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Appendix Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will find some basic information about appendix cancer and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Appendix Cancer. Use the menu to see other pages. Think of that menu as a roadmap to this entire guide.

About the appendix

The appendix is a pouch-like tube that is attached to the cecum, which is the first section of the large intestine or colon. The appendix averages 10 centimeters (about 4 inches) in length. It is considered part of the gastrointestinal (GI) tract. Generally thought to have no significant function in the body, the appendix may be a part of the lymphatic, exocrine, or endocrine systems.

Appendix cancer occurs when healthy cells in the appendix change and grow out of control. These cells form a growth of tissue, called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. Another name for appendix cancer is appendiceal cancer. A benign tumor means the tumor can grow but will not spread.

Types of appendix tumors

There are different types of tumors that can start in the appendix:

  • Neuroendocrine tumor. A neuroendocrine tumor starts in the hormone-producing cells that are normally present in small amounts in almost every organ in the body. A neuroendocrine tumor usually starts in either the GI tract (when it is often called a carcinoid tumor), pancreas, or a lung, but it also may occur in the testicles or ovaries. An appendix neuroendocrine tumor most often occurs at the tip of the appendix. About half of all appendix tumors are neuroendocrine tumors. Appendix cancer usually causes no symptoms until it has spread to other organs and often goes unnoticed until it is found during an examination or procedure performed for another reason. An appendix neuroendocrine tumor that remains confined to the area where it started has a high chance of successful treatment with surgery. Learn more about neuroendocrine tumors (NETs) of the GI tract.

  • Appendiceal mucoceles. Mucoceles are swellings or sacs from swelling of the appendix wall, typically filled with mucus. There is a range of benign to malignant conditions that can occur in the appendix to form a mucocele. Two of these conditions are mucinous cystadenomas and mucinous cystadenocarcinomas. Mucinous cystadenomas are benign and do not spread, and they are similar to adenomatous polyps that can develop in the colon. When contained in the appendix, they can be completely removed with surgery. However, if the appendix ruptures, the cells may spread in the body cavity and continue to secrete a jelly-like substance called mucin into the abdomen. The buildup of mucin can lead to abdominal pain, bloating, and changes in bowel function, including bowel obstruction (blockage). Mucinous cystadenocarcinomas can have similar effects with mucin in the abdomen, but they are malignant, meaning they can spread to other parts of the body.

  • Colonic-type adenocarcinoma. Colonic-type adenocarcinoma accounts for about 10% of appendix tumors and usually occurs at the base of the appendix. It looks and behaves like the most common type of colorectal cancer. It often goes unnoticed, and a diagnosis is frequently made during or after surgery for appendicitis. Appendicitis is inflammation of the appendix that can cause abdominal pain or swelling, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, or a low fever that begins after other symptoms.

  • Signet-ring cell adenocarcinoma. Signet-ring cell adenocarcinoma is rare. It is considered to be more aggressive and more difficult to treat than other types of adenocarcinomas. It is called signet-ring cell adenocarcinoma because, under the microscope, the cell looks like it has a signet ring inside it. This type of appendix cancer is treated similarly to colon cancer.

  • Goblet cell carcinomas/adenoneuroendocrine tumors. Goblet cell carcinomas have features of both adenocarcinomas and neuroendocrine tumors (both described above). They are more aggressive than neuroendocrine tumors, and treatment is often similar to treatment for adenocarcinoma.

  • Paraganglioma. This is a rare tumor that develops from cells of the paraganglia, a collection of cells that come from nerve tissue that remain in small deposits after fetal (pre-birth) development. Paraganglia is often found near the adrenal glands and some blood vessels and nerves, including in the head and neck region of the body. This type of tumor is usually considered benign and is often successfully treated with the complete surgical removal of the tumor. Learn more about paraganglioma.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain how many people are diagnosed with appendix cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with appendix cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with appendix cancer?

Primary appendix cancer is cancer that starts in the appendix. Primary appendix cancer is very uncommon, affecting about 1 to 2 people out of every 1 million people. It is more common among people between 50 and 55 years of age. The number of people diagnosed with appendix cancer appear to have increased over the last 2 decades. This is especially true for malignant neuroendocrine tumors of the appendix diagnosed in younger people.

