ASKEP PADA PASIEN KANKER OVARIUM

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March 24, 2012
ASKEP PADA PASIEN KANKER OVARIUM
I. PENGERTIAN
Kanker Indung telur atau Kanker ovarium adalah tumor ganas pada ovarium (indung telur) yang
paling sering ditemukan pada wanita berusia 50 – 70 tahun. Kanker ovarium bisa menyebar ke
bagian lain, panggul, dan perut melalui sistem getah bening dan melalui sistem pembuluh darah
menyebar ke hati dan paru-paru.
Kanker ovarium sangat sulit didiagnosa dan kemungkinan kanker ovarium ini merupakan awal
dari banyak kanker primer. (Wingo, 1995)
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2) Stadium 1b : pertumbuhan terbatas pada kedua ovarium. berisi sel ganas. dan kelenjar getah bening negativ. sebelum era kombinasi kemoterapi harapan hidup satu tahun kanker ovarium germinal stadium dini hanya mencapai 10 – 19% sekarang ini 90 % pasien kanker ovarium germinal dapat disembuhkan dengan fertilitas dapat dipertahankan. 3) Stadium 3c : implant di abdoment dengan diameter > 2 cm dan atau kelenjar getah bening retroperitoneal atau inguinal positif. • STADIUM II –> Pertumbuhan pada satu atau dua ovarium dengan perluasan ke panggul 1) Stadium 2a : perluasan atau metastasis ke uterus dan atau tuba 2) Stadium 2b : perluasan jaringan pelvis lainnya 3) Stadium 2c : tumor stadium 2a dan 2b tetapi pada tumor dengan permukaan satu atau kedua ovarium. Tumor terbatas dalam pelvis kecil tetapi sel histologi terbukti meluas ke usus besar atau omentum 1) Stadium 3a : tumor terbatas di pelvis kecil dengan kelenjar getah bening negatif tetapi secara histologi dan dikonfirmasi secara mikroskopis terdapat adanya pertumbuhan (seeding) dipermukaan peritoneum abdominal. .2. jenis tumor ini jarang ditemukan. 2) Stadium 3b : tumor mengenai satu atau kedua ovarium dengan implant dipermukaan peritoneum dan terbukti secara mikroskopis. adalah : • STADIUM I –> pertumbuhan terbatas pada ovarium 1) Stadium 1a : pertumbuhan terbatas pada suatu ovarium. Stadium kanker ovarium primer menurut FIGO (Federation InternationalofGinecologies and Obstetricians ) 1987. kapsul pecah atau dengan asitas yang mengandung sel ganas dengan bilasan peritoneum positif. 3) Stadium 1c : tumor dengan stadium 1a dan 1b tetapi ada tumor dipermukaan luar atau kedua ovarium atau kapsul pecah atau dengan asietas berisi sel ganas atau dengan bilasan peritoneum positif. tidak ada tumor di permukaan luar. dysgerminoma dan tumor sinus endodermal. tidak asietas. bentuk yang didapat berupa tumor theca dan tumor sel sartoli-leydig termasuk kanker dengan derajat keganasan yang rendah. • STADIUM III –> tomor mengenai satu atau kedua ovarium dengan implant di peritoneum di luar pelvis dan atau retroperitoneal positif. Tumor germinAL Tumor sel germinal berasal dari sel yang menghasilkan ovum atau telur. kapsul utuh. Insiden keganasan tumor germinal terjadi pada usia muda kadang dibawah usia 20 tahun. 3. kapsul intak. tidak ada pertumbuhan di permukaan luar. Tumor stromal Tumor ovarium stromal berasal dari jaringan penyokong ovarium yang memproduksi hormon estrogen dan progesteron. tidak ada asietas yang berisi sel ganas. bentuk keganasan sel germinal terutama adalah teratoma. diameter melebihi 2 cm. umumnya tumor germinal adalah jinak meskipun beberapa menjadi ganas.

