CURRICULUM VITAE Nama : DR. Poedjo hartono, dr.SpOG (K)

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1 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 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,

2 PERAN PATOLOGI ANATOMI PADA KASUS GINEKOLOGI
Poedjo Hartono SpOG

3 PEMERIKSAAN PATOLOGI ANATOMI
DIAGNOSTIK (GOLDEN STANDARD) PROGNOSIS DERAJAT OPERASI PENGOBATAN TAMBAHAN ASPEK LEGAL SKRINING / CASE FINDING

4 SITUASI PENYAKIT KANKER DI INDONESIA
Dir . PTM Prevalensi kanker 1, 4 per 1000 penduduk sekitar orang Kasus baru Kanker tertinggi di Indonesia untuk wanita adalah Kanker Payudara 40 per dengan angka kematian 21,5 per Kanker leher rahim 17 per dengan angka kematian 10 per Kanker ovarium Lady Killer, kanker endometrium mulai meningkat Kasus baru kanker tertinggi pada pria adalah kasus kanker paru ( 26 per ) dengan kematian 22 per diikuti oleh kanker kolorektal 16 per dengan kematian 10 per penduduk Pasien kanker datang ke RS sudah dalam stadium lanjut

5 Cervical Cancer. developing country. preventable. natural history, hpv
Cervical Cancer developing country preventable natural history, hpv screening 3%, case finding VIA, SEE AND TREAT vaccine program advanced stage treatment problem

6 Lesi pra kanker / sitologi
Standarisasi pemeriksa, pemeriksaan dasar ginekologi metode hasil / kesimpulan Sertifikasi Sering berdampak hukum

7 Cervical cancer CELL TYPE RADICALITY NODAL INVASION PARAMETRIAL INVASION LVSI IMPORTANT PROGNOSTIC FACTORS AJUVANT TX

8 HISTOPATOLOGICAL CLASSIFICATION
Squamous tumor and precursors Glandular tumor and precursors Endometrioid adenocarcinoma Other epithelial tumors Undifferentiated carcinoma HISTOPATOLOGICAL CLASSIFICATION

9 Microinvasive Cervical Cancer / early stage
Stage Ia1 and Ia2 from CONIZATION : LVSI Radical Hysterectomy Pelvic lymphadenectomy + Conservative Depends on the margin of the specimen - LVSI

10 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

11 PF - Squamous + 1 PF Just Follow Up Adjuvant Radiation
Adjuvant chemoradiaton Squamous + 2PF Adeno + PF Adenosquamous + PF PF (PROGNOSTIC FACTOR) 1. Lymph node status 2. Radicality ( Vagina and parametrium) 3. Parametrial Involvement 4. LVSI

12 Endometrial Cancer

13 ENDOMETRIAL CANCER CLINICAL -- SURGICAL STAGING GRADING CURRETAGE CELL TYPE GRADE NODAL INVASION CERVICAL INVOLVEMENT GETTING INCREASE ESTROGEN, PCOS

14 Curretage Specimen : Hyperplasia
Simple hyperplasia without atypia Complex hyperplasia without atypia Simple atypical hyperplasia 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

15 Curretage Specimen : Cell Type
Adenocarcinoma? Clear Cell? Papillary serous adenocarcinoma Clear cell and Papillary serous adenocarcinoma  Poor prognosis  Extensive surgery

16 Curretage Specimen : Grade
Grade is important Grade of endometrial cancer : Grade I Grade II Grade III Grade I  Simple hysterectomy  Very extensive surgery : Hysterectomy + Pelvic node + Paraaortic node

17 Endometrial Cancer Surgical Specimen
What is important Histological type Grade Myometrial invasion Node status (if lymphadenectomy is done) Cervical Involvement These factors determine the adjuvant treatment after surgery

18 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

19 Ovarian Cancer

20 OVARIAN, TUBE AND PERITONEAL CANCER
SURGICAL STAGING FROZEN SECTION CYTOLOGY CELL TYPE CELL DIFFERETIATION RESIDUAL MASS FNAB

21 Ovarian Cancer Cell types “Borderline” Epithelial Germ Cell
Sex cord stromal tumor Clinical consequences : Borderline  Just Tumor Extirpation Germ Cell  Conservative surgery

22 Prognostic Factor in Ovarian Cancer
Early stage : Cell differentiation Advance stage : Residual mass after surgery Prognostic Factor in Ovarian Cancer

23 Frozen Section in Ovarian Cancer
Determine the extensiveness of surgery At least VC can differenciate : - Benign - Borderline - Epithelial ovarian cancer - Non-epithelial ovarian cancer

24 Germ Cell Tumour 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

25 TANTANGAN KEDEPAN INDUSTRIALISASI KESEHATAN GLOBALISASI SJKN / BPJS
PROFESSIONAL TRUST

26 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

27 Usulan solusi Team working internal / eksternal Tumor board / up dating Komunikasi Standarisasi permintaan Standarisasi pelaksanaan skrining / case finding Standarisasi pembacaan Standarisasi hasil Peningkatan kualitas

28 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

29 THERE IS NO BEST DOCTOR FOR CANCER MANAGEMENT, BUT THERE IS ONLY THE BEST TEAM MATURNUWUN, TERIMA KASIH