A focus of metastatic

carcinoma from breast

is seen on the pleural
surface of the lung.
Such pleural
metastases may lead
to pleural effusions,
including hemorrhagic
effusions, and pleural
fluid cytology can
often reveal the
malignant cells.
1

The dense white encircling tumor

mass is arising from the visceral
pleura and is a mesothelioma.
These are big bulky tumors that
can fill the chest cavity.The risk
factor for mesothelioma is
asbestos exposure. However,
mesothelioma is rare even in
persons with asbestos exposure.
Asbestosis more commonly
predisposes to bronchogenic
carcinomas, increasing the risk by
a factor of five. Smoking increases
the risk for lung cancer by a
factor of ten. Thus, smokers with
a history of asbestos exposure
have a risk 50 fold greater
likelihood of for developing lung
cancer.
2

 Mesotheliomas
have either spindle
cells or plump
rounded cells
forming gland-like
configurations, as
seen here at high
power
microscopically.
They are very
difficult to
diagnose
cytologically.
3

TNM staging

T: Tumor (size, extension

to surrounding organsim)

N: lymph node (hilar,

mediastinal, supraclavicular)
M: distant metastasis
(multiple organ,

Thoracic CT scanning for staging

Multicenter, Jakarta
2007-2008
IIIA
IIB
IIA
IIIB
IB
IA

Staging,
nonsmall cell
lung cancer
IB IIA
IA

IIIA

IV

www.kankerparu.org

RS
Persahabatan
2004-2006

IIB

IV
IIIB
6

Treatment modalities for lung cancer

Scalpel: surgery
Beam: radiotherapy
Drugs: chemotherapy,
new targeted therapy
Combined/multimodality
7

General approach NSCLC

NEJM 2004

Surgery
5(1,3%)
Chemoradioth/
(17.2%)

Chemoradio
Chemotherapy 35,26%
10,4%

Untreated 35,1%

Radioth/
No medical
Treatment
39(10,5%)
131(35,1%)

Surgery 1,42%
% Others 27,3%
Chemoth/)
95
( 25.5%)

Others
39(10,5%
)
RS Persahabatan
(n = 373)

Untreat ed 17,6%

targted th 0,9%
Radioth 7,3%/

Multicenter, Jakarta

Treatment: Nonsmall cell Lung Cancer

9

WWW.KANKERPARU.ORG

. Journal of Thoracic Oncology 2007; 2(suppl): S657

Survival rate

Angka tahan hidup

1.00

Stg IA&IIA

0.75

p=0,0000

0.50

Stg IB
0.25

Stg IIIB

0.00
0

Lama hidup
(bulan)

Stg IIB
20

Stg IV Stage

40

Stg IIIA

IB
Stage IIB
Stage IIIB

60

80

Stage
Stage
Stage
Stage

IASurvival
IIA
IIIA
IV

Survival of lung cancer after surgery

in
Persahabatan Hospital

10

time

Survival of lung cancer after surgery

in Persahabatan Hospital
Angka tahan hidup
1.00

0.75

p=0,0002

0.50
0.25
0.00
0

Resection+
adjuvant

Lama hidup
(bulan)

20

Neoadjuvant+resection
40
60

Adjuvan

Resection only

Pembedahan saja
NotTanpa
resected
pembedahan
Neoadjuvan

. Journal of Thoracic Oncology 2007; 2(suppl): S657

11

80

New targeted therapy

for lung cancer
Cancer cells may have receptor for EGF, which then sends
signals to the nucleus, causing
cells to proliferate, invade the
surroundings, metastasize,
and make new blood vessels.
EGFR inhibitors drugs can
block this process, resulting
in clinical improvement and
better prognosis

12

The role clinical laboratory examination

As support to treatment: hematology,
organ function (especially liver, blood,
kidney)
Tumor markers: CEA, SCC, Cyfra 21.1,
NSE may indicate treatment failure,
recurrent or metastasis
As support to diagnosis, but not decisive.
14

