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saco-indonesia.com, Kanker hati primer merupakan penyakit di mana sel kanker yang tumbuh berasal dari organ hati. Beberapa tipe

saco-indonesia.com, Kanker hati primer merupakan penyakit di mana sel kanker yang tumbuh berasal dari organ hati. Beberapa tipe kanker hati primer telah diberi nama sesuai dengan asal tumbuh sel kanker tersebut. Hepatocellular carcinoma (HCC) atau dikenal hepatoma yang tumbuh dari sel utama hati yang disebut hepatocytes dan juga merupakan 85% dari kasus kanker primer. Jenis kanker hati primer yang tidak begitu umum terjadi berasal dari sel berada pada garis saluran empedu yang disebut cholangiocytes, sehingga kanker tipe ini juga lebih dikenal sebagai kanker cholangiocarcinoma atau kanker saluran empedu.

Organ hati juga merupakan tempat dari tumbuhnya satu tipe kanker yang disebut kanker hati sekunder (kanker metastatik). Pada kondisi ini kanker utama sebenarnya berasal dari bagian tubuh yang lain dan telah membentuk deposit sekunder pada hati. Contoh umum dari kasus yang sering terjadi adalah kanker kolorektal yang telah menyebar ke organ hati melalui pembuluh darah.

Umumkah Kanker Hati?

Secara global, kanker hati primer umumnya telah terjadi pada pria dua kali lipat lebih sering dibandingkan pada wanita. Kanker hati juga merupakan kanker paling umum urutan ke-5 dan ke-7 bagi pria dan wanita. Negara-negara Asia juga mempunyai 80% pasien kanker hati primer secara global di mana sekitar 600.000 kasus terdiagnosa setiap tahunnya.

Apa yang menjadi faktor resiko penyebab kanker hati?

Terdapat tiga faktor utama yang dapat menyebabkan tumbuhnya HCC (kanker hati primer paling umum) yaitu infeksi kronis Hepatitis B, infeksi kronis Hepatitis C, dan konsumsi alkohol yang berlebihan. Resiko bagi individual dengan infeksi kronis Hepatitis B untuk terkena HCC adalah 100x dari individu normal.

Faktor lain yang dapat menjadi resiko meliputi aflatoxin (racun yang telah ditemukan pada kacang yang berjamur, gandum, dan kedelai), kondisi yang telah diwariskan (misal haemochromatosis, defisiensi alpha-1 anti-trypsin) dan penyebab cirrhosis (luka sepanjang hati) seperti hepatitis autoimun atau primary biliary cirrhosis. Banyak kanker hati juga dapat dicegah melalui peran masyarakat dalam mengurangi paparan terhadap faktor-faktor resiko yang telah diketahui.

 
Apa saja gejala-gejala kanker hati

Pasien yang terkena HCC biasanya tidak memiliki gejala-gejala yang berbeda dengan penyakit hati kronik lainnya. Dengan gejala yang memburuk dari penyakit hati kronis seperti pembengkakan perut akibat cairan (ascites), encephalopathy (berubahnya kondisi mental), sakit kuning, atau pendarahan pada sistem saluran pencernaan dapat meningkatkan kemungkinan berkembangnya HCC. Disamping itu, beberapa pasien juga mungkin merasakan rasa nyeri pada perut bagian atas, kehilangan berat badan, mudah kenyang, letih lesu, anoreksia, atau benjolan yang dapat dirasakan pada perut bagian atas.

 
Apakah dapat dilakukan skrining untuk kanker hati

Ya, skrining juga dapat membantu dokter untuk dapat menemukan dan mengobati HCC sedini mungkin, saat kanker masih setempat saja dan lebih mudah diangkat melalui proses bedah. Hal ini juga dapat meningkatkan tingkat keselamatan. Mereka yang telah mengidap infeksi Hepatitis B kronis dan luka hati (cirrhosis) karena hepatitis C atau sebab lain memiliki resiko tinggi terkena penyakit ini dan harus melalukan skrining guna untuk mendeteksi kanker hati.

Proses skrining meliputi:

    Tes darah untuk alpha-fetoprotein (AFP) 3-6 bulan sekali.
    Scan ultrasound pada bagian hati 6-12 bulan sekali.

