Appendix cancer secondary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Appendix cancer}} | {{Appendix cancer}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{Soroush}} | ||
==Overview== | ==Overview== | ||
There are neither evidence based [[Medical guideline|guidelines]] nor [[Randomized controlled trial|RCT]]<nowiki/>s for follow up of [[Vermiform appendix|appendix]] [[Carcinoid Tumor|carcinoid tumors]]. Meanwhile, consensus based effective measures for the secondary prevention of [[appendix cancer]] include follow up [[History and Physical examination|history]] and [[physical examination]], tumor marker measurements like [[CEA]], [[CA-125]], [[CA 19-9]], follow up imaging studies, [[Carcinoid Tumor|carcinoid]] tumor markers such [[serotonin]], and specific [[imaging studies]] such as [[octreotide]] [[Nuclear medicine|scintigraphy]]. | |||
==Secondary Prevention== | ==Secondary Prevention== | ||
Effective measures for the secondary prevention of [disease | Effective measures for the secondary prevention of appendix cancer include: | ||
*CEA, CA 125, CA 19-9 every 6 month for the first two years, then yearly for at least 3 more years, plus continued follow up in selected cases. | |||
* | *[[Carcinoid Tumor|Carcinoid tumors]] of appendix: | ||
:*'''National Comprehensive Cancer Network (NCCN)''' and '''North American Neuroendocrine Tumor Society (NANETS)''' recommendations are based on the [[tumor]] '''size:'''<ref name="pmid20664473">Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ et al. (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20664473 The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum.] ''Pancreas'' 39 (6):753-66. [http://dx.doi.org/10.1097/MPA.0b013e3181ebb2a5 DOI:10.1097/MPA.0b013e3181ebb2a5] PMID: [https://pubmed.gov/20664473 20664473]</ref> | |||
::*Less than 2 cm: No follow up | |||
:::* '''NANETS''' devided tumors < 2 cm into two categories: | |||
::::* Tumors less than 1 cm needs no further follow up | |||
::::* Tumors between 1 and 2 cm with nodal [[metastasis]], [[Vascular|vascular invasion]], [[Lymphatic|lymphatic metastasis]], mesoappendical invasion, intermediate and high grade as well as mixed histology: '''The same as tumors larger than 2 cm<math>\blacktriangledown</math>''' | |||
::*Two cm and more: History and [[physical examination]] between 3-12 months plus tumor markers as well as imaging studies consideration for the first year, then tumor markers every 6-12 months ([[5-Hydroxyindoleacetic acid|5-HIAA]] and [[Chromogranin A|chromogranin-A]]), [[imaging]] as clinically indicated. | |||
::* Followup imaging studies: 6 month after surgery, every 6-12 month for at least 7 years. | |||
*Metastatic disease [[Palliative care|palliative]] managements: | |||
:*[[Liver resection]] for selected patients | |||
:*[[Therapeutic embolization|Embolization]] of the [[hepatic artery]] | |||
:* [[Somatostatin]] analogs did not show to reduce the [[tumor]] size, but they are helpful in [[symptom]] control | |||
*Adenocarcinoma | |||
*There are no appropriate evidences in role of tumor markers for follow up of the patients with [[Vermiform appendix|appendix]] [[adenocarcinoma]], indeed current consensus is based on [[colorectal cancer]] experience. | |||
:*[[CEA]], [[CA-125|CA-125,]] [[CA 19-9]] every 6 month for the first two years, then yearly for at least 3 more years, plus continued follow up in selected cases. | |||
:* Follow up [[Imaging studies]]: 6 moth after surgery, every 6-12 months for at least 7 years. | |||
==References== | ==References== | ||
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[[Category:Emergency medicine]] | |||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 21:12, 22 February 2019
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Appendix cancer Microchapters |
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Diagnosis |
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Treatment |
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Appendix cancer secondary prevention On the Web |
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American Roentgen Ray Society Images of Appendix cancer secondary prevention |
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Risk calculators and risk factors for Appendix cancer secondary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
There are neither evidence based guidelines nor RCTs for follow up of appendix carcinoid tumors. Meanwhile, consensus based effective measures for the secondary prevention of appendix cancer include follow up history and physical examination, tumor marker measurements like CEA, CA-125, CA 19-9, follow up imaging studies, carcinoid tumor markers such serotonin, and specific imaging studies such as octreotide scintigraphy.
Secondary Prevention
Effective measures for the secondary prevention of appendix cancer include:
- Carcinoid tumors of appendix:
- Less than 2 cm: No follow up
- NANETS devided tumors < 2 cm into two categories:
- Tumors less than 1 cm needs no further follow up
- Tumors between 1 and 2 cm with nodal metastasis, vascular invasion, lymphatic metastasis, mesoappendical invasion, intermediate and high grade as well as mixed histology: The same as tumors larger than 2 cm<math>\blacktriangledown</math>
- Two cm and more: History and physical examination between 3-12 months plus tumor markers as well as imaging studies consideration for the first year, then tumor markers every 6-12 months (5-HIAA and chromogranin-A), imaging as clinically indicated.
- Followup imaging studies: 6 month after surgery, every 6-12 month for at least 7 years.
- Metastatic disease palliative managements:
- Liver resection for selected patients
- Embolization of the hepatic artery
- Somatostatin analogs did not show to reduce the tumor size, but they are helpful in symptom control
- Adenocarcinoma
- There are no appropriate evidences in role of tumor markers for follow up of the patients with appendix adenocarcinoma, indeed current consensus is based on colorectal cancer experience.
- CEA, CA-125, CA 19-9 every 6 month for the first two years, then yearly for at least 3 more years, plus continued follow up in selected cases.
- Follow up Imaging studies: 6 moth after surgery, every 6-12 months for at least 7 years.
References
- ↑ Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ et al. (2010) The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas 39 (6):753-66. DOI:10.1097/MPA.0b013e3181ebb2a5 PMID: 20664473