Proses penyembuhan sel-sel epitel yang terganggu dapat menimbulkan proses transformasi menjadi sel-sel tumor. dan nafsu makan menurun. makan sedikit tapi cepat kenyang. PATOFISIOLOGI Kanker ovarium disebabkan oleh zat-zat karsinogenik sehingga terjadi tumor primer dimana akan terjadi infiltrasi di sekitar jaringan dan akan terjadi implantasi. penggunaan bedak talk perineal 5. Faktor Resiko : 1. ETIOLOGI Penyebab kanker ovarium belum diketahui secara pasti. menstruasi dini 10. 2. atau endometrium 6. Bila efusi pleura dan hasil sitologinya positif dalam stadium 4. Gejala yang terjadi pada kanker ovarium adalah gejala samar dan ascites. adapun penyebab dari kanker ovarium yaitu: 1. Akan tetapi banyak teori yang menjelaskan tentang etiologi kanker ovarium. riwayat kanker payudara. begitu juga metastasis ke permukaan liver. Dimana implantasi ini merupakan cirri khas dari tumor ganas ovarium. Diet tinggi lemak 2. alkohol 4. merokok 3. Ascites adalah kelebihan volume cairan di rongga perut. nulipara 8. sering kembung. tidak pernah melahirkan III. kolon. II.• STADIUM IV –> pertumbuhan mengenai satu atau kedua ovarium dengan metastasis jauh. sedangkan gejala samarnya yaitu : perut sebah. Hipotesis androgen Androgen mempunyai peran penting dalam terbentuknya kanker ovarium. MANIFESTASI KLINIS . Dalam percobaan in-vitro. infertilitas 9. riwayat keluarga dengan kanker payudara atau ovarium 7. Hal ini didasarkan pada hasil percobaan bahwa epitel ovarium mengandung reseptor androgen. Derajat keganasan kanker ovarium : Derajat 1 : differensiasi baik Derajat 2 : differensiasi sedang Derajat 3 : differensiasi buruk Dengan derajat differensiasi semakin rendah pertumbuhan dan prognosis akan lebih baik. androgen dapat menstimulasi pertumbuhan epitel ovarium normal dan sel-sel kanker ovarium. Hipotesis incessant ovulation Teori menyatakan bahwa terjadi kerusakan pada sel-sel epitel ovarium untuk penyembuhan luka pada saat terjadi ovulasi. IV.

ketegangan menstrual yang terus meningkat 3. Efek buruknya berupa sakit perut. Gejala umum bervariasi dan tidak spesifik. di dalam 3000-4000cc larutan garam faal. satu lagi di resesus posterior kavum pelvis. Pada stadium awal berupa : 1. haid tidak teratur. Jika diperlukan. nyeri tekan pada payudara 5. fungsi ginjal.. pada stadium awal dapat timbul asites. lingkar abdomen yang terus meningkat V. rasa tidak nyaman pada abdomen 7. Obat yang diinfuskan biasanya FU. dan upayakan temperatur itu dipertahankan. USG dengan Doppler untuk menentukan arus darah 2. PENATALAKSANAAN MEDIS Sebagian besar kanker ovarium memerlukan pengobatan dengan kemoterapi. Hanya kanker ovarium stadium awal saja (stadium 1a dan 1b dengan derajat diferensiasi sel yang baik/sedang) yang tidak memerlukan kombinasi pengobatan. Kemoterapi dengan pemanasan intraperitoneal: melalui insisi perkutan dimasukkan dua tabung silicon intraperitoneal. Pemeriksaan tumor marker seperti Ca-125 dan Ca-724. dapat timbul perdarahan per vaginam Tanda & Gejala pada pasien Kanker Ovarium. sistem saluran cerna. menopause dini 6. untuk itu dapat serentak diberikan lidokain intraperitoneal. tekanan pada pelvis 9. pemeriksaan CT-Scan/ MRI 3. Kecepatan pemberian adalah 500cc per jam. Setiap minggu dilakukan 1-2 kali. ujungnya difiksasi di dinding abdomen. akan tetapi hanya sebagai pegangan untuk melakukan tindakan operasi. sistem saluran cerna. Lalu melalui satu tabung silicon dialirkan ke rongga abdomen. flatulenes 11.Manifestasi klinis terutama berupa rasa tidak enak perut bawah atau tenesmus. Metode terapi utama YAITU: 1. fungsi hati. VI. setelah 8-12 jam larutan dikeluarkan lewat tabung yang lainnya. sering berkemih 10. dispepsia 8. . menoragia 4. Sebelumnya larutan itu dipanaskan hingga 42°C. dengan cepat kanker tumbuh melampaui kavum pelvis hingga ke abdomen hingga teraba massa. rasa begah setelah makan makanan kecil 12. Kemoterapi diberikan sebanyak 6 seri dengan interval 3 – 4 minggu sekali dengan melakukan pemantauan terhadap efeh samping kemoterapi secara berkala terhadap sumsum tulang. DDP. satu diletakkan di permukaan hati subdiafragma. sistem saraf dan sistem kardiovaskuler. beta – HCG dan alfafetoprotein Semua pemeriksaan diatas belum bisa memastikan diagnosis kanker ovarium. haid tidak teratur 2. CTX dll. PEMERIKSAAN DIAGNOSTIK 1.

