Appendix cancer differential diagnosis

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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

appendix cancer must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

appendix cancer must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

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 [differential dx1], [differential dx2], and [differential dx3].

OR

appendix cancer must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

OR

As appendix cancer manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Differentiating appendix cancer from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], appendix cancer must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases		Clinical manifestations								Para-clinical findings								Gold standard	Additional findings
		Symptoms					Physical examination
										Lab Findings			Imaging				Histopathology
		Abdominal pain	Change in girdle size	Change in bowel habits		Other symptoms	Abdominal mass	abdominal tenderness	Other physical examination findings	Urinary 5-hydroxyindoleacetic acid (5-HIAA)	Serum Chromogranin A (CgA)	Other lab findings	CT scan	MRI	Utrasounography	Other imaging modalities
				Diarrhea	Constipation
Appendix cancer	Adenocarcinoma1	+/-	-	-	+		-	-		-	-	CEA CA 19-9	Soft tissue thickening Wall irregularity Presence of pseudomyxoma peritonei Calcification Internal septations Periappendiceal fat stranding and intraperitoneal free fluid which is a nonspecific finding Cystic lesion		Dilated appendix Periappendiceal fluid collection Distinct appendix wall layers	Positron emission tomography (PET)		Histopathology
	Carcinoid tumor2	+/-	-	+	-	Flushing Palpitation Dyspnea	-	-	Tricuspid regurgitation murmur Wheezing	+	+	Ki67: a reliable marker of cell proliferation				Somatostatin scintigraphy with 111-indium-octreotide Bone scintigraphy with 99mTc-methylene diphosphonate (99mTcMDP) Positron emission tomography (PET)
Mucocele
Ovarian tumor
Pseudomyxoma peritonei		+	+			Shifting dullness				-	-
Carcinoid syndrome		-/+	-	+	-	Flushing Palpitation Dyspnea	-	-	Tricuspid regurgitation murmur Wheezing	+	+	Ki67 N-terminal pro–B-type natriuretic peptide Substance P Neurotensin Bradykinin Human chorionic gonadotropin Neuropeptide L Pancreatic polypeptide	Depends on the primary tumor location and type	Depends on the primary tumor location and type	Depends on the primary tumor location and type
Appendicitis 3		LLQ / RRQ	-	-/+ Intermittent Secretory type	+	Nausea & vomiting,decreased appetite Anorexia	+/-	+	Rebound tenderness Abdominal guarding Rovsing's sign Psoas sign Obturator sign TR exam might reveal tenderness in the rectovesical pouch Tachypnea Tachycardia Hypotension Diaphoresis Pallor	-	-	Leukocytosis Left shift	Appendiceal wall thickening /perforation peri-appendiceal inflammation, fluid accumulation,fat stranding	Increased fluid signal on T2 weighted sequence	Evidences of inflammation	Tc-99m labeled anti-CD15 antibodies	Evidences of inflammation	CT scan	Alvarado Score
	Differential Diagnosis 4
	Differential Diagnosis 5
	Differential Diagnosis 6

¹ Adenocarcinomas usually present with appendicitis, barely they might present with Pseudomyxoma peritonei; meanwhile Pseudomyxoma peritonei is more prevalent in perforated mucocele, goblet cell tumor or high stages of adenocarcinoma.

² Generally appendix carcinoids are asymptomatic, they were only become symptomatic if they metastasize to the liver, or in rare cases make an obstruction and present with appendicitis which is quit uncommon in appendiceal carcinoids compared to appendiceal adenocarcinoma. Any patient with carcinoid syndrome should be evaluated for appendix carcinoids.

³ Every patient with appendicitis should be evaluated for appendix cancer, 0.5 in 100 appendicitis cases are because of appendix cancer.