Appendix cancer natural history, complications and prognosis: Difference between revisions
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Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%. | Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%. | ||
""""""??????Appendiceal Carcinoid Tumors | |||
Thought to arise from the subepithelial endocrine cells in the lamina propria and submucosa, appendiceal carcinoid tumors are the most common neoplasms affecting the appendix [54–55]. They are most often discovered during the fourth or fifth decade of life as an incidental finding during surgery performed for other reasons. Most patients with appendiceal carcinoids are asymptomatic, likely due to the location of the neoplasm in relation to the appendiceal base; the vast majority (75%) are located in the distal third of the appendix, where the risk of obstruction is low, with the remainder located in the middle third, and less than 10% at the base [11]. In a series of 150 appendiceal carcinoids, Moertel et al demonstrated that most appendiceal neoplasms were less than 1cm in largest dimension, though larger tumors (>2cm) appeared to be associated with poorer prognosis and increased patient discomfort [56]. In fact, more than 50% of patients who had large appendiceal carcinoids in one study presented with a clinical picture suggestive of acute appendicitis [57]. The prognosis for tumors less than 2 cm in size is quite favorable, as few of these neoplasms metastasize. The 5-year survival rate overall is approximately 71% (94% for local disease, 85% for regional metastases, and 34% in the presence of distal disease) [7, 53].??????"""""" | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
Revision as of 20:51, 16 January 2019
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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 [#]%.
""""""??????Appendiceal Carcinoid Tumors
Thought to arise from the subepithelial endocrine cells in the lamina propria and submucosa, appendiceal carcinoid tumors are the most common neoplasms affecting the appendix [54–55]. They are most often discovered during the fourth or fifth decade of life as an incidental finding during surgery performed for other reasons. Most patients with appendiceal carcinoids are asymptomatic, likely due to the location of the neoplasm in relation to the appendiceal base; the vast majority (75%) are located in the distal third of the appendix, where the risk of obstruction is low, with the remainder located in the middle third, and less than 10% at the base [11]. In a series of 150 appendiceal carcinoids, Moertel et al demonstrated that most appendiceal neoplasms were less than 1cm in largest dimension, though larger tumors (>2cm) appeared to be associated with poorer prognosis and increased patient discomfort [56]. In fact, more than 50% of patients who had large appendiceal carcinoids in one study presented with a clinical picture suggestive of acute appendicitis [57]. The prognosis for tumors less than 2 cm in size is quite favorable, as few of these neoplasms metastasize. The 5-year survival rate overall is approximately 71% (94% for local disease, 85% for regional metastases, and 34% in the presence of distal disease) [7, 53].??????""""""
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 appendix cancer include:
- Acute appendicitis
- Pseudomyxoma pritonei
- ?????????
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 rates | ||
|---|---|---|
| Carcinoid tumors | ||
| ||
| Adenocarcinoma | ||
| ||
| * Shows that mucinous adenocarcinoma are less aggressive than nunmnucinous tumors | ||
- 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 are as follows:
- Abdominal distension
- Weight loss
- High histological grade
- Morphological evidence of invasion of underlying structures
??????????
- Genetic studies revolutionized cancer treatment, appendix cancer is not an exception.
- Traditionally appandiceal cancers were approached the same as colorectal cancers.
- Recent genetic studies demonstrated that appendiceal tumors are clearly differ from colorectal cancers.[1]
- Presence of mutated TP53 and APC genes were significantly lower in appendiceal cancers compared to colorectal cancers.
- It has been shown that mutation profiles are associated with the patients’ prognosis. [2]
- Mutations in the TP53 significantly decrease life expectancy in patients with appendix cancer.
- Regardless of tumor grade, Tp 53 mutations were associated with poorer outcomes.
- Patients with GNAS mutations had a life expectancy of 10 years after diagnosis.
- Appendiceal tumors with GNAS mutations rarely develop into high-grade tumors.
References
- ↑ Levine EA, Blazer DG, Kim MK, Shen P, Stewart JH, Guy C; et al. (2012). "Gene expression profiling of peritoneal metastases from appendiceal and colon cancer demonstrates unique biologic signatures and predicts patient outcomes". J Am Coll Surg. 214 (4): 599–606, discussion 606-7. doi:10.1016/j.jamcollsurg.2011.12.028. PMC 3768122. PMID 22342786.
- ↑ Levine EA, Votanopoulos KI, Qasem SA, Philip J, Cummins KA, Chou JW; et al. (2016). "Prognostic Molecular Subtypes of Low-Grade Cancer of the Appendix". J Am Coll Surg. 222 (4): 493–503. doi:10.1016/j.jamcollsurg.2015.12.012. PMC 4808611. PMID 26821970.