LUNG CANCER

KARSINOMA PARU ADALAH PERTUMBUHAN

YANG TIDAK TERKENDALI DARI PADA
SEL SEL ANAPLASTIK DI PARU.

TIPE KARSINOMA PARU

A. EPIDERMOID (SEL SQUAMOUS)
B. ADENOKARSINOMA
C. SMALL CELL UNDIFFERENTIATED (OAT
CELL)
D. LARGE CELL UNDIFFERENTIATED
 Lung Cancer: Defined
Lung Cancer: Defined
• Uncontrolled growth of malignant cells in
one or both lungs and tracheo-bronchial
tree
• A result of repeated carcinogenic irritation
causing increased rates of cell replication
• Proliferation of abnormal cells leads to
hyperplasia, dysplasia or carcinoma in situ
Picture of the Lungs
 LUNG CANCER
HAMPIR 80 % TUMOR PARU
BERHUBUNGAN DENGAN MEROKOK.
ORANG YG BERESIKO TINGGI ADALAH
MEREKA YG MEMULAI MEROKOK PD
USIA REMAJA, MENGHIRUP SECARA
DALAM DAN MEROKOK LEBIH DARI
SEPARUH PAK SEHARI.

ETIOLOGI FAKTOR LAINYA:

TERPAPAR PEKERJAAN SEPERTI
PARTIKEL ASBESTOS, URANIUM, NIKEL,
CHROMATE
Where Does it Come From?

• Radiation Exposure
• Smoking
• Environmental/ Occupational
Exposure
– Asbestos
– Radon
– Passive smoke
Smoking Facts
• Tobacco use is the
leading cause of lung
cancer
• 87% of lung cancers
are related to smoking
• Risk related to:
– age of smoking onset
– amount smoked
– gender
– product smoked
– depth of inhalation
Where does it travel?
• Lymph Nodes, Brain, Liver, Adrenal,
Gland, Bones

• 40% of metastasis occurs in the

Adrenal Gland
 Diagnosis
• History and Physical exam
• Diagnostic tests
– Chest x-ray
– Biopsy (bronchoscopy, needle biopsy,
surgery)
• Staging tests
– CT chest/abdomen
– Bone scan
– Bone marrow aspiration
– PET scan
 Symptoms
– cough
– dyspnea
– hemoptysis
– recurrent infections
– chest pain
Syndromes/Symptoms secondary
to regional metastases:
– Esophageal compression dysphagia
– Laryngeal nerve paralysis hoarseness
– Symptomatic nerve paralysis Horner’s
syndrome
– Cervical/thoracic nerve invasion Pancoast
syndrome
– Lymphatic obstruction pleural effusion
– Vascular obstruction SVC syndrome
– Pericardial/cardiac extension effusion,
tamponade
• Horner's syndrome or Horner syndrome
is a clinical syndrome caused by damage
to the sympathetic nervous system. It is
also known by the names Bernard-
Horner syndrome or oculosympathetic
palsy
• Signs found in all patients on affected side of face include; ptosis
(which is drooping of the upper eyelid from loss of sympathetic
innervation to the superior tarsal muscle, also known as Müller's
muscle [1]), upside-down ptosis (slight elevation of the lower lid),
and miosis (constricted pupil), and anhidrosis (decreased sweating
on the affected side of the face), dilation lag (slow response of the
pupil to light), Enophthalmos (the impression that the eye is sunk in)
loss of ciliospinal reflex and bloodshot conjunctiva may occur
depending on the site of lesion. Sometimes there is flushing of the
face is on the affected side of the face due to dilation of blood
vessels under the skin.
• The clinical features of Horner's syndrome can be remembered
using the mnemonic, "Horny PAMELa" for Ptosis, Anhidrosis,
Miosis, Enophthalmos and Loss of ciliospinal reflex.
 Two Lung Cancer Cells,
Classified
Non Small Cell Lung Small Cell Lung
Cancer (NSCLC) Cancer (SCLC)

