A recent National Cancer Database study found an increasing incidence in appendiceal cancer in patients between 2004 and 2017 who were younger than 50 years old and diagnosed with acute appendicitis.
Appendicitis is the most common cause of sudden abdominal pain, affecting between 5 and 9 percent of people. It is also one of the most common abdominal surgical emergencies. At Austin Surgeons, our surgeons are specially trained in and regularly perform appendectomies.
Appendectomy, or the surgical removal of the appendix, is the most effective and definitive treatment for appendicitis. However, the non-surgical treatment of appendicitis with antibiotics is on the rise in the United States.
Board-certified general surgeon Dr. Jeffrey Meynig interpreted this recent research study and explained that most of the appendiceal cancer found in the study were carcinoid tumors.
Carcinoid tumors are rare and are estimated to be found in up to 0.2 percent of appendectomy specimens. Most are very early and are cured by appendectomy alone. However, they can be more advanced and can spread just like any other cancer.
Preoperative imaging used to diagnose appendicitis will often not show a small carcinoid tumor. They are only found after pathologic examination of the specimen. Therefore, treating patients with antibiotics alone for appendicitis could lead physicians to miss a carcinoid or other rare appendiceal cancer. This could delay a diagnosis and lead to a more advanced cancer.
"As surgeons, when discussing the alternative of treating appendicitis with antibiotics instead of surgery, we always discuss the possibility of recurrent appendicitis," Dr. Meynig said. "However, the implication of this study suggests we may now need to be discussing the apparent increasing frequency of carcinoid tumors in younger patients, and how they can be missed if the appendix is not removed. The takeaway from this study for the general population should not be one of fear, but instead should help them make an educated decision on whether to consider nonoperative management of their appendicitis."
"While I do not believe this article implies an alarming rate of new onset of appendiceal cancer, it certainly this could be happening as result of genetics or more likely, environmental factors," Dr. Meynig explained. "My feeling is that this piece of information, when presented to the patient, will be more influential in patients choosing to move forward with surgery."
It is important to note that the National Cancer Database study has some weaknesses Dr. Meynig pointed out. This is a retrospective study with information obtained from a database that relies heavily on accuracy of reporting. Data from many different private and academic institutions were included, and there was no standard guideline for how appendiceal cancers should be classified.
This is a drawback of retrospective studies in general. Having said that, these types of studies frequently inform surgeons’ recommendations and counseling.
Recent studies suggest up to 35 percent recurrence of appendicitis within a year when treated with antibiotics alone, most of which occur within three months. The National Cancer Database study underestimates these numbers. Appendicitis patients treated with antibiotics alone also have a higher tendency of recurrent emergency room visits, repeated dosing of antibiotics, and higher incidence of a perforated appendix leading to the development of an abscess.
"This study may certainly cause surgeons to rethink how they use antibiotics alone for the treatment of appendicitis," Dr. Meynig stated. "For example, instead of using antibiotics as a final treatment for appendicitis, antibiotics could be used as a temporizing measure to get people out of an emergency situation, so they could plan an elective appendectomy around work schedules, travel schedules, etc. That would address both convenience and safety."
For more information on appendicitis or appendectomies or to schedule an appointment, visit austinsurgeons.net or call (512) 467-7151.
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