Kak Rifda Ppds Paru:

Soal Ujian Lapkas Onko

1. Faktor resiko kanker paru

1.faktor macroenvironment: a.kebiasaan merokok(perokok aktif,perokok pasif,perokok pasif(third hand

smoker) b.paparan zat karsinogen pada pekerja:asbestos,radiasi ion pada pekerja tambang uranium
c.Polusi udara d.diet

2.faktor microenvironment seperti:faktor pertumbuhan,kemokin,sitokin,protease dan komponen seluler

3.,Faktor genetik terhadap kejadian kanker paru:angka kejadian kanker paru lebih tinggi pada pasien
yang memiliki riwayat kanker paru dalam keluarga

Risk factors for lung cancer

1. Macroenvironment factor: smoking habits (active smokers, passive smoking, third hand smoker) b.
exposure to carcinogens in workers: asbestos, ion radiation in uranium mine workers c. Air pollution d.
diet

2. Microenvironment factors such as: growth factors, chemokines, cytokines, proteases and cellular
components

3. Genetic factors for lung cancer incidence: the incidence of lung cancer is higher in patients who have
a history of lung cancer in the family

2. CLINICAL MANIFESTATIONS Clinical symptoms can be divided into:

A. Intrapulmonary symptoms

1. Cough: long cough or repeated, coughing more than 2 weeks. Coughing for more than 3 weeks is a
symptom that should be watched out for in the high risk group (GRT)

2. Chest pain, this condition arises when the tumor mass is more than 2 cm in diameter.

3.Shortness of breath, due to suppression of tumor mass that grows in the airways which may be
accompanied by a buildup of sputum along the airway below, or due to the obstruction caused or due to
atelectasis.

B. Intratoracal Ektrapulmonal symptoms

1. Horner's syndrome : occurs due to suppression of the sympathetic nerve, in the form of: a.
Enopthalmus b. Miosis c. Ptosis. d. Ipsilateral anhydrosis

2.Vena Cava Superior Syndrome:

a. Swelling of the arms, face, neck

b. Collateral veins on the chest wall

c. Venektasi

3. Dysphagia due to esophageal suppression, 4.Spread of intrathoracic regional lymph nodes causes
pleural effusion, chylous effusion and nerve disorders

5. functional heart disorders pericardial

6. Expansion of primary cancer causes an emphasis on n. 8th Cervical and n. Thoracal 1 or brachial
plexus and can cause tracheal obstruction due to tumor invasion or suppression.

C. Non Metastatic Extrathoracal Symptoms

1. Neuromuscular manifestations in the form of carcinomatous neuropathy, in the form of: myopathy,
peripheral neuropatia, encephalomyopatia.

2. Endocrine metabolic manifestations, in the form of :

a. Cushing's syndrome.

b. Hyperparathyroid with hypercalcemia

c. Hyponatremia due to ADH secretion.

d.Hypoglycemia due to excessive insulin secretion.

3.Manifestations of connective tissue and bone.

4. Vascular manifestations and hematology, in the form of: anemia, purpura and migratory
thrombophlebitis

D. Ekstratorakal Metastatic symptoms - Spread / metastasis of extrathoracal lung cancer can

occur hematogen or lymphogen

3.PHOTO TORACTIC Chest X-ray presents manifestations, among others:

1. Radiopaque mass in the lungs and nodules (solitary dane multiple)

2. Mass with airway obstruction with a picture of atelectasis.

3. Mass with a picture of pneumonia

4. Enlargement of the para hilar gland, especially in cell OAT.

5. Cavitation: 2-10% of cases occur.

6. Pancoast tumors have a picture of the superior area or superior lobe apex.
7. Pleural effusion

4.Metastasis lung cancer can occur to:

a. Bone

b. Brain

c. Pleura

d. Contralateral lung

e. Hepar

f. Adrenal Gland

g. skin

h. Ipsilateral lung

5.Diagram Clinically, lung cancer is classified into 2 types :

