Appendix cancer natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

• The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
• The symptoms of (disease name) typically develop ___ years after exposure to ___.
• If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Complications

• Common complications of [disease name] include:
  • [Complication 1]
  • [Complication 2]
  • [Complication 3]

Prognosis

• Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [--]%.
• Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
• The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
• [Subtype of disease/malignancy] is associated with the most favorable prognosis.
• The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

Five year survival
Carcinoid tumors
localized disease 94% Regional disease 85% Distant metastases 34% Goblet cell 12.5% Tubular tumors are benign clinically
Adenocarcinoma
Nonmucinus Localized 95% Distant metastasis 0% Mucinous adenocarcinoma localized 80% Distant metastasis 51%

• Poor prognostic factors for appendiceal adenocarcinoma are as follows:
  • Advanced stage
  • High grade
  • Nonmucinous histology
  • Spread of the tumor beyond the left lower quadrant
  • Presence of malignant cells outside of the visceral peritoneum of the appendix
• Poor prognostic factors in the presence of pseudomyxoma peritonei
  • abdominal distension
  • weight loss
  • high histological grade
  • and morphological evidence of invasion of underlying structures