Appendix Cancer

Overview

Treatment

The treatment of appendix cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.
This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.
Descriptions of the most common treatment options for appendix cancer are listed below.

Surgery

Surgery is the most common treatment for appendix cancer. Most often, appendix cancer is low-grade (see Staging) and therefore slow-growing. Often it can be successfully treated with surgery alone. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Types of surgeries for appendix cancer include:

Appendectomy.

An appendectomy is the surgical removal of the appendix. It is usually the only treatment needed for an appendix tumor smaller than 1.5 centimeters (cm).
In cases where appendix cancer is discovered unexpectedly after an appendectomy was performed for what was originally thought to have been appendicitis, a second operation to remove more tissue (using surgical techniques described below) is often recommended.

Hemicolectomy

For a tumor larger than 2 cm, a hemicolectomy may be recommended. This is the removal of a portion of the colon next to the appendix; removal of nearby blood vessels and lymph nodes is often done at the same time. A right hemicolectomy is surgery performed on the right side of the colon. Even though a large amount of the large intestine is removed, the operation usually does not result in the need for a colostomy or stoma (an opening in the abdomen through which the bowel contents are emptied into a bag).

Debulking surgery

For advanced appendix cancer, debulking (or cytoreduction) surgery may be performed. In this surgery, the doctor removes as much of the tumor “bulk” as possible, which could benefit the patient even though not every cancer cell will be removed from the body. Sometimes, debulking surgery will be followed with chemotherapy (see below) to destroy any remaining cancer cells.
In cases where the tumor produces mucous, much of the bulk of the abnormal tissue is often not cancer, but is due to accumulation of the mucous. The mucous looks like jelly, and this condition is often referred to as “jelly belly.” Removing the mucous from the abdomen can often relieve a patient’s symptoms of bloating.

Removal of the peritoneum

There is some controversy about the extent of surgery that is necessary in patients with slow-growing, low-grade cancer that has spread beyond the colon to involve other areas of the abdomen. Some surgeons recommend aggressive surgery that includes the removal of the peritoneum (the lining of the abdomen) to remove as much of the cancer as possible. In patients with a very slow-growing tumor, such surgery can be effective in removing the majority of the cancer cells. This can benefit the patient by reducing the amount of cancer even if not every cancer cell is removed. However, it is a difficult operation that can have significant side effects. The doctor will consider many different factors, such as the patient’s age and overall health, prior to recommending this extensive surgery. Patients should talk with a specialist with expertise in this type of procedure beforehand.
Learn more about cancer surgery.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. For appendix cancer, chemotherapy is most often used soon after surgery when cancer is found outside of the appendix region. There are different types of chemotherapy, depending on how the drugs are delivered to the body:

Local/intraperitoneal chemotherapy

Local chemotherapy is when the medication delivery is focused on one area or section of the body. This is the most common type of chemotherapy used in the treatment of appendix cancer; more specifically, it is called intraperitoneal chemotherapy, which is chemotherapy that is given directly into the abdominal cavity. Typically, the surgeon will try to remove as much of the tumor as possible (debulking surgery, see above) and then insert a tube in the abdomen, through which chemotherapy can be administered after the operation. In some cases, the chemotherapy is warmed up to above body temperature to increase its ability to penetrate the tissue that may be lined with tumor cells; this is called hyperthermic (or heated) intraperitoneal chemotherapy. Once chemotherapy is completed, the tube is removed, generally without the need for another operation.

Systemic chemotherapy

This type of chemotherapy is delivered through the bloodstream, to target cancer cells throughout the body. This can be done using an IV (a tube inserted into a person’s vein). Some people may receive this type of chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. Specific drugs given in systemic chemotherapy are similar to those for colorectal cancer and can include: fluorouracil (5-FU, Adrucil), leucovorin (Wellcovorin), capecitabine (Xeloda), irinotecan (Camptosar), oxaliplatin (Eloxatin), bevacizumab (Avastin), and cetuximab (Erbitux).

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away when treatment is finished.

Learn more about chemotherapy. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.Radiation therapy

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