Appendix Cancer Definitions and Glossary
Colorectal Cancer, Pseudomyxoma Peritonei, Peritoneal Carcinomatosis
Definitions, descriptions and surgical procedures you may read in your medical report(s):
Adhesions (scar tissue) may more troublesome with any additional debulking surgeries, therefore, it is preferable for the initial surgery to be as complete and thorough as possible.
Antibodies: Proteins made by the body to fight off foreign substances.
Appendectomy refers to the surgical removal of the appendix. Appendectomies may be performed via laparoscopy.
The appendix has been described as a "pouch-like tube", averaging ten centimeters, in length, and attached to the cecum.
Appendiceal carcinoid tumors represent approximately fifty per cent of all appendix tumor cases. Carcinoid tumors are usually less than two centimeters in size and rarely spread to lymph nodes.
Appendiceal non-carcinoid tumors originate from the epithelial cells lining the inside of the appendix. These cells create tumors producing mucin (a gelatinous material defined as Pseudomyxoma Peritonei.) These tumor cells and resulting mucin (Pseudomyxoma Peritonei) can accumulate (increase) gradually taking more space within the abdominal or peritoneal cavity. If these mucin-producing cells spread outside the appendix and into the peritoneal or abdominal cavity, they can lead to fatal bowel obstruction, if left untreated.
Appendiceal adenocarcinoid tumors and goblet cell carcinomas are similar to both carcinoid and adenocarcinoma tumors of the appendix.
Argon beam coagulator ablation is a procedure in which tissue is destroyed by an electrical current passing through a stream of argon gas to the targeted tissue, and may be used to stop or reduce blood loss during surgery.
Ascites is the accumulation of fluid within the peritoneal cavity and may occur for a variety of conditions including post-operative inflammation or cancer.
Bone marrow: The spongy part of some bones, where blood cells develop from immature marrow cells called stem cells
Cachexia or wasting syndrome can be caused by malabsorption of food and may include anorexia, weight loss, muscle atrophy, fatigue and is often a fatal condition.
Catheter: small plastic tube
The cecum is the first section of the large intestine or colon, closest to the small intestine.
Central line or Indwelling catheter: A tube surgically placed in the chest near the neck through which to give chemotherapy, fluids, TPN, etc.,or be used to draw blood. AKA a "port."
The CyberKnife® delivers beams of high dose x-ray radiation to tumors with precision, and is a non-invasive alternative to surgery for the treatment of tumors the brain, liver, and pancreas, as well as other regions/organs of the body.
For the treatment of Pseudomyxoma Peritonei syndrome, mucinous tumors are removed via cytoreductive surgery. The removal of these tumors may possibly involve the resection or removal of other organs or tissues to which the tumors have become attached.
Cytoreductive surgery(CRS) for Pseudomyxoma Peritonei treatment includes thorough removal or destruction of all visible tumors throughout the surfaces of the peritoneum. Surgery may include the removal of segments of small and large bowel, gall bladder, liver, omentum, ovaries, pancreas, spleen, stomach and uterus, when necessary.The degree, or extent of resection, depends on size and location of the tumors(s). Each patient is unique.
Cytoreductive surgery is a detailed procedure often requiring ten or more hours.
Tumors are removed and destroyed using a variety of surgical techniques including argon beam coagulator, electro-evaporation, laser, and ultrasonic dissection. Optimal results may be achieved with the surgeon's ability to remove all visible tumors, with minimal, if any, deposits of residual disease. Less residual tumor may result in a better the opportunity for HIPEC to be effective.
The aim of cytoreductive surgery is to eliminate all tumor and metastatic tissues from the abdominal cavity, in order to effectively deliver intra-peritoneal heated chemotherapy (HIPEC).
Cytoreductive Surgery or Cytoreduction (CRS) is performed under general anesthesia. CRS time averages eight to ten hours.
A longitudinal incision is made in the abdomen. The abdomen, pelvis and organs therein are carefully inspected, during which time all operable visible and palpable tumors and tumor deposits are removed. The peritoneum is stripped.
Following surgery patients are admitted to the intensive care unit (ICU) for 24 hours or longer, depending on the individual patient. Patients are then transferred to regular hospitalization for an average of two weeks. This time period will vary depending on the individual.
Debulking: the purpose of debulking surgery is to remove as much tumor as possible. Debulking may include the removal of the omentum and the right colon. For women, debulking will likely include a hysterectomy, if this was not previously performed. Adhesions may become more troublesome with additional debulking surgeries.
Gastrectomy refers to surgery in which all, or the portion of the stomach is removed. Following a gastrectomy, patients are often able to gradually re introduce solid foods back into their diet and can continue leading an active lifestyle.
Click here to view our NUTRITION link, including information of interest to gastrectomy patients.
