TB DURING PREGNANCY

By

Fontanella Dwiputri

NIM: P 17324415034

Midwifery Study Program Karawang

Bandung Health Polytechnic

2017
 ACKNOWLEDGEMENT

First of all, Id like to introduce myself. My name is Fontanella Dwiputri. Please

call me Fonta. Im from Bekasi. Then, Id like to thank ALLAH SWT who has given
health and long life. Next, I also would like to express my gratitude to. Ms. Jundra
Darwanty The Head of Karawang Midwifery Study Program Bandung Health
Polytechnic, my gratitude also goes to my Lacturer Mr. Suparno, for his guidance and
help in making some corrections. And then, Id like to convey my gratitude to the
examiner who has given me time to deliver a presentation about TB During
Pregnancy.

Ive divided my presentation into five sections. First, Im going to start by telling
the background of the problem. Second, Ill turn to the definition and symptoms.
Then, Ill concern on the aspects can cause of TB during pregnancy. After that, Ill
move on the medical treatments. Finally, Ill discuss about the preventions.

If you have any questions, Ill do my best to answer them at the end.
 TB DURING PREGNANCY

1. INTRODUCTION

Background of the problem

2. DEFINITION AND SYMPTOMS

Definition

The Symptoms

3. ASPECTS THAT CAN CAUSE OF BREAST CANCER

Aspect can cause

4. THE MEDICAL TREATMENTS

The medical treatments

5. THE PREVENTIONS

The prevention

6. CONCLUSION

7. REFERENCES
 TB DURING PREGNANCY

By

Fontanella Dwiputri

1. INTRODUCTION

1.1 Background

Breast cancer occurs when a malignant (cancerous) tumor originates in the breast. As
breast cancer tumors mature, they may metastasize (spread) to other parts of the body.
The primary route of metastasis is the lymphatic system which, ironically enough, is
also the body's primary system for producing and transporting white blood cells and
other cancer-fighting immune system cells throughout the body. Metastasized cancer
cells that aren't destroyed by the lymphatic system's white blood cells move through
the lymphatic vessels and settle in remote body locations, forming new tumors and
perpetuating the disease process.

Breast cancer is fairly common. Because of its well publicized nature, and potential
for lethality, breast cancer is arguably the most frightening type of cancer diagnosis
someone can receive. However, it is important to keep in mind that, if identified and
properly treated while still in its early stages, breast cancer can be cured.

Breast cancer is not just a woman's disease. It is quite possible for men to get breast
cancer, although it occurs less frequently in men than in women. Our discussion will
focus primarily on breast cancer as it relates to women but it should be noted that
much of the information is also applicable for men.

2. DEFINITION AND SYMPTOMS

2.1 Definition

Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may
include a lump in the breast, a change in breast shape, dimpling of the skin, fluid
coming from the nipple, or a red scaly patch of skin. In those with distant spread of
the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or
yellow skin.

Risk factors for developing breast cancer include being female, obesity, lack of
physical exercise, drinking alcohol, hormone replacement therapy during menopause,
ionizing radiation, early age at first menstruation, having children late or not at all,
older age, and family history.

Breast cancer most commonly develops in cells from the lining of milk ducts and the
lobules that supply the ducts with milk. Cancers developing from the ducts are known
as ductal carcinomas, while those developing from lobules are known as lobular
carcinomas.

2.2 The Symptoms

A symptom is only felt by the patient, and is described to the doctor or nurse, such as
a headache or pain. A sign is something the patient and others can detect, for example,
a rash or swelling.

The first symptoms of breast cancer are usually an area of thickened tissue in the
woman's breast, or a lump. The majority of lumps are not cancerous; however, women
should get them checked by a health care professional.

Women who detect any of the following signs or symptoms should tell their doctor:

A lump in a breast

A pain in the armpits or breast that does not seem to be related to the woman's
menstrual period

Pitting or redness of the skin of the breast; like the skin of an orange
 A rash around (or on) one of the nipples

A swelling (lump) in one of the armpits

An area of thickened tissue in a breast

One of the nipples has a discharge; sometimes it may contain blood

The nipple changes in appearance; it may become sunken or inverted

The size or the shape of the breast changes

The nipple-skin or breast-skin may have started to peel, scale or flake.

