Appendix cancer diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]


Either CT-scan or MRI are diagnostic study of choice for appendix cancer. Both MRI (particularly diffusion weighted MRI) and CT scan has been recommended as method of choice for disease staging. Histopathology is the gold standard test for the diagnosis as well as classification of appendix cancers.

Diagnostic Study of Choice

Study of choice

Peritoneal carcinomatosis index

  • Peritoneal carcinomatosis index (PCI): A widely accepted metric for assessment of disease border in appendix cancer:[2]
  • Table and figure below demonstrate abdominal regions as well as scoring system for PCI.
Peritoneal Carcinomatosis Index (PCI) Regions
PCI Scoring System
Lesion Size Score
LS0 No tumor seen
LS1 Tumor up to 0.5 cm
LS2 Tumor up to 5 cm cm
LS3 Tumor > 5 cm or confluence
Maximum Score = 3
Regions (0-3)
0 Central
1 Right Upper
2 Epigasterium
3 Left Upper
4 Left Flank
5 Left Lower
6 Pelvis
7 Right Upper
8 Right Flank
9 Upper Jejunum
10 Lower Jejunum
11 Upper Illeum
12 lower Illeum
Maximum Score = 36
Total Maximum Score = 39

TNM classification of tumors of the appendix

TNM classification of tumors of the appendix 1
Primary tumor (T)
Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ: intraepithelial or invasion of lamina propria 2
T1 Tumor invades submucosa
T2 Tumour invades muscularis propria
T3 Tumor invades through muscularis propria into subserosa,

or into non-peritonealized periappendiceal tissue

T4 Tumor directly invades other organs or structures

and/or perforates visceral peritoneum

Regional Lymph Nodes (N)
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in 1 to 3 regional lymph nodes
N2 Metastasis in 4 or more regional lymph nodes
Distant Metastasis (M)
Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
Stage Grouping
Stage 0 Tis N0 M0
Stage I T1 N0 M0

T2 N0 M0

Stage II T3 N0 M0

T4 N0 M0

Stage III Any T N1 M0

Any T N2 M0

Stage IV Any T Any N M1
1 The classification applies only to carcinomas.

2 This includes cancer cells confined within the glandular basement membrane (intraepithelial)

or lamina propria (intramucosal) with no extension through muscularis mucosae into submucosa.


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