Appendix is a pouch-like tube that is attached to the cecum, which is the first part of large intestine or colon. Though appendix is thought to have no significant function in the body, it supports the functions in lymphatic, exocrine, or endocrine systems. Appendix cancer is a rare type of cancer that originates in the cells of the appendix, a small pouch-like organ attached to the beginning of the large intestine. It’s important to note that appendix cancer is quite uncommon, accounting for less than 1% of all gastrointestinal malignancies. The cancer can be benign (non-cancerous) or malignant (cancerous). The most common type of malignant appendix cancer is adenocarcinoma. Hence, it is crucial to have a detailed understanding and knowledge about appendix cancer and its treatment methods. In this article, we will explore the various treatment options that will help in making informed decisions.
Types of Appendix Cancer: The most common type of malignant appendix cancer is adenocarcinoma, which originates from the cells that line the inside of the appendix. Other less common types include carcinoid tumors, mucinous adenocarcinomas, and goblet cell carcinoids.
Symptoms: Appendix cancer is often asymptomatic (shows no symptoms) in its early stages. As the tumor grows, symptoms may include abdominal pain, discomfort, or bloating, changes in bowel habits, unexplained weight loss, and a feeling of fullness. However, these symptoms are not specific to appendix cancer and can occur with other conditions as well.
Diagnosis: Diagnosis often begins with imaging tests like ultrasound, CT scans, or MRI to visualize the appendix and surrounding structures. A definitive diagnosis is usually made through a biopsy, where a small sample of tissue is taken from the tumor and examined under a microscope.
Staging: Staging helps determine the extent of the cancer’s spread. The most commonly used staging system for appendix cancer is the American Joint Committee on Cancer (AJCC) staging system. It considers factors like tumor size, invasion into nearby tissues, lymph node involvement, and distant metastasis.
Treatment options for appendix cancer depend on factors such as the type and stage of the cancer.
- Surgery: Much like the treatment option to other cancers, Surgery remains as the primary treatment option for appendix cancer as well. Most commonly, this type of cancer will have slow-growing tumours, however it is important to diagnose the stage of its development and treat accordingly.
- Chemotherapy: The process in which drugs are used to destroy the cancer affected cells is called Chemotherapy. This type of treatment plays a significant role in treating appendix cancer. Chemotherapy might be used before surgery to shrink the tumour or after surgery to eliminate any remaining cancer affected cells. It can also be used as a primary treatment option for advanced cases.
- Targeted Therapy: A treatment which involves targeting specific cancer genes, proteins or tissues that contribute to the growth and survival of cancer is called Targeted therapy. Further, it blocks the cancer cells from growing and spreading to other parts of the body. This type of treatment is not suitable for all forms of appendix cancer, however unlike the traditional chemotherapy targeted therapies have shown effective outcomes.
- Radiation Therapy: It is a treatment that uses high-energy x-rays to destroy the cancer affected cells. Radiation therapy is rarely used in the treatment of appendix cancer, but it is most commonly used when the cancer has spread to nearby body parts as other treatment options might be challenging. This treatment technique has minimised side effects and better outcomes.
- Palliative Care: Palliative care becomes an essential aspect of the treatment schedule for patients with advanced or recurring appendix cancer. The primary objective of palliative care is to reduce symptoms, control pain, and enhance overall quality of life. It can be started at any stage during the disease’s course and is not just for serious conditions.
Prevention: Prevention of appendix cancer includes various prctices. A balanced diet with fibre-rich foods, fruits, and vegetables can help lower the risk of appendix cancer, leading to a healthy lifestyle. Due to the connection between obesity and an increased risk of certain malignancies, regular physical activity and keeping a healthy weight is also essential. Smoking and alcohol consumption can contribute to developing this cancer; hence it is recommended to avoid. Furthermore, ignoring any digestive problems might result in persistent inflammation, which could eventually result in the development of cancer. Lastly, maintaining regular medical checkups and screenings can help with early detection and immediate intervention if any anomalies arise, thereby preventing the advancement of appendix cancer.
The type and stage of cancer, potential side effects, the patient’s preferences, and their general health are a few of the factors that can help in deciding the suitable course of therapy. Treatment for symptoms and side effects is an essential part of cancer care and may also be included in the patient’s care plan. It is suggested to examine all the available therapy options and ensure to clarify anything that is unclear.
Dr Nikhil Mehta, MBBS, MS, Mch(Surgical Oncology), Consultant Surgical Oncologist, HCG Cancer Centre Jaipur