Never Too Old To Fight Cancer
As the number of elderly patients with cancer soars, researchers explore how best to treat them
For my hale and hearty father-in-law, the first sign that something was wrong occurred at 88 years of age, when his ever reliable tennis serve kept landing astray. A series of medical tests soon revealed the worst: advanced, metastatic pancreatic cancer. Treatment might buy him a little time, his doctors told him, but that prospect did not outweigh his dread of spending his final days in a toxic and debilitating haze of chemotherapy. He quickly opted for hospice care and died with dignity less than two months later, surrounded by loved ones.
My own father learned he had bladder cancer at 91 and made a very different choice. He underwent the full trifecta of treatment: surgery to pare down a tumor that had already penetrated the bladder wall, plus seven weeks of chemotherapy and 35 radiation treatments to destroy lingering cancer cells. There were times when he regretted it, complaining of weakness and torpor, but 20 months after completing the clinical gauntlet, he is alive and going relatively strong, considering he is 93. His sister made a similar decision when faced with lymphoma at 88 she, too, is a survivorat 91.
SCIENTIFIC AMERICAN ONLINELearn about Arti Hurrias 11-question scoring tool at ScientificAmerican.com/dec2014/soh
This article was originally published with the title Never Too Old for Chemo in Scientific American 311, 6, 34-35
Prostate Cancer In The Elderly
The average age of prostate cancer patients is about 70 years. Roughly one-third of prostate cancer diagnoses are given to patients over the age of 75. Prostate cancer usually grows slowly, and approximately 90% of patients are alive five years after the diagnosis. According to studies, latent, asymptomatic prostate cancer occurs in even up to approximately 60% in men over the age of the 80. However, prostate cancer is the second most common cause of cancer mortality within the age group of over 75 years. If the cancer is confined to the prostate and has not spread more widely, extensive surgery or local radiation therapy will be considered as treatment. Surgical technology and the technical implementation of radiation therapy have evolved in such a way that the severe complications caused by them, such as urinary and bowel function related problems, have been reduced. Surgery requires the patient to be in better general condition than radiation therapy, and thus radiation therapy is often selected for treating elderly patients.
Clinical Data And Tumor Characteristics
The surgeon identifying the cases and constructing the database also collected data regarding date of diagnosis, menopausal status, height, weight, parity, laterality, tumor location, and distant metastases through medical records and the Swedish Cancer Registry. Information concerning tumor size, histological type, and ALNI was retrieved from histopathological examinations. Tumor type was classified using a modification of the World Health Organization classification as proposed by Linell et al. . ALNI was divided into positive, negative, or unknown if no axillary dissection had been performed.
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Cancer As A Cause Of Death
Cancer is the most common cause of death in the world and the second most common in Finland. In Finland, it remains more common to die from cardiovascular diseases, even though mortality caused by cardiovascular diseases is decreasing.
Every fourth death in Finland is caused by cancer. Compared with other Nordic countries, cancer causes relatively less mortality in Finland.
Lung cancer is the most common fatal cancer in men over 75 years of age. The second most common is prostate cancer and the third is pancreatic cancer. In women over 75 years of age pancreatic cancer is the most common fatal cancer, the second most common is lung cancer and the third is breast cancer.
Of skin cancers, particularly basal cell and squamous cell carcinomas often occur in the elderly, but they do not cause mortality.
A Guide To Breast Cancer In Older Adults
Breast cancer is the most common form of cancer found in elderly women. A woman has a one-in-eight chance of developing breast cancer over her lifetime, according to the National Cancer Institute. The older a woman is, the more likely it is she will be diagnosed with the disease. On average and across all races, there is about a 9 percent chance that a 60-year-old woman develops senior breast cancer over her next 20 years.
Nearly 275,000 new cases of breast cancer are diagnosed every year, with more than three million survivors of the disease living at any given time, according to the American Cancer Society. About half of the newly diagnosed breast cancer cases come from women over the age of 60, and another 20 percent come from women over 70 years old. At age 80, the chances of you developing breast cancer over the rest of your life begin to decrease, according to Harvard Medical School.
Unfortunately, women over 65 who are diagnosed with early onset breast cancer are more likely to pass away due to the disease. Women in that same age group are more likely to have the cancer recur, as well. More than 40,000 women die from breast cancer every year.
Its vital that womenand their loved onesknow the warning signs, causes, and different types of breast cancer, as well as how and when to get tested, and how it can be treated and prevented.
