EVALUASI PROGRAM DETEKSI DINI KANKER CERVIX

METODE SEE AND TREAT (SINGLE VISITE APROACH)

DENGAN PEMERIKSAAN INSPEKSI VISUAL ASETAT DAN
KRIOTERAPI DI KABUPATEN KARAWANG

Oleh:
BERLAND BUDIMAN
NPM 1304-2113-0001

Pembimbing :
Dr. dr. Yudi M.H., SpOG(K)DMAS
dr. Ali Budi H., SpOG(K)

USULAN PENELITIAN

Untuk memenuhi salah satu syarat ujian guna memperoleh gelar

Spesialis Obstetri dan Ginekologi Program Pendidikan Dokter Spesialis-1

DEPARTEMEN OBSTETRI DAN GINEKOLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS PADJADJARAN
RSUP Dr. HASAN SADIKIN
BANDUNG
2017
EVALUASI PROGRAM DETEKSI DINI KANKER CERVIX
METODE SEE AND TREAT (SINGLE VISITE APROACH)
DENGAN PEMERIKSAAN INSPEKSI VISUAL ASETAT DAN
KRIOTERAPI DI KABUPATEN KARAWANG

Oleh
Berland Budiman
NPM: 1304-2113-0001

USULAN PENELITIAN
Untuk memenuhi salah satu syarat ujian guna memperoleh gelar
Spesialis Obstetri dan Ginekologi Program Pendidikan Dokter Spesialis-1

Telah disetujui oleh Tim Pembimbing pada tanggal seperti tertera di

bawah ini
Bandung, April 2017

Dr. dr. Yudi M.H., SpOG(K), DMAS dr. Ali Budi H., SpOG(K)

Tim Pembimbing Tim Pembimbing

 DAFTAR ISI

BAB I PENDAHULUAN .........................................................................................1

1.1 Latar Belakang Penelitian .................................................................................1

1.2 Rumusan Masalah.............................................................................................9

1.3 Tujuan Penelitian ..............................................................................................9

1.4 Kegunaan Penelitian .........................................................................................9

1.4.1 Kegunaan Praktis .....................................................................................9

1.4.2 Kegunaan Ilmiah ......................................................................................10

BAB II TINJAUAN PUSTAKA..............................................................................11

2.1 Kajian Pustaka ..................................................................................................11

2.1.1 Evaluasi Program .....................................................................................11

2.1.1.1 Definisi Evaluasi Program ..........................................................11

2.1.1.2 Manfaat Evaluasi Program ..........................................................12

2.1.2 Sistem Kesehatan WHO ..........................................................................13

2.1.2.1 Komponen Kunci Kontrol dan Pencegahan Kanker Serviks

Komprehensif ..........................................................................................15

2.1.2.2 Penetapan struktur manajemen program .....................................18

2.1.2.3 Peran koordinator nasional ..........................................................19

2.1.2.4 Peran tim manajemen multi disiplin nasional .............................21

2.1.3 Perencanaan dan Persiapan Program .......................................................21

2.1.3.1 Perencanaan: pertimbangan kunci program ................................22

 2.1.3.2 Langkah-langkah dan persiapan untuk memperkenalkan

program kontrol dan pencegahan kanker serviks nasional

menggunakan pendekatan strategis .........................................................23

