Appendix cancer

Diagnosis

Appendix cancer is difficult to diagnose early because it usually doesn't cause clear or specific symptoms. The appendix is a small organ tucked deep in the lower right side of the abdomen, so small tumors can grow there for a long time without being noticed. Many people learn they have cancer only after surgery for appendicitis or another abdominal condition.

If a healthcare professional suspects appendix cancer, several steps can help make the diagnosis:

• Medical history and exam. Your health professional usually asks about your symptoms, family history and any past health problems. During the exam, typically your abdomen is examined for swelling or tenderness.
• Imaging tests. Computerized tomography (CT) or MRI scans create detailed pictures of your abdomen and pelvis to look for tumors, fluid buildup or signs that the cancer has spread. Ultrasound can sometimes detect an enlarged appendix or fluid, especially when appendicitis is suspected.
• Surgery and biopsy. The most common way appendix cancer is found is during surgery to remove the appendix, called an appendectomy. After surgery, a pathologist examines the tissue under a microscope to see if cancer cells are present and to determine the exact type and grade.
• Lab and genetic tests. Blood tests may be used to check levels of chemicals made by cancer cells, called tumor markers. This can help medical professionals track treatment or recurrence. Some people also may benefit from genetic testing if there's a family history of cancer or if the tumor type suggests an inherited risk.

Each of these steps helps your care team understand the exact type and stage of your cancer so your care team can create the best treatment plan for you.

Treatment

Treatment for appendix cancer depends on the type of tumor, how advanced it is, and your overall health. Your care team will design a plan that's right for you.

The main treatment options include:

Surgery or other procedures

Surgery is the main treatment for most types of appendix cancer. The goal is to remove the tumor and any nearby tissue where cancer cells may have spread. The exact type of surgery depends on the tumor's size, location and whether it has spread beyond the appendix.

• Appendectomy. If the cancer is small and limited to the appendix, removing the appendix alone may be enough. This is often the case for slow-growing tumors such as neuroendocrine tumors (NETs) or low-grade mucinous neoplasms (LAMNs).
• Right hemicolectomy. If the tumor is larger, high-grade or near the base of the appendix, surgeons may remove part of the colon and nearby lymph nodes to make sure all the cancer is gone.
• Cytoreductive surgery (CRS). When appendix cancer has spread throughout the abdomen, surgeons perform a special operation to remove as much visible cancer as possible. Even if all the cancer can't be removed, this helps other treatments work better. During the surgery, the surgeon may remove tumors from the lining of the abdomen, called the peritoneum, and sometimes parts of nearby organs. CRS is sometimes called debulking surgery. This procedure is often followed by a specialized treatment called hyperthermic intraperitoneal chemotherapy (HIPEC).

Therapies

In addition to surgery, some people with appendix cancer benefit from treatments that use medicine to destroy or control cancer cells. These therapies include:

• Hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is a specialized cancer treatment used for cancers that have spread to the lining of the abdominal cavity, known as the peritoneum. CRS is typically done before HIPEC. After CRS, the abdominal cavity is bathed with heated chemotherapy medicine to target any remaining microscopic cancer cells. This combined approach can significantly reduce the risk of cancer recurrence, improve survival rates and even offer a potential cure for some people.
• Traditional chemotherapy. Chemotherapy treats cancer with strong medicines. For advanced or high-grade cancers that have spread beyond the abdomen, chemotherapy given through a vein may help shrink or slow the cancer.

• Targeted therapy or immunotherapy. For some people with advanced cancer or for those who are not able to have CRS, doctors may recommend medicines that target specific changes in the cancer or help the immune system attack it. These options include treatments that block tumor blood vessel growth, called antiangiogenesis therapy. It may also involve immunotherapy for tumors with certain genetic features.

  These therapies are based on early studies in appendix cancer and research from other digestive system cancers. These therapies are typically only used in specialized centers or clinical trials.

Surveillance

For some slow-growing or completely removed tumors, your healthcare professional may recommend regular checkups and scans instead of immediate further treatment.

There is a higher risk of colon cancer in people with appendiceal tumors, so a colonoscopy is recommended if one has not been done recently.

Alternative medicine

Alternative medicine treatments won't kill cancer cells. But some alternative medicine treatments may help you cope with the side effects of cancer treatment. Your healthcare team can treat many side effects, but sometimes medicines aren't enough. Alternative treatments may offer additional comfort.

Options for common side effects include the following:

• Anxiety — massage, meditation, hypnosis, music therapy, exercise or relaxation techniques.
• Fatigue — gentle exercise or tai chi.
• Nausea — acupuncture, hypnosis or music therapy.
• Pain — acupuncture, massage, music therapy or hypnosis.
• Sleep problems — yoga or relaxation techniques.

While these options are generally safe, talk with your healthcare team first to be sure that alternative medicine options won't affect your cancer treatment.

Coping and support

People facing a serious illness often say they feel worried about the future. With time, you'll find ways to cope with your feelings, but you may find comfort in these strategies:

• Ask questions about appendix cancer. Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your healthcare team for reliable sources where you can get more information.

  Knowing more about your cancer and your treatment options may make you more comfortable when you make decisions about your care.

• Stay connected to friends and family. Your cancer diagnosis can be stressful for friends and family too. Try to keep them involved in your life.

  Your friends and family will likely ask if there's anything they can do to help you. Think of tasks you might like help with. For example, you may ask a friend to be there for you when you want to talk. You may ask for help caring for your home if you have to stay in the hospital.

  You may find comfort in the support of a caring group of your friends and family.

• Find someone to talk with. Find someone you can talk to who has experience helping people facing a life-threatening illness. Ask your healthcare team to suggest a counselor, clergy member or medical social worker you can talk with. For support groups, contact the American Cancer Society or ask your healthcare team about local or online groups.

Preparing for your appointment

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If your health professional thinks you have appendix cancer, you may be referred to a specialist. Often this is a surgeon or doctor who treats digestive diseases, called a gastroenterologist. You also may be referred to a doctor who specializes in treating cancer, called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. For example, you might need to restrict your diet.
• Write down symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you're taking and the doses.
• Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited. Prepare by making a list of questions. List your questions from most important to least important in case time runs out. For appendix cancer, some basic questions to ask include:

• What is the stage of my cancer?
• What other tests do I need?
• What are my treatment options?
• Is there one treatment that's best for my type and stage of cancer?
• What are the potential side effects for each treatment?
• Should I seek a second opinion? Can you give me names of specialists you recommend?
• Am I eligible for clinical trials?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

What to expect from your doctor

Be prepared to answer questions about your symptoms and your health, such as:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?