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All Journal Journal of Biomedicine and Translational Research Indonesian Journal of Cancer Indonesian Journal of Obstetrics & Gynecology Science Diponegoro International Medical Journal (DIMJ) Dinamika Kesehatan: Jurnal Kebidanan dan Keperawatan
Teuku Mirza Iskandar, Teuku Mirza
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health

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Pengelolaan Lesi Prakanker Serviks Iskandar, Teuku Mirza
Indonesian Journal of Cancer Vol 3, No 3 (2009): Jul - Sep 2009
Publisher : "Dharmais" Cancer Center Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (269.174 KB)

Abstract

Tujuan: memahami modalitas terapi terhadap lesi prakanker serta keuntungan dan kerugiannya. Tujuh puluh persen kanker serviks di Indonesia ditemukan dalam stadium lanjut. Salah satu faktor yang menunjang keberhasilan pengelolaan kanker serviks adalah usaha penemuan stadium prakanker dan stadium dini serta bagaimana pengelolaannya. Penemuan dan pengelolaan yang tepat pada stadium dini akan memberikan hasil penyembuhan antara 66,3% - 95,1%. Sedangkan jika pengelolaan pada stadium lanjut akan memberikan hasil yang kurang baik, di samping biaya yang cukup tinggi.1,2Lesi prakanker serviks yang sangat dini dikenal dengan neoplasia intraepitelial serviks atau NIS, yang ditandai dengan adanya perubahan displastik epitel serviks. Sampai saat ini, pemeriksaan sitologi dengan test Pap masih merupakan pemeriksaan standar untuk deteksi dini keganasan serviks. Sejak 1985, WHO merekomendasikan suatu pendekatan alternatif bagi negara yang sedang berkembang dalam deteksi dini kanker serviks dengan konsep inspeksi visual dengan asam asetat (IVA).3Terminologi NIS dibagi menjadi 3. NIS 1 sesuai dengan displasia ringan, NIS 2 sesuai dengan displasia sedang, dan NIS 3 meliputi displasia berat serta karsinoma insitu. Terminologi ini juga dikonfirmasikan dengan sistem Bethesda, yaitu NIS 1 dan infeksi HPV sebagai lesi intraepitelial skuamosa derajat rendah (LISDR) serta NIS 2 dan NIS 3 sebagai lesi intraepitelial skuamosa derajat tinggi (LISDT). Karena tidak dapat diketahui risiko untuk menjadi progresif dari semua tingkatan lesi prekursor maka semua lesi NIS sebaiknya diobati. Berdasarkan perjalanan alamiah dari NIS, disimpulkan bahwa makin rendah derajat kelainan maka makin besar kemungkinan regresi menjadi normal. Sebaliknya, makin berat derajat kelainan maka makin besar kemungkinan menjadi lesi yang lebih berat.Modalitas yang dimiliki dalam penatalaksanaan lesi prakanker cukup banyak, biasanya dibagi dalam 2 golongan, yaitu destruksi dan eksisi. Pada tindakan destruksi, kita tidak dapat memiliki bahan untuk melakukan pemeriksaan histopatologi, sedangkan pada eksisi kita sekaligus dapat memiliki bahan untuk melakukan pemeriksaan histopatologi. Laser ablation, kauterisasi, serta krioterapi merupakan terapi destruksi yang biasa digunakan untuk displasia ringan. Sebenarnya, kauterisasi atau krioterapi masih punya tempat untuk displasia sedang – keras. Sedangkan LEEP, LLETZ, konisasi dengan cold knife atau laser, serta histerektomi merupakan tindakan eksisi yang biasanya digunakan untuk displasia sedang - keras.Pemilihan terapi harus dipertimbangkan secara hati-hati dalam melihat efektivitas terapi serta efek samping. Keberhasilan destruksi lokal dalam pengelolaan lesi prakanker mencapai 95%. Ini berarti, ada faktor 5% kegagalan pengelolaan dengan destruksi lokal ini. Oleh sebab itu, sebagai operator harus teliti dalam mengelola lesi prakanker.Kesimpulan: pengelolaan lesi prakanker dengan destruksi lokal mencapai 95%. Penggunaan metode destruksi lokal sebagai salah satu manajemen lesi prakanker dapat menghindari terjadinya terapi yang berlebihan (over treatment). Tetapi, peningkatan kemampuan dalam menggunakan metode ini sangat diperlukan, di samping pengamatan lanjut yang adekuat.Kata kunci: terapi, lesi, prakanker, serviks
Squamous Cell Carcinoma Cervical Uterine Metastasis in Abdominal Wall: A Rare Case Report Cahyono, Endy; Iskandar, Teuku Mirza; Ambari, Ediwibowo; Eka Putra, Very Great; Lubena, Lubena; Wijaya, Dibyo Mukti
Journal of Biomedicine and Translational Research Vol 10, No 1 (2024): April 2024
Publisher : Faculty of Medicine, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v10i1.19668

