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Treatment options offered to patients with appendicitis should include discussion of appendiceal cancer.

On the right side of the body, as the colon descends downward, rests the appendix, a so-called vestigial organ at about four inches in length.  Appendicitis occurs when a blockage forms within the appendix, possibly caused by viral or bacterial infection.  The appendix becomes inflamed and swollen, reducing blood flow within the appendix. If the inflammation continues, the appendix can perforate or rupture, leading to dangerous discharge of stool into the abdomen which can lead to life-threatening infection.

Symptoms of appendicitis can mimic a less serious affliction, like an upset stomach.  Right-sided pain, bloating, loss of appetite, and nausea are just some of the symptoms that may lead a physician to offer an incorrect diagnosis and send a patient home where the inflammation may worse.  Appendicitis afflicts about seven percent of the US population, usually between the ages of 10 and 30, each year.

In the last decade, science has suggested the appendix may serve as a reservoir for beneficial bacteria that reside in the gut.  With the suggestion that the appendix may play a role in health, and as treatment options have expanded, some patients, or the parents of patients, sometimes have options other than a straightforward trip to the surgical suite. A recent article in the Journal of the American College of Surgeons (JACS) raises some concerns about the incidence of cancer of the appendix in patients who choose a non-operative treatment option.

Earlier studies have suggested rising rates of appendiceal cancer.  Using that basis, the study reviewed data from 387,867 patients diagnosed with right-side colon cancer between 2004 and 2017.  Of these patients, 19,570 were found to have appendiceal cancer, and of these, 5,628 had a carcinoid tumor, a slow-growing but cancerous type of neuroendocrine tumor. As well, over the years of the study, the incidence of appendiceal cancer increased. The rising incidence rate could be the result of more detailed data, but was otherwise not discussed.

In speaking with patients, lead study author, Dr. Michelle Salazar suggests that physicians, “counsel patients based on age. If you’re older, you are at less risk for appendiceal cancer and greater risk for complications from surgery. Younger, healthy patients are more likely to be able to tolerate an operation and may want to rule out cancer by undergoing the operation. The characteristics of appendicitis should be considered in the decision.” 

This research suggests physicians should be well-informed of the options, and the risks of those options, before routinely prescribing antibiotics to younger patients as a non-surgical option for treating appendicitis.  For patients, make sure you understand your options and risk factors.  What you do not know about your medical treatment—can hurt you.

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