Cancer in Older Adults: Understanding the Symptoms and Treatment

Marking 4 February as World Cancer Day Dr Suresh Advani takes us through the nitty-gritty of cancer with some valuable insights

Ageing is a biological process that everyone goes through. It is defined as irreversible structural and functional change which occurs at molecular level affecting all organs and it becomes apparent with advanced age and has chronological perspectives. Word Health Organization defines old age as the period of life, which starts from 65 years of age. 

Due to the advancements in medicines, the life expectancy has doubled to 80 years and is continuously increasing to 90 plus, post 19th century. Therefore, we are having prolonged exposure to carcinogenic agents, cumulative DNA damage, Tumour Suppressor Gene Defects, Oncogenic Activation, and attenuation of immunity, which have been held responsible for higher incidence of Cancer in older individuals. Since carcinogenesis is a very long process, emergence of Cancer in advanced ages is possible. It is seen that 60 per cent of cancers originate from etiological factors that are related to ageing. During the ageing process, the biological processes are impacted, due to which there is deterioration of proteins and DNA in cells. Many of these damaged cells result in senescence, wherein there are not growing, but they are metabolically active and capable of causing problems to a person’s health and can result in a person getting affected with the disease. 

‘Senescence’ is known to be a mechanism which protects one’s body against Cancer, and it helps in stopping the dividing of would-be Cancer cells. But this senescence mechanism sometimes fails and does not work, due to which it results in accumulating Cancer-causing cells to mutate and produce the cell growth, which is uncontrollable. Due to this microenvironment, it causes the formation of the Cancer-cells and spread of Cancer in the body. The longer a person lives, the more errors the genes are bound to make, and over time these mutations can lead to Cancer with Oncogenic Driver Mutations.

Beyond these intrinsic cellular changes, the body’s immune system too weakens, it becomes resilient, and is less efficient in detecting and fighting infection & diseases, including Cancer. Hence, care and treatment for older patients with Cancer should be personalized, and with comprehensive geriatric evaluation, risks, and benefits of the available treatment, alternatives should be properly determined. 

Early diagnosis, treatment, and screening programs are known to reduce Cancer burden and it has also helped in decreasing incidence rates of Cancer in the elderly. Geriatric oncology presents unique challenges specific to age, including competing health and socioeconomic factors. Also, age-related changes in tumour biology influences screening, diagnosis, treatment, and outcome. Many other biological aspects of aging are also under investigation, which includes the dysfunction and shortening of Telomeres, which are the specialized DNA sequences at the ends of chromosomes. Telomeres serve as molecular markers of aging and their dysfunction or shortening has been linked to the transformation of normal cells into Cancer cells. Studies of genetic diseases are also helping to improve our understanding of the relationship between aging and Cancer.

Geriatric Cancer is known to exhibit slower growth as this group already has a body, which has a slower rate of cell development than those of young individuals. However, some elderly patients with tumour have worse prognosis because of delayed diagnosis. The most frequent psychological reactions to Cancer are Anxiety and Depression, which is seen in this age group in addition to various comorbidities limiting the organ functional reserves. For older adults undergoing treatment for Cancer, a health measurement tool called a Geriatric Assessment can be an important part of treatment planning. Older patients whose care is guided by geriatric assessment are much less likely to experience serious side effects. Treating Cancer of elderly patients, who often have other health conditions and comorbidities, may limit the use of specific therapies. Doctors may be reluctant to give these geriatric patients potentially beneficial therapies because there isn’t enough evidence to show that the standard dosage can be safely administered, or whether the treatment that is given is likely to improve survival of this age group. Cancer treatment protocols and drugs doses are adjusted accordingly considering the meticulous geriatric assessment.

An unexplained weight loss, fever of unknown origin, backache, headache or seizures or any unusual symptom may mimic Cancer. Awareness towards Cancer would allow us to diagnose in an early stage and possible cure can be achieved. High or rising Serum PSA should be cause of concern and one should get evaluated for ruling out Prostate Cancer. Seven signs and symptoms of Cancer (CAUTION) are well known and should be considered red flags, they as follows:

1.     Change in bowel or bladder habits
2.     A sore that does not heal
3.     Unusual bleeding or discharge
4.     Thickening or lump in breast or elsewhere
5.     Indigestion or difficulty in swallowing
6.     Obvious change in wart or mole
7.     Nagging cough or hoarseness

General opinion in preventing Cancer involves following a health life by taking measures to improve nutrition, physical activity, and preventing Obesity, among others. The World Cancer Research Foundation assessed that one-third of the Cancer cases in developed countries are overweight or obese, and this is due to lack of physical activity or sufficient nutrition. Thus, it is important to pay attention to a few basic choices of life regarding what you eat, drink and how much you move, as it can make a real difference in your risk of getting Cancer. Cancer can be avoided by lifestyle modifications which are as follows:

1.   Maintain a healthy body weight
2.   Restrict intake of processed meat or red meat
3.   Daily intake of vegetables and fruits
4.   Restrict alcohol intake, best is to stop
5.   Avoidance of using tobacco products
6.   Regular engagement in physical activities (walk for 5 km/day)

Hence, it is crucial to undertake regular self-exams and screenings for cancers, especially Cancer of the skin, Colon, Cervix and Breast. This can help in early diagnosis, which can result in early treatment that is most likely to succeed.

Authored by Dr Suresh Advani, Senior Consultant – Medical Oncology, SL Raheja Hospital, Mahim – A Fortis Associate

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