• Adenocarcinoma • Oat Cell

• Squamous Cell Carcinoma • Intermediate

• Large Cell Carcinoma • Combined

 Treatment and Staging
NSCLC
Stage Description Treatment Options

Stage I a/b Tumor of any size is found only in the Surgery

lung
Stage II a/b Tumor has spread to lymph nodes Surgery
associated with the lung

Stage III a Tumor has spread to the lymph nodes Chemotherapy followed
in the tracheal area, including chest by radiation or surgery
wall and diaphragm

Stage III b Tumor has spread to the lymph nodes Combination of

on the opposite lung or in the neck chemotherapy and
radiation
Stage IV Tumor has spread beyond the chest Chemotherapy and/or
palliative (maintenance)
care
Small Cell Lung Cancer (SCLC)
• Limited Stage
Defined as tumor involvement of one lung, the
mediastinum and ipsilateral and/or contralateral
supraclavicular lymph nodes or disease that can
be encompassed in a single radiotherapy port.
• Extensive Stage
Defined as tumor that has spread beyond one
lung, mediastinum, and supraclavicular lymph
nodes. Common distant sites of metastases are
the adrenals, bone, liver, bone marrow, and
brain.
• Staging of squamous cell carcinoma of the
lung is based on the TNM (Tumour, Node,
Metastasis) system. 'Tumour' refers to
tumour size, which is measured in
centimetres. 'Node' refers to the presence
of cancerous cells in regional lymph
nodes. 'Metastasis' refers to the spread of
cancer beyond regional lymph nodes to
other organs of the body.
• Tumour size (T):
– Tx: Primary tumour not able to be assessed
– T0: No evidence of primary tumour, ie. cancer
cells seen on sputum sampling or bronchial
washing only
– Tis: Carcinoma in situ
– T1: Tumour 3 cm or less, surrounded by
pleura, without evidence of invasion more
proximal than the lobar bronchus.
– T2: Tumour with any of the following features:
– T2: Tumour with any of the following features:
• >3cm in greatest dimension
• Involves main bronchus, 2cm or more distal to the
carina
• Invades visceral pleura
• Associated with atelectasis or obstructive
pneumonitis, extending to the hilar region but not
involving the entire lung.
– T3: Tumour of any size,
• directly invading the chest wall, diaphragm,
mediastinal pleura or parietal pericardium; or
tumour in the main bronchus; or
• in the main bronchus, less than 2cm distal to the
carina, but without involvement of the carina; or
• with associated atelectasis or obstructive
pneumonitis of the entire lung
• T4: Tumour of any size, invading the
mediastinum, heart, great vessels,
trachea, oesophagus, vertebral body,
carina; or with separate tumour nodules in
one lobe, or with malignant pleural
effusion
• Regional lymph nodes (N):
– NX: Regional lymph nodes not able to be
assessed
– N0: No regional lymph node metastasis
– N1: Metastasis in ipsilateral peribronchial
and/or ipsilateral hilar lymph nodes and
intrapulmonary nodes, including involvement
by direct extension
• Regional lymph nodes (N):
– N2: Metastasis in ipsilateral mediastinal
and/or subcarinal lymph nodes
– N3: Metastasis in contralateral mediastinal,
contralateral hilar, ipsilateral or contralateral
scalene, or supraclavicular lymph nodes
• Distant Metastasis (M)
– MX: Distant metastasis not able to be
assessed
– M0: No distant metastasis
• M1: Distant metastasis, including separate
tumour nodule(s) in a different lobe (ipsi-
or contralateral).
Using this classification, non-small cell lung
cancers are grouped into stages as
follows:
• Stage 0: TIS N0 M0
• Stage Ia: T1 N0 M0
• Stage Ib: T2 N0 M0
• Stage IIa: T1 N1 M0
• Stage IIb: T2 N1 M0, T3 N0 M0
Using this classification, non-small cell lung
cancers are grouped into stages as
follows:
• Stage IIIa: T1 N2 M0, T2 N2 M0, T3 N1
M0, T3 N2 M0
• Stage IIIb: any T N3 MO, T4 any N M0
• Stage IV: any T any N M1
• Using this system, outcomes are best for
patients with early stages of disease, with
small tumours, no spread to lymph nodes,
and no distant spread (metastasis) to
other organs. Outcomes are also better for
younger patients. Overall, despite
treatment, 5-year survival for all types of
lung cancer in Australia is not good: 11%
for males and 14% for females.
• Survival for squamous cell carcinoma is
better than that for large cell carcinoma
and small cell lung cancer, though slightly
worse than for adenocarcinoma.
 LUNG CANCER
PATHOPHYSIOLOGY

