Appendix Cancer Staging and Diagnosis
Staging of Appendiceal Neoplasms
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MD Anderson Addresses Appendix Cancer Staging
Improving the AJCC/TNM Staging for Adenocarcinomas of the Appendix: The Prognostic Impact of Histological Grade.
Authors
Overman MJ, Fournier K, Hu CY, Eng C, Taggart M, Royal R, Mansfield P, Chang GJ.
Source
*Departments of Gastrointestinal Medical Oncology †Surgical Oncology ‡Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
PURPOSE:
Though histological grade is known to have a major prognostic impact in metastatic mucinous appendiceal adenocarcinomas, the prognostic impact of grade in localized disease, and the validity of the American Joint Committee on Cancer AJCC Staging Manual 7th edition's decision to combine moderately and poorly differentiated mucinous adenocarcinomas into a single mucinous high-grade category, is not known.
METHODS:
Patients with adenocarcinoma of the appendix diagnosed between 1988 and 2007 were identified from the SEER database. Cancer-specific survival (CSS) stratified by histological subtype, stage, and grade was calculated, and Cox proportional hazards regression analyses were performed. RESULTS:: We analyzed a total of 2469 appendiceal adenocarcinomas, of which 1375 had mucinous histology and 860 had nonmucinous histology.
Though overall CSS was similar for mucinous and nonmucinous subtypes, differences in stage distribution and stage-stratified CSS were seen.
Female sex, stage IV disease, and well-differentiated histology were more common for mucinous adenocarcinomas.
Histological grade had a strong prognostic impact, especially in patients with stage IV mucinous adenocarcinoma.
The adjusted hazard ratios for stage IV moderately and poorly differentiated histological grade were 1.63 [95% confidence interval (CI): 1.14-2.34] and 4.94 (95% CI: 3.32-7.35) for mucinous histology, in comparison with 1.44 (95% CI: 0.82-2.52) and 1.90 (95% CI: 0.95-3.80) for nonmucinous histology, respectively.
CONCLUSIONS:
The strong prognostic impact of histological grade for mucinous adenocarcinomas is primarily restricted to stage IV disease. Stage IV moderately and poorly differentiated mucinous adenocarcinomas have distinctly different CSS and these data do not support the combination of these 2 histological grades in the recent AJCC Staging Manual 7th edition.
Published: PMID:23001080[PubMed - as supplied by publisher]
Authors
Overman MJ, Fournier K, Hu CY, Eng C, Taggart M, Royal R, Mansfield P, Chang GJ.
Source
*Departments of Gastrointestinal Medical Oncology †Surgical Oncology ‡Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
PURPOSE:
Though histological grade is known to have a major prognostic impact in metastatic mucinous appendiceal adenocarcinomas, the prognostic impact of grade in localized disease, and the validity of the American Joint Committee on Cancer AJCC Staging Manual 7th edition's decision to combine moderately and poorly differentiated mucinous adenocarcinomas into a single mucinous high-grade category, is not known.
METHODS:
Patients with adenocarcinoma of the appendix diagnosed between 1988 and 2007 were identified from the SEER database. Cancer-specific survival (CSS) stratified by histological subtype, stage, and grade was calculated, and Cox proportional hazards regression analyses were performed. RESULTS:: We analyzed a total of 2469 appendiceal adenocarcinomas, of which 1375 had mucinous histology and 860 had nonmucinous histology.
Though overall CSS was similar for mucinous and nonmucinous subtypes, differences in stage distribution and stage-stratified CSS were seen.
Female sex, stage IV disease, and well-differentiated histology were more common for mucinous adenocarcinomas.
Histological grade had a strong prognostic impact, especially in patients with stage IV mucinous adenocarcinoma.
The adjusted hazard ratios for stage IV moderately and poorly differentiated histological grade were 1.63 [95% confidence interval (CI): 1.14-2.34] and 4.94 (95% CI: 3.32-7.35) for mucinous histology, in comparison with 1.44 (95% CI: 0.82-2.52) and 1.90 (95% CI: 0.95-3.80) for nonmucinous histology, respectively.