Jepang melaporkan terapi dengan cara ini.terjadi diare/perdarahan terus. 1cc per kali. Pasca injeksi dapat timbul demam yang mencapai 39oC. PENGKAJIAN • Data diri klien • Data biologis/fisiologis –> keluhan utama. umumnya digunakan vaksen kuman Serratia marcescen(S311). hingga kini 18 bulan tidak tampak kekambuhan. persalinan. serentak disuntikkan imunomodulator. 2. lesi lenyap total. Krioablasi argon-helium: terhadap massa ovarium. komplikasi lainnya antara lain luka bakar pada dubur. Mengikat saluran tuba. Namun. 1-2 kali per minggu. nifas. usia 56 tahun. Beberapa studi telah menunjukkan bahwa histerektomi juga akan mengurangi risiko kanker ovarium. PENCEGAHAN Cara termudah untuk mengurangi kemungkinan kanker ovarium adalah. Seorang pasien dari kota Shenyang di RRC. setelah 1 bulan massa ovarium menyusut rata-rata 49%. Metode ini setara dengan operasi debulking.padahal hormone diperlukan untuk gairah seksual dan haid juga mencegah osteoporosis. VII. Imunoterapi intraperitoneal: masukkan tabung ke rongga pelvis. hamil .jika tidak demikian dubur harus diangkat sebagai gantinya akan dibuatkan dubur baru lewat perut. Mengambil kontrasepsi oral atau pil KB. abdomen. suntikkan emulsi campuran kemoterapi (misal DDP) dan lipiodol. 3. Kami sering mengombinasikan cara ini dengan krioablasi argon-helium. kavum pelvis penuh dengan tumor disertai asites. VIII. durasi haid • Riwayat obstetric –> kehamilan. riwayat keluhan utama • Riwayat kesehatan masa lalu • Riwayat kesehatan keluarga • Riwayat reproduksi –> siklus haid.2. tidak peduli itu lesi primer atau metastasis rongga pelvis dan dinding abdomen. rudapaksa bagi pasien jauh lebih keci dibandingkan operasi. KOMPLIKASI Akibat radiasi atau penyinaran maka timbul komplikasi: indung telur mati terkena radiasi akibatnya hormone pun mati. ASUHAN KEPERAWATAN I. tidak akan berdampak buruk. suntikkan obat kemoterapi. tidak dianjurkan untuk memiliki prosedur ini dilakukan kecuali jika itu adalah alasan medis yang baik untuk melakukannya. dapat memakai krioablasi argon-helium. 2-3 jam kemudian reda spontan. setelah terapi intraarteri dan krioablasi argon-helium. 1. 3. Demam pertanda respons imun bekerja. Jika seorang wanita telah melalui menopause atau mendekati menopause maka mungkin ide yang baik untuk memiliki ovarium diangkat melalui histerektomi. Terapi intra-arteri: melalui arteri femoralis dimasukkan kateter hingga mencapai arteri ovarial. 4.

