F.

PATHWAY

VIRUS HPV VIRUS ISV FAKTOR RISIKO

PENEKANAN SEL
CA VULVA
CA PADA SARAF
NYERI

PSIKOLOGIS PENDARAHAN BAU BUSUK PENGOBATAN

KURANG HIPOVOLEMI G.BODY G.POLA EKSTERNAL

PENGETAHUAN ANEMIA IMAGE SEKSUAL RADIASI

CEMAS/TAKUT INTOLERANSI RESTI KULIT DEPRESI MULUT

MERAH HB
SUMSUM KERING
AKTIFITAS INFEKSI
,KERIN TULANG STOMATITIS
ANEMIA
SEL KURANG O2
GASTROINTESTIN KURANG O2

MUAL, MUNTAH
KELEMAHAN/KELELAHAN
CLINICAL PATHWAY
NUTRISI KURANG
1. Management of clinically
DAYA suspicous
TAHAN TUBUH goin nodes
BERKURANG RESIKO INJURY

CLINICALLY SUSPICOUS
RESIKO TINGGI INFEKSI
NODES

CT SCAN OF
PELVIS

RESECTION OF MACROSCOPIC GROIN NODES AND

FROZEN SECTION

POSITIVE
NEGATIVE
NEGATIVE OR 1
PELVIC AND
RETROPERITONEAL TWO OR MORE MICROSCOPICALL
INGUINO FEMORAL
GROINOF ANY
RESECTION POSITIVE NODES OR Y POSITIVE NODE
LYMPHADENECTOMY
RADIATIONPELVIC
MACROSCOPIC EXTRACSAPSULAR OBSERVATIO
 2. Management Of Clinically Obvious Groin Nodes

FIXED OR ULCERATED NODES

SURGICALLY RESECTABLE UNRESECTABLE

RESECTION OF ALL PRE OPERATIVE

MACROSCOPIC NODES IN RADIOTHERAPHY /
GROIN AND ANY ENLARGED CHEMOTERAPHY
PELVIC NODES IN CT-SCAN
POST-OPERATIVE RESECTION
POST-OPERATIVE OF MACROSCOPIC RESIDUAL
RADIOTHERAPHY TO GROINS DISEASE
AND PELVIS
 3. Management of advanced primary tumour

LOCALY ADVANCED
PRIMARY TUMOUR

TUMOUR NESECTABLE RESECTION WOULD

WITHOUT REQUIRING STOMA REQUIRE STOMA

RADICAL TUMOUR PRE-OPERATIVE RADIOTHERAPHY

RESECTION AND CHEMOTERAPHY

SURGICAL RESECTION OF
MARGINS TUMOUR BED

POSITIVE CLOSE (<5MM) MORE THAN 5MM

POST-OPERATIVE CONSIDER OBSERVE

RADIOTHERAPHY RADIOTHERAPHY

4. Stage IBI, Work Up

THERAPHY PATHOLOGY

RADICAL NO RISK FACTORS FOLLOW UP

HYSTERECTOMY
(CLASS II-III) WITH PELVIC RT?
NEGATIVE NODES,
PELVIC LND LVS I OUTER 1/3 SMALL
BIOPSY CLINICAL FIELD
INVASION
STAGING CXR CT OF POSITIVE NODES, PELVIC RT
PELVIS AND POSITIVE WITH
ABDOMEN MR PARAMETRIUM, CISPLATIN
OPTIONAL POSITIVE MARGINS
 PRIMARY
RADIATION

EXTERNAL BEAM
PELVIC RT 45 GY/4-5
WEEKS
INTACAVITARY
BRACHYTHERAPHY
LDR 35-40 GY HDR 7
GY/W X 4
POSITIVE COMMON ILIAC OR EXTENDED-FIELD
PARA PARA-AORTIC NODES AT RADIOTHERAPHY 45GY/5
SURGERY OR FNA PROVEN WEEKS + ONCURRENT
5. Stage IB2 and II A EXTERNAL 40-50 GY4-5/5
CISPLATIN
WEEKS + INTRACAVITARY
LDR BOOST 35-40 GY POINT
A OR HDR EQUIVALENT
BIOLOGICAL DOSE,
CONCURRENT CURRENT
CHEMORADIATI CHEMOTHERAPHY :
ON CISPLATIN 40MG/M Q WEEK
DURING EXTERNAL
IRRADITAION. TOTAL
TREATMENT TIME : 6-7
STAGE IB2 & II RADICAL WEEKS
A, EUA, CXR, CT HYSTERECTOMY,
FOLLOW-UP
ABDOMEN PELVIC
&PELVIC MR LYMPHADENECT
OPTIONAL OMY, ADJUVANT
RADIATION
CR

NEOADJUVANT
ADJUVANT RT +
CHEMOTERAPHY
PR CONCURRENT
RADICAL
CHEMOTERAPHY
HYSTERECTOMY (CLASS
II-III) PELVIC
LYMPHADENECTOMY PROGRESSION PALLIATIVE PELVIC
RT + CONCURRENT
CHEMOTERAPHY