3. ASPECTS THAT CAN CAUSE OF BREAST CANCER

3.1 Aspect Can Cause Of Breast Cancer

Experts are not definitively sure what causes breast cancer. It is hard to say why one
person develops the disease while another does not. We know that some risk factors
can impact on a woman's likelihood of developing breast cancer. These are:

1) Getting older

The older a woman gets, the higher is her risk of developing breast cancer; age is a
risk factor. Over 80% of all female breast cancers occur among women aged 50+
years (after the menopause).

2) Genetics

Women who have a close relative who has/had breast or ovarian cancer are more
likely to develop breast cancer. If two close family members develop the disease, it
does not necessarily mean they shared the genes that make them more vulnerable,
because breast cancer is a relatively common cancer.

The majority of breast cancers are not hereditary.

Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of
developing breast and/or ovarian cancer. These genes can be inherited. TP53, another
gene, is also linked to greater breast cancer risk.

3) A history of breast cancer

Women who have had breast cancer, even non-invasive cancer, are more likely to
develop the disease again, compared to women who have no history of the disease.

4) Having had certain types of breast lumps

Women who have had some types of benign (non-cancerous) breast lumps are more
likely to develop cancer later on. Examples include atypical ductal hyperplasia or
lobular carcinoma in situ.

5) Dense breast tissue

Women with more dense breast tissue have a greater chance of developing breast
cancer.

6) Estrogen exposure

Women who started having periods earlier or entered menopause later than usual have
a higher risk of developing breast cancer. This is because their bodies have been
exposed to estrogen for longer. Estrogen exposure begins when periods start, and
drops dramatically during the menopause.

7) Obesity

Post-menopausal obese and overweight women may have a higher risk of developing
breast cancer. Experts say that there are higher levels of estrogen in obese menopausal
women, which may be the cause of the higher risk.

8) Height

Taller-than-average women have a slightly greater likelihood of developing breast

cancer than shorter-than-average women. Experts are not sure why.

9) Alcohol consumption

The more alcohol a woman regularly drinks, the higher her risk of developing breast
cancer is. The Mayo Clinic says that if a woman wants to drink, she should not exceed
one alcoholic beverage per day.

10) Radiation exposure

Undergoing X-rays and CT scans may raise a woman's risk of developing breast
cancer slightly. Scientists at the Memorial Sloan-Kettering Cancer Center found that
women who had been treated with radiation to the chest for a childhood cancer have a
higher risk of developing breast cancer.

11) HRT (hormone replacement therapy)

Both forms, combined and estrogen-only HRT therapies may increase a woman's risk
of developing breast cancer slightly. Combined HRT causes a higher risk.

12) Certain jobs

French researchers found that women who worked at night prior to a first pregnancy
had a higher risk of eventually developing breast cancer.

Canadian researchers found that certain jobs, especially those that bring the human
body into contact with possible carcinogens and endocrine disruptors are linked to a
higher risk of developing breast cancer. Examples include bar/gambling, automotive
plastics manufacturing, metal-working, food canning and agriculture.

4. THE MEDICAL TREATMENTS

4.1 The Medical Treatments

A multidisciplinary team will be involved in a breast cancer patient's treatment. The

team may consists of an oncologist, radiologist, specialist cancer surgeon, specialist
nurse, pathologist, radiologist, radiographer, and reconstructive surgeon. Sometimes
the team may also include an occupational therapist, psychologist, dietitian, and
physical therapist.

The team will take into account several factors when deciding on the best treatment
for the patient, including:

The type of breast cancer

The stage and grade of the breast cancer - how large the tumor is, whether or
not it has spread, and if so how far

Whether or not the cancer cells are sensitive to hormones

The patient's overall health

The age of the patient (has she been through the menopause?)

The patient's own preferences.

The main breast cancer treatment options may include:

Radiation therapy (radiotherapy)

Surgery

Hormone therapy

Chemotherapy.

Surgery

Lumpectomy - surgically removing the tumor and a small margin of healthy

tissue around it. In breast cancer, this is often called breast-sparing surgery.
This type of surgery may be recommended if the tumor is small and the
surgeon believes it will be easy to separate from the tissue around it.

