Here we look at the common treatment options for appendix cancer or pseudomyxoma peritonei (PMP).
Learn more about:
- Making treatment decisions
- Your healthcare team
- Treatment options
- Surgery
- Radiation therapy
- Chemotherapy
- Clinical trials
- Complementary therapies
- Video: What are clinical trials?
- Podcast: Making treatment decisions
Making treatment decisions
It can be difficult to know which treatment is best for you. It is important to speak with a specialist team before making your decision. Ask them to give you a plan of your treatment options, including information about side effects. Some people prefer to seek several opinions before feeling confident to go ahead with the treatment.
If you are confused or want to check anything, ask your specialist questions. This will make sure you have all the information you need to make decisions about treatment and your future that you are comfortable with.
You may have to attend many appointments. It’s a good idea to take someone with you. They will be able to listen, ask questions and remember what the doctor says. It may help to take a list of questions with you, take notes or ask the doctor if you can record the discussion (many mobile phones have a recording function or you can use the CAN.recall app. Here are some suggestions for questions you could ask.
For more on this, listen to the podcast below and see Cancer care and your rights.
Your healthcare team
You will be cared for by a multi-disciplinary team of health professionals during your treatment for appendix cancer or PMP. These may include:
- a surgeon
- medical oncologist (to prescribe and coordinate a course of systemic therapy which includes chemotherapy)
- radiation oncologist (to prescribe and coordinate a course of radiation therapy)
- nurse and allied health professionals such as a social worker, psychologist or counsellor, dietitian, physiotherapist and occupational therapist.
Discussion with your doctor will help you decide on the best treatment for your cancer depending on:
- the type of cancer you have
- where it is in your body
- whether or not the cancer has spread (stage of disease)
- your age, fitness and general health
- your preferences.
Treatment options
The main treatments for appendix cancer and PMP are surgery and chemotherapy. These can be given alone or in combination and are an effective treatment with a little over 60% of patients receiving both cytoreductive surgery and HIPEC surviving beyond 10 years.
PMP may not be treated straight away if the tumour is small and growing slowly; in this case it will be observed and monitored regularly, an approach known as active surveillance.
Surgery
Surgery is the main treatment for appendix cancer, especially for people with early-stage disease who are otherwise in good health. The type of operation depends on the location and stage of the tumour.
PMP is usually treated with surgery: either cytoreductive surgery followed by chemotherapy (HIPEC) when aiming to cure PMP, or if the cancer cannot be treated effectively debulking surgery may be used instead to remove as much of the tumour as possible to reduce symptoms. Debulking surgery may be done again if the tumour grows back.
If part of the bowel is removed during surgery, the surgeon will usually join it back together. If this isn’t possible, you may need a stoma where the end of the intestine is brought through an opening (the stoma) made in your abdomen and stitched onto the skin to allow faeces to be removed from the body and collected in a bag. The stoma may be temporary (where the operation is reversed later on) or permanent, depending on the amount of bowel that has been removed.
If you need a stoma, the surgeon will refer you to a stomal therapy nurse before surgery. These are nurses with special training in stoma care. They can answer your questions about adjusting to life with a stoma. For more information visit Australian Association of Stomal Therapy Nurses.
For more on this, see our general section on Surgery or call Cancer Council 13 11 20.
Types of surgery
| Appendectomy | Surgery to remove the appendix. Often used for early stage appendiceal neuroendocrine tumours (NETs). |
| Hemicolectomy | Surgery to remove a small part of the large bowel next to appendix; surrounding lymph nodes and blood vessels may also be removed during the procedure. Often used for appendiceal NETs at risk of spreading or appendix cancers that are not neuroendocrine. |
| Cytoreductive surgery (CRS or peritonectomy) | Surgery to remove all visible tumour from the abdominal cavity; part of the bowel and other organs including gallbladder, spleen, stomach and kidney may also be removed. In females the uterus, ovaries and fallopian tubes may be removed; in males the seminal vesicles may be severed. Often used for late-stage appendix cancer and PMP. Chemotherapy may be used after the surgery |
Chemotherapy
Chemotherapy (sometimes just called “chemo”) is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or a combination of drugs. This is because different drugs can destroy or shrink cancer cells in different ways.