CONCLUSIONS:
The strong prognostic impact of histological grade for mucinous adenocarcinomas is primarily restricted to stage IV disease. Stage IV moderately and poorly differentiated mucinous adenocarcinomas have distinctly different CSS and these data do not support the combination of these 2 histological grades in the recent AJCC Staging Manual 7th edition.
Published: PMID:23001080[PubMed - as supplied by publisher]
Importance of Histologic Subtype in the Staging of Appendiceal Tumors
Abstract/Background
Dr Kiran K Turaga
Malignant neoplasms of the appendix have different behavior based on their histologic subtypes in anecdotal series. Current staging systems do not capture the diversity of histologic subtypes in predicting outcomes.
Methods
We queried all patients with appendiceal malignancies captured in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2007.
Tumors were classified as colonic type adenocarcinoma, mucinous adenocarcinoma, signet ring cell type, goblet cell carcinoid, and malignant carcinoid.
We compared incidence, overall survival, and disease-specific survival for these tumors on the basis of patient, tumor, and therapy characteristics.
Estimates from Cox proportional hazard modeling were used to predict hazard ratios for differing histologic subtypes with similar tumor, node, metastasis system (TNM) stages.
Results and Conclusions
Dt T Clark Gamblin
Results
Of the 5672 patients identified, we included 5655 (99%) in our analysis.
The 5-year disease-specific survival rates were 93% for malignant carcinoid, 81% for goblet cell carcinoid, 55% for colonic type adenocarcinoma, 58% for mucinous adenocarcinoma, and 27% for signet ring cell type.
Predicted estimates of adjusted hazard ratios revealed an 8-fold difference between histologic subtypes for similar TNM stages.
Conclusions
Histologic subtype is an important predictor of disease-specific survival and overall survival in patients with appendiceal neoplasms.
Addition of the histologic subtype to the TNM staging is simple and may improve prognostication.
Source: Annals of Surgical Oncology,
Regional Cancer Therapies Online First ™ - February , 2012
Resources, Referrals, Research and Support for Appendiceal Cancer Patients & Their Families
Frequently Asked Questions about Appendiceal Cancer Staging
What does Appendix Cancer Staging mean?
How is Appendix Cancer staged?
Which tests are used to diagnose Appendiceal Cancer?
Diagnostic Tests and Staging for Appendix Cancer, Pseudomyxoma Peritonei
Accurate diagnosis and staging of Appendix Cancer, requires thorough sampling and investigation by both experienced surgeon(s) and pathologist(s).
A variety of tests are utilize the confirm the diagnosis and assess the staging to determine appropriate treatment.
The most common tumor markers (see below) used for the monitoring and diagnosis of appendix cancer are the CEA and the CA 19-9.
The CT (Computerized Tomography) scan (see below) is the preferred method (preferred over PET or MRI) of scanning to detect and monitor appendix cancer.
Your physician may order additional or different tests based on your specific needs.Other tests may include a barium enema, colonoscopy, upper GI series or ultrasonography. However, generally these particular tests may not be effective at all, in detecting or diagnosing or Appendix Cancer.
Ask your physician how the Peritoneal Cancer Index (see below) relates to your specific case.
CT Scans for Diagnosis of Pseudomyxoma Peritonei, Appendix Cancer, DPAM
Several diagnostic tests are utilized to detect and monitor cancer. Among the tools most commonly used are those that utilize imaging techniques. Different scans used for different cancers.
Physicians utilize X rays, CT Scans, MRIs, Nuclear Scanning, PET Scans and Ultrasonography as tools for diagnosing cancer and metastasis. In general, CT scans are most commonly ordered for Pseudomyxoma Peritonei and Appendix Cancer patients. Consult with your physician about which type of scan is most appropriate for your particular medical care.
The CT (Computerized Tomography) scan is the preferred method (preferred over PET or MRI) of scanning to detect and monitor Appendix Cancer and Pseudomyxoma Peritonei.
