15/02/2025
A 66-year-old lady was admitted to the hospital with pain in the lower right side of his abdomen. He had been complaining of increasing pain for several weeks, followed by a fever up to 39°C and vomiting. The patient was diagnosed with peritonitis, with the suspected source of the infection being the appendix. A right-sided hemicolectomy was performed. This procedure involves the removal of the final segment of the small intestine, the cecum, and the appendix, which drains into the initial portion of the ascending colon. The last two elements are part of the large intestine.
The inflammatory condition with an abscess around the appendix was not surprising. The appendix's initial part was surrounded by layers of fat tissue with inflammation and partial necrosis. Microscopic examination confirmed an advanced state of inflammation. However, a further examination of the entire appendix revealed an interesting finding. The initial and middle parts of the appendix, approximately two-thirds, were inflamed, while the final portion of the appendix revealed an 18mm tumor: adenocarcinoma of the large intestine. This is not a common finding in the appendix. The last time I saw cancer in the appendix, it was a form of goblet cell adenocarcinoma. Perhaps I will tell you about that one day 🧐.
This time, it was a “regular” adenocarcinoma.
After the surgery, the patient quickly recovered and was discharged home within a few days. Both she and the medical team were surprised by the additional discovery of the tumor. Since it was not visible during the macroscopic assessment of the specimen, I had to return to the laboratory and select lymph nodes, whose analysis is crucial in cases where a tumor is found in the specimen. The final diagnosis was adenocarcinoma, G2, pT2 N0 Mx R0. This means that the tumor did not extend beyond the muscular layer of the intestine, all the lymph nodes found were free of cancer, the tumor was completely excised, and we have no further information on potential metastases.
Colorectal cancer is the third most common cancer. In most statistics, it ranks second when considered as a cause of death. It most often occurs after the age of fifty, although earlier cases do happen. Early-stage symptoms of cancer are nonspecific, and often, as in the described case, it is detected by chance. Basic symptoms include constipation, diarrhea, and the presence of blood in the stool. Some cases appear in families, but most colorectal cancers (85%) are so-called sporadic cancers, meaning they do not have a genetic (familial) basis.
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