JIKA ANDA MAU BERBAIK HATI TERHADAP SESAMA....TOLONG SEBARKAN
INFORMASI INI...
Penyakit Kanker Sudah Tidak Berbahaya Lagi
Kanker tidak lagi mematikan. Para penderita kanker di Indonesia dapat memiliki harapan hidup yang lebih lama dengan ditemukannya tanaman "KELADI TIKUS" (Typhonium Flagelliforme/ Rodent Tuber) sebagai tanaman obat yang dapat menghentikan dan mengobati berbagai penyakit kanker dan berbagai penyakit berat lain.
Tanaman sejenis talas dengan tinggi maksimal 25 sampai 30 cm ini hanya tumbuh di semak yang tidak terkena sinar matahari langsung. "Tanaman ini sangat banyak ditemukan di Pulau Jawa," kata Drs.Patoppoi Pasau, orang pertama yang menemukan tanaman itu di Indonesia .
Tanaman obat ini telah diteliti sejak tahun 1995 oleh Prof Dr Chris
K.H.Teo,Dip Agric (M), BSc Agric (Hons)(M), MS, PhD dari Universiti
Sains Malaysia dan juga pendiri Cancer Care Penang, Malaysia. Lembaga
perawatan kanker yang didirikan tahun 1995 itu telah membantu ribuan
pasien dari Malaysia , Amerika, Inggris , Australia , Selandia Baru,
Singapura, dan berbagai negara di dunia.
Di Indonesia, tanaman ini pertama ditemukan oleh Patoppoi di
Pekalongan, Jawa Tengah. Ketika itu, istri Patoppoi mengidap kanker
payudara stadium III dan harus dioperasi 14 Januari 1998. Setelah
kanker ganas tersebut diangkat melalui operasi, istri Patoppoi harus
menjalani kemoterapi (suntikan kimia untuk membunuh sel, Red) untuk
menghentikan penyebaran sel-sel kanker tersebut.
"Sebelum menjalani kemoterapi,dokter mengatakan agar kami
menyiapkan wig (rambut palsu) karena kemoterapi akan mengakibatkan
kerontokan rambut, selain kerusakan kulit dan hilangnya nafsu makan,"
jelas Patoppoi.
Selama mendampingi istrinya menjalani kemoterapi, Patoppoi terus
berusaha mencari pengobatan alternatif sampai akhirnya dia mendapatkan informasi mengenai penggunaan teh Lin Qi di Malaysia untuk mengobati kanker. "Saat itu juga saya langsung terbang ke Malaysiauntuk membeli teh tersebut,"
ujar Patoppoi yang juga ahli biologi. Ketika sedang berada di sebuah
toko
obat di Malaysia , secara tidak sengaja dia melihat dan membaca buku
mengenai pengobatan kanker yang berjudul Cancer, Yet They Live karangan Dr Chris K.H. Teo terbitan 1996.
"Setelah saya baca sekilas, langsung saja saya beli buku tersebut.
Begitu menemukan buku itu, saya malah tidak jadi membeli teh Lin Qi,
tapi langsung pulang ke Indonesia ," kenang Patoppoi sambil tersenyum.
Di buku itulah Patoppoi membaca khasiat typhonium flagelliforme itu.
Berdasarkan pengetahuannya di bidang biologi, pensiunan pejabat
Departemen Pertanian ini langsung menyelidiki dan mencari tanaman
tersebut. Setelah menghubungi beberapa koleganya di berbagai tempat,
familinya di Pekalongan Jawa Tengah, balas menghubunginya. Ternyata,
mereka menemukan tanaman itu di sana . Setelah mendapatkan tanaman tersebut dan mempelajarinya lagi, Patoppoi menghubungi Dr. Teo di Malaysia untuk menanyakan kebenaran tanaman yang ditemukannya itu.
Selang beberapa hari, Dr Teo menghubungi Patoppoi dan menjelaskan bahwa
tanaman tersebut memang benar Rodent Tuber. "Dr Teo mengatakan agar tidak ragu lagi untuk menggunakannya sebagai obat,"
lanjut Patoppoi.
Akhirnya, dengan tekad bulat dan do'a untuk kesembuhan, Patoppoi mulai memproses tanaman tersebut sesuai dengan langkah-langkah pada buku tersebut
untuk diminum sebagai obat. Kemudian Patoppoi menghubungi putranya,
Boni Patoppoi di Buduran, Sidoarjo untuk ikut mencarikan tanaman
tersebut.
"Setelah melihat ciri-ciri tanaman tersebut, saya mulai mencari di
pinggir sungai depan rumah dan langsung saya dapatkan tanaman tersebut tumbuh liar di
pinggir sungai," kata Boni yang mendampingi ayahnya saat itu.
Selama mengkonsumsi sari tanaman tersebut, isteri Patoppoi mengalami penurunan efek samping kemoterapi yang dijalaninya. Rambutnya berhenti rontok, kulitnya tidak rusak dan mual-mual hilang. "Bahkan nafsu makan ibu saya pun kembali normal," lanjut Boni.
Setelah tiga bulan meminum obat tersebut, isteri Patoppoi menjalani
pemeriksaan kankernya. "Hasil pemeriksaan negatif, dan itu sungguh
mengejutkan kami dan dokter-dokter di Jakarta ," kata Patoppoi. Para
dokter itu kemudian menanyakan kepada Patoppoi, apa yang diberikan pada isterinya. "Malah mereka ragu, apakah mereka telah salah memberikan dosis kemoterapi kepada kami," lanjut Patoppoi.
Setelah diterangkan mengenai kisah tanaman Rodent Tuber, para dokter pun mendukung Pengobatan tersebut dan menyarankan agar
mengembangkannya. Apalagi melihat keadaan isterinya yang tidak
mengalami efek samping kemoterapi yang sangat keras tersebut. Dan
pemeriksaan yang seharusnya tiga bulan sekali
diundur menjadi enam bulan sekali."Tetapi karena sesuatu hal, para
dokter tersebut tidak mau mendukung secara terang-terangan penggunaan tanaman sebagai
pengobatan alternatif," sambung Boni sambil tertawa.
Setelah beberapa lama tidak berhubungan, berdasarkan peningkatan
keadaan isterinya, pada bulan April 1998, Patoppoi kemudian menghubungi Dr.Teo
melalui fax untukmenginformasik an bahwa tanaman tersebut banyak terdapat di Jawa dan
mengajak Dr. Teo untuk menyebarkan penggunaan tanaman ini di Indonesia. Kemudian Dr . Teo langsung membalas fax kami, tetapi mereka tidak tahu apa yang harus mereka perbuat, karena jarak yang jauh," sambung Patoppoi.
