Treatment of Appendix Cancer

What is appendix cancer

Appendix cancer refers to a group of malignant neoplasms of this organ of various origins. These are not only epithelial, but also neuroendocrine tumors, which are more common. In 50% of cases, appendix cancer is found in the appendix, removed for acute appendicitis. Most often, people aged 60-70 get sick.

The main histological types of appendix cancer are as follows: 

• neuroendocrine tumors;
• goblet cell carcinoma;
• colonic-type adenocarcinoma;
• mucinous appendix cancer;
• lymphoma. 

Diagnostics

Many cases of cancer manifest themselves with acute appendicitis. Cancer blocks the appendix, causing it to become infected.

Sometimes patients come after the onset of symptoms: abdominal pain, weight loss, loss of appetite, fever, vomiting. When the tumor reaches a large size, intestinal obstruction develops. Liver metastases may cause jaundice.

CT or MRI scanning is used to visualize the tumor. Doctors also evaluate the size of the lymph nodes and may detect metastases in the abdominal cavity or other organs.

Before the treatment, a tumor biopsy is usually not performed. The neoplasm is removed, and then the +++histological type is determined.

A percutaneous needle biopsy (insertion of a needle through the skin of the abdomen) can be performed to confirm metastasis spread to the peritoneum.

All patients undergo a colonoscopy. This is because appendix cancer often develops with colon cancer or precancerous processes in the colon.

The determination of the level of cancer fetal antigen in the blood helps to determine prognosis. At normal levels, the prognosis is favorable. The elevated levels of the tumor marker indicate a large tumor mass and a high probability of metastasis.

Surgical treatment

For appendix cancer, the most important way of treatment is surgery. The exception is cases of late detection of the disease, at the stage of the appearance of distant metastases.

Appendectomy is a treatment option for stage one-three cancer if the tumor is in the distal portion of the appendix. This surgery involves the removal of only the appendix, as well as a wide excision of the mesoappendix (mesentery). It is necessary for both therapeutic and diagnostic purposes. Doctors remove lymph nodes, and examine them for metastases, if any. As a result, the exact stage of the disease is determined, indications for postoperative radiation therapy or chemotherapy are determined.

In fact, most appendix tumors are diagnosed after appendectomy, which is performed for acute appendicitis. Cancer causes obstruction and inflammation of the appendix. After its removal, doctors examine the material and detect the tumor tissue that the appendix includes.

A right hemicolectomy is a surgery to remove the ascending colon along with the appendix and lymph nodes. This surgical procedure is performed for the local spread of the tumor, metastasis to the lymph nodes, neuroendocrine tumors with vague boundaries, as well as for mesoappendix invasion of more than 3 mm.

Both appendectomy and right hemicolectomy can be performed: 

• through a large abdominal incision; 
• through several small incisions (laparoscopy). 

Laparoscopic interventions for appendix cancer are performed in specialized centers. If they are performed by experienced doctors, they are no less effective than conventional surgery through a large incision. They are performed without immersing the surgeon's hands in the wound. Thin long instruments and a video camera with illumination are inserted through short incisions, which help the surgeon to control his actions.

Cytoreductive surgery is especially effective for mucinous tumors of the appendix. It allows coping with even the most severe cases of cancer that have spread through the peritoneum. When operating, the doctor removes part of the intestine affected by the tumor, as well as all visible tumor foci in the abdominal cavity. Cytoreduction means the maximum reduction in the volume of the tumor mass. It creates good conditions for subsequent conservative therapy and ensures the long-term survival of patients.

This surgical intervention is always performed through the large abdominal incision. Cytoreduction can be complete, optimal, or suboptimal. Suboptimal cytoreduction is an undesirable outcome of surgery. It means that tumor foci larger than 1 cm remained in the abdominal cavity. Such surgical intervention does not increase the survival rate of patients compared to chemotherapy. However, doctors abroad usually manage to perform surgery in the scope of optimal or even complete cytoreduction. With optimal cytoreduction, foci up to 1 cm can remain in the abdominal cavity, and with complete cytoreduction, all tumors are removed. After the surgical intervention, foreign specialists rinse the abdominal cavity with a heated solution of chemotherapy drugs. Read our blog for more information about treating stage 4 colorectal cancer.

