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| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Appendix cancer}} |
| {{CMG}} {{AE}} {{MV}}
| | '''For patient information, click [[Appendix cancer (patient information)|here]]''' |
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| {{SK}} Tumors of the appendix; Appendiceal cancer; Cancer of the appendix
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| ==Overview==
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| '''Appendix cancer''' '''(also known as appendiceal cancer)''' is a rare malignancy of the vermiform appendix. The most common type of appendix cancer is carcinoid tumor. Appendix cancers often present with peritoneal seeding, resulting in peritoneal carcinomatosis or pseudomyxoma peritonei.<ref name="pmid22302267">{{cite journal |vauthors=Turaga KK, Pappas SG, Gamblin T |title=Importance of histologic subtype in the staging of appendiceal tumors |journal=Ann. Surg. Oncol. |volume=19 |issue=5 |pages=1379–85 |year=2012 |pmid=22302267 |doi=10.1245/s10434-012-2238-1 |url=}}</ref>
| | {{CMG}}; {{AE}} {{Soroush}} |
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| ==Historical Perspective==
| | {{SK}}Appendix malignancy, Appendix tumor, Appendiceal cancer, Appendiceal malignancy, Carcinoid tumor of appendix, Adenocarcinoma of appendix, Goblet cell tumor of appendix, |
| *Appendix cancer was first discovered by Siegfried Oberndorfer, a German Physician, in 1907.
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| *In 1894, the first surgery also known as ''McBurney's incision'' was developed by Charles Heber McBurney, an American surgeon, to treat appendix cancer.<ref name="surgery">McBurney C. (1889). "Experience with early operative interference in cases of disease of the vermiform appendix". NY Med J 50: 676–684.</ref>
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| ==Classification==
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| *Appendix cancer may be classified according to WHO classification into 4 groups:
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| :*Epithelial tumors
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| :*Non-epithelial tumors
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| :*Secondary tumors
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| :*Hyperplastic (metaplastic) polyp
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| *The table below summarizes the different types of appendix cancer according to the WHO classification
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| {|style="border: 5px; font-size: 90%; margin: 5px; width: 800px" align=center
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| !style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="2"|{{fontcolor|#FFF|'''WHO histological classification<br>Tumors of the appendix <br><SMALL> Adapted from WHO/IARC </SMALL>'''}}
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| |valign=top|
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| |+
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Epithelial tumors
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| |-
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| *Adenoma
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| :*Tubular
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| :*Villous
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| :*Tubulovillous
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| :*Serrated
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| *Carcinoma
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| :*Adenocarcinoma
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| :*Mucinous adenocarcinoma
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| :*Signet-ring cell carcinoma
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| :*Small cell carcinoma
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| :*Undifferentiated carcinoma
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| *Carcinoid (well differentiated endocrine neoplasm)
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| *Tubular carcinoid
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| *Goblet cell carcinoid (mucinous carcinoid)
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| *Mixed carcinoid-adenocarcinoma
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| *Others
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Non-epithelial tumors
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| |-
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| *Neuroma
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| *Lipoma
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| *Leiomyoma
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| *Gastrointestinal stromal tumor
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| *Leiomyosarcoma
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| *Kaposi sarcoma
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| *Others
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| |-
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| |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Secondary tumors
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| |-
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| *Metastasis (eg. Primary of urogenital tract, breast, lung)
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| |-
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| |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Hyperplastic polyp
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| |}
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| ==Pathophysiology== | | ==[[Appendix cancer overview|Overview]]== |
| *The pathogenesis of appendix cancer is characterized by a chronic inflammatory process.
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| *The KRAS gene mutation has been associated with the development of appendix cancer.
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| *On gross pathology, well-demarcated mass, less than 1 cm, and gray or yellowish color, and deformed appendix are characteristic findings of appendix cancer.
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| *On microscopic histopathological analysis findings will depend on the subtype of appendicular cancer.
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| *Common histopathological findings, may include:
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| :*Cystic structures
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| :*Angiolymphatic invasion
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| :*Well differentiated and mucinous
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| <ref name=Rosai />
| | ==[[Appendix cancer historical perspective|Historical Perspective]]== |
| <gallery>800px-Appendix_Carcinoid_Torsion_1X_PA.JPG | Appendiceal carcinoid<ref name=aaa>http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_appendix</ref>
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| 800px-Appendix_Carcinoid_HP_14BR---.jpg | Appendiceal carcinoid<ref name=aaa>http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_appendix</ref>
| | ==[[Appendix cancer classification|Classification]]== |
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| 800px-Appendix_Carcinoid_Necrosis_PA.JPG | Appendiceal carcinoid with necrosis<ref name =aaa>http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_appendix</ref>
| | ==[[Appendix cancer pathophysiology|Pathophysiology]]== |
| 800px-Appendix_Carcinoid_Synaptophysin_14BR---.jpg | Carcinoid Synaptophysin<ref name=aaa>http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_appendix</ref>
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| 800px-Appendix_Carcinoid_HP_CTR.jpg | Appendiceal tumor<ref name=aaa>http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_appendix</ref>
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| </gallery>
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| ==Causes== | | ==[[Appendix cancer causes|Causes]]== |
| *Common causes of appendix cancer may include:
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| :*'''Genetic susceptibility'''
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| ::*Familial adenomatous polyposis
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| ::*Hereditary non-polyposis colorectal cancer
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| :*'''Chronic inflammatory diseases'''
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| ::*Ulcerative colitis
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| ::*Crohn's disease
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| ==Differentiating appendix cancer from other Diseases== | | ==[[Appendix cancer differential diagnosis|Differentiating Appendix cancer from other Diseases]]== |
| * Appendix cancer must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
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| :*[Differential dx1]
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| :*[Differential dx2]
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| :*[Differential dx3]
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| ==Epidemiology and Demographics==
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| * The prevalence of appendix cancer is approximately [number or range] per 100,000 individuals worldwide.
