The appendix or appendix (appendix) is an approximately 10 cm long protuberance at the transition from the small intestine to the large intestine. It consists mainly of lymphoid tissue and serves the immune system.
In very rare cases, the cells of the appendix can degenerate and thus lead to an appendix tumor. Cancer of the appendix makes up less than 1% of all gastrointestinal cancers and is mostly treated like colon cancer.
Causes of appendix cancer
The causes for the degeneration of cells are manifold. Depending on which type of cell degenerate, different forms of cancer develop.
The most common form is mucinous adenocarcinoma, which arises from the mucinous cells in the appendix. There are certain mutations in DNA that can promote degeneration in the appendix. These include the TP53 mutation and the GNAS mutation.
In addition, a so-called neuroendocrine tumor (NET) can be the cause of appendix cancer. This type of tumor affects the appendix in 40% of cases.
Find out more about the Causes of Colon Cancer.
Making a diagnosis of appendic cancer is not easy, as the disease rarely causes early symptoms.
The first steps are to describe the symptoms and ask about the medical history (anamnesis). Then the physical exam follows.
Sonography can also be performed, although this does not always give clear results. If colon cancer is suspected, a colonoscopy is very important because it can be used to obtain tissue samples. Examination of these samples provides information regarding the degeneration of the cells. Further imaging procedures such as computed tomography can be connected to rule out the spread of the cancer.
If a neuroendocrine tumor (NET) is suspected, the serotonin level in the blood and 5-hydroxyindole acetic acid in the 24-hour urine would be determined. In addition, a somatostatin receptor scintigraphy is carried out.
They find out, how colon cancer is diagnosed.
These are the symptoms that can be used to identify cancer of the appendix
Appendectal cancer causes almost no early symptoms. Only when the tumor becomes larger can it lead to symptoms.
The appendix is often narrowed so that bacteria can multiply. This can lead to appendicitis. This has to be treated surgically and a tissue sample is always taken. This is how you can make the diagnosis in that case.
Another symptom of advanced appendix cancer can be a hardening of the lower abdomen or pelvic area. This can be caused by the tumor and can also lead to pain.
In severe cases, the appendix wall can be destroyed by the tumor, so that the cancer cells spread in the abdomen (pseudomyxoma peritonei). The cells produce a gel-like liquid that causes adhesions in the abdomen and dissipates the tumor.
In the case of a neuroendocrine tumor (NET), diarrhea, abdominal cramps and sudden red discoloration of the skin with hot flashes can occur.
Read what the typical symptoms of colon cancer are.
Therapy of appendix cancer
Appendectal cancer is treated like colon cancer in most cases.
Find out about the Treatment options for colon cancer.
If the tumor is locally limited or the spread (metastases) can be treated, one would operate first. The right part of the colon is removed and a so-called right hemicolectomy is performed. Attempts are also made to remove the local lymph nodes in order to prevent them from spreading. The operation is performed minimally invasively (laparoscopic) if possible.
Read more about the Colon cancer surgery.
Depending on the stage of the tumor disease, chemotherapy is also given.
If the tumor has already spread to the abdomen, a hemicolectomy is also performed on the right, during which the peritoneum is also removed. The abdomen is also rinsed with a chemotherapeutic agent.
No radiation therapy is performed on the intestine.
In the case of a neuroendocrine tumor (NET), the appendix and local lymph nodes would also be surgically removed. If the findings are very advanced and there is no option for surgery, drugs such as somatostatin analogs are given. In some cases, chemotherapy is also necessary here.
As with normal colon cancer, chemotherapy can be considered for appendix cancer from stage II. The stages are divided according to the size of the tumor and its spread. Most of the time, based on all examinations, an interdisciplinary decision is made as to whether this therapy is appropriate.
In stage II, monotherapy would be carried out, i.e. therapy with a single chemotherapeutic agent. Fluoropyrimidines are mostly used for this.
Combination therapies are possible from stage III. You can give the so-called FOLFOX (5-FU + folinic acid + oxaliplatin) or the combination XELOX (capecitabine + oxaliplatin).
In poorly differentiated neuroendocrine tumors (NET), chemotherapy with cisplatin and etoposide can be given.
Find out more about the Chemotherapy for colon cancer.
How is the disease progressing?
The course of the disease depends on the stage of the colon cancer.
If the findings are minor, surgery is sufficient and the chances of recovery are very high.
If it has spread to the lymph nodes or other organs, chemotherapy is necessary within 8 weeks after the operation. In some cases, the tumor can spread to other organs, such as the liver, and surgery.
If the appendix cancer has reached the peritoneum and spread there, this can lead to adhesions in the intestine. These complications must be treated surgically. Such a case has a bad prognosis.
Let the Course of colon cancer explain in more detail.
Metastasis of appendix cancer
Metastases are spreads of the tumor that spread via the bloodstream, the lymphatic system or neighboring tissue.
The appendix cancer can attack neighboring tissue and, in the event that the appendix bursts, spread into the abdomen. Other structures that can be affected early on are the local lymph nodes, which transport the lymph from the appendix. The tumor can travel through the blood to the liver, lungs, skeleton and brain.
The metastases are usually treated with chemotherapy and in some cases can be operated on.
Find out about possible locations of Colon cancer metastases and their therapy.
What are the chances of recovery from colon cancer?
In most cases, appendix cancer is an incidental finding discovered when the appendix is removed. In these cases, the tumors are usually localized so that healing can be achieved through the operation.
If the tumor has invaded the lymph nodes, the 5-year survival rate drops to 78%.
If distant metastases exist, i.e. if the tumor has spread to other organs, the chances of survival are around 32%.
General statements are difficult to make and should be viewed with caution. The prognosis must always be made individually, depending on previous illnesses and the respective findings.In addition, the chances of recovery are highly dependent on the type of cancer and can therefore vary greatly.
Read more about whether Colon cancer curable is.