Features of the treatment of neuroendocrine tumors of the appendix

Neuroendocrine tumors are the most common type of appendix malignancy, accounting for 60% of all cases. The disease often leads to the development of metastases in the lymph nodes and liver. The choice of treatment depends on the size of the tumor. With a size of up to 1 cm, sparing surgery is performed. Appendectomy often becomes an option of choice. It is important to achieve a negative resection margin. With a size of more than 2 cm, a right hemicolectomy is performed. In the case of a size of 1-2 cm, the decision on the preferred surgical intervention depends on additional factors. Whenever possible, an appendectomy is performed. However, if the risk of recurrence is high, a right hemicolectomy may be required. It is required in the following cases:

• mesenteric invasion (invasion into the mesentery);
• enlarged lymph nodes;
• positive resection margin after appendix removal. 

Since neoplasms of this type often spread to the liver, all patients are examined for metastases. If detected, stage 4 cancer is diagnosed. However, even in this case, the disease is treatable. Surgeons can perform a combined operation: appendix tumor removal and liver resection. Local methods of tumor control can be used, when having unresectable foci or contraindications to radical surgery. These include ablation, chemoembolization, and radiation therapy.

Ablation is a minimally invasive procedure to destroy small tumors in the liver. Radiofrequency ablation is the most common option. When the neoplasm is located near large vessels, large tumors of complex configuration, preference is given to microwave ablation. Depending on the type of procedure, a doctor inserts a probe or antenna into the tumor. It is done percutaneously, through an abdominal puncture. This procedure is performed under anesthesia. The tissues are heated using the radiofrequency or microwave method, as a result, they die, and an area of necrosis is formed at the site of ​​the tumor process.

Chemoembolization is used to suppress large, multiple metastatic foci in the liver. This procedure can be used in combination with any other cancer treatments. This is a safe, minimally invasive procedure performed through an incision in the leg, from inside the blood vessels. Doctors inject tiny, drug-loaded microspheres that contain chemotherapy drugs into the tumor's arterial bed. Blood vessels clog and cancer cells lose their blood supply. Already in the first days after the procedure, most of the neoplasm dies off. Over the next few weeks, chemotherapy drugs are released from the emboli to destroy the remaining cancer cells. Chemoembolization provides destruction of liver metastases or allows achieving long-term remission of the disease.

Features of the treatment of goblet cell carcinoma

Goblet cell carcinoma is a common type of appendix cancer that shares features of adenocarcinoma and neuroendocrine tumors. These neoplasms often spread throughout the peritoneum.

If the tumor is larger than 2 cm, a right hemicolectomy is performed. If the neoplasm is smaller,   then treatment tactics are at the surgeon's discretion. If there are risk factors for recurrence, right hemicolectomy may be considered. However, in many patients, an appendectomy can be performed with the capture of healthy tissue, with the achievement of a negative resection margin.

During surgery, doctors examine the abdominal cavity to look for possible damage to the peritoneum. As a result, they can conclude:

• the presence of tumor foci; 
• the presence of cancer cells in the swabs from the peritoneum. 

With tumor foci detected, cytoreductive surgery is performed. Surgeons remove all areas of neoplasm distribution along the peritoneum.

For the treatment of peritoneal carcinomatosis in appendix cancer, doctors abroad often use hyperthermic intraperitoneal chemotherapy. It is carried out immediately after cytoreductive surgery. In addition, doctors can perform a prophylactic procedure after the removal of a part of the colon or appendix, in case of detection of cancer cells in peritoneal swabs. Perfusion lasts 1-1.5 hours. A heated solution of chemotherapy drugs penetrates the peritoneum to a depth of 2-3 mm, destroying most of the cancer cells remaining after the operation.

Features of the treatment of appendix adenocarcinoma

Adenocarcinoma is the same cancer that usually appears in other parts of the colon. It is quite often detected in the appendix, in about 20% of patients suffering from cancer.

A feature of adenocarcinoma is that it often develops at the base of the appendix, closer to the rectum, and is an aggressive tumor. It often metastasizes to regional lymph nodes, and therefore requires more extensive surgical treatment.

