Currently, cancer in women has become a topic that has received a lot of public attention, especially women in Indonesia. Cases of cancer in women are mainly breast cancer and cervical cancer.

In 2020, the number of new cases of breast cancer in Indonesia reached 68,858 cases (16.6%) of a total of 396,914 new cases of cancer, with the number of deaths reaching more than 22 thousand people. While cervical cancer ranks second most with 36,633 cases or 9.2% of the total cancer cases in Indonesia.

With more and more cases of cancer being found, every February 4 is celebrated as World Cancer Day which aims to raise awareness of cancer and encourage prevention, detection and treatment of cancer.

Get to know 3 (three) types of cancer in women:

1. Breast cancer
Detecting the occurrence of cancer in women in particular, is carried out through several examinations, including:

A Early examination
Usually done to detect the presence of breast cancer, done in 2 ways, namely:

a. Breast self-examination (BSE)
Early detection of breast cancer is important because the sooner cancer cells are found, the greater the potential for cure. This method is done to find out whether there is a lump or physical oddities in the breast.

b. Clinical breast exam (SADANIS)
SADANIS performed by a doctor, aims to determine the shape, size, color and texture of the breast to detect the possibility of cancer.
The doctor will examine the breast in a circular motion to detect the location of a lump or tumor in the breast. Apart from around the breasts, the doctor will also examine the lymph nodes in the armpits and the top of the collarbone.

c. Follow-up check
▪︎ Mammography
Mammography is done by taking pictures of breast tissue with low-dose X-rays (X-rays). When a mammogram shows abnormal tissue, tests will be done to determine whether the abnormal tissue is cancerous or not. This test is recommended for elderly women as a way of early detection of breast cancer.
▪︎ Breast ultrasound
Is a breast cancer test with the help of sound waves that display images on a computer screen. This examination can detect changes in the breast, such as lumps or tissue changes and can distinguish whether the lump is filled with fluid (cyst) or a solid lump.

▪︎Breast MRI
Usually done in patients diagnosed with breast cancer. This examination aims to determine the size of the cancer and the possibility of spreading cancer in other parts.

▪︎ Tumor marker Ca 15-3
Used to identify breast cancer and monitor treatment outcomes. This tumor marker examination will be more sensitive when used with CEA.

▪︎Biopsi
A breast biopsy is done when a physical exam, mammography or other breast cancer tests show cancer cells. This test procedure is carried out by taking a tissue sample that is suspected of having cancer cells in it. This tissue sample is then examined in the laboratory with a microscope.

》》 In medical science, there are four types of biopsies that are commonly performed to check for the possibility of cancer. There are four types of inspections, namely:
• Fine-needle aspiration biopsy.
• Core needle biopsy.
• Surgical biopsies.
• Lymph nodes biopsy.

The choice of the type of biopsy is determined by the doctor according to the suspected cancer.

2. Cervical Cancer
Cervical cancer can be detected in several ways, including:

a. IVA Examination (Acetic Acid Visual Inspection)
It is an early examination that is easy to do, so it is easily accessible and can be done in peripheral areas by fulfilling the following requirements:
• Have ever had intercourse
• Do not have sex at least 24 hours before the examination
• Not menstruating
It was observed that there was a change in the color of the cervical tissue after applying acetic acid to the surface of the cervical tissue. If white spots appear on the surface of the cervix, it indicates the presence of abnormal cells that are suspected of cervical cancer cells.
The accuracy rate of this inspection reaches 60%.

b. PAP smear
It is a simple, fast and painless cytological examination and has a sensitivity level of 80%. This examination is carried out by taking a sample of cervical mucus by a doctor which will then be examined through a microscope to see whether there are abnormalities or the presence of abnormal cells that can lead to cervical cancer.
Women aged 30-65 years are advised to undergo routine pap smear examinations, especially those who have had intimate relationships. For in Indonesia it is recommended once a year. Signs that a woman needs a Pap smear include:
• Experiencing yellowish and greenish vaginal discharge accompanied by an itchy smell and feeling
• Bleeding occurs after sexual intercourse
• Bleeding occurs outside the menstrual schedule
• Late menstruation but no sign of pregnancy
• Pain during sexual intercourse

The requirements for doing a pap smear are:
• Not menstruating and done 5 days after menstruation ends.
• 2 days before having a pap smear, do not have sex, do not clean the inside of the vagina (douching) with any liquid and do not insert anything into the vagina, including tampons, vaginal creams, or drugs for the vagina.

c. HPVDNA
HPV DNA examination is carried out by examining the genetic material (DNA) of the Human Papilloma Virus in cervical cells.

d. Colposcopy
Cervical inspection by using a colposcope.

e. Cervical biopsy is the act of taking tissue samples for histopathological examination under a microscope.

3. Ovarian Cancer
Ovarian cancer rarely causes symptoms in its early stages. Therefore, ovarian cancer is usually only detected when it has entered an advanced stage or has spread to other organs.

Examinations that are often performed to make a diagnosis are:
a. CA-125 tumor marker
CA 125 is a protein found on the surface of ovarian cancer cells and certain healthy tissues. CA 125 levels are higher in about 80% of patients with ovarian cancer. CA 125 can be used to monitor treatment success and detect recurring cancer.
b. Abdominal ultrasound
The initial method used to detect ovarian cancer.
c. Biopsy
In this examination, the doctor will take a sample of ovarian tissue to be examined in the laboratory.


Author : A. Andryani, dr.,Sp.PK (Doctor in charge of PRAMITA Clinical Laboratory Branch Jl. Amir Mahmud No. 460 Cimahi)