Malignant Carcinoid of the Appendix
Carcinoid tumors are the most common of all appendix tumors. They are neuroendocrine tumors, meaning they are tumors that can create and release hormones into the bloodstream, although this usually only happens with metastatic disease (carcinoid tumors that have spread beyond the appendix to other areas of the body). Carcinoids are small yellow tumors usually found in the part of the appendix farthest away from where the appendix attaches to the colon or near the tip of the appendix. The tumors usually do not block the appendix and cause appendicitis. They are most often found unexpectedly during other abdominal or pelvic surgeries, for example surgeries to remove the gall bladder, hysterectomy etc. The tumors are small, slow growing and rarely metastasize (spread to other areas). The term "malignant" is applied to carcinoids that have metastasized to other areas of the body.
Carcinoids usually cause no symptoms. Symptoms of carcinoid syndrome may rarely occur with metastasis, especially metastasis to the liver.
Tumors less then 1 cm in diameter are treated with appendectomy (surgical removal of the appendix) only. Appendectomy is usually considered 100% curative for these small tumors. Over 95% of carcinoid tumors of the appendix are less than 2 cm in size.
Tumors 1.5-2 cm may be treated with appendectomy only or with right hemicolectomy (removal of up to half of the right side of the colon); there is disagreement in the medical community in regards to treatment in for carcinoids this size.
Carcinoids greater than 2 cm are more likely to metastasize. Surgical treatment for these larger carcinoids is appendectomy, right hemicolectomy (removal of up to half of the right side of the colon) and removal of local lymph nodes.
When carcinoid tumors spread (metastasize), they most commonly spread to the liver or lymph nodes. Chemotherapy is not very successful in this disease, with 30% limited response to chemotherapy reported. These metastatic tumors may be removed surgically.
Appendiceal carcinoids are more common in women by a ratio of 2:1 or 3:1. Average age 4th or 5th decade of life. No other known risk factor
Overall 5 year survival reported as high as 90% in some medical research
Caring for Carcinoid Foundation: About Carcinoid
National Cancer Institute: Gastrointestinal carcinoid tumor
American Cancer Society: Tumors of the Appendix
Gastrointestinal Carcinoid Tumors
Carcinoid Tumor of the Appendix: Treatment and Prognosis
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