Questions for Specialists

It is highly recommend that appendix cancer and PMP patients seek out a specialist who deals with these conditions on a regular basis. Here are some important questions to ask your specialists.

  1. How many cytoreductive surgeries have you performed (studies have shown that the peak of the learning curve for CRS/HIPEC is 130140180, or even over 200 procedures)?
  2. What percentage of these CRS surgeries performed were done specifically to treat PMP/Appendix Cancer?
  3. How many years of experience do you have performing these surgeries?
  4. In approximately what percentage of surgeries do you use hyperthermic intraperitoneal chemotherapy (HIPEC)?
  5. What chemo agents do you use for HIPEC, and why?
  6. Do you perform HIPEC using the open or closed technique? Why do you believe this method is superior?
  7. Do you perform HIPEC only during surgery, or do you continue early post-operative intraperitoneal chemotherapy (EPIC) for some days after surgery?
  8. How many days do you estimate for a post-surgical hospital stay? Do you have a set timeframe, or is it based solely on post-op milestones? What are those milestones?
  9. What is a typical operating time for cytoreductive surgery?
  10. What are your current outcome statistics for disease-free survival for LAMN (DPAM), HAMN (PMCA), PMCA-I (intermediate), appendiceal adenocarcinoma (with and without signet ring cells), and goblet cell carcinoid tumors?
  11. What is your philosophy about using systemic chemo before and/or after surgery?
  12. What chemotherapy agents (including systemic “cocktails”) do you use/recommend and why?
  13. Are there any special therapies you provide? If any, can you provide research on which they are based? Are you pursuing this therapy in a research context?
  14. What is your average (or typical) patient age and gender?
  15. Do you recommend chemo sensitivity assays? Why or why not? If yes, what lab(s) do you use?
  16. Do you recommend molecular assays of tumor samples? Why or why not? If yes, what lab(s) do you use?
  17. What is the typical waiting time for a patient to be scheduled for surgery?
  18. Please describe your surgical selection criteria (for LAMN (DPAM), HAMN (PMCA), PMCA-I (intermediate), appendiceal adenocarcinoma [with and without signet ring cells], and goblet cell carcinoid tumors).
  19. Do you recommend molecular and genetic testing of tumor tissue or circulating tumor DNA testing to identify targetable mutations for immunotherapy or other precision medicine therapies?