Meskipun Patoppoi mengusulkan agar buku mereka diterjemahkan dalam
bahasa Indonesiadan disebar-luaskan di Indonesia, Dr. Teo enganjurkan
agar kedua belah pihak bekerja sama dan berkonsentrasi dalam usaha nyata membantu penderita kanker di Indonesia.
Kemudian, pada akhir Januari 2000 saat Jawa Pos mengulas habis mengenai meninggalnya Wing Wiryanto, salah satu wartawan handal Jawa pos,Patoppoi sempat tercengang. Data-data rinci mengenai gejala, penderitaan, pengobatan yang diulas di Jawa Pos, ternyata sama dengan salah satu pengalaman pengobatan penderita kanker usus yang dijelaskan di buku tersebut. Dan eksperimen pengobatan
tersebut berhasil menyembuhkan pasien tersebut.
"Lalu saya langsung menulis di kolom Pembaca Menulis di Jawa Pos,"
ujar Boni.
Dan tanggapan yang diterimanya benar-benar diluar dugaan. Dalam sehari, bisa sekitar 30 telepon yang masuk. "Sampai saat ini, sudah ada sekitar 300 orang
yang datang ke sini," lanjut Boni yang beralamat di Jl. KH. Khamdani,
Buduran Sidoarjo.
Pasien pertama yang berhasil adalah penderita Kanker Mulut Rahim
stadium dini. Setelah diperiksa, dokter mengatakan harus dioperasi.
Tetapi karena belum memiliki biaya dan sambil menunggu rumahnya laku dijual
untuk biaya operasi, mereka datang setelah membaca Jawa Pos.
Setelah diberi tanaman dan cara meminumnya, tidak lama kemudian pasien tersebut datang lagi dan melaporkan bahwa dia tidak perlu dioperasi, karena hasil pemeriksaan mengatakan negatif.
Berdasarkan animo masyarakat sekitar yang sangat tinggi, Patoppoi
berusaha untuk menemui Dr. Teo secara langsung. Atas bantuan Direktur Jenderal Pengawasan Obat dan Makanan Departemen Kesehatan, Sampurno, Patoppoi dapat menemui Dr. Teo di Penang , Malaysia . Di kantor Pusat Cancer Care Penang, Malaysia , Patoppoi mendapat penerangan lebih lanjut
mengenai riset tanaman yang saat ditemukan memiliki nama Indonesia .
Ternyata saat Patoppoi mendapat buku "Cancer, Yet They Live" edisi
revisi tahun 1999, fax yang dikirimnya di masukkan dalam buku tersebut,
serta pengalaman
isterinya dalam usahanya berperang melawan kanker. Dari pembicaraan mereka, Dr. Teo merekomendasi agar Patoppoi mendirikan
perwakilan Cancer Care di Jakarta dan Surabaya . Maka secara resmi,
Patoppoi dan putranya diangkat sebagai perwakilan lembaga sosial Cancer Care Indonesia , yang juga disebutkan dalam buletin bulanan Cancer Care, yaitu di
Jl. Kayu Putih 4 No. 5, Jakarta , telp. 021-4894745,
dan di Buduran, Sidoarjo.
Cancer Care Malaysiatelah mengembangkan bentuk
pengobatan tersebut secara lebih canggih. Mereka telah memproduksi ekstrak Keladi Tikus
dalam bentuk pil dan teh bubuk yang dikombinasikan dengan berbagai
tananaman lainnya dengan dosis tertentu. "Dosis yang diperlukan
tergantung penyakit yang diderita," kata Boni.
Untuk mendapatkan obat tersebut, penderita harus mengisi formulir yang menanyakan keadaan dan gejala penderita dan akan dikirimkan melalui fax
ke Dr. Teo. "Formulir tersebut dapat diisi disini, dan akan kami fax-kan.
Kemudian Dr. Teo sendiri yang akan mengirimkan resep sekaligus
obatnya, dengan harga langsung dari Malaysia , sekitar 40-60 Ringgit
Malaysia ," lanjut Boni.
"Jadi pasien hanya membayar biaya fax dan obat, kami tidak menarik
keuntungan,
malahan untuk yang kurang mampu, Dr.Teo bisa memberikan perpanjangan waktu pembayaran. " tambahnya.
Sebenarnya pengobatan ini juga didukung dan sedang dicoba oleh salah satu dokter senior di Surabaya, pada pasiennya yang mengidap kanker ginjal. Adadua pasien yang sedang dirawat dokter yang pernah menjabat sebagai direktur salah satu rumah sakit terbesar di Surabayaini. Pasien pertama yang
mengidap kanker rahim tidak sempat diberi pengobatan dengan keladi tikus, karena telah
ditangani oleh rekan-rekan dokter yang telah memiliki reputasi. Setelah
menjalani kemoterapi dan radiologi, pasien tersebut mengalami kerontokan rambut, kulit rusak dan gatal, dan selalu muntah.
Tetapi pada pasien kedua yang mengidap kanker ginjal, dokter ini
menanganinya sendiri dan juga memberikan pil keladi tikus untuk membantu proses penyembuhan kemoterapi.
Pada pasien kedua ini, tidak ditemui berbagai efek yang dialami
penderita pertama, bahkan pasien tersebut kelihatan normal. Tetapi
dokter ini menolak untuk diekspos karena
menurutnya, pengobatan ini belum resmi diteliti di Indonesia .
Menurutnya, jika rekan-rekannya mengetahui bahwa dia memakai pengobatan alternatif, mereka akan memberikan predikat sebagai "ter-kun" atau dokter-dukun.
"Disinilah gap yang terbuka antara pengobatan konvensional dan modern," kata dokter tersebut.
Banyak hal menarik yang dialami Boni selama menerima dan memberikan bantuan kepada berbagai pasien. Bahkan ada pecandu berat putaw dan sabu-sabu di Surabaya , yang pada akhirnya pecandu tersebut mendapat kanker paru-paru. Setelah mendapat vonis kanker paru-paru stadium III, pasien tersebut mengkonsumsi pil
dan teh dari Cancer Care. Hasilnya cukup mengejutkan, karena ternyata
obat tersebut dapat mengeluarkan racun narkoba dari peredaran darah penderita dan
mengatasi ketergantungan pada narkoba tersebut.
"Tapi, jika pecandu sudah bisa menetralisir racun dengan keladi tikus,
dia tidak boleh memakai narkoba lagi, karena pasti akan timbul
resistensi. Jadi jangan
seperti kebo, habis mandi berkubang lagi," sambung Boni sambil tertawa.