2.1.3.3 Implementasi program.................................................................24

2.1.3.4 Monitoring dan Evaluasi Program ..............................................25

2.1.4 Anatomi, Histologi, dan Perubahan Epitel Normal pada Serviks ...........27

2.1.4.1 Perubahan Keganasan .................................................................31

2.1.4.2 Epidemiologi ...............................................................................32

2.1.4.3 Etiologi Kanker Serviks ..............................................................34

2.1.4.3 Deteksi Dini Kanker Serviks .......................................................39

2.1.5 Metoda pemeriksaan ................................................................................42

2.1.5.1 IVA Test ......................................................................................42

2.1.5.2 VILI Test .....................................................................................44

2.1.5.3 Modifikasi atau Teknik Pemeriksaan Lain..................................45

2.1.5.4 Tes Papanicolau...........................................................................48

2.1.5.5 Thinprep Test ..............................................................................53

2.1.5.6 Pemeriksaan Kolposkopi .............................................................54

2.1.5.7 Polar Probe ..................................................................................55

2.1.5.8 Tes HPV DNA ............................................................................57

2.2 Kerangka Pemikiran .........................................................................................61

BAB III METODE PENELITIAN .........................................................................65

3.1 Subjek Penelitian ..............................................................................................65

3.1.1 Populasi Sasaran ......................................................................................65

 3.1.2 Populasi Terjangkau ................................................................................65

3.1.3 Ukuran Sampel ........................................................................................66

3.2 Metode Penelitian .............................................................................................68

3.2.1 Bentuk dan Rancangan Penelitian ...........................................................68

3.3 Definisi Operasional Variabel Terkait ..............................................................68

3.4 Sumber Data Penelitian ....................................................................................69

3.4.1 Cara Kerja dan Teknik Pengumpulan Data .............................................69

3.4.2 Pengolahan Data ......................................................................................75

3.5 Rancangan Analisis ..........................................................................................75

3.5.1 Analisis Univariabel ................................................................................75

3.6 Tempat dan Waktu Penelitian...........................................................................77

3.7 Implikasi/Aspek Etik Penelitian .......................................................................77

DAFTAR PUSTAKA ...............................................................................................79

Lampiran ..................................................................................................................87
 DAFTAR TABEL

halaman

Tabel 2.1 Kerangka Sistem Kesehatan WHO............................................ 13

Tabel 2.2 Struktur tim manajemen kanker serviks nasional...................... 19

Tabel 2.3 Contoh pertimbangan program pada berbagai tingkat

sistem kesehatan ............................................................................... 22

 DAFTAR GAMBAR

halaman

Gambar 2.1 Contoh susunan layanan penapisan, rujukan dan pengobatan 25

Gambar 2.2 Anatomi Serviks dan Uterus....... 27

Gambar 2.3 Gambaran Histopatologi normal Serviks . 29

Gambar 2.4 Gambaran Histopatologi Metaplasia Skuamosa .... 30

Gambar 2.5 Perbedaan Gambaran Histopatologi NIS 1, NIS 2, dan NIS 3 31

Gambar 2.6 Epidemiologi Kanker Serviks .... 33

Gambar 2.7 Peran HPV pada mutasi sel .... 35

Gambar 2.8 Perjalanan alamiah Infeksi HPV pada kanker Serviks .... 37

Gambar 2.9 Perjalanan Penyakit Kanker Serviks .... 38

Gambar 2.10 Gambaran mikroskopik dengan VILI 45

Gambar 2.11 Cara melakukan pemeriksaan papsmear....... 51

Gambar 2.12 Kerangka Pemikiran .... 64

Gambar 3.1 Alur Penelitian .... 70

 DAFTAR SINGKATAN

IVA : Inspeksi Visual Asetat

HPV : Human Papilloma Virus

WHO : World Health Organization

SSK : Sambungan Skuamo Kolumnar

NIS : Neoplasia Intraepitelial Serviks

KSS : Karsinoma Sel Skuamosa

DNA : Deoxyribonucleic Acid

dsDNA : Double Stranded DNA

Rb : Retinoblastoma

IARC : International Agency for Research on Cancer

LSIL : Low Grade Squamous Intraepithelial Lesions

HGSIL : High Grade Squamous Intraepithelial Lesions

ASCUS : Atypical Squamois Cells of Uncerttain Significance

LEEP : Loop elecrosurgical excision procedure

PICSM : Practice Iprovement in cervical Screening and

Management

VILI : Visual Inspection with Lugol Iodine

PAP : Papanicolau

CIN : Cervical Intraephitelial Neoplasia

AIS : Adenocarcinoma in Situ

AGC-H : Atypical Glandular cell

PCR : Polymerase Chain Reaction

OASE KK : Organisasi Aksi Solidaritas Era Kabinet Kerja