Wanita dan

kanser
DR NIK ROSMAWATI NIK HUSAIN

MD(USM), MASTER OF COMMUNITY MEDICINE (USM)

PENSYARAH, JABATAN PERUBATAN MASYARAKAT
KANSER

PAYUDARA
 KONSEP KANSER /BARAH
 cells change and grow out of control
 Most cancer cells form a lump or mass called a tumor, and are
named after the part of the body where the tumor first starts
 Most tumors in the breast are benign; that is, they are not
cancer at all, abnormal growths, but they do not grow and
spread, and are not life threatening
 Some breast tumors are cancerous, but are called in situ,
confined within the ducts or lobules, majority will not progress to
become an invasive tumor, and at this early stage nearly all of
these cancers can be cured.
 Other cancerous breast tumors are invasive, or infiltrating
 local stage; confined to the breast;
 regional stage; spread to the lymph nodes;
 distant stage; metastasized (spread to distant sites).
 Breast Anatomy

Breast profile:
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
Lymph node areas adjacent to breast area.
E fat
A pectoralis major muscle
F pectoralis major muscle
B axillary lymph nodes: levels I
G chest wall/rib cage
C axillary lymph nodes: levels II
D axillary lymph nodes: levels III
Enlargement:
E supraclavicular lymph nodes
A normal duct cells
F internal mammary lymph nodes
B basement membrane
C lumen (center of duct
Range of Ductal Vascular and
Carcinoma in situ (DCIS) Lymphatic Invasion
 Epidemiology of Breast Ca -
WORLDWIDE
 most common cancer among women,
nearly one of every three cancers
diagnosed in American women
 > than 1 million cases annually
(IR=>80/10,000)
 2nd leading cause of death by Ca in
women (1% occur in male)
 Incidence is high in developed country
(US,UK<Australia), but mortality rate is
low there compare to the developing
countries
 There is a marked geographical diff due
to genetic, lifestyle and environ
Epidemiology of Breast Ca - WORLDWIDE
Epidemiology of Breast Ca - WORLDWIDE
Epidemiology of Breast Ca - MALAYSIA

In 2003, 3738 incidence of BC

Accounted for 31.3 % of all newly
diagnosed cancers in women
Commonest female cancer in all age
groups from the age of 15 years
64.1% were in women aged 40-59 years
Mortality high in Malay

Malaysian Cancer Registry 2003-2005

Percentage of all cancers
Percentage of all cancers
Percentage of all cancers
CR= crude rate (per 100,000 per year)
 TANDA-TANDA KANSER
PAYUDARA
Most- painless mass
10% of patients - breast pain and no mass
Less common symptoms;
 persistent changes to the breast - thickening,
swelling, skin irritation or distortion
 nipple symptoms - spontaneous discharge,
erosion, inversion, or tenderness

Note: Early breast cancer, when it is most treatable,

typically does not produce any symptoms.
TANDA-TANDA KANSER
PAYUDARA
TANDA-TANDA KANSER
PAYUDARA
TANDA-TANDA KANSER
PAYUDARA
 TANDA-TANDA AM KANSER
PAYUDARA

Cepat letih dan rasa tidak sihat

Hilang selera makan
Susut berat badan
Sakit-sakit seluruh badan dan tulang
How can breast cancer
be detected early?
Kepentingan Mammogram & PSP
 Mammogram
 best method available
 identify cancer several years before physical
symptoms develop.
 low-dose x-ray procedure that allows visualization of
the internal structure of the breast
 detect ~ 90% of the breast
cancers in women without
symptoms
 more accurate in
postmenopausal women
compared with
premenopausal women
Mammogram
Pemeriksaan Sendiri Payudara

Gunakan tapak jari-jari

Kaedah –
Vertical Strip Method
Circular Method
Breast Self-Exam - Step 1
Begin by looking at your breasts in the
mirror with your shoulders straight and
your arms on your hips

Here's what you should look for:

Breasts that are their usual size, shape,
and color
Breasts that are evenly shaped without
visible distortion or swelling

