Pre Invasive Lesion Of Cervix

PRE INVASIVE LESION OF CERVIX LESI PRAKANKER

Fadhlina Muharmi Harahap 0708112239

DEFINISI

• Tumbuhnya sel-sel abnormal pada jaringan leher rahim (serviks) • Tumor ganas yang tumbuh di dalam leher rahim/serviks (bagian terendah dari rahim yang menempel pada puncak vagina) • Adanya lesi atau kelainan pada perubahanperubahan epitel leher rahim menuju keganasan

EPIDEMIOLOGI

• Tumor ganas ginekologik  peringkat pertama • Sarwono  1975-1979  RSUGM/RSUP Sardjito 179 diantara 263 kasus (68,1%) • Soeripto dkk  Prop D.I.Y  1970 – 73 [25,7%] 1980 – 82 [20%] • American Cancer Society  US  2009  11,270 kasus baru • Umur  30-60 tahun  >>> 45-50 tahun

ETIOLOGY

Classification of HPV Types by Oncogenic Risk HPV subtypes 16, 18, 45, 56

Risk category High

30, 31, 33, 35, 39, 51, 52, 58, Intermediate 66 6, 11, 42, 43, 44, 53, 54, 55

Low

• Human immunodeficiency virus – a higher prevalence of HPV in HIV-seropositive women than in seronegative women, and the HPV prevalence was directly proportional to the severity of immunosuppression as measured by CD4 counts. – Impaired lymphocyte function has been postulated to enhance latent or subclinical HPV activity, resulting in a higher rate of persistent infection.

RISKS

• • • •

Early coitarche Multiple sexual partners Increased parity Smokers

KLASIFIKASI

1. NIS 1/displasia ringan  perubahan mencakup 1/3 tebal epitel & atipia sel masih ringan. 2. NIS 2/displasia sedang  perubahan mencakup ½-¾ tebal epitel & atipia derajat sedang. 3. NIS 3/displasia berat & karsinoma insitu  perubahan mencakup ¾ atau seluruh tebal dan tidak teratur, atipia sel berat serta ditemukan mitosis sel.

PATOPHYSIOLOGY

SCJ • The location of the SCJ varies with age and hormonal status. • It everts outward onto the ectocervix during adolescence, pregnancy, & with use of combination hormonal contraceptives. • It regresses into the endocervical canal with menopause & other low-estrogen states