hypertension crisis 8 CONCLUSION

1. Hypertensive crisis occurs when there is increased blood pressure suddenly, where TD diastole above 120-130 mmHg.
2. Interference in the target organs in acute or hypertension attack en route to emergency associated with hypertension, and should receive treatment as soon as possible in matter of minutes or hours to avoid complications - complications that can occur.
3. Increased high blood pressure without a disruption in the target organ is known as a hypertensive urgency (hypertensive urgency), where treatment can be done in a few hours to 48 hours but remain in close supervision.
4. handling and proper management can reduce the risk of complications there, so patients can perform activities as usual.

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hypertension crisis 7 Management AND THERAPY

Management of inpatients
Patients with hypertension  genuine emergency requiring the careful IV therapy to control both blood pressure and decrease slowly but steadily.
 strict monitoring is needed. Treated in the ICU is appropriate.
 Another issue or another broadcaster needs to be acknowledged and addressed (for example, surgery for aortic dissection)
Management on an outpatient
 Hypertension is a chronic problem. The main thing to reduce the risk of disability and death of patients is long-term treatment.
 If the patient is known with high BP examination in the emergency room but did not show any interference with the target organ, the patient does not need to get treatment as soon as possible. Patients only need difollow-ups regularly.
 JNC recommendation from high blood pressure for routine follow-up in patients without target organ disorders:
 Prehypertension (TDS 120-139, TDD 80-89)  BP should be checked again in 1 year.
 Hypertension degree I (TDS 140-159, TDD 90-99)  TD should be checked again in 2 months.
 Hypertension degrees II (TDS> 160 or TDD> 100)  need treatment at a health center within 1 month.
 If TDnya> 180/110, the patient should be examined and given within 1 week of therapy.
Referral of patients can be done with consideration of the existing condition of the broadcaster. If known there are other disorders that accompany, such as aortic dissection or subarachnoid hemorrhage, it is necessary to be referred to health centers higher.
COMPLICATIONS, PREVENSI, and Prognosis
Complications that may arise from the crisis of hypertension or side effects of treatment given:
Congestive heart failure 
Myocardial miokardial 
Renal 
 retinopathy
Injury  brain blood vessels
Disturbance due to a decrease   TD cerebral blood perfusion and heart inadekuat, so it can towards stroke or ischemic infarction.
Some things that need to be considered in patients with high BP to prevent an attack or hypertensive crisis reactivation:
Examination  good in the long run for hypertension is the best way to prevent a sudden attack of hypertension crisis.
 Educate patients and follow-up routine in patients with essential hypertension crisis as to prevent re-attack emergency hypertension.
 Use appropriate antihypertensive drugs by doctors is the main thing to avoid the development of hypertensive emergency.
Prognosis
 The death rate within 1 year more than 90% in patients with hypertension who did not handle the emergency.
 life expectancy of about 144 months for all patients with hypertensive emergency encountered in the emergency room.
Life expectancy  5 years in all patients with hypertensive crises around 74%.

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hypertension crisis 6 Management AND THERAPY

If a case of hypertensive crisis, which first had to do is do not panic. Things - things you can do before bringing the patient into the ER, among others:
 Know all signs - there are clinical signs of hypertensive crisis, such as chest pain or heart failure. Actions to lower blood pressure is not indicated before the patient was taken to hospital.
 Oxygen, a strong diuretic (furosemide), and nitrate, all of which may be given.
 In most cases, action to deal with hypertension before being taken to the hospital was not wise. In certain circumstances, reduction in blood pressure which can drastically reduce the target organ perfusion significantly.
Subsequent handling in the ER for patients with hypertension in principle is to determine the presence or absence of interference with the target organ.
 initial action (if the patient is not in a state of distress)
 Put in patients who are not depressed in a quiet room and checked again after initial examination. In one study, 27% of patients with early diastole blood pressure> 130 mmHg can decrease significantly after relaxation without special handling.
 Consider whether there are other reasons that cause increased blood pressure (such as severe pain which sometimes causes a rise in blood pressure).
Looking for the presence or absence  interference with target organ of patients  know history, physical examination, laboratory tests, other investigations.
 Patients without interference with the target organ can be moved without the provision of therapy as soon as possible, but still difollow - up in the hope that lowering blood pressure in stages. (JNC recommendations)
 misconception is that patients should not be moved from the emergency room with blood pressure is still high. So that the patients were given oral medication, such as nifedipin, with the hope to decrease blood pressure before it moved. This is not indicated and may be dangerous.
 The work done in this way may be difficult in improving blood pressure "drop". If this happens, then the target organ will experience hipoperfusi.
 Some patients may have a talent for an increase in blood pressure and takes a long time to control it but he was not familiar with the blood pressure drops rapidly, although it was the normal number.
 Patients with target organ disorders usually requires immediate action to lower blood pressure through the line quickly. Drug therapy is given depends on the organ - the organ.
 In the case of hypertensive crisis, blood pressure should not be lowered to the normal rate.
 The decrease of blood pressure can quickly lead to decrease blood flow to the brain, kidney, and / or coronary blood vessels, which allows the emergence of ischemic and infarction.
 In general, MAP should not be lowered more than 20 - 25% in the first hours of therapy. If the patient is stable, then further blood pressure can be lowered to 160/100-110 the next 2-6 hours.
 For the best results are expected, can be obtained by continuing the infusion of working quickly, can be titrated from parenteral antihypertensive medications with a continual monitoring of patients - sustained and intensive.
 blood pressure drop rapidly as indicated in the following circumstances:
 Ischemic acute myocardial
 Nitroglycerin IV
  - blockers IV
 congestive heart failure with pulmonary edema
 Nitroglycerin IV
 Lasix IV
 Nitroprusside IV
  acute aortic dissection in this situation, if possible systole blood pressure should be lowered quickly to 100 to 110 mm Hg or more lower.
 Labetalol IV
 Alternative IV with nitroprusside   - blockers (esmolol cont.)
 Injury  brain blood vessels using antihypertensive drugs are not always recommended for stroke patients with hypertension.
 Controlling blood pressure is influenced by the use of thrombolytic drugs in ischemic stroke. TD systole> 185 mmHg or diastole TD> 110 mm Hg is a contraindication to the use of tissue plasminogen activator (TPA) in the first 3 hours of ischemic stroke patients.
 latest recommendations from the American Stroke Association explains that patients with ischemic stroke and sistolenya TD> 220 mmHg or diastolenya TD> 120-140 can be lowered blood pressure approximately 10-15% (with IV nitroprusside or labetalol IV), if the patient is always monitored closely to decrease the status neurologist associated with blood pressure lower.
Intracranial hemorrhage   there is no evidence to support that hypertension trigger further bleeding in patients with intracranial hemorrhage.
Drastic reduction  systole blood pressure can reduce perfusion in the brain and increase the risk of death.
 Control to lower blood pressure by giving IV nitroprusside or labetalol IV (there are no bradikardi) is recommended when the systole TD> 200mmHg or diastole TD> 110mmHg.
 Interaction monoamine oksidade - tiramin with acute hypertension  phentolamin IV
 Pheokromositoma
 Phentolamin IV
 Labetalol IV
 Hypertension enselopati
 Nitroprusside IV
 Labetalol IV
IV Fenoldopam 
 Acute renal failure
IV Fenoldopam 
 Nicardipin IV
  - blockers IV
 Eklamsia
 Hydralazin IV
 Labetalol IV
IV Magnesium 
 blood pressure drop quickly in the ER in addition to the above conditions is controversial and should be avoided.
 In patients who initiated because of the use of drugs - illegal drugs can be given a combination of nitroprusside with α and  - adrenergic blockers.