What is the survival rate for appendix cancer?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from appendix cancer. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with appendix cancer are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with appendix cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

For grade 1 or grade 2 gastrointestinal (GI) neuroendocrine tumors overall, a category that includes neuroendocrine tumor of the appendix, the 5-year relative survival is between 68% and 97%. Due to the rare nature of other types of appendix cancer, specific statistics are not available. Talk with your doctor about the factors related to your specific diagnosis.

The 5-year relative survival rates for appendix cancer vary based on several factors. These include the stage of disease at time of diagnosis, a person’s age and general health, and how well the treatment plan works. Another factor that can affect outcomes is the type of appendiceal tumor (see “Types of appendix tumors” in the Introduction).

Experts measure relative survival rate statistics for appendix cancer every 5 years. This means the estimate may not reflect the results of advancements in how appendix cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the websites of the American Cancer Society, National Cancer Institute, and the National Organization for Rare Disorders. Additional reference is: Singh H, et al. Continued increasing incidence of malignant appendiceal tumors in Canada and the United States: A population-based study. Cancer. 2020;126(10):2206-2216. doi:10.1002/cncr.32793. (All sources accessed February 2023.)

The next section in this guide is Risk Factors. It describes the factors that may increase the chance of developing appendix cancer. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Risk Factors

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will find out more about the factors that increase the chance of developing appendix cancer. Use the menu to see other pages.

What are the risk factors for appendix cancer?

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The cause of appendix cancer is unknown, and no avoidable risk factors have been identified. The following factors may raise a person’s risk of developing appendix cancer:

  • Age. The only consistent risk factor for various types of appendix cancer is increasing age. Appendix cancer is rare in children.

  • Sex. Neuroendocrine tumors of the appendix are more common in women.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems appendix cancer can cause. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will find out more about the changes and medical problems that can be a sign of appendix cancer. Use the menu to see other pages.

What are the symptoms and signs of appendix cancer?

Symptoms are changes that you can feel in your body. Signs are changes in something measured, like taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. Sometimes, people with appendix cancer do not have any of the symptoms and signs described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer. People with appendix cancer may experience one or more of the following symptoms or signs:

  • Appendicitis, which is inflammation of the appendix

  • Ascites, which is fluid in the abdomen

  • Bloating

  • Pain in the abdomen or pelvis area

  • Increased girth (size of the waistline), with or without a protrusion of the navel (bellybutton)

  • Changes in bowel function

  • Infertility, which is the medical inability to have a child

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will try to understand what is causing your symptom(s). They may do an exam and order tests to understand the cause of the problem, which is called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called "palliative and supportive care," which is not the same as hospice care given at the end of life. This type of care focuses on managing symptoms and supporting people who face serious illnesses, such as cancer. You can receive palliative and supportive care at any time during cancer treatment. Learn more in this guide’s section on Coping With Treatment.

Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How appendix cancer is diagnosed

There are different tests used for diagnosing appendix cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general condition

  • The results of earlier medical tests

In addition to a physical exam, the following tests may be used to diagnose appendix cancer:

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During a biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    However, appendix cancer is often found unexpectedly during or after abdominal surgery for another reason. If cancer is suspected at the time of surgery, the doctor will remove a portion of the colon and surrounding tissue (called a margin) for examination. Often, a patient will have an appendectomy, which is the surgical removal of the appendix. This is usually done for what is first thought to be appendicitis, and the cancer is diagnosed after the pathologist has looked at the tissue under the microscope. In that case, another surgery may be recommended to remove another margin of tissue around the area where the tumor began, depending on the type of appendix cancer (such as a neuroendocrine or adenocarcinoma tumor) and size of tumor (if it is a neuroendocrine tumor). Appendix cancer may also be discovered by accident when a CT scan is done for another reason.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional (3D) image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Ultrasound. An ultrasound creates a picture of the internal organs using sound waves.

  • Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Biomarker testing can also be done through a blood test called a liquid biopsy. Results of these tests can help determine your treatment options.

  • Radionuclide scanning (68Ga-DOTATATE PET scan or OctreoScan). These tests are used for neuroendocrine tumors and not other types of appendix cancers. A small amount of a radioactive, hormone-like substance that is attracted to a neuroendocrine tumor is injected into a vein. The amount of radiation in the substance is too low to be harmful. A special camera is then used to show where the radioactive substance accumulates. This procedure is useful in detecting spread of a neuroendocrine tumor.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is appendix cancer, these results also help the doctor describe the cancer and determine where the cancer is in the body. This is called staging.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Stages and Grades

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition, you can read about how doctors evaluate and compare cancer cells to normal cells, called the grade. Use the menu to see other pages.