Juga ada pengalaman pasien yang meraung-raung kesakitan akibat serangan
kanker yang menggerogotinya, karena obat penawar rasa sakit sudah tidak
mempan lagi. Setelah diberi minum sari keladi tikus, beberapa saat
kemudian pasien tersebut tenang dan tidak lagi merasa kesakitan.
Menurut data Cancer Care Malaysia, berbagai penyakit yang telah
disembuhkan adalah berbagai kanker dan penyakit berat seperti kanker payudara, paru-paru, usus besar-rectum,
liver, prostat, ginjal, leher rahim, tenggorokan, tulang, otak, limpa,
leukemia, empedu, pankreas,
dan hepatitis.
Jadi diharapkan agar hasil penelitian yang menghabiskan milyaran
Ringgit
Malaysiaselama 5 tahun
dapat benar-benar berguna bagi dunia kesehatan.
Bagi teman-teman yang memerlukan informasi lebih lanjut sehubungan dengan artikel "Obat Kanker" bisa menghubungi perwakilan lembaga sosial
"Cancer Care Indonesia " beralamat di Jl. Kayu Putih 4 no.5 Jakarta ,
telp : 021-4894745,
Sabtu, 15 Maret 2008
Rabu, 12 Maret 2008
chondrosarcoma
Chondrosarcoma, which constitutes ~20 to 25% of all bone sarcomas, is a tumor of adulthood and old age with a peak incidence in the fourth to sixth decades of life. It has a predilection for the flat bones, especially the shoulder and pelvic girdles, but can also affect the diaphyseal portions of long bones. Chondrosarcomas can arise de novo or as a malignant transformation of an enchondroma or, rarely, of the cartilaginous cap of an osteochondroma. Chondrosarcomas have an indolent natural history and typically present as pain and swelling. Radiographically, the lesion may have a lobular appearance with mottled or punctate or annular calcification of the cartilaginous matrix. It is difficult to distinguish low-grade chondrosarcoma from benign lesions by x-ray or histologic examination. The diagnosis is therefore influenced by clinical history and physical examination. A new onset of pain, signs of inflammation, and progressive increase in the size of the mass suggest malignancy. The histologic classification is complex, but most tumors fall within the classic category. Like other bone sarcomas, high-grade chondrosarcomas spread to the lungs. Most chondrosarcomas are resistant to chemotherapy, and surgical resection of primary or recurrent tumors, including pulmonary metastases, is the mainstay of therapy. There are two histologic variants for which this rule does not hold, however. Dedifferentiated chondrosarcoma has a high-grade osteosarcoma or a malignant fibrous histiocytoma component that responds to chemotherapy. Mesenchymal chondrosarcoma, a rare variant composed of a small cell element, also is responsive to systemic chemotherapy and is treated like Ewing's sarcoma.
osteosarcoma
Osteosarcoma, accounting for almost 45% of all bone sarcomas, is a spindle cell neoplasm that produces osteoid (unmineralized bone) or bone. About 60% of all osteosarcomas occur in children and adolescents in the second decade of life, and about 10% occur in the third decade of life. Osteosarcomas in the fifth and sixth decades of life are frequently secondary to either radiation therapy or transformation in a preexisting benign condition, such as Paget's disease. Males are affected 1.5 to 2 times as often as females. Osteosarcoma has a predilection for metaphyses of long bones; the most common sites of involvement are the distal femur, proximal tibia, and proximal humerus. The classification of osteosarcoma is complex, but 75% of osteosarcomas fall in the "classic" category, which include osteoblastic, chondroblastic, and fibroblastic osteosarcomas.
The remaining 25% are classified as "variants" on the basis of
(1) clinical characteristics, as in the case of osteosarcoma of the jaw, postradiation osteosarcoma, or Paget's osteosarcoma
(2) morphologic characteristics, as in the case of telangiectatic osteosarcoma, small-cell osteosarcoma, or epithelioid osteosarcoma
(3) location, as in parosteal or periosteal osteosarcoma.
Diagnosis usually requires a synthesis of clinical, radiologic, and pathologic features. Patients typically present with pain and swelling of the affected area. A plain radiograph reveals a destructive lesion with a moth-eaten appearance, a spiculated periosteal reaction (sunburst appearance), and a cuff of periosteal new bone formation at the margin of the soft tissue mass (Codman's triangle). A CT3 scan of the primary tumor is best for defining bone destruction and the pattern of calcification, whereas MRI4 is better for defining intramedullary and soft tissue extension. A chest radiograph and CT scan are used to detect lung metastases. Metastases to the bony skeleton should be imaged by a bone scan. Almost all osteosarcomas are hypervascular. Angiography is not helpful for diagnosis, but it is the most sensitive test for assessing the response to preoperative chemotherapy. Pathologic diagnosis is established either with a core-needle biopsy, where feasible, or with an open biopsy with an appropriately placed incision that does not compromise future limb-sparing resection. Most osteosarcomas are high-grade. The most important prognostic factor for long-term survival is response to chemotherapy. Preoperative chemotherapy followed by limb-sparing surgery (which can be accomplished in >80% of patients) followed by postoperative chemotherapy is standard management. The effective drugs are doxorubicin, ifosfamide, cisplatin, and high-dose methotrexate with leucovorin rescue. The various combinations of these agents that have been used have all been about equally successful. Long-term survival rates in extremity osteosarcoma range from 60 to 80%. Osteosarcoma is radioresistant; radiation therapy has no role in the routine management. Malignant fibrous histiocytoma is considered a part of the spectrum of osteosarcoma and is managed similarly.
The remaining 25% are classified as "variants" on the basis of
(1) clinical characteristics, as in the case of osteosarcoma of the jaw, postradiation osteosarcoma, or Paget's osteosarcoma
(2) morphologic characteristics, as in the case of telangiectatic osteosarcoma, small-cell osteosarcoma, or epithelioid osteosarcoma
(3) location, as in parosteal or periosteal osteosarcoma.
