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home - Colon - Colorectal and Anal Cancer - Appendiceal Cancers Written by Dr Sebastian Zeki
Knowledge

Knows the pathology of benign and malignant tumours of the colon
and rectum
Has awareness of the molecular genetics of colorectal
carcinogenesis and the adenoma-carcinoma sequence
Knows the range of predisposing conditions including inherited
syndromes and acquired colonic diseases
Knows the range of clinical presentation and the means of
diagnosis, investigation, management and follow-up
Knows the strategy for prevention including procedures for
screening

Skills
Uses clinical assessment and selects investigations to reach a rapid
conclusion as to whether a patient might have colorectal cancer and
arranges timely investigation.
Refers the patient to the multi-disciplinary team CbD, mini-CEX,

Behaviours
Shows ability to react to possible diagnosis of malignancy in a timely
manner

Communicates with patient and family in a sympathetic and
understanding manner, explains next steps, involves other health
professionals (including the GP) as appropriate

Appendiceal Cancers

PathologyIt accounts for 0.25 % of appendectomies. It is more prevalent in males.Average age at diagnosis is 70. Subtypes:Mucinous cystadenomas -look like colonic villous adenomas) (52%).Mucosal hyperplasia- looks like hyperplastic colon polyp. (20%).Simple or retention cysts which are degenerative epithelial changes due to obstruction (eg, fecalith) and distention (18%).Mucinous cystadenocarcinomas- demonstrate glandular invasion into the stroma and/or pseudomyxoma peritonei (10%) Elevated CEA, CA 19-9. Management of mucocoeles: Surgical resection with careful handling to avoid seeding.Standard appendectomy- 100% survival after standard appendectomy of retention cysts, mucosal hyperplasia, or cystadenoma/ cystadenocarcinoma.Right hemicolectomy if complicated mucocele with TI/ caecal involvement. Appendiceal Mucocoele(=Distended, mucus-filled appendix.) Pseudomyxoma peritonei Appendiceal Cancers 1 Pseudomyxoma peritonei pathology It consists of diffuse collections of gelatinous material in the abdomen and pelvis and mucinous implants on the perito-neal surfaces. It is usually from a cystadenoma of the appendix which ruptures and seeds the peritoneal cavity with mucus-producing epithelial cells.It progresses to intestinal obstruction. Scalloping and calcifications of the liver, spleen, and mesentery Similar in density to fat and appears heterogeneous. CT : Diahphragm undersurface thick-ened by large cystic masses of muci-nous tumor. Peripheral location of tumor within the abdomen and pelvis and relative sparing and central displacement of the small bowel and mesentery (termed the "redistribution phenom-enon"). Clinical presentation of Pseudomyxoma peritonei:It is more common in females.Increasing abdominal girth.Elevated tumour markers (sometimes used for moni-toring (CEA/ CA19-9/Ca12-5)). Treatment of Pseudomyxoma peritonei:Repeated surgical debulking for symp-tomatic disease- not curative.Radical surgical cytoreduction of all intraabdominal and pelvic disease and intraperitoneal heated chemotherapy -5 yr survival of 80% in selected patients. Soft on poking with biopsy forceps= ‘cushion sign’ Appendiceal orifice in the center of the mound= ‘volcano sign’ Submucosal lesion Somtimes get inflammatory exudate from appendix Encapsulated mass with curvilinear or punctate wall calcif-cation -No wall thickening (different to appendicitis) Variable echogenicity and nodular wall Written by Dr Sebastian Zeki Associations of mucoeles: Other GI tumours, ovary, breast, and kidney.Colonic adenocarcinoma-found in 20% of mucocoeles. Labs: CT: USS:

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