Treatment considerations for high-grade appendiceal adenocarcinoma

This chapter focuses on the treatment of high-grade appendiceal neoplasms with specific emphasis on how treatment differs from that of low-grade tumors. It discusses high-grade tumors as those including moderate and poorly differentiated appendiceal adenocarcinoma as that is what is most consistent in the literature. Most treatment decisions are made only after the appendix has been resected and a formal pathologic diagnosis rendered. Though the molecular characteristics of appendiceal adenocarcinoma remain to be fully elucidated, there are some data to suggest that such characterization may be helpful in guiding treatment. The decision to proceed with definitive therapies such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) requires careful consideration and thoughtful patient selection due to the high morbidity of the procedure and the significant early, negative impact on the patients’ quality of life. Patients with high-grade tumors should be evaluated for potential surgical treatment in the form of CRS and HIPEC.