From the Guidelines
Appendix cancer often presents with vague symptoms that can mimic other gastrointestinal conditions, making early diagnosis challenging. The most common presenting symptoms include abdominal pain (particularly in the lower right quadrant), bloating, increased abdominal girth, changes in bowel habits (such as diarrhea or constipation), nausea, vomiting, and unintentional weight loss 1. Some patients may develop appendicitis-like symptoms if the tumor causes obstruction of the appendix. In advanced cases, patients might experience fatigue, loss of appetite, and a feeling of fullness even after eating small amounts of food. Many cases are discovered incidentally during imaging studies or surgery performed for other reasons. A significant number of patients with appendiceal cancer, particularly those with mucinous tumors, may develop pseudomyxoma peritonei, characterized by accumulation of mucin in the abdominal cavity, causing progressive abdominal distension 1. Due to the nonspecific nature of these symptoms, patients experiencing persistent abdominal discomfort or changes in bowel habits should seek medical evaluation promptly, as early detection significantly improves treatment outcomes. Key symptoms to watch out for include:
- Abdominal pain
- Bloating
- Increased abdominal girth
- Changes in bowel habits
- Nausea
- Vomiting
- Unintentional weight loss
- Fatigue
- Loss of appetite
- Feeling of fullness even after eating small amounts of food.
From the Research
Presenting Symptoms of Appendix Cancer
The presenting symptoms of appendix cancer can vary, but some common symptoms include:
- Abdominal pain, particularly in the lower right quadrant
- Nausea and vomiting
- Loss of appetite
- Weight loss
- Bloating and abdominal distension
- Changes in bowel habits
Diagnosis and Staging
Appendix cancer is often diagnosed incidentally during surgery for acute appendicitis 2. The staging and management of appendix cancer depend on the subtype of the tumor, with different subtypes having distinct histological and biological characteristics 3.
Symptom Associations with Stage at Diagnosis
Research has shown that certain presenting symptoms are associated with a higher likelihood of advanced stage cancer at diagnosis. For example, symptoms such as neck lump, chest pain, and back pain are consistently associated with increased odds of stage IV cancer 4. However, for most symptoms, a large proportion of patients are diagnosed at stages other than stage IV.
Surveillance and Detection
Surveillance MRI imaging has been shown to be superior to serum tumor markers for detecting early tumor recurrence in patients with appendiceal cancer treated with surgical cytoreduction and HIPEC 5. This highlights the importance of regular surveillance and monitoring for patients with appendix cancer.
Treatment and Management
The treatment and management of appendix cancer depend on the subtype and stage of the disease. While some patients may undergo nononcologic resection, oncologic colectomy is generally recommended for high-risk appendiceal adenocarcinoma 6. Despite established guidelines, some patients may still undergo nononcologic resection, which can be associated with worse survival outcomes.