Appendix Cancer

About

Dr. Deepak Chhabra

Surgical Oncologist

MS. (Bom), DNB, M.R.C.S. (Edin. UK)

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FAQ

  1. What is cancer
  2. Cancer Risk factors
  3. Stages of Cancer
  4. Early signs of Cancer
  5. Early detection of Cancer

The world knows this man as a consultant oncosurgeon with vast experience in Gastrointestinal and Hepatobiliary-Pancreatic cancers,who specializes in stapled anastomosis for bowel cancers and sphincter saving resections for rectal cancers. In short, he is the person to be contacted for all kinds of cancer related cases.

Richa AgrawalPancreatic Cancer

Thank you Dr Deepak for all you have done for mum, for putting the smile back of her face. I wish you success in all your future endeavors and know that you will continue to touch peoples lives and help them be healthy - the way you have done for my mum….. and me.

Nicola MathiasStomach Cancer

For 67years I've led a very healthy life and thank the "Almighty" for it. However as I said all good things come to an end some time and so be it. Out of the blues was detected the dreadful illness "C" which had shown no signs or symptoms whatsoever..... Time had now come for me to choose a very efficient Oncologist for my treatment.

Patient

My mother was diagnosed of colon cancer, and I was recommended to see Dr Deepak Chhabra for consultation.
The first impression of Dr Chhabra was… he is so young! But after consulting him we realized his level of experience and there was a sense of confidence he spilt over us.We knew we could trust him.....

Neelu GroverColon Cancer
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Appendix Cancer

The appendix is a small hollow tube attached to the large colon (the large colon is also called large bowel or large intestine). The appendix is approximately 4 inches long and shaped like a worm. The appendix serves no known purpose, although it is thought to possibly play a role in the immune system. Very rarely, the appendix may become cancerous. Since the appendix is attached to the colon, most of the times appendix cancer is considered a type of colorectal cancer.

Tumor size is directly related to prognosis (outlook). Appendix tumors less than two centimeters have a low tendency to spread while tumors larger than 2.5 centimeters may require more aggressive treatment.

About

Appendix cancer occurs when cells in the appendix become abnormal and multiply without control.

Types of appendix tumors

The appendix like many other organs in the body has hormone producing cells. If a tumor starts from the hormone producing cells it is termed as Carcinoid tumor. If it has not started from the hormone producing cells it is called non-carcinoid tumor.

Carcinoid tumor: A carcinoid tumor starts in the hormone-producing cells that are normally present in small amounts in almost every organ in the body. A carcinoid tumor arises primarily in either the gastrointestinal tract or lungs, but it also may occur in the pancreas, a man’s testicles, or a woman’s ovaries. Approximately 66% of all appendix tumors are carcinoid tumors. This type of cancer usually causes no symptoms until it has spread to other organs and often goes unnoticed until it is found during an examination or procedure performed for another reason. An appendix carcinoid tumor that remains confined to the area where it started has a high chance of successful treatment with surgery.

Non-Carcinoid Tumors: Non-carcinoid tumors of the appendix originate from the epithelial cells lining the inside of the appendix. Most of the cells creating these tumors produce a gelatinous material known as mucin. Due to the anatomic structure of the appendix and the mucin production of these tumors, patients with non-carcinoid tumors of the appendix are at risk of perforation and spread of tumor cells and mucin within the abdominal cavity. If left untreated, both tumor cells and mucin can accumulate over time. This situation is called Pseudomyxoma peritonei and can lead to life-threatening bowel obstruction and cachexia (weight loss, muscle atrophy, significant loss of appetite, fatigue).

Which part of the pancreas is affected with cancer?

Cancer can affect any part of the pancreas, the head, body or the tail but is more common in the wide right end or commonly called as the head of pancreas. Sometimes a common label of “periampullary cancer” is used indicating that the location of cancer can be either in the head of pancreas, at the common opening called ampulla, at the lower end of the bile duct or at the intestine where the pancreatic duct opens.

Causes

What are the risk factors of appendix cancer?

Appendix cancer has no known cause. There are no known lifestyle changes that one can make to lower the risk of developing appendix cancer.

Symptoms

Most of the times there are no symptoms of appendix cancer until it has progressed and is advanced.