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What is cancer staging?

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it can help predict a patient's prognosis, which is the chance of recovery and longevity. There are different stage descriptions for different types of cancer.

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TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4), depending on the type of cancer. The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

There are 2 different ways that doctors stage appendix cancer. One is for neuroendocrine tumors and the other for carcinomas, which also includes adenocarcinomas. More details on each part of the TNM system for appendix cancer are described below.

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Staging for neuroendocrine tumors of the appendix

Read about the staging of neuroendocrine tumors of the appendix in another section of this website.

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Staging for carcinomas of the appendix

Appendiceal carcinomas are staged according to the TNM staging system, below:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Stage may also be divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T zero): There is no evidence of cancer in the appendix.

Tis: This refers to carcinoma in situ (also called cancer in situ). Cancer cells are found only in the first layers lining the inside of the appendix.

Tis (LAMN): A low-grade appendiceal mucinous neoplasm (LAMN) confined by the muscularis propria, which is the muscle layer of the appendix wall. Mucin without cells may invade into the muscularis propria.

T1: The tumor has invaded the submucosa, which is the next deepest layer of the appendix.

T2: The tumor has invaded the muscularis propria.

T3: The tumor has grown through the muscularis propria and into the subserosa (a thin layer of connective tissue) of the appendix or into the mesoappendix, which is an area of fatty tissue next to the appendix that provides the blood supply for the appendix.

T4: The tumor has grown through the visceral peritoneum, or it has invaded other nearby organs. The peritoneum is a tissue that lines the abdomen and most of the organs in the abdomen.

  • T4a: The tumor has invaded the visceral peritoneum.

  • T4b: The tumor has invaded other organs or structures, such as the colon or rectum.

Node (N)

The "N" in the TNM system stands for lymph nodes. The lymph nodes are small, bean-shaped organs that are located throughout the body that help the body fight infections as part of the body's immune system. There are regional lymph nodes, which are lymph nodes near the appendix. All others are distant lymph nodes, which are lymph nodes found in other parts of the body.

NX: The regional lymph nodes cannot be evaluated because of a lack of information.

N0 (N zero): There is no regional lymph node metastasis.

N1: Cancer has spread to 1 to 3 regional lymph nodes.

N2: Cancer has spread to 4 or more regional lymph nodes.

Metastasis (M)

The "M" in the TNM system describes cancer that has spread to other parts of the body, such as the liver or lungs.

M0 (M zero): The cancer has not metastasized.

M1: There is metastasis or spread of the cancer to distant parts of the body.

  • M1a: This refers to an area of spread called intraperitoneal acellular mucin.

  • M1b: This refers to a metastasis within the peritoneum beyond M1a.

  • M1c: This refers to a metastasis beyond the peritoneum.

Grade (G)

Doctors also describe appendix cancer by its grade (G). The grade describes how much cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and has different cell groupings, it is called “differentiated” or a “low-grade tumor.” If the cancerous tissue looks very different from healthy tissue, it is called “poorly differentiated” or a “high-grade tumor.” The cancer’s grade may help the doctor predict how quickly the cancer will spread or grow. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be identified.

G1: The tumor cells are well-differentiated.

G2: The tumor cells are moderately differentiated.

G3: The tumor cells are poorly differentiated.

G4: The tumor cells are undifferentiated.

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Stage groups for carcinomas of the appendix

Doctors combine the T, N, M, and G information (see above) to say what stage the cancer is.

Stage 0: This refers to cancer in situ. The cancer is found in only 1 place and has not spread (Tis or Tis(LAMN), N0, M0).

Stage I: The cancer has spread to inner layers of appendix tissue but has not spread to the regional lymph nodes or to other parts of the body (T1 or T2, N0, M0).

Stage IIA: The cancer has grown into the connective or fatty tissue next to the appendix but has not spread to the regional lymph nodes or to other parts of the body (T3, N0, M0).

Stage IIB: The cancer has grown through the lining of the appendix but has not spread to the regional lymph nodes or to other parts of the body (T4a, N0, M0).

