Audrey Hepburn Appendix Cancer
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By Jocelyn Selim

The Fairest of All

Audrey Hepburn died of appendix cancer at 63, leaving behind a legacy of style and good works

By Jocelyn Selim



“The impact of the rarity of these cancers can’t be underestimated,” says Paul F. Mansfield, a surgical oncologist at M. D. Anderson Cancer Center in Houston. “Because there are so few cases, it’s much more difficult to extrapolate meaningful statistics about survival. And [looking back] over a long period of time, it becomes even more difficult, because in the past many of these have been lumped into the studies with colorectal cancers. So not only are there not neat official data on survival and treatment by stage—the way there are for more common cancers—there aren’t really any clinical studies, and there is very little funding for research.”

Appendix cancer’s rarity means that those who are diagnosed with it are often left with little of the support that other cancer patients rely on. Carolyn Langlie-Lesnik, a nurse who started an advocacy group and website for appendix cancer, tells how frightening her own diagnosis was eight years ago. “They basically said, ‘We don’t really know what this is or where to refer you, but the prognosis is really bad,’ and sent me home to die,” she says. After finding one of the dozen or so doctors experienced in these cancers, Langlie-Lesnik is alive today and helping others in similar situations find information, support and appropriate medical care. “Cancer is frightening enough without it being a kind of cancer no one seems to know anything about,” she says.

By all accounts, websites like Langlie-Lesnik’s have been a major development in getting appendix cancer patients the help they need. But when Hepburn was diagnosed 17 years ago, the internet was a slow prototype version of today’s information superhighway. “I would spend all night making calls to doctors and reading texts, anything I could find trying to learn about this, and then wake up and look bright for visiting hours,” says Ferrer. “It was desperate. I looked at everything from shark cartilage, to alternative therapies in Mexico, to drastic surgeries suggested by a doctor in Sweden.”

To further complicate matters, appendix adenocarcinomas can vary greatly from patient to patient. “They present with different degrees of aggressiveness and in a variety of different forms,” says Levine. “Some patients will have tumors with a few cells and a lot of mucin production, so the abdomen is full of this Jell-O-like material, while others will have more solid-appearing tumors that behave more like typical colon cancers. Some you can scrape off like rubber cement; others you have to [remove] the colon to get out.”

And the tumor’s aggressiveness can affect survival. “Some of the tumors are very slow-growing, so that the patient can survive for years with minimal treatment,” says Martin Goodman, a surgical oncologist at Tufts Medical Center in Boston, “while others have faster growing [cancers] and may only live a few months after diagnosis.”

Unlike colon cancers, appendix cancers very rarely spread through the blood or lymph system, he says. “We’re not sure why this happens at a molecular level, but we do know that because the appendix is so narrow it tends to rupture very early on, often without the patient knowing,” Goodman says. “So cancer cells disseminate inside the abdomen instead of through the blood or lymph.”



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