 
Diagnosis dan Penilaian
          

Bagaimana proses diagnosa kanker hati?

Rangkaian tes dan prosedur berikut bisa dilakukan untuk dapat mendiagnosa HCC dan untuk dapat menunjukkan stadium kanker:

    Pemeriksaan fisik untuk kesehatan secara umum. Pemeriksaan bagian perut dilakukan untuk dapat mendeteksi adanya gumpalan keras atau ascites.
    Tes darah untuk kesehatan secara umum, fungsi hati dan jumlah/kadar AFP. Jumlah AFP pada penderita HCC lebih tinggi daripada pada orang normal.
    Scan ultasound pada hati dengan menggunakan gelombang suara untuk dapat menghasilkan citra hati. Prosedur tes ini juga tidak menimbulkan rasa sakit dan hanya perlu beberapa saat untuk dapat dilakukan. Citra yang dihasilkan dapat menunjukkan ada tidaknya tumor pada hati.
    Scan pencitraan Tomografi terkomputasi (CT) atau Magnetic Resonance Imaging (MRI) pada bagian perut juga akan memberikan gambar 3 dimensi dari hati. Gambar tersebut juga dapat menunjukkan ukuran dan posisi tumor, serta penyebarannya.

            
Walau diagnosa HCC dapat dibuat berdasarkan kadar AFP dalam darah dan pada hasil scan CT atau MRI, biopsi hati kadang kala juga perlu dilakukan untuk dapat memastikan hasil diagnosa. Bila kanker belum dapat menyebar dan masih dapat diangkat, maka biopsi tidak perlu dilakukan. Hal ini juga disebabkan oleh adanya resiko kecil penyebaran kanker sebagai akibat dari pengangkatan kanker oleh jarum biopsi. Pada situasi seperti ini, diagnosa dipertegas setelah bedah pengangkatan tumor.

 
Pengobatan dan Perawatan

Bagaimana cara mengobati kanker hati?

Tipe pengobatan untuk pasien kanker hati sangat tergantung pada stadium kanker (yaitu ukuran dan tingkat penyebaran kanker) dan kondisi kesehatan pasien secara umum. Prosedur pengobatan utama yang digunakan adalah bedah, ablasi tumor, kemoterapi, terapi kanker terarah dan radioterapi.
Pembedahan
          
Ablasi tumor

Pembedahan telah memiliki potensi penyembuhan dan juga merupakan prosedur pengobatan pilihan untuk pasien dengan HCC tahap dini. Bila hanya bagian tertentu dari hati yang terkena kanker dan bagian hati lainnya sehat, maka prosedur bedah juga dapat dilakukan untuk bisa mengangkat bagian yang terkena kanker. Prosedur bedah tipe ini juga disebut reseksi hati. Bentuk prosedur lain dari pembedahan adalah cangkok hati. Prosedur ini telah melibatkan pengangkatan seluruh organ hati dan menggantinya dengan organ hati donor yang masih sehat. Prosedur bedah besar seperti ini telah dilakukan bila kanker hanya terdapat pada hati dan donor hati tersedia. Bila prosedur bedah tidak memungkinkan, maka metode pengobatan lain akan diberikan guna untuk mengendalikan pertumbuhan kanker, dengan begitu mengurangi efek/gejala kanker serta meningkatkan kualitas hidup pasien.
          

Ablasi tumor bertujuan untuk dapat menghancurkan sel kanker hati primer dengan menggunakan panas (ablasi frekuensi radio: RFA) atau dengan alkohol (percutaneous ethanol injection; PEI). Prosedur ini umumnya hanya dilakukan di departemen scanning dimana ultrasound atau CT dapat membantu dokter untuk dapat mengarahkan jarum melalui kulit dan masuk ke dalam kanker yang berada di hati. Prosedur ini juga menggunakan anastesi lokal. Pengobatan RFA dengan menggunakan sinar laser atau gelombang radio yang dihantarkan melalui jarum menuju kanker guna untuk menghancurkan sel kanker. Pengobatan PEI dengan mengunakan alkohol yang disuntikkan masuk melalui jarum untuk dapat menghancurkan sel-sel kanker. Ablasi tumor juga dapat dilakukan berulang-ulang apabila tumor kembali tumbuh.
            