Stage IIC: The tumor has grown into other organs, such as the colon or rectum, but has not spread to the regional lymph nodes or to other parts of the body (T4b, N0, M0).

Stage IIIA: The cancer has spread to inner layers of appendix tissue and to 1 to 3 regional lymph nodes but has not spread to other parts of the body (T1 or T2, N1, M0).

Stage IIIB: The cancer has grown into nearby tissue of the appendix or through the lining of the appendix and to 1 to 3 regional lymph nodes but has not spread to other areas of the body (T3 or T4, N1, M0).

Stage IIIC: The cancer has spread to 4 or more regional lymph nodes but not to other areas of the body (any T, N2, M0).

Stage IVA: Stage IVA describes any of the following situations:

  • The cancer has spread to other areas in the abdomen but not to the regional lymph nodes (any T, N0, M1a).

  • The cancer has spread to other areas in the abdomen and may be in the regional lymph nodes; the cancer cells are well differentiated (any T, any N, M1b, G1).

Stage IVB: The cancer has spread to other areas in the abdomen and may be in the regional lymph nodes; the cells are moderately or poorly differentiated (any T, any N, M1b; G2, G3, or GX).

Stage IVC: The cancer has spread outside the abdominal area to distant parts of the body, such as the lungs (any T, any N, M1c, any G).

Recurrent: For both neuroendocrine tumors and carcinomas, recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

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Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with appendix cancer. Use the menu to see other pages.

This section tells you the treatments, also known as therapies, that are the standard of care for appendix cancer. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for appendix cancer in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How appendix cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for appendix cancer because there are different treatment options. Learn more about making treatment decisions.

The most common types of treatments for appendix cancer are described below. Find treatment information for neuroendocrine tumors of the appendix in another section of this website.

READ MORE BELOW:

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is the most common treatment for appendix cancer. Most often, appendix cancer is low grade (see Stages and Grades) and, therefore, slow growing. Often it can be successfully treated with surgery alone. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

Types of surgeries for appendix cancer include:

  • Appendectomy. An appendectomy is the surgical removal of the appendix. Often, an appendectomy is not the surgery performed to treat this kind of cancer. Instead, it is more typical that patients have an appendectomy for appendicitis and then when the tissue is sent to the pathologist, cancer is discovered. If the pathology analysis finds a neuroendocrine tumor and it is small, less than 1 or 2 centimeter (cm), then the appendectomy may be enough to remove all of the cancer. However, if the neuroendocrine tumor is larger or has aggressive features or if it is not a neuroendocrine tumor, such as an adenocarcinoma or a goblet cell carcinoma, then a second operation to remove more tissue will likely be needed.

  • Hemicolectomy. For a neuroendocrine tumor larger than 2 cm or appendix cancers that are not neuroendocrine, a hemicolectomy may be recommended. This is the removal of a portion of the colon next to the appendix. Removal of nearby blood vessels and lymph nodes is often done at the same time. A right hemicolectomy is surgery performed on the right side of the colon, which is where the appendix is normally attached. Even though a large amount of the large intestine is removed, the operation usually does not result in the need for a colostomy or stoma, which is an opening in the abdomen through which the bowel contents are emptied into a bag.

  • Debulking surgery. For later-stage appendix cancer, debulking (or cytoreduction) surgery may be considered depending on the type of appendix cancer and if there is only spread in the abdominal cavity. In this surgery, the doctor removes as much of the tumor “bulk” as possible, which can benefit the patient even though it will not remove every cancer cell from the body. Sometimes, debulking surgery will be followed with chemotherapy (see below) to destroy remaining cancer cells.

    When the tumor produces mucus (also known as mucin in medical terms), much of the bulk of the abnormal tissue often is not cancer but is due to accumulation of the mucus. The mucus looks like jelly, and this condition may be referred to as “jelly belly” (also known as pseudomyxoma peritonei or PMP in medical terms). Removing the mucus from the abdomen can often relieve a patient’s bloating.

  • Removal of the peritoneum. Some surgeons recommend aggressive surgery to remove the peritoneum (the lining of the abdomen) in order to remove as much of the cancer as possible. This type of surgery is also called a peritonectomy. Not all surgeons agree that extensive surgery like peritonectomy is necessary in people with slow-growing, low-grade appendix cancer that has spread beyond the colon to involve other areas of the abdomen.

