Appendix Cancer: Treatment Options

Approved by the Cancer.Net Editorial Board, 07/2015



Treatment overview


Listed below are descriptions of the most common treatment options for appendix cancer that is not a carcinoid tumor. Find treatment information for carcinoid tumors of the appendix, in another section of this website.



Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is the most common treatment for appendix cancer. Most often, appendix cancer is low-grade (see Stages and Grades) and, therefore, slow-growing. Often it can be successfully treated with surgery alone. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

Types of surgeries for appendix cancer include:

  • Appendectomy. An appendectomy is the surgical removal of the appendix. It is usually the only treatment needed for an appendix carcinoid tumor smaller than 1.5 centimeters (cm).

    If appendix carcinoid cancer is discovered unexpectedly after an appendectomy that was performed for what was originally thought to have been appendicitis, a second operation to remove more tissue using surgical techniques (described below) is often recommended.

  • Hemicolectomy. For a carcinoid tumor larger than 2 cm or appendix cancers that are not carcinoid, a hemicolectomy may be recommended. This is the removal of a portion of the colon next to the appendix. Removal of nearby blood vessels and lymph nodes is often done at the same time. A right hemicolectomy is surgery performed on the right side of the colon. Even though a large amount of the large intestine is removed, the operation usually does not result in the need for a colostomy or stoma, which is an opening in the abdomen through which the bowel contents are emptied into a bag.

  • Debulking surgery. For later-stage appendix cancer, debulking (or cytoreduction) surgery may be performed. In this surgery, the doctor removes as much of the tumor “bulk” as possible, which can benefit the patient even though it will not remove every cancer cell from the body. Sometimes, debulking surgery will be followed with chemotherapy (see below) to destroy remaining cancer cells.

    When the tumor produces mucous, much of the bulk of the abnormal tissue often is not cancer but is due to accumulation of the mucous. The mucous looks like jelly, and this condition is often referred to as “jelly belly.” Removing the mucous from the abdomen can often relieve a patient’s symptoms of bloating.

  • Removal of the peritoneum. There is some controversy about the extent of surgery that is necessary in patients with slow-growing, low-grade appendix cancer that has spread beyond the colon to involve other areas of the abdomen. Some surgeons recommend aggressive surgery that includes the removal of the peritoneum (the lining of the abdomen) to remove as much of the cancer as possible. This type of surgery is also called a peritonectomy.

In patients with a very slow-growing tumor, such surgery can be effective in removing the majority of the cancer cells. This can benefit the patient by reducing the amount of cancer, even if it does not remove every cancer cell. However, it is a difficult operation that can have significant side effects. The doctor will consider many different factors, such as the patient’s age and overall health, before recommending this extensive surgery. Patients should talk with a specialist with expertise in this type of procedure beforehand.  

Learn more about the basics of cancer surgery.


Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. For appendix cancer that is not a carcinoid tumor, chemotherapy is most often used soon after surgery when cancer is found outside of the appendix region. It may also be given for a non-carcinoid appendix cancer after surgery to prevent the cancer from coming back, depending on the stage of disease. There are different types of chemotherapy, depending on how the drugs are delivered to the body:

  • Local/intraperitoneal chemotherapy. For local chemotherapy, the medication delivery is focused on one area or section of the body. This is the most common type of chemotherapy used in the treatment of appendix cancer. More specifically, it is called intraperitoneal chemotherapy, which is chemotherapy that is given directly into the abdominal cavity. Typically, the surgeon will try to remove as much of the tumor as possible (debulking surgery, see above) and then insert a tube in the abdomen through which chemotherapy can be given after the operation. In some cases, the chemotherapy is warmed above body temperature to increase its ability to penetrate the tissue that may be lined with tumor cells; this is called hyperthermic (or heated) intraperitoneal chemotherapy. Once chemotherapy is completed, the tube is removed, generally without the need for another operation.

  • Systemic chemotherapy. This type of chemotherapy gets into the bloodstream to reach cancer cells throughout the body. This can be done using an intravenous (IV) tube, which is a tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). Some people may receive this type of chemotherapy in their doctor’s office or outpatient clinic; others may go to the hospital.

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Specific drugs given in systemic chemotherapy for non-carcinoid appendix cancers are similar to those for colorectal cancer and can include fluorouracil (5-FU, Adrucil), leucovorin (Wellcovorin), capecitabine (Xeloda), irinotecan (Camptosar), oxaliplatin (Eloxatin), bevacizumab (Avastin), ziv-aflibercept (Zaltrap), ramucirumab (Cyramza), cetuximab (Erbitux), and panitumumab (Vectibix).

For chemotherapy for carcinoid tumors, see more information about carcinoid tumors in the Overview section.



Radiation therapy


Radiation therapy is rarely used in the treatment of appendix cancer.  However, sometimes it may be used to treat a particular area when the cancer has spread (such as the bone) to help relieve symptoms (see below.) 


Learn more about the basics of radiation therapy.

Getting care for symptoms and side effects 



Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.


Metastatic appendix cancer



Your health care team may recommend a treatment plan that includes a combination of surgery, chemotherapy, and radiation therapy. Palliative care will also be important to help relieve symptoms and side effects.


Remission and the chance of recurrence






If treatment fails




