Appendix Tumours

What are appendix tumours?

A tumour is an abnormal growth of cells. The cells of the appendix suddenly change their appearance and start growing into these abnormal growths. These can be benign or cancerous. These tumours can grow enough to block the opening (lumen) of the appendix and can cause acute appendicitis. Unfortunately these tumours do not cause any direct symptoms when they start to form. This is why some patients with appendix tumours are only diagnosed after their appendix has been removed for acute appendicitis and the tumour is found when the appendix is examined under the microscope. In other patients these tumours grow through the wall of the appendix and spill cells within the tummy without causing appendicitis. Therefore patients usually get diagnosed when they have a scan for non specific abdominal symptoms or for some other condition. It is important to stress that these tumours are very rare.

The Appendix

The appendix is a thin, tube like structure (about 5-10mm wide) that has a blind end with its lumen opening into the beginning of the large bowel called the Ceacum at the junction between the small and large bowel. Its length can vary from person to person but it is usually less then 10cm long.

Types of Appendix Tumours

Low Grade Appendiceal Mucinous Neoplasm (LAMN)

These tumours arise from the cells that form the lining of the appendix. In general they grow slowly and produce mucin (jelly). These tumours can be contained within the appendix however if they perforate through the appendix they can give rise to the condition called Pseudomyxoma Peritonei. This means the presence of jelly and or abnormal cells within the abdominal cavity.

High Grade Appendiceal Mucinous Neoplasm (HAMN)

These tumours arise from the cells that form the lining of the appendix. They tend to grow faster than LAMNs and are in general more aggressive. Cells from these tumours can spread to the lymph nodes and other organs in the body and in the abdomen. They too produce mucin and can cause Pseudomyxoma Peritonei.

Appendiceal Adenocarcinoma

These tumours arise from the cells that form the lining of the appendix and are categorised as well differentiated, moderately differentiated and poorly differentiated disease. This is based on how much the tumour cells resemble the normal cells of the appendix. They grow significantly faster than LAMNs and are more aggressive. Cells from these tumours can spread to the lymph nodes and other organs in the body and in the abdomen. Some types of these tumours also produce mucin and can give rise to Pseudomyxoma Peritonei.

Appendiceal Goblet Cell Adenocarcinoma

These cells are named as such due to the appearance of their cells under the microscope. They are classified into three categories based on their prognosis. In the majority of patients these tumours are found after appendicectomy.

Treatment options for appendix tumours

These are dependent on individual circumstances and will be discussed with you in your clinic appointment. However below we highlight some of these options:

Watchful wait (active surveillance):
This option is usually adopted for patients with an incidental low grade appendix tumour (LAMN) found in an appendix specimen after appendicectomy for appendicitis. If there was no peritoneal involvement then patients are usually entered on a surveillance program with regular scans. In addition in some patients with peritoneal disease and an excised LAMN we also adopt this aproach if the risks of treatment outweighs the benefits.

Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS and HIPEC):
This is a major operation and you can find more details on the CRS and HIPEC page of our website. It aims at removing all visible disease and is combined with a warm chemotherapy wash to try and kill cells that can not be seen.

Staging Laparoscopy:
Laparoscopy is a small operation where a camera is inserted into the abdomen to allow assessment of the abdominal and pelvic cavities to establish if CRS and HIPEC would be indicated. For more details please see our staging laparoscopy page.

Systemic Chemotherapy:
This is treatment delivered by specialist doctors called Oncologists where a combination of drugs are given in treatment cycles usually over a period of three to six months. These medications are given either in tablet form or into the veins. In certain patients systemic chemotherapy is the recommended treatment usually if surgery is unlikely to benefit them or can be combined with surgery, either before and or after surgery.

Basingstoke Colorectal & Peritoneal
The Hampshire Clinic
Basing Road
Basingstoke RG24 7AL

Call us

01256 354747