Appendix Cancer

Appendix cancer is a type of cancer that occurs in the appendix. The appendix is a blind ending tubular structure that is 4-12 cm long and is connected to the first part of the colon (caecum). Appendix cancer is very rare (0.5% of all gastrointestinal cancers).

Different types of cancer occurring in the appendix include carcinoid tumours (tumours with the ability to secrete hormones), adenocarcinoma ('normal' colon cancer), signet ring cell adenocarcinoma (a very aggressive form of cancer) and lymphoma (cancer of the lymphatic/glandular tissue).

What are the symptoms of appendix cancer?

Tumours of the appendix usually present with very non-specific symptoms which make them difficult to diagnose. These symptoms may include:

• Abdominal pain
• Appendicitis
• Fluid accumulating in the abdomen
• Change in stool pattern
• Infertility in females
• Discomfort in the lower right abdomen

Appendix cancer is usually discovered during surgery or during an imaging test for another surgical condition such as appendicitis. It may also be discovered during a routine colonoscopy. Appendix cancer symptoms may only occur once the cancer is well advanced.

What are the possible treatment options for appendix cancer?

Treatment depends on the size of the tumour, the type of cancer and the presence of metastatic disease. Most patients present with advanced disease associated with a poor prognosis. Surgery in these cases is mostly palliative (aimed at relieving symptoms and not curing the patient). However, if the patient does present early surgery can still be curative. In these cases, a simple appendectomy (tumour less than 1.5 cm, in the distal appendix) or a right hemicolectomy (tumour more than 1.5 cm) will be performed. Some patients with diffuse intra-abdominal disease might benefit from debulking surgery (removing as much visible tumour as possible) and even intraoperative, intraperitoneal chemotherapy to try and improve survival rates.

Prognosis depends on the type of cancer and the presence of metastases (distant spread) but is mostly poor.