Appendicular cancer, or cancer of the appendix, is a rare malignancy that occurs in the small, tube-like organ attached to the large intestine. This type of cancer often presents with symptoms that are similar to other abdominal conditions, particularly acute appendicitis, making early diagnosis challenging.
WHAT IS APPENDICULAR CANCER?
The symptoms of appendicular cancer can be non-specific and often mimic other gastrointestinal conditions, such as appendicitis. Common signs and symptoms include:
Abdominal pain:
Often in the lower right quadrant.
Bloating or a feeling of fullness.
Changes in bowel habits:
Such as diarrhoea or constipation.
Nausea and vomiting.
Unintended weight loss.
Pelvic discomfort.
Abdominal mass/ swelling.
Appendiceal rupture:
Leading to widespread abdominal pain.
In some cases, the cancer may not cause noticeable symptoms until it has progressed to a more advanced stage.
The exact cause of appendiceal cancer is not well understood, and specific risk factors are not clearly defined. However, some potential risk factors may include:
Age:
Appendicular cancer is more common in adults, particularly in those over 50.
Sex:
Some studies suggest a higher incidence in women.
Family history:
A history of gastrointestinal cancers may increase the risk.
Chronic inflammatory conditions:
Conditions such as inflammatory bowel disease (IBD) might
increase the risk.
Symptoms
The symptoms of appendicular cancer can be non-specific and often mimic other gastrointestinal conditions, such as appendicitis. Common signs and symptoms include:
Abdominal pain:
Often in the lower right quadrant.
Bloating or a feeling of fullness.
Changes in bowel habits:
Such as diarrhoea or constipation.
Nausea and vomiting.
Unintended weight loss.
Pelvic discomfort.
Abdominal mass/ swelling
Appendiceal rupture:
Leading to widespread abdominal pain.
In some cases, the cancer may not cause noticeable symptoms until it has progressed to a more advanced stage.
Risk
The exact cause of appendiceal cancer is not well understood, and specific risk factors are not clearly defined. However, some potential risk factors may include:
Age:
Appendicular cancer is more common in adults, particularly in those over 50.
Sex:
Some studies suggest a higher incidence in women.
Family history:
A history of gastrointestinal cancers may increase the risk.
Chronic inflammatory conditions:
Conditions such as inflammatory bowel disease (IBD) might
increase the risk.
Diagnosis and Investigation
Diagnosis of appendicular cancer is often incidental, occurring during surgery for suspected appendicitis or other abdominal issues. However, if appendiceal cancer is suspected, several diagnostic methods are used:
Imaging studies
CT scan: Helps visualise the appendix and detect masses, thickening, or other abnormalities.
Laparoscopy
May be performed to directly visualise the appendix and surrounding tissues.
Histopathological examination
Definitive diagnosis is made by examining the appendix after surgical removal.
Treatment
The treatment of appendicular cancer depends on the type, stage, and location of the tumour. The main treatment options include:
Surgery
- Appendectomy: Removal of the appendix is the most common procedure, particularly if the cancer is localised.
- Right hemicolectomy: If the tumour has spread, part of the colon and lymph nodes may also be removed.
- Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC): For advanced cases with peritoneal spread, surgery is followed by HIPEC to kill remaining cancer cells.
Chemotherapy
Systemic chemotherapy may be used for more advanced or aggressive cancers, especially if there is a high risk of recurrence or metastasis.
Targeted therapy
In cases where specific genetic mutations are present, targeted therapies may be an option.
Prognosis
The prognosis of appendiceal cancer varies significantly depending on the type of cancer, stage at diagnosis, and response to treatment. Early-stage, localised tumours often have a better prognosis, while advanced cancers with metastasis may have a poorer outlook. Regular follow-up and monitoring are crucial for managing this condition.
Prevention
There is no known way to prevent appendix cancer.
Conclusion
Appendicular cancer is a rare and often challenging condition to diagnose. Awareness of the potential signs and symptoms, along with timely investigation and appropriate treatment, is crucial for improving outcomes. Multidisciplinary care involving surgeons, oncologists, and pathologists is often necessary for the optimal management of patients with this rare malignancy.
