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CHAPTER 1 INTRODUCTION 1 .

BACKGROUND Lung cancer is a disorder that can affect the organs in the lungs or respiratory system . Usually caused by cells in the abnormal lung and can also come from parts of the body affected by cancer to spread to other organs . In the early 20th century , lung cancer is a global problem . Lung cancer is the most frequent cancer in the world . Currently , 1.2 million people died from lung cancer every year and the global incidence of lung cancer is increasing ( Hansen , 2008 ) . World Health Organisation ( WHO ) in 2007 reported that the incidence of cancer in the world reached 12 million people with PMR 13 % . In developed countries like the U.S. and the UK , deaths from cancer ranks second after cardiovascular disease . One of the diseases The highest cause of cancer death in the world is lung cancer . WHO World Report 2000 report , PMR lung cancer in 1999 in the world of 2.1 % . According to WHO , Cause Specific Death Rate ( CSDR ) cancer of the trachea , bronchus , and lung in the world with 13.2 per 100,000 population PMR 2.3 % ( WHO , 2004) . The results of the survey of non-communicable diseases by the Directorate Je nderal PPM & PL in 5 provincial hospitals in Indonesia ( West Java , Central Java , East Java , Lampung and South Sumatra ) in 2004 , shows the morbidity caused by lung cancer by 30 % . ( MOH, 2004) The high rates of smoking in Indonesian society will make lung cancer as one of the health problems in Indonesia . Lung cancer is one type of lung disease that requires treatment and rapid and effective action . Diagnosis of this disease requires skills and tools that are not simple and requires a multidisciplinary approach medicine . The discovery of lung cancer at an early stage will help the patient ( PDPI , 2003) 2 . PURPOSE OF WRITING The objectives to be achieved in the writing of this paper are: 1 . To Know the epidemiology of Ca . lung 2 . To Know the definition of Ca . lung 3 . To determine the etiology of lung ca 4 . To know the symptoms of lung ca 5 . To determine the pathogenesis of lung ca 6 . To determine the prevention of lung ca 7 . To determine the shape control of lung ca 3 . BENEFITS OF WRITING The author hopes of the writing of this paper can provide benefits such kebanyak the following : 1 . For the author , gives an overview of lung cancer in general and detailed 2 . For students , utilized and used by friends as a reference material related to Ca lung problem and its application in the field of health science , but it can also be useful as a reference for further research 3 . Party general , as reading material , resources and references related problems ca lung disease

CHAPTER II LITERATURE REVIEW

1 . Epidemiology Lung cancer is still the sala h one of the most frequent malignancies , around 20 % of all cancer cases in men deng 's risk of developing one of 13 people and 12 % of all cases of cancer in women at risk of developing one of 23 people . In the UK an average of 40,000 new cases reported each year . Approximate inside Qu lung cancer pa da man in 2005 in the United States was 92,305 with an average of 91 537 people die of cancer . The American Cancer Society estimates that lung cancer in the United States in 2010 as follows : 1 . Approximately 222,520 new cases of lung cancer will be diagnosed ( 116,750 men and 105,770 women ) . 2 . Estimates of deaths due to cancer pa ru approximately 157 300 cases ( 86,220 in men and 71,080 in women ) , ranging from 28 % of all cases of death due to cancer . The risk of lung cancer is approximately 4 times greater in men than women and risk increases with age : the incidence of lung cancer in Europe 7 of 100,000 men and 100,000 women 3 at the age of 35 years , but in patients > 75 years , incidence of 440 in men and 72 in women . Variations in the incidence of lung cancer is also reported wide geographic and it is mainly related to smoking habits vary across the world . According to research Widyastuti , the number of lung cancer patients in Hospital H.Adam Malik in 2000 there were 36 people ( 7.07% ) , 54 ( 12.62 % ) in 2001, 88 people ( 15.52 % ) in 2002 ( Sri Widyastuti , 2004) . Research conducted Melindawati shows the number of lung cancer patients as many as 378 people in 2004 -2008 with details in 2004 as many as 63 people , in 2005 as many as 88 people , in 2006 as many as 68 people , in 2007 as many as 70 people , and in 2008 as many as 89 people ( Melindawati , 2008) . According to the Ministry of Health through the center of health promotion said Indonesia is one of the developing countries that have high levels of cigarette consumption and the highest cigarette production . Based on data from the WHO , the prevalence of smoking among adults increased to 31.5 % in 2001 from 26.9 % in 1995 . In 2001 , 62.2 % of adult men smoke , compared with 53.4 % in 1995 . Average - The average age of starting to smoke which was originally 18.8 years in 1995 declined to 18.4 years in 2001 . The prevalence of smoking among men increased rapidly with age : from 0.7 % ( 10-14 years ) , to 24.2 % ( 15-19 years ) , jumped to 60.1 % ( 20-24 years ) . Young men aged 15-19 years increased consumption by 65 % between 1995 and 2001 - higher than any other group . ( WHO , 2001) . It can be seen that an increase in the prevalence of smoking in a period of 5 years .