Kemoterapi
          
          
Kemoterapi adalah penggunaan obat-obatan anti kanker untuk dapat menghancurkan sel kanker atau menghentikan pertumbuhannya. Prosedur ini juga dapat membantu mengendalikan kanker dengan menyusutkan kanker serta memperlambat pertumbuhannya. Obat-obatan kemoterapi pada umumnya telah diberikan melalui suntikan pada pembuluh darah (secara intravena), walau terkadang dapat pula diberikan dalam bentuk tablet. Kemoterapi juga dapat diberikan sebagai bagian dari pengobatan yang disebut kemo embolisasi. Porses kemo embolisasi juga melibatkan suntikan obat kemoterapi langsung pada kanker dalam hati, bersamaan dengan sebuah jel atau titis plastik kecil untuk dapat menghambat aliran darah menuju kanker (embolisasi). Tidak semua pasien dapat menjalani prosedur kemoterapi ini karena prosedur ini telah memerlukan hati yang masih bisa berfungsi dengan baik.
            
Terapi kanker terarah
          
Radioterapi

Terapi kanker terarah (Targeted Cancer Therapy) dengan menggunakan obat-obatan atau pengobatan lainnya untuk dpat mencegah pertumbuhan serta penyebaran kanker dengan melakukan interfensi pada molekul tertentu yang terlibat dalam pertumbuhan kanker. Satu obat untuk terapi kanker terarah bernama Sorafenib dapat digunakan untuk dapat mengobati pasien dengan HCC tahap lanjut. Sorafenib menyerang kanker dengan cara mencegah kanker mengembangkan pembuluh darahnya sendiri. Sel kanker juga memerlukan asupan darah untuk dapat membawa nutrisi dan oksigen. Sorafenib juga berfungsi untuk dapat membatasi kemampuan kanker untuk berkembang. Sorafenib telah melalui dua uji klinis besar pada pasien dengan HCC tahap lanjut, dibandingkan dengan mereka yang dirawat hanya dengan perawatan pendukung. Sorafenib adalah tablet yang umumnya diberikan 2 kali sehari. Efek samping yang diberikan termasuk diare, cepat letih, mual dan tekanan darah tinggi.
          

Radioterapi dengan menggunakan sinar energi tinggi untuk dapat menghancurkan sel kanker atau menghentikan pertumbuhannya. Radioterapi eksternal dengan menggunakan mesin yang digunakan secara eksternal dari tubuh untuk dapat menghantarkan radiasi pada kanker. Prosedur pengobatan ini juga jarang digunakan pada penderita kanker HCC karena hati tidak dapat terpapar oleh radiasi tinggi. Namun, prosedur ini juga dapat mengurangi rasa sakit, seperti misalnya pada pasien yang kankernya telah menyebar hingga ke tulang. Sebagai prosedur alternatif, radiasi internal yang menggunakan zat radioaktif dihantarkan secara selektif menuju kanker melalui pembuluh darah arteri yang mengantarkan darah ke hati.

 
Apakah kanker hati dapat dicegah?

Tentu saja. Ada beberapa hal yang dapat kita lakukan untuk dapat mencegah kanker hati:

    Vaksinasi terhadap virus hepatitis B
    Hindari mengkonsumsi bahan-bahan yang mengandung karsinogen hati, khususnya alkohol.
    Hindari daging berlemak dan lemak hewani. Hindari kacang dan gandum berjamur.
    Lakukan skrining secara regular bila Anda termasuk dalam kelompok dengan resiko kanker yang tinggi

 
Dukungan apa yang tersedia?
          

CanHOPE, adalah badan non-profit yang bergerak di bidang layanan konseling dan dukungan terhadap penderita kanker yang diprakarsai oleh Parkway Cancer Centre.

Sebagai bagian dari sebuah pendekatan holistik untuk dapat mengobati kanker, CanHOPE juga bekerjasama dengan tim medis dan ahli-ahli kesehatan professional yang telah menawarkan sumber daya serta informasi yang luas mengenai kanker untuk dapat membantu pasien dan keluarga mereka agar dapat mengambil keputusan yang tepat selama perjalanan mereka menuju kesembuhan.


