Management of Colorectal Cancer in Older Adults
A pooled analysis of the safety and efficacy of oxaliplatin in elderly patients with CRC was reported in [ 72 ]. They identified that adding oxaliplatin onto a 5-FU-based regimen exhibited some improvement of PFS, although not statistically significant. Aging is one of the factors we need to take into account in determining a comprehensive strategy of CRC treatment. Several studies reported that aging itself was an independent prognostic factor in these patients.
To date, there is not enough evidence to develop a standardized treatment of elderly patients with CRC. A personalized strategy is required, considering each patient's comorbidities, performance status, and life styles. The authors declare that there are no conflicts of interest regarding this paper. National Center for Biotechnology Information , U. Journal List Biomed Res Int v.
Biomed Res Int. Published online Mar Author information Article notes Copyright and License information Disclaimer. Corresponding author. Kenji Kawada: pj. Received Aug 24; Accepted Feb This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract Colorectal cancer CRC is one of the leading causes of cancer-related deaths worldwide. Introduction Expansion of the worldwide population and elevation of life expectancy have increased the number of elderly individuals, resulting in aging of the population. Clinical Characteristics One of the most prominent clinical characteristics of elderly, compared to younger, patients with CRC is their higher frequency of right-sided colon cancer. Open in a separate window. Figure 1. Figure 2. Pathological Characteristics and Genetic Background Mucinous carcinoma and serrated adenocarcinoma are often found in elderly patients [ 19 , 20 ].
Figure 3. Endoscopic Resection Endoscopic resection is a minimally invasive approach for adenomas and early cancers. Table 1 Representative studies comparing laparoscopic colectomy and open surgery for elderly CRC patients. General Management of Chemotherapy Particular attention is required when planning chemotherapy for elderly cancer patients, because of reductions in organ function and preexisting comorbidities. Conclusion Aging is one of the factors we need to take into account in determining a comprehensive strategy of CRC treatment.
Conflicts of Interest The authors declare that there are no conflicts of interest regarding this paper. References 1. Malvezzi M. European cancer mortality predictions for the year Annals of Oncology. Hori M. Japanese Journal of Clinical Oncology. Jemal A. Journal of the National Cancer Institute.
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Basic Information About Colorectal Cancer | CDC
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The serrated pathway of colorectal carcinogenesis. Current Colorectal Cancer Reports. Jass J. Emerging concepts in colorectal neoplasia. Leggett B. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Among the markers proposed, the length of telomeres as measured in circulating lymphocytes is one of the best documented and proved biological markers of ageing. Telomeres are highly repetitive DNA sequences situated at the ends of the chromosomes; for vertebrates, the sequence is TTAGGG which is repeated approximately times in humans.
During cell division, telomeres are truncated and shorten at cell division.
However, the enzyme, telomerase, is able to replenish telomere sequences but is not expressed in somatic cells. Telomere length works like a molecular clock reporting the actual remaining cell proliferation capacity. Shorter telomeres of circulating lymphocytes have been found in patients with cardiovascular diseases, COPD, dementia, osteoporosis and were associated with a higher mortality rate.
The association with frailty is less clear from the literature. Besides several other cytokines and chemokines associated with ageing, some hormonal blood levels show consistent decrease with age and have been found to be associated with frailty, as the growth hormone and its peripheral effector insulin-like growth factor 1 IGF-1 or somatomedin C, a peptide hormone secreted primarily by the liver, with anabolic effects on almost all tissues.
They found that telomere length and IGF-1 correlated more with calendar age, whereas interleukin 6 more reliably increased with clinical markers of frailty. Ageing induces changes in functional organ capacities that should be considered for the planning and dosing of therapies, for example, drug therapies. Age-related changes in organ functions may affect all pharmacokinetic and pharmacodynamic parameters.
For orally taken drugs, this starts with decreased production of saliva and gastric acid, gastric gland, anapepsia and decreased production of all digestive enzymes, and a decrease of perfusion of the gastrointestinal tract, all contributing to a high variability of gastrointestinal uptake of drugs. As the perfusion of the liver also decreases with age, the metabolism of drugs might be prolonged favouring increased toxicity.
Moreover, changes in body composition contribute to a smaller plasma volume, increasing the concentration of water-soluble drugs and decreasing the concentration of liposoluble drugs. Dosage of renally excreted drugs should be adjusted to the reduced renal function; this can easily be achieved by using web-based services.
The need to consider all resources, but also all impairments of elderly patients, and prior ranking the person's wishes and fears in decision-making for oncological therapy has become widely accepted.