Diagnosis usually requires a synthesis of clinical, radiologic, and pathologic features. Patients typically present with pain and swelling of the affected area. A plain radiograph reveals a destructive lesion with a moth-eaten appearance, a spiculated periosteal reaction (sunburst appearance), and a cuff of periosteal new bone formation at the margin of the soft tissue mass (Codman's triangle). A CT3 scan of the primary tumor is best for defining bone destruction and the pattern of calcification, whereas MRI4 is better for defining intramedullary and soft tissue extension. A chest radiograph and CT scan are used to detect lung metastases. Metastases to the bony skeleton should be imaged by a bone scan. Almost all osteosarcomas are hypervascular. Angiography is not helpful for diagnosis, but it is the most sensitive test for assessing the response to preoperative chemotherapy. Pathologic diagnosis is established either with a core-needle biopsy, where feasible, or with an open biopsy with an appropriately placed incision that does not compromise future limb-sparing resection. Most osteosarcomas are high-grade. The most important prognostic factor for long-term survival is response to chemotherapy. Preoperative chemotherapy followed by limb-sparing surgery (which can be accomplished in >80% of patients) followed by postoperative chemotherapy is standard management. The effective drugs are doxorubicin, ifosfamide, cisplatin, and high-dose methotrexate with leucovorin rescue. The various combinations of these agents that have been used have all been about equally successful. Long-term survival rates in extremity osteosarcoma range from 60 to 80%. Osteosarcoma is radioresistant; radiation therapy has no role in the routine management. Malignant fibrous histiocytoma is considered a part of the spectrum of osteosarcoma and is managed similarly.
bone sarcoma
INCIDENCE AND EPIDEMIOLOGY
Bone sarcomas are rarer than soft tissue sarcomas; they accounted for only 0.2% of all new malignancies and ~2400 new cases in the United States in 2004. Several benign bone lesions have the potential for malignant transformation. Enchondromas and osteochondromas can transform into chondrosarcoma; fibrous dysplasia, bone infarcts, and Paget's disease of bone can transform into either malignant fibrous histiocytoma or osteosarcoma.
CLASSIFICATION
Benign Tumors The common benign bone tumors include enchondroma, osteochondroma, chondroblastoma, and chondromyxoid fibroma, of cartilage origin; osteoid osteoma and osteoblastoma, of bone origin; fibroma and desmoplastic fibroma, of fibrous tissue origin; hemangioma, of vascular origin; and giant cell tumor, of unknown origin.
Malignant Tumors The most common malignant tumors of bone are plasma cell tumors. The four most common malignant nonhematopoietic bone tumors are osteosarcoma, chondrosarcoma, Ewing's sarcoma, and malignant fibrous histiocytoma. Rare malignant tumors include chordoma (of notochordal origin), malignant giant cell tumor and adamantinoma (of unknown origin), and hemangioendothelioma (of vascular origin).
Musculoskeletal Tumor Society Staging System Sarcomas of bone are staged according to the Musculoskeletal Tumor Society staging system based on grade and compartmental localization. A Roman numeral reflects the tumor grade: stage I is low-grade, stage II is high-grade, and stage III includes tumors of any grade that have lymph node or distant metastases. In addition, the tumor is given a letter reflecting its compartmental localization. Tumors designated A are intracompartmental (i.e., confined to the same soft tissue compartment as the initial tumor), and tumors designated B are extracompartmental (i.e., extending into the adjacent soft tissue compartment or into bone)
Bone sarcomas are rarer than soft tissue sarcomas; they accounted for only 0.2% of all new malignancies and ~2400 new cases in the United States in 2004. Several benign bone lesions have the potential for malignant transformation. Enchondromas and osteochondromas can transform into chondrosarcoma; fibrous dysplasia, bone infarcts, and Paget's disease of bone can transform into either malignant fibrous histiocytoma or osteosarcoma.
CLASSIFICATION
Benign Tumors The common benign bone tumors include enchondroma, osteochondroma, chondroblastoma, and chondromyxoid fibroma, of cartilage origin; osteoid osteoma and osteoblastoma, of bone origin; fibroma and desmoplastic fibroma, of fibrous tissue origin; hemangioma, of vascular origin; and giant cell tumor, of unknown origin.
Malignant Tumors The most common malignant tumors of bone are plasma cell tumors. The four most common malignant nonhematopoietic bone tumors are osteosarcoma, chondrosarcoma, Ewing's sarcoma, and malignant fibrous histiocytoma. Rare malignant tumors include chordoma (of notochordal origin), malignant giant cell tumor and adamantinoma (of unknown origin), and hemangioendothelioma (of vascular origin).
Musculoskeletal Tumor Society Staging System Sarcomas of bone are staged according to the Musculoskeletal Tumor Society staging system based on grade and compartmental localization. A Roman numeral reflects the tumor grade: stage I is low-grade, stage II is high-grade, and stage III includes tumors of any grade that have lymph node or distant metastases. In addition, the tumor is given a letter reflecting its compartmental localization. Tumors designated A are intracompartmental (i.e., confined to the same soft tissue compartment as the initial tumor), and tumors designated B are extracompartmental (i.e., extending into the adjacent soft tissue compartment or into bone)
staging bone tumor
MUSCULOSKELETAL TUMOR SOCIETY CLASSIFICATION
In 1980, the Musculoskeletal Tumor Society (MSTS) adopted a surgical staging system for bone sarcomas. The system is based on the fact that mesenchymal sarcomas of bone behave similarly, regardless of histiogenic type. The surgical staging system, as described by Enneking and colleagues, is based on the GTM classification: grade (G), location (T), and lymph node involvement and metastases (M).
G represents the histologic grade of a lesion and other clinical data. Grade is further divided into two categories: G1 is low grade, and G2 is high grade.
T represents the site of the lesion, which may be intracompartmental (T1) or extracompartmental (T2). Compartment is defined as “an anatomic structure or space bounded by natural barriers or tumor extension.” The significance of T1 lesions is easier to define clinically, surgically, and radiographically than that of T2 lesions, and the chance is better for adequate removal of the former without amputation. In general, low-grade bone sarcomas are intracompartmental (T1), whereas high-grade ones are extracompartmental (T2).
Lymphatic spread is a sign of widespread dissemination. Regional lymphatic involvement is equated with distal metastases (M1). Absence of any metastasis is designated as M0.
The surgical staging system developed by Enneking and colleagues for surgical planning and assessment of bone sarcomas is summarized thus:
Stage IA (G1,T1,M0): low-grade intracompartmental lesion, without metastasis
Stage IB (G1,T2,M0): low-grade extracompartmental lesion, without metastasis
Stage IIA (G2,T1,M0): high-grade intracompartmental lesion, without metastasis
Stage IIB (G2,T2,M0): high-grade extracompartmental lesion, without metastasis
Stage IIIA (G1 or G2,T1,M1): intracompartmental lesion, any grade, with metastasis
Stage IIIB (G1 or G2,T2,M1): extracompartmental lesion, any grade, with metastasis
AMERICAN JOINT COMMITTEE ON CANCER BONE TUMOR CLASSIFICATION
In 1983, the American Joint Committee on Cancer Bone Tumor Classification (AJCC) recommended a staging system for the malignant tumors of bone. This system has undergone minimal changes and remains unchanged in the fifth edition of the AJCC Cancer Staging Manual. This system is based on two indications: TNM designation [extent of the tumor (T), nodal status (N), and distant metastases (M)] and grade (G). This system is similar to the MSTS classification; however, the AJCC uses four stages instead of three. The four stages are designated I to IV and may be further modified with A or B. Stages I and II are defined by the histologic grade (grade I and II) and modified by tumor extent (i.e., cortical involvement; designated E1 to E6) . T(I) indicates that the tumor is confined within the cortex (similar to the MSTS classification A), and T(II) indicates that the tumor extends beyond the cortex (similar to the MSTS classification B). In the AJCC, stage III has remained undefined and stage IV is defined as the presence of metastases. Stage IV tumors are modified by A, which is equivalent to III M1 in the MSTS system (i.e., indicates a nodal metastasis), and B, which is equivalent to III M1 in the MSTS system (i.e., indicates distant metastases).
