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Cancer is one of the five most common causes of death in elderly Indians. Age is the strongest risk factor in the development of cancer. Though the relationship between cancer and ageing is unclear, the increased risk of cancer in old age is possibly due to: poor cellular repair mechanisms, activation of genes that stimulate cancer and suppression of genes that prevent cancer, decline in surveillance against cancer and life time exposure to carcinogens.
There are certain cancers which mostly occur after the age of 50 years. These include head and neck cancer and cancers of the female genital tract, upper and lower gastrointestinal tract, pancreas and prostate. Half of the breast and haematological malignancies are encountered after the age of 60 years
There is evidence to suggest that though the progression of cancer may be different in old age, its diagnosis in older patients is invariably accomplished at an advanced stage of the disease. The delay in diagnosis is due to:
Principles of management
Elderly patients are usually under-treated due to a widely prevalent misconception that elderly patients are less eligible for surgery and they tolerate radiotherapy and chemotherapy poorly. Scientific data on very old patients with cancer is scant as most studies tend to exclude this group of patients. While deciding on the treatment the life expectancy of older patients should not be underestimated. The older patient with cancer should be approached with the same principles of therapy as patients of any other age-group.
Age does not adversely influence the efficacy of treatment nor does it predispose to higher toxicity. The state of physical fitness and mental health should be the consideration rather than the chronological age and all options of therapy should be considered.
Palliative care is defined as active care of pain, distressing symptoms and other psychological issues of an incurable or terminal cancer patient. Older cancer patients are more likely to require palliative care. The most important action in palliative care is pain relief with even round- the-clock oral opium or its derivatives. Symptomatic care for all symptoms should be attempted in the right earnest.
Prevention of cancer and screening
Measures that include lifestyle changes, diet and exercise are probably of lesser value in the primary prevention of cancer in old age.
On the other hand, secondary prevention by early detection by screening is of great
practical value. Cancer is a hundred times more common in males aged 75 years than
in those aged 25 years, so screening is most cost-effective in old age.
However, because of several social and behavioural reasons older individuals are usually not very keen on cancer screening programmes.