John Paul Shen, MD | Conquer Cancer, the ASCO Foundation

Of the approximately 78 organs in the human body, there are a handful that scientists have ultimately deemed unnecessary for survival. Of these, few are more problematic—or confounding—than the appendix.  

Even today—more than 150 years after it was first deemed unnecessary by Charles Darwin—its exact purpose and function remain a subject of debate. Yet this relatively small organ (frequently described as looking like a worm) can produce potentially fatal illnesses, including cancer. And much like the organ itself, appendix cancer remains relatively under-explored, and, as a result, still lacks an agreed-upon standard of care and FDA-approved treatment.  

It’s a particularly concerning reality at a time when appendiceal cancers are on the rise. In June 2025, one study in the Annals of Internal Medicine¹ reported tripling and quadrupling rates of appendix cancer among Generation X (those born between 1965 and 1980, approximately) and millennials (between 1981 and 1996), respectively. 

It’s also a reality that gastrointestinal oncologist John Paul Shen, MD, hopes to change.  

Based at the University of Texas MD Anderson Cancer Center, Dr. Shen is a two-time recipient of grants from Conquer Cancer®, the ASCO Foundation. Much of his research focuses on developing chemotherapy designed specifically to treat appendix cancer. In this interview, Dr. Shen talks about the challenges of pursuing research and treatments for rare and under-investigated cancers and the impact of Conquer Cancer funding on his career. 

Conquer Cancer: We know that finding funding is always difficult, but it can be even more so when you’re studying something so incredibly uncommon or that people don’t fully understand. What have you found to be some of the biggest challenges when it comes to studying appendix cancer?  

Dr. Shen: There are definitely challenges in studying rare cancers, and funding is part of it. There’s not a huge financial incentive from an industry standpoint because the market is small. Logistically, it can also be challenging because you might not have enough patients to enroll in your clinical trial or enough banked samples to analyze.

Dr. Shen: There are definitely times when researching one cancer can make an impact on multiple other types. We see this a lot in rare tumors. In the long term, we want to develop drugs specifically for appendix cancer. But, in the short term, we have to repurpose drugs designed for other tumor types because we know there’s just not that many people out there specifically trying to develop drugs for appendix cancer. What we do know is that there are only so many pathways that allow tumors to develop, which means drugs developed for one cancer might also work for another. So, this idea of repurposing is really powerful. But to do that effectively you really have to understand at a deeper level what is driving each individual cancer. 

Conquer Cancer: What kind of impact is the current funding landscape having on our ability to gain that understanding? 

Dr. Shen: It can take 20 years to “make” a physician-scientist. You have four years of medical school and then generally six of residency and fellowship. And then, on top of that, you have to actually learn how to be a scientist. When we don’t have funding for junior scientists now, the pipeline stops, and in 10 years we might not have people to replace those who are retiring or leaving the field. There isn’t a tap we can just turn back on to generate more scientific investigators. If you don’t support people early in their careers, they’re not going to develop into senior investigators, and that has an impact for patients. When you shut down the pipeline of scientists, you aren’t going to have new ideas and innovation, which ultimately means fewer new therapies for patients.  

Conquer Cancer: As a physician-scientist studying a rare cancer in such a difficult funding landscape, what’s one of the things that most worries you? What keeps you up at night? 

Dr. Shen: What keeps me up at night is just knowing how far we have to go for our patients. I treat a rare cancer that still doesn’t have a single FDA-approved drug, and often I don’t have a clinical trial to offer them. And I see people my age and younger who are dying of this disease every week. It’s why I do this. But it’s also what keeps me up at night. 

Conquer Cancer: What gives you hope for patients in the future?  

Dr. Shen: What gives me hope is seeing the resources we have now. Of course, we still have a long way to go, and there are still a lot of mysteries. But we’ve come so far even during my career—which has been about 20 years.  

Our ability to understand how tumors interact with the immune system will be transformative and allow us to come up with better treatments in the future. It can never happen fast enough for our current patients, but I’m still very hopeful that in 10 years, our landscape will be different. 

Conquer Cancer: What do you think a world where cancer has been conquered might actually look like?  

Dr. Shen: To me, conquering cancer means we have effective therapies for every patient. Cancer isn’t just one disease. And even within a single cancer type, one person’s colon cancer might be very different from another’s. It’s why we can’t give every patient the same drugs. But by conquering cancer, we’ll be able to understand each patient’s cancer, what’s causing it, and, as a result, how to treat it for that specific patient.  

Conquer Cancer: What would you say to an early-career investigator who’s currently struggling to find funding and perhaps getting discouraged or on the verge of giving up?

Dr. Shen: Finding funding in the early years of becoming a physician-scientist is challenging. You don’t have a lot of experience, and funds often go to more seasoned investigators. It can be very easy to get discouraged. But you have to remember that even the best scientists see their grants rejected. Nobel Prize winners have had grants rejected.  

You can’t dwell on defeats. You have to get back up and try again. The funding I’ve received from Conquer Cancer—first my Young Investigator Award and then my Career Development Award—has been amazingly helpful to my career. Conquer Cancer is really focused on that transition point that early-career researchers experience, when you’re just starting out and still vulnerable. Filling that void was really instrumental in my career. I don’t think I would be where I am now without that funding. 

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