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CURRICULUM VITAE
Nama
: DR. Poedjo hartono, dr.SpOG (K)
Lahir
: Probolinggo, 28 Maret 1955
Pekerjaan
: Divisi onkologi ginekologi
RSUD Dr. Soetomo Surabaya
FK Univ. Airlangga Surabaya
Alamat kantor
: jl. Mayjen dr. Moestopo 6-8 Surabaya
Telp. +62 31 5037732
Pendidikan
:
FKUA 1981
SpOG FKUA 1988
Konsultan Onkologi Ginekologi 2000
Doktor FKUA 2015
Riwayat Pekerjaan
:
Ka Puskesmas Dili Barat Timor Timur 1981
RSU Gianyar Bali 1989
RSUD DR. soetomo 1990
Organisasi
:
Ketua PG POGI 2015
Ketua MPPK IDI 2015
Ketua IDI cab. Surabaya 2012
HP, Email
:
+62 81 131 9905
[email protected]

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PERAN PATOLOGI ANATOMI
PADA KASUS GINEKOLOGI
Poedjo Hartono SpOG
2
PEMERIKSAAN PATOLOGI ANATOMI
DIAGNOSTIK (GOLDEN STANDARD)
PROGNOSIS
DERAJAT OPERASI
PENGOBATAN TAMBAHAN
ASPEK LEGAL
SKRINING / CASE FINDING
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SITUASI PENYAKIT KANKER DI INDONESIA
Dir . PTM
Prevalensi kanker 1, 4 per 1000 penduduk sekitar 330.000 orang
Kasus baru Kanker tertinggi di Indonesia untuk wanita adalah
Kanker Payudara 40 per 100.000 dengan angka kematian 21,5 per 100.000
Kanker leher rahim 17 per 100.000 dengan angka kematian 10 per 100.000
Kanker ovarium Lady Killer, kanker endometrium mulai meningkat
Kasus baru kanker tertinggi pada pria adalah kasus kanker paru ( 26 per 100.000)
dengan kematian 22 per 100.000 diikuti oleh kanker kolorektal 16 per 100.000
dengan kematian 10 per 100.000 penduduk
Pasien kanker datang ke RS sudah dalam stadium lanjut
CERVICAL CANCER
DEVELOPING COUNTRY
PREVENTABLE
NATURAL HISTORY, HPV
SCREENING 3%, CASE FINDING
VIA, SEE AND TREAT
VACCINE PROGRAM
ADVANCED STAGE
TREATMENT PROBLEM
LESI PRA KANKER / SITOLOGI
Standarisasi
pemeriksa, pemeriksaan dasar ginekologi
metode
hasil / kesimpulan
Sertifikasi
Sering berdampak hukum
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CERVICAL CANCER
CELL TYPE
RADICALITY
NODAL INVASION
PARAMETRIAL INVASION
LVSI
IMPORTANT PROGNOSTIC FACTORS
AJUVANT TX
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Squamous tumor and precursors
Glandular tumor and precursors
Endometrioid adenocarcinoma
Other epithelial tumors
Undifferentiated carcinoma
HISTOPATOLOGICAL CLASSIFICATION
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MICROINVASIVE CERVICAL CANCER /
EARLY STAGE
Stage Ia1 and Ia2 from CONIZATION : LVSI
+
LVSI
-
•Radical Hysterectomy
•Pelvic
lymphadenectomy
•Conservative
•Depends on the margin
of the specimen
ADJUVANT TREATMENT AFTER CERVICAL
CANCER SURGERY (STAGE IA1 – STAGE IIA)
Important Prognostic Factors :
1. Lymph node status
2. Radicality ( Vagina and parametrium)
3. Parametrial Involvement
4. LVSI
PF Squamous
+ 1 PF
Squamous + 2PF
Adeno + PF
Adenosquamous + PF
• Just Follow Up
• Adjuvant Radiation
• Adjuvant chemoradiaton
PF (PROGNOSTIC FACTOR)
1. Lymph node status
2. Radicality ( Vagina and parametrium)
3. Parametrial Involvement
4. LVSI
ENDOMETRIAL CANCER
ENDOMETRIAL CANCER
CLINICAL -- SURGICAL STAGING
GRADING CURRETAGE
CELL TYPE
GRADE
NODAL INVASION
CERVICAL INVOLVEMENT
GETTING INCREASE
ESTROGEN, PCOS
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
Hyperplasia :
1. Simple hyperplasia without atypia
2. Complex hyperplasia without atypia
3. Simple atypical hyperplasia
4. Complex atypical hyperplasia