Editor : dian sukmawati

Sebuah fragmen bagian dari Malioboro dengan kisah yang cukup sudah lama sejak berdirinya Kraton Ngayogyakarta Hadiningrat. Pasar

Sebuah fragmen bagian dari Malioboro dengan kisah yang cukup sudah lama sejak berdirinya Kraton Ngayogyakarta Hadiningrat. Pasar ini juga telah menjadi sentra kegiatan ekonomi selama ratusan tahun dan keberadaannya telah mempunyai makna filosofis. Sebagai salah satu pilar Catur Tunggal yang terdiri dari Kraton, Alun-alun Utara, Masjid Agung dan Pasar Beringharjo sendiri.

Pasar Beringharjo yang kita kenal sekarang pada awalnya adalah hutan beringin, tiga tahun setelah Perjanjian Gianti, wilayah pasar ini juga telah menjadi tempat transaksi ekonomi bagi warga Yogyakarta dan sekitarnya. Pembangunan Pasar Beringharjo secara permanen di mulai pada awal tahun 1920 silam yang telah ditandai dengan adanya bangunan yang sudah jadi pada tahun 1925. Asal mula nama Beringharjo telah diberikan oleh Sri Sultan HB IX yang artinya membawa kesejahteraan.

Pada saat ini, Pasar Beringharjo telah menjadi salah satu kegiatan ekonomi yang besar untuk kawasan Malioboro. Bangunan bertingkat yang setiap lantanya diisi oleh berbagai macam komoditas perdagangan, mulai dari konveksi, akseoris, sembako dan rempah-rempah. Pasar Beringharjo juga sudah menjadi salah satu tujuan wisata belanja bagi wisatawan yang berkunjung di kota Yogya. Berbasiskan pasar tradisional serta berkolaborasi dengan gaya modern telah membuat pasar ini membawa banyak cerita bagi para pengunjung untuk kembali dan membawa teman-temannya berkunjung di sini lagi. Puncak kepadatan di Pasar Beringharjo biasanya terjadi di musim liburan dimana banyak wisatawan berbondong-bondong mengunjungi dengan berbagai macam kepentingan di sini dari belanja atau sekedar berjalan-jalan.

Pintu gerbang Pasar Beringharjo dari sini kita bisa menemukan banyak pedagang pecel dengan ciri khas kursi panjang kayu dan payung-payung besar sebagai atap pelindung dari hujan dan panas. Masuk ke pintu gerbang kita akan menemukan sebuah rancang bangun tangga yang telah membawa pengunjung menuju lantai paling atas. Lantai dasar dari ruangan ini juga merupakan lorong panjang yang telah menghubungkan dengan pasar Beringharjo di bagian timur, setiap sisi dari lorong ini dipenuhi dengan para penjual batik baik masih berbentuk kain ataupun pakaian jadi. Selain pakaian batik, los pasar bagian barat juga telah menawarkan baju surjan, blangkon, dan sarung tenun maupun batik. Sandal dan tas yang dijual dengan harga miring dapat dijumpai di sekitar tangga berjalan pasar bagian barat.

Pasar Beringharjo bisa dikatakan memiliki kelenturan dalam menghadapi perubahan jaman dengan ditandainya banyak perubahan dalam aktifitas masyarakat termasuk belanja. Berdiri diantara pusat perbelanjaan modern, pasar ini juga mampu bertahan dan memberikan sentuhan tradisional yang unik ketika bertransaksi antara pembeli dan penjual. Tawar menawar harga menjadi telah semacam bentuk komunikasi yang terjalin mulai dari cara menawar yang ringan hingga sistem tembak langsung.

 

THE WRITERS ASHLEY AND JAQUAVIS COLEMAN know the value of a good curtain-raiser. The couple have co-authored dozens of novels, and they like to start them with a bang: a headlong action sequence, a blast of violence or sex that rocks readers back on their heels. But the Colemans concede they would be hard-pressed to dream up anything more gripping than their own real-life opening scene.

In the summer of 2001, JaQuavis Coleman was a 16-year-old foster child in Flint, Mich., the former auto-manufacturing mecca that had devolved, in the wake of General Motors’ plant closures, into one of the country’s most dangerous cities, with a decimated economy and a violent crime rate more than three times the national average. When JaQuavis was 8, social services had removed him from his mother’s home. He spent years bouncing between foster families. At 16, JaQuavis was also a businessman: a crack dealer with a network of street-corner peddlers in his employ.

