Oncology in older people

Malignant neoplasms constitute a group of diseases of great importance in the elderly population. With age, the incidence of most tumors increases. In Spain, 65% of people who die from cancer are patients over 70 years of age. Above that age, the incidence has increased by 17%, while in patients under 65 years of age it has decreased by 23%.

Age is a clear risk factor for cancer, as confirmed by epidemiological studies. It has been postulated that age could modify the biological behavior of cancer, based on in vitro experiences. This has not been verified in clinical practice and it has not been shown that neoplasms that develop in the elderly are less aggressive than those suffered by younger patients. Some of the factors that favor the development of tumors in old age are described below.

Carcinogenesis

Throughout life, one is in permanent contact with endogenous and exogenous factors that favor the development of cancer. These agents may accumulate over the years until they have a sufficient effect to induce the development of cancer. The incidence of many neoplasms such as breast cancer, prostate cancer or non-melanoma skin cancer increases exponentially with age. It has been observed that the molecular changes in DNA that occur in the early stages of carcinogenesis are the same molecular changes that have been associated with aging, so that 'aged' tissues would be more susceptible to the effects of the latter stages of carcinogenesis and therefore tumor development.

Metabolism

Physiological changes occur in old age, such as a decrease in kidney function and, to a lesser extent, in the liver, which implies less metabolism and excretion of carcinogens. The atrophy of the digestive mucosa, the decrease in gastric secretions and the tendency to decrease the intestinal movements make them more vulnerable to certain carcinogens present in the diet. There are many times dietary deficiencies that can favor the appearance of neoplasms.

Immune system

The function of the immune system declines with age. The older the age, the lower the number of T lymphocytes and, furthermore, the greater the susceptibility to infection. These modifications have been linked to the development of cancer.

Free radicals

Aging is mainly due to the damage of cells produced continuously by free radicals (oxidant particles) from different reactions in which oxygen is the main source. These lesions can cause chromosome breaks and mutations that facilitate the development of cancer.

Problems often exist when a histological and extension diagnosis is made in an elderly patient with cancer. Unfortunately, not only the elderly population, but also a large part of their relatives, and even the health personnel who treat them, retain the vision of cancer as an intractable and irremediably fatal disease. This makes the elderly person or their relatives, by virtue of an age prejudice, reject the performance of diagnostic biopsies and other examinations aimed at staging the disease. The therapeutic approach to an elderly patient with cancer will vary depending on the type of neoplasm, as is evident, and depending on the functional status and comorbidity. The existence of frailty contraindicates the performance of active treatments in most cases and in these situations, palliative treatment should be prioritized. Age by itself should not be a contraindication when proposing any cancer treatment.