Appendiceal Mucinous Neoplasms: Diagnosis and Management

Walid L Shaib; Rita Assi; Ali Shamseddine; Olatunji B Alese; Charles Staley 3rd; Bahar Memis; Volkan Adsay; Tanios Bekaii-Saab; Bassel F El-Rayes

doi:10.1634/theoncologist.2017-0081

Appendiceal Mucinous Neoplasms: Diagnosis and Management

Oncologist. 2017 Sep;22(9):1107-1116. doi: 10.1634/theoncologist.2017-0081. Epub 2017 Jun 29.

Authors

Walid L Shaib^{1

2}, Rita Assi³, Ali Shamseddine³, Olatunji B Alese^{4

2}, Charles Staley 3rd⁵, Bahar Memis⁶, Volkan Adsay⁶, Tanios Bekaii-Saab⁷, Bassel F El-Rayes^{4

2}

Affiliations

¹ Department of Hematology and Oncology, Atlanta, Georgia, USA wshaib@emory.edu.
² GI Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
³ Division of Hematology and Oncology, American University of Beirut, Beirut, Lebanon.
⁴ Department of Hematology and Oncology, Atlanta, Georgia, USA.
⁵ Division of Surgical Oncology, Atlanta, Georgia, USA.
⁶ Department of Pathology, Atlanta, Georgia, USA.
⁷ Division of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona, USA.

Abstract

Objective: Appendiceal mucinous neoplasms (AMNs) are a rare and heterogeneous disease for which clinical management is challenging. We aim to review the literature regarding modalities of treatment to guide the management of AMNs.

Methods and review criteria: We conducted a PubMed search in February 2016 for English-language publications, using the terms "appendiceal," "appendix," "carcinoma," "cancer," "mucinous," "treatment," "genes," "target," "genomic," and terms listed in the articles' subheadings. Published reports and abstracts from the American Society of Clinical Oncology meetings were also searched.

Results: In this review, we summarize current data and controversies in AMN classification, clinical presentation, molecular alterations, treatment outcomes with regard to cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and the role of systemic chemotherapy.

Conclusion: Appendiceal mucinous neoplasms are a heterogeneous group of tumors with a rising incidence. Treatment is based on stage and histology. Low-grade tumors are treated surgically with resection of the primary site in early stage disease, or peritoneal debulking and HIPEC in patients with advanced stage disease. Treatment of high-grade tumors requires further prospective trials, and options include debulking surgery and HIPEC with or without preoperative chemotherapy. Trials evaluating novel therapies based on the molecular profiling of AMN tumors are needed to evaluate therapeutic options in patients who are not surgical candidates.

Implications for practice: This review provides a reference to guide gastroenterologists, pathologists, surgeons, and oncologists in the management of appendiceal mucinous neoplasms (AMNs), a rare and heterogeneous disease with no consensus on histologic classification or guidelines for treatment algorithms. This review summarizes all AMN classifications and proposes a treatment algorithm based on stage and histology of disease.

Keywords: Abdominal surgery; Appendix carcinoma; Review.

Publication types

Review

MeSH terms

Adenocarcinoma, Mucinous / classification
Adenocarcinoma, Mucinous / diagnosis
Adenocarcinoma, Mucinous / pathology
Adenocarcinoma, Mucinous / therapy*
Antineoplastic Combined Chemotherapy Protocols
Appendiceal Neoplasms / classification
Appendiceal Neoplasms / diagnosis
Appendiceal Neoplasms / pathology
Appendiceal Neoplasms / therapy*
Appendix / pathology
Appendix / surgery
Cytoreduction Surgical Procedures
Humans
Hyperthermia, Induced
Neoplasm Staging
Practice Guidelines as Topic
Rare Diseases / classification
Rare Diseases / diagnosis
Rare Diseases / pathology
Rare Diseases / therapy*
Treatment Outcome