    In patients with a very slow-growing tumor, peritonectomy can be effective in removing the majority of the cancer cells. This can benefit the patient by reducing the amount of cancer, even if it does not remove every cancer cell. However, it is a difficult operation that can have significant side effects. The doctor will consider many different factors, such as the patient’s age and overall health, before recommending this extensive surgery. Patients should talk with a specialist with expertise in this type of procedure beforehand.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for appendix cancer include:

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy (based on biomarker testing)

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy. The type of medication depends on the type of appendix cancer. The drugs used for neuroendocrine tumors, for example, are not the same as those used for adenocarcinomas. Your doctor will need to know the type of appendix cancer to know which drugs may be effective.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

For appendix cancer that is not a neuroendocrine tumor, chemotherapy is most often used soon after surgery when cancer is found outside the appendix region. It may also be given after surgery for a non-neuroendocrine appendix cancer to prevent the cancer from coming back, depending on the stage of disease.

There are different types of chemotherapy, depending on how the drugs are delivered to the body:

  • Local/intraperitoneal chemotherapy. For local chemotherapy, the medication is delivered to 1 area or section of the body. More specifically, this is called intraperitoneal chemotherapy, which is chemotherapy that is given directly into the abdominal cavity. Typically, the surgeon will try to remove as much of the tumor as possible (debulking surgery, see above) and then insert a tube in the abdomen through which chemotherapy can be given after the operation. In some cases, the chemotherapy is warmed above body temperature to increase its ability to penetrate the tissue that may be lined with tumor cells; this is called hyperthermic (or heated) intraperitoneal chemotherapy or HIPEC. Once chemotherapy is completed, the tube is removed, generally without the need for another operation.

  • Systemic chemotherapy. This type of chemotherapy is given through the bloodstream to reach cancer cells throughout the body. This can be done using an intravenous (IV) tube, which is a tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). Some people may receive this type of chemotherapy in their doctor’s office or outpatient clinic; others may go to the hospital.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

For non-neuroendocrine appendix cancers, systemic chemotherapy is similar to that used for colorectal cancer. Chemotherapy may include fluorouracil (5-FU), leucovorin (folinic acid), capecitabine (Xeloda), irinotecan (Camptosar), and oxaliplatin (Eloxatin).

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, mouth sores, diarrhea, nerve problems (neuropathy) in the hands and feet, and cold sensitivity. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. For example, if your tumor has a particular marker called mismatch repair deficiency or dMMR, then it will most likely respond well to specific treatments like immunotherapy. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapy for non-neuroendocrine appendix cancer is similar to that used for colorectal cancer and includes bevacizumab (Avastin), ziv-aflibercept (Zaltrap), ramucirumab (Cyramza), cetuximab (Erbitux), and panitumumab (Vectibix).

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

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Immunotherapy

Immunotherapy uses the body’s natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.

Certain advanced appendix cancers may have a molecular feature called microsatellite instability (MSI-H). Doctors can check for MSI-H by using biomarker testing. If the cancer is MSI-H, then pembrolizumab (Keytruda) or nivolumab (Opdivo) plus ipilimumab (Yervoy) may be treatment options. These medications are immune checkpoint inhibitors that target receptors on tumor cells and prevent tumor cells from hiding from the immune system.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, low thyroid hormone level, mild fatigue, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Radiation therapy is rarely used in the treatment of appendix cancer. Sometimes it may be used to relieve symptoms when the cancer has spread to a particular area, such as the bone.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.

Learn more about the basics of radiation therapy.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Metastatic appendix cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, chemotherapy, targeted therapy, and radiation therapy. Palliative and supportive care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you are feeling with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, targeted therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent appendix cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced, end-stage, or terminal cancer.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Appendix Cancer - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are studied to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with appendix cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of appendix cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects of the treatment itself that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Others volunteer for clinical trials because they know that these studies are a way to contribute to the science of treating appendix cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future people with appendix cancer.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. In many cases, standard things like routine blood work or CT scans will be covered by your health insurance while you are on a clinical trial, but other things like the clinical trial medication or special research testing will need to be paid for by the sponsor or company conducting the clinical trial. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. It is extremely rare that people in a cancer clinical trial would receive a placebo without any other treatment. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for appendix cancer, learn more in the Latest Research section.