One day that summer, JaQuavis met a fellow dealer in a parking lot on Flint’s west side. He was there to make a bulk sale of a quarter-brick, or “nine-piece” — a nine-ounce parcel of cocaine, with a street value of about $11,000. In the middle of the transaction, JaQuavis heard the telltale chirp of a walkie-talkie. His customer, he now realized, was an undercover policeman. JaQuavis jumped into his car and spun out onto the road, with two unmarked police cars in pursuit. He didn’t want to get into a high-speed chase, so he whipped his car into a church parking lot and made a run for it, darting into an alleyway behind a row of small houses, where he tossed the quarter-brick into some bushes. When JaQuavis reached the small residential street on the other side of the houses, he was greeted by the police, who handcuffed him and went to search behind the houses where, they told him, they were certain he had ditched the drugs. JaQuavis had been dealing since he was 12, had amassed more than $100,000 and had never been arrested. Now, he thought: It’s over.

But when the police looked in the bushes, they couldn’t find any cocaine. They interrogated JaQuavis, who denied having ever possessed or sold drugs. They combed the backyard alley some more. After an hour of fruitless efforts, the police were forced to unlock the handcuffs and release their suspect.

JaQuavis was baffled by the turn of events until the next day, when he received a phone call. The previous afternoon, a 15-year-old girl had been sitting in her home on the west side of Flint when she heard sirens. She looked out of the window of her bedroom, and watched a young man throw a package in the bushes behind her house. She recognized him. He was a high school classmate — a handsome, charismatic boy whom she had admired from afar. The girl crept outside and grabbed the bundle, which she hid in her basement. “I have something that belongs to you,” Ashley Snell told JaQuavis Coleman when she reached him by phone. “You wanna come over here and pick it up?”

Photo
Three of the nearly 50 works of urban fiction published by the Colemans over the last decade, often featuring drug deals, violence, sex and a brash kind of feminism.Credit Marko Metzinger

In the Colemans’ first novel, “Dirty Money” (2005), they told a version of this story. The outline was the same: the drug deal gone bad, the dope chucked in the bushes, the fateful phone call. To the extent that the authors took poetic license, it was to tone down the meet-cute improbability of the true-life events. In “Dirty Money,” the girl, Anari, and the crack dealer, Maurice, circle each other warily for a year or so before coupling up. But the facts of Ashley and JaQuavis’s romance outstripped pulp fiction. They fell in love more or less at first sight, moved into their own apartment while still in high school and were married in 2008. “We were together from the day we met,” Ashley says. “I don’t think we’ve spent more than a week apart in total over the past 14 years.”

That partnership turned out to be creative and entrepreneurial as well as romantic. Over the past decade, the Colemans have published nearly 50 books, sometimes as solo writers, sometimes under pseudonyms, but usually as collaborators with a byline that has become a trusted brand: “Ashley & JaQuavis.” They are marquee stars of urban fiction, or street lit, a genre whose inner-city settings and lurid mix of crime, sex and sensationalism have earned it comparisons to gangsta rap. The emergence of street lit is one of the big stories in recent American publishing, a juggernaut that has generated huge sales by catering to a readership — young, black and, for the most part, female — that historically has been ill-served by the book business. But the genre is also widely maligned. Street lit is subject to a kind of triple snobbery: scorned by literati who look down on genre fiction generally, ignored by a white publishing establishment that remains largely indifferent to black books and disparaged by African-American intellectuals for poor writing, coarse values and trafficking in racial stereotypes.

But if a certain kind of cultural prestige is shut off to the Colemans, they have reaped other rewards. They’ve built a large and loyal fan base, which gobbles up the new Ashley & JaQuavis titles that arrive every few months. Many of those books are sold at street-corner stands and other off-the-grid venues in African-American neighborhoods, a literary gray market that doesn’t register a blip on best-seller tallies. Yet the Colemans’ most popular series now regularly crack the trade fiction best-seller lists of The New York Times and Publishers Weekly. For years, the pair had no literary agent; they sold hundreds of thousands of books without banking a penny in royalties. Still, they have earned millions of dollars, almost exclusively from cash-for-manuscript deals negotiated directly with independent publishing houses. In short, though little known outside of the world of urban fiction, the Colemans are one of America’s most successful literary couples, a distinction they’ve achieved, they insist, because of their work’s gritty authenticity and their devotion to a primal literary virtue: the power of the ripping yarn.