2 . DEFINITIONS According to WHO , cancer is a general term for a large group of diseases that can affect any part of the body . Other terms used are malignant tumors and neoplasms . One defining feature of cancer is the growth of cells - new cells that grow abnormally beyond the normal , and which can then invade

adjoining parts of the body and spread to other organs . According to the National Cancer Institute (2009 ) , Cancer is a term for diseases in which cells - the cells divide abnormally without control and can invade nearby tissues. This process is called metastasis . Metastasis is the primary cause of death due to cancer ( WHO , 2009) Lung cancer is the growth of cancer cells that can not be controlled in the lung tissue which can be caused by a number of environmental carcinogens , especially cigarette smoke ( Internal Medicine , 2001) Lung cancer is a tumor that grows diparu dangerous , mostly derived from lung cancer cells in the lungs but can also come from other parts of the body affected by cancer . Lungs are cone-shaped and elastic organ located inside the chest cavity . Types of lung tumors were divided for purposes of treatment , including SCLC ( small cell lung cancer ) and NSLC ( Non Small Cell Lung Cancer / Squamous carcinoma , adenocarcinoma , large cell carcinoma ) . 3 . Etiology 1 . smoke Is a major cause of lung Ca . A definitive statistical relationship has been established between heavy smokers ( more than twenty cigarettes a day ) from lung cancer ( bronchogenic carcinoma ) . Smokers like this has tendency to ten times greater than in light smokers . further the previous heavy smokers and had quit his habit will return to the pattern of risk nonsmokers within about 10 years . Carcinogenic hydrocarbons have been found in the tar from tobacco smoke which if imposed on animal skin , cause tumors . 2 . Irradiation . The incidence of lung carcinoma is high in cobalt miners in Schneeberg miners and radium in Joachimsthal ( more than 50 % died of lung cancer ) associated with the presence of radioactive material in the form of radon . This material is believed to be the etiologic agent operative . 3 . Inhaled substances in the workplace . There is a high incidence of workers exposed to nickel carbonyl ( nickel smelters ) and arsenic ( exterminator grass ) . Workers breaking hematite ( lungs - pulmonary hematite ) and people - people who work with asbestos and with chromate also have an increased incidence . example : radon , nickel , arsenic and radiation . 4 . Air Pollution Those who live in cities have numbers higher lung cancer than those who live in the village and although it has been known of the carcinogens from industrial and diesel vapor in the atmosphere in the city . Example : Air pollution , exposure RT gases , fumes / burning ( Thomson , Pathology Lecture Notes , 1997) . 5 . Genetic . There is a change / mutation of several genes that play a role in lung cancer , namely :

