Add this to the list of cancers disproportionately impacting young people

Appendix cancer is incredibly rare, but it has been making an unsettling appearance in millennials and Gen X.

Traditionally, cancers of the appendix were almost exclusively seen in older adults, but in recent years, there’s been a noticeable uptick in cases among younger people. So what’s going on?

A rare cancer on the rise

First, some context: Appendiceal cancer is diagnosed in about 1–2 people per million per year.^[]

It often flies under the radar until it’s advanced enough to be picked up via imaging or during surgery for what’s assumed to be a run-of-the-mill appendicitis.

While older adults still make up the bulk of cases, the increase in incidence among people in their 30s and 40s has researchers scratching their heads—and rethinking how we detect and manage these tumors.

“When you take these alarming rates that we are seeing for appendiceal cancer across generations, together with the fact that 1 in every 3 patients diagnosed with appendiceal cancer is diagnosed under the age of 50, these point to a timely need for everyone to be aware of the signs and symptoms of appendix cancer," said Andreana Holowatyj, PhD, assistant professor of medicine at Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center.

What’s driving the spike?

The million-dollar question is why. We’re seeing a similar trend with other cancers that used to be considered diseases of older adults—like colorectal cancer—now being diagnosed at younger ages.^[] Some theories getting traction include:

• Lifestyle and environment: Shifts in diet, sedentary behavior, smoking, alcohol consumption, and exposure to environmental toxins may be driving an uptick in early-life inflammation and gut microbiome changes that could predispose young people to these cancers.^[]

• Obesity and metabolic factors: Rising rates of obesity and insulin resistance have been tied to multiple GI cancers.^[] These factors might also be at play in appendiceal cancer.

• Improved detection: Advanced imaging for abdominal pain (think CT scans for suspected appendicitis) might be picking up cancers that previously would have gone undetected until they were symptomatic much later in life.^[]

What this means for you and your patients

This trend underscores the importance of considering cancer even in younger patients presenting with appendicitis.

While most appendicitis cases are straightforward infections, a subset could actually be driven by an underlying neoplasm—especially in patients with atypical presentations or those with concerning features on imaging.

For physicians, it’s a reminder to stay vigilant: When you’re taking out that appendix in a 28-year-old, consider sending the specimen for thorough pathologic examination.

And if the pathology does come back as an appendiceal neoplasm, know that these patients may need more than just an appendectomy—they might need oncologic follow-up, more extensive surgery, or even systemic therapy, depending on the histologic subtype and staging.

The bottom line

The rising incidence of appendix cancer among millennials and Gen X is part of a broader trend of GI cancers hitting younger adults. While the exact causes remain murky, awareness is key.

For now, it’s about keeping these cancers on our radar—especially when treating appendicitis in young patients—and advocating for more research to understand what’s fueling this unexpected rise.