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Appendix Cancer Diagnosis and Treatment - A Detailed Guide

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Doctors recommend several tests for appendix cancer diagnosis. Along with diagnosis, these tests help in staging the disease and devising an appropriate treatment plan. Based on the disease’s stage and other factors, the treatment plan may comprise one treatment or multiple treatments. Multiple treatment options available for appendix cancer include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy.

Procedures or Tests for Appendix Cancer Diagnosis

The following are the different test methods available for appendix cancer diagnosis:

Medical history and Physical evaluation

Patients should pay attention to symptoms related to the gastrointestinal system and should consult with experienced gastroenterologists or physicians. The doctor will comprehensively evaluate the patient's overall health status and detect the cause of the symptoms. The doctor may ask the patient about the starting and progression of the signs and their severity.

The doctor may also ask about smoking history, as it increases the risk of appendix cancer. Further, a medical history of atrophic gastritis, pernicious anemia, and Zollinger-Ellison syndrome may also be evaluated, as these diseases may enhance appendix cancer risk. The doctor may also ask the patients about their family history of appendix cancer.

Blood Tests

No blood test confirms the diagnosis of appendix cancer. However, blood tests may help determine the patients' overall health status. As patients with appendix cancer present with symptoms similar to appendicitis, the doctor may recommend the patients undergo tests for neutrophil percentage, total leukocyte count, and C-reactive protein (CRP) concentration. There are specific tumor markers present in the blood that may indicate appendix cancer. These include CA-125 (cancer antigen 125), CEA (carcinoembryonic antigen), and CA 19-9 (cancer antigen 19-9).

Imaging Tests

Imaging tests play a vital role in obtaining additional information about the tumor, including its size, exact location, and its extent. These tests also help specialists plan customized treatment plans, monitor the treatment response shown by patients, and detect recurrences.

CT Scan

A CT scan helps in detecting the presence of a tumor and its shape, size, and location in or surrounding the appendix. The image quality of the CT scan can be enhanced by using a contrast agent. A CT scan involves the use of X-rays to obtain images. A CT scan is also used to guide the needle during the biopsy.

MRI

Magnetic resonance imaging assists in identifying incidental appendiceal adenomas and extra-appendiceal mucin. It can also differentiate between large mucinous neoplasms and retroperitoneal and intraperitoneal conditions. MRI is preferred for the staging and follow-up of appendix carcinoma due to its higher specificity and sensitivity.

Ultrasound

Ultrasound is one of the primary imaging tests recommended for detecting gastrointestinal tract diseases. It involves sound waves, unlike other imaging techniques that use radiation. Ultrasound is highly reliable for detecting surrounding inflammation in patients with appendicitis. It is especially useful in obtaining images of the appendix in children with less abdominal fat and thin musculature.

PET Scan

A PET scan helps detect localized and metastatic tumors of the appendix. The scan uses radioactive sugar analogs taken up by the metabolically active cells, including the cancer cells. A study reported that PET/CT scans detect the fluid-filled cystic appendix with low-grade uptake. It is recommended for staging appendix cancer.

Biopsy

As an important appendix cancer detection test, a biopsy involves obtaining samples of abnormal cells and examining them in the laboratory under a microscope. A biopsy may serve as a confirmatory test for diagnosing appendix cancer.

Endoscopy

As an appendix cancer test, it uses an endoscope to view the internal tissues of the appendix. An endoscope is a thin, long tube with a camera fitted at the end that transmits the images of the appendix on the monitor. The doctor takes the samples from the abnormal areas of the appendix with the help of image guidance.

Surgical Biopsy

Surgery is considered a biopsy method when the endoscopic method fails to obtain the appropriate number of tissue samples. The surgeon makes a long incision in the abdomen to expose the appendix during surgery. The surgeon then collects samples of the tissues for further evaluation.

Laparoscopy

Laparoscopy is a minimally invasive procedure for performing a biopsy of the appendix. It uses a laparoscope, a thin, long tube with an attached camera. The surgeon makes a small incision in the abdomen and inserts the laparoscope. The images of the internal tissues of the appendix are transmitted on the monitor. After evaluating the images, the surgeon makes small holes to insert the instruments to take the tissue samples.

Pathology Examination

The patients suspected of appendix cancer undergo a pathology examination of the appendix. Pathological examination helps in determining the cause of the symptoms. The most common condition mimicking the symptoms of appendix cancer is acute appendicitis.

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What are the Effective Appendix Cancer Treatments?

Following are the appendix cancer treatment options:

Surgery

Surgery is a preferred primary treatment for all types of appendix cancer except goblet cell adenocarcinoma. The procedure is used in early-stage cancer to remove the cancerous tissues. As the disease progresses, surgery is often combined with other treatment approaches, such as radiation therapy and chemotherapy, for better outcomes.

In advanced stages, such as stage 4 appendix cancer, surgery may be performed to ease the pain and discomfort associated with the disease and improve the quality of life for patients.

Appendectomy

An appendectomy is a procedure that involves the removal of appendix cancer. Apart from treating appendix cancer, it is also performed as an emergency surgery in patients diagnosed with acute appendicitis in case of an imminent danger of appendix rupture. This procedure may be performed through open surgery or laparoscopic surgery.

