Appendectomy for neuroendocrine tumors of the appendix

This page was reviewed under our medical and editorial policy by

Chukwuemeka Obiora, MD, Surgical Oncologist

This page was reviewed on March 17, 2023.

An appendectomy is a surgery to remove your appendix.

If you have a neuroendocrine tumor of the appendix, removing this pouchlike organ may be part of your treatment plan—especially if the tumor is small.

An appendectomy is the most common treatment option for stages 1 to 3 neuroendocrine tumors of the appendix.

  • If the neuroendocrine tumor is smaller than 2 cm, an appendectomy may be all the treatment you need.
  • Tumors larger than 2 cm may require removal of the appendix and other nearby structures such as blood vessels, lymph nodes and part of the colon.

Stage 4 cancer is more likely to be treated with chemotherapy and/or targeted therapy than with an appendectomy—though treatment may include surgery to remove cancer that has spread to other areas of the body and is causing symptoms.

In some cases of stage 4 cancer metastasis to the peritoneum (the lining of the inside of the abdomen), additional surgery may be performed to remove the areas affected by the tumor.

A planned appendectomy may be a part of your treatment plan, but in some cases of appendix cancer, the appendix can rupture. In this case, as with appendicitis, emergency surgery is the most likely treatment option. Treatment may also focus on any areas where cancer may have spread when the appendix ruptured.

Often, neuroendocrine tumors of the appendix are found during or after an appendectomy done for another reason. According to a retrospective analysis in Emergency Medicine International, undiagnosed neuroendocrine tumors are found in about 1 percent of appendectomies.

Neuroendocrine tumors of the appendix

Appendix cancer is rare to begin with. Not all appendix cancer cases are caused by neuroendocrine tumors, but most are. They typically start at the tip of the appendix in specific hormone-producing cells that help break down food and move it through the gastrointestinal tract. Other types of appendix cancers start in the lining of your appendix, or epithelium, and these are treated very differently than neuroendocrine tumors.

Neuroendocrine tumors are often found as a result of noncancer-related procedures or imaging tests, since they don’t often cause symptoms. You may also hear them called gastrointestinal carcinoid tumors.

Aside from the appendix, these tumors may also be found in the:

  • Stomach
  • Small intestine
  • Large intestine (colon)
  • Rectum

Though they’re tough to diagnose early, most types of neuroendocrine tumors are typically slow-growing.

Grades of neuroendocrine tumors

In addition to stages, neuroendocrine tumors are organized into grades that describe how likely the tumor is to spread.

  • Grade 1 neuroendocrine tumors are low grade, with cells that don’t multiply quickly and look more or less like normal cells.
  • Grade 2 neuroendocrine tumors are intermediate grade, with cells that differ from normal cells, but not as drastically as grade 3 tumors.
  • Grade 3 neuroendocrine tumors are high grade, with cells that multiply quickly and look very different from normal cells.

Survival rates for neuroendocrine tumors

Since neuroendocrine tumors of the appendix are rare, it’s hard to get exact survival rates, but these cancers are very treatable. According to the American Society of Clinical Oncology, the percentage of people alive five years after the diagnosis of a neuroendocrine tumor—in any area of the gastrointestinal tract and at any stage—is 94 percent.

This survival rate remains similar for neuroendocrine tumors that haven't spread to distant parts of the body: Localized neuroendocrine tumors have a 97 percent survival rate, and those that have spread to nearby tissue or regional lymph nodes have a 95 percent survival rate. The survival rate only changes drastically when the neuroendocrine tumor has spread to a distant area of the body—it drops to 67 percent.

How to prepare

Because some neuroendocrine tumors are detected during or after an unplanned appendectomy, you may not have time to prepare. If you do have an upcoming planned appendectomy for a neuroendocrine tumor, be sure to communicate with your care team before the procedure and ask any questions that you have.

Some questions you may want to ask your care team include:

  • Do I need to stop eating and drinking before my surgery? If so, when?
  • Should I take my regular medications before my surgery?
  • Who will I be meeting with before the surgery?
  • Can I bring someone with me?
  • How long will the surgery take?
  • How long will I stay in the hospital after my surgery?
  • Will I need someone to drive me home from the hospital?
  • What will my recovery be like?
  • When will I know the results from my surgery?
  • Will I need other treatment after the surgery?