In 1980, the Musculoskeletal Tumor Society (MSTS) adopted a surgical staging system for bone sarcomas. The system is based on the fact that mesenchymal sarcomas of bone behave similarly, regardless of histiogenic type. The surgical staging system, as described by Enneking and colleagues, is based on the GTM classification: grade (G), location (T), and lymph node involvement and metastases (M).
G represents the histologic grade of a lesion and other clinical data. Grade is further divided into two categories: G1 is low grade, and G2 is high grade.
T represents the site of the lesion, which may be intracompartmental (T1) or extracompartmental (T2). Compartment is defined as “an anatomic structure or space bounded by natural barriers or tumor extension.” The significance of T1 lesions is easier to define clinically, surgically, and radiographically than that of T2 lesions, and the chance is better for adequate removal of the former without amputation. In general, low-grade bone sarcomas are intracompartmental (T1), whereas high-grade ones are extracompartmental (T2).
Lymphatic spread is a sign of widespread dissemination. Regional lymphatic involvement is equated with distal metastases (M1). Absence of any metastasis is designated as M0.
The surgical staging system developed by Enneking and colleagues for surgical planning and assessment of bone sarcomas is summarized thus:
Stage IA (G1,T1,M0): low-grade intracompartmental lesion, without metastasis
Stage IB (G1,T2,M0): low-grade extracompartmental lesion, without metastasis
Stage IIA (G2,T1,M0): high-grade intracompartmental lesion, without metastasis
Stage IIB (G2,T2,M0): high-grade extracompartmental lesion, without metastasis
Stage IIIA (G1 or G2,T1,M1): intracompartmental lesion, any grade, with metastasis
Stage IIIB (G1 or G2,T2,M1): extracompartmental lesion, any grade, with metastasis
AMERICAN JOINT COMMITTEE ON CANCER BONE TUMOR CLASSIFICATION
In 1983, the American Joint Committee on Cancer Bone Tumor Classification (AJCC) recommended a staging system for the malignant tumors of bone. This system has undergone minimal changes and remains unchanged in the fifth edition of the AJCC Cancer Staging Manual. This system is based on two indications: TNM designation [extent of the tumor (T), nodal status (N), and distant metastases (M)] and grade (G). This system is similar to the MSTS classification; however, the AJCC uses four stages instead of three. The four stages are designated I to IV and may be further modified with A or B. Stages I and II are defined by the histologic grade (grade I and II) and modified by tumor extent (i.e., cortical involvement; designated E1 to E6) . T(I) indicates that the tumor is confined within the cortex (similar to the MSTS classification A), and T(II) indicates that the tumor extends beyond the cortex (similar to the MSTS classification B). In the AJCC, stage III has remained undefined and stage IV is defined as the presence of metastases. Stage IV tumors are modified by A, which is equivalent to III M1 in the MSTS system (i.e., indicates a nodal metastasis), and B, which is equivalent to III M1 in the MSTS system (i.e., indicates distant metastases).
classification bone tumor
Bone consists of cartilaginous, osteoid, and fibrous tissue and bone marrow elements. Each tissue can give rise to benign or malignant spindle cell tumors. Bone tumors are classified on the basis of cell type and recognized products of proliferating cells. Each tumor be considered a separate clinicopathologic entity. Radiographic, histologic, and clinical data are necessary to form an accurate diagnosis and to determine the degree of activity and malignancy of each lesion.
Cartilage tumors are lesions in which cartilage is produced. They are the most common bone tumors. Osteochondroma is the most common benign cartilage tumor; some 1% to 2% of solitary osteochondromas become malignant and Enchondroma is a benign cartilage tumor that occurs centrally; in adults, malignant transformation may occur. Chondrosarcoma, the most common malignant cartilage tumor, is either intramedullary or peripheral. Ten percent are secondary, arising from an underlying benign lesion. Most chondrosarcomas are low grade, although 10% dedifferentiate into high-grade spindle cell sarcomas or, rarely, a mesenchymal chondrosarcoma.
Osteoid tumors are lesions in which the stroma produce osteoid. The benign forms are osteoid osteoma and osteoblastoma. Osteoid osteomas are never malignant. Osteoblastomas rarely metastasize; when they do, it is only after multiple local recurrences.Osteosarcomas are the most common primary malignant tumors of the bone. Histologically, they are composed of malignant spindle cells and osteoblasts that produce osteoid or immature bone. Several variants are now recognized.60 Parosteal, periosteal, and low-grade intraosseous osteosarcoma are histologically and radiographically distinct from the “classic” central medullary osteosarcomas and have a more favorable prognosis.
Fibrous tumors of bone are rare. Desmoplastic fibroma is a locally aggressive, nonmetastasizing tumor, analogous to fibromatosis of soft tissue.Fibrosarcoma of bone appears histologically as its soft tissue counterpart. Multiple sections must be obtained to demonstrate the lack of osteoid production. If osteoid is present, the lesion is classified as an osteosarcoma. MFH, a rare lesion and the counterpart of soft tissue MFH, has been described in bone.The pathophysiologic behavior of bone and soft tissue MFH is similar, consisting of a storiform pattern with a histiocytic component. Giant cell tumors of unknown origin were originally called benign but are now considered low-grade sarcomas. They have high rates of local recurrence and malignant transformation.
Tumors presumably arising from bone marrow elements are the round cell sarcomas. The two most common are Ewing's sarcoma and the rarer non-Hodgkin's lymphoma.
