III. DISCUSION
1. Anamnesis
From this patient, obtained signs of lung tumors that are a
history of cough, shortness of breath, weight loss fast. History of
pulmonary tuberculosis disease 8 years ago was also a risk factor
for lung cancer. The incidence of lung cancers was approximetly
11-folds higher based oin the cohort studies of patient with
tuberculosis than non-tuberculosis subjects.
The patient has made investigation to diagnose lung tumors.
thoracic images has been carried out on the patient. Answer of
thoracic images obtained in the consolidated picture of the right
lung with tracheal and mediastinal shift to the left side.
Anatomical pathology examination showed a tumor with an overview of
macroscopic squamous sell thoracic reactive cells and groups of
cells with pleomorphic nuclei, vesicular and coarse chromatin.
Patients also had bronchoscopy examination, the results show there
is a mass in the right main bronchus lung. CT-scan results appear
opaque homogeneous in hemithoraks right top to bottom.
Based on the results mentioned above, the diagnosis can be
established lung tumors, lung tumor which is the kind of epidermoid
carcinoma with stage IIIB. Stage IIIB enforced by category TNM for
lung cancer in which the tumor mass has invaded major blood vessel
invasion into the superior vena cava. It is characterized by
superior vena cava syndrome. Superior vena cava syndrome is
established by a shortness of breath, cough history and symmetrical
swelling in the neck.
2. Carcinoma of lung and tuberculosis
Lung tumor consisted of malignant epithelial tumors, sarcomas,
carcinosarcoma, and pulmonary metaplasia. Epithelial malignant
tumor is a malignant tumor that most frequently occurs. Malignant
epithelial tumors can be divided into bronchogenic cancer,
bronchiolar cancer, and bronchial adenoma.
Bronchogenic cancer consisting of cancerous epidermoid /
squamous cell cancer, adenocarcinoma, anaplastic carcinoma, and
mix. Bronchogenic cancer associated with a history of TB lesion was
squamous cell cancer. TB lession had a higher probability of having
EGFR mutations, especially exon 19 delitions. Squamous cell cancer
(SCC) of the lung was found in mice subjected to chronic infection
with mycobacterial tuberculosis.
3. Treatment
Patients with stage IIIB lung cancer treated with palliative
chemotherapy or radiotherapy. As for the requirement does
chemotherapy in patients, among others:a. Hb 10 gr%, anemia
patients without acute bleeding, although HB 70 ml/minute)
Chemotherapy is done by using some anticancer drugs in
combination chemotherapy regimens. As for the regimen include CAP
II (cisplatin, adriamin, cyclophosphamide) and PE (cisplatin or
carboplatin + etoposide), paclitaxel + cisplatin or karboplatin,
gemsitabin + cisplatin or carboplatin, docetaxel + cisplatin or
carboplatin, oral gefitinib (used as an adjuvant therapy). In
patients given gemsitabin + cisplatin, at a dose gemsitabin 1250
mg/m2 and cisplatin 60 mg/m2. Surface area is 103 m2 so patient
dose cisplatin gemsitabin 128.750 mg and 6180 mg.
4. Mortality Rate
The death rate from lung cancer has increased significantly with
a history of TB infection. In patients with TB, the risk of 0.511%,
while healthy people the risk is much smaller, which is 0.082%.
Survival rarte in this disease is increased if it was cured
earlier. This patient didnt take any step (chemotherapy). Besides,
presents of many complication and metastatic of the cancer,
increased mortality rate and worsening her outcome.
5. Metastatic pulmonary tumor
The lung is a frequent site of metastases from primary cancers
outside the lung. Usually such metastatic disease is incurable.
However, two special situations should be borne in mind. The first
is the development of an SPN or a mass on chest x-ray in a patient
known to have an extrathoracic neoplasm. This nodule may represent
a metastasis or a new primary lung cancer. Because the natural
history of lung cancer is often worse than that of other primary
tumors, a single pulmonary nodule in a patient with a known
extrathoracic tumor is approached as though the nodule is a primary
lung cancer, particularly if the patient is >35 years and a
smoker.
If a vigorous search for other sites of active cancer proves
negative, the nodule is surgically resected. Second, in some cases
multiple metastatic pulmonary nodules can be resected with curative
intent. This tactic is usually recommended if, after careful
staging, it is found that (1) the patient can tolerate the
contemplated pulmonary resection, (2) the primary tumor has been
definitively and successfully treated (disease-free for >1
year), and (3) all known metastatic disease can be encompassed by
the projected pulmonary resection. Patients with uncontrolled
primary tumors and other extrapulmonary metastases are not
considered. Primary tumors whose pulmonary metastases have been
successfully resected for cure include osteogenic and soft tissue
sarcomas; colon, rectal, uterine, cervix, and corpus tumors; head
and neck, breast, testis, and salivary gland cancer; melanoma; and
bladder and kidney tumors. Five-year survival rates of 2030% have
been found in selected series, and dramatic results have been
achieved in patients with osteogenic sarcomas, where resection of
pulmonary metastases (sometimes requiring several thoracotomies) is
a standard curative treatment approach.
From this patient, theres history that she has a mass on her
right breast but it seems disappeared after traditional medication.
Further investigation is needed so we could concluded weather this
lung carcinoma was related with tuberculosis or breast
cancer.76
