Discuss appendiceal cancer incidence, significance, and management?

Discuss appendiceal cancer incidence, significance, and management?

Discuss appendiceal cancer incidence, significance, and management?

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Appendiceal Cancer

 Appendiceal cancer is a rare type of a cancer that arises from the mutations of the cells of the appendix. It can either be epithelial i.e. mucinous, non-mucinous, adenocarcinoma and signet cell tumors or non-epithelial i.e. Neuroendocrine tumors, lymphomas and sarcomas. Malignant appendiceal tumors are so rare that they account for approximately 1-1.5% of incidental appendicectomy findings(Orchard et al., 2022).Data from the National Cancer institute indicates that appendiceal cancer affects an estimated 1-2 people per one million population annually with men and women being affected equally.

Significance

 Appendiceal cancer if not detected on time can lead to a series of complications and even mortality. Of importance to note is that the incidence rates of appendiceal cancer have been reported to be on the rise over the past decades. Most epithelial appendicular cancers can lead to accumulation of mucin which can cause appendix rupture. If this mucin accumulates in the abdomen it can cause pseudomyxoma peritonei (PMP). They can also metastasize to other parts of the body with peritoneal metastasis being the most common site.

Management

The management of appendiceal cancer is dependent on the type and staging of the disease. Appendiceal cancer can be treated medically, surgically or using radiations. Medical treatment entails the use of chemotherapy, immunotherapy and targeted therapy. Hyperthermic Intraperitoneal chemoperfusion (HIPEC) is highly recommended whereby agents such as cisplatin, carboplatin and folinic acid can be used. Surgical management may include cytoreductive surgery (CRS) where all visible intraabdominal tumors are removed (Hoehn et al., 2021). In some cases, HIPEC is recommended after CRS to get rid of the microscopic malignant cells left behind after surgical resectioning.

References

Hoehn, R. S., Rieser, C. J., Choudry, M. H., Melnitchouk, N., Hechtman, J., & Bahary, N. (2021). Current Management of Appendiceal Neoplasms. American Society of Clinical Oncology Educational Book, 41, 118–132. https://doi.org/10.1200/EDBK_321009

Orchard, P., Preece, R., Thomas, M. G., Dixon, S. W., Wong, N. A. C. S., Chambers, A. C., & Messenger, D. E. (2022). Demographic trends in the incidence of malignant appendiceal tumours in England between 1995 and 2016: Population-based analysis. BJS Open, 6(4), zrac103. https://doi.org/10.1093/bjsopen/zrac103