CT scans may include the administration of enteric IV ionic or non ionic contrast, oral contrast and rectal contrast. On average, after the contrasts have been administered, the patient spends approximately ten minutes being scanned. Scanned images may be transferred to CD format so that the patient may retain a personal copy of the test(s.)
Appendix Cancer Diagnostic Tests: Scans
Several diagnostic tests are utilized to detect and monitor cancer. Among the tools most commonly used are those that utilize imaging techniques, also known as scans. Physicians utilize X rays, CT Scans, MRIs, Nuclear Scanning, PET Scans and Ultrasonography as tools for diagnosing cancer and monitoring metastasis.
Different scans are used for different cancers. In general, CT scans are preferred for monitoring Pseudomyxoma Peritonei patients. Your surgical oncologist will tell you which type of scan is the most appropriate for your particular medical case.
Prior to the scheduled day of the scan, ask your physician or radiologist the following questions:
Why do I need this scan?
Are any risks associated with this scan?
Will I be hospitalized for the scan or can it be taken on an outpatient basis?
Preparing for the scan
Will I be medicated for the scan?
Can I drive myself home following the scan?
What do I need to do to prepare for the scan? Fasting? Bowel preparation?
How long will the scan take?
Will I experience any side effects after the scan?
What are the health risks, if any, of the scan itself?
Cost and insurance
How much will the scan cost? Is the cost covered by my healthcare insurance?
The scan itself
What will I feel during the scan?
Is the scan uncomfortable?
Will I feel claustrophobic during the scan?
Will I hear loud noises during the scan?
Do I need to wear special clothing for the scan?
Can I take this test if I have a pacemaker, implants, hearing aids, contact lenses or am wearing jewelry?
After the scan
When will the scan results be available and who will review them with me?
May I have my own copies of the scan burned on a CD?
Articles of interest:
CT Scans: What to Expect When you have a CT Scan
Source: Radiology.org
How CT scans are performed
Source: Medline
Contrasts used for CT Scans
Prevent Kidney Damage during CT Scans
Source: MedNews, July 2009
Prevention of Risks to Kidneys in Preparation for CT Scan
Source: University of Michigan, Study funded by NIH
Diagnostic Imaging in the Detection of Pseudomyxoma Peritonei originating from the Appendix
CT Images of Pseudomyxoma Peritonei
Source: MedPix
CT Diagnostics for Pseudomyxoma Peritonei
Source: Bejing 2008
Diagnostic Imaging of Pancreatic Cancer
Source: Dr Haydee Ojeda-Fournier, UCSD
Radiation Risk Articles
Radiation Risks Nearly Double for Younger Patients
Source: Health Day News, May 2010
Radiation Risks from Scans
Source: Web MD, 2010
Australians examine possible links between cancer and exposure from CT Scans
Source: The World Today, March, 2010
What are the radiation exposure risks from CT scans?
Source: ABC TV News, January 2010
Appendix Cancer Staging
"What is appendix cancer staging?"
"How is appendix cancer staged?”
Appendix cancer staging describes:
Where the cancer is located.
Where it has metastasized and
Whether it affects other organs.
Staging is determined from a series of diagnostic tests and helps physicians determine the most appropriate course of treatment. Staging may also be used to assess the patient’s prognosis.
Definition of Cancer Staging
Source: American Joint Committee on Cancer
TNM
"What does TNM mean?"
TNM is an abbreviation for:
Tumor
Node (lymph nodes)
Metastasis (where the cancer has spread)
Tumor Grade
What does "tumor grade" refer to?
“Tumor grade” describes how much the tumor appears like normal tissue when examined under a microscope. The tumor grade helps physicians predict how quickly the cancer may grow.
G1: well-differentiated tumor cells
G2: moderately differentiated tumor cells
G3: poorly differentiated tumor cells
G4: undifferentiated tumor cells
Tumor Markers
What is a tumor marker?
Tumor Markers for Diagnosis of Appendix Cancer and Pseudomyxoma Peritonei
The most common tumor markers used for the monitoring and diagnosis of Pseudomyxoma Peritonei and Appendix Cancer are the CEA** and the CA 19-9.
