Appendix cancer

Addressing unmet needs in rare cancers

H&E stained section of pseudomyxoma peritonei (PMP)

Rare cancers are cancers which have an incidence of fewer than 6 out of 100,000 people each year. Consequently, they comprise an area that lacks research and, as a result, patient prognosis is often poor and development of new treatments lagging. In order to research rare cancer, international collaborations are required to share learnings and address unmet clinical needs.

Appendix cancer is a rare and often aggressive cancer that forms from the cells lining the appendix. To date, this cancer has been under-researched and is poorly understood as a result. Our current biological understanding of appendix cancer lags behind that of other malignancies and there has not been a change in clinical practice for over 25 years.

Dr Madeleine Strach is a Medical Oncologist and European Society for Medical Oncology (ESMO) Translational Research Fellow from Sydney, Australia, who is working within The Christie Colorectal and Peritoneal Oncology Centre (CPOC) research group. Her research on appendix cancer hopes to provide crucial biological insights into a relatively unexplored disease, presenting opportunities to identify new therapies and improve patient outcomes.

The most exciting part of cancer research now is that we've got the tools to be able lay these strong scientific foundations for rational future cancer treatments.

Madeleine Strach

Medical Oncologist and European Society for Medical Oncology (ESMO) Translational Research Fellow from Sydney, Australia


Madeleine completed her medical degree at The University of Melbourne, Australia and trained as a specialist Medical Oncologist though the Royal Australasian College of Physicians. In 2018, she moved to Sydney to work as a Phase One Clinical Trial Fellow and subsequently as a consultant at the Chris O’Brien Lifehouse and Royal Prince Alfred Hospital. During her time in Sydney, she became interested in the unmet clinical needs of rare cancers and wanted to better understand the translational ‘bench to bedside’ aspects of cancer research.

In 2020, Madeleine commenced her PhD in appendix cancer. To explore additional translational research experience, Madeleine’s supervisors in Australia began discussions with Mr Omer Aziz, . Madeleine applied successfully for a prestigious ESMO on appendix cancer, with the aim of strengthening the collaboration between these two institutions.

Madeleine Strach headshot
I hope that we can continue with this collaboration many years into the future and strive to improve outcomes for patients with appendix cancer.

Madeleine Strach


Madeleine now conducts her research with the CPOC research group here in Manchester. Her research focus is on understanding the genetic profile of appendix cancer with the hope of finding targets of novel treatments to ultimately improve patient outcomes.

Specifically, she will be evaluating the role of peri-operative chemotherapy, establishing predictors of clinical outcomes in patients with appendix cancer who undergo cytoreductive surgery.

Additionally, she will be focusing on comparing patient tumour genomics and clinical outcomes and characterising the tumour microenvironment of this cancer using novel ‘multi-omics’ approaches. Exploring the tumour microenvironment provides a greater understanding of tumour characteristics. Ultimately, this should help in finding novel treatments to improve patient outcomes.

Scale of the need

As a rare cancer, appendix cancer requires better identification of prognostic and predictive biomarkers to better understand how we can select patients for existing therapies and improve treatments. This Manchester-Sydney collaboration hopes to address these unmet clinical needs.

“People who have rare cancers are often neglected in terms of research, and when you combine all the patients with rare cancers together into one group, they’re actually not so rare.”


Clinically, I have met a lot of patients who have rare cancers and need better treatments, but unfortunately their cancers are lagging behind in the research world. Addressing these research disparities is essential to improving treatments.

Madeleine Strach

Madeleine hopes that through this collaboration here in Manchester, she can share her experience with her home institute to address unmet needs in rare cancers in Australia.

Why Manchester

Madeleine was drawn to Manchester by the great international profile of the MCRC and her professional networks with researchers here. The Christie is an OECI-accredited Comprehensive Cancer Centre and has certain dedicated services attached to it such as the peritonectomy unit that lend themselves to international collaborations.

“For me, Manchester is an ideal place to be for appendix cancer research and The Christie has an excellent international reputation for cancer research,” Madeleine said.

“The best thing about translational research is the multidisciplinary team of scientists and clinicians working together, and the Manchester team have been incredibly welcoming. I’m pleased to contribute to their ongoing work; I’m excited for this significant chapter in my research career,” she continued

The CPOC treats patients from the majority of Northern England and Wales, meaning there is a vast potential for research into these rare cancers.

Advice to those wanting to do a PhD

“Do a PhD because you want to do it, don’t just do it because you think it will help progress your career. Make sure that the topic is something that you are passionate about. It’s hard work, but worth it.”

Post PhD aspirations

Madeleine’s background as a Medical Oncologist in early clinical trials has seen her interests evolve in ‘bench to bedside’ research and she is keen to continue work in understanding the preclinical aspects of cancers. Looking forward, she hopes to continue postdoctoral translational research work to improve outcomes for patients with rare cancers.

LAMNs and Pseudomyxoma peritonei

Discover the CRUK Accelerator project to build a living biobank to find new treatments for rare appendix tumours.


Navigate back to the News page