Recently, I had a couple of appendix cancer surgeries that made me realize something and wanted to write a science article to share with you. The reason for this is that these cases of appendiceal cancer have been mistaken for appendicitis and delayed! So which patients with appendicitis need to be alerted or screened for appendix cancer? 1, middle-aged and old patients with lower right abdominal pain Patients with unexplained intermittent lower right abdominal pain come to the hospital, the doctor has localized pressure pain, of course, may be appendicitis, but we need to know that a lot of diseases can cause lower right abdominal pain, including: gynecological diseases, ureteral stones, intestinal tumors and so on. Therefore, it is also necessary to ask more carefully about the history and physical examination, including the characteristics of pain, family history of tumors or history of other tumors, and the doctor’s deep palpation of the abdomen for abdominal masses, etc., so as to make a more accurate diagnosis. For middle-aged or elderly patients older than 45 years old, especially those with a family history of tumor or a history of suffering from a tumor, it is necessary to consider the possibility of cecum tumor. Appendix is the end structure of cecum, cecum and appendix are neighbors, cecum is the high incidence of colorectal malignant tumors, but due to the early symptoms of cecum cancer are not obvious, mostly manifested as atypical symptoms such as fatigue, and the patient will feel the pain in the right lower abdominal region only when the tumor grows to a certain volume, and the symptom may exist in a chronic manner, which is easy to be mistaken as chronic appendicitis or do not pay attention to; at the same time, some of the cecum tumors were born around appendix, resulting in the obstruction of the lumen of the appendix. At the same time, some appendiceal tumors are born around the appendiceal orifice, leading to appendiceal lumen obstruction, which will lead to appendicitis, or even acute appendicitis, which is easy to be missed if the doctor does not have the sense of differential diagnosis, and is not careful in asking medical history and physical examination. 2.Patients with right lower abdominal pain accompanied by anemia Anemia is one of the important clinical manifestations of cecum cancer. Cecum tumor is a chronic growth process, and the tumor will break and bleed repeatedly in the process of growth, resulting in chronic blood loss, which leads to anemia, and at this time, there may be no other typical symptoms, and maybe accompanied by fatigue, weight loss and other manifestations caused by anemia. Therefore, for a patient with lower right abdominal pain, in the routine blood test, found to have decreased hematocrit and anemia, need to attract the attention of doctors, need to further targeted history, physical examination and auxiliary examination. What tests can be done to exclude cecum cancer? For a patient with right lower abdominal pain to investigate cecum cancer, it is necessary to do the following tests: blood routine (to see whether there is anemia, etc.), tumor markers (whether CEA, etc., is elevated), abdominal and pelvic enhancement CT (fast booking, non-invasive examination, which can find the larger volume of cecum tumors or ureteral stones, gynecological diseases, etc.), fiberoptic colonoscopy (the gold standard for diagnosis of colon cancer but relatively slow booking, which can not find intestinal tract), and fiberoptic colonoscopy (relatively slow booking, which cannot find intestinal tract cancer). (relatively slow, cannot detect lesions outside the intestinal tract). To sum up, for a patient with right lower abdominal pain, doctors need to consider thoroughly and make differential diagnosis, especially for middle-aged and elderly patients with right lower abdominal pain over 45 years old, family history of tumor or history of other tumors, accompanied by fatigue or anemia, need to be alert to the possibility of cecum, the patient needs to go to the hospital in a timely manner, and the doctor needs to pay attention to give the relevant examination.