RADIOGRAPHIC EVALUATION AND DIAGNOSIS
Radiographic evaluation combined with the clinical history and histologic examination is necessary for accurate diagnosis. Bone scans, angiography, CT, and MRI are generally not helpful in determining a diagnosis but are important in delineating the extent of local involvement. A systematic approach to the radiographic evaluation of skeletal lesions has been described by Madewell and colleagues, who studied and correlated several hundred radiographic and pathologic specimens. They considered the radiograph as the gross specimen from which a detailed histologic interpretation could be made and biologic activity accurately diagnosed. According to their system, a bone tumor is evaluated by five radiographic parameters:
1. Anatomic site. Specific anatomic sites of the bone give rise to specific groups of lesions. Johnson explained this by a “field” theory, which hypothesizes that the most active cells of a certain area of bone give rise to tumors that are characteristic of that area. In general, spindle cell sarcomas are metaphyseal, whereas round cell sarcomas tend to be diaphyseal.
2. Borders. The border reflects the growth rate and the response of the adjacent normal bone to the tumor. Most tumors have a characteristic border. Benign lesions (e.g., nonossifying fibromas and unicameral bone cysts) have well-defined borders and a narrow transition area that is often associated with a reactive sclerosis. Aggressive or benign tumors [e.g., chondroblastoma and giant cell tumors (GCTs)] tend to have faint borders and wide zones of transition with very little sclerosis, reflecting a faster-growing lesion. Poorly delineated or absent margins indicate an aggressive or malignant lesion.
3. Bone destruction. Bone destruction is the hallmark of a bone tumor. Three patterns of bone destruction are described : geographic, moth-eaten, and permeative. In general, these patterns are found in the tubular bone rather than in the flat bone and represent a combination of cortical and cancellous destruction. These patterns reflect a progressively increasing growth rate of the underlying tumor.
4. Matrix formation. Calcification of the matrix, or new bone formation, may produce an area of increased density within the lesion. Calcification typically appears as flocculent or stippled rings or clusters. The appearance of the new bone varies from dense sclerosis that obliterates all evidence of normal trabeculae, to small, irregular, circumscribed masses described as “wool” or “clouds.” Calcification and ossification may appear in the same lesion. Neither type of matrix formation per se is diagnostic of malignancy.
5. Periosteal reaction. Periosteal reaction is indicative of malignancy but not pathognomonic of a particular tumor. A combination of periosteal changes is often noted. In malignant tumors, periosteal reaction is noncontinuous and thin, with multiple laminations. A parallel or a perpendicular pattern may be present.
The radiographic parameters of benign and malignant tumors are quite different. Benign tumors have round, smooth, well-circumscribed borders. No cortical destruction and, generally, no periosteal reaction are found. Malignant lesions have irregular, poorly defined margins. Evidence of bone destruction and a wide area of transition with periosteal reaction are noted. Soft tissue extension is common.
NATURAL HISTORY
Tumors arising in bone have characteristic patterns of behavior and growth that distinguish them from other malignant lesions. These patterns form the basis of a staging system and current treatment strategies. These principles and their relationship to management, as formulated by Enneking and colleagues, are described here.
BIOLOGY AND GROWTH
Spindle cell sarcomas form a solid lesion that grows centrifugally. The periphery is the least mature part of this lesion. In contradistinction to a true capsule, which surrounds a benign lesion and is composed of compressed normal cells, a malignant tumor is generally enclosed by a pseudocapsule and consists of compressed tumor cells and a fibrovascular zone of reactive tissue with an inflammatory component that interdigitates with the normal tissue adjacent to and beyond the lesion. The thickness of the reactive zone varies with the degree of malignancy and histiogenic type. The histologic hallmark of sarcomas is their potential to break through the pseudocapsule to form satellite lesions of tumor cells. This characteristic distinguishes a nonmalignant mesenchymal tumor from a malignant one.
High-grade sarcomas have a poorly defined reactive zone that may be invaded and destroyed by the tumor. In addition, tumor nodules in tissue may appear to be normal and not continuous with the main tumor. These are termed skip metastases. Although low-grade sarcomas regularly demonstrate tumor interdigitation into the reactive zone, they rarely form tumor nodules beyond this area.
The three mechanisms of growth and extension of bone tumors are:
(1) compression of normal tissue
(2) resorption of bone by reactive osteoclasts
(3) direct destruction of normal tissue.
Benign tumors grow and expand by the first two mechanisms, whereas direct tissue destruction is characteristic of malignant bone tumors. Sarcomas respect anatomic borders and remain within one compartment. Local anatomy influences tumor growth by setting the natural barriers to extension. In general, bone sarcomas take the path of least resistance. Most benign bone tumors are unicompartmental; they remain confined and may expand the bone in which they arose. Malignant bone tumors are bicompartmental; they destroy the overlying cortex and go directly into the adjacent soft tissue. The determination of anatomic compartment involvement has become more important with the advent of limb-preservation surgery.
On the basis of biologic considerations and natural history, Enneking and colleagues classified bone tumors into five categories, each of which shares certain clinical characteristics and radiographic patterns and requires similar surgical procedures.
1. Benign/latent: lesions whose natural history is to grow slowly during normal growth of the individual and then to stop, with a tendency to heal spontaneously. They never become malignant and, if treated by simple curettage, heal rapidly. Surgery is not indicated unless they become symptomatic.
2. Benign/active: lesions whose natural history is one of progressive growth. Simple curettage leaves a reactive rim with some tumor. Curettage is associated with a high recurrence rate. Wide excision through normal bone results in local control in approximately 95% of all cases.
3. Benign/aggressive: lesions that are locally aggressive but do not metastasize. The tumor extends through the capsule into the reactive zone. Local control can be obtained only by removing the lesion with a margin of normal bone beyond the reactive zone.
4. Malignant/low grade: lesions that have a low potential to metastasize. Histologically, a pseudocapsule rather than a true capsule is found. Tumor nodules exist within the reactive zone but rarely beyond. Local control can be accomplished only by removal of all tumor and reactive tissue with a margin of normal bone. These lesions can be treated successfully by surgery alone.
5. Malignant/high grade: lesions whose natural history is to grow rapidly and metastasize early. Tumor nodules are often found within and beyond the reactive zone and at some distance in the normal tissue. Surgery is necessary for local control, and systemic therapy is warranted to prevent metastasis.
METASTASIS
Bone tumors, unlike carcinomas, disseminate almost exclusively through the blood; bones lack a lymphatic system. Early lymphatic spread to regional nodes has only rarely been reported.Lymphatic involvement, which has been noted in 10% of cases at autopsy, is a poor prognostic sign. McKenna and associates noted that patients (3%) with osteosarcoma who underwent amputation demonstrated lymph node involvement. None of these patients survived 5 years. Hematogenous spread is manifested by pulmonary involvement in its early stage and secondarily by bone involvement. Bone metastasis is occasionally the first sign of dissemination. With the use of adjuvant chemotherapy, the skeletal system has become a more common site of initial relapse.
