Appendix Cancer

Surgery is the main treatment for appendix cancer, and it depends upon the type of cancer.

• Appendectomy – It is the surgical removal of the appendix. It is usually the only treatment needed for an appendix neuroendocrine tumor smaller than 1.5 centimeters (cm).

• Hemicolectomy – It is the removal of the appendix, caecum, ascending colon and part of the transverse colon and adjoining lymph nodes.
• Cytoreductive Surgery and Peritonectomy – For advanced appendicular cancers with PMP (mucinous deposits in the abdominal cavity), cytoreductive surgery with right hemicolectomy and removal of involved organs and peritoneum is considered. This is an advanced and complex form of treatment.
• HIPEC – Following cytoreductive surgery, the peritoneal cavity is infused with heated chemotherapy to treat microscopic residual tumor cells (HIPEC).
  In this procedure, the abdominal cavity is filled with a chemotherapy drug, which is heated to more than 41-42 degrees Celsius and perfused via a special perfusion equipment in the abdomen for 90 minutes. This allows the chemotherapy drugs to reach microscopic tumor cells and treat them.

• Cystectomy is a major procedure and can be done either by an open technique or a minimally invasive approach (laparoscopic or robot assisted) depending upon factors like feasibility and overall health. It is a procedure where the whole bladder along with adjacent structures are removed.
• In men the Cystectomy is also associated with prostate gland hence, it is also called Cystoprostatectomy.
• In women most often the Cystectomy is associated with removal of the uterus and ovaries and is called anterior pelvic exenteration.
• Following this, the urine which is produced by the kidney will need to be re-channeled and brought out of the body. This can be done through:
  • – Urostoma (ileal conduit)– a diversion of urine with a segment of the bowel which is brought out to the abdominal wall.
  • – Neobladder – A new artificial bladder is created from a long segment of the bowel and placed where the bladder was previously existing.

• Radiation therapy using a schedule is rarely used in the treatment of appendix cancer. However, sometimes it may be used to treat a particular area when cancer has spread, to help relieve symptoms.

• Chemotherapy– Chemotherapy uses drugs to destroy cancer cells. The indication for chemotherapy is based on the stage of cancer and risk factors.
  Chemotherapy may be used before surgery (Neoadjuvant therapy) to shrink large tumors, which makes it easier to remove the tumor.
  Few patients may require chemotherapy after surgery (Adjuvant therapy) which helps to kill any residual cancer cells. It is also indicated in cases when the disease has spread to other parts of the body.

• Targeted drug therapy- The indication for targeted therapy is based on molecular changes in the cancer cell. This may be combined with chemotherapy in selected cases. In the case of recurrent disease, based on the molecular alterations noted in the tumor, specific targeted therapy is also an option.
• Immunotherapy-
  Immunotherapy is a drug treatment that uses the immune system to fight cancer. Immunotherapy may be an option in selected patients who have advanced disease and recurrent disease.