Appendicitis, Appendix Cancer, and PSM: Symptoms and Specialized Treatment Options.

While the exact function of the appendix remains unclear, some studies suggest it may play a role in gut immunity or in maintaining healthy gut bacteria. However, it is often referred to as a 'vestigial organ' due to its minimal function in modern humans.

We do know the appendix can cause a lot of trouble. Whether that’s appendicitis (common), appendix cancer (rare), or as a source of peritoneal surface malignancy (PSM)—cancer of the lining of the abdominal cavity—the little appendix can make a big health impact.

About 250,000 people in the U.S. are diagnosed with appendicitis each year. In contrast, cancer of the appendix is very rare. Recent data suggests that appendiceal neoplasms may be more common than previously thought, with some estimates closer to 1-2 cases per 100,000 per year.

Appendix cancer is one of the ways PSM develops. It can spread from other cancers of the abdomen, such as the uterus, pancreas, stomach, or colon. PSM is rare, impacting about 7 people per million each year in the U.S.

If you are diagnosed with cancer, the best treatment is available from high-volume centers, such as MedStar Washington Hospital Center, that care for a lot of patients. The earlier you spot symptoms and seek care the sooner we can identify an appendix condition and provide the best treatment.

Symptoms of appendicitis and appendix cancer.

Appendicitis is a common medical emergency caused by inflammation of the appendix. This can happen when the open end of the appendix is blocked by anything, including feces (poop). Left untreated, appendicitis can cause the appendix to rupture, which is a life-threatening complication.

Symptoms of appendicitis can include:
​

• Pain the middle of abdomen near the belly button. This pain often shifts to the lower right part of the abdomen as the condition gets worse.

• Fever

• Loss of appetite

• Nausea and vomiting

Men sometimes dismiss these symptoms as signs of a muscle injury. Women most often assume this discomfort is related to their monthly period. If you have symptoms of appendicitis, go to the emergency room right away.

If imaging such as CT scans confirm your appendix is inflamed, you may need emergency surgery to remove it. This procedure is usually minimally invasive, with easier recovery than with traditional open procedures.

Appendix cancer is often diagnosed unexpectedly during surgery for suspected appendicitis, though most people undergoing appendectomy do not have cancer. Symptoms of appendix cancer and appendicitis can be similar:
​

• Bloating

• Changes in toilet habits

• Difficulty digesting food

• Loss of appetite

• Pain in the lower right side of the abdomen

• Vomiting

• Unexplained weight loss

With advanced imaging techniques, appendix cancer is being spotted earlier, when treatment can be most effective. To confirm cancer, pathologists examine a sample of cells from the appendix under a microscope. 

If cancer is diagnosed, we work to learn whether the disease has spread and plan treatment that is specific to each patient’s cancer. This can include surgery, chemotherapy, and radiation therapy. We also use advanced techniques such as immunotherapy and targeted therapy to help patients get the best possible outcomes. 

Related reading: Death of Actor Adan Canto Highlights Uptick in Appendix Cancer Diagnoses in Young Hispanic Adults.

Peritoneal Surface Malignancy: Symptoms and treatment.

PSM is the term for any cancer within the abdomen that spreads to the peritoneum, which is the lining that protects and supports the organs inside the belly. PSM is rare, but at MedStar Washington Hospital Center we treat roughly two patients per week with the condition.

There aren’t usually symptoms of PSM early on, which can make it a challenge to detect. Approximately 70% of PSMs are diagnosed at an advanced stage. The more cancerous cells build up in the abdominal cavity, the more difficult PSM is to treat.

Up to 20% of PSM tumors are not visible on conventional imaging, such as MRI and CT scan due to their microscopic size. We use other techniques such as laboratory tests to search for tiny signs of cancer and to create a personalized treatment plan.

Pioneers in PSM treatment.

At MedStar Washington Hospital Center, we’re pioneers of advanced techniques to provide effective treatment for this challenging cancer. Treatment for PSM most often involves two primary steps:

• Complete cytoreduction: Surgery to remove all visible tumors in the abdomen, leaving behind no traces of cancer. This surgery, which can take 6 to 12 hours, is sometimes known as The Sugarbaker Technique. It was invented by Dr. Paul Sugarbaker, the former Director of Gastrointestinal Malignancies here at MedStar Washington Hospital Center. 

• Intraoperative HIPEC: Heated chemotherapy/hyperthermic intraperitoneal chemotherapy is an advanced treatment that “washes” the abdominal space with heated, concentrated chemotherapy. This 90-minute treatment spares the rest of the body from the chemotherapy and helps eliminate tiny cancer cells that can’t be seen with the naked eye.