Few of us give much thought to our appendix unless it starts to 'grumble' – the non-medical term for swelling or pain.
asserted
it → give → swelling
This can potentially become full-blown appendicitis, which may require an operation to remove the four-inch-long organ or risk a life-threatening rupture.
uncertain
which → become → rupture
While the exact function of the appendix remains a mystery, it forms part of the digestive system and is connected to the bowel.
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it → remain → bowel
But it has been drawing increasing attention globally because it has been linked to a rising tide of cancers – particularly in younger people.
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it → draw → people
Statistics show a dramatic increase in the number of under-50s diagnosed with appendix cancer, at a rate which is even outpacing other fast-growing diseases such as bowel cancer.
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which → show → cancer
One study in the US last year found people aged between 29 and 44 were now the most likely to develop tumours in their appendix, with cases rising 71 per cent in just ten years.
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cases → find → years
Researchers from Bristol in 2022 found the incidence of appendix cancer increased a staggering five-fold in the 20 years from 1995 to 2016, with the biggest rises again found among those aged between 20 and 39.
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rises → find → 20
While the cancer remains rare and overall numbers are reassuringly small – at just 1.6 cases for every 100,000 people in Britain – any increase should, as the Bristol researchers pointed out, be a 'cause for concern'.
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researchers → remain → concern
Appendix cancer is not an easy disease to diagnose because it can progress without symptoms, or with vague symptoms such as mild abdominal pain and bloating.
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it → diagnose → pain
As a result, many cases are often picked up only after it has already spread and is harder to treat.
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it → pick → result
Relapse is common, and around half of patients do not survive five years if diagnosed at this stage.
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half → survive → stage
Statistics show a dramatic increase in the number of under-50s diagnosed with appendix cancer, at a rate which is even outpacing other fast-growing diseases such as bowel cancer
The gruelling treatment, which can involve extensive abdominal surgery as well as a procedure to bathe the abdomen in chemotherapy to kill off remaining cancer cells, can leave women infertile.
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which → show → women
Professor Omer Aziz, who leads the appendix cancer unit at The Christie NHS Foundation Trust in Manchester, one of two national specialist centres which assess and treat the disease, says: 'I am definitely seeing younger and younger people developing cancer.'
Tim Brill, a trustee of the appendix cancer charity Pseudomyxoma Survivor, described it as 'a worrying trend' and called for more research to drive early diagnosis and better treatments.
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Brill → lead → diagnosis
There is a lot scientists still do not understand about this rise and, frankly, about the appendix itself.
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scientists → be → appendix
Situated in the lower right of the abdomen, it is thought to play a role in the gut's immune system and in helping to clear waste from the body.
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it → situate → body
A 2025 review published in the leading journal Nature emphasised how little is known about the causes of appendix cancer, branding it 'an enigma'.
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little → publish → it
But there are some clues as to what may be driving some of the headline figures.
uncertain
what → be → figures
Ultimately, more early-stage cancers are being detected when people have surgery to remove their appendix, a procedure known as an appendectomy.
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people → detect → appendectomy
These cancers tend to be the most common type to affect the appendix, and are known as neuroendocrine tumours, or NETs, which start in cells involved in hormones and signalling.
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which → tend → hormones
They tend to be small and slow growing, but once removed along with the appendix often need no further treatment.
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They → tend → treatment
The appendix is situated in the lower right of the abdomen and is thought to play a role in the gut's immune system and in helping to clear waste from the body
Over the years the number of appendectomies has risen steadily, giving doctors more opportunities to find these previously hidden tumours.
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number → situate → tumours
In England, for instance, 10,000 more such operations were carried out in 2016 compared with 1999.
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operations → carry → 1999
And because people having their appendix removed are often relatively young, this may help explain some of the rise in diagnoses.
uncertain
this → have → diagnoses
In parallel to this, the World Health Organisation (WHO) has changed the way such tumours are classified.
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tumours → change → way
Before 2000, they were often called carcinoids and were thought to be benign, or at least less aggressive.
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they → call → 2000
But research that suggested they could grow and become malignant meant that, from 2000 onwards, WHO guidelines introduced new terminology to describe them as NETs which meant, for the first time, they were recorded as cancer.
uncertain
they → suggest → cancer
The Bristol study concluded the rising tide of UK diagnoses was being driven largely by an increase in the number of these NETs being picked up at grade one – the earliest cancer stage.
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tide → conclude → grade
Professor Aziz says: 'Previously, if a clinician saw something odd in an appendix when it was being removed it wouldn't be investigated.
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it → say → appendix
Now it's sent off to be studied.
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it → send → ?
That is resulting in more cancers being diagnosed, and is certainly part of why we're seeing figures suggesting a rise in the number of young people with the disease.
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we → result → disease
The good news is that, with grade one NETs, no further treatment is needed once your appendix has been removed.
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appendix → need → NETs
Professor Amy Berrington, leader of the Clinical Cancer Epidemiology Group at The Institute of Cancer Research, says: 'Some of this rise is due to a change in the way the disease is classified, but we are working to understand whether there are other causes along with the increase in colorectal [bowel] cancers.'
There has also been a rise – albeit not so steep – in the number of other tumours of the appendix which are not as well explained by better detection and classification changes.
The number of adenocarcinomas – tumours similar to those found in the bowel but which behave slightly differently – have trebled since 1995.
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which → say → 1995
And tumours known as pseudomyxoma peritonei, or PMP, which start in mucus-producing cells and can spread throughout the abdomen, have also risen by 2.5 times.
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which → know → times
Both remain extremely rare, with only a few hundred picked up every year.
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hundred → remain → ?
But they tend to be found at a late stage, when they have already spread beyond the appendix.
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they → tend → appendix
PMP in particular requires gruelling treatment which is only carried out at The Christie and the other NHS specialist centre at Hampshire Hospitals NHS Foundation Trust.
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which → require → Trust
It often involves removing the gallbladder, spleen, parts of the intestines and colon, the ovaries and uterus in women, as well as the appendix itself.
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It → involve → women
The abdominal cavity is then 'washed' with a heated chemotherapy treatment known as HIPEC to kill off remaining cancer cells.
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cavity → wash → cells
But there is a high chance it can come back.
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it → be → ?
At the moment there is no clear reason for there being a rise in either of those forms of appendix cancer, although experts suggest more CT scans are now carried out in A&E for abdominal pain and radiologists are better at identifying the disease.
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radiologists → be → disease
…and 21 more, not listed.
The Aporia
