Flashcards in Cancer Deck (9)
The incidence of CA increases with age up to ____ at which point it levels off.
What is the single biggest risk factor in the development of cancer?
60% of all CAs occur in those age 65 or older, T/F?
70% of all cancer deaths occur in those age 65 or older, T/F?
75 years old
Aging is the biggest risk factor
The biological behavior of the cancer changes with aging. What are some ways this occurs?
Blunted T cell activity and decreased NK cell activity
CA growth factors differ with age
-IL-6 increases with age
-Angiogenesis is altered
-chronic inflammation may promote tumor growth
What are some cancers that have a more indolent course in the elderly? (3)
More aggressive? (3)
Most common Cancers overall (4)
-some non-small cell lung adenocarcinomas
-estrogen/progesterone responsive positive breast CA
-Large cell non-hodgkin lymphoma
-celomic ovarian cancer
-lung/bronchus (This is the most common CA in geriatric pts ages 55-74)
-colon and rectum
Why are cancer death rates so high in elderly patients?
-more aggressive tumors
-more likely to have advanced disease at presentation
-age bias: under treatment, reduced participation in CA screening programs, under-representation in clinical trails, health care access issues
Treatment of CA
-surgery: what are the risk factors for the elderly
-radiation: what are the risks for the elderly
-chemo: downfalls to this tx in the elderly
Surgical risk factors for elderly
-emergency surgery or prolonged surgery
-co-existing disease (especially CVD, COPD, DM)
-poor nutritional status (wound healing, infections)
-poor functional status
-overall very safe and convenient
-major risks: mucositis (dehydration, malnourishment, sepsis) and radiation pneumonitis
-more SE than surgery or RT
-increased susceptibility to toxicity
-dose adjustments for reduced GFR or anemia leads to decreased treatment effectiveness
-major risks: myelosuppression (anemia, neutropenia, thrombocytopenia), mucositis (dehydration, malnutrition, sepsis), drug specific toxicities
What is Ca tx based on?
The TUMOR CHARACTERISTICS, not the age of the patient
*include risk of tc vs benefit and effects on quality vs quantity of life
What is physiologic age?
good estimate of quality of life, life expectancy, and ability to tolerate CA tx
components include: co-morbidities, functional status (ADLs, IALDs), nutritional status, geriatric syndromes (dementia, delirium, depression, falls, spontaneous fx, neglect, abuse, incontinence, nutritional problems)
How do we treat CA if the elderly pt is frail?
If frail, palliative tx
If not, llife prolonging tx
intermediate, individualize tx
*treatment is not always warranted