Adenocarcinoma is often detected after the operation has been performed. The patient is coming to the hospital with signs of acute appendicitis. The inflamed appendix is removed, and cancer cells are found in the surgical material. When they are detected, a repeated, more extensive operation is required to cure cancer.

With adenocarcinoma, appendectomy is rarely performed. Doctors always prefer right hemicolectomy with lymphadenectomy. It is because of the high incidence of lymphatic collector involvement. The choice of surgery is not affected by either the size of the tumor or the presence of signs of metastasis to the lymph nodes, according to the preoperative diagnostics.

Features of the treatment of mucinous cancer

A mucinous tumor mimics a benign tumor. It looks like a cyst, enclosed in a capsule. Before the operation, the doctor does not know whether the tumor is benign or malignant. In addition, as in the case of adenocarcinoma, many patients are admitted to the hospital with acute appendicitis. The diagnosis of cancer is established upon treatment.

During surgery to remove mucinous cancer, doctors must be careful not to damage the tumor capsule. Otherwise, malignant cells will scatter throughout the peritoneum, and treating advanced cancer is much more difficult than treating a localized tumor.

Mucinous cancer often spreads throughout the peritoneum already at the time of diagnosis. Therefore, doctors carefully check the abdominal cavity, perform a biopsy to check the suspicious areas, and take swabs for cytological examination. Mucinous cancer responds well to intraperitoneal chemotherapy.

When spreading along the peritoneum, pseudomyxoma peritonei develops. To provide its treatment, doctors perform cytoreductive surgery, which is supplemented with intraperitoneal hyperthermic chemotherapy.

Why is it worth undergoing treatment abroad?

You can receive treatment abroad. Countries with advanced medicine use the latest methods, which are more effective and safer for health. Therefore, you can expect good results, regardless of the stage of the disease.

The advantages of treatment abroad are as follows: 

• in the stage 1-3, with a low risk of recurrence, preference is given to less traumatic operation – appendectomy;
• not only open but also minimally invasive laparoscopic interventions are performed to remove appendix malignancies (they are safer for health and provide quick rehabilitation);
• successful treatment of even end-stage cancer that has spread through the peritoneum: doctors perform cytoreductive surgery and use hyperthermic intraperitoneal chemotherapy;
• with metastases detected, combined surgical interventions are performed: simultaneous removal of the appendix tumor and metastatic foci in other organs;
• the use of modern and safe procedures to suppress liver metastases, including microwave ablation, hepatic artery chemoembolization, and stereotactic radiation therapy.

When undergoing treatment in foreign hospitals, you will receive high-quality medical assistance, full care, and rehabilitation. The treatment will be less traumatic, more sparing, and provide a high quality of life after the victory over cancer.

Treatment in Europe with Booking Health

To undergo treatment for appendix cancer in one of the European hospitals, you are welcome to use the services of the Booking Health company. On our website, you can find out the cost of treatment and compare prices in different hospitals to book a medical care program at a favorable price. Treatment in Europe will be easier and faster for you, and the cost of treatment will be lower.

Please leave your request on the Booking Health website. Our specialist will contact you and consult you on treatment in Europe. Booking Health company will fully organize your trip to another country. We will provide the following benefits to you:

• We will select the best European hospital, whose doctors specialize in the treatment of appendix cancer.
• We will solve the problem of the language barrier problem, and we will ensure communication with the doctor of the European hospital.
• We will reduce the waiting period for the medical care program. You will receive treatment on the most suitable dates.
• We will reduce the price. The cost of treatment in Europe will be lower due to the lack of overpricing and additional coefficients for foreign patients.
• We will solve any organizational issues: we will draw up documents, meet you abroad and take you to the hospital; book a hotel, and provide interpreting services.
• We will prepare the program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
• We will help you keep in touch with doctors after the completion of treatment in Europe.
• We will organize additional diagnostic examinations and treatment in European hospitals.
• We will buy medicines abroad and forward them to your native country.

Leading doctors from around the world will take care of your health. Booking Health specialists will help reduce the cost of treatment, organize your trip to the European hospital, and you can fully focus on restoring your health.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Cancer Research Institute

European Society for Medical Oncology

NORD - National Organization for Rare Disorders