Your oncologist may order additional tumor marker tests.
Tumor markers are usually not used to diagnose cancer but they may used a diagnostic tool or as a method of monitoring the success of whether or not a cancer treatment, (such as chemotherapy) is effective for the patient. Although often less expensive and less invasive than other diagnostic tests, tumor marker testing is not a substitute for other tests (ie biopsies, scans, etc.)
Tumor markers may be found in blood, tumors and other tissue, and in urine. Tumor markers (proteins) may be produced by cancer cells, or may be made by the body in response to cancer or other conditions including inflammation. Some cancer patients do not exhibit or produce elevated levels of particular tumor markers.
Whenever possible, tumor marker tests should be prepared at the same lab, every time, using results of the same value, ie ng/mL (nanograms per milliliter) or U/mL (units/milliliter) to avoid confusion or misinterpretation of any fluctations.
The presence of tumor markers does not necessarily indicate the diagnosis of cancer. Some tumor markers are created by normal cells. Non-cancerous conditions (ie inflammation)may also cause levels of particular tumor markers to be higher than normal.
Generally, the CEA** or Carcinoembryonic Antigen, is used to monitor appendix, colon,colorectal, gastric, liver, stomach and pancreatic cancer.
The CA 19-9* is used to monitor appendix, colorectal and pancreatic cancer.
Normal blood levels of CA 19-9 are below 37 U/mL (units/milliliter)
The CA 72-4 is use to monitor gastric, pancreatic and stomach cancer.
The Epidermal Growth Factor Receptor (EGFR) is also known as HER1. It may be used to monitor colon and pancreatic cancers. An increased amount of EFGR may indicate that the cancer may grow more quickly and metastasize. Patients with elevated EGFR may require more aggressive treatment, including with drugs that block (or inhibit) the EGFR receptors.
The Alpha fetoprotein (AFP) used for liver cancer.
The CA 125 is used for epithelial ovarian cancer.
Normal blood levels are usually less than 35 U/mL (units/milliliter.)
The BTA may be used to monitor patients with bladder cancer, but may also be an indication of kidney stones or urinary tract infections.
Blood tests for early detection of GI Cancers
Source: Medscape Oncology Jan 2010
What are Tumor Markers?
Source: Lab Tests Online
Tumor Marker Descriptions
Source: ACS
Tumor Marker descriptions
CA 19-9 Tumor Marker Test
CEA Tumor Marker Test**
Tumor marker evaluations for Pseudomyxoma Peritonei following surgery and HIPEC
What causes slight elevations in tumor markers?
Source: PMP Pals Network
The most common tumor markers used for the monitoring and diagnosis of Pseudomyxoma Peritonei and Appendix Cancer are the CEA** and the CA 19-9.
Your oncologist may order additional tumor marker tests.
Tumor markers are usually not used to diagnose cancer but they may used a diagnostic tool or as a method of monitoring the success of whether or not a cancer treatment, (such as chemotherapy) is effective for the patient. Although often less expensive and less invasive than other diagnostic tests, tumor marker testing is not a substitute for other tests (ie biopsies, scans, etc.)
Tumor markers may be found in blood, tumors and other tissue, and in urine. Tumor markers (proteins) may be produced by cancer cells, or may be made by the body in response to cancer or other conditions including inflammation. Some cancer patients do not exhibit or produce elevated levels of particular tumor markers.
Whenever possible, tumor marker tests should be prepared at the same lab, every time, using results of the same value, ie ng/mL (nanograms per milliliter) or U/mL (units/milliliter) to avoid confusion or misinterpretation of any fluctations.
The presence of tumor markers does not necessarily indicate the diagnosis of cancer. Some tumor markers are created by normal cells. Non-cancerous conditions (ie inflammation)may also cause levels of particular tumor markers to be higher than normal.
Generally, the CEA** or Carcinoembryonic Antigen, is used to monitor appendix, colon,colorectal, gastric, liver, stomach and pancreatic cancer.