Hemicolectomy

Hemicolectomy involves the removal of one side of the colon. As a part of appendix cancer treatment, the surgeon removes a portion of the colon present near the appendix. It is performed when the neuroendocrine tumor is larger than 2 cm or when the cancer diagnosed is not a neuroendocrine tumor. The lymph nodes and blood vessels are removed during the hemicolectomy procedure.

Cytoreductive Surgery (Debulking)

Cytoreductive or debulking surgery is performed in the advanced stages of appendix cancer, i.e., when the tumor spreads to the surrounding organs. During the debulking surgery, the surgeon removes most of the tumor and surrounding fluid. The surgeon also removes the parts of organs that are inseparable from the malignant cells, such as parts of the gallbladder, small intestine, uterus, ovaries, spleen, and abdominal cavity lining.

Removal of the peritoneum

The procedure that involves the removal of the peritoneum is also known as peritonectomy. It is an aggressive treatment, and several surgeons are against performing this surgery on patients diagnosed with low-grade, slow-growing appendix cancer. It is also considered a form of debulking surgery as it removes most of the cancer cells. However, the surgery is complex and may have significant side effects.

Chemotherapy

Chemotherapy is an important appendix cancer treatment option. It uses various drugs, usually in combination, to kill cancer cells or prevent their growth. Chemotherapy may be done in combination with surgery or radiation therapy.

Intraperitoneal Chemotherapy

In intraperitoneal chemotherapy, the drugs are delivered directly into the abdominal cavity. It improves efficacy and lowers side effects. Intraperitoneal chemotherapy is usually done after debulking surgery to remove the remaining cancer cells. Sometimes, the temperature of the drug solution is raised to improve penetration. This procedure involving heating the drug solution is known as hyperthermic intraperitoneal chemotherapy (HIPEC).

Systemic Chemotherapy

Systemic chemotherapy is the procedure that involves the administration of the drug into the systemic circulation. This procedure is used when there is a spread of cancer to other organs. The drug is delivered either orally or through injection. Chemotherapy is given in cycles and involves a resting period between two consecutive cycles. Depending on the dose administered and overall patient health, patients may experience various side effects, including fatigue, hair loss, nausea and vomiting, loss of appetite, and an increased risk of infection.

Radiation Therapy

Radiation therapy is a method of treating appendix cancer that kills the cell through high-energy radiation. Radiation therapy is delivered in multiple sittings or sessions spread over a predetermined period.

Targeted Therapy

There are specific proteins or genes specific to cancer cells that are vital for the growth and development of cancer cells. As one of the latest appendix cancer treatment options, targeted therapy targets these proteins or genes and interferes with the proliferation of tumor cells. Targeted therapy has relatively fewer side effects compared to conventional chemotherapy.

Clinical Trials

Clinical trials are recommended for patients who have exhausted all their treatment options. Clinical trials help patients access new drugs, new treatment methods, etc. that are not available on the wider market. Some patients find clinical trials helpful for their condition.

Those wanting to be a part of clinical trials should talk to their treating doctor for more information and appropriate guidance.

Why Choose HCG for Appendix Cancer Diagnosis and Treatment?

As a top cancer hospital in India, HCG Cancer Center is one of the most advanced centers with ultramodern facilities for diagnosing and managing appendix cancer. There are several advantages to choosing HCG for appendix cancer. These include extensive experience and specializations of the medical and paramedical staff, multidisciplinary care, highly sophisticated diagnostic tools, conventional and modern treatment options, support services, and the availability of second opinion solutions.

Conclusion

The appendix cancer diagnosis can be done through imaging techniques, blood tests, medical history and physical examination, biopsy, and pathology examination. Different options for appendix cancer treatment include surgery, chemotherapy, radiation therapy, and targeted therapy.

Frequently Asked Questions

What is the latest treatment for appendix cancer?

The latest treatment for appendix cancer includes intraperitoneal chemotherapy, targeted therapy, and robotic-assisted appendix cancer surgeries.

Removing the appendix as a part of appendix cancer treatment is effective in patients with early-stage cancer. However, advanced-stage appendix cancer requires other treatments along with surgery.

The recurrence of appendix cancer depends on several factors, such as the stage of the primary diagnosis, the overall response to treatment, and adherence to the advice of the oncologists.

Although chemotherapy is highly efficient in managing appendix cancer, its efficacy depends on the stage of cancer diagnosis, overall patient health, age, and response to chemotherapy drugs.

Appendix cancer survival rate is lower in patients with advanced-stage cancer. Chemotherapy, along with radiation therapy and surgery, may be used as a part of palliative care or appendix cancer pain treatment to reduce the severity of symptoms.

Patients diagnosed in the early stages of cancer have a favorable prognosis and may live a healthy life after the completion of treatment. However, patients with advanced-stage appendix cancer may have treatment challenges, a poor prognosis, and a relatively higher risk for recurrence.

The preparation depends on the types of tests recommended by the doctor. The expert team will provide patients with detailed information about preparing for the procedure before every test.