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hypertension crisis 5 DIAGNOSIS

Knowing the previous history and clinical findings are very important to distinguish between hypertension and hypertensive emergency urgency. Information about previous history of hypertension should include that have been diagnosed, the duration, degree, and control of blood pressure taken. Also find information about the previous history should take precedence in the discovery of the organ - the target organ affected, the situation during hypertension, and findings - that there are other findings.
Some other things that can be asked related to the occurrence of hypertensive crisis:
 Drugs - drugs
- Antihypertensive therapy previously obtained.
- The use of substances - substances "over - the - counter", as an example of a drug - a drug simpatomimetik.
- The use of drugs - drugs such as cocaine.
 Date of last menstrual
 other health problems (ex: hipertens earlier, thyroid disease, Cushing's syndrome, systemic lupus, and kidney disease).
 assessment of complaints that lead to hypertension crisis clinical findings:
-  chest pain of ischemic heart muscle or myocardium
- Back pain  aortic dissection
- Difficulty in breathing  pulmonary edema or congestive heart failure
- Symptoms - anxiety symptoms  neurologist, vision problems, level of chaos that changes - change (hypertension enselopati)
Physical examination should be given priority on things - things that can explain the crisis of hypertension in the emergency situation.
 Alerts - vital signs
 blood pressure should be measured in standing and sitting position (if possible  assess whether or not the volume depletion
 blood pressure should also be measured on both arms  significant differences leading to the aortic dissection.
Funduskopi examination may include changes that are consistent from chronic hypertension. Acute changes include arterial spasm (focal or diffus), retinal edema, bleeding in the retina (surface and shape as a tongue of fire, or deep and wide), exudate in the retina (hard or like cotton wool), or papiledema.
Examination focused on the cardiovascular whether there is a sign - a sign of heart failure (such as the lungs ronkhi voice, increased jugular venous pressure, askultasi emergence of S3 in the heart, and peripheral edema) or aortic dissection. Results further possibility of compensation can occur from an artery that is usually caused by a decrease in pulse rate, and this may result in ischemic brain, muscles, or digestive tract. Additional sound new murmur or mitral insufficiency penigkatan than may sound as a result of increased left ventricular afterload.
With the heart - the heart, neurological examination can directly explain the sign - a sign that will soon happen / is happening. Symptoms often arise as a result of hypertension among other enselopati, disorientation, decreased level of consciousness, and in some cases focal neurological deficit or seizures comprehensive or specific focal only. Enselopati hypertension is a stand-alone diagnosis, where the existence of other lesions (cont: stroke, subarachnoid hemorrhage, mass lesions) could be set aside. This is possible because of cerebral edema caused by the loss of autoregulation of cerebral blood vessels that appear because of hypertension weight.
The laboratory should be done immediately upon discovery of clinical symptoms and explain the important results for the ongoing situation. Routine blood tests can determine the presence or absence of mikroangiopati hemolytic anemia. Examination of urine can also indicate a hematuri, proteinuri or sediment on the state azotermia or kidney failure. Urine examination to determine the levels metanefrin can also be done to eliminate the possibility of pheokromositoma. Increased levels of serum urea and creatinine, metabolic acidosis, and hypokalemia can be seen on the blood chemistry tests which can indicate a decrease in kidney function. Aldosterone levels and plasma rennin can also be examined to rule out the existence of primary hiperaldosteronism in patients with significant hypokalemia previously not received diuretic drugs at the time of attack .. Hypokalemia which is the description of secondary aldosteronism, is at approximately 50% of patients with hypertensive crisis. In patients with elevated blood pressure due to natriuresis, serum sodium levels are usually lower than the state of primary aldosteronism. This happens because the increase in hydrostatic pressure peritubuler kidney-related increase in arterial pressure. This Natriuresis causes a secondary decrease in sodium reabsorbsi. Laboratory tests that can be done as an alternative to support the diagnosis of hypertensive crisis, among others, toxicology tests, pregnancy testing, and endocrine examinations.
Hipertropi the left ventricle and changes associated with ischemia or infarction can be seen on electrocardiography examination. Photo roentgens thoracic show evidence of heart enlargement, pulmonary edema, or a widened mediastinum, where it all can lead to aortic dissection. In addition, to further strengthen the suspicion of aortic dissection, can be performed chest CT examination, transesofageal ekhokardiografi, or with aortic arteriogram. Ekhokardiografi two dimensions can be used to distinguish pure diastole dysfunction of the heart during systole dysfunction sign - a sign of heart failure appear. All this may help in determining the therapy given and the provision of long-term therapy.
Head CT scan can be performed on patients with symptoms of neurological disorders. Sign - a sign that may arise from this investigation, among others, brain hemorrhage, brain edema, or ischemia in the brain.
In the end, it is important to determine the cause of secondary hypertension (eg hypertension renovaskular) which may cause the crisis. Test with a single dose of captopril may be given, especially in patients who did not receive drug therapy for hypertension before. Aktvitas levels of plasma rennin known in advance and then the patients were given 25 to 50 mg of captopril, 60 minutes and then re-examined rennin levels. The sensitivity value is a good test, but for very low spesifisitasnya. For further examination, such as Doppler ultrasound, MRI renal angiography, angiography with contrast, may be done to better diagnosis.
Using Skrening captopril test for secondary causes of the crisis of hypertension:
METHOD
o Patients receive adequate intake of salt and not getting a diuretic drug.
o Stop all hypertension medications three weeks before the test, if possible.
o The patient is seated at least 30 minutes, take blood samples and determined aktvitas levels of plasma rennin.
o captopril 50 mg diluted in 10 ml of water, the patient should immediately take the solution.
o After 60 minutes, take back the blood sample and measured re-elevated levels of plasma rennin.
INTERPRETATION
Expressed a positive test if:
 There was elevated levels of plasma rennin or more 12 ng/ml/jam.
and
 absolute increase in plasma rennin levels of 10 ng / ml / hour or more.
and
 Increased levels of plasma rennin > 150 % or > 400 % if the lower threshold value of plasma rennin levels were < 3 ng / ml / days.

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hypertension crisis 4 Pathophysiology

Pathophysiology for sure about the development of hypertensive crisis is unknown. Progressive malignant hypertension may be a nonspecific process that causes increased blood pressure is extreme. Humoral factors (especially the renin-angiotensin axis) and local products produced by blood vessels (eg prostaglandins and free radicals) may also be involved in increasing blood pressure very quickly.
However, the progressive increase in blood pressure is an important first step. There are three major organ systems are affected by high blood pressure is the central nervous system, cardiovascular system, renal system.

Central Nervous System 
Cerebral autoregulation is an important ability of the cerebral blood vessels to maintain cerebral blood flow remained constant in addition to changes in blood pressure. When the average arterial pressure - mean (MAP) increased, disturbed and endhotelium cerebral brain barrier can become loose. Fibrinoid material deposited in the brain blood vessels and cause lumen narrowed. Then the blood vessels of the brain trying to vasodilatation in the lumen was narrowed. This could be the beginning of cerebral udem and mikrohemoragik. Patients with chronic hypertension may tolerate a high MAP before an interruption in autoregulasi system.
Enselopati Hypertension is one of the clinical manifestations of cerebral edema and mikrohemoragi, which occur dysfunction of cerebral autoregulation. Without immediate treatment, enselopati hypertension can lead to cerebral hemorrhage, coma and eventually died.
Cardiovascular system 
Hypertension affects the structure and function of coronary arteries and left ventricle. Hypertension also activate the renin-angiotensin system, aldosterone, which causes systemic vasokonstriktif. This resulted in increased oxygen demand of the heart muscle because of increased left ventricular wall stress that can lead to hipertropi left ventricle and compression of the coronary blood vessels. When hypertension emergency occurs, the left ventricle can not compensate for systemic vascular resistance. This will ultimately lead to left ventricular failure and pulmonary edema, or ischemic heart muscle.
 renal system
Chronic hypertension causes pathological changes in small arteries of kidney. This continued on endothelial dysfunction and a weak vasodilatation, which will affect renal autoregulation. When disturbed renal autoregulation, intraglomerular pressure is directly related to systemic arterial pressure, this makes the lack of protection of renal changes in fluctuating blood pressure. When the crisis of hypertension, such interference can cause ischemia in acute renal.

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hypertension crisis 3

CAUSES AND RISK FACTORS
Although the causes of the crisis relatively low blood pressure, but hypertension is a disorder of pervasive and highly significant effect for men. Most of hypertension is essential or primary (no other cause), and hypertensive crisis appears more frequently in patients who have a history of previous hypertension. Hypertensive crisis may also arise because the disease that causes hypertension or any other cause:
  kidney disease parenkhim chronic pyelonephritis, preimer glomerulonephritis, tubulointerstitial nephritis (approximately 80% of all secondary causes).
 systemic disorders involving the kidney erimatosus  systemic lupus, systemic sclerosis, vasculitides.
Renovascular disease   atherosklerotik disease, displasi fibromuskuler, poliartritis nodosa.
Endocrine   pheokromositoma, Cushing syndrome, primary hiperaldosteronism.
  drugs cocaine, amphetamines, cyclosporin, dismissal klonidin, phensiklidin, diet pills, oral contraceptive pill.
  drug interactions Monoamine oxidase inhibitors with Tricyclic antidepressants, antihistamines, or tyramine-containing foods.
  central nervous system CNS trauma or spinal disorders, for example Guillain-Barré syndrome.
Aortic Koarktasio 
 Preeclampsia - eklamsia
Hypertension  post-surgery.
Hypertensive crisis can occur at any time. Hypertensive crisis may occur in neonates with congenital renal artery hipoplasi, children with acute glomerulonephritis, a young pregnant woman with eklamsia, or parents with atherosclerosis and renal artery stenosis. Some individuals may not be used to increase blood pressure significantly, and the symptoms and clinical manifestations of hypertensive crises arise in blood pressure are lower than those with chronic hypertension. However, treatment must be provided.
In the United States, approximately 50 million people stricken with hypertension. Prevalence increases with age. More than half of people aged between 60-69 years and about three-quarters of people aged 70 years or older who attacked hypertension. According to Mc Cowan, 2006, the crisis of hypertension attacked about 500,000 U.S. residents, or about 1% of adults who suffer from hypertension. And approximately one billion people worldwide suffer from hypertension.
Death due to ischemic heart disease and stroke increases with increasing blood pressure. For every increase in blood pressure 20 mmHg 10 mmHg systole and diastole, the risk of death due to ischemic heart disease and stroke would double.
When compared to existing inter-racial, African-American race is a race that has the greatest risk factor for hypertension crisis stricken. Hypertensive crisis appears more frequently in patients with advanced age. And overall, the prevalence and incidence of hypertension incidence is greater in men than women. The frequency of occurrence of hypertension crisis also two times more in men than women.
From a research note that blood pressure control is less effective in terms of systole blood pressure measurement is an independent risk factor for hypertension crisis cases that appeared in the ER.
But instead of that, mobilities and mortality due to hypertensive crisis, depending on the number of infected target organs and the extent of blood pressure can be controlled.