1 Lung cancer is a type of Small Cell Carcinoma (KPKSK) or Small Cell Lung Carsinoma (SCLC).

2.Heterogeneous types of non-small cell carcinoma (KPKBSK) or heterogeneous Non Small Cell Liung
Carsinoma (NSCLC) consist of:

A, Adenocarcinoma, incidence of 40% of cases of KPBSK (NSCLC) with radiological features similar to
those of pneumonia

b. Squamous cell carcinoma / epidermoid carcinoma: incidence of about 20-30%, located centrally so
that it is sometimes easy to diagnose, usually sputum cytology with good sampling can be detected.

c.large cell insidens of cancer 5-10 % origin from periferal epitel bronhus.

6.Management of lung cancer is a multi-modality therapy (combined modality therapy) such as:
1. Surgery 2. Radiotherapy 3. Chemotherapy 4. Targetted therapy 5. Monoclonal antibody 6.
Immunotherapy

7. Indikasi bronkoskopy :

1.Diagnostik : Batuk,batuk darah,mengi dan stridor,gambaran foto toraks yang abnormal,Pemeriksaan

BAL,Lymphadenopati,karsinoma bronkus,karsinoma metastasis,tumor esophagus dan
mediastinum,benda asing pada trakea,striktur dan stenosis pada trakeobronkial,cedera akibat zat kimia
dan panas pada trakeobronkial,trauma dada,kelumpuhan pita suara dan suara serak,kelumpuhan
diafragma,efusi pleura,pneumotorax,miscellaneous,bronkografi,memastikan pemasangan
ETT,memastikan endotracheal tube,pemeriksaan pasca operasi trakea

2.indikasi terapeutik dahak yang tertahan,benda asing trakeobronkial,mengeluarkan sesuatu dengan

bronkoskopy,laser therapy,brachytherapi,pemasangan stent pada trakeobronkial,melebarkan
bronkus,laser,dilatasi dengan menggunakan balon,pemasangan stent,abses paru,kista pada
mediastinum,kista pada bronkus,pneumotoraks,fistel bronkopleura,miscellaneous,injeksi
intralesi,pemasangan ETT,kistik fibrosis,asma,trauma dada,therapeutic lavage

7. Bronchoscopic indication :

1. Diagnostik : Coughing, coughing up blood, wheezing and stridor, abnormal chest X-ray, BAL
examination, Lymphadenopathy, bronchial carcinoma, metastatic carcinoma, esophageal and mediastinal
tumors, tracheal foreign bodies, stricture and tracheobronchial stenosis, chemical injury and heat in
tracheobronchial, chest trauma, hoarseness of hoarseness and vocal cords, diaphragmatic paralysis,
pleural effusion, pneumothorax, miscellaneous, bronchography, ensuring installation of ETT, ensuring
endotracheal tube, post tracheal surgery.

2. therapeutic indications retained phlegm, tracheobronchial foreign body, removing something with
bronchoscope, laser therapy, brachytherapy, stenting on the tracheobronchial, widening bronchus, laser,
dilating using balloons, stenting, lung abscess, cyst in the mediastinum, cyst in the bronchi, bronchi,
pneumothorax, fistula bronkopleura, miscellaneous, intralesional injection, ETT insertion, cystic fibrosis,
asthma, chest trauma, therapeutic lavage.

