Latest news with #AmitJaved
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First Post
28-06-2025
- Health
- First Post
Doctor explains: Why appendix cancer is rising among the young and how it differs from colon cancer
Appendix cancer, once rare, is now rising sharply among younger people. Firstpost brings out an expert's views on the risk factors, symptoms and why early detection remains a challenge. read more Once considered extremely rare, appendix cancer is now showing a worrying rise particularly among younger adults. New research suggests that cases have quadrupled in recent decades with many detected at advanced stages due to vague or absent symptoms. As awareness remains low and early detection difficult, understanding the signs, risk factors and treatment pathways becomes critical. Firstpost spoke to Dr Amit Javed, Senior Director – GI & GI Oncology, Fortis Hospital (Gurugram) to understand why appendix cancer is on the rise, how it presents clinically and what can be done to improve outcomes. Why are appendix cancer cases rising among younger adults, particularly millennials and Gen Z? Dr Amit: While appendiceal cancer remains a relatively rare malignancy, there has been a noticeable increase in diagnoses among younger adults in recent years. This trend, similar to what has been observed in early-onset colorectal cancers, may be attributed to a combination of improved diagnostic capabilities and changing risk factors. Advanced imaging techniques, greater use of diagnostic laparoscopy, and more frequent appendectomies for non-specific abdominal pain have likely led to increased incidental detection of early-stage appendiceal tumors. However, this alone may not fully explain the shift in age demographics. Emerging research suggests that shifts in gut microbiota, rising obesity rates, dietary patterns rich in processed foods, sedentary lifestyles, and possible environmental exposures may be influencing cancer biology in younger cohorts. More data is needed to conclusively identify causative links, but the trend is certainly being observed across high-resource healthcare settings. Is there a known link between appendix cancer and lifestyle, genetics or environmental exposures in younger populations? Dr Amit: Currently, there is no single established cause of appendix cancer. However, certain associations are being actively studied: •Lifestyle Factors: Diets high in red or processed meats, low fibre intake, and obesity known contributors to colorectal cancer may also play a role in appendix malignancies, though data is limited. •Environmental Exposures: Exposure to microplastics, industrial chemicals, and endocrine-disrupting substances may influence carcinogenesis in the gastrointestinal tract, including the appendix. However, this is still an area of ongoing investigation. •Genetic Predisposition: Some appendiceal tumours may be associated with Lynch syndrome or familial cancer syndromes, though far less commonly than colorectal cancer. Molecular profiling is now recommended in many cases to evaluate for potential hereditary links. In most young patients, appendix cancer appears sporadic, but the rising numbers point toward the need for deeper evaluation of modern environmental and epigenetic influences. Given that appendix cancer is often detected late due to vague symptoms, what early signs should individuals especially young adults watch out for? Dr Amit: Appendix cancer often presents with non-specific symptoms, making early detection challenging. In younger adults, the following signs should prompt medical evaluation: •Persistent or recurrent right lower abdominal pain, especially if similar to appendicitis but not resolving •Unexplained abdominal bloating or distension •Altered bowel habits without an identifiable cause •Unintended weight loss, fatigue, or anemia •A palpable mass or fullness in the lower abdomen In many cases, appendiceal tumours are incidentally discovered during appendectomy for presumed acute appendicitis. This underlines the importance of histopathological analysis of every appendectomy specimen, even in young patients. How is appendix cancer different, genetically and clinically from other gastrointestinal cancers such as colon or rectal cancer? Dr Amit: Appendix cancer is a biologically and clinically distinct entity from colorectal malignancies. It encompasses several histologic subtypes, including: •Neuroendocrine tumours (NETs) •Mucinous adenocarcinomas •Goblet cell carcinoids •Signet ring cell carcinomas Each of these has unique behaviour, prognosis, and treatment pathways. Genetically, appendix tumours may harbour different molecular signatures, including variations in KRAS, GNAS, and TP53 mutations, particularly in mucinous tumours. Unlike colorectal cancers, microsatellite instability (MSI) and APC mutations are less common. Clinically, mucinous tumours can produce large amounts of mucin, sometimes leading to pseudomyxoma peritonei (PMP) — a condition rarely seen in other GI cancers. Treatment and surveillance strategies are therefore quite different. Can you walk us through how appendix cancer is typically diagnosed and staged? Are there improvements in imaging or biomarkers that aid in earlier detection? Dr Amit: Diagnosis often begins incidentally during surgery for suspected appendicitis. If a tumour is suspected pre-operatively, the following steps are involved: Imaging: •Contrast-enhanced CT scans remain the mainstay for detecting masses, mucinous ascites, or peritoneal spread. •MRI with diffusion-weighted imaging is increasingly used, particularly for mucinous tumours, to better characterise peritoneal involvement. •PET-CT may be helpful in certain subtypes, especially aggressive variants or high-grade neuroendocrine tumours. Tumour Markers: •CEA, CA 19-9, and CA-125 may be elevated in mucinous appendiceal cancers, although they are not diagnostic and are mainly used for monitoring. •Histopathology and Immunohistochemistry: •Once the appendix is removed, detailed pathological examination is essential to classify the tumour type, grade, and margins. Staging: •Staging follows the AJCC TNM system, but peritoneal cancer index (PCI) scoring is also critical in cases involving