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Tantangan dalam mengobati kanker payudara stadium lanjut tipe Luminal B HER2 negatif dengan krisis viseral

  • Elvidawati ,
  • Khairiyah Darojat ,
  • Lia Sasmithae ,
  • Trinugroho Heri Fadjari ,

Abstract

Introduction: Breast cancer is the most prevalent form of malignancy in women, with over two million new cases yearly. The complex instance of advanced breast cancer with visceral crisis occurs when cancer has spread to vital organs such as the liver, lungs, and brain. This case report aims to teach us how to prevent visceral crisis, which will increase mortality, particularly in advanced breast cancer.

Case presentation: A 50-year-old woman who presented with complaints of shortness of breath was diagnosed with advanced breast cancer and visceral crisis. On examination, there were indications of hypervolemia, including a rightward displaced trachea and diminished vocal fremitus. The anatomical pathology results revealed a grade II invasive breast carcinoma. (Luminal B HER2 negative). X-rays of the chest reveal bilateral pleural effusion. The lumbosacral X-ray and abdominal ultrasonography both revealed liver metastases. Before intra-thoracic metastases and visceral crisis, the patient received hormonal therapy (tamoxifen). When intra-thoracic metastases and visceral problems occurred, the treatment was substituted with capecitabine for 3 months. However, capecitabine was discontinued because the cancer spread to the bones and liver. Patients were administered chemotherapy using docetaxel following NCCN and ESMO guidelines. The patient perished during chemotherapy with docetaxel due to complications from the disease and adverse effects.

Conclusion: Patients with advanced breast cancer who are not appropriately treated run a high risk of developing visceral crisis complications. Therefore, it is crucial that clinicians provide education about routine examinations and adhere to established evaluation procedures in order to prevent these complications.

 

Latar Belakang: Kanker payudara adalah jenis keganasan yang paling umum terjadi pada wanita dengan lebih dari dua juta kasus per tahun. Kanker payudara stadium lanjut dengan krisis viseral merupakan kasus yang kompleks, dimana kanker menyebar ke organ vital seperti hati, paru-paru dan otak. Tujuan diangkatnya laporan kasus ini adalah menjadi pembelajaran bagi kita bagaimana upaya untuk mencegah kondisi krisis viseral terutama pada kanker payudara stadium lanjut yang akan meningkatkan mortalitas.

Presentasi kasus: Seorang perempuan berusia 50 tahun datang dengan keluhan sesak nafas, pasien terdiagnosa kanker payudara stadium lanjut dengan krisis viseral. Pada pemeriksaan didapatkan adanya tanda-tanda hipervolemia, trakea terdorong ke kanan, penurunan fremitus vokal. Hasil patologi anatomi didapatkan gambaran invasive carcinoma mammae grade II. (Luminal B HER2 negative). Gambaran rontgen thorax menunjukkan adanya efusi pleura bilateral. Hasil rontgen lumbosakral didapatkan metastasis ke tulang dan pada ultrasonografi abdomen didapatkan metastasis hati. Sebelumnya pasien mendapatkan terapi hormonal (tamoxifen), dan pada saat terjadi metastasis intra thoracal serta krisis viseral terapi diganti dengan capecitabine selama 3 bulan namun terjadi progresifitas berupa penyebaran ke tulang dan hati, selanjutnya capecitabine dihentikan. Pasien diberikan kemoterapi berupa docetaxel sesuai guidelines pada NCCN dan ESMO. Selama masa kemoterapi menggunakan docetaxel akhirnya pasien meninggal dunia akibat komplikasi penyakit dan efek samping.

Kesimpulan: Pasien yang menderita kanker payudara stadium lanjut dapat mengalami komplikasi krisis viseral yang berisiko tinggi jika tidak ditangani dengan tepat. Oleh karena itu, laporan kasus ini sangat penting bagi klinisi untuk memberikan edukasi tentang pemeriksaan rutin dan mematuhi prosedur evaluasi yang ditetapkan guna mencegah terjadinya komplikasi tersebut.

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How to Cite

Elvidawati, Darojat, K. ., Sasmithae, L. ., & Fadjari, T. H. . (2023). Tantangan dalam mengobati kanker payudara stadium lanjut tipe Luminal B HER2 negatif dengan krisis viseral . Intisari Sains Medis, 14(1), 429–433. https://doi.org/10.15562/ism.v14i1.1715

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