A 58-year-old woman is found to have a 2 cm carcinoid tumour (well-differentiated neuroendocrine tumour) in the appendix on pathology after appendicectomy for acute appendicitis. No local or distant spread is identified. The appropriate additional management is:

• A Right hemicolectomy is required for any appendiceal carcinoid
• B Octreotide analogue therapy for life regardless of tumour size
• C Systemic chemotherapy with streptozotocin and 5-FU
• D No further surgery required; appendicectomy alone is curative for carcinoid tumours <2 cm of the appendix ✓

Explanation

Appendiceal carcinoid tumours <2 cm in diameter have a <2% risk of lymph node metastasis and appendicectomy alone is curative. Tumours ≥2 cm (and especially >2 cm) have significantly higher rates of lymph node and distant metastasis (up to 30–70% for tumours >2 cm), and in such cases right hemicolectomy with mesenteric lymph node clearance is recommended. This tumour is exactly 2 cm — which represents the critical threshold — and current guidelines generally accept appendicectomy for tumours ≤2 cm without mesoappendix or caecal invasion. Octreotide is used for functioning carcinoid syndrome, not for curative-intent post-surgical adjuvant therapy of localised disease.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.