Late diagnosis of appendix cancer a concern, say experts

New Delhi: Being typically asymptomatic until later stages, it is difficult to diagnose appendix cancer, which can affect treatment outcomes, said experts on Wednesday.

August is appendix cancer awareness month.

The appendix is a pickle organ attached to the colon.

Appendicitis is a common problem, but appendicular cancer is rare. It is usually detected by chance while diagnosing or treating some other condition.

While early diagnosis is key to better survival in most diseases, including cancers, the rarity of appendix cancer coupled with the lack of symptoms makes it more difficult to detect, said the experts.

“Appendicular cancer, something that has recently been realised as a separate entity. Previously, it used to be merged with intestinal cancer itself, the small intestine, and large intestine cancers. Unfortunately, because it is such a rare diagnosis, it is suspected as a normal acute appendicitis in most people,” Dr. Shubham Jain, Senior Consultant, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), told IANS.

“So, the majority of the patients get misdiagnosed as having acute appendicitis in the beginning. For this, an appendectomy is done and then the biopsy report confirms whether it is an appendiceal neoplasm or appendix cancer,” the doctor explained.

As a result, the majority of the cases are identified in advanced stages and the majority of cancers are mistreated in the initial stages.

While there are no noticeable symptoms, or are mild and non-specific in the early stages of appendix cancer, as cancer progresses, one may experience abdominal pain, often in the lower right abdomen, changes in bowel habits or unexplained diarrhoea, unexplained weight loss, fatigue, feeling a mass or lump in the abdomen, inflammation of the abdominal lining if the appendix ruptures.

“Appendicular cancer is more common in women and the incidence gets higher with increasing age. Smoking is a risk factor. It can also run in the family. A history of atrophic gastritis or pernicious anaemia may also increase one’s risk of developing the disease,” Dr. Vinay Gaikwad, Director - Surgical Oncology, CK Birla Hospital, Gurugram

“Unfortunately, most appendicular cancers are detected only after surgical removal of the appendix. While neuroendocrine tumours, and low-grade mucinous tumours are less aggressive with better treatment outcomes, appendicular adenocarcinomas behave similar to colorectal cancers and can be difficult to treat, especially at later stages,” the doctor added.

The usual treatment is surgical and usually requires complete cytoreductive surgery and HIPEC (Hyperthermic intraperitoneal chemotherapy). If chemotherapy is required as part of the treatment, fertility may be affected as one of the side effects.

As the tumour biology is better understood, the results after treatment are encouraging. Advancements in therapies including aggressive surgical treatment are contributing to better outcomes.

“Appendicular cancer can affect all groups and early diagnosis and treatment is the key to better survival and quality of life,” Dr. Gaikwad said.