Abstract

ABSTRACTBackground: About 80% of cervical cancers are squamous cell carcinomas. After severe surgery for squamous cervical cancer, abdominal metastasis is an uncommon occurrence.Case Presentation: A 33-year-old lady was diagnosed with cervical cancer and had a radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy. The histopathological examination showed non-keratinizing squamous cell carcinoma moderately differentiated. A 6 cm suggestive metastatic mass from abdominal region came up three months later after the surgery. An abdominal wall reconstruction surgery was conducted as the treatment for the metastasis mass.Conclusion: The best course of treatment for cervical cancer is still unknown due to the rarity of abdominal metastases. Depending on the severity of the illness and the existence of metastases, each patient receives a unique course of treatment.Keywords: squamous cell carcinoma, hysterectomy, cervical malignancies
Endothelin-1 Level In Early Onset Preeclampsia Riantyoko, Yoshi; Hadijono, Raden Soerjo; Iskandar, Teuku Mirza; Trisetiyono, Yuli; Pramono, Besari Adi; Suhartono, Suhartono; Kristanto, Herman
DINAMIKA KESEHATAN: JURNAL KEBIDANAN DAN KEPERAWATAN Vol 14, No 1 (2023): Dinamika Kesehatan: Jurnal Kebidanan dan Keperawatan
Publisher : Universitas Sari Mulia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33859/dksm.v14i1.917

Abstract

Introductions: Preeclampsia is a specific syndrome in pregnancy as a result of abnormal placental invasion leading to placental hypoperfusion. Persistent hypoxia of the placenta causes the release of various inflammatory mediators into the circulation and results in local endothelial dysfunction. Increased endothelin-1 (ET-1) secretion and increased inflammatory mediators occur in preeclampsia.Aims: To analyze the relationship between endothelin-1 and early onset preeclampsia.Methods: This crosssectional study included 50 pregnant women with early onset preeclampsia (n=25) and normal pregnancies (n=25). Pregnant women aged 20-35 years with single intrauterine fetus, primigravida and multigravida who experienced early onset preeclampsia 34 weeks of gestation were included in this study. Endothelin-1 levels was measured using the Enzyme Linked Immunosorbant Assay (ELISA) method. The analysis was performed using the Mann-Whitney test. Receiving Operator Characteristic (ROC) curve analysis was used to find the cut-off value and diagnostic accuracy of endothelin-1 levels.Results: The mean of ET-1 level was significantly higher in early onset preeclampsia (0.732 ± 0.56 pg/mL) compared to normal pregnancy (0.318 ± 0.09 pg/mL) with value of p = 0.000. The ROC analysis showed the AUC value of 87.8% (p = 0.000, 95% CI 78.6%-97.1%). The cut-off value for ET-1 was 0.385 pg/mL, with 80% sensitivity and 68% specificity (PR=3.14; 95% CI 1.40-7.03).Conclusion: Increased levels of endothelin-1 (ET-1) significantly associated with early onset preeclampsia. ET-1 level ≥ 0.385 pg/mL in pregnant women with 34 weeks of gestation is potential biomarkers to predict the occurrence of early onset preeclampsia with a risk up to 3.14 times.
Factors Associated With Recurrence Of Epithelial Ovarian Cancer In RSUP Dr. Kariadi Semarang Kurube, Isabela Marsialina; Ambari, Ediwibowo; Iskandar, Teuku Mirza; Tjahjanto, Hary; Dewantiningrum, Julian; Mochtar, Arufiadi Anityo; Trisetiyono, Yuli
Diponegoro International Medical Journal Vol 3, No 2 (2022): December 2022
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v3i2.15448

