The procedures, techniques and equipment aspiration biopsy cytology is simple and cheap with a high diagnostic accuracy. The combination of aspiration biopsy cytology and mammography provides an assessment of alternative diagnosis, if the aspiration biopsy can not be done or failed to provide correct information.
Most breast cancers are found by the patient himself, which means the condition inoperable advanced stage. Because of the size of tumors usually affect the prognosis, then the response given priority on efforts to find these tumors in asymptomatic tiny size by: (one) breast self-examination (SARARI) and (five) clinical breast examination (SARANIK) by physicians, midwives or paramedics trained. If the second examination nodule is found, then the examination followed by (two) aspiration biopsy cytology with or without (two) mammography or (three) surgical biopsy.
Breast tumor always give the impression of intimidating for females. In fact, plenty of specialists agree that every nodule on breast cancer is regarded as a group in females at high risk although the likelihood of a benign tumor can not be ignored. The opinion that "excessive" is understandable, given the high incidence of breast cancer not only in developing countries, but also in developed countries. In Indonesia, breast cancer ranked second from the existing types of cancer and about 60-80% was found at an advanced stage are deadly.
INTRODUCTION
The purpose of this paper is to give various simple approach to finding breast cancer at an early stage in an effective and efieisn.
The growth rate or stage of breast cancer tumor is determined, the spread in lymph nodes in the armpit or the supraclavicular and other organs such as lung, liver and bone. The smaller the tumor, the smaller the likelihood of the spread of tumors and healing surgical procedure can be expected although its "unpredictable" because of the likelihood mikrometastasis can not be ignored (five). Therefore prevention of breast cancer today priority on efforts to find cancer in sizes as tiny as feasible.
The reason for breast cancer is not clearly known, but hormonal influences are a significant part. If in females aged less than 35 years carried out ovarian or adrenal castration, then the risk of breast cancer in females is smaller than that of ordinary females. Females who menarkhe at age before 11 years and females who are difficult to babies, the incidence of breast cancer is higher than normal females.
Etiology
Outside factors, among others, the likelihood of food, presumably related to the incidence of breast cancer. The incidence of breast cancer in Japanese females is lower than Western females.
Group risk
one. Females aged over 40 years
five. Parents (mothers) with breast cancer
two. Relatives (brother, brother) with breast cancer
two. Ever had cancer in breast
three. Patients with benign breast tumors
6. First pregnancy occurs after age 35 years.
Group risk is often helpful in diagnosis of breast carcinoma. What is meant by risk group is the group of females who have a higher probability of contracting breast cancer, with criteria:
95% Breast cancer is carcinoma, originating from glandular epithelium and breast lines. Growth begins in the ducts or glands called lobules noinvasif carcinoma. Then the tumor broke through the outer walls of the ducts or lobules and glands in the area of ��invasion in to the stroma, which is called invasive carcinoma. In the later growth of the tumor extends in to the fascia pectoralis muscle or skin area cause adhesions, adhesions. In this condition, categorized as an advanced stage inoperable tumor.
GROWTH
The spread of tumor occurs through the lymphatic vessels, deposits and grow in lymph nodes, and axillary lymph nodes or supraclavicular enlarged. Then through the blood vessels, the tumors spread to distant organs such as lung, liver, bone and brain. But from research specialists, mikrometastasis in distant organs can also occur without first distributing limfogen (five).
Some authors propose the idea that breast carcinoma is a systemic disease, although a tiny tumor, but the likelihood can not be ignored mikrometastasis. However, staging and prognosis of breast carcinoma is usually determined based on tumor size, extensive invasion of the breast, axillary lymph node involvement or supraclavicular and metastasis to distant organs. The smaller the tumor size, growth rate / lower stage and better prognosis.
Power factor deterrent body
Most widespread of progressive breast carcinoma, some grow latent for years and some are even regress (Townsend). This incident is presumably related to the body's defense power factor which sponsored the lymphoid tissue. Defective lymphocyte reaction in lymph nodes in ila speed up the growth of tumors and worse prognosis. In addition to the hormone dependency of tumors, estrogen effect on tumor growth.
CLINICAL SYMPTOMS
The main patient complaint was swelling of the breast. Feelings of pain never occurs, even if there was to appear in growth rates further. Therefore there is no pain complaints, patients do not feel the necessity to go seek treatment, so that the tumors allowed to grow without realizing the danger that will happen. That is why most (60-80%) patients with breast cancer was present in the growth rate of advanced inoperable.
In such a situation often present in tumors cling to the skin or look like boils or ulcers accompanied by swollen lymph nodes in the armpit or the neck. In such disease states, treatment is usually only a palliative. Healing treatment can be done if the tumor is present in tiny size or the early stages.