What We Need to Be Aware of

15

What We Need to Be Aware of

Mangunnegoro:

43% of lung cancer patients were

previously diagnosed as pulmonaryTb

Taufik:

38% of lung cancer patients

have been treated as pulmonary Tb
when the diagnosis of lung cancer was
established.
16

Laki2 58 thn,

17

What We Need to Be Aware of

A male smoker patient in
cancer age, diagnosed as
pneumonia or smear negative pulmonary TB,

Not responding to an
adequate treatment
within 1-2 weeks
should be evaluated for the
possibility of lung ca ncer

18

What We Need to Be Aware of

The esponse to treatment in a smer negative Tb ptnt must be
assessed clinically in the 1st 2 weeks
Anamnesis
is very important to detect improvement
*is the
patient feeling better?
* is
fever subsiding*
*is appetite reappearing? Is cough decreasing?
Adequate verbal contact is mandatory,
just drug prescribingdrugs is not enough

If the patient complains of no improvement

do not feel offended,
continue assessment towards lung cancer
19

What We Need to Be Aware of

frequently neglected symptoms & signs

Beware!

persistent pain
in the shoulder and/or arm
20

Male, 44 yrs

Persistent pain
on rgt shoulder,
treated as tb for
>2 months,

not improved.
Biopsy: adeno
carcinoma

23/5/2008
After chemothrp I
& radiotherapy 10x

110608
After chemothrp II
& radiotherapy
20x
21

230308

080508
Before therapy

Male, 44 yrs

Persistent pain
on rgt shoulder,
treated as tb for
>2 months,

not improved.
Biopsy: adeno
carcinoma

23/5/2008
After chemothrp I
& radiotherapy 10x

110608
After chemothrp II
& radiotherapy
20x
22

What We Need to Be Aware of

frequently neglected symptoms & signs

Beware!
Netter FH, et al

persisten pain in the shoulder

and/arm plus a lesion on the apex
of the lung

Look for signs:

paresthesia, paresis
myosis, ptosis,
enophtalmos
(brachial plexsus syndrome.
23

What We Need
to Be Aware of
frequently neglected
symptoms & signs

24
Netter FH, et
al

What We Need to Be Aware of

frequently neglected symptoms &

igns
Severe
headache or signs of stroke

may indicate
cerebral metastasis from lung cancer
Chest x-ray film must be made
before brain surgery.
Lung cancer is often found after extirpat-ion of brain lesion
suspected for tumor.

25

Prevention: risk factors for lung

cancer

Yayasan Jantung Indonesia

26
REPUBLIKA

False images of tobcco: trends?

glamour? success?

27

Facts and fictions of

female cigarette smoking

28

Further reading & acknowledgment

1. Rukmini Mangunkusumo, Pidato Pengukuhan Guru Besar FKUI , 2004
2. Netter FH, Divertie MB, Brass E (eds): the Ciba Collection of Medical Illustration
vol 7 Ciba 1979
3. Sun S, Schiller JH, Gazdar AF. Lung cancer in never smokers a different disease.Nature Rev Cancer.2007; 7:778-90
4. Subramanian J, Govindan R. Molecular genetics of lung cancer
in people
who have never smoked. Lancet Oncol.2008;9:676-82
5. Jusuf A: Pidato Pengukuhan Guru Besar FKUI , 2004
6. Kanker Paru: Pedoman Dignosis&Pengobatan PDPI & POI, 2005
7. Sjahruddin E. Journal of Thoracic Oncol 2007;2 (suppl):657
8. www.kankerparu.org
9. Files, Departmnt of Respiratory Medicine, FKUI-RS Persahabatan

29

Lung cancer:
Diagnosis, treatment,
prevention
Anwar Jusuf
Departmnt of Respiratory Medicine
Fac. of Me dicine, UI

30

38

39

40

41

Sun S, Schiller JH, Gazdar AF.

Lung
cancer in never smokersa different disease.Nature Rev
Cancer.2007;7:778-90

42