Cancer.Net offers more information about cancer clinical trials in other areas of the website, including a complete section on clinical trials.

There are many resources and services to help you search for clinical trials for appendix cancer, including the following services. Please note that these links will take you to separate, independent websites:

  • ClinicalTrials.gov. This U.S. government database lists publicly and privately supported clinical trials.

  • World Health Organization (WHO) International Clinical Trials Registry Platform. The WHO coordinates health matters within the United Nations. This search portal gathers clinical trial information from many countries’ registries.

Read more about the basics of clinical trials matching services.

The next section in this guide is Latest Research. It explains areas of scientific research for appendix cancer. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will read about the scientific research being done to learn more about appendix cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about appendix cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with appendix cancer.

Research for appendix cancer is challenging because the disease is rare. So, clinical trials specifically for appendix cancer may be hard to find. Patients are encouraged to talk with their doctors about broader clinical trials that may be open to them, such as those studying gastrointestinal neuroendocrine tumors or colorectal cancer.

The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Enhanced delivery of chemotherapy. Doctors are looking for different ways to deliver chemotherapy to the abdomen. One approach is called hyperthermic intraoperative peritoneal chemotherapy. This is similar to the hyperthermic intraperitoneal (local) chemotherapy (HIPEC) described in Types of Treatment, but the drugs are delivered directly to the open abdomen during debulking surgery, instead of after surgery.

  • Combining cancer drugs. There are studies looking for the best combinations of different drugs to effectively treat appendix cancer.

  • New medications to treat neuroendocrine tumors. While standard chemotherapy has been less effective for treating metastatic neuroendocrine tumors, there is a lot of research ongoing for new targeted therapies for neuroendocrine tumors as more and more is learned about these tumors.

  • Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current appendix cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in appendix cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

READ MORE BELOW:

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative and supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for appendix cancer are described in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

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Coping with emotional and social effects

You can have emotional and social effects after a cancer diagnosis. This may include dealing with a variety of emotions, such as sadness, anxiety, fear, or anger, or managing stress. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

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Coping with the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations in a separate part of this website.

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Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer diagnosis. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minorities, people with fewer financial resources, sexual and gender minorities (LGBTQ+), adolescent and young adult populations, adults older than 65, and people who live in rural areas or other underserved communities.

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people.

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Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should I call about side effects?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

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Caring for a loved one with appendix cancer

Family members and friends often play an important role in taking care of a person with appendix cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One With Cancer in English or Spanish.

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Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression, constipation, diarrhea, and rash that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

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The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

After treatment for appendix cancer ends, talk with your doctor about developing a follow-up care plan. People treated for appendix cancer will generally need to follow up with an oncologist, a surgeon, or an internal medicine specialist to watch for a recurrence. Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Computed tomography (CT) or magnetic resonance imaging (MRI) scans may be recommended as part of your follow-up care.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. Symptoms of a recurrence in the abdomen include pain, nausea, blood in the stool, severe bloating, and cramping.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person's life.

For some, the term “survivorship” itself does not feel right, and they may prefer to use different language to describe and define their experience. Sometimes long-term treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from appendix cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Guide to Cancer Survivorship: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of appendix cancer do I have?

  • Can you explain my pathology report (laboratory test results) to me?

  • Is the cancer localized, regional, or advanced? What does this mean?

  • How often do you treat people with appendix cancer?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What types of research are being done for appendix cancer in clinical trials? Do clinical trials offer additional treatment options for me?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What is my prognosis?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, or perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I'm worried about managing the cost of cancer care, who can help me?

  • What support services are available to me? To my family?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • Can surgery be done to remove all of the cancer?

  • Can surgery be done to debulk the cancer? How will this help me?

  • What type of surgery will I have? Will lymph nodes be removed?

  • How much experience does the surgeon have with this type of operation?

  • How long will I be in the hospital?

  • What will my recovery be like after this operation?

  • Do you recommend chemotherapy or other treatment after surgery?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having therapies using medication

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will those tests be needed?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • When should I return to my primary care doctor for regular medical care?

  • Who will be leading my follow-up care?

  • What support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Appendix Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 12/2023

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Appendix Cancer. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Appendix Cancer. Use the menu to choose a different section to read in this guide.