BAB II

PEMBAHASAN
2.1 SKENARIO E
Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health
centre with chief complain of vaginal bleeding. She experienced post coital bleeding for 1
month. Since 1 years ago she has been complaining about vaginal discharge with smelly
odor and sometimes accompanied by vulvar itchy. She already has 2 children before and
the youngest child is 6 years old. Her husband is a truck driver. She has never gone to
doctor related to her complain about vaginal discharge, not using any medication, no
history of paps smear examination, and no history of HPV vaccination. She has a history of
using intrauterine device (IUD) as contraception for 5 years since her youngest child birth
and the IUD has been removed 1 year ago. Her older sister died two years ago caused by
breast cancer.
You act as the doctor in public health centre and be pleased to analyse this case.
In the examination findings:
Height : 155 cm, weight: 50 kg,
Blood pressure 120/80 mmHg, pulse: 80x/m, RR: 20x/m
Palpebral conjunctiva: anemic
Breast: there was no mass on both mammae
Abdomen: flat and souffl, symmetric, uterine fundus is not palpable, there are no mass, no
painful tenderness and no free fluid sign.
Internal Examination:
Inspection: vulva and urethra was normal, there was no mass on the vulva, urethra, hymen
and perineum
Speculum examination: mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed, no
infiltration to the vagina, flour +
Bimanual examination: cervix is soft, the external os is closed, no cervical motion
tenderness, exophytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the
vagina, uterine size is normal, both adnexa and parametrium are within normal limit.

Then you performed VIA, the result was you could define the external os,
squamocollumnar junction and there was thick acetowhite epithelium at the 2 oclock until
5 oclock position, so you performed biopsy.
Laboratory result: Hb 8,3 g/dL; WBC 12.000/mm3; Thrombocite 770.000/mm3; ESR 30
mm/hour.
The Next week, the patient come with histopathology result squamous cell carcinoma,
moderate differentiation, without limphovascular space invasion. You gave the informed
consent to the patient and family to refer her to the hospital, she asked you the diagnosis,
kind of examination that will be performed to her, and the possible treatment.

2.2 Paparan
I. Klarifikasi Istilah
No. Istilah

Pengertian

Perdarahan

Keluarnya darah dari liang vagina

pervaginam
Pendarahan

Keluarnya darah dari liang vagina setelah berhubungan seksual dan

postcoital

paling banyak disebabkan karena dysplasia serviks dan kanker

serviks

Keluarnya lendir dengan berbau busuk

Vaginal
discharge
berbau busuk
Pemeriksaan

Pemeriksaan usapan mulut Rahim untuk melihat sel sel serviks

paps smear

dibawah mikroskop. Pap smear merupakan tes screening untuk

IUD

mendeteksi dini kanker serviks

Sebuah alat kontrasepsi berupa kumparan kecil yang dimasukkan ke

Vaksinasi HPV

Breast cancer

Kanker pada payudara

Exophytic

Tumbuh kearah permukaan luar, istilah menunjukan proliferasi pada

dalam rahim untuk mencegah kehamilan

epitel permukaan atau bagian luar organ atau struktur lainnya tempat
9

pertumbuhan itu berasal

Pemeriksaan screening kanker serviks dengan cara inspkesi visual

Tes VIA

pada serviks dengan pemberian asam asetat

10

Acetowhite

11

epithelium
Squamous

cell

Suatu proliferasi ganas dari keratinosit epidermis yang merupakan

carcinoma

tipe sel epidermis yang paling banyak dan merupakan salah satu

12

Vulvar itchy

kanker kulit yang paling sering dijumpai setelah basalioma

Gatal pada daerah vulva

13

contraception

Pengaturan kelahiran

II. Identifikasi masalah

Identifikasi
Keluhan utama

Vaginal bleeding

Keluhan tambahan

Post coital bleeding for 1 month

Riwayat perjalanan penyakit

Vaginal discharge for 1 year, sometimes

accompanied by vulvar itchy

Riwayat social ekonomi

Riwayat kehamilan

Middle income family, husband is a truck driver

Riwayat penggunaan kontrasepsi

Penggunaan kontrasepsi IUD 5 tahun yang lalu dan

Riwayat keluarga

dilepas 1 tahun yang lalu

kakak perempuan meninggal 2 tahun yang lalu

P2A0

karena kanker payudara

Pemeriksaan fisik

Height : 155 cm, weight: 50 kg,

Blood pressure 120/80 mmHg, pulse: 80x/m,
RR: 20x/m
Palpebral conjunctiva: anemic
Breast: there was no mass on both mammae
Abdomen: flat and souffl, symmetric, uterine
fundus is not palpable, there are no mass, no

Pemeriksaan dalam

painful tenderness and no free fluid sign.

Inspection: vulva and urethra was normal, there
was no mass on the vulva, urethra, hymen and
perineum
Speculum examination: mass on the portio size
2x2 cm, exophytic, fragile, easy to bleed, no
infiltration to the vagina, flour +
Bimanual examination: cervix is soft, the
external os is closed, no cervical motion
tenderness, exophytic mass size 2x2x1 cm,
fragile, easy to bleed, no infiltration to the
vagina, uterine size is normal, both adnexa and

Pemeriksaan laboratorium

parametrium are within normal limit.

Hb 8,3 g/dL; WBC 12.000/mm3; Thrombocite
770.000/mm3; ESR 30 mm/hour.

Riwayat pencegahan dan pengobatan

Tidak pernah pap smear, vaksin HPV, dan konsumsi

Riwayat tindakan

obat-obatan.
Dilakukan pemeriksaan VIA, dengan hasil terlihat os
eksternal squamous collumnair junction dan epitel
acetowhite pada pukul 2 sampai 5. Kemudian
dilakukan biopsi