Cancer of the appendix may cause appendicitis or cause the appendix to rupture. Sometimes this is the first symptom of appendix cancer.

A ruptured appendix may cause a very serious condition called peritonitis, which is an infection of the lining of the abdomen and pelvis. A cancerous tumor of the appendix may also “seed” the abdomen with cancer cells. This may cause more cancerous tumors to develop in the abdomen before it is discovered.

Abdominal discomfort and bloating of the abdomen can be signs of advanced appendiceal cancer.

Tests

What tests are carried out to diagnose appendix cancer?

Often, appendix cancer remains undiagnosed until it is unexpectedly found during or after abdominal surgery or when an abdominal mass is seen during a CT scan for an unrelated condition.

If appendix cancer is suspected during abdominal surgery, the surgeon would take a tissue sample (biopsy) for a pathologist to review. Otherwise, the cancer may be diagnosed after your abdominal surgery as part of the routine pathology reading. In that case, another surgery may be recommended to make sure all the cancerous tissue is removed.

Treatment

What is the treatment of appendix cancer?

Treating appendix cancer depends on the type of tumor, its location within the appendix and whether or not it has spread. Because these tumors are relatively rare, particularly the non-carcinoid tumors, most treatment strategies have not been tested in standard clinical trials. In general, patients will undergo surgery to remove the appendix and/or right colon.

Surgery

Surgery For Appendix Cancer

The majority of cases, carcinoid tumors are small (less than two centimeters) and have a very low risk of spread to nearby lymph nodes. Appendectomy (removal of the appendix) is adequate treatment in these cases. Larger tumors have a slightly higher risk of spreading to surrounding lymph nodes and the liver. Removal of the right colon and regional lymph nodes is recommended. (Right Hemicolectomy)

For patients with non-carcinoid tumors that have spread within the abdominal cavity, the most effective therapy appears to be a combined approach of cytoreductive (tumor debulking) surgery and hyperthermic intraperitoneal (i.e., in the abdominal cavity) chemotherapy.

Appendix cancer has often spread to the peritoneal surfaces of the abdomen by the time it is discovered. The surgery to remove as much of the cancer in the abdomen as possible, reducing the “bulk” of the cancer is called “debulking” or “cytoreduction” surgery. “Cyto” is a word root meaning cells, so cytoreduction means to surgically “reduce” number of cancer cells. Both terms mean the same thing and are usually used interchangeably.

Cytoreduction (debulking) surgery is often long , complicated and a major operation to remove all the tumor and mucin present within the abdominal cavity. This can often require removing involved organs such as parts of the intestine, gallbladder, spleen, ovaries, uterus and even the lining of the abdominal cavity (peritoneum). “Complete cytoreduction” or “complete debulking” means that all of the visible tumors are successfully removed during surgery. “Incomplete cytoreduction” or “incomplete debulking” means that all of the tumors could not be removed during the surgery and that visible tumors were left behind.

The factor most associated with long term survival is completeness of cytoreduction, or the removal of all visible tumors.

To destroy very small tumors and cancer cells left behind that are too small to be seen, and to prevent them from later growing into new cancerous tumors in the abdomen, the surgery can be followed by treatment with intraoperative Hyperthermic Intraperitoneal Chemotherapy or by treatment with early post-operative intraperitoneal chemotherapy (EPIC) at facilities that have the capability to provide these treatments.

These chemotherapy treatments may be effective on very tiny tumors that cannot be removed, but are not able to completely destroy larger tumors left behind.

HIPEC is performed only if a complete tumor debulking is achieved. During the surgery, the abdominal cavity is filled with a chemotherapy drug, which is heated to over 40 degrees Celsius. The patient’s abdomen is then gently rocked back and forth for 90 minutes to ensure that the chemotherapy bathes all areas of the abdominal cavity, killing any remaining tumor cells.

When intravenous chemotherapy (IV chemo) is indicated for the treatment of appendix cancer, the specific drugs used are usually the same as those used to treat colon cancer. Appendix cancer is so uncommon that clinical trials comparing the effectiveness of the various available chemotherapy agents have not been done. Since colon cancer and appendix cancer pathologies are similar, the effectiveness of these chemotherapy medications is assumed to be beneficial in the treatment of appendix cancer, and in many cases it has been demonstrated to be effective. Most often a combination of several drugs is used.