If you see any of the following changes,

bring them to your doctor's attention:
Dimpling, puckering, or bulging of the skin
A nipple that has changed position or
become inverted (pushed inward instead
of sticking out).
Redness, soreness, rash, or swelling
Breast Self-Exam - Steps 2 and 3

 Raise arms and look for

the same changes
 While you're at the mirror,
gently squeeze each
nipple between your
finger and thumb and
check for nipple
discharge
 Breast Self-Exam - Step 4

Feel your breasts while lying down, using

your right hand to feel your left breast and
then your left hand to feel your right
breast.
Breast Self-Exam - Step 5
 Finally, feel your breasts
while standing or sitting.
 Many women find that the
easiest way to feel their
breasts is when their skin is
wet and slippery, so they like
to do this step in the shower
 Checking your Armpit
Bring your right arm down by
your side and feel your
armpit firmly and carefully for
any lumps.
 RAWATAN KANSER PAYUDARA
 Peringkat awal - Rawatan bertujuan untuk
menyembuhkan pesakit dari kanser payudara
 Peringkat lanjut - Rawatan bertujuan
memastikan kualiti hidup yang sebaik mungkin
dalam masa yang ada
 RAWATAN KANSER PAYUDARA
1. Surgery : The primary goal of breast cancer surgery
is to remove the cancer from the breast and lymph
nodes
 Lumpectomy - Hanya membuang benjolan kanser,
(jika saiz Benjolan < 2 sm)
 Simple or total mastectomy - removal of the entire
breast
 Modified radical mastectomy - removal of the entire
breast and lymph nodes under the arm (not include
removal of the underlying chest wall)
 Radical mastectomy - removal of the underlying chest
wall muscle
 RAWATAN KANSER PAYUDARA
2. Radiation Therapy
 to destroy cancer cells remaining in the breast, chest wall, or
underarm area after surgery
 or to reduce the size of a tumor before surgery

3. Systemic Therapy
a) chemotherapy [cyclophosphamide, methotrexate, fluorouracil,
doxorubicin (adriamycin), epirubicin, and paclitaxel (taxol)]
 Adjuvant systemic therapy is used after all visible cancer has been
surgically removed in order to kill any undetected tumor cells that
may have migrated to other parts of the body - reducing rates of
recurrence and death that persist more than 15 years after
treatment.
 treating women with advanced breast cancer
b) hormone therapy - Tamoxifen
 Lumpectomy

A: dark area indicates tumor

B: light pink highlighted area indicates tissue removed at lumpectomy
 Total (Simple) Mastectomy eg; multiple or large
areas of ductal carcinoma in situ (DCIS)

removes the entire

breast.
No removal of axillary
lymph node dissection
No muscles are
removed from beneath
the breast

A: pink highlighted area indicates tissue removed at mastectomy

B: axillary lymph nodes: levels I
C: axillary lymph nodes: levels II
D: axillary lymph nodes: levels III
 Radical Mastectomy
A: pink highlighted area indicates tissue
removed at mastectomy
B: axillary lymph nodes: levels I
C: axillary lymph nodes: levels II
D: axillary lymph nodes: levels III
E: supraclavicular lymph nodes
F: internal mammary lymph nodes
removal of both breast tissue and
lymph nodes levels I and II
No muscles are removed from
beneath the breast (modified
radical)
removes the chest wall muscles
under the breast and level III LN
(radical)
 Breast reconstruction
Right modified radical mastectomy, immediate
TRAM-flap reconstruction, chest wall radiation,
later lymphedema
Left modified radical
mastectomy with immediate
reconstruction, tissue
expander, saline implant
 Can breast cancer be prevented?

At this time, there is no known strategy

Best strategy
early detection through BSE & mammography
increase physical activity
minimizing alcohol intake
Avoiding obesity
antiestrogen drug tamoxifen (women at very high Risk)
– side effects, particularly an increased risk of
endometrial cancer
Prophylactic mastectomy - one or both breasts are
removed before there is a known breast cancer
TERIMA
KASIH