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hypertension crisis 2

DEFINITIONS
Hypertensive crisis can be defined as an increase in blood pressure arrived - arrived and meaningful, which diastolic pressure above 120 mm Hg - 130 mm Hg. Increased blood pressure is reached - arrived this may cause damage to several organs and can trigger a stroke occurs. Where in the incident, the heart can not function as well as function.

CLASSIFICATION
Mostly the crisis of hypertension is divided into two, namely hypertensive emergency (emergency hypertension) and hypertensive urgency (urgency hypertension).
Hypertension  emergency (emergency hypertension) which occurs  increased blood pressure is very high and there are abnormalities / target organ damage is progressive, so that in these circumstances blood pressure should be taken down immediately (within minutes to hours) in order to prevent / reduce damage to the target organ occurred.
Hypertension  urgent (urgency hypertension)  where there are blood pressure is very high but it is not accompanied by abnormalities / progressive organ damage, thus lowering blood pressure can be implemented more slowly, within hours to days.
The term for the progressive hypertension (accelerated hypertension) and malignant hypertension (malignant hypertension) is used in explaining the high blood pressure associated with clinical findings in retina. Accelerated hypertension is associated with bleeding of the retina and the presence of exudate (group 3 Keith-Wagener-Barker retinopathy). And
Malignant hypertension associated with the papiledema (group 4 Keith-Wagener-Barker retinopathy). Current clinical findings are not much different in funduscopy examination. And the situation can be described as a progressive malignant hypertension (accelerated-malignant hypertension).

SYMPTOMS AND clinical manifestations
The crisis is a symptom hypertension target organ affected, including chest pain and shortness of breath on cardiac and aortic dissection; eyes blurred in the eye papilla edema; severe headaches, disturbance of consciousness and brain disorders lateralisasi; acute renal failure in renal impairment; in addition to headache and neck pain on the increase in blood pressure in general.

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hypertension crisis 1

Community lifestyle today is a luxury lifestyle and sometimes far away from health considerations. So many health problems that arise as a result of it. One of them is hypertension.
Until now hypertension still remains a problem for several reasons, among others, increasing prevalence, is still the number of hypertension patients who had received treatment or been treated, but her blood pressure has not reached the target, as well as the accompanying diseases and complications that can increase morbidity and mortality.
Epidemiological data show that with the increasing elderly population, the number of patients with hypertension will likely increase, in which both systolic hypertension or a combination of systolic and diastolic hypertension often occurs in more than half of people aged> 65 years. In addition, blood pressure control rate of the former continue to increase, in the last decade shows no progress anymore (horizontal curve pattern), and blood pressure control was achieved only 34% of all hypertensive patients. Until now, data are incomplete hypertension most come from countries - countries that have been developed.
Hypertension of unknown cause was defined as essential hypertension, or by some doctors prefer the term primary hypertension. This is to distinguish with other hypertension secondary cause - for the unknown. Essential hypertension itself is 95% of the total cases of hypertension.

According to The Seventh Report of the Jonit National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), the classification of blood pressure in adults are divided into:
Classification TDS (mmHg) TDD (mmHg)
Normal <120> 160 or> 100

Hypertension can cause organ damage, either directly or indirectly. Disturbances in the organ - a common target organ in patients with hypertension found among others:
 Heart
 left ventricular hypertrophy
 angina or myocardial infarction
 Heart failure
 Brain
 stroke or transient ischemic attack
 Dementia
 chronic kidney disease
Peripheral arterial disease 
 retinopathy
The evaluation of hypertension in patients aims to:
1. assess and identify lifestyle factors - other cardiovascular risk factors or to assess the existence of an accompanying disorder that affects the prognosis and determine treatment.
2. find the cause of an increase in blood pressure.
3. determine the presence or absence of target organ disorders and cardiovascular disease.
Of all of the above, there is a situation where an increase in blood pressure is very high with the possibility of occurrence or interference / damage to the target organ. The situation is called hypertensive crisis. In general, hypertensive crisis occurs in patients with hypertension who do not or neglects to take antihypertensive drugs. Such conditions can cause disability or even death to the person who attacked them.
Problems that often occur during the handling of this crisis of hypertension patients are not quite right. Often, patients with blood pressure high blood pressure-lowering drugs are given directly by large doses in the hope that lowering blood pressure immediately. This is tantamount to overcome a problem but it adds another problem, as it can possible happen hipoperfusi organs - organs that targets can lead to occurrence of ischemic and infarction.

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cancer lungs: 14 PREVENTION

The most important prevention is not smoking from an early age. Quitting smoking can reduce the risk of lung cancer. Research from the group of smokers trying to quit smoking, only 30% were successful.

Lately a lot of preventive chemopreventif done. Aims to intervene Chemopreventif carcinogenic process, using natural or pharmacological drugs. Kemoprevensi agents are widely used micronutrients or antioxidants, retinoids, carotenoids, vitamin C, selenium, hormone therapy. Chemopreventif agents must be accompanied by experimental or epidemiological data showing efficacy, the mechanistic basis for the activity and same granting chemopreventif the long term.

Conclusion:
1. In men, lung cancer and the leading cause of death in women, lung cancer the third leading cause of death.
2. Practical division for medicinal purposes: a). small cell lung cancer (SCLC), b). NSCLC (non small cell lung cancer / squamous carcinoma, adenocarcinoma, large cell carcinoma).
3. Treatment for lung cancer depends on the type, the SCLC is chemotherapy treatment, radiotherapy for NSCLC, while surgery is the best option.

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cancer lungs: 13 THERAPY

Treatment of lung cancer, depending on the type and stage of cancer, in addition to the overall health of patients. If the patient has emphysema, for example, the poor pulmonary function inhibits the operation on patients, even if the patients have tumors that can be surgically removed. Other factors may also play a role, no matter what type of cancer patients. There was a time where, for example, when the side effects of treatment greater than the benefits gained. If that happens, patients can be given supportive therapy. This means, treat symptoms of cancer, causing pain and difficulty in breathing, but does not cure the cancer itself.

The purpose of lung cancer treatment are:
 Curative: cure or prolong disease-free period and increase the life expectancy of patients.
 Palliative: reducing the impact of cancer, improve the quality of life.
 Treat home (Hospice Care) in the case of terminals; reduce physical and psychological impact of cancer both in patients and families.
 Supportive: supporting palliative and curative treatment such as terminal nutrition, blood transfusion and blood components, growth factor anti-pain medication and anti-infective drugs.

There is a fundamental difference of biological temperament Small Cell Lung Cancer in Non-Small Cell Lung Cancer, so the treatment must be distinguished:

Small Cell Lung Cancer (SCLC)

Because most small cell lung cancer has spread outside the lungs when found, surgery is usually not an option. The most effective treatment is chemotherapy, either as monotherapy or in combination with radiation therapy.

SCLC is divided into two, namely:
1. Limited stage disease who were treated with curative purposes (the combination of chemotherapy and radiation) and treatment success rates of 20 %.
2. Extensive-stage disease treated with chemotherapy and initial treatment response rates of 60-70% and complete treatment response rates for 20 - 30 %. Median survival time for limited disease state is for 18 months and extensive disease state is 9 months.

Radiotherapy. In some cases inoperable, radio therapy performed as curative and can pengobatab as adjuvant therapy / palliative in tumors with complications are like reducing the effects of obstruction / suppression of blood vessels / bronchus.

