BAB II PEMBAHASAN 2.1 SKENARIO E Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health centre with chief complain of vaginal bleeding. She experienced post coital bleeding for 1 month. Since 1 years ago she has been complaining about vaginal discharge with smelly odor and sometimes accompanied by vulvar itchy. She already has 2 children before and the youngest child is 6 years old. Her husband is a truck driver. She has never gone to doctor related to her complain about vaginal discharge, not using any medication, no history of paps smear examination, and no history of HPV vaccination. She has a history of using intrauterine device (IUD) as contraception for 5 years since her youngest child birth and the IUD has been removed 1 year ago. Her older sister died two years ago caused by breast cancer. You act as the doctor in public health centre and be pleased to analyse this case. In the examination findings: Height : 155 cm, weight: 50 kg, Blood pressure 120/80 mmHg, pulse: 80x/m, RR: 20x/m Palpebral conjunctiva: anemic Breast: there was no mass on both mammae Abdomen: flat and soufflé, symmetric, uterine fundus is not palpable, there are no mass, no painful tenderness and no free fluid sign. Internal Examination: Inspection: vulva and urethra was normal, there was no mass on the vulva, urethra, hymen and perineum Speculum examination: mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed, no infiltration to the vagina, flour + Bimanual examination: cervix is soft, the external os is closed, no cervical motion tenderness, exophytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the vagina, uterine size is normal, both adnexa and parametrium are within normal limit.
Then you performed VIA, the result was you could define the external os, squamocollumnar junction and there was thick acetowhite epithelium at the 2 o’clock until 5 o’clock position, so you performed biopsy. Laboratory result: Hb 8,3 g/dL; WBC 12.000/mm3; Thrombocite 770.000/mm3; ESR 30 mm/hour. The Next week, the patient come with histopathology result ‘’squamous cell carcinoma, moderate differentiation, without limphovascular space invasion”. You gave the informed consent to the patient and family to refer her to the hospital, she asked you the diagnosis, kind of examination that will be performed to her, and the possible treatment.
2.2 Paparan I. Klarifikasi Istilah No. Istilah
Pengertian
1
Perdarahan
Keluarnya darah dari liang vagina
2
pervaginam Pendarahan
Keluarnya darah dari liang vagina setelah berhubungan seksual dan
postcoital
paling banyak disebabkan karena dysplasia serviks dan kanker serviks
3
Keluarnya lendir dengan berbau busuk
Vaginal discharge berbau busuk Pemeriksaan
Pemeriksaan usapan mulut Rahim untuk melihat sel sel serviks
paps smear
dibawah mikroskop. Pap smear merupakan tes screening untuk
5
IUD
mendeteksi dini kanker serviks Sebuah alat kontrasepsi berupa kumparan kecil yang dimasukkan ke
6
Vaksinasi HPV
7
Breast cancer
Kanker pada payudara
8
Exophytic
Tumbuh kearah permukaan luar, istilah menunjukan proliferasi pada
4
dalam rahim untuk mencegah kehamilan
epitel permukaan atau bagian luar organ atau struktur lainnya tempat 9
pertumbuhan itu berasal Pemeriksaan screening kanker serviks dengan cara inspkesi visual
Tes VIA
pada serviks dengan pemberian asam asetat 10
Acetowhite
11
epithelium Squamous
cell
Suatu proliferasi ganas dari keratinosit epidermis yang merupakan
carcinoma
tipe sel epidermis yang paling banyak dan merupakan salah satu
12
Vulvar itchy
kanker kulit yang paling sering dijumpai setelah basalioma Gatal pada daerah vulva
13
contraception
Pengaturan kelahiran
II. Identifikasi masalah Identifikasi Keluhan utama
Vaginal bleeding
Keluhan tambahan
Post coital bleeding for 1 month
Riwayat perjalanan penyakit
Vaginal discharge for 1 year, sometimes accompanied by vulvar itchy
Riwayat social ekonomi Riwayat kehamilan
Middle income family, husband is a truck driver
Riwayat penggunaan kontrasepsi
Penggunaan kontrasepsi IUD 5 tahun yang lalu dan
Riwayat keluarga
dilepas 1 tahun yang lalu kakak perempuan meninggal 2 tahun yang lalu
P2A0
karena kanker payudara
Pemeriksaan fisik
Height : 155 cm, weight: 50 kg, Blood pressure 120/80 mmHg, pulse: 80x/m, RR: 20x/m Palpebral conjunctiva: anemic Breast: there was no mass on both mammae Abdomen: flat and soufflé, symmetric, uterine fundus is not palpable, there are no mass, no
Pemeriksaan dalam
painful tenderness and no free fluid sign. Inspection: vulva and urethra was normal, there was no mass on the vulva, urethra, hymen and perineum Speculum examination: mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed, no infiltration to the vagina, flour + Bimanual examination: cervix is soft, the external os is closed, no cervical motion tenderness, exophytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the vagina, uterine size is normal, both adnexa and
Pemeriksaan laboratorium
parametrium are within normal limit. Hb 8,3 g/dL; WBC 12.000/mm3; Thrombocite 770.000/mm3; ESR 30 mm/hour.
Riwayat pencegahan dan pengobatan
Tidak pernah pap smear, vaksin HPV, dan konsumsi
Riwayat tindakan
obat-obatan. Dilakukan pemeriksaan VIA, dengan hasil terlihat os eksternal squamous collumnair junction dan epitel acetowhite pada pukul 2 sampai 5. Kemudian dilakukan biopsi