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Adenoid Cystic Carcinoma Of The Breast
Less than 1 in 100 breast cancers are adenoid cystic cancer. This type of cancer is also sometimes called a cribriform cancer. It is a cancer type that is more often diagnosed in the salivary glands, but some develop in the breast tissue.
It is generally seen in older people but has been seen in people as young as 25.
Adenoid cystic breast cancer tends to be slow growing. Doctors usually recommend surgery. Most women dont need to have the whole breast removed . Instead, your doctor will just remove the area of the cancer. This operation is called breast conserving surgery.
The cancer rarely spreads elsewhere in the body. So you don’t usually need to have your lymph nodes removed. The risk of this type of tumour coming back is low, so the outlook is good.
Searching For Clarity Among Conflicting Breast Cancer Screening Guidelines
In January, the U.S. Preventive Services Task Force released new recommendations on screening for breast cancer. These differed slightly from new recommendations by the American Cancer Society and from recommendations by the American College of Obstetricians andGynecologists last updated in 2011.
But even while the three sets of guidelines offer slight disagreements about whether, for example, a 40-year-old woman should begin annual screening mammograms, experts stress the recommendations have more in common than not.
ACOG aimed to reach a consensus at a conference it hosted in Washington, D.C., later in January, attended by representatives from the ACS, the USPSTF, the National Comprehensive
Cancer Network, the American College of Radiology, and other groups, including patient advocate organizations.
We saw this as a good next step, said Dr. Mark DeFrancesco, President of ACOG. There are different ways of interpreting evidence. We want to have stakeholders around the same table and try to find agreement.
After the conference, an ACOG spokeswoman said the groups will continue to address screening recommendations but did not announce any agreement.
Dr. Bibbins-Domingo said that the USPSTF is an independent panel that cannot sign any consensus documents. But she said that most groups agree that mammography is a valuable tool to reduce deaths from breast cancer and that those benefits increase with age.
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If Breast Cancer Has Spread To My Lymph Nodes Do They All Have To Be Removed
Not always, says Tran. We are performing fewer axillary lymph node removal surgeries now. Just a few years ago, if you came to me with breast cancer that had spread to the lymph nodes, those nodes would all have to come out, which raises the risk of lymphedema.
Recent studies have found that for some patients with cancer in their lymph nodes, radiation to the remaining lymph nodes may control local cancer as well as axillary lymph node dissection removing all of your lymph nodes.
Another way to avoid axillary dissection is to shrink the cancer with a course of chemotherapy first. If there is a good response, we can remove fewer lymph nodes.
Incidence Of Cancer In The Aging Population
The incidence of cancer increases with age.
- Overall, the lifetime cancer risk is 44% in men & 38% in women.
- Among people over the age of 65 years, there is an 11-fold increased incidence of developing cancer as compared to younger individuals.
- The median age at the time of a cancer diagnosis is 68 yrs
- 56% of all cancer diagnoses & 70% of all cancer deaths occur in the over-65 population
- In the last 30 years, the incidence of cancer has increased 26% in > 65 year-old population as compared with a 10% increase in the population < 65 years.
- Cancer-related mortality has increased among the older population by 15%, but has decreased by 5% < 65 year-old population.
Thus, the elderly are disproportionately affected by cancer and its associated sequelae
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Good News And Bad News About Breast Cancer
Women are more alarmed than they need to be about the chances that they will develop breast cancer. But they are also more confident than they should be that the advances medicine has made in treating the disease and prolonging life mean that it can be cured
Few things frighten a woman more than discovering a lump in one of her breasts. With good reason: breast cancer may transform a womans breast into the vehicle of her death. It is twice as likely to be diagnosed in an American woman today as it was sixty years ago. And the treatmentsurgery, usually followed by radiation and chemotherapyis disfiguring, painful, and all too often unsuccessful.
I have been researching and treating this disease for more than thirty-five years, a period in which the publics awareness of breast cancer has risen enormously. The disease has brought into being an entire industry of research organizations, charitable agencies, commercial ventures, and advocacy groups. Every new statistic is trumpeted in the media, and every encouraging research finding, no matter how tenuous, is held up as a potential breakthrough.
IS BREAST CANCER AN EPIDEMIC?
To our grandparents, this picture would have seemed amazing. At the turn of the century cancer of the breast was a relatively unusual disease. What happened? Why does the incidence of breast cancer seem so much higher today?