prognosis dan pengobatan III. • Ajarkan klien strategi baru untuk meredakan nyeri dan ketidaknyamanan: imajinasi. meningkatkan kenyamanan.d perubahan struktur atau fungsi tubuh. frekuensi R/:membantu mengevaluasi derajat ketidaknyamanan. • Kaji faktor lain yang menunjang nyeri. Resiko tinggi terhadap disfungsi seksual b. PERENCANAAN Diagnosa 1 : Nyeri akut b. Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan fungsi dan peran 3. • Kolaborasi dengan tim medis dalam memberi obat analgesic R/: menurunkan nyeri.d kondisi. dan pasien tidak meringis Intervensi : • Kaji karakteristik nyeri : lokasi. Diagnosa 2 : Perubahan citra tubuh dan harga diri b. • Berikan dorongan untuk keikutsertaan kontinyu dalam aktifitas dan pembuatan keputusan R/: mempertahankan / membuka garis komunikasi . Kurang pengetahuan/kurang informasi b. • Jelaskan kegunaan analgetik dan cara-cara untuk mengurangi efek samping. sehingga menurunkan nyeri dan ketidaknyamanan. marah pasien.• Pemeriksaan fisik • Data psikologis/sosiologis–> reaksi emosional setelah penyakit diketahui II. R/: membantu pasien untuk istirahat lebih efektif dan memfokuskan kembali perhatian. Kriteria Hasil : . DIAGNOSA KEPERAWATAN 1.Klien dapat menerima status kesehatannya .d perubahan dalam penampilan fungsi dan peran Tujuan : Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya. R/: agar pasien mengetahui mengenai penggunaan dan efek samping dari analgetik.d agen cidera biologi Tujuan : Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan Kriteria Hasil : Nyeri berkurang atau skala nyeri berkurang 1-3. Ansietas b. stimulasi kutan.Klien dapat menerapkan koping individu yang adaptif Intervensi : • Kaji perasaan klien tentang citra tubuh dan tingkat harga diri R/: mengetahui respon pasien dalam penegakan diagnosa. R/: mengevaluasi factor – factor yang yang dapat meningkatkan persepsi akan intensitas nyerinya.d agen cidera biologi 2.d perubahan status kesehatan 5. perubahan kadar hormone 4. keletihan. kualitas. Nyeri akut b. relaksasi.

• Kaji informasi klien dan pasangan tentang anatomi/ fungsi seksual dan pengaruh prosedur pembedahan R/: menunjukan kesalahan informasi/konsep yang mempenagruhi pengambilan keputusan. ini dapat dialami selama beberapa minggu atau bulan untu kembali baik.Pasien tidak merasa gelisah.• Berikan dorongan pada klien dan pasangannya untuk saling berbagi kekhawatiran tentang perubahan fungsi seksual dan menggali alternatif untuk ekspresi seksual yang lazim R/: menjelaskan keadaan yang terjadi dan memberi pengertian kepada pasangan serta mendiskusikan dalam pemenuhan kebutuhan seksual . dan menerima kehilangan yang memebutuhkan penerimaan sehingga pasien dapat membuat rencana untuk masa depan. • Identifikasi faktor budaya/nilai budaya R/: dapat mempengaruhi kembalinya kepuasan hubungan seksual. Diagnosa 3 : Resiko tinggi terhadap disfungsi seksual b. • Berikan solusi masalah terhadap masalah potensial.Klien menyatakan paham tentang perubahan struktur dan fungsi seksual. Kriteria hasil: . hilangnya bagian tubuh.d perubahan status kesehatan Tujuan : Menyatakan kesadaran terhadap perasaan dan rasa cenas yang sedang dihadapinya. perubahan pada respons individu R/: nyeri vagina dapat nyata menyertai prosedur vagina atau kehilanagn sensori dapat terjadi sehubungan dengan trauma bedah. perubahan kadar hormon Tujuan : Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa alternatif cara mengekspresikan keinginan seksual Kriteria Hasil : . . Harapan negative sehubungan dengan hasil yang buruk. • Dorong klien untuk berbagi pikiran/masalah dengan orang terdekatnya R/: komunikasi terbuka dapat mengidentifikasi area penyesuaian / masalah dan meningkatkan diskusi dan resolusi.Klien mampu memenuhi kebutuhan seksualnya sesuai dengan kemampuan Intervensi: • Mendengarkan pernyataan klien dan pasangan R/: masalah seksual sering tersembunyi sebagai pernyataan humor dan/ atau ungkapan yang gamblang • Diskusikan sensasi atau ketidaknyamanan fisik. .d perubahan struktur atau fungsi tubuh. Meskipun kehilangan sensori biasanya sementara. • Dorong klien untuk menyadari atau menerima tahap berduka R/: kehilangan bagian tubuh. Diagnose 4 : Ansietas b. ex : menunda koitus seksual saat kelelahan R/: membantu pasien kembali pada hasrat / kepuasan aktivitas seksual.Pasien tanpak rileks Intervensi: .