Before your procedure, you should know which organs your care team is planning to remove. Depending on where cancer cells are found, the surgeon may only remove your appendix, or also remove a part of your colon (hemicolectomy) and/or nearby lymph nodes.

Your care team may have specific instructions for you to follow in the days before and after surgery. Make sure you know how to best prepare your home to be a comfortable place for you to recover.

What to expect

A planned appendectomy takes place in a hospital. It’s performed by a surgeon, and you’ll be put under general anesthesia. You may meet with several members of your care team before the procedure.

An appendectomy might be done in one of two ways.

Laparotomy: In a laparotomy, also called an open appendectomy, the surgeon makes one incision in the lower right of your abdomen and uses it to access and remove the appendix.

Laparoscopic surgery: During a laparoscopic surgery, the surgeon makes several small incisions, inserting tools through them to remove the appendix. This type of surgery is typically safer and easier to recover from.

Appendix cancer rarely spreads outside the abdomen, but it may spread within it. Tumors that grow inside the long, thin appendix organ—similar in shape to a finger—may break through the appendix wall and into other parts of the abdomen. The amount of tissue that your surgeon needs to remove during the procedure depends on where the cancer cells have spread.

Your care team will monitor you while you’re under general anesthesia. You’ll likely wake up from the anesthesia in a recovery room after the procedure is complete.

Benefits and risks

By the time neuroendocrine tumors of the appendix are found, they’re often causing symptoms such as abdominal discomfort or a hernia. After surgery, you may find that your symptoms lessen or go away.

An appendectomy has been deemed the main treatment for most neuroendocrine tumors of the appendix because researchers have concluded that the benefit of surgically removing cancerous cells outweighs the risks.

The use of general anesthesia, for example, is considered to be generally safe but always comes with some risks, including the possibility of:

  • Breathing problems
  • Changes to your heartbeat
  • Allergic reaction to the anesthesia
  • Confusion upon waking from general anesthesia

You may experience side effects as you recover from surgery. Be sure to ask your care team which side effects to expect and which ones could signal a problem. Tell your care team if you have any of these signs after surgery:

  • Chills
  • Fever
  • Bleeding from the surgery site
  • Worsening pain at your surgery site
  • Difficulty urinating

After surgery

Your recovery time depends on the type of surgery. Be sure to ask your care team exactly what to expect as you recover.

Typically, the recommendation is to limit activity for up to two weeks after a laparotomy and up to five days for laparoscopic surgery. In general, you don’t need to make major lifestyle changes once you’ve recovered from an appendectomy—you may continue to eat and exercise however you normally do. There aren’t typically long-term complications after an appendectomy.

After surgery, your care team can let you know if they were able to remove all signs of cancer, or if you’ll need additional treatment. Regardless of the results, you’ll have follow-up appointments and tests to make sure the cancer isn’t recurring or spreading.

Follow-up care is especially important in the case of neuroendocrine tumors because they may recur up to several years after treatment. So, once the surgery is complete, your cancer care team may still monitor your health through imaging tests and physical examinations for years to come.

Three tips for moving forward

Communicate with your care team: If you’ve been diagnosed with a neuroendocrine tumor of the appendix, you may have a lot of questions, even after an appendectomy. Your care team is there to answer your questions. Don’t hesitate to share questions or concerns that are on your mind.

Follow through on follow-up care: Follow-up care is always critical when it comes to cancer treatment. Even after an appendectomy that has removed all signs of a neuroendocrine tumor, your care team may want to keep an eye on your health to make sure it doesn’t return. If your care team recommends additional treatment after an appendectomy, following the plan you create together is your best chance at success.

Seek support: Though neuroendocrine tumors of the appendix are rare, the experience of having cancer and getting treatment is shared by many. Seek out support through family or friends or a support group of people who are also undergoing cancer treatment. The American Cancer Society offers a list of resources you can tap into.

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