“When you read our books, you’re gonna realize: ‘Ashley & JaQuavis are storytellers,’ ” says Ashley. “Our tales will get your heart pounding.”

THE COLEMANS’ HOME BASE — the cottage from which they operate their cottage industry — is a spacious four-bedroom house in a genteel suburb about 35 miles north of downtown Detroit. The house is plush, but when I visited this past winter, it was sparsely appointed. The couple had just recently moved in, and had only had time to fully furnish the bedroom of their 4-year-old son, Quaye.

In conversation, Ashley and JaQuavis exude both modesty and bravado: gratitude for their good fortune and bootstrappers’ pride in having made their own luck. They talk a lot about their time in the trenches, the years they spent as a drug dealer and “ride-or-die girl” tandem. In Flint they learned to “grind hard.” Writing, they say, is merely a more elevated kind of grind.

“Instead of hitting the block like we used to, we hit the laptops,” says Ashley. “I know what every word is worth. So while I’m writing, I’m like: ‘Okay, there’s a hundred dollars. There’s a thousand dollars. There’s five thousand dollars.’ ”

They maintain a rigorous regimen. They each try to write 5,000 words per day, five days a week. The writers stagger their shifts: JaQuavis goes to bed at 7 p.m. and wakes up early, around 3 or 4 in the morning, to work while his wife and child sleep. Ashley writes during the day, often in libraries or at Starbucks.

They divide the labor in other ways. Chapters are divvied up more or less equally, with tasks assigned according to individual strengths. (JaQuavis typically handles character development. Ashley loves writing murder scenes.) The results are stitched together, with no editorial interference from one author in the other’s text. The real work, they contend, is the brainstorming. The Colemans spend weeks mapping out their plot-driven books — long conversations that turn into elaborate diagrams on dry-erase boards. “JaQuavis and I are so close, it makes the process real easy,” says Ashley. “Sometimes when I’m thinking of something, a plot point, he’ll say it out loud, and I’m like: ‘Wait — did I say that?’ ”

Their collaboration developed by accident, and on the fly. Both were bookish teenagers. Ashley read lots of Judy Blume and John Grisham; JaQuavis liked Shakespeare, Richard Wright and “Atlas Shrugged.” (Their first official date was at a Borders bookstore, where Ashley bought “The Coldest Winter Ever,” the Sister Souljah novel often credited with kick-starting the contemporary street-lit movement.) In 2003, Ashley, then 17, was forced to terminate an ectopic pregnancy. She was bedridden for three weeks, and to provide distraction and boost her spirits, JaQuavis challenged his girlfriend to a writing contest. “She just wasn’t talking. She was laying in bed. I said, ‘You know what? I bet you I could write a better book than you.’ My wife is real competitive. So I said, ‘Yo, all right, $500 bet.’ And I saw her eyes spark, like, ‘What?! You can’t write no better book than me!’ So I wrote about three chapters. She wrote about three chapters. Two days later, we switched.”

The result, hammered out in a few days, would become “Dirty Money.” Two years later, when Ashley and JaQuavis were students at Ferris State University in Western Michigan, they sold the manuscript to Urban Books, a street-lit imprint founded by the best-selling author Carl Weber. At the time, JaQuavis was still making his living selling drugs. When Ashley got the phone call informing her that their book had been bought, she assumed they’d hit it big, and flushed more than $10,000 worth of cocaine down the toilet. Their advance was a mere $4,000.