This therapy uses X-rays to kill cancer cells. In some cases, radiation may come from outside the body (external radiation). On the other hand, radioactive compounds can be placed on the needle, using a catheter inserted into or near the lung (internal radiation). How radiation given depending on the type and stage of cancer is handled. Radiation therapy can be administered before, during, or after chemotherapy. In all cases, the goal of treatment is to destroy cancer cells with as little as possible interfere with the normal tissue.

Medication side effects may include redness and swelling of the skin, where the radiation enters the body, shortness of breath, fatique, and sometimes hard to swallow. Dysphagia due to post radiation esophagitis often occurs while the post radiation pneumonitis are rare ( <> 50 % tumor measured 50 or more than 5 the number of detected lesions disappeared; c). stable disease 50 % reduction or <> 25 % bigger; e). lokoprogresif: tumors growing within a radius of the tumor (local).

Side effects of chemotherapy is the most disturbing aspect of the treatment of cancer cells with rapid growth. As contained in the digestive tract, bone marrow and hair, is part of the most influential of these drugs. Although many side effects occurred, severity of cancer depends on these drugs. Sometimes patients have several reactions. On the other hand, patients may experience symptoms such as nausea and vomiting, dizziness, feeling very tired and the risk of infection increases.

Non-Small Cell Carcinoma
Surgical therapy is the first choice in stage I or II in patients with adequate reserves remaining lung. In stage IIIA there is still controversy about the success of the operation if the ipsilateral mediastinal lymph or there thorax wall metastases. Tumor removal technique performed a variety of techniques. Thoracotomy or the opening of the chest wall for surgical procedures and operations sternotony median or do by cutting through the breastbone is the standard method for lung cancer surgery.

Operation to treat lung cancer include:
 Wedge resection. In this operation carried out removal of the lung tumors, along with the soft tissue margin.
 Lobectomy. Operation of lung cancer most often committed. Lobectomy is the appointment of the entire lobe of one lung.
 Pneumonectomy. In this operation, the entire lung removed. Because pneumonectomy would reduce lung function, and cause other complications, this action is only done when necessary and if the patient is able to breathe with one lung.

Operating procedures will also have side effects that can cause lymphocytopenia or low number of lymphocytes (white blood cells) in the blood that causes the short survival time in patients with advanced-stage cancer.

The use of chemotherapy in NSCLC patients in the last two decades has been investigated. Curative chemotherapy for the treatment of combined integrated with other cancer treatment modalities in patients with advanced disease lokoregional.

Chemotherapy is used as standard therapy for patients ranging from stage IIIA and for palliative treatment. Sitostatika drugs have good activity in NSCLC with response rates between 15 - 35 %, however the use of a single drug did not achieve complete remission.

Combination has been investigated sitostatika to increase response rates that will have an impact on life expectancy. According to the Food and Drug Administration (FDA), the use of Avastin with paclitaxel and carboplatin can be used for initial systemic therapy in patients who can not do surgery. For patients with metastatic lung tumors in the colon and rectum, Avastin can be used as sitostatika combined with intravenous 5 - fluorouracil.

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cancer lungs: 12 STAGING

Staging is a system of classifying information about cancer, including location and how far the cancer has spread. TNM system is often used in establishing the stages of lung cancer, especially for Non-Small Cell Lung Cancer. Lung tumors are classified according to tumor size (T), the level of lymph node involvement (N), and how far the cancer has spread (M). Staging Non-Small Cell Lung Cancer include:
 Stage 0. At this stage, limited cancer of the lining of the airways and lung tissue had invaded. 0 cancer, is often found during bronchoscopy performed, which may be done to see the X-ray abnormalities in the chest. When found and treated as soon as possible, of cancer at this stage can be eliminated.
 Stage I. Cancer at this stage has invaded lung tissue, but has not spread to the lymph node.
 Stage II. At this stage the cancer has spread to surrounding lymph nodes and invade the chest wall
 Stage IIIA. At this stage, the cancer has spread from the lungs to the lymph node in the center of the chest.
 Stage IIIB. The cancer has spread to areas such as the heart, blood vessels, trachea and esophagus or to the lymph nodules in the collarbone area.
 Stage IV. The cancer has spread to other parts of the body such as the liver, bones or brain.

Staging for Small Cell Lung Cancer is different from Non-Small Cell is divided into limited and extensive:
 Limited. Cancer of the lungs and nearby lymph nodes.

 Extensive. The cancer has spread outside the lung and surrounding lymph nodes, and may have attacked the lungs or other organs.

Staging test used to determine how far the cancer has spread is important in planning treatment. In addition to CT scan, this test includes:
 Magnetic Resonance Imaging (MRI). In addition to radiation, this test uses radio waves and powerful magnets to produce images of body parts. This is very good for detecting tumors that have spread to the brain or spinal cord.
 Positron Emission Tomography (PET) scans. Unlike other imaging techniques, PET scans do not produce images clear organ structure. Even this way of producing color images of the area with more or less intense to provide information about chemical activity within certain organs and tissues. This chemical activity may indicate whether the cancer cells have spread to nearby lymph node, even before the enlarged lymph node. However, PET scans should be interpreted carefully, because sometimes benign conditions can mimic cancer.

Read More - cancer lungs: 12 STAGING

cancer lungs: 11 Prognosis

A. Small Cell Lung Cancer (SCLC):
 With a change therapy in the past 15 - 20 years the possibility of life on average (median survival time) who had < 3 months increased to 1 year.
 The possibility Disease Limited group average life up to 1-2 years, while 20% of it remained alive in 2 years.
 30 % died because of local complications of the tumor.
 70 % died of carsinomatosis.
 50 % metastasize to the brain (autopsy)

B. Non-Small Cell Lung Cancer (NSCLC):
 Most important in the prognosis of lung cancer is to determine the stage of the disease.
 Compared with other types of NSCLC, karsinomaskuamosa not as bad as others. In patients who performed surgery, the possibility of life after 5 years was 30 % surgey.  Survival after surgery, 70 % on Occult carcinoma; 35 - 40 % in stage 1; 10 - 15% in stage II and less than 10 % at stage III.
 75 % of squamous carcinoma died of complications torakal, 25 % because of the extra torakal, 2 % of them died because of the central nervous system disorders.
 40 % of adenocarcinoma and large cell carcinoma died of complications torakal, 5 for 55 extra torakal.
 15 % of adenocarcinoma and large cell carcinoma metastatic to the brain and 8 - 9 % die from central nervous system disorders.
 The possibility of life on average tumor metastases patients varies from 6 months to 1 year, where it is highly dependent on performance status (Karnofsky scale), extent of disease, the weight loss in the last 6 months.

Read More - cancer lungs: 11 Prognosis

cancer lungs: 10 DIAGNOSTIC PROCEDURES

A. Photo chest roentgens in Posterior-anterior (PA) and lateral

Simple initial examinations that can detect lung cancer. Mayo Clinic Study of the USA, found 61 % of lung tumors were detected in routine examination with normal chest roentgens images, whereas sputum cytologic examination can detect only 19 % . In lung cancer, breast examination roentgens photo also necessary to re-evaluate its doubling time. Reported that most lung cancer has a doubling time of 37 - 465 days. When the doubling time> 18 months, mean tumor benign. The signs of other tumors are benign lesions, concentric spherical, solid and calcification of the firm.

Inspection photos chest roentgens tomography more accurate ways to support the possibility of lung tumors, when the usual way breast images can not confirm the presence of tumors. Investigations another radiologist who sometimes is also necessary bronkografi, fluoroscopy, superior vena cavografi, ventilation / perfusion scanning, ultrasound sonography.

In photos roentgens primary lung cancer can be seen as a solitary round shadow or cause the collapse of a lobe due to bronchial tumor block. Early cancer can be very small and irregular shape, but usually will be fine when growing up. While the picture radiologist for secondary lung tumors does not indicate where the location of the primary tumor.

B. Examination Computed Tomography and Magnetic Resonance Imaging

CT scan at thorax, more sensitive than normal chest image examination, because it can detect abnormalities or nodules with a minimum diameter of 3 mm, although false positives for abnormalities of this magnitude can reach 25 - 60 %. If this facility possible, a CT scan could be a second screening examination after normal chest images. Magnetic Resonance Imaging examination (MRI) is not routinely done, because he is limited to assessing the invading tumor abnormalities in the vertebrae, spinal medulla, the mediastinum, in addition to cost is also quite expensive.

MR examination thorax not superior to CT scan thorax. We are developing a technique that is more accurate imaging of Positron Emission Tomography (PET) can distinguish benign and malignant tumors based on differences in metabolism of biochemical substances case of glucose, oxygen, proteins, nucleic acids. Examples of substances used methionine 11 C and F - 18 fluorodeoxyglucose (FD6).

