Q: I am a middle-aged man and for the past three months, I have been experiencing persistent lower abdominal pain. It is worse on the right side. I have occasional constipation and, sometimes, I have to take laxatives to manage this. Recently, I went to the doctor and he suggested that I get a CT scan of my belly to assess the problem. The scan shows that I have some abnormalities in my appendix and my doctor is worried that it might be cancer. I was astonished. I have never heard of cancer of the appendix. Most people who I spoke to told me that it can get infected or inflamed but no one has heard of cancer of the appendix. If I truly have cancer of the appendix, what are my treatment options? Will I need chemotherapy? Can it be treated without surgery? How long can one live with it should I choose not to have any intervention?
The appendix is a tubular hollow structure attached to the large intestines (colon). It is about eight to 12cm long and is located on the right lower part of the belly. In adults, it does not have any significant function. It can develop several conditions, of which cancer is one of them. Cancer of the appendix is rare, accounting for less than five per cent of all colon cancers. In addition, it can get inflamed and infected (a condition known as appendicitis).
—Discomfort/pain in the lower right section of the abdomen.
—Bloating and fullness of the belly
—Change in the way you go to the toilet (may get either constipation or diarrhoea).
—Lack of appetite —Occasionally, the cancer may present like appendicitis giving you abdominal pain, nausea, vomiting and fever.
Treatment depends on various factors. These include: Type of cancer: There are different subtypes of cancer of the appendix. Some of the cancers cause an abnormal release of chemicals in the body (neuroendocrine tumours). The treatment of all of the different subtypes involves surgery. A few may need chemotherapy/medication in addition to the surgery. Location and size of the cancer: If the cancer is small and located at the tip of the appendix, treatment involves removal of the appendix only. Larger tumours and those located near the base of the appendix require removal of part of the colon. Spread of the cancer: In some cases, cancer of the appendix may spread to the colon and distant organs like the liver (this is, however, relatively rare).
In some cases, the cancer may rupture and the cells spread to the stomach lining. In these cases, mucus like fluid may build up inside the belly. General health: If you are in good shape, you will be able to handle any treatment. However, if you are in poor health like have a weak heart or lung problems, you may not be able to handle the anaesthesia needed for surgery.
Usually, the appendix is removed. Sometimes, the section of colon to which the appendix is attached must be removed. In most cases, this is the only thing needed to treat the cancer. In cases where the cancer has spread to an organ like the liver, the area where the cancer has spread to may sometimes be removed (metastatectomy).
Can one live without an appendix?
Yes. Removing it does not affect one’s digestion or immunity (these are the two main concerns surrounding the surgery). One can also live without the right side of the colon (in case it is removed during the cancer surgery).
Can one successfully treat the cancer without surgery?
Occasionally, very advanced cancers (those that have spread extensively) are treated without surgery — this is done because there may be no survival benefit to the procedure. However, cure is not achieved in these advanced cases.
Survival with appendix cancer
If cancer of the appendix is successfully treated, one can live a full life. The survival rate of these cancer patients is more than 95 per cent when followed up over five years. Untreated cancer of the appendix can have a grim prognosis. Most people do not live for longer than five years after diagnosis.
Your next step
I would suggest that you visit a general surgeon working in a hospital with cancer specialists. He or she will collaborate with an oncologist (cancer specialist) to tailor your care.
In most cases, a colonoscopy may be done to rule out cancer in the rest of the colon. Colonoscopy also assesses the area where the appendix is attached to the colon. Your treatment will be individualised based on the findings of all your tests and your general well being.
Is specialised care available in Kenya?
Yes, all the care needed for cancer of the appendix is available locally. In most cases, NHIF and your health insurance company should be able to pay for your treatment.