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Lung Cancer

Lung cancer is one type of cancer that has a high incidence rate in the world, as much as 17% incidence in men(ranked second after prostate cancer) and 19% in women (ranked third after breast cancer and colorectal cancer) (Ancuceanu and Victoria, 2004). In Indonesia, lung cancer became the leading cause of death of men and more than 70% of cancer cases will be diagnosed at an advanced stadium (Anonim, 2006).

Lung cancer can be caused due to various factors, among others, cigarette smoke and genetic changes. Smoking is the major cause of lung cancer in 80-90% of lung cancer cases although only 10-15% of smokers attacked lung cancer (Kopper and Timar, 2005). Cigarette smoke has been proven to be a major cause of lung cancer, both the active and passive smokers. Morbidity and mortality due to lung cancer increased in proportion to the number of cigarettes smoked per day, age at start of smoking, sucking it, the old habit of smoking and high carcinogenic substances in the tar in cigarette smoke. Carcinogenic substances include naftilamin, pirena, toluidine, dibenzacridin, cadmium, benzo [a] pirena, vinilklorida, and polonium-210 (Serpi, 2003). Besides cigarette smoke is known to contain more than 20 types of carcinogen especially tobacco-specific nitrosamine4 – (methylnitrosamino) -1 – (3-pyrydyl) -1 – butanone (NKK). The carcinogenic substances can cause changes in bronchial epithelial cells toward malignancy.

Most cases of lung cancer diagnosed from symptoms, associated with the incidence of primary, metastatic or praneoplastik. Most lung cancers are the four forms of histologic types consisting of a form of squamous cell cancer, adenocarcinoma, large cell cancer, which three are classified in non-small cell lung cancer (NSCLC).While the fourth form is a small cell lung cancer (SCLC) (Minna et al., 2002). Lung cancer incidence rate reached 25% of SCLC types of lung cancer incidence, which has the characteristics of early metastasis and sensitivity to chemotherapy and radiotherapy (Ancuceanu and Victoria, 2004). While cases of NSCLC, occurring in 15% of patients diagnosed with lung cancer, which has the characteristic is less sensitive to chemotherapy and radiotherapy (Ancuceanu and Victoria, 2004).

Levels-stage lung cancer is divided into four (Anonim, 2006) :

Stadium

Clinical manifestations

Stadium I

Growth of lung cancer is still confined to the lung and is surrounded by lung tissue

Stadium II

Cancer has spread near the lymph nodes

Stadium IIIa

Cancer has spread beyond the lungs but can still be taken to surgery

Stadium IIIb

Cancer has spread beyond the lungs and can not be taken to surgery

Stadium IV

The cancer has spread to the other organs / tissues of the body (metastasis)

Genetic changes that occur in lung cancer due to mutations in the tumor suppressor gene or oncogene.The imbalance between the two genes trigger the development of cancer cells. Lung cancer occurring mutations in the Ras oncogene that plays an important role in cell proliferation and signal transduction. Ras gene family is frequently mutated in cancer cells is H-Ras, K-Ras and N-Ras.AàC, transition GàMutations that occur in the K-Ras, among others transversion G C whereas N-Ras mutations in amongst the other transverseàand transversions G G. Ras mutations are rare in SCLC and occursin àG and transition AàT 15-20% NSCLC (Forgacs et al., 2001). In addition to Ras, an oncogene that plays a role in the growth of lung cancer is BCl-2 is downregulated apoptosis, programmed cell death of cancer (Petmirt et al., 2003). In lung cancer patients also found the mutation in the tumorTàsuppressor gene, p53 is a transversion G so that the function of the p53 protein as in suppressing the growth of cancer cells disrupted (Hainaut and Pfeifer, 2001).

Lung cancer can be prevented by adopting a healthy lifestyle and avoid smoking habits. Protection against exposure karsingen absolutely necessary for those working in polluted environments such as asbestos industry, uranium, chromium and other carcinogenic compounds.

The most important therapy for lung cancer patients is a combination of surgery, chemotherapy and radiotherapy. Surgery is the treatment of patients with NSCLC stage I, II and some IIIa. Chemotherapy and radiotherapy can be given to patients with limited stadium disease, physiologically if they are still able to undergo this treatment.Patients with extensive stadium disease treated just with chemotherapy. Combination chemotherapy regimens are commonly used are cyclophosphamide-doxorubicin-vincristine and cyclophosphamide – doxorubicin-vincristine-etopoksid. Radiation therapy is also used for prophylaxis of metastasis to the brain and for the palliative treatment of pain, recurrent hemoptysis, effusion or airway obstruction (Price and Wilson, 1995).

Contributors : Yudi Afrianto, Muh. Farid Fauzy, Agustina Setiawati

Ancuceanu, R. V., and Victoria, I, 2004, Pharmacologically Active Natural Compounds for Lung Cancer, Altern. Med. Rev., 9, 4, 402-419.

Anonim, 2006, Kanker Pembunuh Nomor Satu, Info Aktual, Koran media Indonesia, No.9204/Tahun XXXVI
http:/www.litbang.depkes.go.id/actual/kliping/kanker paru diakses tanggal 5 Mei 2006

Forgacs, E., Zochbauer-Muller, S., Olah, E. and Minna, J.D., 2001, Molecular Genetic Abnormalities in tha Pathogenesis of Human Lung Cancer, Pathology Oncology Research, Vol 7, No 1.

Kopper, L. and Timar, J., 2005, Genomics of Lung Cancer may Change Diagnosis, Prognosis and Therapy, Pathology Oncology Research, 11(1)5-10.

Hainaut, P. and Pfeifer, G., 2001, Patterns of p53 G –> T Transversion in Lung Cancer Reflect the Primary Mutagenis Signature of DNA by Tobacco Smoke, Carcinogenesis, 21(23) : 367-374.

Petmitr, S., Wongsommart, D., Chaksangchaichot, P.,Pakeetoot, T., Sutinont, P., Sirivaidyapong, P. and Karalak, A., 2003, Mutational Analysis of Ras Gene Family in Lung Cancer in Thai, Oncology Report, (10):1497-1501

Price, S.A. and Wilson, L.M., 1995, Patofisiologi: Konsep Klinis Proses-Proses Penyakit, Penerbit Buku Kedokteran EGC, Jakarta.
Serpi, Raisa, 2003, Mechanism of Benzo[a]pyrene-Induced Accumulation of p53 Tumour Suppresor Protein in Mouse, Thesis, Departement of Pharmacology and Toxicology, University of Oulu, Oulu.