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The roots of street lit, found in the midcentury detective novels of Chester Himes and the ‘60s and ‘70s “ghetto fiction” of Iceberg Slim and Donald Goines.Credit Marko Metzinger

Those advances would soon increase, eventually reaching five and six figures. The Colemans built their career, JaQuavis says, in a manner that made sense to him as a veteran dope peddler: by flooding the street with product. From the start, they were prolific, churning out books at a rate of four or five a year. Their novels made their way into stores; the now-defunct chain Waldenbooks, which had stores in urban areas typically bypassed by booksellers, was a major engine of the street-lit market. But Ashley and JaQuavis took advantage of distribution channels established by pioneering urban fiction authors such as Teri Woods and Vickie Stringer, and a network of street-corner tables, magazine stands, corner shops and bodegas. Like rappers who establish their bona fides with gray-market mixtapes, street-lit authors use this system to circumnavigate industry gatekeepers, bringing their work straight to the genre’s core readership. But urban fiction has other aficionados, in less likely places. “Our books are so popular in the prison system,” JaQuavis says. “We’re banned in certain penitentiaries. Inmates fight over the books — there are incidents, you know? I have loved ones in jail, and they’re like: ‘Yo, your books can’t come in here. It’s against the rules.’ ”

The appeal of the Colemans’ work is not hard to fathom. The books are formulaic and taut; they deliver the expected goods efficiently and exuberantly. The titles telegraph the contents: “Diary of a Street Diva,” “Kiss Kiss, Bang Bang,” “Murderville.” The novels serve up a stream of explicit sex and violence in a slangy, tangy, profane voice. In Ashley & JaQuavis’s books people don’t get killed: they get “popped,” “laid out,” get their “cap twisted back.” The smut is constant, with emphasis on the earthy, sticky, olfactory particulars. Romance novel clichés — shuddering orgasms, heroic carnal feats, superlative sexual skill sets — are rendered in the Colemans’ punchy patois.

Subtlety, in other words, isn’t Ashley & JaQuavis’s forte. But their books do have a grainy specificity. In “The Cartel” (2008), the first novel in the Colemans’ best-selling saga of a Miami drug syndicate, they catch the sights and smells of a crack workshop in a housing project: the nostril-stinging scent of cocaine and baking soda bubbling on stovetops; the teams of women, stripped naked except for hospital masks so they can’t pilfer the merchandise, “cutting up the cooked coke on the round wood table.” The subject matter is dark, but the Colemans’ tone is not quite noir. Even in the grimmest scenes, the mood is high-spirited, with the writers palpably relishing the lewd and gory details: the bodies writhing in boudoirs and crumpling under volleys of bullets, the geysers of blood and other bodily fluids.

The luridness of street lit has made it a flashpoint, inciting controversy reminiscent of the hip-hop culture wars of the 1980s and ’90s. But the street-lit debate touches deeper historical roots, reviving decades-old arguments in black literary circles about the mandate to uplift the race and present wholesome images of African-Americans. In 1928, W. E. B. Du Bois slammed the “licentiousness” of “Home to Harlem,” Claude McKay’s rollicking novel of Harlem nightlife. McKay’s book, Du Bois wrote, “for the most part nauseates me, and after the dirtier parts of its filth I feel distinctly like taking a bath.” Similar sentiments have greeted 21st-century street lit. In a 2006 New York Times Op-Ed essay, the journalist and author Nick Chiles decried “the sexualization and degradation of black fiction.” African-American bookstores, Chiles complained, are “overrun with novels that . . . appeal exclusively to our most prurient natures — as if these nasty books were pairing off back in the stockrooms like little paperback rabbits and churning out even more graphic offspring that make Ralph Ellison books cringe into a dusty corner.”

Copulating paperbacks aside, it’s clear that the street-lit debate is about more than literature, touching on questions of paternalism versus populism, and on middle-class anxieties about the black underclass. “It’s part and parcel of black elites’ efforts to define not only a literary tradition, but a racial politics,” said Kinohi Nishikawa, an assistant professor of English and African-American Studies at Princeton University. “There has always been a sense that because African-Americans’ opportunities to represent themselves are so limited in the first place, any hint of criminality or salaciousness would necessarily be a knock on the entire racial politics. One of the pressing debates about African-American literature today is: If we can’t include writers like Ashley & JaQuavis, to what extent is the foundation of our thinking about black literature faulty? Is it just a literature for elites? Or can it be inclusive, bringing urban fiction under the purview of our umbrella term ‘African-American literature’?”

