Appendix cancer secondary prevention

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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]

Overview

There are neither evidence based guidelines nor RCTs for follow up of appendix carcinoid tumors. Meanwhile, consensus based effective measures for the secondary prevention of appendix cancer include follow up history and physical examination, tumor marker measurements like CEA, CA-125, CA 19-9, follow up imaging studies, carcinoid tumor markers such serotonin, and specific imaging studies such as octreotide scintigraphy.

Secondary Prevention

Effective measures for the secondary prevention of appendix cancer include:

• Carcinoid tumors of appendix:

• National Comprehensive Cancer Network (NCCN) and North American Neuroendocrine Tumor Society (NANETS) recommendations are based on the tumor size:

• Less than 2 cm: No follow up

• NANETS devided tumors < 2 cm into two categories:

• Tumors less than 1 cm needs no further follow up
• Tumors between 1 and 2 cm with nodal metastasis, vascular invasion, lymphatic metastasis, mesoappendical invasion, intermediate and high grade as well as mixed histology: The same as tumors larger than 2 cm<math>\blacktriangledown</math>

• Two cm and more: History and physical examination between 3-12 months plus tumor markers as well as imaging studies consideration for the first year, then tumor markers every 6-12 months (5-HIAA and chromogranin-A), imaging as clinically indicated.
• Followup imaging studies: 6 month after surgery, every 6-12 month for at least 7 years.

• Metastatic disease palliative managements:

• Liver resection for selected patients

• Embolization of the hepatic artery

• Somatostatin analogs did not show to reduce the tumor size, but they are helpful in symptom control

• Adenocarcinoma
• There are no appropriate evidences in role of tumor markers for follow up of the patients with appendix adenocarcinoma, indeed current consensus is based on colorectal cancer experience.

• CEA, CA-125, CA 19-9 every 6 month for the first two years, then yearly for at least 3 more years, plus continued follow up in selected cases.
• Follow up Imaging studies: 6 moth after surgery, every 6-12 months for at least 7 years.