RENTANG WAKTU DARI SESEORANG

TERPAPAR AWAL ZAT KARSINOGEN
DENGAN KEJADIAN KANKER PARU
BERKISAR 10 – 30 TAHUN.
LESI TIDAK TERDETEKSI PADA
RONGENT (X-RAY/SINAR X) TETAPI
DITEMUKAN DARI PEMERIKSAAN
SITOLOGI SPUTUM DAN DENGAN
PEMBEDAHAN FIBEROPTIC
BRONCHOSCOPY DAPAT DILAKUKAN
PENANGKATAN TUMOR DAN
BERPOTENSIAL TERIOBATI.
 LUNG CANCER
PATHOPHYSIOLOGY

LESI TIDAK TERDETEKSI PADA RONGENT (X-

RAY/SINAR X) SECARA UMUM TIDAK BENAR
KARENA SUATU LESI DAPAT DITEMUKAN
PADA PEMERIKSAAAN X-RAY DADA BILA
UKURAN TERKECIL TUMOR 1 CM UNTUK
DAPAT DIDETEKSI OLEH ROENTGENOGRAM

TIPE HISTOLOGIK MAYOR KANKER PARU

TERBAGI 2 KATEGORI

KANKER PARU NON-SMALL CELL (NSCLCs)

UMUMNYA TIDAK SEAGGRESIF KANKER
SMALL CELL LUNG CANCER PADA STADIUM
AWAL PENYAKIT.
 LUNG CANCER
PATHOPHYSIOLOGY

BEBERAPA FAKTA TENTANG KANKER

PARU;
1. TUMOR SEL SQUAMOUS LEBIH UMUM
TERJADI HINGGA 35 % DARI SEMUA
TUMOR PARU. 90 % TERJADI PADA
PRIA. TUMOR INI CENDERUNG
BERLOKASI DI PUSAT/SENTRAL DAN
MENIMBULKAN
OBSTRUKSI/PENYUMBATAN
BRONKHIAL
2. .
 LUNG CANCER
PATHOPHYSIOLOGY

BEBERAPA FAKTA TENTANG

KANKER PARU;
1. .
2. ADENOKARSINOMA SERING
TERJADI DILOKASI TEPI/PERIFER ;
UMUMNYA SCAR KARSINOMA
TIMBUL DIAREA FIBROSIS TEMPAT
DIMANA PERTAMA TERJADI
KERUSAKAN PARU.
 LUNG CANCER
PATHOPHYSIOLOGY

BEBERAPA FAKTA TENTANG KANKER

PARU;
2. ADENOKARSINOMA BERHUBUNGAN
DENGAN MEROKOK DARI PADA TIPE
LAINYA. TUMOR INI SERING MENYEBAR
LEWAT LIMPHATIS SUB MUKOSA PADA
LYMPHA NODUS REGIONAL DAN
SERING BERMETASTASE KE OTAK DAN
ORGAN TERDEKAT MELALUI INVASI
VASKULER.
 LUNG CANCER
PATHOPHYSIOLOGY

