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| __NOTOC__
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| {{Appendix cancer}}
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| {{CMG}}; {{AE}} {{Soroush}}
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| ==Overview==
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| 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.
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| ==Secondary Prevention==
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| Effective measures for the secondary prevention of appendix cancer include:
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| *Cartcinoid tumors of appendix:
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| :*[https://www.nccn.org/ National Comprehensive Cancer Network] (NCCN) and North American Neuroendocrine Tumor Society (NANETS) recommendations are base on the tumor '''size'''<ref name="pmid20664473">Boudreaux JP, Klimstra DS, Hassan MM, Woltering EA, Jensen RT, Goldsmith SJ et al. (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20664473 The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum.] ''Pancreas'' 39 (6):753-66. [http://dx.doi.org/10.1097/MPA.0b013e3181ebb2a5 DOI:10.1097/MPA.0b013e3181ebb2a5] PMID: [https://pubmed.gov/20664473 20664473]</ref>
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| ::*Less than 2 cm : No follow up
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| :::* NANETS devided tumors < 2 cm into two categories:
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| ::::* Tumors less than 1 cm needs no further follow up
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| ::::* 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>
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| ::*2 cm and more: History an d 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 (5HIAA and Chromogranin), imaging as clinically indicated.
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| ::* Followup Imaging studies: 6 moth after surgery, every 6-12 months for at least 7 years.
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| *Metastatic disease palliative managements:
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| :*Liver resection for selected patients
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| :*Embolization of the hepatic artery
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| :* Somatostatin analogs did not show to reduce the tumor size, but they are helpful in symptom control
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| *Adenocarcinoma
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| *There no appropriate evidences in role tumor markers for followup of the patients with appendix adenocrcinoma, indeed current consensus is based on colorectal cancer experience.
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| :*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.
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| :* Followup Imaging studies: 6 moth after surgery, every 6-12 months for at least 7 years
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| ==References==
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| {{Reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category: (name of the system)]]
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