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Wake Forest Baptist Research Sheds Light on Cancer of the Appendix

Analysis of Gene Expression Could Lead to Better Treatments

WINSTON-SALEM, N.C. - March 7, 2012 - Researchers at Wake Forest Baptist Medical Center have demonstrated that cancer of the appendix is different than colon cancer, a distinction that could lead to more effective treatments for both diseases.

The study by Edward A. Levine, M.D., professor of surgery and chief of the surgical oncology service at Wake Forest Baptist, is the result of gene analysis of cases covering a 10-year period. It appears in the early online edition of the April issue of the Journal of the American College of Surgeons.

Cancer of the appendix, which is part of the colon, affects approximately 2,500 people in the United States annually and has the propensity to spread throughout the peritoneal cavity, the space within the abdomen that contains the intestines, stomach and liver.

"Our treatment program, which was the catalyst for this research, is one of the largest worldwide and consists of aggressive surgery coupled with heated chemotherapy placed directly into the abdominal cavity at the time of surgery," Levine said. "Given the uncertainty of predicting outcomes in patients with disseminated appendiceal cancer, we sought to use the tools of gene expression profiling to better understand these rare malignancies at a molecular level in order to better predict oncologic outcomes. We've looked at the genes that make these cancers tick, and we actually started to pick them apart for the first time."

For the study, the researchers examined tumor samples from Wake Forest Baptist's tissue bank for patterns of expression of different genes.

"By looking at these genetic signatures, we found that the genes active in cancer of the colon and those active in cancer of the appendix are very different," Levine said. "For years, however, cancer of the appendix, which is part of the colon, has been treated with the same chemotherapy treatment used for colon cancer. This study shows that we need a fresh approach to how we treat appendix cancer."

This research, which was done in collaboration with Duke University, was supported, in part, by a grant from Golfers Against Cancer. Co-authors include Perry Shen, M.D., and John Stewart, M.D., both of Wake Forest Baptist, and David Hsu, M.D., and Trey Blazer, M.D., both of Duke University.

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