BEBERAPA FAKTA TENTANG KANKER

PARU;
3. TUMOR LARGE CELL
UNDIFFERENTIATED (TUMOR SEL
BESAR TIDAK BERDIFENSIASI) DAPAT
MENCAPAI BEBERAPA AREA DI PARU.
TIPE INI CENDERUNG MULAI
MENYEBAR DARI LOKASI AWAL DAN
BERHUBUNGAN DENGAN PROGNOSA
YG JELEK. SUBTIPENYA ADALAH GIANT
CELL (SEL GIANT) DAN CARCINOMA
CLEAR CELL.
 LUNG CANCER
PATHOPHYSIOLOGY
KANKER PARU SEL KECIL (SMALL CELL
LUNG CANCER) JUGA DISEBUT KANKER
SEL OAT (OAT CELL CANCER) DGN
PERBANDINGAN 10 % TUMOR PARU.
TUMOR INI LEBIH AGRESIF, DENGAN
LIMPHATIS DAN JARAK METASTASE
BIASANYA PADA SAAT TERDIAGNOSIS.
SINDROM PARANEOPLASTIK ADALAH
PALING UMUM DENGAN TIPE INI. LEBIH
TINGGI SENSITIFNYA TERHADAP
TERAFI KEMOTERAFI DAN RADIASI
 LUNG CANCER
PATHOPHYSIOLOGY
SEMUA TIPE KANKER DAPAT
BERMETASTASE DINI PADA BAGIAN
PENYEAKIT KE TEMPAT LAIN DIMULAI
DARI BRONKHIAL, NODUS
MEDIASTINAL, DAN MENYEBAR
KEATAS KE NODUS SUPRAKLAVIKULAR
DAN TURUN KE NODUS DIBAWAH
DIAPHRAGMA DAN KE LIVER, KELENJAR
ADRENAL/GINJAL. DPAT
BERMETASTASIE MELALUI ALIRAN
DARAH KE OTAK, TULANG DAN PARU-
PARU DISEBELAHNYA.
 LUNG CANCER
TANDA UMUM DINI ADALAH
BATUK DAN WHEEZING KRONIS,
GEJALA LAINYA FATIQUE /LELAH,
CHEST TIGHTNESS (DADA RASA
TERTEKAN/SESAK/PENUH), NYERI
SENDI. LAMBAT TETAPI SECARA
KLINIS TANDA BERMAKNA
MELIPUTI HEMOPTYSIS/BATUK
DARAH, CLUBING OF THE
FINGERS/JARI-JARI TABUH,
KEHILANGAN BERAT BADAN, DAN
EFUSI PLEURA.
 LUNG CANCER
INVASI KE VENA CAVA SUPERIOR
MENIMBULKAN GEJALA EDEMA DI
LEHER, DAN WAJAH. JIKA
MENYERANG SYARAF PHRENIC
NERVE MENIMBULKAN PARALISIS
DIAPHRAGMA/LUMPUH
DIAPHRAGMA. TUMOR SULKUS
SUPERIOR YANG MELIPUTI
PLEXUS BRAKHIAL DAPAT
MENIUMBULKAN GEJALA NYERI
DAN PARESTESIA /MATIRASA
PADA BAHU DAN LENGAN.
 LUNG CANCER
ADANYA LESI KANKER DIDADA RELATIF
TIDAK MENIMBULKAN KELUHAN
(ASIMTOMATIS) DARIPADA KELUHAN
UTAMA YG DISEBABKAN METASTASE
PENYAKIT. METASTASE KE OTAK
DAPAT MENIMBULKAN
HEADACHE/SAKIT KEPALA, UNSTEADY
GAIT/BERDIRI GOYANG, DAN GEJALA
NEUROLOGIS LAINYA. JIKA
MENYERANG LIVER DAPAT
MENIMBULKAN KEHILANGAN BERAT
BADAN, JAUNDICE/KUNING DIMATA,
ANOREXIA/TIDAK ADA NAFSU MAKAN.
JIKA MENYERANG MUSKULOSKELETAL
DAPAT MENIMBULKANB NYERI TULANG
TERLOKALISIR, FRAKTUR PHATOLOGIS.
 LUNG CANCER
SYNDROM PARANEOPLASTIK DAPAT
BERHUBUNGAN DENGAN KANKER
PARU KHUSUSNYA TIPE KANKER SEL
KECIL (SMALL CELL CANCER).
SINDROME PARANEOPLATIK SEPERTI
SYNDROME OF INAPPROPRIATE
ANTIDIURETC HORMONE (SIADH),
PENURUNAN KADAR SERUM
NATRIUM/SODIUM (LOW SERUM
SODIUM) ATAU CUSHING’S
SYMDROMES AKIBAT DARI PRODUKSI
HORMON EKTOPIK
ADRENOKORTIKOTROPIK YG TERJADI
PADA BEBERAPA PASIEN KANKER SEL
KECIL.
 LUNG CANCER
SYNDROM LAINYA MELIPUTI
HIPERKALSEMIA (PENINGKATAN KADAR
KALSIUM DALAM DARAH) AKIBAT
PRODUKSI PARATHORMONE EKTOPIK
(MIRIP SUBSTANSI SEL KANKER
SQUAMOUS); NEUROPATI
KARSINOMATOUS, DAN MYOPATI,
DERMATOMIOSIS DAN HYPERTROPIK
PULMONARY OSTEOARTHROPATHY.
KARENA KANKER PARU PENYEBAB
MENDASAR, PEMBERIAN KEMOTERAFI
LEBIH BERMAKNA MEMBERIKAN
PERBAIKAN.
 LUNG CANCER
STUDI DIAGNOSTIK