Tumors less than 1 cm, somewhat difficult to detect because of the small size is less resolusion by PET Scanner. Sensitivity and specificity reported how PET is 83-93% 60-90% sensitive and specific.

Some false positives to be found also a sign of malignant lesions such as inflammation and infection and tuberculosis aspergilosis. Although it is known from several studies PET examination has better accuracy values than CT scans.

C. Inspection of Bone Scanning

This examination is required if the expected signs of metastases to the bone. Tumor incidence of non small cell lung cancer (NSCLC) to bone was reported by 15 %.

D. Sputum cytology examination

Sputum cytology examination is done routinely, especially when patients have complaints such as cough. Cytologic examination does not always give positive results because it depends on:
 Location of tumors of the bronchus
 Type of tumor
 Engineering issued a sputum
 The number of sputum examination. Examination is recommended 3 - 5 days in a row
 When sputum examination (sputum must be fresh)

In lung cancer, which is central to good sputum examination can give positive results up to 67 - 85 % in squamous cell carcinoma. Sputum cytology examination is recommended as a routine examination and screening for early diagnosis of lung cancer, and they are developing early diagnosis using sputum examination staining with immune MAB with antigen antibody 624 H 12 for SCLC (small cell lung cancer) and 703 D4 antibodies to antigens NSCLC (non small cell lung carcinoma). Reports from the National Cancer Institute USA this technique gives results 91 %, 88 % sensitive and specific.

Other cytologic examination for lung cancer diagnostics can be performed on pleural fluid, aspiration of cervical lymph nodes, supraklavikula, rinse and bronchus on bronchoscopy sweep.

E. Histopathology examination

Histopathologic examination is the gold standard for diagnosis of lung cancer to obtain biopsy specimens in a way through:

Bronchoscopy. Modification of fiber-optic bronchoscopy may include:
 Trans bronchial lung biopsy (TBLB) with the demands of fluoroscopy or ultrasound.
 Recently fuorescence examination was developed by using fluorescence bronchoscopy exchanging agent such as Hp D (hemato porphyrin derivate) gave fluorescence concentrates in cancer tissue. The newer technique is to auto fluorescence bronchoscopy. The results of this examination showed 50% more sensitive than white light bronchoscopy for detection of carcinoma in situ and severe dysplasia.
 Ultrasound bronchoscopy, also developed at this time to detect peripheral tumors, endobronkial tumors, lymph node lesions of the mediastinum and hilar regions.
 positive result with bronchoscopy can be reached: 95 % for centrally located tumors and 70-80% for tumors of peripheral location.
 Trans-bronchial-Needle Aspiration (TBNA). Working against lymph nodules in the hilar or mediastinal. The result will be better when guided by CT scan.

How to examination by bronchoscopy is to insert a tube pipe flexible bronchoscope into the airways. In this way doctors can look inside the lungs and lung tissue samples taken for laboratory examination.


Trans Torakal biopsy (TTB)
If the patient has cavities fluid in the lungs, the doctor may take a sample by inserting a thin needle into the chest between the ribs. Fluid is then examined in the laboratory, to see whether or not cancer cells. Raised a number of liquids with a biopsy or torasentesis can also improve breathing.

Biopsy with TTB especially for lesions located peripheral to the size of < 2 cm sensitivity reached 90 - 95 %. Complications pneumothorak can reach 20 - 25 % and haemoptysis up to 20 %. With better preparation, these complications can be minimized. Examination results will be better if there is demand for CT scans, ultrasound, or fluoroscopy. Biopsy of lymph nodes palpable, can be done in Daniel's biopsy of the lymph-nodes scalaneus supraklavikular. Torakoskopi. Biopsy of the tumor in the pleura give better results than by way torakoskopi blind (blind). For tumors located on the surface of the pleural biopsy with the way visceralis Video Assisted Thoracoscopy has a sensitivity and specificity to 100 %, whereas complications occur is very small. Mediatinoskopi. More than 20 % of lung cancers metastasize to the mediastinum, especially Small Cell and Large Cell Ca Ca. to obtain tumor metastases or lymph nodes involved can be done by mediastinoskopi where mediastinoskopi inserted through the supra-sternal incision. This can help assess how far the cancer has spread and whether the operation is wise choice to remove the tumor. Biopsy results positive value 40 %. From other studies on the false negative values obtained mediastinoskopi of 8 - 12 (followed by Thoracotomy).

Thoracotomy for lung cancer diagnostic procedures done when non-invasive and invasive previously failed to find tumor cells.

Read More - cancer lungs: 10 DIAGNOSTIC PROCEDURES

cancer lungs: 9 Early Detection

Complete anamnesis and thorough physical examination is the key to proper diagnosis. In addition to clinical symptoms mentioned above, several factors need to be considered in patients with suspected lung cancer, including: factors of age, smoking habits, a history of cancer in the family, exposure to carcinogenic substances or exposed to the fungus, and infections that can cause solitary pulmonary nodule. Finding lung cancer at an early stage is very difficult because at this stage there are no complaints or symptoms. The size of tumors at early stages is relatively small (<1cm)> 40 years, smoking> 1 pack per day and / or working in polluted environment that allows happens lung cancer (factory paint, plastic, asbestos, etc.) . Research conducted by the NCI on cancer research center 3 for> 20 years of more than 30,000 volunteers male heavy smokers, where half undergo intensive screening with sputum cytologic examination every 4 months and chest roentgens images (PA and lateral) of each year and a half other as the control group. The results of this study showed a positive early-stage tumors in the first group of 45% and 15% in the control group. Patients with lung cancer has a 5-year rate of survival by 35% compared to the control group 13%. In this study, examination of malignant cells by cytologic examination of sputum more easily find squamous cell carcinoma, while the image more chest roentgens found adenocarcinoma and squamous cell carcinoma. Small cell carcinoma rare detected in early stages. Overall the study concluded that there is a positive value (benefits) in the early detection of lung cancer.

Read More - cancer lungs: 9 Early Detection

cancer lungs: 8

Lung cancer can also spread through the bloodstream to the liver, brain, adrenal glands and bone. This can happen at an early stage, especially in small cell carcinoma. Symptoms of liver failure, confusion, seizures, and bone pain; that could arise before the occurrence of various lung disorders, so that early diagnosis difficult to enforce.

Some lung cancer effect in a place far away from the lungs, such as metabolic disorders, neurological disorders and muscle disorders (paraneoplastik syndrome). This syndrome is not related to the size and location of the cancer and does not necessarily indicate that the cancer has spread outside the chest; syndrome is caused by substances released by cancer. The symptoms can be an early sign of cancer or a preliminary indication that the cancer had returned, after such treatment. One example of the syndrome is paraneoplastik Eaton-Lambert syndrome, characterized by muscle weakness extraordinary. Another example is the muscle weakness and pain due to inflammation (polimiositis), which may be accompanied by inflammation of the skin (dermatomiositis).

Some lung cancer hormone or hormone-like substances, resulting in high levels of the hormone.
Small cell carcinoma producing corticotropin (causing Cushing's syndrome) or antidiuretic hormone (causing fluid retention and low sodium levels in the blood). The formation of excessive hormones can also cause carcinoid syndrome, namely redness, wheezing breath sounds, diarrhea and heart valve abnormalities. Squamous cell carcinoma releasing hormone-like substances that cause blood calcium levels are very high.

Other hormonal syndrome associated with lung cancer are:
- Breast enlargement in men (gynecomastia)
- Excess thyroid hormone (hyperthyroidism)
- Changes in the skin (skin in the armpit become darker).
Lung cancer can also cause changes in the form of fingers and toes and change at the end of long bones, which can be seen on x-rays.

Read More - cancer lungs: 8

cancer lungs: 7

The symptoms of lung cancer depends on the type, location and how its spread:

Usually the main symptoms are persistent cough. Patients who suffer from chronic bronchitis, lung cancer often realize that the cough gets worse.

Sputum may contain blood. If the cancer grows into the blood vessels underneath, can cause bleeding.

Cancer can cause wheezing sound due to a narrowing of the airways in or around the growth of cancer. Bronchial obstruction can cause the collapse of the lung which is the branching of the bronchi, a condition called atelectasis. Another result is a form of pneumonia with symptoms of cough, fever, chest pain and shortness of breath.

If the tumor grows into the chest wall, can cause persistent chest pain.

Symptoms that occur later are loss of appetite, weight loss and weakness. Lung cancer often leads to accumulation of fluid around the lungs (pleural effusion), so that the patient experienced shortness of breath. If the cancer spreads in the lungs, shortness of breath can occur great, blood oxygen levels are low and heart failure.

Cancer can grow into certain nerves in the neck, results in Horner syndrome, which consists of:
- Eyelid closure
- Small pupils
- Eyes sunken
- Reduced perspiration on one side of the face.

