Sunday, January 20, 2008

Payudara Benjol


Kepala benjol itu biasa. Kalo payudara benjol? Ehm.. Hati-hati ya...

Semua benjolan yang tidak normal, yang seharusnya tidak ada pada tubuh disebut tumor. Tumor ada yang jinak dan ada yang ganas. Tumor jinak disebut tumor saja , sedangkan tumor ganas disebut kanker.
.
Bila tumor atau kanker itu menyerang payudara maka disebut tumor atau kanker payudara. Untuk memastikan apakah benjolan itu tumor jinak atau kanker, harus dengan pemeriksaan histopatologi atau patologi anatomi (PA).
.
Untuk pemeriksaan histopatologi ini bahan yang diperiksa adalah dari tumornya sendiri, bisa sebagian atau seluruhnya. Tindakan pengambilan bahan contoh (sample) tumor untuk pemeriksaan ini disebut biopsi .
.
Pengobatan atau tindakan operasi pada tumor jinak dan kanker sangat jauh berbeda. Jenis tindakan disesuaikan dengan diagnosis klinis dan hasil PA. Untuk tumor dan kanker yang harus dioperasi , terdapat beberapa jenis operasi .
.
Pengangkatan tumor saja
Pada tumor payudara yang secara pemeriksaan klinis diyakini benar-benar jinak, maka tindakan operasinya adalah pengangkatan tumornya saja, sementara payudaranya tetap utuh. Bila ukuran tumornya tidak terlalu besar , operasi ini tidak memerlukan perawatan lama, dan bila memungkinkan biasanya dapat dengan operasi satu hari pulang (one day surgery).
.
Operasi dilaksanakan umumnya dengan pembiusan total di rumah sakit . Setelah tumor diangkat, tumor diperiksakan ke dokter patologi untuk diperiksa jenis tumornya. Bila hasilnya benar-benar jinak, maka tidak ada pengobatan lanjutan, kecuali untuk penyembuhan luka operasinya .
.
Pengangkatan tumor dan payudara.
Pada tumor payudara yang secara klinis ada dugaan kearah keganasan, maka harus dilakukan tindakan biopsi dulu. Jenis biopsi tergantung pada ukuran tumornya. Bila tumor ukuran kecil, biopsi dilakukan dengan pengangkatan seluruh tumor. Bila ukuran tumor besar, biopsi dilakukan dengan pengangkatan sebagian tumor saja.
.
Setelah dilakukan biopsi, kemudian diperiksakan ke bagian patologi anatomi untuk dipastikan apakah positif kanker atau bukan. Pemeriksaan PA ini bisa dilakukan pada saat penderita masih dibius total, bila sarana pemeriksaan potong beku sudah tersedia di rumah sakit tersebut, dimana hasil PA bisa ditentukan saat itu juga, sehingga cukup satu kali operasi saja. Bila tidak ada sarana potong beku, maka jaringan tumor dikirim ke dokter PA, dan hasilnya baru ada beberapa hari kemudian.
.
Bila hasilnya positif kanker, untuk kanker yang ukurannya tidak terlalu besar, maka jenis operasinya adalah pengangkatan tumor beserta payudaranya disertai pembersihan kelenjar getah bening di ketiaknya. Tindakan operasi seperti ini disebut mastektomi radikal. Operasi ini harus dilakukan di rumah sakit, dan dilakukan dengan pembiusan total, serta .memerlukan waktu perawatan cukup lama setelah operasinya yaitu sekitar satu minggu .
.
Bila ukuran tumornya sangat besar, maka dilakukan kemoterapi terlebih dahulu beberapa siklus, baru kemudian setelah itu dilakukan tindakan operasi mastektomi radikal. Besar kecilnya tumor dinilai oleh dokter dan juga dibandingkan dengan ukuran payudaranya.
.
Operasi penyelamatan payudara