SKIP METASTASIS
A skip metastasis, as previously defined, is a tumor nodule that is located within the same bone as the main tumor but not in continuity with it. Transarticular skip metastases are located in the joint adjacent to the main tumor. Skip metastases are most often seen with high-grade sarcomas. A skip lesion develops by the embolization of tumor cells within the marrow sinusoids; in effect, they are local micrometastases that have not passed through the circulation. Transarticular skips are believed to occur via the periarticular venous anastomosis. The clinical incidence of skip metastases is less than 1%. These lesions are a prognosticator of poor survival.
LOCAL RECURRENCE
Local recurrence of a benign or malignant lesion is due to inadequate removal. The aggressiveness of the tumor determines which surgical procedure is required for local control. Ninety-five percent of all local recurrences, regardless of histology, develop within 24 months of attempted removal. Local recurrence of a high-grade sarcoma decreases overall survival prospects substantially. Local recurrence in patients who have undergone therapy is associated with an even poorer prognosis.
Cartilage tumors are lesions in which cartilage is produced. They are the most common bone tumors. Osteochondroma is the most common benign cartilage tumor; some 1% to 2% of solitary osteochondromas become malignant and Enchondroma is a benign cartilage tumor that occurs centrally; in adults, malignant transformation may occur. Chondrosarcoma, the most common malignant cartilage tumor, is either intramedullary or peripheral. Ten percent are secondary, arising from an underlying benign lesion. Most chondrosarcomas are low grade, although 10% dedifferentiate into high-grade spindle cell sarcomas or, rarely, a mesenchymal chondrosarcoma.
Osteoid tumors are lesions in which the stroma produce osteoid. The benign forms are osteoid osteoma and osteoblastoma. Osteoid osteomas are never malignant. Osteoblastomas rarely metastasize; when they do, it is only after multiple local recurrences.Osteosarcomas are the most common primary malignant tumors of the bone. Histologically, they are composed of malignant spindle cells and osteoblasts that produce osteoid or immature bone. Several variants are now recognized.60 Parosteal, periosteal, and low-grade intraosseous osteosarcoma are histologically and radiographically distinct from the “classic” central medullary osteosarcomas and have a more favorable prognosis.
Fibrous tumors of bone are rare. Desmoplastic fibroma is a locally aggressive, nonmetastasizing tumor, analogous to fibromatosis of soft tissue.Fibrosarcoma of bone appears histologically as its soft tissue counterpart. Multiple sections must be obtained to demonstrate the lack of osteoid production. If osteoid is present, the lesion is classified as an osteosarcoma. MFH, a rare lesion and the counterpart of soft tissue MFH, has been described in bone.The pathophysiologic behavior of bone and soft tissue MFH is similar, consisting of a storiform pattern with a histiocytic component. Giant cell tumors of unknown origin were originally called benign but are now considered low-grade sarcomas. They have high rates of local recurrence and malignant transformation.
Tumors presumably arising from bone marrow elements are the round cell sarcomas. The two most common are Ewing's sarcoma and the rarer non-Hodgkin's lymphoma.
RADIOGRAPHIC EVALUATION AND DIAGNOSIS
Radiographic evaluation combined with the clinical history and histologic examination is necessary for accurate diagnosis. Bone scans, angiography, CT, and MRI are generally not helpful in determining a diagnosis but are important in delineating the extent of local involvement. A systematic approach to the radiographic evaluation of skeletal lesions has been described by Madewell and colleagues, who studied and correlated several hundred radiographic and pathologic specimens. They considered the radiograph as the gross specimen from which a detailed histologic interpretation could be made and biologic activity accurately diagnosed. According to their system, a bone tumor is evaluated by five radiographic parameters:
1. Anatomic site. Specific anatomic sites of the bone give rise to specific groups of lesions. Johnson explained this by a “field” theory, which hypothesizes that the most active cells of a certain area of bone give rise to tumors that are characteristic of that area. In general, spindle cell sarcomas are metaphyseal, whereas round cell sarcomas tend to be diaphyseal.
2. Borders. The border reflects the growth rate and the response of the adjacent normal bone to the tumor. Most tumors have a characteristic border. Benign lesions (e.g., nonossifying fibromas and unicameral bone cysts) have well-defined borders and a narrow transition area that is often associated with a reactive sclerosis. Aggressive or benign tumors [e.g., chondroblastoma and giant cell tumors (GCTs)] tend to have faint borders and wide zones of transition with very little sclerosis, reflecting a faster-growing lesion. Poorly delineated or absent margins indicate an aggressive or malignant lesion.
3. Bone destruction. Bone destruction is the hallmark of a bone tumor. Three patterns of bone destruction are described : geographic, moth-eaten, and permeative. In general, these patterns are found in the tubular bone rather than in the flat bone and represent a combination of cortical and cancellous destruction. These patterns reflect a progressively increasing growth rate of the underlying tumor.
4. Matrix formation. Calcification of the matrix, or new bone formation, may produce an area of increased density within the lesion. Calcification typically appears as flocculent or stippled rings or clusters. The appearance of the new bone varies from dense sclerosis that obliterates all evidence of normal trabeculae, to small, irregular, circumscribed masses described as “wool” or “clouds.” Calcification and ossification may appear in the same lesion. Neither type of matrix formation per se is diagnostic of malignancy.
5. Periosteal reaction. Periosteal reaction is indicative of malignancy but not pathognomonic of a particular tumor. A combination of periosteal changes is often noted. In malignant tumors, periosteal reaction is noncontinuous and thin, with multiple laminations. A parallel or a perpendicular pattern may be present.
The radiographic parameters of benign and malignant tumors are quite different. Benign tumors have round, smooth, well-circumscribed borders. No cortical destruction and, generally, no periosteal reaction are found. Malignant lesions have irregular, poorly defined margins. Evidence of bone destruction and a wide area of transition with periosteal reaction are noted. Soft tissue extension is common.
NATURAL HISTORY
Tumors arising in bone have characteristic patterns of behavior and growth that distinguish them from other malignant lesions. These patterns form the basis of a staging system and current treatment strategies. These principles and their relationship to management, as formulated by Enneking and colleagues, are described here.