a. Proton oncogene . b . Tumor suppressor gene . c . Gene encoding the enzyme . Theory oncogenesis . The occurrence of lung cancer based on the appearance of a tumor suppresor genes in the genome ( oncogenes ) . The existence of tumor suppressor genes initiator change by removing (deletion / del ) or insertion ( insertion / INS ) most couples alkaline composition , appearance and or neu/erbB2 erbB1 gene plays a role in anti- apoptosis ( cell mechanisms to die naturally -programmed cell death ) . Change the look of this case causes the gene to target cells in the lung cells turn into cancer cells with autonomous growth properties . Thus cancer is a genetic disease that is limited to the beginning and then become aggressive target cells in the surrounding tissue . 6 . diet Reported that low consumption of beta-carotene , vitamin A seleniumdan cause high risk of lung cancer . ( Internal Medicine , 2001) . 4 . SYMPTOMS The most common symptoms encountered in patients with lung cancer are : Persistent cough or become great . Bloody sputum , change colors and more . Shortness of breath and shallow. Headache, sore or cracked bone with no apparent cause . chronic fatigue Losing selara eating or weight loss for no apparent reason . Voice hoarse / husky . Swelling in the face or neck . Symptoms of lung cancer are generally not too obvious , so that most lung cancer patients who seek medical attention have to be in an advanced stage . Kasusk early - stage cases / early often found accidentally when someone does a routine medical examination 5 . Pathogenesis The pathogenesis of lung cancer is not known with certainty . Bronchial mucosal cells undergo metaplastic changes in response to chronic exposure to inhaled particles and then injure the lung . In response to the presence of cellular injury , then there is inflammation . Basal cell proliferation and mucosal will have differentiated into mucus -secreting goblet cells . Activity occurs as a result of metaplastic columnar epithelium lining the turn of the squamous epithelium , which is accompanied by cellular atypia and increased mitotic activity which develops into mucosal dysplasia . Span of time this process has not been established , only estimated approximately between 10 to 20 years . When viewed from the clinical manifestations , the symptoms can be categorized into intratorakal intrapulmonary , extrapulmonary symptoms intratorakal , non- metastatic rakal ekstrato symptoms and symptoms of metastasis ekstratorakal 1 . Local manifestations of Lung Cancer ( intrapulmonary Intratorakal )

The most common symptom is a chronic cough with / without sputum production . Excessive sputum production is a symptom bronchoalveolar cell carcinoma ( bronchoalveolar cell carcinoma ) . Hemoptysis ( coughing up blood ) is a symptom in about 50 % of cases . Chest pain are also common and varied ranging from pain or pain at tumor sites heavier because of the invasion of the chest wall or mediastinum . Difficulty breathing ( dyspnea ) , and weight loss are also often complained of by patients with lung cancer . Pneumonia and recurrent focal segmental pneumonia may occur due to obstructive lesions in the respiratory tract . Unilateral wheezing and monophonic rarely occur because of tumor bronchial obstruction . Stridor can be found when the trachea has been involved . 2 . Extrapulmonary manifestations Intratorakal This manifestation is caused by the invasion / ekste Qu lung cancer to structures / organs. Shortness of breath and chest pain can be caused by pleural or pericardial involvement . Pleural effusion can cause shortness of breath , and pericardial effusion can cause cardiovascular problems . Right upper lobe tumors or mediastinal nodes may invade or cause compression of the superior vena cava external . Thus these patients will demonstrate a superior vena cava syndrome , namely headache , swollen face / plethora , edema and congestion lehar , widening of the veins of the chest. Apical tumor may extend and involve the sympathetic branch of the superior and cause Horner syndrome , involving the brachial plexus and causes pain in the neck and shoulders with atrophy of the small muscles of the hand . Tumor may compress the left recurrent nerve ringeus He goes over da n aortic arch causing hoarseness and vocal cord paralysis left . Direct tumor invasion or enlarged mediastinal nodes can lead to compression of the esophagus and finally dysphagia . 3 . Manifestations of Metastatic Non Ekstrato rakal Approximately 10-20 % of lung cancer patients experience a paraneoplastic syndrome . Usually this occurs is not caused by a tumor , but because of hormonal substances / peptides produced by the tumor itself . The patient may show symptoms such as fatigue , nausea , abdominal pain , confusion , or symptoms such as galactorrhea esifik more sp ( galactorrhea ) . Hormone production is more common in small cell carcinoma and some cells showed neuro- endocrine istik character . Peptide secreted form of adrenocorticotrophic hormone ( ACTH ) , antidiuretic hormone ( ADH ) , calcitonin , parathyroid hormone oxytocin da n . Although the peptide - peptide levels are high in white en - lung cancer patients , but only about 5 % of patients who showed clinical syndrome . Finger clubbing ( clubbing finger ) and hypertrophic pulmonary osteo - arthropathy ( HPOA ) also includes non- metastatic manifestation of lung cancer . Peripheral neuropathy and neurological syndromes such as Lambert-Eaton myasthenic syndrome is also associated with lung cancer . 4 . Manifestations Ekstratorakal Metastasis Weight loss > 20 % body weight ri da previous ( previous month ) often indicates metastatic anya ad . Patients with metastases to the liver often mengeluhka n weight loss . Lung cancer is also commonly metastasize to the adrenal glands , bone , brain , and skin . The involvement of these organs can cause local pain . Metastasis to bone to bone can occur anywhere , but tend to involve the ribs, vertebrae , humerus , and femur . If there is metastasis to the brain , there will be neurological symptoms , such as confusion , personality changes , and seizures . Supraclavicular lymph glands geta h and anterior cervical may be involved in 25 % of patients and should be assessed routinely in evaluating patients with lung cancer .

