The sharp pain prompted Chris Williams to head to the hospital.
It was a Tuesday evening in September 2021 when he began feeling intense abdominal pain and nausea, which had escalated by the next morning.
“I had to go to the ER,” said Williams, a Brooklyn resident.
At the hospital, doctors diagnosed him with appendicitis, leading to the removal of his appendix. About a week later, during a follow-up to remove his staples, he received unexpected news.
“They found a tumor on my appendix, and after a biopsy, they confirmed it was cancer,” said Williams, who was 48 back then.
“It was actually a blessing,” he reflected. “To me, it felt like good fortune that the tumor triggered my appendix to nearly rupture, prompting them to discover it – because later, they identified it as stage III. If it had gone unnoticed longer, it could have progressed to stage IV,” which is a more advanced and harder-to-treat stage of cancer.
Now cancer-free after finishing treatment in November 2022, Williams is part of a rising number of young adults in the U.S. diagnosed with appendix cancer.
‘Alarming and worrisome’
The appendix is a small organ connected to the large intestine, aiding the immune system.
Though appendix cancer is rare—about 1 or 2 cases per million people yearly in the U.S.—incidences are sharply rising among Generation X and millennials, according to a new study.
Contrasting those born from 1941 to 1949, cases have more than tripled for those born from 1976 to 1984 and quadrupled for those born between 1981 and 1989, as per research in the Annals of Internal Medicine. These trends were observed from 1975 to 2019.
“It’s alarming overall,” noted Dr. Andreana Holowatyj, the study’s lead author and assistant professor at Vanderbilt University.
“We are witnessing similar trends in colon, rectal, and stomach cancers, prompting our investigation into rare appendix cancers. Nevertheless, the observed trends are concerning,” she added.
The researchers, from Vanderbilt University Medical Center, West Virginia University, and the University of Texas Health Science Center, examined data from 4,858 adults diagnosed with appendix cancer between 1975 and 2019, sourced from the National Cancer Institute’s database.
The data revealed rising incidences by birth cohort, especially for those born after 1945.
While the study didn’t pinpoint reasons for the uptick, researchers believe it’s “unlikely” due to improvements in screening or diagnostic tools.
“No standardized screening exists for appendiceal cancers. Most cases are discovered incidentally after acute appendicitis,” Holowatyj explained.
The trend might link to “environmental exposures that could raise risks for generations now reaching mid-adulthood.” Similar patterns have also been reported in colon, rectal, and gastric cancers, indicating potential shared risk factors.
For instance, obesity is known as a risk factor for appendix cancer, and it also applies to colon cancer. Holowatyj suggested identifying these risk factors could help in finding ways to prevent the disease.
“Seeing parallel trends in gastrointestinal cancers suggests there may be both shared and distinct risk factors influencing cancer development in younger generations,” she said.
Understanding these factors—what overlaps exist and how they differ—is crucial for developing effective prevention strategies and potentially reversing these growing trends.
No specific screening recommendations exist for appendix cancers, but symptoms include abdominal pain, bloating, nausea, and vomiting, which can mimic appendicitis. Treatment often involves surgery to remove the appendix; if cancer has spread, chemotherapy may be needed.
“If the cancer isn’t identified before the appendix ruptures, tumor cells can spread throughout the abdominal cavity,” Holowatyj indicated. “That’s why about half of patients are diagnosed with metastatic disease.”
The increasing diagnosis of appendix cancer among young adults doesn’t surprise Dr. Andrea Cercek, co-director at Memorial Sloan Kettering Cancer Center, who treated Williams.
“We’ve recognized early-onset appendix cancer as part of a broader trend of early-onset gastrointestinal cancers, including colorectal cancer,” she noted.
She witnessed this pattern with her patients, yet the exact reasons for these increases remain unclear.
“There are many possibilities like lifestyle and dietary changes. People mention obesity, decreased activity levels. But no single factor fits everyone. Environmental changes might also be involved,” Cercek explained. “It likely stems from a combination—something multifactorial—though it hasn’t been pinpointed. Thankfully, extensive research is underway.”
Even with the rise in cases, Cercek emphasized that appendix cancer remains uncommon.
“It’s still very rare, despite its increase,” she stated. “However, it’s a significant part of the larger narrative about rising cancer rates in young adults.”
Williams’ path post-diagnosis was challenging, but he’s thankful for his care team. After his diagnosis, he sought treatment at Memorial Sloan Kettering, undergoing further surgery and chemotherapy.
“From my perspective, I could view this in several ways. I could complain or be upset. Or I could appreciate that this was found and that treatment was available,” Williams said. “It could have been something lethal, and since it wasn’t, I have every reason to be grateful.”
Before being diagnosed, he thought he was living healthily—eating a balanced diet and exercising—yet, as a project manager for New York, he dealt with significant stress.
At 42, he suffered his first heart attack, followed by another just weeks after his cancer diagnosis. A third occurred shortly after surgery at Memorial Sloan Kettering, and just last year, he experienced a fourth. Blockages were found and treated with stenting to improve blood flow.
“Much of what I experienced stems from stress,” Williams shared.
“I’ve always been one to internalize issues. Men often tend to carry a lot on their shoulders,” he added. “But internalizing can be harmful. It leads to stress, which can trigger heart disease or even cancer.”
Motivated by his health challenges, Williams started a nonprofit named Heart, Body & Soul in Brooklyn to link communities of color, especially Black men in underserved areas, to essential health resources and encourage better communication with healthcare professionals.
“We also educate them on self-advocacy, as many face challenges in being heard during medical visits,” he remarked, emphasizing the importance of being attentive to one’s body and having a primary healthcare provider.
“With diseases appearing at younger ages, it’s crucial we prioritize establishing a care team,” he stated. “We need to adopt a more holistic view of our health and well-being.”
