Surgeon Garrett Nash cares for nearly 80 people with appendix cancer each year, making him one of the most experienced physicians in the country with expertise in treating this rare disease.
At Memorial Sloan Kettering, treatment of appendix cancer depends on the stage of the cancer, the type of tumor, and your general health. Your team may include a surgical oncologist, who performs the surgery, and a medical oncologist, who prescribes and monitors chemotherapy. Radiation therapy is not a common treatment for appendix cancer.
Surgery
Surgery is the most common first step in treating localized cancer of the appendix. Depending on the stage of your disease, your surgeon may perform one of the following operations.
Appendectomy
If the tumor is not growing into other organs, an appendectomy — removal of the appendix — may be sufficient to remove the cancer.
Hemicolectomy
If the cancer is a carcinoid tumor and it is larger than 2 cm, your surgeon may offer a hemicolectomy in addition to the appendectomy. Your surgeon would remove the part of the colon that is next to your appendix and reattach the remaining parts of the colon to make it whole again. A hemicolectomy also might be recommended for other types of appendix cancers.
Cytoreductive, or debulking, surgery
If your appendix cancer is not a carcinoid and is found to be at a later stage (which means it has spread), your surgeon may recommend cytoreductive, or debulking, surgery. During this procedure, your surgeon removes the tumor, and surrounding fluid if present, as well as any organs that are inseparable from the tumor, such as parts of the intestine, gallbladder, spleen, ovaries, uterus, and lining of the abdominal cavity.
Chemotherapy
Chemotherapy uses a drug or combination of drugs to target and kill cancer cells in your body. If your cancer has spread beyond the appendix, your doctor may recommend treatment with chemotherapy, which is given in one of three ways:
- Systemic chemotherapy is given intravenously (using an IV) or orally (by mouth). It is usually given in cycles over a certain period of time. This type of chemotherapy can be used before or after debulking surgery.
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Regional chemotherapy, or intraperitoneal chemotherapy (IPC) in the case of appendix cancer, is a one-time treatment that is administered directly to the abdomen during or shortly after debulking surgery. The two most common methods of administering IPC are early post-operative intraperitoneal chemotherapy (EPIC) and hyperthermic intraperitoneal chemotherapy (HIPEC).
EPIC is administered through a port into the abdomen three days in a row after surgery. HIPEC is a heated solution of chemotherapy introduced into your abdominal cavity during surgery. Once your surgeon has filled your abdomen with the chemotherapy, it is gently rocked back and forth for 100 minutes, to make sure the drug has been spread throughout. - A combination of these two types can also be used.
Radiation therapy
Many types of cancer are treated with radiation therapy, though this is rarely done with appendix cancer. Your medical team may recommend it if the cancer has spread to other organs.