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| * In [year], the incidence of appendix cancer was estimated to be [number or range] cases per 100,000 individuals in [location].
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| ===Age===
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| *Patients of all age groups may develop appendix cancer.
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| * Appendix cancer is more commonly observed among patients aged [age range] years old.
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| * Appendix cancer is more commonly observed among [elderly patients/young patients/children].
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| ===Gender===
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| * Appendix cancer affects men and women equally.
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| *[Gender 1] are more commonly affected with appendix cancer than [gender 2].
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| * The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
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| ===Race===
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| *There is no racial predilection for appendix cancer.
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| * Appendix cancer usually affects individuals of the [race 1] race.
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| *[Race 2] individuals are less likely to develop appendix cancer.
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| ==Risk Factors==
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| *Common risk factors in the development of appendix cancer are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
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| == Natural History, Complications and Prognosis==
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| *The majority of patients with appendix cancer remain asymptomatic for [duration/years].
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| *Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
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| *If left untreated, [#%] of patients with appendix cancer may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
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| *Common complications of appendix cancer include [complication 1], [complication 2], and [complication 3].
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| *Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with appendix cancer is approximately [#%].
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| == Diagnosis ==
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| ===Diagnostic Criteria===
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| *The diagnosis of appendix cancer is made when at least [number] of the following [number] diagnostic criteria are met:
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| :*[criterion 1]
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| :*[criterion 2]
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| :*[criterion 3]
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| :*[criterion 4]
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| === Symptoms ===
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| * Appendix cancer is usually asymptomatic.
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| *Symptoms of appendix cancer may include the following:
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| :*[symptom 1]
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| :*[symptom 2]
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| :*[symptom 3]
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| :*[symptom 4]
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| :*[symptom 5]
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| :*[symptom 6]
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| === Physical Examination ===
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| *Patients with appendix cancer usually appear [general appearance].
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| *Physical examination may be remarkable for:
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| :*[finding 1]
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| :*[finding 2]
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| :*[finding 3]
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| :*[finding 4]
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| :*[finding 5]
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| :*[finding 6]
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| === Laboratory Findings ===
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| *There are no specific laboratory findings associated with appendix cancer.
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| *A [positive/negative] [test name] is diagnostic of appendix cancer.
| | ==[[Appendix cancer epidemiology and demographics|Epidemiology and Demographics]]== |
| *An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of appendix cancer.
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| *Other laboratory findings consistent with the diagnosis of appendix cancer include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
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| ===Imaging Findings===
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| *There are no [imaging study] findings associated with appendix cancer.
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| *[Imaging study 1] is the imaging modality of choice for appendix cancer.
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| *On [imaging study 1], appendix cancer is characterized by [finding 1], [finding 2], and [finding 3].
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| *[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
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| === Other Diagnostic Studies ===
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| * Appendix cancer may also be diagnosed using [diagnostic study name].
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| *Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
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| == Treatment ==
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| === Medical Therapy ===
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| *There is no treatment for appendix cancer; the mainstay of therapy is supportive care.
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| *The mainstay of therapy for appendix cancer is [medical therapy 1] and [medical therapy 2].
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| *[Medical therapy 1] acts by [mechanism of action1].
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| *Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
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| === Surgery ===
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| *Surgery is the mainstay of therapy for appendix cancer.
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| *[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of appendix cancer.
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| *[Surgical procedure] can only be performed for patients with [disease stage] appendix cancer.
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| === Prevention ===
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| *There are no primary preventive measures available for appendix cancer.
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| *Effective measures for the primary prevention of appendix cancer include [measure1], [measure2], and [measure3].
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| *Once diagnosed and successfully treated, patients with appendix cancer are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
| | ==[[Appendix cancer risk factors|Risk Factors]]== |
| ==References== | | |
| {{Reflist|2}}
| | ==[[Appendix cancer screening|Screening]]== |
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| [[Category: Oncology]] | | ==[[Appendix cancer natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| | ==Diagnosis== |
| | [[Appendix cancer diagnostic study of choice|Diagnostic study of choice]] | [[Appendix cancer history and symptoms|History and Symptoms]] | [[Appendix cancer physical examination|Physical Examination]] | [[Appendix cancer laboratory findings|Laboratory Findings]] | [[Appendix cancer electrocardiogram|Electrocardiogram]] | [[Appendix cancer x ray|X-Ray Findings]] | [[Appendix cancer echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Appendix cancer CT scan|CT-Scan Findings]] | [[Appendix cancer MRI|MRI Findings]] | [[Appendix cancer other imaging findings|Other Imaging Findings]] | [[Appendix cancer other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
| | [[Appendix cancer medical therapy|Medical Therapy]] | [[Appendix cancer interventions|Interventions]] | [[Appendix cancer surgery|Surgery]] | [[Appendix cancer primary prevention|Primary Prevention]] | [[Appendix cancer secondary prevention|Secondary Prevention]] | [[Appendix cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Appendix cancer future or investigational therapies|Future or Investigational Therapies]] |
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| | ==Case Studies== |
| | [[Appendix cancer case study one|Case #1]] |
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| | [[Category:Surgery]] |
| | [[Category:Medicine]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Oncology]] |
| | [[Category:Up-To-Date]] |