Click here to view information about our Gastrectomy Pals' Resource Group
A Groshong ® Catheter is a thin walled tube used to administer IV fluids, including systemic chemotherapy drugs. The tube tunnels under the skin, going under or over the collarbone, then enters one of the large central veins in the upper chest and neck. The catheter may be connected to a PICC line or port (see below) that has been surgically implanted under the skin. Learn more about Groshong Catheters.
Hemicolectomy is a surgical procedure involving the removal of a portion of the colon next to the appendix. This procedure may also include the removal of nearby blood vessels and lymph nodes at the same time.
Hepatic artery embolization may be used to treat unresectable tumors.
HIPEC or Hyperthermic intraperitoneal chemotherapy, is a procedure in which heatedchemotherapy is circulated within the abdomen. The chemotherapy agents (most commonly Mitomycin C or Mitomycin C plus Oxaliplatin) are heated to 42°C or 107.6°F with the goal of killing any hidden tumor cells. The HIPEC treatment is applied directly following peritonectomy or cytoreductive surgery.
The HIPEC treatment provides surgeons with the ability to apply high doses of chemotherapy directly into the peritoneal cavity without significant toxicity to the remainder of the body. The effects of heat with regionally applied chemotherapy, may increase the efficacy of the treatment, with the goal of achieving a cure. See also: Regional Perfusion, below.
Hyperthermia refers to the high temperature administration of chemotherapy agents. The heating of chemotherapy increases the penetration of into tissues and may be used to damage and destroy cancer cells.
Ileus: See Obstructions
Immune system: A network of cells, tissues, and organs that protect the body from disease and infection.
Indwelling catheter (central line): A tube surgically placed in the chest near the neck through which to give chemotherapy, fluids, TPN, etc.,or be used to draw blood. AKA a "port."
Infusion: Delivery of liquid medicine or treatment through a vein
Interperitoneal infusion: see peritoneal perfusion, below.
The intraoperative period takes place in the operating room. During this period the patient is monitored, anesthetized, prepped, and surgery performed.
An IRB (Institutional Review Board) is a committee reviews, monitors and approves medical, biomedical and behavioral research studies that involve human subjects, for the purpose of protecting the rights and welfare of these human research subjects.
Kras genes: see Ras genes below
Laparotomy is the surgical procedure used to open and explore the abdomen and its contents, including the liver, pancreas, stomach, colon, etc.
Click here to read a description for Laparotomy (source NIH)
Laparoscopic surgery may be used as a diagnostic tool, and has become a less invasive surgical option for specific patients.
Malignant: cancer
Mucinous Adenoma: benign
Mucinous Adenocarcinoma: malignant
A mucocele is a cystic mass resulting from a dilated appendiceal lumen or inner lining of the appendix caused by the abnormal accumulation of mucus.
NED: "No evidence of disease." NED may be interpreted to mean, "no cancer is detected."
A neoplasm is abnormal tissue that grows by cellular proliferation more rapidly than normal. It continues to grow after the stimuli that initiated the new growth ceases. Neoplasms show partial or complete lack of structural organization and functional coordination with normal tissue, and usually form a distinct mass of tissue that may be either benign (benign tumor) or malignant (cancer).
Nutrition: See Nutrition
Ostomies: some patients require a temporary or permanent ostomy to assist them during recuperation. The two most common ostomies are Colostomies and Ileostomies.
Colostomies are created from the colon or large intestine. The "stoma" or opening from the colostomy through the skin, produces a solid, more formed stool, and generally requires less care than an ileostomy.
Ileostomies are created from the small intestine. The output from a stoma close to the small intestine is liquid.
Ostomy Pals Resource and Support Group
PACU: when the surgery has been completed the patient is transfered to the Postanesthesia Care Unit,or PACU, for intensive postoperative monitoring.
PAD: Peritoneal Dissemination of Carcinoma of appendiceal origin.
Paracentesis is a procedure to drain/remove fluid ascites from the abdomen.
Paracolic gutter(s): space(s) between colon and abdominal wall
Perioperative care refers to care provided immediately before, during and after surgery.
Peristalsis is the contraction and relaxation of muscles in the intestine that move or propel contents through the digestive system.
Peritoneal carcinomatosis requires specialized treatment, generally including detailed CRS and HIPEC.
The peritioneal cavity of a healthy adult includes approximately 100 ml. of pale colored, clear fluid. This fluid includes water, proteins, electrolytes and a variety of cell types.
Peritoneal infusion is a method of infusing or delivering fluids, chemotherapy, or other medications into the abdominal cavity.
Peritoneal surface malignancy describes metastasis to the peritoneal surfaces originating from the appendix, colon, ovaries, etc. spreading throughout the abdominal cavity. Mesothelioma is also a peritoneal surface malignancy.