Your treatment will depend on your situation and the type of cancer you have. It may also be used to help stop your cancer coming back after surgery. Your medical oncologist will discuss your options with you.
There are different types of chemotherapy used to treat appendix cancer and PMP:
- Local chemotherapy – where the chemotherapy drugs are delivered directly to the cancer. When placed directly in the abdomen it is called intraperitoneal chemotherapy (see below).
- Systemic chemotherapy – where the chemotherapy drugs enter the bloodstream and travel throughout the body to target rapidly dividing cancer cells in the organs and tissues. This type of chemotherapy is given through a drip into a vein (intravenously) or as a tablet that is swallowed.
For more on this, see our general section on Chemotherapy or call Cancer Council 13 11 20.
Types of intraperitoneal chemotherapy
| HIPEC (heated intraperitoneal chemotherapy) | The chemotherapy drug is heated to around 40°C (body temperature is about 37°C) to increase its effectiveness and placed directly in the abdomen to kill any tumour cells that remain after surgery or help control ascites (build-up of fluid); typically removed after 30–90 minutes. |
| EPIC (early post-operative intraperitoneal chemotherapy) | The chemotherapy drug is delivered to the abdomen the day after surgery using an access port (small plastic device); continued for several days. Usually used after HIPEC when able to be tolerated. |
Radiation therapy
Radiation therapy (also known as radiotherapy) uses high energy rays to destroy cancer cells. It may be used for appendix cancer when it has spread to other parts of the body, such as the bone. Radiation therapy can shrink the cancer and relieve symptoms.
A course of radiation therapy needs careful planning. During your first consultation you will meet with a radiation oncologist. At this session you will lie on an examination table and have a CT scan in the same position you will be placed in for treatment. The information from this session will be used by your specialist to work out the treatment area and how to deliver the right dose of radiation. Radiation therapists will then deliver the course of radiation therapy as set out in the treatment plan.
Radiation therapy does not hurt and is usually given in small doses over a period of time to minimise side effects.
For more on this see our general section on Radiation therapy or call Cancer Council 13 11 20.
Clinical trials
Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.
You may find it helpful to talk to your specialist, GP, or clinical trials nurse. If you decide to take part in a clinical trial, you can withdraw at any time.
For more information, see Clinical trials and research. To find current clinical trials near you, visit Cancer Institute NSW or Australian Cancer Trials.
You can also contact the Australian and New Zealand Head and Neck Cancer Society who have a special fund to support research into ACC.
Complementary therapies
Complementary therapies are designed to be used alongside conventional medical treatments (such as surgery, radiation therapy and chemotherapy) and can increase your sense of control, decrease stress and anxiety, and improve your mood.
Some Australian cancer centres have developed “integrative oncology” services where evidence-based complementary therapies are combined with conventional treatments to improve both wellbeing and clinical outcomes. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe.
For more on this see our general section on Complementary therapies or call 13 11 20.
Alternative therapies are therapies used instead of conventional medical treatments. These are unlikely to be scientifically tested and may prevent successful treatment of the cancer. Cancer Council does not recommend the use of alternative therapies as a cancer treatment.
Finding a specialist
- Rare Cancers Australia have a knowledge base directory of health professionals and cancer services across Australia.
- Pseudomyxoma Survivor have a directory of PMP surgeons and specialists in Australia.
→ READ MORE: Managing side effects
Video: What are clinical trials?
In this video, Medical Oncologist Dr Elizabeth Hovey explains what clinical trials are and how they can improve cancer treatment.
Podcast: Making Treatment Decisions
Listen to more of our podcast for people affected by cancer
Key resource
The information on this page is also available for download.
John Henriksen, Consumer; Prof David Morris, Surgical Oncologist, St George Hospital, Sydney, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA.
View the Cancer Council NSW editorial policy.