peritoneal spread to guide surgical decision-making. While no single biomarker currently allows for early non-invasive detection, research is ongoing into liquid biopsy and circulating tumour DNA (ctDNA) for earlier diagnosis and monitoring. What are the current treatment options available for appendix cancer? How effective are newer approaches like HIPEC (Hyperthermic Intraperitoneal Chemotherapy)? Dr Amit: Treatment depends heavily on the tumour histology, grade, and extent of spread: •Localised tumours (e.g., small neuroendocrine tumours <2 cm) may be treated with appendectomy alone. •Larger or invasive tumours typically require a right hemicolectomy to ensure adequate lymph node clearance. •Mucinous tumours with peritoneal dissemination or PMP are managed with: •Cytoreductive surgery (CRS) — complete surgical removal of visible tumour •Followed by HIPEC — heated chemotherapy circulated in the abdomen to target microscopic residual disease HIPEC has revolutionized survival outcomes in selected patients with peritoneal spread, offering long-term survival and in some cases, cure particularly when performed in high-volume centers with surgical expertise. •Systemic chemotherapy is used selectively in high-grade tumours or inoperable cases, often with regimens similar to colorectal cancer. Do you see a need for changes in screening guidelines or increased awareness in primary care to address this rise in younger patients? Dr Amit: Given the rarity and variable presentation of appendix cancer, routine population-based screening is not currently recommended. However, there is a growing need for: •Greater awareness among primary care physicians and emergency practitioners to consider malignancy in atypical or recurrent abdominal pain, especially in younger patients •Routine histopathological examination of all appendectomy specimens, regardless of patient age •Genetic counselling and testing in young patients with aggressive or familial patterns of disease •Investment in biobanking and molecular profiling to better understand early-onset GI cancers, including appendiceal tumours As trends evolve, surveillance strategies may eventually be tailored for higher-risk populations, especially if environmental or genetic risk markers are identified in the future.
News18
22-05-2025
- Health
- News18
In Rare Surgery, Doctors Unburden 70-Year-Old Gurugram Man Of 8,000 Gallstones
Last Updated: An ultrasound led to the diagnosis of acute cholecystitis, an infection of the gallbladder, with additional complications like gangrene, pus formation, and signs of chronic disease In a major medical accomplishment, doctors at a private hospital in Gurugram said on Thursday that they had surgically removed over 8,000 stones from the abdomen of an elderly man—possibly the third highest number of gallstones ever extracted in India. The 70-year-old Gurugram-based patient was admitted to Fortis Memorial Research Institute (FMRI), complaining of persistent abdominal pain, irregular fever, loss of appetite, and weakness, along with a feeling of heaviness in the chest and back that had persisted for more than four years. Like many elderly patients, he was reluctant to seek treatment and visit a doctor despite months of abdominal discomfort. However, when his condition deteriorated due to increased and uncontrollable pain, his family rushed him to the hospital. Upon admission, an ultrasound of the abdomen revealed a densely packed gallbladder. 'The ultrasound led to the diagnosis of acute cholecystitis, which is an infection of the gallbladder, with additional complications like gangrene, pus formation, and signs of long-standing chronic disease," Dr Amit Javed, senior director, gastrointestinal oncology, who led the team of doctors to perform the gallstone removal surgery, told News18. 1 hour for surgery, 5 hours for counting stones Looking at the condition, the team of doctors immediately performed 'minimally invasive laparoscopic surgery" to remove the massive number of gallstones visible on ultrasound. While the surgery was completed in an hour, it took almost five hours for the team to count the stones. 'While laparoscopic gallbladder removal is a routine procedure, this case was exceptional due to the massive number of stones," Javed said while sharing that 'the surgery itself took only one hour. However, it took six hours to perform the post-surgery task of manually counting the stones. The support team spent this time meticulously sorting and counting all 8,125 stones to document this rare occurrence." The patient was discharged in a stable condition within two days, the hospital said. In 2015, a team of doctors in Kolkata set a record by removing 11,950 gallstones from a 51-year-old woman's gallbladder—an achievement that was recognised by the Guinness Book of World Records. In another notable case that occurred in 2016 at Sawai Man Singh (SMS) Hospital in Jaipur, surgeons extracted 11,816 gallstones from a 46-year-old man. Why and how does such a condition develop? The key challenge for doctors was to avoid puncturing the gallbladder during the surgery, as doing so could have released thousands of stones into the abdomen, complicating the surgery and increasing the risk of infection or further complications. 'What sets this case apart is the exceptionally high number of stones removed. Most gallstones are composed of cholesterol and are often linked to obesity and high-cholesterol diets," Javed explained. However, he said, 'The exact cause of the collection of these many stones is not known but may be related to being overweight, underlying diabetes, and long-standing disease. The patient was symptomatic for the last four to five years. The gallstones may have been present much before symptoms started." The key takeaway, Javed believes, is the importance of early diagnosis and timely treatment. 'Delaying care for gallbladder-related symptoms can lead to serious and complex complications, some of which can be life-threatening. People should not ignore persistent abdominal discomfort and should seek medical attention promptly. Maintaining a healthy diet and weight can also reduce the risk of gallstone formation." First Published: May 22, 2025, 21:13 IST