Defenders of street lit note that the genre has a pedigree: a tradition of black pulp fiction that stretches from Chester Himes, the midcentury author of hardboiled Harlem detective stories, to the 1960s and ’70s “ghetto fiction” of Iceberg Slim and Donald Goines, to the current wave of urban fiction authors. Others argue for street lit as a social good, noting that it attracts a large audience that might otherwise never read at all. Scholars like Nishikawa link street lit to recent studies showing increased reading among African-Americans. A 2014 Pew Research Center report found that a greater percentage of black Americans are book readers than whites or Latinos.

For their part, the Colemans place their work in the broader black literary tradition. “You have Maya Angelou, Alice Walker, James Baldwin — all of these traditional black writers, who wrote about the struggles of racism, injustice, inequality,” says Ashley. “We’re writing about the struggle as it happens now. It’s just a different struggle. I’m telling my story. I’m telling the struggle of a black girl from Flint, Michigan, who grew up on welfare.”

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The Colemans in their new four-bedroom house in the northern suburbs of Detroit.Credit Courtesy of Ashley and JaQuavis Coleman

Perhaps there is a high-minded case to be made for street lit. But the virtues of Ashley & JaQuavis’s work are more basic. Their novels do lack literary polish. The writing is not graceful; there are passages of clunky exposition and sex scenes that induce guffaws and eye rolls. But the pleasure quotient is high. The books flaunt a garish brand of feminism, with women characters cast not just as vixens, but also as gangsters — cold-blooded killers, “murder mamas.” The stories are exceptionally well-plotted. “The Cartel” opens by introducing its hero, the crime boss Carter Diamond; on page 9, a gunshot spatters Diamond’s brain across the interior of a police cruiser. The book then flashes back seven years and begins to hurtle forward again — a bullet train, whizzing readers through shifting alliances, romantic entanglements and betrayals, kidnappings, shootouts with Haitian and Dominican gangsters, and a cliffhanger closing scene that leaves the novel’s heroine tied to a chair in a basement, gruesomely tortured to the edge of death. Ashley & JaQuavis’s books are not Ralph Ellison, certainly, but they build up quite a head of steam. They move.

The Colemans are moving themselves these days. They recently signed a deal with St. Martin’s Press, which will bring out the next installment in the “Cartel” series as well as new solo series by both writers. The St. Martin’s deal is both lucrative and legitimizing — a validation of Ashley and JaQuavis’s work by one of publishing’s most venerable houses. The Colemans’ ambitions have grown, as well. A recent trilogy, “Murderville,” tackles human trafficking and the blood-diamond industry in West Africa, with storylines that sweep from Sierra Leone to Mexico to Los Angeles. Increasingly, Ashley & JaQuavis are leaning on research — traveling to far-flung settings and hitting the books in the libraries — and spending less time mining their own rough-and-tumble past.

But Flint remains a source of inspiration. One evening not long ago, JaQuavis led me on a tour of his hometown: a popular roadside bar; the parking lot where he met the undercover cop for the ill-fated drug deal; Ashley’s old house, the site of his almost-arrest. He took me to a ramshackle vehicle repair shop on Flint’s west side, where he worked as a kid, washing cars. He showed me a bathroom at the rear of the garage, where, at age 12, he sneaked away to inspect the first “boulder” of crack that he ever sold. A spray-painted sign on the garage wall, which JaQuavis remembered from his time at the car wash, offered words of warning:

WHAT EVERY YOUNG MAN SHOULD KNOW
ABOUT USING A GUN:
MURDER . . . 30 Years
ARMED ROBBERY . . . 15 Years
ASSAULT . . . 15 Years
RAPE . . . 20 Years
POSSESSION . . . 5 Years
JACKING . . . 20 YEARS

“We still love Flint, Michigan,” JaQuavis says. “It’s so seedy, so treacherous. But there’s some heart in this city. This is where it all started, selling books out the box. In the days when we would get those little $40,000 advances, they’d send us a couple boxes of books for free. We would hit the streets to sell our books, right out of the car trunk. It was a hustle. It still is.”

One old neighborhood asset that the Colemans have not shaken off is swagger. “My wife is the best female writer in the game,” JaQuavis told me. “I believe I’m the best male writer in the game. I’m sleeping next to the best writer in the world. And she’s doing the same.”

 

Ms. Turner and her twin sister founded the Love Kitchen in 1986 in a church basement in Knoxville, Tenn., and it continues to provide clothing and meals.

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