8.Indications for CT chest

Ct scan toraks dengan kontras dapat menilai: .keterlibatan lymph node .penekanan terhadap
bronkus,tumor intrabronkial,atelektasis,efusi yang tidak massif dan telah terjadi invasi ke mediastinum
dan dinding dada meski tanpa gejala .metastasis intrapulmoner

Thoracic CT scan with contrast can assess: . involvement of lymph nodes . bronchial pressure,
intrabronchial tumor, atelectasis, non-massive effusions and mediastinal invasion and chest wall despite
symptoms intrapulmonary metastasis

There are many indications for a CT chest. CT is the gold standard investigation for diagnosis of
pulmonary embolus and after major trauma, CT of the head, neck, and body is now mandatory. In
thoracic anaesthesia, preoperative CT scans of the chest are invaluable for planning the insertion of
a double-lumen tube. On the intensive care unit (ICU), they are not just used to diagnose conditions
such as interstitial lung disease, atypical infection, and acute respiratory distress syndrome (ARDS)
but can help detect small or anterior pneumothoraces and evaluate loculated pleural effusions that
can aid interventional strategies. Other imaging modalities should always be considered as they
may confer certain advantages. Magnetic resonance imaging (MRI) is increasingly used for
evaluation of structural and functional cardiac pathology. Positron emission tomography (PET), or
PET CT confers advantages for diagnosis of malignant tumours or metastatic disease. Ultrasound
(US) scan use is increasing on the ICU for echocardiography, lung ultrasound, and before
percutaneous tracheostomy insertion. US has the major advantage of being deliverable at the point
of care and is relatively safe with an absence of radiation exposure.

I.V. contrast media enables the confident identification of vascular anatomy, aids delineation of adjacent
non-vascular structures, and improves both the detection and characterization of pathological lesions. It is
used to aid assessment of mediastinal structures, vascular structures, chronic pleural disease, lung masses,
and differentiation of parenchyma from the pleura or pleural collections. Contrast may also be
administered orally for assessment of the oesophagus.
I.V. contrast is administered via a high-pressure syringe pump at between 3 and 6 ml s−1. Vascular access
must be of an adequate gauge to allow flow at these rates while being robust enough to cope with the
pressure injection (most institutions favour an 18 G cannula placed correctly in the ante cubital fossa).
Administration via central access risks catheter rupture and great vessel perforation. Certain central
venous catheters are re-inforced and safe to administer contrast through, but local policy and
manufacturer's guidance should always be followed.
There are certain situations where it is important to scan in the absence of contrast and for this reason, it is
essential that the radiologist is given a full history and is aware of the issues that are to be addressed.
Examples of such situations are:
Acute aortic dissection: intramural haematoma, an early sign, may be obscured by the dense aortic
contrast.
Small oesophageal leaks: leaked oral contrast may be difficult to detect if i.v. contrast has been
administered, as it can be obscured by adjacent vessel enhancement.

8.DEFINITIONS

A pulmonary nodule is defined on imaging as a small (≤30 mm), well defined lesion
completely surrounded by pulmonary parenchyma [1-4]. Morphologically, nodules are
classified as solid (image 1) or subsolid; subsolid nodules are subdivided into pure
ground-glass nodules (ie, no solid component) (image 2) and part-solid nodules (ie,
both ground-glass and solid components) (image 3) [1]. Lesions that measure >30 mm
are considered masses, rather than nodules, harbor a much higher likelihood of being
malignant, and are discussed separately. (See "Overview of the initial evaluation,
diagnosis, and staging of patients with suspected lung cancer".)
Multiple pulmonary nodules are, on occasion, also encountered incidentally. In this
setting, the diagnostic evaluation refers to the predominant type or the most suspicious
nodule (eg, largest, growing).

DIFFERENTIAL DIAGNOSIS

The causes of incidental pulmonary nodules can be categorized as benign or malignant

(table 1). The estimated frequency of each etiology varies substantially among studies,
reflecting differences in the population studied and the methodology used to establish a
diagnosis [5-11]. Nonetheless, screening studies of smokers who are at high risk of
malignancy suggest that the vast majority of nodules identified on computed
tomography (CT) are benign. As an example, in the Pan-Canadian Early Detection of
Lung Cancer and the British Columbia Cancer Agency studies, among the 12,029
nodules found, only 144 (1 percent) were malignant [12]. The incidence of malignant
nodules is likely much lower in patient at average or low risk for lung cancer.