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Flashcards in Cancer Deck (9)
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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
-Prostate CA

-Large cell non-hodgkin lymphoma
-celomic ovarian cancer

Most common
-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?

-organ vulnerability
-co-existing illnesses
-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


Cancer in the elderly
-supportive care examples (things to treat their SE)

-nutritional support: dietary counseling/supplements, G/J tube
-anemia: epoetin alpha
-Neutropenia: epogen or leukine
-Thrombocytopenia: platelet infusion
-Mucositis: supportive care, hydration, magic mouth wash
-N/V: serotonin receptor antagonists (ondansetron)
-Pain: often undertreated in the elderly*
--pt reluctance to report pain
--atypical presentation
--providers fear older pts wont tolerate opiates
--communication problems