TREATMENT
FOR
APPENDICEAL CANCER
           

             While intravenous chemotherapy (IV chemo) is indicated for the treatment of appendiceal cancer, the specific drugs used are usually the same as those used to treat colon cancer. Appendiceal cancer is so uncommon that clinical trials comparing the effectiveness of the various available chemotherapy agents have not been done.  Since colon cancer and appendiceal cancer pathologies are similar, the effectiveness of these chemotherapy medications is assumed to be beneficial in the treatment of appendiceal cancer, and in many cases it has been demonstrated to be effective.  Most often a combination of several drugs are used.  Acronyms for these combinations are listed below.

The combinations of chemotherapy drugs most commonly used when systemic chemotherapy is indicated for appendiceal cancer are:


    1. FOLFOX

    2. FOLFIRI

     3. XELOX




  • Other drugs that may be added to these regimens-
     

  • Avastin (bevacizumab): a monoclonal antibody that interferes with a tumor's ability to form blood vessels
     

  • Erbitux (cetuximab): a monoclonal antibody used colorectal cancer
     
  • Xaliproden (SR57746A)- a new drug currently being tested in clinical trials for the prevention of neuropathy in patients receiving oxaliplatin. 

1. Eloxatin  (oxaliplatin)- Intravenous chemotherapy used to treat colorectal cancer 

     

    Most common side effects:

  • Effects the nerve endings resulting in numbness or tingling in the hands and feet. Nerve endings in the neck and throat may also be effected. These symptoms can be triggered especially by anything cold, such as cold air or cold drinks. This side effect may become more pronounced as therapy continues over time, and should improve after treatment is completed.   Xaliproden (SR57746A) is a new drug being tested in clinical trials for the prevention of neuropathy in patients receiving oxaliplatin.  See information under "Related Links" at the bottom of this page.
     
  • Lowered resistance to infection related to a decreased production of white blood cells by the bone marrow.  If white blood count gets too low, treatment may be delayed.  In some cases medications such as Aranesp or Neulasta may be administered to help increase white blood cell production.
     
  • Bruising or bleeding- the ability of your body to form clots may be reduced related to a decreased number of platelets circulating in the blood.  This is caused by the drugs effects on platelet production by the bone marrow.
     
  • Diarrhea- controlled with medication if it occurs
     
  • Anemia- also caused by the drug's effect on the bone marrow that results in a decreased number of red blood cells produced
     
  • Nausea and vomiting- may occur a few hours after treatments and may last for a few days.  Drugs such as Kytril or Zofran may be used to control or prevent this side effect.

      Uncommon side effects that may occur:

  • Changes in ability to taste or small sores in your mouth.  Be sure to use good oral hygiene.
     
  • Laryngeal spasm- spasm in the area around your voice box that can cause difficulty swallowing or breathing, may be triggered by cold or drinking cold liquids

2. Camptosar (Irinotecan)- intravenous chemotherapy drug used for colorectal

                                                  cancer


         Most common side effects:

  • Diarrhea- can be immediate or may be delayed more than 24 hours after receiving the chemotherapy.  Can be severe.  Needs to be controlled with anti-diarrheal medications to prevent dehydration and electrolyte imbalance.
     
  • Lowered resistance to infection related to a decreased production of white blood cells by the bone marrow.  If white blood count drops too low, treatment may be delayed.  In some cases medications such as Aranesp or Neulasta may be administered to help increase white blood cell production.
     
  • Bruising or bleeding- the ability of your body to form clots may be reduced related to a decreased number of platelets circulating in the blood.  This is caused by the drug's effect on platelet production by the bone marrow.
     
  • Anemia- also caused by the drug's effect on the bone marrow that results in a decrease in the number of red blood cells produced
     
  • Hair loss- up to 35% of patients may experience total hair loss, others may experience various degrees of  thinning.  Hair will grow back after treatment completed.  See Hair Loss and Chemotherapy.
     
  • Nausea and vomiting- may occur a few hours after treatments and may last a few days.  Drugs such as Kytril or Zofran may be used to control or prevent this side effect.
     
  • Increased sweating and saliva production- if this occurs, it usually occurs soon after treatment and can be controlled with the administration of a drug called atropine.

        Uncommon side effects:

  • Muscle cramps- can be controlled with medication or pain relievers
     
  • Mouth sores and change in taste: use good oral hygiene.
     
  • Changes in liver function that are temporary and most likely will not be noticeable
     
  • Skin rash/itching that can be treated with medication

3. Fluorouracil (5FU)- intravenous chemotherapy drug used to treat colorectal cancers


    Most common side effects:

  • Lowered resistance to infection related to a decrease in production of white blood cells by the bone marrow.  If white blood count drops too low, treatment may be delayed.  In some cases medications such as Aranesp or Neulasta may be given to help increase white blood cell production.
     
  • Bruising or bleeding- the ability of your body to form clots may be reduced related to a decrease in number of platelets circulating in the blood.  This is caused by the drug's effects on platelet production by the bone marrow.
     