Cairan ascitic dapat mempunyai banyak sumber-sumber . V. Menyatakan kesadaran terhadap perasaan dan rasa cemas yang sedang dihadapinya.prognosis dan pengobatan Tujuan : klien mengetahui tentang kondisi dan prognosis tentang penyakitnya Kriteria hasil: . Klien mengetahui tentang kondisi dan prognosis tentang penyakitnya. 5. IMPLEMENTASI Implementasi merupakan pelaksanaan dari rencana yang telah disusun. 3.• Orientasikan klien pada lingkungan yang baru R/: membantu mengurani ansietas dan meningkatkan keamanan • Beritahu klien tentang perjalanan penyakitnya R/: memberikan informassi kepada klien tentang penyakitnya dan mengurangi ansietas • Beritahu klien tentang tindakan pengobatan yang akan dilakukan R/: mengurangi ansietas klien Diagnosa 5 : Kurang pengetahuan/kurang informasi b. Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan 2.d kondisi. Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya. EVALUASI 1. Rongga perut berlokasi dibawah rongga dada.prognosis dan pengobatan R/: meningkatkan pemahaman perawat tentang kondisi klien • Beritahu klien tentang perjalanan penyakitnya serta pengobatan yang akan dilalukan R/: memberikan informasi kepada klien tentang penyakitnya IV.Klien mengerti tentang kondisinya Intervensi: • Kaji informasi tentang kondisi individu.Klien terlihat tenang . Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa alternatif cara mengekspresikan keinginan seksual 4. WOC Ascites Definisi Ascites Ascites adalah akumulasi dari cairan (biasanya cairan serous yang adalah cairan kuning pucat dan bening) dalam rongga perut (peritoneal). dipisahkan darinya oleh diaphragm.

kanker-kanker. Ini memberi sinyal pada ginjal-ginjal untuk menyerap kembali lebih banyak garam dan air untuk mengkompensasi volume yang hilang. Faktr-faktor lain yang mugkin berkontribusi pada ascites adalah penahanan garam dan air. berakibat pada portal hypertension tanpa cirrhosis. atau kanker indung telur. Pancreatic ascites dapat terlihat pada orang-orang dengan pancreatitis atau peradangan pankreas kronis. . Meskipun mekanisme yang tepat dari perkembangan tidak dimengerti sepenuhnya. Contoh-contoh dari ini dapat adalah massa (atau tumor) yang menekan pada pembuluh-pembuluh portal dari rongga perut bagian dalam atau pembentukan bekuan (gumpalan) darah dalam pembuluh portal yang menghalangi aliran normal dan menongkatkan tekanan dalam pembuluh (contoh. Pancreatic ascites dapat juga disebabkan oleh pankreatitis akut serta trauma pada pankreas. lymphoma. Volume darah yang bersirkulasi mungkin dirasakan rendah oleh sensor-sensor dalam ginjalginjal karena pembentukan dari ascites mungkin menghabiskan beberapa volume dari darah. kanker payudara. Tipe-tipe ascites ini secara khas adalah manifestasi-manifestasi dari kanker-kanker yang telah lanjut dari organ-organ dalam rongga perut. Beberapa penyebab-penyebab lain dari ascites berhubungan dengan gradien tekanan yang meningkat adalah gagal jantung kongestif dan gagal ginjal yang telah lanjut yang disebabkan oleh penahanan cairan keseluruhan dalam tubuh. atau gagal ginjal. Budd-Chiari syndrome). gagal jantung congestif. Pada kasus-kasus yang jarang. Kenaikan dalam tekanan darah portal dan pengurangan dalam albumin (protein yang diangkut dalam darah) mungkin bertangung jawab dalam pembentukan gradien tekanan dan berakibat pada ascites perut. Kira-kira 80% dari kasus-kasus ascites diperkirakan disebabkan oleh cirrhosis. dalam kasus ini. Ada juga pembentukan ascites sebagai akibat dari kanker-kanker. kanker paru-paru. Penyebab Ascites Penyabab yang paling umum dari ascites adalah penyakit hati yang telah lanjut atau cirrhosis. yang disebut malignant ascites. kebanyakan teori-teori menyarankan portal hypertension (tekanan yang meningkat adalam aliran darah hati) sebagai penyumbang utama. seperti. kanker usus besar. rongga perut (ruang tekanan rendah). kanker pankreas. Penyebab yang paling umum dari pankreatitis kronis adalah penyalahgunaan alkohol yang berkepanjangan.seperti penyakit hati. tekanan yang meningkat dalam sistim portal dapat disebabkan oleh rintangan internal atau eksternal dari pembuluh portal. kanker lambung. Asas dasarnya adalah serupa pada pembentukan dari edema ditempat lain di tubuh yang disebabkan oleh ketidakseimbangan tekanan antara sirkulasi dalam (sistim tekanan tinggi) dan luar.

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