a (ila"u"an menuru in(i"asi.

H. PR+, +SIS Fa" #r<9a" #r 0an$ menen u"an pr#$n#sis a(alah: umur2 "ea(aan umum2 in$"a "lini" "e$anasan2 7iri his #l#$i sel um#r2 "emampuan im pen#l#n$2 (an sarana pen$#4a an. Angka keta!anan !i"up * ta!un menurut "ata internasional Tin$"a
TIS T1 T2 T5 T6

AK'<8 Thn
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DA&)AR PUS)AKA 1. Mi"n:#sas r# '. Karsin#ma SerBi"s U erus. Dalam : Mi"n:#sas r# '. Ilmu Kan(un$an. Ya0asan Bina Pus a"a Sar/#n# Pra/ir#har(:# : Ja"ar a : 1>>>258+< 588 2. &ans:#er A ("". Kan"er SerBi"s. Dalam : &ans:#er A ("". Kapi a Sele" a Ke(#" eran. &e(ia Aes7ulapius : Ja"ar aD 2++12 5,><581. 5. &#e7h ar ). Sin#psis 34s e ri. E%C : Ja"ar aD 1>>8 6. A$us ria TS. Penun un pela"sanaan pra" is "an"er $ine"#l#$i. Palem4an$2 2++6D2+<2* 8. Campi#n &. PreinBsiBe (isease. In: Bere" JS22 'a7"er NF. Pra7 i7al $ine"#l#$i7 #n7#l#$0. 5r( e(.. Phila(elphia: !ippin7# Milliams U Mil"ins2 2+++D2,1<518 *. S:amsu((in S. Pen7e$ahan (an (e e"si (ini "an"er serBi"s. Cermin Dunia Ke(#" eran 2++1D155D><16. ,. Mri$h TC2 Kurman )J2 FerenC0 . Pre7an7er#us lessins #9 he 7erBi@. In: Kurman )J. E(. Blaus einVs p h#l#$0 #9 he 9emale $enil ra7 . 6 e( . Ne/ Y#r": Sprin$e< Gerrl$2 1>>6D22><22,.

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8. Sulas ri '. Pa #l#$i ne#plsma in raepi helial s"uam#sa -NIS.. Kursus "#lp#s"#pi pra<PIT P3%I LII. Palem4an$2 2++1. >. Kau9man )'. A(am E. G#n"a G. 'uman papill#ma Birus in9e7 i#n an( 7erBi"al 7ar7in#ma. Clin #4s e $0ne7#l 2++2D65:5*5<8+ 1+. S:amsu((in S. K#lp#s"#pi serBi"s n#rmal. Kursus "#lp#s"#pi pra<PIT P3%I LII.Palem4an$2 2++1 11. Nuranna !. K#lp#s"#pi serBi"s a4n#rmal. Kursus "#lp#s"#pi pra<PIT P3%I LII.Palem4an$2 2++1 12. Bere" JS2 A(ashi ES2 'illan( PA. N#Ba"Vs %0ne7#l#$0. 2+ h e(. USA2 1>>*D1121<1151. 15. &anua4a IB. 3perasi %ine"#l#$i 3n"#l#$i. Dalam : &anua4a IB. Dasar<(asar Te"ni" 3perasi %ine"#l#$i. E%C : Ja"ar a : 2++6D62><65+. 16. B#sman FT2 Ma$ener DJ2 e al. Tum#r ala "elamin /ani a. Dalam : B#sman FT2 Ma$ener DJ2 e al. 3n"#l#$i. E(isi "elima. Y#$0a"ar a : 1>>*D6>6<8+,. 18. An(ri:#n#. Sin#psis Kan"er %ine"#l#$i. Ja"ar a : 2++5D 16<58. 1*. Ansari &A2 S ae4ler A2 Tain# )J2 e al. Dis in7 i#n #9 En(#7erBi7al an( En(#me rial A(#n#7ar7in#mas Immun#his #7hemi7al p1* E@pressi#n C#rrela e( Mi h 'uman Papill#maBirus -'PG. DNA De e7 i#n. Am J Sur$ Pa h#l 2++6D28:1*+<1*,. 1,. Mri$h TC2 Kurman )J2 Feren7C0 A. Blaus einVs Pa h#l#$0 #9 he Female %eni al Tra7 . F#ur h E(i i#n. Bal im#r:1>>5D 22><512.

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