Appendiceal tumors have attracted multidisciplinary attention
For appendicitis, periappendiceal abscess, perforated appendicitis and such problems, people more or less have a certain understanding, will not feel unfamiliar; but on the “appendix tumor” of this disease, it is estimated to know the people may be very few. Seeing the name of this disease, some people may feel surprised, “How, a small or else appendix, can also suffer from cancer?” As a matter of fact, although the incidence of appendix tumor is very low, it has been increasing year by year in our digestive tract cancer population. As a member of the tumor family, although the appendix tumor “volume” is insignificant, it is still as life-threatening as colorectal cancer.
In July this year, under the auspices of the Colorectal Tumor Committee of China Medical Doctors’ Association, dozens of experts from more than 30 authoritative medical institutions in China in the fields of pathology, imaging, gastroenterology, surgical oncology, medical oncology, radiotherapy, as well as rehabilitation, nutrition, psychology and other specialties, for the first time compiled the “Expert Consensus on Multidisciplinary Comprehensive Treatment of Appendiceal Tumor in China” (the Consensus), which jointly “draws a picture” for appendiceal tumors with respect to their histological classification, clinical features, diagnostic basis and treatment points. Together, they have drawn a picture of the histological classification, clinical characteristics, diagnostic basis and treatment points of appendiceal tumors, aiming at raising awareness and early diagnosis and treatment. In this regard, Prof. Qingchao Tang, chief of Colorectal Oncology Surgery Department of the Second Affiliated Hospital of Harbin Medical University, the main author of the Consensus, explained the popularization of appendiceal tumors.
Hidden onset, possibility of missed diagnosis
“With the great improvement of the living standard, “China on the tip of the tongue” let the people appreciate the profoundness of our culinary culture, but the poor dietary structure and eating habits may give birth to the dreaded digestive tract tumors. Professor Tang Qingchao said, according to the latest survey data of the International Agency for Research on Cancer under the WHO: in 2020, the number of new cancer cases in China will be 4.57 million, far exceeding that of the rest of the world; while the new cases of cancer in the top ten, digestive tract tumors occupy five seats, in the order of colorectal cancer, gastric cancer, liver cancer, esophageal cancer, and pancreatic cancer, i.e., for every 10 cancer patients, there will be four or five cases of digestive tract tumors. In these digestive tract cancers, people know little about appendix tumor, due to often “mixed” in the acute and chronic appendicitis, right lower abdominal inflammatory masses in the team, and difficult to identify, often resulting in omission of diagnosis, misdiagnosis of the possibility.
Tang Qingchao explained that the human appendix in the lower right side of the abdomen, located between the cecum and ileum, an average length of 11 cm, diameter 0.5-0.7 cm, is a single opening tube-like organ, the distal end atresia. Compared with the large and small intestines, which are about 7 meters long, the appendix is too small, only equivalent to the size of a small thumb; tumors originating from this part of the body are insidious in their onset and lack of specificity, which naturally make them easy to become “fish out of water”. Professor Tang pointed out that the nature of appendiceal tumor is uncertain, benign and malignant, with appendiceal mucus cyst, appendiceal adenocarcinoma and appendiceal carcinoid tumor (a kind of low-grade malignant tumors, the structure of the tissue is like cancer) as the most common, in which appendiceal carcinoid cancer has the highest prevalence rate, accounting for 50-70% of all appendiceal tumors; in contrast to it, primary appendiceal tumor is very rare, and it is the lowest incidence rate of digestive cancer, accounting for 0.2% of the gastrointestinal tract tumors. It is the least common type of digestive tract cancer, accounting for about 0.2% of gastrointestinal tract tumors.
Appendicitis and appendiceal tumor are not necessarily related.
