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 <10 g% do not

need transfusions of fresh blood, just given calibration according to the cause of
b.
c.
d.
e.

anemia
Granulocytes 1500/mm3
Trombocytes 100.00/ mm3
good liver function
good renal function (creatinine clearance > 70 ml/minute)

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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

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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.

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