6 . PREVENTION The principle of prevention is better than cure extent . There are 3 Stages in the prevention of lung cancer epideemiologi , namely : 1 . Primordial prevention ( Prevention of First Instance ) Prevention of etiology ( cause ) of the disease. The primary prevention in people who are healthy ( cancer-free ) . Concrete steps that can be done is to provide information to the public about cancer prevention . Efforts to do is attempt Health Promotion , an attempt to provide the conditions in society that allow lung cancer can not thrive in the absence of the opportunity and the support of the habits , lifestyle and other conditions that are risk factors for the emergence of lung cancer . For example : create the preconditions that people feel that smoking is a bad habit and communities are able to be positive to not smoke . Someone smokers who have successfully quit 10 years has been to reduce the risk means 30 -50 percent for lung cancer . In addition , always keep the immune system through a healthy lifestyle ( regular exercise , adequate sleep , stress -free living and healthy eating ) , and feed supplements on a regular basis . 2 . Prevention of Second Level Secondary prevention is prevention performed on people who are already sick . The goal is to prevent further disease progression of the disease and limit the occurrence of disability . Efforts is a) Early Diagnosis : Screening for example . b ) Treatment : for example with chemotherapy , surgery or irradiation . 1 . surgery The purpose of the surgery for lung cancer as other lung diseases , to pick-up all the diseased tissue as possible while maintaining lung function - which is not affected by lung cancer . 1 . Toraktomi exploration . For the diagnosis of suspected pulmonary disease mengkomfirmasi or thoracic carcinoma in particular , to do the biopsy . 2 . Pneumonectomy lung removal ) . Bronchogenic carcinoma lobectomy does not fit in with all the lesions can be removed . 3 . Lobectomy (removal of a lobe of the lung ) . Bronchogenic carcinoma is confined to one lobe , bronkiaktesis emphysematous bleb or bulla ; lung abscess ; fungal infections ; tuberkulois benign tumors . 4 . recession segmental Is the removal of one or more segments of the lung . 5 . Recession wedge . Benign tumors with firm boundaries , tumor metas picking , or a localized inflammatory diseases . Is the removal of the surface of the lungs - pulmonary wedge shaped ( ice chunks ) 6 . Decortication . Is the removal of material - material from pleural fibrin viscelaris ) 2 . radiation Radiotherapy is the use of ionizing rays in an effort to treat cancer patients . The principle of radiotherapy is a deadly cancer cells by delivering the right dose to the tumor volume / intended target and keep the effects of radiation on surrounding healthy tissue to a minimum