PEMERIKSAAN SITOLOGI SPUTUM

(HASIL POSITIF UNUTK SEL
GANAS /MALIGNANT CELLS)

PEMERIKSAAN X-RAY DADA/

ROEGNTEN (TERLIHAT ADANYA
TUMOR, INVASI DI DINDING DADA
ATAU MEDIASTINUM.
 LUNG CANCER
STUDI DIAGNOSTIK

CT (COMPUTED TOMOGRAM)
DADA
MENGGAMBARKAN DENGAN
TEPAT DAN JELAS NODULE,
DENSITASNYA, DAN ADANYA
KALSIUM, INVASI ATAU KOMPRESI
STRUKTUR VASKULER, ADA
TIDAKNYA KETIDAKNORMALAN
LIMPHA NODUS MEMDIASTINAL
 LUNG CANCER
STUDI DIAGNOSTIK

CT (ABDOMEN ATAS)
TERLIHAT METASTASE KANKER KE LIVER
ATAU KELENJAR ADRENAL
MRI (MAGNETIC RESONANCE IMAGING) TERLIHAT
INVASI ATAU KOMPRESI STRUKTUR
VASKULER OLEH TUMOR

FLUOROSCOPY (TERLIHAT GAMBARRAN

PARALISIS SYARAF PHRENIK

BRONCHOSCOPY DENGAN BIOPSI DAN

BRONCHIAL BRUSHING; TERLIHAT ADANYA
SEL GANAS/MALIGNANT CELLS
 LUNG CANCER
STUDI DIAGNOSTIK
MEDIASTINOSCOPY DAN
MEDIASTINOTOMY: MENUNJUKAN
ADANYA SEL GANAS/MALIGNA DI
LIMPHA NODUS MEDIASTINAL

TRANSTHORACIC ATAU TRANSBRONCHIAL

FINE-NEEDLE ASPIRATION:
MENUNJUKAN ADANNYA SEL
MALIGNA/GANAS

THORACENTESIS; MENUNJUKAN ADANYA

SEL MALIGNA
 LUNG CANCER
STUDI DIAGNOSTIK

MEDIASTINOSCOPY DAN
MEDIASTINOTOMY: MENUNJUKAN
ADANYA SEL GANAS/MALIGNA DI
LIMPHA

SCALENE ATAU BIOPSI NODUS

SUPRAKLAVIKULA; MENUNJUKAN
ADAANYA SEL GANAS DI LIMPHA
NODUS PALPABLE
 LUNG CANCER
STUDI DIAGNOSTIK

TEST PUNGSI PARU: HASILNYA

PENURUNAN 50 % KAPASITAS PARU
PAKSA (FORCED VITAL CAVASITY,
MAXIMUM VOLUNTARY VENTILATION
(MVV) & KAPASITAS VITAL PARU.

