open access
Colon cancer in the older population
Affiliations- Department of General, Gastrointestinal, Oncologic Surgery and Transplantology, I Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
open access
Abstract
Fifty percent of new diagnoses of colorectal cancer are made in patients aged over 70 years, and 25% are aged 80 years or over. Older patients tend to have locally advanced colon cancer, with negative lymph nodes and without distant metastasis. Frequently the colon cancer is located on the right side. There is still a belief that older patients can not manage curative treatment regimens. This is based on the results of older studies showing higher rates of short-term morbidity and mortality. At present, we are observing significant improvements in the outcomes of older patients with colon cancer in high volume centers. This could be due to better preoperative staging, increased use of minimally invasive techniques, better anesthesiology and perioperative care, awareness of complications, expertise and high-volume care. A standardized pre-operative diagnostic approach, individualized surgical technique selection and tailored postoperative care are essential for the successful treatment of older patients. Furthermore, counseling and shared decision-making should be based on modern insights in surgical outcomes rather than outdated data.
Abstract
Fifty percent of new diagnoses of colorectal cancer are made in patients aged over 70 years, and 25% are aged 80 years or over. Older patients tend to have locally advanced colon cancer, with negative lymph nodes and without distant metastasis. Frequently the colon cancer is located on the right side. There is still a belief that older patients can not manage curative treatment regimens. This is based on the results of older studies showing higher rates of short-term morbidity and mortality. At present, we are observing significant improvements in the outcomes of older patients with colon cancer in high volume centers. This could be due to better preoperative staging, increased use of minimally invasive techniques, better anesthesiology and perioperative care, awareness of complications, expertise and high-volume care. A standardized pre-operative diagnostic approach, individualized surgical technique selection and tailored postoperative care are essential for the successful treatment of older patients. Furthermore, counseling and shared decision-making should be based on modern insights in surgical outcomes rather than outdated data.
Keywords
older oncologic patients; elderly; colon cancer; frailty
About this articleTitle
Colon cancer in the older population
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
119-121
Published online
2021-04-06
Page views
592
Article views/downloads
460
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2021;71(2):119-121.
Keywords
older oncologic patients
elderly
colon cancer
frailty
Authors
Jakub Kenig
References (18)- Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010; 116(3): 544–573.
- Balducci L. Studying cancer treatment in the elderly patient population. Cancer Control. 2014; 21(3): 215–220.
- Siegel R, Naishadham D, Jemal A, et al. Cancer statistics, 2012. CA Cancer J Clin. 2012; 62(1): 10–29.
- Kotake K, Asano M, Ozawa H, et al. Tumour characteristics, treatment patterns and survival of patients aged 80 years or older with colorectal cancer. Colorectal Dis. 2015; 17(3): 205–215.
- Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017; 67(3): 177–193.
- Xue DD, Cheng Y, Wu M, et al. Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis. Clin Interv Aging. 2018; 13: 723–736.
- Fariña-Castro R, Roque-Castellano C, Marchena-Gómez J, et al. Five-year survival after surgery in nonagenarian patients. Geriatr Gerontol Int. 2017; 17(12): 2389–2395.
- Simmonds PD, Best L, George S, et al. Surgery for colorectal cancer in elderly patients: a systematic review. The Lancet. 2000; 356(9234): 968–974.
- Grodzicki T, Kenig J. Problemy okołooperacyjne u osób w wieku podeszłym. PZWL Wydawnictwo Lekarskie , Warszawa 2018.
- Chong RC, Ong MW, Tan KY. Managing elderly with colorectal cancer. J Gastrointest Oncol. 2019; 10(6): 1266–1273.
- Aquina CT, Mohile SG, Tejani MA, et al. The impact of age on complications, survival, and cause of death following colon cancer surgery. Br J Cancer. 2017; 116(3): 389–397.
- Takahashi Y, Mizuno KI, Takahashi K, et al. Long-term outcomes of colorectal endoscopic submucosal dissection in elderly patients. Int J Colorectal Dis. 2017; 32(4): 567–573.
- Takahashi Y, Mizuno KI, Takahashi K, et al. Long-term outcomes of colorectal endoscopic submucosal dissection in elderly patients. Int J Colorectal Dis. 2017; 32(4): 567–573.
- Ngu JCY, Kuo LJ, Teo NZ. Minimally invasive surgery in the geriatric patient with colon cancer. J Gastrointest Oncol. 2020; 11(3): 540–544.
- Cone MM, Herzig DO, Diggs BS, et al. Dramatic decreases in mortality from laparoscopic colon resections based on data from the Nationwide Inpatient Sample. Arch Surg. 2011; 146(5): 594–599.
- Webb S, Rubinfeld I, Velanovich V, et al. Using National Surgical Quality Improvement Program (NSQIP) data for risk adjustment to compare Clavien 4 and 5 complications in open and laparoscopic colectomy. Surg Endosc. 2012; 26(3): 732–737.
- Stefanou AJ, Reickert CA, Velanovich V, et al. Laparoscopic colectomy significantly decreases length of stay compared with open operation. Surg Endosc. 2012; 26(1): 144–148.
- Ketelaers SHJ, Fahim M, Rutten HJT, et al. When and how should surgery be performed in senior colorectal cancer patients? Eur J Surg Oncol. 2020; 46(3): 326–332.