LUNG TUMOR (CARCINOMABRONCHOGENIC)
DEFINITION
Bronchogenic carcinoma is a malignant tumor originating from primary lung airways.
Most of the primary lung tumor is a carcinoma bronchi (John E. Stark, 1990).
PHYSICAL SYMTOMS
Hemopthisis, Cough, Chest pain, Shortness of breath, this is due to enlargement of the tumor and due to collapse of the lung, Wheezing / stridor, this sounds arising from the trachea or bronchus obstruction, Hoarse, this happens due to his stricken recurents left laryngeal nerve, Pneumonia Recurents, Dysfagia, this may occur due to the spread of tumors via lymphatic vessels to the area mediatinum or to the esophagus, Obstruction of superior vena cava, Systemic symptoms: such as weight loss, no appetite, which is the initial symptom in 50% of patients with lung cancer, Symptoms of metastasis, the most common of the organs of the brain, liver, bone and adrenal gland, Non-metastatic effects: such as peripheral neuropathy, dermatomiositis or syndrome whose symptoms such as secretion of hormones (eg ADH, ACTH, PTH).
ETIOPATOGENSIS
Such as cancer in general, the exact etiology of carcinoma bronkogenik still unknown, but it is expected that the long-term inhalation of carcinogenic materials is a major factor, without prejudice to possible predisposing role of family relations or ethnic / racial and immunologis status. Inhalation of carcinogenic materials is highlighted that many cigarettes.
HIGH RISK GROUPS:
- Smokers.
- Workers at asbestos factories.
- History fibrosis suffer from chronic lung diffus.
EFFECT OF CIGARETTE:
The materials are carcinogens in tobacco smoke include: polomium 210 and 3.4 benzypyrene. The use of a filter is said to reduce her risk of carcinoma broncogenik, but still remained higher than non-smokers.
In the long term ie, 10-20 years, smoking:
1-10 cigarettes / day increases the risk 15 times
20-30 cigarettes / day increases the risk 40-50 times
40-50 cigarettes / day increases the risk 70-80 times.
Industry Influence
The most widely associated with the carcinogen is asbestos, which otherwise increases the risk of cancer is 60-10 times. Following the industrial radioactive materials, miners uramium 4 times the population at risk in general. Exposure to this industry only visible effect after the 15-20 years.
Effect of Other Diseases
Pulmonary tuberculosis is associated as much bronchogenik carcinoma predisposing factors, through mechanisms hyperplasi - metaplasi - carcinoma in situ-carcinoma - bronkogenik as a result of scar tissue tuberculosis.
Effect of Genetic and immunological status
In 1954, Tokuhotu can prove that despite the influence of heredity rather than factors of environmental exposure, this provides an opinion that can be derived bronkogenik carcinoma. Research recently skewed that the factors involved with Aryl Hydrocarbon hydroxylase enzymes (AHH). Status immonologis patients are monitored from cellular mediated showed a correlation between the degree of cell differentiation, stage of disease, response to treatment and prognosis.
Classification by histopathology using ordinary light microscope (WHO, 1977).
1. Epidermois carcinoma (squamous cell carcinoma).
2. Adeno carcinoma
3. Undiferentiated small cell carcinoma (oat cell)
4. Large cell carcinoma undeferentiated.
INVESTIGATIONS
Radiological
Radiopaque mass in the lung, Airway obstruction with resultant atelectasis, Pneumonia, Enlarged hilar glands, Cavitation.
Sputum cytology:
In sputum cytologic examination to help establish the case up to 70%. Sputum for cytologic sample should be received by the laboratory within 2 hours after ekspectorasi / expenditure. Sample dawn is not required.
Bronchoscopy:
In the biopsy is used to determine the type of tumor cells. Bronkografi
The picture is considered bronkografi patognomonik irregular stenosis is obstruction, stenosis rats and indented thumb.
Pleural aspiration and biopsy:
Aspiration is an action that must be done if patients with lung tumors have effusi pleura. Effusi not always result from the spread of tumors to the pleura, but may result from pneumonia reaction to the tumor or lymphatic obstruction.
Biopsy needle percutan:
This examination is useful for diagnosing tumors that are difficult peripheral transbronchial biopsied denag techniques.
Mediatinoscopy:
This technique is used to take samples of lymph gland enlargement mediatinum experiencing, this is done if no visible pulmonary tumor.
Endoscopy
Includes examining laryngoscopy and bronchoscopy and bronchial washings, scrapings / sweep and biopsy. The objective examination of Bronchoscopy (fiber optics) are:
a. Knowing the changes in the bronchus of lung cancer.
b. Retrieving material for cytological examination.
c. Noting the changes on the surface of tumor / mucosa to predict the type of malignancy.
d. Assessing the success of therapy.
e. Determining overbilitas lung cancer.
