Appendix cancer occurs when the healthy cells in the appendix become abnormal and start growing rapidly, turning into cancerous cells. These cancerous cells become a tumor or mass inside the appendix, which may be benign (non-cancerous) or malignant (cancerous) in nature.
The appendix is a tube that appears like a thin pouch. It is attached to the large intestine and sits in the lower right part of the stomach.
Types:
The different types of appendix tumors are:
1. Neuroendocrine tumor or carcinoid tumor: This is the most common type of malignant appendix tumor that starts in the tip of the appendix.
2. Mucinous cystadenoma or low-grade mucinous neoplasm: This is a benign type of tumor that starts in the mucoceles, which are mucus-filled sacs present in the appendix wall.
3. Mucinous cystadenocarcinoma: This type of malignant tumor begins in the mucoceles.
4. Colonic-type adenocarcinoma: This is a malignant type of appendix tumor that begins at the base of the appendix.
5. Goblet cell carcinoma or adenoneuroendocrine tumor: This type of tumor has characteristics similar to adenocarcinoma and neuroendocrine tumor, but is more aggressive than a neuroendocrine tumor.
6. Signet-ring cell adenocarcinoma: It is a rare type of malignant tumor, which is difficult to remove.
7. Paraganglioma: This type of tumor is usually benign in nature, and very rarely malignant.
Causes:
The exact cause of appendix cancer is not known. Appendix cancer occurs when the healthy cells in the appendix turn abnormal and start growing and multiplying at an abnormal rate. These abnormal cells become cancerous. This leads to the formation of a mass or tumor inside the appendix. The tumor formed may be benign or non-cancerous in nature that does not spread to the other parts of the body, or it may be malignant or cancerous and may spread to the other parts of the body.
Risk factors:
Certain factors can increase the risk of having appendix cancer. These factors include:
The symptoms of appendix cancer may not be apparent in the initial stages. The symptoms, if present, may include the following:
Appendix cancer is usually difficult to diagnose at an early stage since it shows little or no symptoms early on. It is usually accidentally diagnosed during an imaging test, or after an individual has appendicitis (surgical removal of the appendix following an inflammation) surgery, or when the tumor has spread to the other organs leading to symptoms. Diagnosis of appendix cancer can be done by:
1. Physical examination: The doctor will physically examine the patient and note down the symptoms of the patient. The medical history and family history of the patient are also noted.
2. Imaging tests: Tests like CT scans, MRI scans, and ultrasound help in checking for the presence of any tumor in and around the appendix.
3. Colonoscopy: A thin, long tube known as a colonoscope, with a camera and light on one end is inserted into the rectum (last several inches of the large intestine) up into the colon (the longest part of the large intestine) to check for the presence of any tumor or mass.
4. Biopsy: This procedure involves the excision or removal of a small sample of the suspected tissue growth and sending it to the laboratory to check for the presence of any cancer cells.
The treatment of appendix cancer depends on the stage and type of tumor, and the patient’s overall health. The different types of treatments for appendix cancer include:
1. Surgery: Surgery is the most common form of treatment for appendix cancer which is localized. The different forms of surgeries include:
a) Appendectomy: In the case of cancer that is localized to the appendix only, the treatment includes removal of the appendix. This procedure is known as appendectomy.
b) Hemicolectomy: If the appendix tumor is larger in size, the treatment may include removal of one-half of the colon and the affected lymph nodes. The surgery done for the removal of half of the colon is called hemicolectomy.
c) Cytoreductive surgery or debulking: In the case of an appendix tumor that has spread to the surrounding tissues and organs, the surgeon removes the tumor, surrounding fluid, and nearby organs attached to the tumor. This is known as cytoreductive surgery.
2) Chemotherapy: Chemotherapy involves the use of a group of drugs to kill cancer cells.
Chemotherapy may be done before or after the surgery in cases of appendix tumors that are larger than 2 centimeters, tumors that are more aggressive in nature, or cancer that has spread to the other parts of the body.
The different types of chemotherapy may include:
a) Systemic chemotherapy: Chemotherapy drugs are given in the form of pills orally or injected into the veins (intravenously) in systemic chemotherapy.
b) Regional chemotherapy: In the case of regional chemotherapy, drugs are given directly into the abdomen, like intraperitoneal chemotherapy (the chemotherapy drugs are directly put into the abdominal cavity) or hyperthermic intraperitoneal chemotherapy (the chemotherapy drugs are heated and put into the abdominal cavity).
c) Combination of systemic and regional chemotherapy.
The risks involved with the various appendix cancer treatments include:
MBBS, MS - ENT, MCh - Head and Neck Surgery, DNB - ENT - Surgical Oncologist/Cancer Surgeon