How much do you know about appendix tumors?

Appendix tumors have attracted multidisciplinary attention

People have more or less some knowledge of diseases such as appendicitis, periappendiceal abscess, and perforated appendicitis, and they are not unfamiliar with them. However, few people know about the disease "appendiceal tumor". Seeing the name of this disease, some people may be surprised, "How can a small appendix also get cancer?!" In fact, although the incidence of appendiceal tumor is very low, it has an increasing trend among the digestive tract cancer population in my country. As a member of the large family of tumors, although the "size" of appendix tumors is insignificant, it is still as life-threatening as colorectal cancer.

In July this year, under the auspices of the Colorectal Tumor Professional Committee of the Chinese Medical Doctor Association, dozens of experts from more than 30 authoritative medical institutions in my country, including pathology, imaging, gastroenterology, surgical oncology, oncology, radiotherapy, rehabilitation, nutrition, psychology and other specialties, compiled the "Chinese Expert Consensus on Multidisciplinary Comprehensive Treatment of Appendiceal Tumors" (hereinafter referred to as the "Consensus") for the first time, jointly "portraying" the histological classification, clinical characteristics, diagnostic basis, and treatment points of appendix tumors, aiming to improve awareness and early diagnosis and treatment. In this regard, Professor Tang Qingchao, the main author of the "Consensus" expert group and director of the Department of Colorectal Tumor Surgery of the Second Affiliated Hospital of Harbin Medical University, gave a popular science interpretation of appendix tumors.

The onset is insidious, and there is a possibility of missed diagnosis

"Food is the first necessity of the people." With the great improvement of living standards, "A Bite of China" has allowed the people to appreciate the profoundness of my country's food culture. However, poor dietary structure and eating habits may give rise to daunting digestive tract tumors. Professor Tang Qingchao said that according to the latest survey data from the International Agency for Research on Cancer under the World Health Organization: In 2020, the number of new cancer cases in my country was 4.57 million, far exceeding that of other countries in the world; and among the top ten cancers with the highest number of new cases, digestive tract tumors accounted for five seats, namely colorectal cancer, gastric cancer, liver cancer, esophageal cancer and pancreatic cancer, that is, four or five out of every 10 cancer patients are digestive tract tumors. Among these digestive tract cancers, appendix tumors, which are little known to people, are difficult to identify because they are often "mixed" with acute and chronic appendicitis and inflammatory masses in the right lower abdomen, which often leads to the possibility of missed diagnosis and misdiagnosis.

Tang Qingchao explained that the human appendix is ​​located in the lower right side of the abdomen, between the cecum and the ileum, with an average length of 11 cm and a diameter of 0.5-0.7 cm. It is a tubular organ with a single opening and closed distally. Compared with the large and small intestines, which are about 7 meters long, the appendix is ​​too small, only the size of a little finger; tumors originating from this part are insidious and lack specific manifestations, so they are naturally easy to "slip through the net". Professor Tang pointed out that the nature of appendix tumors is uncertain, both benign and malignant, with appendix mucocele, appendix adenocarcinoma and appendix carcinoid (a low-grade malignant tumor with a cancer-like tissue structure) being the most common. Among them, appendix carcinoid has the highest prevalence, accounting for 50-70% of all appendix tumors; in comparison, primary appendix tumors are very rare, the type with the lowest incidence of digestive tract cancer, accounting for about 0.2% of gastrointestinal tumors.

There is no necessary connection between appendicitis and appendix tumors

Clinically, the symptoms of patients with appendix tumors are generally not obvious, and most of them are discovered accidentally during pathological examination of specimens during or after surgery. Among them, most appendix mucoceles are asymptomatic, with a mass in the right lower abdomen, which grows slowly, has a smooth and elastic surface, clear and movable boundaries, and mild tenderness and discomfort; the clinical characteristics of appendix carcinoid are chronic right lower abdominal pain, symptoms of acute appendicitis, and some patients have a mass in the right lower abdomen, with a good prognosis; appendix adenocarcinoma usually has no specific clinical manifestations, atypical symptoms of appendicitis or accompanied by appendix abscesses, and long-term unhealed fistulas may be left after appendectomy. Tang Qingchao pointed out that when the appendix tumor is in the progressive stage, patients often have problems such as fatigue, chronic abdominal pain and satiety, and may also have symptoms related to appendicitis, intestinal obstruction or pelvic tumors. Therefore, when removing the appendix for patients suspected of appendicitis, it is recommended that surgeons consider the possibility of appendix tumors.

Here, someone may ask: Is it that appendicitis recurs and the appendix tumor is formed due to its inflammatory stimulation? Professor Tang Qingchao explained that according to existing research results, there is no necessary connection between appendicitis and appendix tumors. The two are two completely different diseases. Although the detection rate of appendix tumors accounts for a certain proportion of patients who undergo appendectomy due to appendicitis, this does not prove that appendicitis is the "originator" of appendix tumors. Instead, with the continuous improvement of diagnosis and treatment technology and scientific concepts, some appendix tumors that "lurk" in the symptoms of appendicitis and "disguise" as appendicitis have gradually been discovered. So everyone does not need to worry too much. There is no need to extend from "talking about cancer to talking about appendicitis" to "talking about appendicitis" or even casually "get rid of everything" about the appendix.

People with chronic abdominal pain should not take medicine on their own

But from another perspective, it is irrational and undesirable for people to simply regard the mild pain in the right lower abdomen as "appendicitis attack". You should not take medicine at home, but go to the hospital for timely examination and diagnosis. Because in cases of appendectomy for appendicitis, the detection rate of appendix tumors is about 2.3-12%, and in patients with periappendiceal abscesses, the proportion of appendix tumors is as high as 20%. At the same time, 13-42% of patients with appendix tumors are accompanied by colorectal tumors. Therefore, it is necessary to give colonoscopy to those who have been diagnosed with appendix tumors to help confirm whether there are any abnormalities in the colorectum. Director Tang Qingchao warned that although appendicitis and appendix cancer are only one letter different, the scope of surgical resection and cleaning is completely different. The latter often requires right hemicolectomy to completely clear the appendix cancer lesions, and requires combined chemotherapy, immunotherapy, etc.

In daily life, how should we prevent digestive tract tumors? Professor Tang Qingchao suggested: First of all, we should pay attention to a reasonable diet structure. High-protein diet, high-oil and high-salt food have more disadvantages than advantages, which have contributed to the high incidence of gastric cancer and intestinal cancer. Therefore, we should appropriately reduce meat intake, eat less high-salt foods such as pickles and sauerkraut, increase the proportion of fruit and vegetable intake, and appropriately add some coarse grains to the table; secondly, bad personal hobbies, such as smoking and drinking, also have a significant stimulating effect on the occurrence and development of tumors, and we must be determined to quit smoking and limit alcohol; thirdly, we should encourage physical exercise of appropriate intensity. According to personal physical fitness, physical exercise of at least 30 minutes at least 3 times a week will help increase health level; maintaining exercise intensity, keeping heart rate above 100 beats/minute is the best.

Director Tang Qingchao finally said that if we adhere to the principle of "early detection, early diagnosis, and early treatment", appendix tumors are not difficult to "catch" and invincible; at the same time, this also reminds us clinicians that no illness is minor, and we must be extremely cautious when diagnosing and treating diseases and not miss any clues.