Immunology
The existence of a negative correlation between cancer and immunological reactions have been generally known. Immunological disorders mainly seen in cell mediated immunity that can be given through a delayed hypersensitivity reaction is clearly, tolerance to skin graft, total circulatory low T cell, and lymphocyte transformation in vitro is low. At this time more immunological examination serve as prognostic factors than diagnostic factor. Conclusion Correlation of skin test and response to cytostatic:
a. Less than 1.0 cm. : Prognosis is poor, widespread disease.
b. Less than 2.5 m. ; Better prognosis, limited disease, good response to chemotherapy.
PHASING CLASSIFICATION CLINIC (Clinical Staging)
Based on TNM
T = Tumor: N. : Nodules, namely the lymph nodes of M. : Metastases
1. T: T-0: No visible primary tumor
- T-1: tumor diameter of less than 3 cm. Without the invasion of bronchus
- T-2: tumor diameter more than 3 cm. Can be accompanied by atelectasis or pneumonitis, but is more than 2 cm. From Karina, and there is no pleural effusion.
- T-3: Tumor size with an invasion into the surrounding (thoracic wall, diaphragm or mediastinum) or have been near Karina accompanied by pleural effusion.
- N-1: There is a propagation to the ip silateral hilar lymph nodes.
- N-2: There is a spreading to the lymph limfemediastinum or contralateral
- N-3: There extratoracal spreading to lymph nodes.
M-1: Already there are distant metastasis to other organs.
Based on TNM. Compiled phasing following clinics.
a. Carcinoma in situ: T-0, N-0, M-0, but positive sputum cytology for malignant cells.
b. Phase I. T-1, N-0, M-0, or T-2, N-0, M-0
c. Phase II. T-2, N-1, M-0.
d. Stage III: when there are already T-3, N-2, or M-1.
MANAGEMENT
Treatment of lung tumors depend on tumor cell types.
1. Surgical resection.
2. Palliative therapy.
ASSASSMENT:
Activity / rest : Weakness, inability, to maintain regular habits, dyspnea because the activity, lethargy usually advanced stage.
Cardiovaskuler and circulation :
Pallor, cyanosis, diaphoresis, hypotension, bradycardi, tachycardi, arrytmia in atrial or ventricular, decreased cardiac output, shock. Increased jugular vein, heart sound: friction pericardial (addressing effusion) Dysrhythmias, finger percussion.
Ego Integrity : Anxiety, fear of death, resist harsh conditions, anxiety, insomnia, the question is repeated. lack of rest.
Elimination :
Diarrhea that intermittent (hormonal imbalance) Increased frequency / amount of urine (Hormonal Imbalance).
Food / liquids :
Weight loss, poor appetite, decreased food input, difficulty swallowing, thirst / increase fluid intake, Thin, wiry, less weight or appearance (stage 0, edema face, periorbital (hormonal imbalance), Glucose in the urine.
Discomfort / pain :
Chest pain, which does not / can be affected by the change of position. Painful shoulder / hand, bone pain / joint, cartilage erosion secondary to the increase of growth hormone. Abdominal pain is gone / arise.
Respiratory :
Cough mild cough or a change from the usual pattern, increased sputum production, shortness of breath, workers exposed to carcinogenic substances, hoarse, vocal cord paralysis, and smoking history. dyspnea, increased employment, increased tactile fremitus, wheezing on inspiration or expiration (air flow interruption). persistent wheezing tracheal deviation (the area that suffered lesions) hemoptysis.
Blood gas analysis (obtained hypoksemia, acidosis, an increase or decrease in CO2). Respiratory function (VC reduction, increased tidal volume). ECG (may show a arrytmia).
Security : Fever, maybe there is / are not, reddish, pale skin.
Sexuality :
Gynecomastia, amenorrhea, or impotence.
family risk factors: a history of lung cancer, tuberculosis.
NURSING DIAGNOSIS
- Ineffective breathing pattern related to decreased lung expansion.
- Ineffective airway clearance related to airway obstruction.
- Damage to gas exchange associated with chronic hypoxia in lung tissue.
- Anxiety associated with an inability to breathe.
- Acute pain b / d of cancer invasion into the pleura, chest wall.
- Nutrition less than body requirements b / Inadequate nutrition, increased metabolism, the process of malignancy.
- Impaired body image b / d of changes in body structure.
3 komentar:
Immunological conditions mainly seen in cellular mediated resistance that can be given through a late sensitivity response is clearly
Fine information, many thanks to the author. It is puzzling to me now, but in general, the usefulness and significance is overwhelming. Very much thanks again and good luck!
what parts are confusing you? write books for many different times, but on the same basis and subject knowledge. This may be due to the limitations that I can reference.
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