Risk of Malignancy :

Simple hyperplasia without atypia – 1 of 93 patients (1 %)

Complex hyperplasia without atypia – 1 of 29 patients (3 %)

Simple atypical hyperplasia – 1 of 13 patients (8 %)

Complex atypical hyperplasia – 10 of 35 patients (29 %)
CURRETAGE SPECIMEN : HYPERPLASIA
CURRETAGE SPECIMEN : CELL TYPE
 Adenocarcinoma?
Clear Cell?
Papillary serous adenocarcinoma
 Clear
cell and Papillary serous adenocarcinoma
 Poor prognosis
 Extensive surgery
CURRETAGE SPECIMEN : GRADE
Grade is important
 Grade of endometrial cancer :
Grade I
Grade II
Grade III
 Grade I  Simple hysterectomy
 Grade III
 Very extensive surgery : Hysterectomy + Pelvic node +
Paraaortic node

ENDOMETRIAL CANCER SURGICAL SPECIMEN
What is important
1. Histological type
2. Grade
3. Myometrial invasion
4. Node status (if lymphadenectomy is done)
5. Cervical Involvement
These factors determine the adjuvant treatment after surgery
ADJUVANT TREATMENT

Low risk  Just follow up
Grade I-II
Invasion less than 50%
No cervical involvement

Intermediate risk  Vaginal Brachytherapy
Grade III + invasion < 50%
Grade I-II + invasion > 50%
•
High Risk  Vaginal brachytherapy + External Radiation
Grade III
Invasion > 50%
•
Lymph nodes +  External Radiation
OVARIAN CANCER
OVARIAN, TUBE AND PERITONEAL
CANCER
SURGICAL STAGING
FROZEN SECTION
CYTOLOGY
CELL TYPE
CELL DIFFERETIATION
RESIDUAL MASS
FNAB
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OVARIAN CANCER
 Cell

types
1.
“Borderline”
2.
Epithelial
3.
Germ Cell
4.
Sex cord stromal tumor
Clinical consequences :
Borderline  Just Tumor Extirpation
Germ Cell  Conservative surgery
Early stage : Cell differentiation
Advance stage : Residual mass after surgery
PROGNOSTIC FACTOR IN
OVARIAN CANCER
FROZEN SECTION IN
OVARIAN CANCER

Determine the extensiveness of surgery

At least VC can differenciate :
- Benign
- Borderline
- Epithelial ovarian cancer
- Non-epithelial ovarian cancer

Chemosensitive  Conservative surgery

All germ cell tumors need chemotherapy, except :
1. Dysgerminoma Stage IA
2. Immature Teratoma Stage IA, Grade 1

Grade is vey important in Immature Teratoma

Stage Ia grade 1  No Chemotherapy

Stage Ia grade 2-3  Chemotherapy
GERM CELL TUMOUR
TANTANGAN KEDEPAN
INDUSTRIALISASI KESEHATAN
GLOBALISASI
SJKN / BPJS
PROFESSIONAL TRUST
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FAKTA YANG ADA
MASYARAKAT BELUM TERLALU PERCAYA
HASIL KADANG DIPERTANYAKAN
SERING TERPAKSA DILAKUKAN REVIEW
BELUM ADA KESERAGAMAN
ADA KESENJANGAN
KOMUNIKASI ANTAR PROFESI KURANG BAIK
KESEJAHTERAAN ANGGOTA
TIDAK DIPERIKSAKAN PA
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USULAN SOLUSI
Team working internal / eksternal
Tumor board / up dating
Komunikasi
Standarisasi permintaan
Standarisasi pelaksanaan skrining / case finding
Standarisasi pembacaan
Standarisasi hasil
Peningkatan kualitas
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KESIMPULAN
PERAN PA SANGAT PENTING
KERJASAMA / TEAM WORKING
KOMUNIKASI
RUJUKAN, HELP, FOLLOW UP
MEETING / TUMOR BOARD
RUJUK BALIK , KONFIRMASI HASIL
PELATIHAN
NO SHAME, NO BLAME
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THERE IS NO BEST DOCTOR FOR CANCER
MANAGEMENT, BUT THERE IS ONLY THE BEST TEAM
MATURNUWUN, TERIMA KASIH
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