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PERITONEAL SURFACE ONCOLOGY
Appendix Cancer & Pseudomyxoma Peritonei (PMP)
Rare appendix tumours and PMP — a condition where mucin-producing tumour cells spread throughout the abdomen — are best treated with CRS + HIPEC, offering long-term survival and potential cure.
ABOUT THE PROCEDURE
The Best-Outcome Peritoneal Cancer — When Treated Right
Appendix tumours — including low-grade and high-grade appendiceal mucinous neoplasms (LAMN/HAMN) and appendiceal adenocarcinoma — are rare but critically important to identify early. When an appendix tumour ruptures or is otherwise disrupted, it can seed the peritoneal cavity with tumour cells and mucin, resulting in Pseudomyxoma Peritonei (PMP).
PMP is characterised by progressive accumulation of mucin-producing tumour cells throughout the abdomen, causing increasing abdominal distension, bowel obstruction, and ultimately death if untreated. CRS + HIPEC is the established treatment — removing all visible mucinous deposits and killing microscopic residual cells with heated chemotherapy.
The outcomes for PMP after CRS + HIPEC are among the best in peritoneal oncology. Low-grade PMP patients have 10-year survival rates exceeding 60–70% after complete cytoreduction. This makes accurate diagnosis and early referral to a specialist centre critically important.
How It Is Performed
Diagnosis & Staging
CT and MRI to map mucinous deposits throughout the peritoneal cavity. PCI scoring. Tumour markers CEA, CA 19-9, CA 125. Core biopsy confirmation of histological grade.
Cytoreduction (CRS)
Complete removal of all mucin and visible tumour deposits — greater and lesser omentum, pelvic peritoneum, right colon (often removed), diaphragmatic stripping as needed to achieve CC-0.
HIPEC
Immediately following CRS, HIPEC with mitomycin-C (low-grade PMP) or oxaliplatin + 5-FU (high-grade or adenocarcinoma) at 41–42°C for 60–90 minutes.
Recovery & Surveillance
Hospital stay 10–14 days. CT surveillance every 6 months for 5 years. CEA and CA 19-9 monitoring. Low-grade PMP patients may need repeat CRS + HIPEC for recurrence.
CANDIDACY
Who May Benefit?
Pseudomyxoma Peritonei (any grade)
All PMP patients with disease confined to the abdomen and acceptable performance status should be evaluated for CRS + HIPEC — the standard of care with no effective alternative.
High-grade appendiceal mucinous neoplasm (HAMN)
Higher-grade tumours carry worse prognosis but CRS + HIPEC still offers significant survival benefit over systemic chemotherapy alone.
Appendiceal adenocarcinoma with peritoneal spread
True appendiceal adenocarcinoma behaves like colorectal cancer; CRS + HIPEC is appropriate for peritoneal disease with acceptable PCI score.
Incidentally diagnosed appendix tumour post-appendicectomy
Patients who had an appendicectomy and are told the appendix showed a mucinous tumour or PMP features must be urgently referred to a peritoneal oncology specialist.
ESSO FELLOW · PERITONEAL ONCOLOGY
PMP & Appendix Cancer Expertise from Hannover
Dr. Imaduddin trained in the management of appendix cancers and PMP during his ESSO Fellowship at University Hospital Hannover — a European centre of excellence for peritoneal surface oncology — under Prof. Dr. Beate Rau.
Get Expert Advice for Appendix Cancer or PMP
Appendix cancer and PMP are rare — most oncologists and surgeons will have seen very few cases. Dr. Imaduddin’s specialist peritoneal oncology training means he can provide expert, evidence-based guidance.