The CA 19-9* is used to monitor appendix, colorectal and pancreatic cancer.
Normal blood levels of CA 19-9 are below 37 U/mL (units/milliliter)
The CA 72-4 is use to monitor gastric, pancreatic and stomach cancer.
The Epidermal Growth Factor Receptor (EGFR) is also known as HER1. It may be used to monitor colon and pancreatic cancers. An increased amount of EFGR may indicate that the cancer may grow more quickly and metastasize. Patients with elevated EGFR may require more aggressive treatment, including with drugs that block (or inhibit) the EGFR receptors.
The Alpha fetoprotein (AFP) used for liver cancer.
The CA 125 is used for epithelial ovarian cancer.
Normal blood levels are usually less than 35 U/mL (units/milliliter.)
The BTA may be used to monitor patients with bladder cancer, but may also be an indication of kidney stones or urinary tract infections.
Blood tests for early detection of GI Cancers
Source: Medscape Oncology Jan 2010
What are Tumor Markers?
Source: Lab Tests Online
Tumor Marker Descriptions
Source: ACS
Tumor Marker descriptions
CA 19-9 Tumor Marker Test
CEA Tumor Marker Test**
Tumor marker evaluations for Pseudomyxoma Peritonei following surgery and HIPEC
What causes slight elevations in tumor markers?
Source: PMP Pals Network
Tumor Profiling: Cell Based Oncology Assays
Exigon Diagnostics (formerly Oncotech)
Source: Exigon
Parkland OncoDiagnostic Lab personal tumor profiling
Rational Therapeutics: personal tumor profiling
(The PMP Pals' Network does not specifically endorse this or any other company. We simply provide this link for your information and for discussion with your personal healthcare provider.)
Precision Therapeutics:personal tumor profiling and analysis
The PMP Pals' Network does not specifically endorse this or any other company. We simply provide this link for your information and for discussion with your personal healthcare provider.)
Red Path: personal tumor case analysis
The PMP Pals' Network does not specifically endorse this or any other company. We simply provide this link for your information and for discussion with your personal healthcare provider.)
Nanogram
"What is a nanogram?"
A nanogram is one-billionth of a gram.
EFGR
EFGR definition
Source: NCI
Click here to reference additional information about EFGR on our CHEMOTHERAPY page
Biomarkers Predict Outcome of EFGR Targeted Therapy Colorectal Cancers
Source: Journal of the National Cancer Inst, 2009
KRAS
KRAS Mutation Testing and Therapy
KRAS Mutatation Predictors and Colorectal Cancers
Source: Exiqon
Genzyme Diagnostics
Source: Genzyme
Exigon Diagnostics (formerly Oncotech)
Source: Exigon
Kras mutation testing
KRAS Mutant
Source: New England Journal of Medicine, 2009
KRAS Oncogene Predictor of Response to Cetuximab
Source: Medscape July 2009
KRAS mutant status helps predict survival of Colorectal Cancer pts treated w/Cetuximab, Folifiri, Folfox 6
Source: ESMO GI, June 2009
KRAS mutant targeted therapy
Source: Biochemical and Biophysical Research, 2009
Kras mutation testing
Parkland OncoDiagnostic Lab
Ras and Carcinogenesis
Source: Pub Med 1988
KRAS Mutatation Predictors and Colorectal Cancers
Source: Exiqon
Genzyme Diagnostics
Source: Genzyme
Exigon Diagnostics (formerly Oncotech)
Source: Exigon
Kras mutation testing
KRAS Mutant
Source: New England Journal of Medicine, 2009
KRAS Oncogene Predictor of Response to Cetuximab
Source: Medscape July 2009
KRAS mutant status helps predict survival of Colorectal Cancer pts treated w/Cetuximab, Folifiri, Folfox 6
Source: ESMO GI, June 2009
KRAS mutant targeted therapy
Source: Biochemical and Biophysical Research, 2009
Kras mutation testing
Parkland OncoDiagnostic Lab
Ras and Carcinogenesis
Source: Pub Med 1988
Pathology
Pathology
Pathologists experienced with the diagnosis of Pseudomyxoma Peritonei and Appendix Cancer
Armed Forces Institute of Pathology
Pathogenesis
Insights into Pathogenesis of CRC: Colorectal Cancer
Source: Current Opinion in Gastroenterology,2010
Peritoneal Cancer Index
Peritoneal Cancer Index
Source: Annual of Surgical Oncology, Feb, 2009, Dr David Morris, Dr Tristan Yan
Peritoneal Cancer Index
Source: Dr Paul H Sugarbaker
Peritoneal Cancer Index
Source: ASCO 2007, Dr Jesus Esquivel
Peritoneal Cancer Index (Ovarian)
Source: Dr A Tentes, European Journal of Surgical Oncology 2003
PET Scans for Diagnosis of Pseudomyxoma Peritonei, Appendix Cancer, DPAM
PET Scans for Healthy Adults
Source: ASCO 2004
Histoendoscopy
Histoendoscopy: Endoscopic Imaging for Colorectal Adenomas
Source: Medscape June 2009
Lab Tests, Misc.
