Appendix cancer physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Patients with appendix cancer usually appear normal, pale or diaphoretic. If the patient with appendix cancer present with acute appendicitis which is quite common, abdominal tenderness, rebound tenderness, abdominal guarding, Rovsing’s sign, as well as Psoas sign might be present. Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome. Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common. In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive of Pellagra disease.

• Physical examination of patients with appendix cancer is usually normal.^[1]
• If the patient with appendix cancer present with acute appendicitis which is quite common, abdominal tenderness, rebound tenderness, abdominal guarding, Rovsing’s sign, as well as Psoas sign might be present. ^[2]
• Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome.
• Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common.^[3]
• In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive of Pellagra disease.^[4]

• Patients with appendix cancer usually appear normal but might be pale or diaphoretic, or even present with a facial flushing.

• Fever might be present in patients presenting with appendicitis.
• Tachycardia is prevalent in patients with carcinoid syndrome as well as patients with appendicitis.
• Tachypnea
• Hypertension

• Skin examination of patients with appendix cancer is usually normal.
• In the presence of carcinoid syndrome the following might be present:
  • Flushing
  • Hirsutism
  • Pallor
  • Dermatitis in the presence of Pellagra

• HEENT examination of patients with appendix cancer is usually normal.
• Glossitis may be suggestive of Pellagra.

• Neck examination of patients with appendiceal cancer is usually normal.
• Cervical lymphadenopathy might be present.

• Pulmonary examination of patients with appendix cancer is usually normal.
• Wheezing : If the patient develop carcinoid syndrome.

• Cardiovascular examination of patients with appendix cancer is usually normal.
• If the patient develop carcinoid syndrome systolic or diastolic murmur might be present.
• Right heart murmurs specially TR is prevalent.

• Considering small size of must of appendiceal tumors, abdominal examination of patients with appendix cancer is usually normal.
• But in the cases of complicated tumors such as perforated appendicitis, abdominal examination may be remarkable for:
  • Abdominal tenderness in the right lower abdominal quadrant
  • Rebound tenderness
  • A palpable abdominal mass in the right lower abdominal quadrant
  • Guarding may be present
• In cases of late stage metastatic disease hepatosplenomegaly might be present.
• Additional findings, such as obturator test, Psoas test, McBurney point test are common in appendicitis.

Palpation

• The abdominal wall is very sensitive to mild palpation:
  • Rebound tenderness
  • Abdominal guarding
  • Rovsing’s sign
  • Psoas sign

Rectal examination

• Tenderness in the rectovesical pouch

• Back examination of patients with appendix cancer is usually normal.

• Genitourinary examination of patients with appendix cancer is usually normal.

• A pelvic adnexal mass may be palpated; in fact a number of appendiceal cancers are misdiagnosed as ovarian masses vise versa.

• Neuromuscular examination of patients with appendix cancer is usually normal.
• Dementia, aggression, and mental confusion are rare complications of complicated carcinoid syndrome patients that develop Pellagra.

• Extremities examination of patients with appendix cancer is usually normal.

• Rarely patients with carcinoid syndrome might present with lower limb edema.

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