ANALISA GAS DARAH ARTERI (ARTERIAL

BLOOD GAS ANALYSIS); HASILNYA
MENUNJUKAN PaO2 DIBAWAH 65
MMHG, PaCO2 DIATAS 45 MMHG
 LUNG CANCER
STUDI DIAGNOSTIK

VENTILATION AND PERFUSION

RADIONUCLIDE SCANING;
MENUNJUKAN SEDIKIT ATAU
TIDAK ADA FUNGSI DALAM
JARINGAN PARU

ABDOMINAL CT ATAU ULTRASOUND;

UNTUK MELIHAT ADANYA
METASTATIK KE LIVER
 LUNG CANCER
STUDI DIAGNOSTIK

CT ATAU MRI OTAK; UNTUK MELIHAT

METASTASE KE OTAK

SCAN TULANG ; UNTUK MELIHAT

METASTASE KE TULANG
 LUNG CANCER
PENATALAKSANAAN
PEMBEDAHAN / SURGERY
THORACOTOMY BEDAH EXPLORASI
INSISI DINDING DADA SELAMA
BIOPSI SPESIMEN DIKUMPULKAN
(CELAH ANTAR TULANG IGA
DILEBARKAN DAN PLEURA DIBUKA

RESEKSI TERBATAS PARU (LIMITED

PULMONARY RESECTION)
(SEGMENTAL DAN IRISAN)
 PENATALAKSANAAN
Surgical treatment:
Surgery offers the best chance of cure,
but is usually only possible with small
tumours that have not yet spread (stage I
or II). In some cases, lobectomy may be
more appropriate than limited resection.
If surgical treatment is to be given, the
lymph nodes draining the tumour should
be sampled and removed if the cancer
has spread.
 PENATALAKSANAAN
Radiotherapy:
Patients with tumours which are not
suitable for surgical resection can benefit
from radiotherapy to the chest.
Patients with early disease (Stage I or II
cancer) who have had the tumour
completely surgically removed do not
usually need radiotherapy.
 PENATALAKSANAAN
Chemotherapy:
Chemotherapy can increase survival for
patients with advanced cancer who are
otherwise medically fit. Chemotherapy may
also have improve quality of life for these
patients.
If chemotherapy is to be used, combination
regimes (using more than one drug
together) are better than single-drug
regimes. Chemotherapy using platinum-
based drugs produces the best results.
 PENATALAKSANAAN
New classes of treatment agents, such as
biological therapies, are finding a
place alongside chemotherapy. Watch
this site for breaking news regarding
this treatment.Palliative care Lung
symptoms commonly reported by
patients with incurable lung cancer
include shortness of breath from
pleural effusion, coughing, or
haemoptysis (coughing up blood).
 PENATALAKSANAAN
Pain may be from the lung tumour itself,
or from spread (metastasis) to other
organs, including bone. Treatment is
available for all of these symptoms. In
some cases, radiotherapy may be
used to manage cancer pain. Spinal
cord compression is a complication of
bony metastasis which requires urgent
treatment.
 LUNG CANCER
PENATALAKSANAAN
PEMBEDAHAN / SURGERY
LOBECTOMY; MENGANGKAT SATU LOBUS
PARU DAN DISEKSI NODUS REGIONAL

PNEUMONECTOMY : PEMBEDAHAN UNTUK

MENGANGKAT SELURUH PARU

EXTENDED RESECTION; MENGANGKAT

BLOK PADA BAGIAN DINDING DADA ,
BADAN VERTEBRAL, ATRIUM KIRI ATAU
DIAPHRAGMA
 LUNG CANCER
PENATALAKSANAAN
PEMBEDAHAN / SURGERY

RESECTION OF SUBCARINAL, LOBAR

DAN NODUS MEDIASTINAL

SURGICAL EXCISION OF SOLITARY

METASTATIC DISEASE TO BRAIN
 LUNG CANCER
PENATALAKSANAAN
TERAFI RADIASI

EXTERNAL BEAM
INTERSTITIAL / ENDOBRONCHIAL
BRACHYTHERAPY
PROPHYLACTIC CRANIAL
IRRADIATION FOR SMALL CELL
LUNG CANCER
 LUNG CANCER
PENATALAKSANAAN
CHEMOTHERAPY