New cancer biomarkers for diagnostic testing
Source: UCSF News, June 2009
HER2 Overexpression in Gastric Cancer Patients
Source: ASCO 2009
Nano signals: healthy vs cancerous cells
Source: ACOR June 2009
Interpreting Lab Test Results
Estrogen and Progestrogen receptor markers
K167 MIB cell marker
DNA Ploidy Cell Cycle Analysis
Kidney function testing
Biomarkers
Personalized Biomarkers
Source: NCI Bulletin, 2010
Biomarkers, Defined
Source: Massachusetts General Hospital, Center for Biomarker Imaging
Biomarkers Predict Outcome of EFGR Targeted Therapy Colorectal Cancers
Source: Journal of the National Cancer Inst, 2009
Biopsies
The Biopsy Report: Explains biopsies, pathology terminology, etc
Source: The Cancer Guide
Optical Biopsy
Optical Biopsy: Endoscopic Detection and Diagnosis
Source: Thomas D Wang, Stanford University 2004
WavStat Optical Biopsy
Source: SpectraScience, Inc, 2008
Colonoscopy
Colorectal Cancer Screening
Source: MD Anderson March 2010
PC's Limit Colon Cancer /Colorectal Cancer Screening Methods
Source: Reuters, July 2009
Colonoscopy is the "gold standard" test for Colorectal Cancer
Deep sedation during Colonoscopy improves cancer detection
Source: Digestive Distress Week, June 2009
CT Colonography vs Colonoscopy
Source: Reuters April 2009
"Virtual" Colonoscopy may not be covered by Medicare
Source: Medscape, May 2009
Improved screening techniques may be needed for Appendix Cancer
Source: Cancer Journal of Gastroenterology, Canada, 2009
Colonoscopies may not detect obstructions
Source: The Oncologist June 2009
Virtual Colonscopy
Source: Dept of Radiology State University of New York
Atlas of Colonscopy (graphic photos, excellent suggestions for patients prepping for post op endoscopy or colonoscopy)
Source: Helmet Messman and Jurgen Barnet, 2005
Atlas of Colonscopy (lumen and stoma details)
Video of tapeworm disovery during colonoscopy
Source: Symposier 2010
Researchers find new ways to detect flat polyps: VA hospital Palo Alto CA
Source: ABC News San Francisco, March 16, 2010
Patients who have colonoscopies performed by gastroenterologists may be less likely to develop colon cancer
Source: Science Daily, Feb 2010
Enteroscopy
Genetic Counseling
Genomes
Genomics of Metastasis
Source: MedScape 2009
International Cancer Genome Consortium
Source:ICGC November 2008
Red Path: personal tumor case analysis
The PMP Pals' Network does not specifically endorse this or any other company. We simply provide this link for your information and for discussion with your personal healthcare provider.)
Health Insurance for Diagnostic Tests
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Updated 03.08.13