EARLY DETECTION METHOD
Despite advances in cancer treatment sitostatica increasing, but the discovery of tumors at an early stage is an important factor in breast cancer prevention. Most breast cancers are found by the patients themselves, meaning that the tumor in the growth rate further. To find these tumors at an early stage takes the initiative of patients and medical examination:
one) breast self-examination (SARARI)
five) by clinical breast examination (SARANIS)
Breast self examination was shown to find tumors in the tiny size. With a specific pattern of breast examination every month checked himself 5-7 days after menstruation stops. Breast self-examination time was in the shower is effective as using a lump of soap more basically palpable. If palpable lump although tiny and painless, in females at high risk groups, give you a warning to the relatives doctor or the doctor at the hospital / health middle. According to research by specialists, SARARI valuable in the detection of breast cancer as early as feasible (five, two).
SARANIS carried out systematically by following these steps:
GP is the spearhead in the response to public health; are estimated to have ample opportunity to find tiny size breast cancer. This chance is feasible, if at all females aged over 40 years of age or females who belonged to high risk, although he came because of other diseases, clinical breast examination (SARANIS) by a doctor, midwife or paramedic females is a strategy to break through the barriers " culture of disgrace that a doctor examined the man who is often happens in a clinic or health middle. Some authors document that the content specialist is not unusual to find tiny breast tumors.
two) Examination of mammography
one. The patient sits facing the medical officer, observed simetrisasi or alter the type of both breasts.
five. Both the patient's hand raised above her head as he noticed simetrisasi or changes in the second movement of the breast. The existence of tension on the skin is a sign of feasible malignancy. To see more clearly, pull the skin that covers the mass is pressed between fingers and occurred dimpling sign.
two. Palpate lymph nodes in the axillary region performed with the patient's hand placed casually in the examiner's hand pads.
two. At the position of head flexion, palpable supraclavicular area closely to see the likelihood of enlarged lymph nodes.
three. In the supine position, both breasts palpated systematically began to edge up to the local area breast areola. Palpation is more intensive in the lateral upper quadrant area, because in this region is more often encountered carcinoma. More clearly palpable nodules in the skin of the breast if dilapukan soap while palpated.
If on examination SARANIS SARARI or found a lump in the breast, followed by a mammography examination. Mammography examination followed by pathological examination: aspiration biopsy cytology or surgical biopsy. Diagnostic accuracy of mammography is kind of 80%. Another indication of mammography are females with complaints that the risk class of the nipple discharge brown or mixed blood. Lately appear xeromamografi advanced device that has the ability to more correct detection.
Mammography is a photograph of the breast using a special device. Simple method, no pain and no injection of contrast. In this way the tiny size of breast cancer 0.5 cm can be detected, even this process can be used as a mass screening device, high-risk groups, although tumomya not palpable.
Ultrasound is often used for the diagnosis of cysts in the breast. However, with the use of ultrasound aspiration cytology dwindle.
two) aspiration biopsy
* Preoperative diagnosis of suspected malignant tumor clinic.
* The diagnosis of malignant tumors konfirmatif clinic or recurrent tumor.
* Diagnosis of tumors or neoplastic nopnneoplastik.
* Taking of aspirates for culture or research material.
Needle aspiration biopsy cytology examination is often used as a diagnostic procedure various tumors including breast tumors with the indication:
Techniques and equipment is simple, cheap and fast and there was no significant complications. Using a fine needle and plastic syringe ten ml, tissue extract material was taken, made preparations to remove and stained with MGG. In a couple of minutes (15-30 minutes) preoperative diagnosis can be determined and in a short time further action can be determined. Diagnostic accuracy of cytology BAJAH 80-96% and with the combination of mammography diagnostic accuracy increased to 98.7%.
Positive cytology is a mandate to survey metastasis and treatment plan. However, negative cytology, yet can be used as a handle to select the therapy because of the likelihood of false negatives may occur. In such cases require to be thought about aspects of the clinic, where clinical aspects in accordance with negative cytology, the surgical procedure can be performed. In contrast to the case where a negative cytology does not comply with the clinic to do a surgical biopsy examination. Application procedures aspiration cytology diagnosis of breast tumors, allowing management simpler.
three) True-cut
Cyst is indication of aspiration biopsy cytology. Clear cyst liquid when the liquid is usually benign and evacuated, cysts are not palpable (collapse) and often do not reappear. However, if the chocolate cyst liquid or blood and quickly intervened repeatedly, it is necessary to do other tests such as mammography and biopsy.
6) Open biopsy
The network obtained using large-caliber needle equipped with cutting tools network. Tissues were done under local or general anesthesia. This process is not widely used anymore because of the aspiration biopsy cytology.
Open biopsy (open biopsy) is a procedure for removal of tissue by minor surgical procedure, excision or incision is performed as a preoperative diagnosis or operationam Durante. In hospitals that do not have facilities aspiration cytology or mammography, the breast lumps on each open do open biopsy.
Durante operationam incision biopsy and histopathologic examination of frozen tissue with a cutting method (frozen section) was conducted to select the nature of benign or malignant tumors. In a short time (5-10 minutes) the nature of the tumor can be determined and surgical procedure can be performed in stage.
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