Cancer at the top of the lungs can grow into the nerves to the arms so that the arm pain, numbness and weakness. Damage can also occur in the nerve cords so that the patient's voice becomes hoarse.

Cancer can grow directly into the esophagus, or grew up in near his throat and squeezed, resulting in swallowing disorders. Sometimes formed abnormal channels (fistulas) between the esophagus and bronchi, causing great cough during swallowing process took place, because food and liquid into the lungs.

Lung cancer may grow into the heart and causes:
- An abnormal heart rhythm
- Enlargement of the heart
- Accumulation of fluid in the pericardial sack.

Cancer also can grow around the superior vena cava. This venous obstruction causes blood to flow back to the top, the other into the veins of the upper body:
 vein in the chest wall will enlarge
 face, neck and upper chest wall (including breast) will swell and look dark purple.

This condition also causes shortness of breath, headache, vision disturbances, dizziness and drowsiness. Symptoms usually get worse if the patient bend forward or lie down.

Read More - cancer lungs: 7

cancer lungs: 6

Only a small proportion of lung cancer (about 10% -15% in men and 5% in women) are caused by substances that met or inhaled in the workplace. Working with asbestos, radiation, arsenic, chromate, nickel, klorometil ethers, mustard gas and coke oven emission can cause lung cancer, although usually only occurs in workers who also smoked.

The role of air pollution as a cause of lung cancer is still unclear. in more lung cancer patients in many urban areas air pollution than many who live in rural areas.

Lung cancer can also be associated with genetic where there is a change / mutation of several genes that play a role in lung cancer, namely: Proto oncogen, tumor supressor gene, Gene encoding enzyme. The occurrence of lung cancer based on the appearance of tumor suppressor genes in the genome (oncogene). The existence of the initiator of tumor suppressor genes changed by removing (deletions / del) or insertion (insertion / INS) some basa acid composition, appearance and / or erbB1 gene neu/rbB2 role in the anti-apoptosis (a mechanism for cells to die naturally programmed cell death). Change the look of this case gene causes the target cells in this case lung cells turn into cancer cells with the growth nature of the autonomic.

Cigarettes as well as an initiator and promoter known progresor and cigarettes are related (the largest) with the occurrence of lung cancer. Thus cancer is a genetic disease at the outset limited to target cells and then become aggressive in the surrounding tissue and even of other organs.

Diet. Several studies have reported that the low consumption of betakarotene, selenium and vitamin A causes high risk of lung cancer.

Sometimes lung cancer (particularly adenocarcinoma and alveolar cell carcinoma) occur in people who have lung scarring due to a lung disease, such as tuberculosis and fibrosis.

Read More - cancer lungs: 6

cancer lungs: 5

Like most other cancers than the exact cause of lung cancer are unknown, but prolonged exposure or inhalation of a carcinogenic substance which is the main causative factor in addition to other factors such as immune, genetic, and others.

From some literature has reported that the etiology of lung cancer is related to smoking. Lombard and Doering (1928) have reported high incidence of lung cancer in smokers compared with nonsmokers.

Layer formed from the respiratory tract cells to the surface of a rectangular shape (columnar epithelium) and the glands that produce mucus and other fluids. In the lungs of healthy, these cells divide in a controlled and orderly arrangement. However, when a cell becomes cancerous, the cells continued to divide even when new cells are not needed. Although it took years to develop lung cancer, lung tissue changes may occur as soon as possible after exposure with lung cancer causing compounds (carcinogens) in cigarette smoke. When exposed continuously, normal cells are damaged and eventually become cancerous. Because of easy access to the bloodstream and lymph vessels, cancer cells can spread to other parts of the body before the patient develops symptoms.

Smoking is the main cause of approximately 90% of cases of lung cancer in men and about 70% in women. The more cigarettes smoked, the greater the risk for suffering from lung cancer.

There is a relationship between the average number of cigarettes smoked per day with a high incidence of lung cancer. It is said that, 1 of 9 heavy smokers will suffer from lung cancer. Later the report several studies suggest that passive smokers would be at risk for lung cancer. Children who are exposed to smoke for 25 years in adulthood will be subject to the risk of lung cancer doubled compared with the not exposed, and women living with husband / partner is also affected smokers lung cancer risk 2-3 fold. An estimated 25% of lung cancer than non-smokers is derived from passive smokers. Lung cancer incidence in women in the USA in the last 10 years also increased to 5% per year, partly because of the increasing number of women smokers or passive smokers.

Effect of cigarettes not only lead to lung cancer, but can also cause cancer in other organs such as the mouth, larynx and esophagus.

Report of the NCI (National Cancer Institute) in the USA in 1992 declared cancer in other organs such as kidneys, urinary vesika, ovary, uterus, colon, rectum, liver, penis and others higher in patients who smoke than non-smoking.

Read More - cancer lungs: 5

cancer lungs: 4 Mesotelioma Malignant

Bronchial adenoma is a small group of malignant neoplasms of low the agresifitas. Occur in the lower trachea or main bronchi. Two of the most important forms are bronchial carcinoid and rare silindroma. Bronchial carcinoid as small cell carcinoma, derived from cells of bronchial mucosa Kulchitsky. These tumors develop nearly 4% of all bronchial tumors. Can become real in adolescence until middle age (average age at diagnosis, 45 years), where the number of men and women are affected about the same lot. Signs and symptoms of bronchial obstruction such as chronic cough, haemoptysis, or pneumonitis are common. Bronchial carcinoid tumors like carcinoid of the small intestine. Some tumors secrete serotonin, 5-hydroxy tryptophan, and other biologic substances which generate a complex of symptoms known as carcinoid syndrome. The symptoms include a red face, bronchoconstriction, and wheezing, and diarrhea. Carcinoid tumors follow the course of the disease is relatively benign, and surgical resection is usually quite useful, given the survival rate 5 years, exceeding 90% of typical carcinoid.

Mesotelioma malignant tumor that is generally not of the pleura, where the majority of cases associated with exposure to an abscess. This exposure may be brief but usually the time between the exposure and clinical awitan is 25 years old. Malignant Mesotelioma very fierce and the survival of less than 1 year from the time of diagnosis.

Both primary sarcoma of lung and primary malignant melanoma both lungs are rare, but it is a form of lung cancer are very fierce. Usually the type of lung cancer is more of a metastasis from the primary tumor was diagnosed rather than a locus of primary tumors.

Finally, it must be remembered that the lung is more often a place as metastasis cancer than the location of primary malignant neoplasms. The lungs are often the place deposits of cancer cells from the secondary other organs, because microscopic tumor emboli are carried by the blood is usually caught in the capillary network of the lungs. Tumors carried by the lymph from the lower half of the body and the abdominal cavity can be detained while walking through the duct torasikus. Neoplasms that often lead to lung metastases, respectively from the most common carcinoma of the breast, gastrointestinal tract, female genital tract and kidney, melanoma and male genital cancers.

Read More - cancer lungs: 4 Mesotelioma Malignant

cancer lungs: 3

Type of carcinoma is distinguished from the histological cell type:
Squamous cell carcinoma histological type of carcinoma is the most common bronkogenik found. Cancer is derived from the surface of bronchial epithelium. Epithelial changes including metaplasia or dysplasia due to long-term smoking, typically precedes the emergence of tumors. Squamous cell carcinoma usually located around the central hilum, and protruding into the major bronchi. The diameter of the tumor rarely exceeds a few centimeters, and tends to spread directly to the hilar lymph nodes, chest wall and mediastinum. Squamous cell carcinoma is often accompanied by cough and haemoptysis due to irritation or ulceration, pneumonia and abscess formation due to obstruction and secondary infection. Because these tumors tend to be somewhat slow to metastasize, so early treatment can improve prognosis.

Adenocarcinoma, as the name shows such as the cellular composition of bronchial glands and may contain mucus. Frequency increases and as a variant of carcinoma is the most widely bronkogenik. Most of these tumors arise in the peripheral segment bronchus and sometimes can be associated with local scarring of the lungs and chronic interstitial fibrosis. Lesions often extends through blood and lymph vessels in the early stages, and is still not showing clinical symptoms until the distant metastasis occurred.

Cell carcinoma, bronchial alveolar carcinoma is a subtype Adeno rarely found, and that comes from alveolar or bronchial epithelium of the terminal. general cause not real, accompanied by signs that resemble pneumonia. These neoplasms are macroscopic in some cases of pneumonia-like consolidation lobaris uniform. In microscopic look alveolar groups are limited by clear cells produce mucus and sputum are many mukoid. The prognosis is poor unless the affected lobe disposal during early disease. Adenocarcinoma is the only type of histology of lung cancer that have no obvious connection with smoking.