Untuk kanker payudara dengan syarat-syarat tertentu, dapat dilakukan operasi penyelamatan payudara. Operasi ini berupa pengangkatan tumornya saja beserta beberapa cm jaringan sehat disekitar tumor sampai didapatkan jaringan payudara yang benar-benar bebas tumor, disertai pembersihan kelenjar getah bening ketiak, sementara payudara dipertahankan utuh. Jenis operasi ini dilakukan untuk kanker payudara dengan ukuran sekitar 2 cm dan letak tumornya tidak didaerah tengah payudara atau di daerah sekitar puting susu.
.
Sesudah operasi harus dilanjutkan dengan pengobatan radioterapi. Dilakukan di rumah sakit yang memiliki fasilitas pemeriksaan potong beku untuk pemeriksaan PA. Juga ada syarat dan indikasi lainnya. Bila syarat dan indikasi ini tidak terpenuhi, maka tidak dapat dilakukan jenis operasi ini dan sebagai alternatifnya dipilih operasi mastektomi radikal.
.
Rekonstruksi payudara
Bagi penderita kanker payudara yang masih menginginkan payudara tetapi payudaranya tidak mungkin dipertahankan, maka dapat dilakukan operasi rekonstruksi payudara.
.
Rekonstruksi payudara dilakukan dengan syarat dan indikasi tertentu. Rekonstruksi payudara ini dapat dilakukan segera setelah dilakukan operasi mastektomi atau dilakukan beberapa bulan atau tahun kemudian.
.
Salah satu jenis operasi ini adalah dengan mengambil otot dan kulit perut kemudian dipindahkan ke bekas operasi payudara yang telah diangkat dan dibentuk payudara baru. Sementara luka di perut ditutup kembali. Penentuan jenis operasi Apapun jenis operasi yang akan dilakukan , satu prinsip yang harus diutamakan adalah jenis operasi yang dipilih haruslah yang terbaik yang sesuai dengan kondisi penderita , jadi kasus per kasus.
.
Pemilihan tindakan operasi tetap didasarkan pada kaidah onkologi, yaitu menghindari terjadinya kekambuhan lokal di daerah operasi. Hal yang paling penting sedapat mungkin pasien bebas kanker terlebih dahulu. Setelah operasi dilanjutkan dengan pengobatan kombinasi kemoterapi. Bila memerlukan tindakan kosmetik untuk membentuk payudara baru, maka prinsip tersebut tetap diikuti, sehingga kekambuhan kembali kanker ditempat yang sama dapat dihindarkan.
.
Jadi untuk menentukan pemilihan jenis tindakan operasi ini, ditentukan oleh dokter yang akan menangani dengan mempertimbangkan syarat-syarat dan indikasinya. Namun penderita sebaiknya juga mengetahui rencana tindakan yang akan dilakukan, sehingga memahami mengapa tindakan itu dilakukan dengan segala resikonya. Walaupun sama mengidap kanker payudara, tindakan operasi yang dipilih untuk setiap penderita bisa berbeda tergantung pada stadium dan sifat kankernya .
.
Jika merasa ada benjolan, jangan terlalu khawatir berlebihan terlebih dahulu, takut payudara dibuang, sementara tumornya saja belum diperiksa. Sebaiknya segera periksakan ke dokter, untuk ditentukan diagnosisnya apakah tumor jinak atau ganas. Bila tumornya jinak , tumornya saja yang diangkat, payudara tetap utuh. Bila ganas, apa boleh buat, payudara beserta tumornya harus diangkat, bila tidak maka kanker akan menyebar kemana-mana, ke liver, ke tulang dan lainnya, dan akhirnya malah tidak dapat diobati dengan hasil yang baik.
PS: Gambar hasil rekonstruksi payudara dapat dilihat di http://www.msnbc.msn.com/id/22345759/

Sumber: Tulisan di atas ditulis oleh dr. Yusuf Heriady Spb SpBOnk dalam rubrik konsultasi kesehatan di Pontianak Post. Bagus ya. Kalah deh koran Jakarta..!

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