Radiation Oncology/Appendix-carcinoma

Carcinoma of the Appendix

This chapter is about carcinomas only. For carcinoid tumors of the appendix, see Carcinoid of the appendix

Staging

Was added as a separate classification starting with the 7th edition of the AJCC Staging Manual. Previously, this was staged using the colorectal staging system.

Carcinoid tumors of the appendix are staged separately.

AJCC 7th Edition (2009)
Tumor

• Tis - carcinoma in situ
• T1 - invasion of submucosa
• T2 - invasion of muscularis propria
• T3 - invasion through muscularis propria into subserosa or into mesoappendix
• T4
  • T4a - penetrates visceral peritoneum, including mucinous peritoneal tumor within the right lower quadrant
  • T4b - directly invades other organs or structures (includes invasion of other segments of the colorectum by way of the serosa)

Nodes

• N0 - no regional lymph node metastasis
• N1 - metastasis in 1-3 regional LN
• N2 - metastasis in 4 or more LN

Distant Metastasis

• M0 - none
• M1 - distant metastasis
  • M1a - intraperitoneal metastasis beyond the right lower quadrant, including pseudomyxoma peritonei
  • M1b - nonperitoneal metastasis

Stage grouping

• I - T1-2 N0
• IIA - T3 N0
• IIB - T4a N0
• IIC - T4b N0
• IIIA - T1-2 N1
• IIIB - T3-4 N1
• IIIC - N2
• IVA - M1a N0 and Grade 1
• IVB - M1a N0 and Grade 2-3, M1a and N+ (any Grade)
• IVC - M1b