Mastectomy - surgically removing the breast. Simple mastectomy involves

removing the lobules, ducts, fatty tissue, nipple, areola, and some skin.
 Radical mastectomy means also removing muscle of the chest wall and the
lymph nodes in the armpit.

Sentinel node biopsy - one lymph node is surgically removed. If the breast
cancer has reached a lymph node it can spread further through the lymphatic
system into other parts of the body.

Axillary lymph node dissection - if the sentinel node was found to have
cancer cells, the surgeon may recommend removing several nymph nodes in
the armpit.

Breast reconstruction surgery - a series of surgical procedures aimed at

recreating a breast so that it looks as much as possible like the other breast.
This procedure may be carried out at the same time as a mastectomy. The
surgeon may use a breast implant, or tissue from another part of the patient's
body.

Radiation therapy (radiotherapy)

Controlled doses of radiation are targeted at the tumor to destroy the cancer cells.
Usually, radiotherapy is used after surgery, as well as chemotherapy to kill off any
cancer cells that may still be around. Typically, radiation therapy occurs about one
month after surgery or chemotherapy. Each session lasts a few minutes; the patient
may require three to five sessions per week for three to six weeks.

The type of breast cancer the woman has will decide what type of radiation therapy
she may have to undergo. In some cases, radiotherapy is not needed.

Chemotherapy

Medications are used to kill the cancer cells - these are called cytotoxic drugs. The
oncologist may recommend chemotherapy if there is a high risk of cancer recurrence,
or the cancer spreading elsewhere in the body. This is called adjuvant chemotherapy.
If the tumors are large, chemotherapy may be administered before surgery. The aim is
to shrink the tumor, making its removal easier. This is called neo-adjuvant
chemotherapy.

Chemotherapy may also be administered if the cancer has metastasized - spread to

other parts of the body. Chemotherapy is also useful in reducing some of the
symptoms caused by cancer.

Chemotherapy may help stop estrogen production. Estrogen can encourage the growth
of some breast cancers.

Side effects of chemotherapy may include nausea, vomiting, loss of appetite, fatigue,
sore mouth, hair loss, and a slightly higher susceptibility to infections. Many of these
side effects can be controlled with medications the doctor can prescribe. Women over
40 may enter early menopause.

Hormone therapy (hormone blocking therapy)

Hormone therapy is used for breast cancers that are sensitive to hormones. These
types of cancer are often referred to as ER positive (estrogen receptor positive) and
PR positive (progesterone receptor positive) cancers. The aim is to prevent cancer
recurrence. Hormone blocking therapy is usually used after surgery, but may
sometimes be used beforehand to shrink the tumor.

If for health reasons, the patient cannot undergo surgery, chemotherapy or

radiotherapy, hormone therapy may be the only treatment she receives. Hormone
therapy will have no effect on cancers that are not sensitive to hormones. Hormone
therapy usually lasts up to five years after surgery.

The following hormone therapy medications may be used:

Tamoxifen - prevents estrogen from binding to ER-positive cancer cells. Side

effects may include changes in periods, hot flashes, weight gain, headaches,
nausea, vomiting, fatigue, and aching joints.

Aromatase inhibitors - this type of medication may be offered to women who

have been through the menopause. It blocks aromatase. Aromatase helps
 estrogen production after the menopause. Before the menopause, a woman's
ovaries produce estrogen. Examples of aromatase inhibitors include letrozole,
exemestane, and anastrozole. Side effects may include nausea, vomiting,
fatigue, skin rashes, headaches, bone pain, aching joints, loss of libido, sweats,
and hot flashes.

5. THE PREVENTIONS

5.1 The Preventions

These eight simple steps can help lower the risk of breast cancer. Not every one
applies to every woman, but together they can have a big impact.

1) Keep Weight in Check

Its easy to tune out because it gets said so often, but maintaining a healthy weight is
an important goal for everyone. Being overweight can increase the risk of many
different cancers, including breast cancer, especially after menopause.

2) Be Physically Active

Exercise is as close to a silver bullet for good health as there is, and women who are
physically active for at least 30 minutes a day have a lower risk of breast cancer.
Regular exercise is also one of the best ways to help keep weight in check.

