New hope for rare cancers: Regional One Health improves access to advanced care for appendix cancer and peritoneal surface malignancies

It can be difficult for patients to access care for rare cancer diagnoses, but Regional One Health Cancer Care is changing that for Mid-South patients.

Surgical oncologist Ian Solsky, MD, MPH specializes in the treatment of rare cancers including appendix cancer and peritoneal surface malignancies.

Thanks to Dr. Solsky's expertise and Regional One Health Cancer Care's advanced resources, the hospital can offer complex, advanced treatment options that can give patients new hope.

Appendix cancer and peritoneal surface malignancies are rare diagnoses, and that can make it hard for patients to access the specialized care they need.

Thanks to physician expertise and multidisciplinary team, Regional One Health is making that care available in the Mid-South.

Ian Solsky, MD, MPH, recently hosted a Lunch & Learn to discuss symptoms and treatment outcomes for these illnesses, including CRS-HIPEC (Cytoreductive Surgery-Hyperthermic Intraperitoneal Chemotherapy), a complex procedure that is only available through advanced academic oncology services like Regional One Health Cancer Care.

"It's a complex treatment, and it requires a great team like we have at Regional One Health," he said. "It's a meaningful treatment opportunity for the right patients, and identifying the right patients requires a thoughtful selection process and multidisciplinary team."

That starts with achieving an accurate diagnosis.

"One of the challenges with appendix cancer is it can present in a subtle manner," Dr. Solsky said. "The symptoms aren't very specific. Patients may have generalized abdominal pain, bloating, or ongoing fatigue. Sometimes, it is found after a patient has an appendectomy."

Diagnosis starts with imaging, followed by a biopsy or diagnostic laparoscopy. There are several types of appendix cancer, and reaching a precise diagnosis is key to providing the right care.

For example, Dr. Solsky said CRS-HIPEC can come into play for Low-Grade Appendiceal Mucinous Neoplasms (LAMN)

LAMNs are a type of cancer that can spread to the peritoneum, which includes the lining of the abdominal wall and some abdominal organs. Several cancer types can also spread to the peritoneum including ovarian, colon, appendix, and gastric cancers. When a cancer spreads the peritoneum, it is considered a peritoneal surface malignancy.

"Peritoneal surface malignancies are serious, but that doesn't mean nothing can be done," Dr. Solsky said. "We have good treatment options for many patients. The treatment varies greatly based on the tumor types. Ultimately, it comes down to the biology of the tumor."

CRS-HIPEC is one of the options.

First, doctors map the disease - the location, type of tumor and how much cancer is visible-which is determined by imaging, biopsies, and sometimes a procedure called a diagnostic laparoscopy.

Next, they perform cytoreductive surgery to remove all cancer the surgeon can see. Some patients just need the lining removed from the abdominal wall, while others have tumors on abdominal organs like the gallbladder, colon, stomach, spleen, etc.

"The extent of the surgery can escalate dramatically depending on where the cancer is," Dr. Solsky said. "However, we do this with quality of life and recovery in mind."

Finally, certain patients will be considered for HIPEC, which targets microscopic cancer cells that aren't visible by placing heated chemotherapy directly in the abdominal cavity.

The chemotherapy is delivered at a higher concentration than traditional chemotherapy and it is heated which may allow the chemotherapy to better penetrate the tumor.

Dr. Solsky said that some patients may receive only CRS and not HIPEC and that it is important for these two to be considered as separate procedures that are not always performed together.

For carefully selected patients, outcomes after CRS with or without HIPEC can be meaningful. However, the exact prognosis is ultimately dependent on the cancer type.

All of that is factored into determining if the surgery is right for each individual patient.

Other factors are key as well, Dr. Solsky said.

Tumor biology, volume of disease, and location of disease are all important. Patient characteristics are also very important.

"We discuss these factors with a multidisciplinary team," Dr. Solsky said. "The best outcomes come from having an experienced team and choosing patients appropriately."

Dr. Solsky said treatment options for appendix cancer and PSMs continue to advance, with studies focused on improving CRS-HIPEC, immunotherapy medications, new types of systemic chemotherapy, and more.

"The future involves more personalized care, smarter patient selection, more tumor testing, and additional focus on quality of life," Dr. Solsky said.

Along with appendix cancer and peritoneal surface malignancies, Dr. Solsky treats skin, soft tissue, and gastrointestinal cancers. He sees patients at Regional One Health Cancer Care, 880 Madison Avenue. For appointments, call 901-515-HOPE (5673).