Abstract

Introductions: Epithelial ovarian cancer accounts for 90% of all ovarian malignancies. More than 70% of patients will experience a relapse even after receiving operative therapy and chemotherapy. There are several prognostic factors that influence the recurrence of ovarian cancer. In Indonesia, especially at Dr. Kariadi Hospital, Semarang, the data as mentioned above is still very limited.objective: Knowing the disease-free survival rate, optimizing surgery and factors related to the incidence of recurrence in epithelial ovarian cancer patients at Dr. Kariadi Hospital SemarangMethods: This study is a retrospective cohort study with survival analysis. Data were collected through medical records, with the study population are patients with a diagnosis of epithelial ovarian cancer who were treated at Dr. Kariadi Hospital Semarang in period January 2018-December 2019. Furthermore, patients who had been remission were observed for signs of disease recurrence for 2 years period.Results: There were 361 patients with epithelial ovarian cancer who underwent primary treatment at Dr. Kariadi Hospital, Semarang in  2018-2019. Furthermore, there were observations of recurrence in 148 patients who achieved remission. Of these 76 patients (51.4%) experienced recurrence, while 72 patients not relapse. From 148 epithelial ovarian cancer patients who underwent cytoreduction surgery at Dr. Kariadi Hospital, Semarang, 113 patients (76.4%) achieved optimal operation with a residu less than 2 cm, while 35 patients (23.6%) were not optimal with a residu more than 2 cm. FIGO stage (HR 2.44) and tumor residu (HR 2.15) were shown to be significant factors associated with the recurrence of epithelial ovarian cancer.Conclusion: Overall disease-free survival in epithelial ovarian cancer at Dr. Kariadi Semarang were 74.8% (6 months), 57.1% (1 year), 42.5% (18 months), and 37.4% (2 years). Tumor residual factors and FIGO stage were shown to be significant prognostic factors influencing the recurrence of epithelial ovarian cancer. 
RECURRENCE IN NON-EPITHELIAL OVARIAN CANCER PATIENTS AT RSUP DR. KARIADI SEMARANG Badia, Gabriele Emi; Iskandar, Teuku Mirza; Suhartono, Suhartono
Diponegoro International Medical Journal Vol 4, No 2 (2023): December 2023
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v4i2.20963

Abstract

BACKGROUND: Non-epithelial ovarian cancer is a very rare type, accounting for less than 10% of ovarian cancers. This type of cancer originates from germ cells or stromal-sex cord cells. Disease-free survival (DFS) in cancer is the length of time after primary treatment for cancer ends so that patients survive without signs or symptoms of cancer. Recurrence is the return of cancer that has been declared in remission, usually after a certain period in which cancer cannot be detected. Cancer can return to the same place (primary) or other parts of the body. Ovarian cancer is a disease with a high probability of recurrence, after achieving a complete response to chemotherapy, >70%. Assessment of the recurrence rate is one of the ways used to assess the effectiveness of therapyAIM: Knowing the incidence of recurrence in patients with non-epithelial ovarian cancer who have received operative therapy with or without adjuvant chemotherapyMETHOD: Descriptive study with a case series research design and analytical works. The research sample was 50 non-epithelial ovarian cancer patients who were treated at RSUP Dr. Karadi Semarang from 2018-2019 who met the inclusion criteria and did not have exclusion criteria, 22 patients were loss of follow up during observation. The data collection technique used is total sampling. Data analysis was performed using the Chi-Square test with a significance level of p<0.05.RESULT:  The most reported types of non-epithelial ovarian cancer were granulosa (39.3%), dysgerminoma (21.4%), yolk sac (17.9%), and mixed germ cell (17.9%). Most of the cancer cases are progressive (60.7%). There were 3 recurrence incidents happen during observation period, 2 patients with granulosa cell tumor in >50 years age group and 1 patient with Yolk Sac cell tumor in 20-50 years age group. Higher survival rates were found for tumor residues <2cm compared to >2cm at 6 months (54.5% vs 45.5%), 12 months (54.5% vs 36.4%), 18 months (45.5% vs 36.4%), and 24th month (45.5% vs 36.4%).CONCLUSION: Optimization of surgery depends on the type of non-epithelial ovarian cancer cells, age, and the stage when the diagnosis was first established to be a factor in the incidence of recurrence. 
A Comparative Analysis of Internal Radiation vs Box System in Treatment Efficacy and Patient Survival of Advanced Stage Cervical Cancer Marpaung, Mona Galatia; Iskandar, Teuku Mirza; Pramono, Noor; Suhartono, Suhartono
Indonesian Journal of Obstetrics & Gynecology Science Volume 8 Nomor 3 November 2025
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v8i3.942