Clinically, patients with appendiceal tumors usually have insignificant symptoms, and most of them are found by chance during intraoperative or postoperative pathological examination of specimens. Among them, most of the appendiceal mucus cysts are asymptomatic, and there is a mass in the right lower abdomen, which is increasing slowly, with smooth and elastic surface, clear and movable border, and mild pressure pain and discomfort; appendiceal carcinoid tumors are clinically characterized by chronic pain in the right lower abdomen, and presenting symptoms of acute appendicitis, and the individual patients are accompanied by masses in the right lower abdomen, with better prognosis; appendiceal adenocarcinoma is usually clinically non-specific, and the symptom of appendicitis is atypical or accompanied by appendix abscess, which may leave long lasting pain after the removal of the appendix. Appendicitis symptoms are atypical or accompanied by appendiceal abscess, which may leave long-term fistula after appendectomy. Tang Qingchao pointed out that when appendiceal tumor is in the progressive stage, patients often have problems such as fatigue, chronic abdominal pain and satiety, and may also have symptoms related to appendicitis, intestinal obstruction or pelvic mass. Therefore, when removing the appendix in patients with suspected appendicitis, surgeons are advised to consider the possibility of an appendiceal tumor.
Here, some people may ask: Is it possible that appendicitis is recurrent and an appendiceal tumor is formed due to its inflammatory stimulation? Professor Tang Qingchao explained that, according to the existing research results, there is no inevitable connection between appendicitis and appendiceal tumor, they are two very different diseases; although appendicitis appendectomy patients, appendiceal tumor detection rate accounted for a certain percentage, but this does not prove that appendicitis is the appendiceal tumor “initiator”, but with the continuous improvement of diagnostic and treatment technology and scientific concepts, some “latent” appendiceal tumors are formed due to its inflammatory stimulation. But this does not prove that appendicitis is the “originator” of appendiceal tumor, but with the continuous improvement of diagnostic and treatment technology and scientific concepts, some appendiceal tumors “lurking” in the symptoms of appendicitis and using appendicitis as a “camouflage” have been gradually discovered by people. So we don’t have to worry too much, there is no need to extend from the “talk about cancer” to “talk about appendicitis”, or even randomly appendix “everything”.
Chronic abdominal pain, do not take their own medicine
But look at it from another angle, the right lower abdomen can tolerate mild pain, was simply considered “appendicitis attack”, is not rational, not desirable, not at home on their own medication, but to the hospital in a timely manner to accept the relevant diagnostic examinations. Because in appendicitis appendectomy cases, the detection rate of appendiceal tumors is about 2.3-12%, while the proportion of appendiceal tumors in patients with periappendiceal abscess is as high as 20%. At the same time, 13-42% of patients with appendiceal tumors have colorectal tumors. Therefore, it is necessary to give colonoscopy to those who have been diagnosed with appendiceal tumors to help diagnose any colorectal abnormalities. Director Tang Qingchao cautioned that appendicitis and appendiceal cancer, although there is only one word difference, but the scope of surgical resection and clearance is completely different, the latter often need to carry out the right half of the colectomy, in order to completely clear the appendiceal cancerous foci, and the need for a combination of chemotherapy, immunotherapy and so on.
In daily life, how to prevent digestive tract tumors? Prof. Tang Qingchao suggests that: firstly, we should pay attention to the reasonable dietary structure, high protein diet, high oil and high salt food does more harm than good, which contributes to the high incidence of gastric and intestinal cancers, therefore, we should appropriately reduce the intake of meat and eat less salty food such as salted vegetables and sauerkraut, and improve the proportion of fruits and vegetables, and increase the proportion of roughage on the dining table; secondly, the bad personal hobbies, such as smoking and alcoholism, also have obvious stimulating effect on the development of tumors; thirdly, we should encourage appropriate intensity of physical exercise, according to the physical quality of individuals to maintain more than 3 times a week at least 30 minutes each time. Secondly, bad personal habits, such as smoking and alcoholism, also have obvious stimulating effects on tumor development, so we must make up our mind to quit smoking and limit alcohol consumption; thirdly, we should encourage appropriate intensity of physical exercise, according to the physical quality of the individual, keeping more than 3 times a week, at least 30 minutes of physical exercise each time helps to increase the health level; maintaining the intensity of exercise, keeping the heart rate above 100 beats/minute is the optimal.
Director Tang Qingchao concluded that, adhering to the principle of “early detection, early diagnosis, early treatment”, appendix tumor is not easy to “fall into the net”, invincible; at the same time, this also reminds us clinicians that there is no small disease, and we must be prudent in diagnosis and treatment of the disease and do not let any slightest trace slip through. At the same time, it also reminds us clinicians that there is no such thing as a small disease.