3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

Appendiceal Tumours

Appendiceal-Tumours

What are appendiceal tumours?

Appendiceal tumours are rare growths that develop in the appendix (which is also the site for the appendicitis). These tumours can be benign (non-cancerous) or malignant (cancerous), and they can vary widely in terms of their behavior, growth pattern, clinical presentation, and treatment.

Benign appendiceal tumours include appendiceal adenomas, which are non-cancerous tumours that are symptomatic and may grow large but typically do not spread beyond the appendix. Malignant appendiceal tumours, also known as appendiceal neoplasms, include the following types:
  • Carcinoid tumours: are the most common type of appendix cancers and they have a slow growth rate. Most times, these neuroendocrine tumours lead to good prognosis.
  • Mucinous adenocarcinomas: are tumours that produce mucin (a jelly-like substance that protects the gastrointestinal tract). The build-up of mucin caused by these tumours can lead to the rupture of the mucus-filled appendix (also commonly known as mucocele). This allows the cancer cells to spread to other parts of the body.
  • Non-mucinous adenocarcinomas: non-mucinous adenocarcinomas of the appendix are rare and aggressive tumours that spread through the lymphatic system. As they produce less mucin, non-mucinous adenocarcinomas tend to behave similarly to colorectal cancer, and are often found during appendectomies.
  • Goblet cell carcinomas: are rare and aggressive tumors that may exhibit characteristics from both adenocarcinomas and carcinoids. However, these cancerous tumours have a poorer prognosis than normal carcinoid appendix tumours as they are more likely to spread to other parts of the body.

What causes appendiceal tumours?

The exact cause of appendiceal tumours are not fully understood, but they likely involve a combination of genetic mutations and cellular changes. These tumours arise from the epithelial cells lining the appendix, which can undergo mutations that lead to uncontrolled cell growth. Specific genetic alterations, such as mutations in the KRAS, GNAS, and TP53 genes, have been implicated in various types of appendiceal tumours. These mutations can disrupt normal cell cycle regulation, promoting the formation and proliferation of tumour cells.
Additionally, chronic inflammation in the appendix may contribute to a microenvironment that fosters malignant transformation. Over time, these abnormal cells can accumulate, forming tumours that may eventually invade surrounding tissues or metastasize to other parts of the body.

What are the symptoms of appendiceal tumours?

Appendiceal tumours may be asymptomatic in the early stages. When symptoms do occur, they can include abdominal pain, changes in bowel habits, a palpable mass in the abdomen, weight loss, and symptoms of appendicitis (lower right abdominal pain). However, different types of the appendiceal tumours may present themselves with different symptoms, as specified in the table below:
Type of Appendiceal Tumour Symptom
Appendiceal Adenomas (benign) Often asymptomatic but can cause abdominal pain or discomfort if they enlarge
Appendiceal Carcinoid Tumours (malignant) May produce hormones that lead to flushing, diarrhea, or other symptoms related to hormone release
Appendiceal Adenocarcinomas (malignant) Abdominal pain, changes in bowel habits, weight loss, and a palpable mass in the abdomen
If you are experiencing any of the symptoms mentioned above, schedule an appointment with our doctors at CRCS Clinic today.
Appendiceal tumour pain is commonly centralised at the right lower abdomen

How are appendiceal tumours diagnosed?

Appendiceal tumours are usually detected with the following methods:

Medical history and physical examination:

your doctor usually begins by assessing you and your family’s medical history to determine the probability of an appendiceal tumour, followed by a physical examination. When there is an appendiceal mass, a lump in the right lower abdomen (where the appendix is situated) may be palpable by your doctor during the physical examination.

Imaging:

Imaging tests, such as ultrasound, CT scan, MRI scan and PET scan, can help your doctor to visualie the tumour in or around the appendix and assess its extent (whether it has spread to other parts of the body).

Biopsy:

Biopsy is often needed to confirm the type of tumor. It is done by cutting a piece of tissue from the appendix or the tumour itself and then sent to the laboratory. An histological examination is done by examining the tissue sample under a microscope for mutated or cancerous cells and determining the tumour’s characteristics.

