One of the most beloved commentators on TV, Stuart Scott left a hole in sports fans’ hearts when in 2015 he passed away at age 49 after a seven-year battle with appendiceal cancer, or cancer of the appendix.
Despite his public battle, the disease is still somewhat mysterious. And Scott himself preferred to keep the details of his condition private. He even told The New York Times in an interview shortly before his death that:
"I never ask what stage I’m in. I haven’t wanted to know. It won’t change anything to me. All I know is that it would cause more worry and a higher degree of freakout. Stage 1, 2 or 8, it doesn’t matter. I’m trying to fight it the best I can.”
But his cancer was rare enough that experts didn’t even know all the facts. According to the American Cancer Society, fewer than 1,000 cases of appendix cancer occur in the United States each year.
Cancers of the appendix account for less than 1% of all diagnosed cancers, according to a review published in International Scholarly Research Notices, so choosing the right course of treatment is incredibly challenging because doctors simply don't have clinical trials or case studies to refer to.
Additionally, it can be hard to diagnose in the first place because there are often no symptoms until the cancer has gotten to a nearly unmanageable state. And even then, the signs—such as bloating, abdominal pain, nausea, fatigue, and unexplained weight loss—can mimic other gastrointestinal problems. Like most other cases, Scott’s cancer was discovered during a routine appendectomy surgery when an abnormal tumor was on his appendix.
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What is appendiceal cancer?
According to the Appendix Cancer Research Foundation, appendiceal cancer starts in the cells lining the inside of the appendix.
There are a number of different types of cancers of the appendix. The different types are determined by which type of cells in the appendix become cancerous and what the cells look like under the microscope.
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The different types are associated with different behaviors (i.e. likelihood of spreading to other organs or other parts of the body, rate of growth, ability to be completely removed with surgery etc.) and therefore the types of treatment that are offered. Appendix cancers are the most common cause of pseudomyxoma peritonei.
Carcinoid tumors, which start in hormone-producing cells, make up more than half of all cases of appendix cancer, are more common in women, and usually occur in people in their 40s. Carcinoid tumors can also occur in the stomach, intestines, and lungs. This type of appendiceal cancer has a five-year survival rate of 85%. For people whose cancer has spread outside of the abdomen, however, the five-year survival rate drops to 34%.
What are the treatments?
There is presently no consensus in the medical community about the use of systemic chemotherapy and/or radiation in treating appendix cancer and PMP. Some individuals appear to benefit from systemic chemotherapy (typically the higher grade pathologies), while others do not.
There are no systemic chemotherapy regimens designed specifically for appendix cancer, so many appendix cancer patients who may benefit from systemic chemotherapy are typically given the same types of chemotherapy that are used for colon cancer such as 5-fluorouracil + leucovorin + oxaliplatin or irinotecan, otherwise known as FOLFOX or FOLFIRI, with or without a drug called bevacizumab, also known as Avastin®.
In general, there is no role for radiation in the management of appendix cancer that has spread in the abdominal cavity or PMP. Radiation may be used on an individual basis for example in situations where there is a high risk of recurrence in a localized space or for palliation of symptoms.
Neither systemic chemotherapy alone nor radiation has proven to be curative for appendix cancer or PMP.
For more information, please visit acpmp.org.
BDO’s Black History of Health series is designed to show the correlation between the health of historical black figures and Black Americans today. Many of the health disparities we currently experience have been in our community for centuries. This series is meant to bring these conditions to the forefront and provide blacks with preventative and management steps to reduce these disparities and improve the overall health of the Black American community. It’s time to change the narrative.