BREAST-CANCER BASICS DOES MAMMOGRAPHY HELP?STATISTICAL TROUBLESARE WE CURING BREAST CANCER? ANOTHER VIEW OF BREAST CANCER
Physical Emotional And Social Effects Of Cancer
In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Supportive care treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies.
Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.
Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.
Meditation and yoga to improve general quality of life.
Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.
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Breast Cancer: Types Of Treatment
Have questions about breast cancer? Ask here.
ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.
This section explains the types of treatments, also known as therapies, that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less drug or radiation treatment or doing less extensive surgery than what is usually done as the standard of care. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
Basal Type Breast Cancer
Basal type breast cancer has particular genetic changes in the cells. The cells make large amounts of a protein called cytokeratin 5/6.
Basal type breast cancers are often triple negative. This means that they don’t have many receptors for oestrogen, progesterone, or HER2. So, hormone therapies and targeted drugs don’t work for most basal type cancers.
Doctors use other treatments, such as surgery, chemotherapy and radiotherapy, instead.
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Harms Of Cancer Treatments
Cancer found in its early stages is usually curable by surgery and adjunctive therapy, regardless of the patients age. Therefore, early cancer diagnosis is important also in the elderly. Even though a patient is very old and has other diseases, early-stage cancer can often be operated. Surgery may improve the patients quality of life, even if the aim is not to extend the patients life span. Particular care is placed in evaluating the elderlys eligibility for operations. Radiation and medical treatments provided after surgery reduce the risk of cancer spreading. These adjuvant treatments may cause temporary harms, but in spite of them it is easier for elderly patient to live with other illnesses without metastatic cancer. Many special features are associated with the treatment of cancer in the elderly. Little research exists on antitumor and radiation treatments for the elderly, as most clinical trials have not included patients over the age of 65. Hence for example chemotherapy has been avoided in treating patients that are over 65. In radiotherapy, in turn, smaller dosages than usual may have been used.
Effective chemotherapy should be started in spite of the expected harms in the elderly patients, for example, in the treatment of aggressive lymphoid tissues if healing is possible on the basis of earlier data. Supportive treatments help in carrying out chemotherapy.
Lung Cancer In The Elderly
Lung cancer is still one of the cancers with the worst prognosis, and smoking is its main risk factor. The decrease in mens smoking is visibly seen in the reduction of lung cancer cases. Surgery is a curative treatment for early-stage lung cancer. It is, however, only rarely possible, and the poor functioning of the heart or lungs of the elderly patient may prevent the surgery. Local radiation therapy can be used to relieve the symptoms of lung cancer, regardless of age. Chemotherapy treatments for lung cancer are quite severe and their effectiveness weak, so they are rarely given to elderly patients.
In recent years, new biological medicines have become available on the market, and they are used in the treatment of certain rare types of lung cancer.
Individualized Breast Cancer Treatment For Older Adults
Tran says her groups approach to dealing with breast cancer in patients of any age is highly individualized. We recommend both the treatments and the order in which the patient will receive them, which is very important. For instance, radiation is not common before surgery, since it makes wound healing more difficult.
She notes that most cancers are found early, and generally surgery is the first step in treatment. But for cancers that are more advanced when they are diagnosed, starting out with chemotherapy can offer some advantages.
In cases where the cancer is advanced, chemotherapy is often done first to shrink the tumor. Another benefit of doing chemotherapy first is the tumors response to the chemotherapy gives us information on your prognosis, and surgery afterward can confirm those findings.
Pathophysiology In Older Women
According to both clinical observations5 and laboratory studies,13 breast cancer becomes more indolent in the aged. Thus, as women age, the prevalence of nonlife-threatening metastases appears to increase, while the incidence of life-threatening metastases tends to decrease. The risk of death due to metastatic disease also decreases with advancing age.5
One explanation for the more indolent course of breast cancer in older women is that the prevalence of hormone-receptorrich, well-differentiated and slowly proliferating neoplasms increases with age. The ability of the host to support tumor growth may also decrease with age.13
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Factors Associated With More Rapid Spread
Some types of breast cancer, as well as their subtypes, are more likely to spread than other types. For example, ductal carcinoma is more likely to spread than lobular carcinoma, among tumors that are the same size and stage.
Many breast cancers do not spread to lymph nodes until the tumor is at least 2 cm to 3 cm in diameter. Some types may spread very early, even when a tumor is less than 1 cm in size.