BIOLOGY AND GROWTH
Spindle cell sarcomas form a solid lesion that grows centrifugally. The periphery is the least mature part of this lesion. In contradistinction to a true capsule, which surrounds a benign lesion and is composed of compressed normal cells, a malignant tumor is generally enclosed by a pseudocapsule and consists of compressed tumor cells and a fibrovascular zone of reactive tissue with an inflammatory component that interdigitates with the normal tissue adjacent to and beyond the lesion. The thickness of the reactive zone varies with the degree of malignancy and histiogenic type. The histologic hallmark of sarcomas is their potential to break through the pseudocapsule to form satellite lesions of tumor cells. This characteristic distinguishes a nonmalignant mesenchymal tumor from a malignant one.
High-grade sarcomas have a poorly defined reactive zone that may be invaded and destroyed by the tumor. In addition, tumor nodules in tissue may appear to be normal and not continuous with the main tumor. These are termed skip metastases. Although low-grade sarcomas regularly demonstrate tumor interdigitation into the reactive zone, they rarely form tumor nodules beyond this area.
The three mechanisms of growth and extension of bone tumors are:
(1) compression of normal tissue
(2) resorption of bone by reactive osteoclasts
(3) direct destruction of normal tissue.
Benign tumors grow and expand by the first two mechanisms, whereas direct tissue destruction is characteristic of malignant bone tumors. Sarcomas respect anatomic borders and remain within one compartment. Local anatomy influences tumor growth by setting the natural barriers to extension. In general, bone sarcomas take the path of least resistance. Most benign bone tumors are unicompartmental; they remain confined and may expand the bone in which they arose. Malignant bone tumors are bicompartmental; they destroy the overlying cortex and go directly into the adjacent soft tissue. The determination of anatomic compartment involvement has become more important with the advent of limb-preservation surgery.
On the basis of biologic considerations and natural history, Enneking and colleagues classified bone tumors into five categories, each of which shares certain clinical characteristics and radiographic patterns and requires similar surgical procedures.
1. Benign/latent: lesions whose natural history is to grow slowly during normal growth of the individual and then to stop, with a tendency to heal spontaneously. They never become malignant and, if treated by simple curettage, heal rapidly. Surgery is not indicated unless they become symptomatic.
2. Benign/active: lesions whose natural history is one of progressive growth. Simple curettage leaves a reactive rim with some tumor. Curettage is associated with a high recurrence rate. Wide excision through normal bone results in local control in approximately 95% of all cases.
3. Benign/aggressive: lesions that are locally aggressive but do not metastasize. The tumor extends through the capsule into the reactive zone. Local control can be obtained only by removing the lesion with a margin of normal bone beyond the reactive zone.
4. Malignant/low grade: lesions that have a low potential to metastasize. Histologically, a pseudocapsule rather than a true capsule is found. Tumor nodules exist within the reactive zone but rarely beyond. Local control can be accomplished only by removal of all tumor and reactive tissue with a margin of normal bone. These lesions can be treated successfully by surgery alone.
5. Malignant/high grade: lesions whose natural history is to grow rapidly and metastasize early. Tumor nodules are often found within and beyond the reactive zone and at some distance in the normal tissue. Surgery is necessary for local control, and systemic therapy is warranted to prevent metastasis.
METASTASIS
Bone tumors, unlike carcinomas, disseminate almost exclusively through the blood; bones lack a lymphatic system. Early lymphatic spread to regional nodes has only rarely been reported.Lymphatic involvement, which has been noted in 10% of cases at autopsy, is a poor prognostic sign. McKenna and associates noted that patients (3%) with osteosarcoma who underwent amputation demonstrated lymph node involvement. None of these patients survived 5 years. Hematogenous spread is manifested by pulmonary involvement in its early stage and secondarily by bone involvement. Bone metastasis is occasionally the first sign of dissemination. With the use of adjuvant chemotherapy, the skeletal system has become a more common site of initial relapse.
SKIP METASTASIS
A skip metastasis, as previously defined, is a tumor nodule that is located within the same bone as the main tumor but not in continuity with it. Transarticular skip metastases are located in the joint adjacent to the main tumor. Skip metastases are most often seen with high-grade sarcomas. A skip lesion develops by the embolization of tumor cells within the marrow sinusoids; in effect, they are local micrometastases that have not passed through the circulation. Transarticular skips are believed to occur via the periarticular venous anastomosis. The clinical incidence of skip metastases is less than 1%. These lesions are a prognosticator of poor survival.
LOCAL RECURRENCE
Local recurrence of a benign or malignant lesion is due to inadequate removal. The aggressiveness of the tumor determines which surgical procedure is required for local control. Ninety-five percent of all local recurrences, regardless of histology, develop within 24 months of attempted removal. Local recurrence of a high-grade sarcoma decreases overall survival prospects substantially. Local recurrence in patients who have undergone therapy is associated with an even poorer prognosis.
Minggu, 09 Maret 2008
mau sharing aja
akhir-akhir ini aku sering menderita pusing yang teramat sangat di bagian kiri kepala. awalnya aku kira migrain. Tapi kok sampe mau nangis rasanya.Akhirnya aku tidur dengan posisi hadap ke kanan. (kayak posisi nabi tidur)
nah kalo kuhubung-hubung kan dengan aktivitas dan pola makanan ku akhir-akhir ini tampaknya pusing ku ini bisa menjadi sebuah hubungan.
1. aku udah jarang olah raga
2. pola tidur ku gak terartur, subuhan sering telat
3. suka makan gorengan
4. sering main laptop, megang hape, telpon-telponan sampai sejam lebih (kayaknya pengaruh radiasi
5. Kemaren makan daging kambing
berhubung aku habis belajar tentang kanker, jadi ketakutan ku mengarah ke arah sana. Tapi insya Allah nggak..
sekarang udah agak enakan. Lagi pula akhir-akhir ini aku stress banget
intinya aku harus mengubah pola hidup ku
akhir-akhir ini aku sering menderita pusing yang teramat sangat di bagian kiri kepala. awalnya aku kira migrain. Tapi kok sampe mau nangis rasanya.Akhirnya aku tidur dengan posisi hadap ke kanan. (kayak posisi nabi tidur)
nah kalo kuhubung-hubung kan dengan aktivitas dan pola makanan ku akhir-akhir ini tampaknya pusing ku ini bisa menjadi sebuah hubungan.
1. aku udah jarang olah raga
2. pola tidur ku gak terartur, subuhan sering telat
3. suka makan gorengan
4. sering main laptop, megang hape, telpon-telponan sampai sejam lebih (kayaknya pengaruh radiasi
5. Kemaren makan daging kambing
berhubung aku habis belajar tentang kanker, jadi ketakutan ku mengarah ke arah sana. Tapi insya Allah nggak..
sekarang udah agak enakan. Lagi pula akhir-akhir ini aku stress banget
intinya aku harus mengubah pola hidup ku
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