Large cell carcinoma is a malignant cells are large and very poorly differentiated with large cytoplasm and nucleus sizes vary. These cells tend to occur in lung tissue of peripheral, grew rapidly with extensive and rapid spread to places far away.

Small cell carcinoma, such as squamous cell type, usually located in the center around the main branching bronchi. Unlike lung cancer, the other, this type of tumor arising from Kulschitsky cells, the normal component of the bronchial epithelium. In microscopic, this tumor is made up of small cells (about twice the size of lymphocytes) with the nucleus and cytoplasm hiperkromatik slightly thick. These cells often resemble oat seeds, so named oat cell carcinoma. Carcinoma cellule have time fastest division worst prognosis compared all carcinoma bronkogenik. Early metastasis to the mediastinal and hilar lymph nodes, as well as with haematogenous spread to the distal organs, often encountered. Approximately 70% of patients had evidence of extensive disease (metastasis to distal) at the time of diagnosis, and number 5-year survival of less than 5%.

In addition bronkogenik carcinoma, another form of lung cancer include primary adenoma, sarcoma, and mesotelioma bronchus. Although rare, these tumors is important because it may mimic carcinoma bronkogenik and life-threatening.

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cancer lungs: 2

Lung cancer is usually classified according to primary histology types and all have a natural history and response to treatment varies. Although there are more than a dozen types of lung cancer primary, but bronkogenik cancer, including four first types of cells is 95% of all lung cancers.

Practical division for medicinal purposes: a). small cell lung cancer (SCLC), b). NSCLC (non small cell lung cancer / squamous carcinoma, adenocarcinoma, large cell carcinoma).
1999 WHO histological classification for tumors and pleural tumors: (2)
Epithelial tumors:
1. Benign: papilloma, adenoma
2. Preinvasive lesion: squamous dysplasia / carcinoma in situ, atypical adenomatous hyperplasia, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia.
3. Malignant:
1. Squamous cell carcinoma: papillary, clear cell, basaloid.
2. Small cell carcinoma: combined small cell carcinoma
3. Adenocarcinoma:
• Acinar
• Papillary
• bronchoalveolar: nonmusinous, musinous, musinous and nonmucinous mixed or indeterminate cell type

• Solid carcinoma with mucin formation
• Adenocarcinoma with mixed subtypes
4. Large cell carcinoma: neurondocrine Large cell carcinoma, Basaloid carcinoma, Lymphoepitelioma-like carcinoma, Clear cell carcinoma, Large cell carcinoma with rhabdoid phenotype
5. Adenosquamous carcinoma
6. Carcinoma with pleomorphic sarcomatoid or sarcomatous elements
7. Carcicoid tumors: typical carcinoid, atypical carcinoid
8. Salicary gland carcinomas of type: mucoepidermoid carcinoma, adenoid cystic carcinoma
4. Others: soft tissue tumors
5. Mesothelial tumors: Benign, Malignant mesothelioma
6. Miscellaneous tumors
7. Lymphoproliferative diseases
8. Secondary tumors
9. Unclassified tumors
10. Tumor like lesions

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cancer lungs: 1

Currently, cancer is a major cause of death in the productive age. It is estimated that, at least there are 150 new cancer patients each year per 100,000 people in Indonesia. This means, of the 200 million population is estimated there will be 300,000 cancer patients each year.

The prevalence of lung cancer in developed countries is very high, in the USA in 2002 there were 169,400 reported new cases (of which 13% of all new cancers are diagnosed) with 154,900 deaths (of which 28% of all cancer deaths), the prevalence of events in the UK reached 40,000 / year, while in Indonesia was ranked 4th largest cancer, the cancer hospital Dharmais occupied Jakarta in 1998 ranked third after breast cancer and cervix. The death rate from lung cancer worldwide reach approximately one million residents each year. Because of our recording system that prevalence was not good but certainly not yet known, and pulmonary tumor clinic at the hospital felt the true increase. In other developing countries reported the incident quickly rising partly because of excessive tobacco consumption in China is like 30% of cigarettes consumed the world. Most of the male lung cancer (65%) life-time risk in women 1:13 and 1:20.

Lung cancer is one of the biggest causes of death worldwide, with incidence rates increasing from time to time. Among all the diseases of cancer in men, lung cancer is the most common cause of death in the world. In women although the number
low incidence of lung cancer but it is the third leading cause of death due to cancer.

More than 1.3 million new cases of lung and bronchial cancer worldwide, causing 1.1 million deaths each year. Based on the number of incidents and the prevalence in the world, Asia, Australia, and Far East are at the first level with an estimated number of cases more than 670 thousand with a mortality rate of more than 580 thousand people. In Indonesia, lung cancer became the main cause of death of men and more than 70% of new cancers were diagnosed at an advanced stage (stage IIIB or IV). Therefore, only 5% of patients can survive for up to 5 years after being found positive.

According to Ahmad Hudoyo from Friendship Hospital, in Indonesia, lung cancer is the most cancers. This is mainly because the number of smokers, particularly smokers is very much a beginner. In the United States and European anti-cigarette programs are running and can hit smokers from 70% to 20%, lung cancer rates are still too many.

Until now, lung cancer is still a major problem in medicine. Difficult to detect lung cancer. In the early stages, this cancer has no symptoms, so that when the patient had been diagnosed at an advanced stage. Cancer cells that are not controlled in the lung tissue, making wild production causing that inhibits tumor growth and stop the lung function as they should. The large size of the lungs, causing cancer to grow for years undetected and without symptoms. The disease is only detected after the cancer reaches an advanced stage.

Read More - cancer lungs: 1

skin; verruca 8 destructive therapy

Method Virusidal
A. Formaldehyde
Formasidal is virusidal agent and is in packaging gel 0.7% or 3% solusio. By cooling will accelerate the eradication of the virus verruca. Two hundred children with plantar verruca treated with 3% formaldehyde for 6 - 8 weeks to produce 80% verruca eradication. A control study comparing the use of formaldehyde with the soaking liquid and the second with saccharose showed no difference in eradication rates between the three groups.

B. Glutaraldehyde
Glutaraldehyde in solusio packaging or 10% formaldehyde gel and the like, this hardened skin and cause peeling easier. In studies without control by the use solusio 20% once a day at verruca eliminate 72% of 25 patients in three months. The disadvantage is that your skin is brown and there are reports of skin necrosis after the use of glutaraldehyde 20%.

Antimitotik Therapy
A. Podofillin / Podofillotoksin
Podofillotoksin, an active ingredient in a mixture of raw podofillin which acts as a binding coil antimitotik during mitosis. Inhibited cell division. This agent is used in therapy veruka anogenital, but weak in the penetration into the thick stratum corneum and podofillin more effective for treatment of skin verruca. Cessation of use after peeling verruca, may be effective, but there is a risk of inflammation, the formation of sterile pustules, and secondary infections.

B. Bleomisin
Bleomisin (blenoksan) is a kemoterapeutik agent that inhibits DNA synthesis in cells and viruses. Bleomisin is verruca alternative therapies that do not respond to other therapies or difficult verruca removed by surgery. Bleomisin in 1 - 5 unit vial diluted with 30 mL of physiological salt and 0.3 mL ( 0.15 units) injected into the verruca. Additional injections can be given every three or four weeks until resolution is reached. The pain is the biggest factor for therapy. Potential side effects is the formation of scar tissue, changes in pigmentation, nail damage, and Raynaud's phenomenon. Bleomisin recorded against pregnancy in category D, potentially absorbed after injection. One study reported that bleomisin used for the naughty verruca therapy. After the use of topical anesthetic, is injected into the bleomisin needle verruca. Resolution level reached 92%.
Although a number of RCT (randomized control trial) who reported that the level of effectiveness is low bleomisin, one article has been concluded that there was no consistent evidence on the effectiveness of therapy bleomisin intralesi in verruca nongenital and the data is not meant entirely for analysis. Another article based on RCT and a series of four different cases that present evidence of the effectiveness bleomisin, advocated its use as a third-line therapy for verruca vulgaris and plantar verruca.

C. Retinoids
Systemic retinoids have been used in the management of verruca for its ability to alter and accelerate the eradication keratinisasi way verruca induces irritant dermatitis. Small study reported etretinat effectiveness in children with a wide veruka. Etreninat not used widely in the United States, asitretin (soriatan) is now used. Etretinat dose of 1 mg / KgBB / day given no more than three months. In the 20 children who were included in this study, 16 of which showed complete resolution of verruca and without recurrence. Verruca relapse in four other patients after regression part.
One article found evidence supporting the use of topical retinoids based on one cohort study that examined the effectiveness of retinoids using a number of case reports and a number of experiments using systemic retinoids. Other articles from several case studies suggest the use of oral and topical retinoids as second-line therapy as a treatment verruca Plana.