Colonoscopy:

a colonoscope; long tube with light and camera is inserted from your rectum, to your colon. An appendiceal tumour can be seen when the tumour protrudes out of the appendix into the colon.
A colonoscopy is a reliable diagnostic in detecting appendiceal tumours.
If you have done these diagnostic tests somewhere else, our doctors at CRCS Clinic can provide you with a second opinion.

What are the treatment options for appendiceal tumours in Singapore?

Treatment depends on the type, size, and stage of the appendiceal tumor. Here are some of the common treatment methods utilised for treating appendiceal tumours:

Surgery:

The removal of the appendix (appendectomy) may suffice for treating small tumours (less than 1 or 2 centimeters in size) that do not grow into other organs.
  • Hemicolectomy:
  • If the appendiceal tumour appears to be a cancerous carcinoid tumour that is larger than 2cm and is more aggressive, your doctor may suggest the removal of part of your colon that is next to the appendix through hemicolectomy in addition to appendectomy as a treatment option.
  • Cytoreduction:
  • If your appendiceal tumour was discovered when it has spread to other parts of the body (late stage non-carcinoid tumours), your doctor may suggest debulking surgery (cytoreduction),which involves the removal of the tumour along with accumulated mucus if present (which relieves bloating), as well as any organs where the tumour has metasised to, such as parts of the intestine, ovaries, uterus, spleen, gallbladder, and the peritoneum (lining of the abdominal cavity).

    Chemotherapy:

    This treatment option may be suggested before the surgery or as adjuvant therapy after the surgery if the appendiceal tumour is more aggressive and is larger than 2 centimeters in size or if the appendiceal cancer has spread to other parts of the body (especially the lymph nodes). Chemotherapy for appendiceal tumours is usually administered by injecting the drugs directly into the abdomen (regional chemotherapy) or into the bloodstream (sometimes given as pills to be taken orally) (systemic chemotherapy) or a combination of both.

    Hyperthermic Intraperitoneal Chemotherapy (HIPEC):

    This is a type of regional chemotherapy that is administered during surgery, when you are under general anesthesia. HIPEC involves the heating of chemotherapy drugs and pumping them directly into your abdominal cavity, where traditional methods of chemotherapy cannot reach effectively. This treatment option intensifies the drugs’ anti-cancer effects while directly targeting cancer cells, thus providing better prognosis to patients who are in later stages of the appendiceal tumour.

    Targeted drug therapy:

    This therapeutic approach targets cancer cells so less healthy cells are damaged compared to chemotherapy. Targeted drug therapy treats cancer by destroying specific proteins or genes that encourage the tumours to grow and spread to other parts of the body.

    Radiation:

    This treatment is used to treat many types of cancer, but rarely implemented into the treatment regimen for appendiceal tumours. It may be recommended by your doctor if your appendiceal tumour has spread to other parts of the body.

    Frequently Asked Questions

    Appendiceal tumours are rare, with an incidence of about 1 to 2 cases per million people per year. They are often discovered incidentally during surgeries for other conditions.

    The likelihood of recurrence depends on the type and stage of the tumour. Regular follow-up appointments and imaging tests are essential to monitor for any signs of recurrence.

    Yes, some types of appendiceal tumours, particularly malignant ones, can spread to other parts of the body, including the peritoneum, liver, and lymph nodes. This process is known as metastasis.

    Recovery from surgery varies but typically includes a hospital stay of a few days, followed by several weeks of rest at home. Patients may experience some pain and will need to avoid strenuous activities during this period.

    Follow-up frequency depends on the tumor type and treatment. Typically, patients will have check-ups every few months initially, which may decrease to annual visits if there are no signs of recurrence.

    While there are no specific dietary restrictions, maintaining a balanced and healthy diet can support overall recovery and well-being. Your doctor may provide personalised dietary advice based on your treatment and health status.

    Location

    Colorectal Care Specialists (CRCS)

    3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

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