3 . chemotherapy Chemotherapy is an attempt to kill cancer cells by disrupting the function of cell reproduction . Chemotherapy is a cancer treatment method by way of substance / drug that kills cancer cells have properties . 3 . Prevention of Third Level Tertiary prevention is the effort to improve the cure rate , survival rate ( survival ) , and quality of life in cancer treatment in the form of rehabilitative therapy management , palliative , and pain-free . For example, patients with advanced cancer requiring palliative therapy , which is therapy that aims to improve the quality of life of cancer patients , either with radiotherapy or with drugs . 7 . CONTROL Cancer is one of the leading causes of death are getting serious attention from the Ministry of Health of the Republic of Indonesia. Some control programs have also developed and implemented since five years ago . Organized cancer control program has been implemented since the last five years in Indonesia , along with established and active Controlling Directorate Directorate General of Communicable Diseases in P2PL . The economic burden of cancer treatment not only impact on the health system , but also to individuals and their households affected by cancer . This impact will be felt most strongly in lower socioeconomic groups , particularly ( though not exclusively ) in countries of low and middle income where social safety nets , such as universal health insurance is less available . As a consequence , the cancer can be a major cause of poverty . Given cancer patients requiring long-term care , it is necessary to separate the additional economic burden for the patient and family . Therefore , the necessary control measures of this disease . Here are five cancer control activities that have been developed and implemented in Indonesia : 1 ) promotive and Prevention Program The main cause of cancer is the implementation of an unhealthy lifestyle . Thus , promotion and prevention is one of the important programs of cancer control efforts . The Ministry of Health has strengthened the dissemination of cancer control in different regions . Guidelines for the control of risk factors for cancer have been developed for health workers , cadres , school-age children , and high-risk communities . Promotive and preventive programs implemented by the Ministry of Health in collaboration between programs, sectors , government organizations , private and public . Content promotion and prevention programs that have been implemented include the National Campaign Program Clean and Healthy Behaviors ( PHBs ) , and policy advocacy Smoking Area ( KTR ) . Efforts to control smoking , increased physical activity , increased consumption of vegetables and fruits have been integrated in the program PHBs . 2 ) Detection and Follow-up Program Early Early detection of cancer is the attempt to find any cancer that is curable, namely : the cancer has not grown old , still small , still local , still not cause significant damage , in particular social class and at a certain time .

3 ) Surveillance and cancer registration Surveillance and cancer registration is another important step in cancer control program . Epidemiological Surveillance of Communicable Diseases . Is a continuous and systematic analysis of the non-communicable diseases and risk factors to support efforts to combat non-communicable diseases . While the purpose of registration is to collect and classify cancer is cancer of data in an effort to produce a specific cancer incidence in the population is known , and provides a framework for assessing and controlling the effects of cancer on society 4 ) Diagnosis and treatment At this time various hospitals in Indonesia have the ability to diagnosis and treatment of various types of cancer . Definitive diagnosis of cancer with anatomic pathology examination can be done in many laboratories in our country . Cancer surgery and chemotherapy have also been carried out in various hospitals in Indonesia 5 ) Palliative Care Palliative care is needed because the majority of cancer patients who are at an advanced stage is difficult to cure , so the effort to overcome the symptoms and meet the needs of patients and families in the terminal phase becomes important .

CHAPTER III CONCLUSION The conclusions of this paper are: 1 . Lung cancer ( Ca Lung ) is the leading cause of death from cancer in men and women . Lung cancer is increased with a greater number of women than in men , and now exceeds breast cancer as the most common cause of cancer deaths in women . 2 . Lung cancer is the growth of cancer cells that can not be controlled in the lung tissue which can be caused by a number of environmental carcinogens , especially cigarette smoke 3 . Cigarette smoke is a major cause Ca . lung . 4 . Lung cancer can cause a variety of clinical symptoms and syndromes are quite diverse , depending on iokasi , size , substances released by the tumor and metastasis to organs that subject . 5 . There are many symptoms of this disease , the most common symptoms encountered in patients with lung cancer is a persistent cough or become great , bloody sputum , change colors and more and more , and shortness of breath shallowly , headache , sore or cracked bone with reasons that are not clear , losing selara eating or weight loss for no apparent reason . 6 . There are three forms of Ca Lung prevention can be done by primary prevention , secondary and tertiary 7 . Chemotherapy , surgery and radiotherapy are actions that can be performed as a form of control of Ca . lung

REFERENCES Available from : http://www.who.int/tobacco/research/youth/ health_effects / en / index.html . [ accessed December 28, 2012 ] Amin , Z. , 2006. Lung Cancer . In : Sudoyo , A.W. , Setryohadi , B. , Alwi , I. , Li tbang Board of Health , Ministry of Health , 2008 . National Symposium on Research and Development set of paper IV . Available from : http://www.litbang . depkes.go.id/Simnas4/Day_2/SUMUT.pdf . [ accessed 29 Dec 2012 ] Indonesian Ministry of Health & WHO Indonesia , 2003. Tobacco Consumption and Smoking Prevalence in Indonesia . Available from : http://www.litbang.depkes.go.id/tobaccofree/media/FactSheet/FactInd/7_konsumsi_prevalensi.pdf . [ accessed 29 Dec 2012 ] Hansen , N. ( 2008) . Adaptive Encoding : How to Render Search Coordinate System Invariant . In Rudolph et al .

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