Kemoterafi kombinasi untuk NON SMALL CELL LUNG

CANCER (NSCLC) meliputi;
CISPLATIN DENGAN 1 ATAU LEBIH AGEN LAINYA
TELAH DIGUNAKAN GUNA MENCAPAI
KELANGSUNGAN HIDUP: VINBLASTINE,
MITOMYCIN, VINORELBINE, PAELITAXEL DAN
GEMCITABINE.
CARBOPLATIN, PACLITAXEL
IFOSFAMIDE
VINDESINE
ETOPOSITE
 LUNG CANCER
PENATALAKSANAAN
CHEMOTHERAPY

KEMOTERAFI UNTUK SMALL CELL LUNG CANCER

(SCLC) meliputi;
CAV; CYCLOPHOSPHAMIDE, DOXORUBICIN
(ADRYAMYCIN), VINCRISTINE.
CEA: CYCLOPHOSPHAMIDE, ETOPOSIDE,
DOXORUBICIN (ADRYAMYCIN)
ICE: IFOSFAMIDE, CARBOPLATIN, ETOPOSIDE (VP-
16)
EP ATAU EC: ETOPOSIDE (VP-16), CISPLATIN ATAU
CARBOPLATIN
CODE: CISPLATIN, VINCRISTINE, DOXORUBICIN
(ADRYAMYCIN), ETOPOSIDE.
 LUNG CANCER
PENATALAKSANAAN
TERAFI LAINYA :
ENDOBRONCHIAL LASER THERAPY
SCLEROSIS UNTUK PENGOBATAN EFUSI PLEURA
MALIGNA/GANAS

PROGNOSIS

PROGNOSIS BERHUBUNGAN DENGAN TYPE

SEL TUMOR. KELANGSUNGAN HIDUP
PENDERITA KANKER PARU TIPE SEL
SQUAMOUS DIFFERENTIATED DARI PADA TIPE
SEL KANKER PARU UNDIFFERENTIATED
SMALL CELL CANCER.
 LUNG CANCER
PROGNOSIS

TUMOR PERIPHERAL LEBIH DAPAT

DIOBATI DARI PADA LESI SENTRAL.
TERKENANYA LIMPHA NODUS DAN
METASTASE MENGURANGI
PERUBAHAN DARI PENGUBATAN.
STADIUM PENYAKIT, STATUS
PERFORMAN PASIEN, STATUS
IMUNITAS MENENTUKAN PROGNOSIS.
PASIEN YG MENGALAMI GROSS
SUPRACLAVICULA ADENOPATI, EFUSI
PLEURA MALIGNA DAN MENGALAMI
METASTASE KELANGSUNGAN
HIDUPNYA KURANG DARI 1 TAHUN
 LUNG CANCER
PENGKAJIAN KEPERAWATAN

FUNGSI PERNAPASAN;
BATUK PRODUKTIF ATAU NONPRODUKTIF
KRONIS, WHEEZING, CHEST TIGHNESS (DADA
RASA TERTEKAN,SESAK,PENUH),
HEMOPTYSIS (BATUK DARAH), DYSPNEA,
HOARSENES (SUARA SPT SUARA KUDA),
PERUBAHAN WARNA DAN BAU SPUTUM,
ORTHOPNEA, TACHYPNEA, SERING
MENGALAMI INFEKSI SALURAN ATAS,
RESONANCE ABNORMAL, BUNYI DULLNESS
PADA PERCUSI, CLUBBED FINGGERS (JARI-
JARI TABUH), SYNDROME PANCOAST’S (NYERI
LENGAN DAN BAHU DISERTAI PARESTESIA),
PUCAT SIANOSIS.
 LUNG CANCER
PENGKAJIAN KEPERAWATAN

FUNGSI KARDIOVASKULER;
NYERI DADA DAN CHEST TIGHNESS
(DADA RASA TERTEKAN,SESAK,PENUH)

FUNGSI NEUROLOGIS;
- HEADACHES/SAKIT KEPALA
- PERUBAHAN STATUS MENTAL
BERHUBUNGAN DENAN
METASTASE/PENYEBARAN TUMOR
KEOTAK ATAU AKIBAT PENINGKATAN
TEKANAN INTRAKRANIAL
FUNGSI ENDOKRIN;
 LUNG CANCER
PENGKAJIAN KEPERAWATAN
FUNGSI ENDOKRIN;
- SIADH (Syndrome of inappropriate
antidiuretic hormone) DENGAN
HIPONATREMIA

