This document discusses cervical cancer in Indonesia. It notes that cervical cancer is the most frequent cancer in Indonesia, accounting for 34% of female cancers, yet over 70% of cases are diagnosed in advanced stages. Screening coverage in Indonesia is very low, at less than 5%, ideally it should be around 80%. The main problems related to cervical cancer in Indonesia include its geographical challenges as an archipelago, lack of cytology and treatment facilities, low compliance from patients, and low awareness, knowledge, and economic ability. Screening via Pap smears or visual inspection with acetic acid, early treatment, vaccination, and education are emphasized as key to prevention and reducing mortality from cervical cancer in Indonesia.

1. DR. DR. HARIYONO WINARTO, SPOG(K)
KANKER SERVIKS DI
INDONESIA

4. Gondhowiardjo S, et al. CO Glob Oncol. 2021

5. TAMPILAN LEHER RAHIM
Anatomi Serviks
Normal Kanker Serviks
Normal

6. ETIOLOGI
HPV
(Human Papilloma Virus)
• 99,7% Kanker Serviks disebabkan
oleh HPV onkogenik (penyebab
kanker)
• HPV 16&18 penyebab utama 70%
kanker serviks di dunia

7. STADIUM

8. Mild
Dysplasia
Moderate
Dysplasia
Severe
Dysplasia
Carcinoma
Insitu
(=Stage 0)
Cervical
Cancer
Pre cancer Lesion Cancer
SCREENING !
------------------- 3-17 years --------------------
HPV
PERJALANAN KANKER SERVIKS

9. FAKTOR RISIKO
Menikah usia
muda <20th
Berganti-ganti
pasangan
Infeksi menular
seksual
Merokok
Kekurangan vit
A/C/E
SETIAP PEREMPUAN berisiko terkena HPV penyebab
kanker serviks

10. GEJALA & TANDA
KANKER SERVIKS

11. Inspeksi Visual Asam Asetat
Tes Pap – Pap Smear
Kolposkopi
Servikografi
Tes HPV DNA
Biopsi
DETEKSI DINI

12. Inspeksi Visual Asam Asetat
Tes Pap – Pap Smear
Kolposkopi
Servikografi
Tes HPV DNA
Biopsi

13. Inspeksi Visual Asam Asetat
Tes Pap – Pap Smear
Kolposkopi
Servikografi
Tes HPV DNA
Biopsi

14. Inspeksi Visual Asam Asetat
Tes Pap – Pap Smear
Kolposkopi
Servikografi
Tes HPV DNA
Biopsi

15. Inspeksi Visual Asam Asetat
Tes Pap – Pap Smear
Kolposkopi
Servikografi
Tes HPV DNA
Biopsi

16. Inspeksi Visual Asam Asetat
Tes Pap – Pap Smear
Kolposkopi
Servikografi
Tes HPV DNA
Biopsi

17. PERBANDINGAN PAP SMEAR DAN IVA
Metode skrining PAP SMEAR IVA
Petugas kesehatan Sample takers ( Bidan /
perawat / Dokter Umum /
Dokter Spesialis )
Skrinner / Sitologist /
Patologist
Bidan
Perawat
Dokter umum
Dr. Spesialis
Sensitivitas 70-80% 65-96%
Spesifisitas 90-95% 54-98%
Hasil 1 hari – 1 bulan Langsung
Waktu periksa Diluar waktu haid, sehari
sebelumnya tidak senggama
Kapan saja (sebaiknya tidak
saat haid banyak)
Sarana Spekulum
Lampu sorot
Kaca benda
Laboratorium
Speukulum
Lampu sorot
Asam asetat
Biaya Rp. 50.000,00 – Rp.
150.000,00
Rp. 10.000,00
Dokumentasi Ada (dapat dinilai ulang) Tidak ada / sekarang dapat
difoto dengan kamera digital
atau smartphone

18. KAPAN WAKTU YANG TEPAT
UNTUK SCREENING?
Sudah
menikah
Seksual
aktif
>18th
beberapa
negara
1 kali
dalam
setahun

19.  The most frequent cancer in Indonesia
(34% of female cancer)
 Almost 70% in advanced stages ( > stage IIB)
 Very Low Screening coverage < 5% (ideally ~ 80%)
MASALAH UTAMA TERKAIT KANKER SERVIKS
DI INDONESIA
Indonesia consists of over 13.500 islands; Women at risk ± 48
million
Dirjen Pelayanan Medik Departemen Kesehatan RI. Badan Registrasi Kanker IAPI, Yayasan Kanker Indonesia. Kanker di Indonesia Tahun1998. Data Histopatologik.

20. Faktor Geografik  >13.000 pulau
Kurangnya fasilitas sitologi
Kurangnya fasilitas terapi
Kurangnya kepatuhan pasien
Sebagian besar kasus ditemukan
pada stadium lanjut
Rendahnya pengetahuan dan
kemampuan ekonomi
Program deteksi dini tes Pap masih
banyak kendala

21. KONSEP DASAR PENCEGAHAN
KANKER SERVIKS
• Screening (Pap Smear, IVA)
• Early treatment (Cryotherapy)
• (“See & treat” Program)
• Kesadaran
• Edukasi
• Vaksin HPV
Secondary
Tertiary
• Treatment Invasif Cancer
• Paliatif
• Screening Coverage (70-80%)
• Vaccination coverage
• Increasing the finding of
precancerous lesion
• Reducing the advance stage
• Reducing the mortality rate
GOAL

22. PENCEGAHAN
• Edukasi
• Kondom
• Vaksinasi
PENGOBATAN
• Stadium I-II  Operasi
• Stadium IIB – IIIB 
Radiasi
• Stadium IV  Paliatif
radiasi/
kemoterapi(Gabungan
Operasi/ Radiasi/
Kemoterapi)

23. KANKER SERVIKS DAPAT
DICEGAH!