Abstract

Objectives: To evaluate the comparative effectiveness of brachytherapy and the box system in therapeutic success and patient survival in cervical cancer, along with associated prognostic factors.Methods: This retrospective analytical study used medical records from the Obstetrics & Gynecology Oncology Clinic and Radiotherapy Unit at Dr. Kariadi General Hospital in Semarang. The study included cervical cancer patients with stage IIB-IIIB disease who were treated between January 2017 and December 2022. Data analysis involved both statistical methods and survival analysis using the Kaplan-Meier approach.Results: During the 2017-2022 study period, a total of 939 patients with stage IIB-IIIB cervical cancer who completed full radiation therapy were evaluated for their 2-year survival rate. The cohort included 89 patients in the box system group and 850 in the brachytherapy/internal radiation group. Complete response was achieved in 46.1% of box system patients compared to 75.5% in the brachytherapy group (p<0.0001); partial response rates were 53.9% and 24.5%, respectively. Kaplan-Meier analysis showed a 2-year survival rate (2 YSR) of 41.6% for the box system and 64.0% for brachytherapy. The mean survival time was 15.37 months for the box system and 19.09 months for brachytherapy.Conclusion: Internal radiation therapy (brachytherapy) showed significantly better clinical outcomes compared to the box system approach. It resulted in a longer mean survival time (19.09 vs 15.37 months; p<0.001) and higher 2-year survival rates (64.0% vs 41.6%; log-rank p<0.001).Keywords: Cervical cancer, box system, brachytherapy, therapy response, survivalPerbandingan antara Radiasi Interna vs Box System dalam KeberhasilanTerapi dan Kelangsungan Hidup Pasien Kanker Servik Stadium LanjutAbstrakTujuan: Penelitian ini bertujuan untuk mengetahui perbandingan radiasi interna dan box system dalam keberhasilan terapi dan kelangsungan hidup pasien kanker serviks serta faktor-faktor yang memengaruhi.Metode: Penelitian ini menggunakan metode analitik retrospektif dengan menggunakan rekam medis Poli Kandungan dan Onkologi dan Instalasi Radioterapi RSUP Dr. Kariadi Semarang. Subyek penelitian adalah pasien kanker servik stadium IIB-IIIB mulai periode januari 2017-Desember 2022. Analisis statistika menggunakan analisis analitik dan analisis survival menggunakan metode Kaplan Meier.Hasil: Hasil penelitian menunjukkan bahwa selama tahun 2017– 2022 didapatkan total 939 pasien dengan diagnosis kanker servik stadium IIB-IIIB yang menjalankan terapi radiasi lengkap dan dapat dilakukan evaluasi survival rate 2 tahun. Total subjek pada kelompok box system sebanyak 89, sedangkan kelompok brakiterapi/radiasi interna sebanyak 850 subjek. Respon terapi komplet sebesar 46,1% pada kelompok box system, dan 75,5% pada kelompok radiasi interna, respon terapi parsial 53,9% pada kelompok box system dan 24,5% pada kelompok radiasi interna, dengan nilai p <0.0001. Analisis survival dengan metode Kaplan -Meier didapatkan 2-YSR 41,6% pada kelompok Box system, sedangkan 64% pada kelompok radiasi interna sedangkan mean survival time pada kelompok box system 15,37 bulan dan kelompok radiasi interna 19,09 bulan dengan nilai p <0.001Kesimpulan: Pemberian radiasi interna memberikan keberhasilan terapi klinis yang lebih tinggi dengan nilai mean survival time lebih tinggi. Pemberian radiasi interna memberikan kelangsungan hidup 2 tahun sebanyak 64%, sedangkan box system sebanyak 41,6%Kata kunci: Kanker servik, box system, brakiterapi, respon terapi, survival   
Co-Authors AA Sudharmawan, AA Badia, Gabriele Emi Besari Adi Pramono Cahyono, Endy DIBYO MUKTI WIJAYA Ediwibowo Ambari Eka Putra, Very Great Hadijono, Raden Soerjo Hary Tjahjanto Herman Kristanto Julian Dewantiningrum Kurube, Isabela Marsialina Lubena Lubena, Lubena Marpaung, Mona Galatia Mochtar, Arufiadi Anityo Noor Pramono Riantyoko, Yoshi Suhartono Yuli Trisetiyono, Yuli