3) Eat Your Fruits & Vegetables and Avoid Too Much Alcohol

A healthy diet can help lower the risk of breast cancer. Try to eat a lot of fruits and
vegetables and keep alcohol at moderate levels or lower (a drink a day or under).
While moderate drinking can be good for the heart in older adults, even low levels of
intake can increase the risk of breast cancer. If you dont drink, dont feel you need to
start. If you drink moderately, theres likely no reason to stop. But, if you drink more,
you should cut down or quit.
4) Dont Smoke

Smokers and non-smokers alike know how unhealthy smoking is. On top of lowering
quality of life and increasing the risk of heart disease, stroke, and at least 15 cancers
including breast cancer it also causes smelly breath, bad teeth, and wrinkles. Now
thats motivation to stay smoke-free or work to get smoke-free.

5) Breastfeed, If Possible

Breastfeeding for a total of one year or more (combined for all children) lowers the
risk of breast cancer. It also has great health benefits for the child.

6) Avoid Birth Control Pills, Particularly After Age 35 or If You Smoke

Birth control pills have both risks and benefits. The younger a woman is, the lower
the risks are. While women are taking birth control pills, they have a slightly
increased risk of breast cancer. This risk goes away quickly, though, after stopping the
pill. The risk of stroke and heart attack is also increased while on the pill
particularly if a woman smokes. However, long-term use can also have important
benefits, like lowering the risk of ovarian cancer, colon cancer and uterine cancer
not to mention unwanted pregnancy so theres also a lot in its favor. If youre very
concerned about breast cancer, avoiding birth control pills is one option to lower risk.

7) Avoid Post-Menopausal Hormones

Post-menopausal hormones shouldnt be taken long term to prevent chronic diseases,

like osteoporosis and heart disease. Studies show they have a mixed effect on health,
increasing the risk of some diseases and lowering the risk of others, and both
estrogenonly hormones and estrogen-plus-progestin hormones increase the risk of
breast cancer. If women do take post-menopausal hormones, it should be for the
shortest time possible. The best person to talk to about the risks and benefits of post-
menopausal hormones is your doctor.

8) Tamoxifen and Raloxifene for Women at High Risk

Although not commonly thought of as a healthy behavior, taking the prescription

drugs tamoxifen and raloxifene can significantly lower the risk of breast cancer in
woman at high risk of the disease. Approved by the FDA for breast cancer prevention,
these powerful drugs can have side effects, so they arent right for everyone. If you
think youre at high risk, talk to your doctor to see if tamoxifen or raloxifene may be
right for you.

6. CONCLUSION

Breast cancer is cancer that develops from breast tissue. The symptoms of breast
cancer these are: a lump in a breast, a pain in the armpits or breast that does not seem
to be related to the woman's menstrual period, pitting or redness of the skin of the
breast; like the skin of an orange, a rash around (or on) one of the nipples, a swelling
(lump) in one of the armpits, an area of thickened tissue in a breast, one of the nipples
has a discharge, the nipple changes in appearance, the size or the shape of the breast
changes, the nipple-skin or breast-skin may have started to peel, scale or flake.

Some risk factors can impact on a woman's likelihood of developing breast cancer.
These are: getting older, genetics, a history of breast cancer, having had certain types
of breast lumps, dense breast tissue, estrogen exposure, obesity, Alcohol consumption,
Radiation exposure, HRT (hormone replacement therapy), and certains job.

The main breast cancer treatment options may include:

Radiation therapy (radiotherapy)

Surgery

Hormone therapy

Chemotherapy.
These eight simple steps can help lower the risk of breast cancer, these
are keep weight in check, be physically active, eat your fruits &
vegetables and avoid too much alcohol, dont smoke, breastfeed (if
possible), avoid birth control pills, particularly after age 35 or if you
smoke, avoid post-menopausal hormones, tamoxifen and raloxifene for
women at high risk.
REFERENCES

https://www.cancer.org/cancer/breast-cancer/treatment.html

http://www.medicalnewstoday.com/articles/37136.php?page=3

https://www.mentalhelp.net/articles/breast-cancer-introduction/

https://siteman.wustl.edu/prevention/take-proactive-control/8-ways-to-prevent-breast-
cancer/