Appendix cancer physical examination
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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
The majority of patients with appendix cancer are asymptomatic. Patients may complaint of vague abdominal pain or discomfort and/or girdle size changes. However, most of them are presenting with acute appendicitis due to obstruction of the appendix by tumor, or present with malignancy complications like pseudomyxoma peritonei; the rest of diagnosed cases are result of serendipitous finding in imaging studies or discovered during laparotomy or laparoscopy because of cancer complications. The patients complaints and presentation is influenced by the tumor histology and stage. Range from a small asymptomatic adenocarcinoma to a metastatic carcinoid tumor with liver metastasis and carcinoid syndrome signs, symptoms and complications.
Physical Examination
- Physical examination of patients with appendix cancer is usually normal.[1]
- If the patient with appendix cancer present with acute appendicitis which is quit common, abdominal tenderness, Rebound tenderness, abdominal guarding, Rovsing's sign, as well as Psoas sign might be present. [2]
- Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome.
- Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common.[3]
- In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive of Pellagra disease.[4]
Appearance of the Patient
- Patients with appendix cancer usually appear normal but might be pale or diaphoretic, or even present with a facial flushing.
Vital Signs
- Fever might be present in patients presenting with appendicitis.
- Tachycardia is prevalent in patients with carcinoid syndrome as well as patients with appendicitis.
- Tachypnea
- Hypertension
Skin
- Skin examination of patients with appendix cancer is usually normal.
- In the presence of carcinoid syndrome the following might be present:
- Flushing
- Hirsutism
- Pallor
- Dermatitis in the presence of Pellagra
HEENT
Neck
- Neck examination of patients with appendiceal cancer is usually normal.
- Cervical lymphadenopathy might be present.
Lungs
- Pulmonary examination of patients with appendix cancer is usually normal.
- Wheezing : If the patient develop carcinoid syndrome.
Heart
- Cardiovascular examination of patients with appendix cancer is usually normal.
- If the patient develop carcinoid syndrome systolic or diastolic murmur might be present.
- Right heart murmurs specially TR is prevalent.
Abdomen
- Considering small size of must of appendiceal tumors, abdominal examination of patients with appendix cancer is usually normal.
- But in the cases of complicated tumors such as perforated appendicitis, abdominal examination may be remarkable for:
- Abdominal tenderness in the right lower abdominal quadrant
- Rebound tenderness
- A palpable abdominal mass in the right lower abdominal quadrant
- Guarding may be present
- In cases of late stage metastatic disease hepatosplenomegaly might be present
- Additional findings, such as obturator test, Psoas test, McBurney point test are common in appendicitis
Palpation
- The abdominal wall is very sensitive to mild palpation
- Rebound tenderness
- Abdominal guarding
- Rovsing's sign
- Psoas sign
Rectal examination
- Tenderness in the rectovesical pouch
Back
- Back examination of patients with appendix cancer is usually normal
Genitourinary
- Genitourinary examination of patients with appendix cancer is usually normal.
- A pelvic adnexal mass may be palpated; in fact a number of appendiceal cancers are misdiagnosed as ovarian masses vise versa.
Neuromuscular
- Neuromuscular examination of patients with appendix cancer is usually normal.
- Dementia, aggression and mental confusion are rare complications of complicated carcinoid syndrome patients that develop Pellagra.
Extremities
- Extremities examination of patients with appendix cancer is usually normal.
- Rarely patients with carcinoid syndrome might present with lower limb edema
References
- ↑ Chapter 5: Tumours of the Appendix - IARC. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb2/bb2-chap5.pdf Accessed on January 15, 2019
- ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
- ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
- ↑ Hegyi J, Schwartz RA, Hegyi V (2004) Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol 43 (1):1-5. PMID: 14693013