  • Anemia-  caused by the drug's effect on the bone marrow resulting in a decreased number of red blood cells produced
     
  • Changes in taste and small sores in mouth.  Use good oral hygiene. 
     
  • Darkening of skin caused by an increase in skin pigmentation.  Skin color will return to normal after treatment ends.
     
  • Changes in eyes: gritty feeling in eyes, blurred vision, increase in tearing.  Eye drops may be recommended to sooth irritated eyes.

        Less common side effects:

  • Nausea and vomiting- may occur a few hours after treatments and may last a few days.  Drugs such as Kytril or Zofran may be used to control or prevent this side effect.
     
  • Hair loss or thinning- complete hair loss is rare, but may occur.  Hair will grow back after treatment completed. 
     
  • Hand-foot syndrome- soreness and redness of the hands and feet.  More common when given via continuous infusion
     
  • Increased sensitivity to sunlight.  Avoid direct sunlight on unprotected skin or use sun block
     
  • Skin rashes- can be treated with medication if occurs

4. Leucovorin- (Folinic acid):Vitamin used to increase the effectiveness of            

                Fluorouracil(5FU). Side effects related to the use of this drug are rare.
 

5. Xeloda -(Capecitabine): a drug similar to the chemotherapy drug 5FU but in pill form


         Most common side effects:

  • Diarrhea- controlled with medication if it occurs
     
  • Nausea and vomiting- may occur a few hours after treatments and may last a few days.  Drugs such as Kytril or Zofran may be used to control or prevent this side effect.
     
  • Hand-foot syndrome- soreness and redness of the hands and feet.
     
  • Changes in taste and small sores in mouth.  Use good oral hygiene. 
     
  • Loss of appetite
     
  • Constipation and abdominal cramping: prevent by eating a diet high in fiber, exercising, and drinking plenty of fluids. Laxatives may be prescribed if needed.

  Less common side effects:

  • Hair loss or thinning- complete hair loss is rare, but may occur.  Hair will grow back after treatment completed.  See Hair Loss and Chemotherapy.
     
  • Lowered resistance to infection related to a decrease in production of white blood cells by the bone marrow.  If white blood count drops too low, treatment may be delayed.  In some cases medications such as Aranesp or Neulasta may be administered to help increase white blood cell production.
     
  • Bruising or bleeding- the ability of your body to form clots may be reduced related to a decreased number of platelets circulating in the blood.  This is caused by the drug's effects on platelet production by the bone marrow.
     
  • Anemia- also caused by the drug's effect on the bone marrow that results in a decreased number of red blood cells produced
     
  • Headache and dizziness

6. Avastin (bevacizumab)- intravenous medication- a monoclonal antibody that prevents cancerous tumors from forming a  blood supply.


          Most common side effects:

  • Lowered resistance to infection related to a decrease in production of white blood cells by the bone marrow.  If white blood count gets too low, treatment may be delayed.  In some cases medications such as Aranesp or Neulasta may be administered to help increase white blood cell production.
     
  • Bruising or bleeding- the ability of your body to form clots may be reduced related to a decreased number of platelets circulating in the blood.  This is caused by the drug's effects on platelet production by the bone marrow.
     
  • increased blood pressure
     
  • increased angina (chest pain),  increased risk of blood clots and strokes and possible changes in heart function causing difficulty breathing and swelling of the ankles
     
  • mild or severe allergic reactions
     
  • possible kidney damage
     
  • slower wound healing
     
  • Constipation- prevent by eating a diet high in fiber, exercising, and drinking plenty of fluids. Laxatives may be prescribed if needed.

    Less common side effects:

  • Nausea and vomiting- may occur a few hours after treatments and may last a few days.  Drugs such as Kytril or Zofran may be used to control or prevent this side effect.
     
  • Changes in taste and small sores in mouth.  Use good oral hygiene. 
     
  • Headache
     
  • Loss of appetite
     
  • Diarrhea- controlled with medication if it occurs

7. Erbitux (cetuximab): a monoclonal antibody given intravenously


      Common side effects:

  • Up to 90% of those receiving this drug may experience a mild  skin rash similar to acne.  In some cases this rash may become more severe and resemble eczema. Avoid using harsh soaps.
     
  • Nausea and vomiting- may occur a few hours after treatments and may last a few days.  Drugs such as Kytril or Zofran may be used to control or prevent this side effect.
     
  • Diarrhea- controlled with medication if it occurs
     
  • Shortness of breath, especially if you have a pre-existing respiratory problem
     
  • Allergic reaction that can be mild or severe- antihistamines may be prescribed to prevent this reaction
     
  • Conjunctivitis- red, sore or itch eyes.  Eye drops may be prescribed to alleviate these symptoms
The information above has been provided by The Appendix Cancer Connection



This website is for informational and educational purposes only. Readers are encouraged to confirm the information contained herein with other sources. The information on this website is not complete and not intended to replace medical advice offered by physicians or health care providers.  Patients and consumers should review the information carefully with their professional health care provider.