Immune stimulation
A. Topical sensitization
Slow induction of hypersensitivity reactions have been used as verruca therapy. Dinitroklorobenzen and squarit dibutilester acid has been used, but many studies have seen difensipron effects. Two open studies have shown the difensipron great results. In one study, difensipron used every week for 8 weeks in 134 patients and provides approximately 60% response (complete resolution occurred in 44% of patients within 4 months). In another retrospective study, 48 patients were treated every 3 weeks, 88% of patients in verruca net 14 weeks. Return to this therapy that some patients can not sensitisation, while others have dermatitis reaction.

B. Cimetidin
Cimetidin have imunomodulator effects that are not clear and are used for therapies that have been advanced verruca. Open trial reported some effectiveness, but studies with controls showed no benefit compared with placebo.

C. Immunotherapy Intralesi
Intralesi Immunotherapy uses the immune system's ability to recognize viral antigens and certain fungi. Antigens for Candida skin test commonly used. It is believed that the slow type hypersensitivity reaction induced by this antigen improve the immune system's ability to identify and eradicate HPV. One study showed complete resolution of verruca participants and 47% ,75 - 99% resolution in 13% of participants. In the 34% who enrolled in this study had documented complete resolution of all verruca remote from the injection site. In 22% of participants, the level of 75 - 99% verruca resolution remote from the injection site has also been noted. Regression verruca remote from the injection site was not found on other therapies. Although some recent RCT has been published, an article states that intralesi Immunotherapy as second-line therapy for plantar verruca and third-line therapy for verruca vulgaris and verruca Plana.

Other Therapies
Many other therapies have been used to therapy verruca, although few are receiving these types of therapy. Traditional medicines are still used but without evaluation. Homeopathy uses a variety of drugs that contain calcium, netrium, and sulfur which showed the advantage over placebo. Hypnosis has been evaluated with a double-blind placebo-controlled trial of 40 individuals who were treated for more than 6 weeks. The group that got hypnosis lost more than verruca groups received topical salicylic acid or placebo. Local warming therapy has been tested on 13 patients. At 29 verruca who were treated, 86% net, while 41% of the placebo group, verruca regresses. Intralesi interferon has shown some effect on the experiment verruca open. Imiquimod 5% cream for 9-11 weeks has been used by a minority of patients with great results. Irradiation, one of the most commonly used, now no longer used for treatment of benign.

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skin; verruca 7 destructive therapy

Destructive Therapy

A. Salicylic acid
Salicylic acid is a slow acting keralolitik epidermis infected. Results with mild irritation may stimulate an immune response. Salicylic acid itself has shown the results of a resolution on 67% of patients with verruca in hand and 84% in patients with plantar verruca within 12 weeks.
There are many patented products salicylic acid, but no recent information to compare these products:
1. 11-17% salicylic acid in kolodio and gels such as kolodio lactic acid, copper
2. 26% salicylic acid in the basic poliakrilik designed to mix their own
3. salicylic acid with 25% podofilin in oinment, used for plantar verruca
4. 50% salicylic acid is used to ointment plantar verruca.
Before applying ointment verruca, keratin layer must first exfoliated or removed with sandpaper or a polished and smooth the surface by soaking in warm water. Kolodio products to form a layer of exfoliated before re-application. Product occlusion has been shown to increase the level of plantar verruca cleansing.
The comparison between the content of salicylic acid ointment and a single treatment with glutaraldehyde, folouroasil, podifilin, benzalklonium, cryotherapy with liquid nitrogen, does not prove more effective than salicylic acid.

B. Cryotherapy (Surgical Frozen)
Liquid nitrogen (LN2, 2196 8C) is the agent most frequently used. Mixture of dimethyl ether / propane (257 8C) is used as pleased with this product, but the effectiveness in making a sufficient temperature to necrotic cells was low. Cryotherapy have any effect on either resolution verruca necrosis by simple destruction keratinocytes infected with HPV and local condition inflammatory response to induce cell-mediated immune effective.
Different techniques between physicians with a variety of freezing time, the way the distance between the application and therapy. Many doctors use a cotton stick spray, but still widely used and better used in children or verruca close to the eye. Generally done freezing until halo around verruca lost and the time between 5-30 seconds depending on the location and size verruca. When an application re-LN2 with cotton sticks, to note that HPV and other viruses like HIV can survive in liquid nitrogen.
Verruca with surgical destruction of frozen every three weeks can give resolution results in 69% of patients with verruca in hand within 12 weeks. This study used liquid nitrogen with a cotton bud to disappear from the surrounding halo verruca (about 5-30 seconds). Cleanup levels increased when cryotherapy combined with salicylic acid ointment, although not significant.
Two cycles of freeze-liquid has been shown to improve resolution in plantar verruca but not in palmar verruca. The ideal interval between surgery frozen with the next one is not clear. Bunney study showed that the interval of more than three weeks, reducing the rate at 12 weeks of treatment, other studies show that the resolution depends on the amount of therapy, so that weekly therapy produces a more rapid resolution.
Patients should be reminded that the frozen surgical pain and heat. Need to be careful when passing tendon surgery and frozen in patients with little circulation. Can occur hypo and hyperpigmentation, especially in blacks. Therapy can be followed by onikodistrofi on verruca periungual.

C. Termokauter or Kuretase and cautery
Verruca surgery has been practiced mainly with a blunt kuretase or surgery followed by cautery. This method is particularly used in verruca filiformis on the face and extremities. In an open study, the success rate of patients reported an average of 65-85%. This procedure usually leaves scar tissue and recurrence occurs more than 30%. The growth of scar tissue on the soles of the feet is a relative contraindication in this surgical method.
A study conducted in India, which compare the effectiveness of 5-flouroasil (pyrimidin fluorine which cuts the viral DNA synthesis) with electrosurgery performed on 50 patients who were divided into two groups, showed 52% of patients showed good response to 5-flourourasil, whereas 72 patients showed good response to electrosurgery. 5-flouroasil give a better effect on verruca Plana, verruca plantar, and condyloma akuminata, whereas electrosurgery provides a better response to the verruca vulgaris especially in the case verruca filiformis. Electrosurgery side effect of pain, secondary infection, the growth of scars, and hipopigmentasi, while 5-flouroasil have side effects of eritem, photosensitive, and hiperpigmentasi.8

D. Chemical cautery: Batang Silver Nitrate
Chemical cautery with daily re-use silver nitrate sticks can cause destruction to effect adequate resolution verruca, but sometimes hyperpigmented scars formed. In a placebo control study in 70 patients, three silver nitrate application all verruca resolution at more than 9 days at 43% and 26% probandus improvement verruca one month after treatment compared to 11% and 14% in the placebo group.

E. Carbon dioxide laser
Destruction produced by CO2 laser has been used to therapy virus verruca. Periungual and subungual lesions are difficult resolusition with other treatment methods, appropriate when using this method. The level of recovery was reported in two cases of 64-71% after 12 months, but pain can occur after an operation scar tissue growth.

F. Pulsed Dye Laser
Therapy with vascular lesion laser, also known as pulsed dye laser therapy that can selectively target a hemoglobin contained in verruca. When hemoglobin heat, thermal energy dissipated into the surrounding tissue, causing the blood vessels cautery. The result is a frequent necrosis verruca peeling. The use of pulsed dye laser absorption of energy depending on the capillary matting in verruca and local tissue necrosis. Pain and less scarring than the laser occurs CO2.1 Many studies have studied the effectiveness of pulsed dye laser therapy after about two or three times a therapy reported cure rates of about 48-93% verruca at various locations. One study showed a resolution rate of about 72%. Highest resolution level of 85.7% in periungual and verruca lowest level in 50% verruca plantar.
In a separate study comparing the pulsed dye laser therapy with cryotherapy and cantaridin. In patients treated with cryotherapy and cantaridin, 70% showed the cleaning, while 66% of patients showed eradication after pulsed dye laser therapy. The researchers conclude that pulsed dye laser therapy effective as conventional therapy. Pulsed dye laser therapy is recommended as second-line therapy in verruca and third-line therapy for verruca vulgaris and verruca Plana. However, another article found EBM weak to support the use of pulsed dye laser as sole therapy for this study method can only be used for therapy verruca located on the hands and feet.

G. Fotodinamik Therapy
This therapy depends on the chemical capture by abnormal cells, usually an amino acid-levulinat (AAL) was involved in track and photograph porphyrin oxidation by irradiation using laser or non laser that affect the network. Comparison of responses in 45 patients who received three laser therapy with wavelengths of 589-700 nm after the AAL 20% cream or placebo cream showed that active treatment resulted in an increase or reduction of the size of the resolution after 4 months verruca with AAL and irradiation.

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