FUNGSI GASTROINTESTINAL
- ABDOMINAL DISCOMFORT/PERUT RASA
TIDAK NYAMAN/ENAK
- PENINGKATAN NILAI TEST FUNGSI
LIVER
- PEMBESARAN LIVER AKIBAT
METASTASE
 LUNG CANCER
PENGKAJIAN KEPERAWATAN
TINGKAT KENYAMANAN;
- FATIQUE/KELETIHAN
- NYERI BAHU DAN LENGAN
DISERTAI PARESTESIA
- NYERI TULANG BERHUBUNGAN
METASTASE KE TULANG

STATUS PSIKOSOSIAL
- KETAKUTAN, KECEMASAN
 LUNG CANCER
PENGKAJIAN KEPERAWATAN
STATUS NUTRISI
- KEHILANGAN BERAT BADAN
- ANOREXIA/TIDAK ADA NAFSU MAKAN
- NAUSEA/MUAL,
- VOMITING/MUNTAH
- PENURUNAN KADAR SERUM PROTEIN
- DYSPHAGIA

POTENSIAL KOMPLIKASI
- SYNDROME VENA CAVA SUPERIOR
 LUNG CANCER
DIAGNOSA KEPERAWATAN DAN INTERVENSI
A. TIDAK EFEKTIFNYA BERSIHAN JALAN NAPAS
BD OBSTRUKSI BRONKHIAL SEKUNDER
TERHADAP INVASI TUMOR
B. TIDAK EFEKTIFNYA POLA NAPAS BD
DISCONFORT/KETIDAKNYAMANAN,
PENURUNAN EKSPANSI PARU
(PENGEMBANGAN PARU)

RENCANA INTERVENSI
- TEMPATKAN PASIEN PADA POSISI DUDUK DAN
UBAH POSISI SESERING MUNGKIN GUNA
MENINGKATKAN MEMUDAHKAN PERNAPASAN
 LUNG CANCER
DIAGNOSA KEPERAWATAN DAN INTERVENSI
- ANJURKAN BATUK DAN NAPAS DALAM
DENGAN SPLINTING DADA GUNA
MENGURANGI KONGESTI
- AMBULASI PASIEN SESEGERA MUNGKIN
GUNA MENINGKATKAN SIRKULASI DAN
PENGEMBANGAN DADA
- ANJURKAN PENINGKATAN MASUKAN CAIRAN
GUNA MENGENCERKAN SEKRESI
- BERIKAN OKSIGEN SESUAI DOSIS TERAFI
GUNA MEMPERTAHANKAN OKSIGENISASI
JARINGAN SECARA ADEQUAT
- ANTISIPASI KEBUTUHAN PASIEN GUNA
MENGURANGI PENGELUAAN ENERGI YG
TIDAK PERLU
- HINDARI MEROKOK GUNA MENURUNKAN
BEBAN KERJA PARU
 LUNG CANCER
DIAGNOSA KEPERAWATAN DAN INTERVENSI
ANJURKAN BATUK DAN NAPAS DALAM
DENGAN SPLINTING DADA GUNA
MENGURANGI KONGESTI
- AMBULASI PASIEN SESEGERA MUNGKIN
GUNA MENINGKATKAN SIRKULASI DAN
PENGEMBANGAN DADA
- ANJURKAN PENINGKATAN MASUKAN CAIRAN
GUNA MENGENCERKAN SEKRESI
- BERIKAN OKSIGEN SESUAI DOSIS TERAFI
GUNA MEMPERTAHANKAN OKSIGENISASI
JARINGAN SECARA ADEQUAT
- ANTISIPASI KEBUTUHAN PASIEN GUNA
MENGURANGI PENGELUAAN ENERGI YG
TIDAK PERLU
- HINDARI MEROKOK GUNA MENURUNKAN
BEBAN KERJA PARU