The treatment of peritoneal surface malignancies generally includes cytoreductive surgery (CRS) and HIPEC, and may also include systemic chemotherapy. If left untreated, ascites, mucin, nodules and tumors, may increase in size and quantity, eventually causing intestinal obstruction.
Peritonectomy refers to stripping the parietal peritoneum and resecting structures at the sites that contain adenomucinosis. A combination of surgical techniques are utilized including organ resection, when necessary and tumor destruction via electro-evaporation and argon beam coagulation.
The peritoneum is the transparent serous membrane lining the cavity of the abdomen.
A PICC line is a catheter placed in a vein in the arm and ends in a vein near the heart.
A port is a device surgically placed under the skin of the chest that is connected to a catheter leading to a vein near the heart. A port may be implanted in a patient undergoing systemic chemotherapy or frequent CT scans to eliminate the need for regular insertion of IV needles in the arm. A special needle is inserted through the skin and the silicone top surface of the port. Liquids can be administered through the connected to the needle. Ports need to be flushed with heparin monthly to keep the catheter clear.
Post Op: Abbreviation for "post operative" meaning "after surgery.
Tumor developing from the peritoneum, may be referred to as Primary Peritoneal Surface Malignancy.
A protocol is a specific detailed plan for a course of medical treatment, procedure, test or research trial.
Due to several factors, radiation has not been an effective form of treatment for Pseudomyxoma Peritonei syndrome.
Radiofrequency ablation destroys tumors through the placement of a thin electrode directly into the tumor.High-frequency alternating current passing through the electrode heats the tumor to destroy it.
Ras genes include Kras, Hras, and Nras. This family of genes may cause cancer when they mutate. Ras genes produce proteins involved in cell growth and death.
Regional perfusion refers to the technique of isolating a region of the body, or an organ, and delivering heated chemotherapy directly to that region, ie the abdominal cavity. See also: HIPEC.
Resection is the removal of all or part of an organ by cutting it away from nearby tissue. In cytoreduction surgery tumors may be removed from the peritoneum, stomach, small, or large intestine. The tumor removal may require removing part or all of these organs.
Residual disease refers to cancer cells remaining following treatment (surgery, chemotherapy, radiation, etc.)
Systemic chemotherapy targets cancer cells throughout the body and is delivered throughoutthe bloodstream.
Side effects of chemotherapy vary among individual patients and type(s) of chemotherapy agents administered, and may include anorexia (loss of appetite) fatigue, risk of infection, nausea, vomiting, and diarrhea.
Tumor marker: A substance, known as an antigen, sometimes found in the blood, other body fluids, or tissues. The human body produces the antigen in response to the growth of a tumor. Thus a high level of tumor marker may indicate cancer. Examples of tumor markers commonly used to diagnose PMP include CA 125 (carbohydrate antigen 125), CA 19-9 (carbohydrate antigen 19-9), and CEA (carcinoembryonic antigen).
Watchful waiting: the treatment process may also include periodic monitoring, commonly referred to as "watch and wait." Monitoring may include periodic diagnostic scans, laboratory tests and detection of physical symptoms.
The Whipple procedure, or Pancreatoduodenectomy, includes the removal of the head of the pancreas, most of the duodenum, part of the bile duct and may include a part of the stomach.
Dr Paul Sugarbaker Provides List of Abbreviations for Surgery and HIPEC
Dr Paul H Sugarbaker
Thank you to Dr Paul Sugarbaker for providing the PMP Pals' Network with the following listing of abbreviations commonly used for the treatment of Appendiceal Cancer.
1. CS – Chemosurgery (most general abbreviation includes CRS, HIPEC, EPIC and ABC)
2. HIPEC – Hyperthermic intraperitoneal chemotherapy
3. HIPEC + 5FU – Hyperthermic intraperitoneal chemotherapy plus intravenous 5-fluorouracil
4. HIPEC + IFO – Hyperthermic intraperitoneal chemotherapy plus intravenous ifosfamide
5. EPIC – Early postoperative intraperitoneal chemotherapy usually 5-FU or paclitaxel
6. ABC – Adjuvant bidirectional chemotherapy
7. CRS – Cytoreductive surgery
8. CCRS – Complete cytoreductive surgery
9. PM – Peritoneal metastases (should replace PC)
10. PC – Peritoneal carcinomatosis
11. POC – Perioperative chemotherapy
12. LM – Liver metastases
13. LNM – Lymph node metastases
14. LR – Local-regional
15. IP port – Intraperitoneal port used for ABC
16. Tenckhoff catheter – Temporary catheter used to deliver EPIC
Thank you to the family and friends of Mark Olson 1949-2011
The Appendix Cancer Glossary is sponsored by the family and friends of Pal, Mark Olson, in his memory.
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This page last updated on 10.01.12