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Appendix cancer treatments

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Appendix cancer is typically treated with surgery or surgery in combination with chemotherapy. The type of surgery recommended depends on the type and stage of the cancer.

As with other types of cancer, treating appendix cancer involves a team of doctors trained in different specialties. Having multiple doctors be part of your cancer care allows for a comprehensive treatment strategy. Some of the types of doctors who may be involved in appendix cancer treatment include:

At the same time, you will likely encounter many other health-care workers besides your core cancer care team, including nurses, pharmacists, counselors, dietitians and social workers. Your team will talk over evidence-informed treatment options with you and support you in myriad ways while you receive care.

Radiation therapy

Radiation therapy aims to destroy cancer cells with high-dose X-rays that are aimed at particular parts of the body. Depending on the type of cancer, radiation therapy may be used as the main treatment, or to shrink a tumor before or after another treatment, or to relieve symptoms in a particular area.

In most cases, radiation therapy isn’t used as a primary treatment option for cancer in the appendix. Radiation therapy may be used if appendix cancer spreads (metastasizes) to another part of your body. For example, if it spreads to a bone, the bone may be treated with radiation therapy to help alleviate symptoms.

Radiation therapy may cause side effects, including:

  • Tiredness
  • Stomach problems
  • Diarrhea

Surgery

Appendix cancer is primarily treated with surgery. The type of surgical procedure performed varies depending on the type and location of the tumor, whether it is contained or has spread, as well as the patient’s general health. Surgeries to treat appendix cancer include:

Hemicolectomy is the surgical removal of a portion of the colon located near the appendix, along with nearby lymph nodes and blood vessels. This surgery may be used for both neuroendocrine tumors in the appendix and non-neuroendocrine appendix cancers.

When used to treat neuroendocrine tumors in the appendix, hemicolectomy is typically only performed on tumors larger than 2 cm (stage 2, 3 or 4).

After surgery, since part of the colon has been removed, there is a chance you may need a stoma, or an opening in the stomach through which waste is expelled and collected in an external bag. However, most of the time, the remaining ends of the colon can be reattached during a hemicolectomy, and a stoma isn’t needed.

Cytoreductive surgery (commonly known as debulking surgery) may be recommended to treat late-state appendix cancer by removing as much of the tumor bulk as possible, and may be followed by chemotherapy to destroy residual cancer cells. It’s usually recommended for stage 4 appendix cancer that has only spread within the abdomen and not any farther. The surgery may help reduce the amount of cancer cells in your body, but it doesn’t eradicate the cancer completely. It may also help relieve and reduce bloating symptoms related to appendix cancer.

Peritonectomy removes the peritoneum (the lining of the abdomen) to treat slow-growing, low-grade appendix cancer that has spread beyond the colon to other areas of the abdomen. These cancers are classified as stage 4A, which is an advanced stage, but they don’t grow quickly. According to the American Society of Clinical Oncology, some doctors view peritonectomy as too aggressive of an approach for a slow-growing cancer, but others recommend it because it increases the chances that the cancer may be completely removed from the body and unable to continue spreading. Your care team can help you go over the benefits and risks.

Appendectomy is a surgery to remove the appendix. It’s a common treatment option for early-stage, small neuroendocrine tumors in the appendix. For stage 1 neuroendocrine tumors that are smaller than 1-2 cm, an appendectomy alone may be all that’s needed to treat the cancer.

Chemotherapy

In the case of appendix cancer, chemotherapy—anticancer drugs taken orally or intravenously—is most often used in combination with surgery to improve outcomes. Chemotherapy drugs are designed to slow or stop the growth of rapidly dividing cancer cells that form tumors.

For non-neuroendocrine tumors in the appendix, chemotherapy is usually used to treat cancers that have already spread outside of the appendix (stage 2 and higher). In this case, the chemotherapy tends to follow surgery. The goal of the chemo is to eradicate any small amounts of cancer in the body and lower the chances that the cancer will continue to spread or come back.

Chemotherapy drugs may be delivered systemically, through an intravenous (IV) line or a pill. Systemic chemotherapy delivered intravenously may be recommended for stage 4 appendix cancer that has spread to lymph nodes or organs beyond the abdominal area.

Chemotherapy may also be delivered locally, which is called intraperitoneal chemotherapy. This allows for chemotherapy drugs to be placed directly within the abdominal cavity, where they may more successfully reach and destroy cancer cells. Intraperitoneal chemotherapy is given during surgery. The process usually starts with debulking surgery, in which a surgeon cuts out as much of the cancerous tissue as possible. Then, a tube is placed within the abdomen. After the operation is over, chemotherapy drugs are delivered into the abdominal cavity through this tube.

Alongside debulking surgery, intraperitoneal chemotherapy may be recommended for stage 4 appendix cancer that has only spread within the abdominal cavity. This may be followed with systemic chemotherapy.

Side effects of chemotherapy vary, but generally include:

  • Tiredness
  • Stomach upset
  • Loss of hair
  • Poor appetite
  • Diarrhea

Recurrent appendix cancer

Cancer may return after treatment has concluded, which is called recurrent cancer. Cancer may come back in the same part of the body it began or somewhere else.

When recurrent cancer occurs, another round of testing must be done to figure out its location. Based on these findings, your doctor will come up with a new treatment plan.

The treatment options may be largely the same as they are for appendix cancer in general (radiation therapy, chemotherapy and surgery). For recurrent cancer, however, your care team may choose a different combination of these options or use them in a different order than what was given the first time.

Clinical trials may also be an option for any type of recurrent appendix cancer.

Clinical trials

Cancer treatment is always evolving as doctors test new treatments through clinical trials. Clinical trials may give you access to new therapies.

These new treatments may not end up being more efficacious than traditional treatments. However, for some patients with appendix cancer, enrolling in a clinical trial may be a beneficial option, especially for those who have already tried the standard approaches.

Cancer Treatment Centers of America® (CTCA) may have clinical trials available to eligible patients with appendix cancer. Ask your doctor if enrolling in a clinical trial may be a beneficial option for you. Next topic:

What are the facts about appendix cancer?

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