Colorectal cancer in the elderly

The article was written by Internal Oncologist - Internal Oncology Department - Vinmec Times City International General Hospital.

The incidence and mortality of colorectal cancer mainly falls on the elderly, accounting for more than 70% of patients. Appropriate elderly patients can be treated in the same manner as younger patients, however the treatment of elderly patients with frailty and comorbidities remains problematic. difficult. Many factors need to be taken into account, including fitness for treatment, patient and family wishes, and quality of life.

Aging is not an exclusion criterion for radical treatment, but many elderly patients are intolerant or respond poorly to standard therapies. In addition, side effects should be carefully considered before recommending treatment and an individualized approach should be devised.
Aging is one of the factors we need to take into account to define a comprehensive colorectal cancer treatment strategy. Aging itself is an unfavorable prognostic factor in these patients. The aging process is associated with decline in other organ functions such as: Decreased liver and kidney function, decreased bone marrow reserve, increased risk of cardiovascular events, cognitive decline, other comorbidities. ... These impairments lead to higher toxicity with chemotherapy, leading to reduced quality of life and adherence. The scales most commonly used to assess functional status, such as Karnofsky performance status or overall health (ECOG)..., should be used in the context of assessment. Comprehensive patient assessment to classify the elderly as suitable or unsuitable for specific treatment, may have higher toxicity to chemotherapy, radiation therapy, symptomatic treatment and mortality risk. Patients assessed as weak with ECOG PS 3 or 4 or IK less than 60 are ineligible for chemotherapy due to poor return and high toxicity; patients in the ECOG PS 1 or 2 group or IK over 60 should apply more aggressive treatment measures.

Many elderly patients will benefit from radical treatments, but others will not, and in some cases, nonspecific 'palliative' management should be used. In addition, comorbidities can put patients at greater risk of adverse treatment outcomes, and increase the risk of all causes of death, in many cases where the benefits of treatment are not clearly seen. the treatment.
There is a way to classify elderly patients for assessment in the application of treatment:
Class I: Patients with normal organ function, without significant comorbidities: these patients are likely to ability to receive specific treatment using standard protocols. Class II: Patients with functional effects with two or fewer comorbidities, who can benefit from a fraction of the specific treatment modifiers compared to the standard regimen. Class III: Patients with functional effects with three or more comorbidities or geriatric syndromes who should receive only symptomatic treatment (palliative care). Colorectal cancer surgery is one of the main treatments, which can improve the quality of life of elderly patients, even if surgical resolution does not prevent metastatic progression of colorectal cancer. sick. In cases where surgery cannot be performed to restore intestinal circulation, a possible alternative management may be endoscopic stenting, particularly when left colonic obstruction is present. The use of these self-expanding metal stents will help doctors have more "time" to better assess the patient's clinical status and stage of the disease, improve nutritional status, and manage comorbidities. . In some cases, after stenting allows for subsequent elective surgery. Therefore, this is a suitable option for palliation or as an intermediate step for radical surgery in the treatment of colorectal cancer in elderly patients.

Chemotherapy is used as adjuvant therapy after surgery for colorectal cancer, and there is ample evidence that chemotherapy is safe and effective for older patients. Chemotherapy for colorectal cancer in the form of tablets may be appropriate for patients who are elderly or have heart disease for whom intravenous infusion may be more risky. Chemotherapy and biologic treatments that slow disease progression and reduce symptoms may also be considered in elderly colorectal cancer patients. In treatment, caution must always be taken against possible risks to the heart, liver or kidneys.
However, the majority of colorectal cancer patients over 65 years of age do not receive the full range of treatment regimens that are considered standard. The degree of specific treatment is markedly reduced at this age due to the influence of comorbidities, and it significantly reduces the effectiveness of preventing disease progression.
People who are “old and frail” may consider only palliative treatment to control symptoms, maintaining organ function is a key goal of treatment that can lead to a better quality of life. Taking care of patients' quality of life is paramount in treatment decisions, as these patients often struggle not only with cancer but also with many other problems such as comorbidities and other health problems. other social topics.
To date, there is no standard treatment for elderly patients with colorectal cancer. An individualized strategy is needed that considers each patient's comorbidities, functioning status, and lifestyle to recommend optimal treatment. By clearly defining goals through conversation, most elderly patients with cancer have priorities besides prolonging their lives. Their primary concerns include avoiding suffering, strengthening relationships with family and friends, being spiritually aware, not being a burden to others, and achieving a sense that their lives is complete. The treatment plan set out must be comprehensive: Cancer-specific treatment, specific symptomatic treatment, supportive treatment modalities, and end-of-life care.

With the development of modern medicine, surgical methods have made many strides with the introduction of traditional laparoscopic surgery, and the latest and most advanced today is robotic laparoscopic surgery. Compared with old methods, robotic laparoscopic surgery offers many outstanding advantages such as:
Unrestricted vision, optimal image quality, accurate surgical manipulation. Unnecessary vibrations during surgery (hand tremor) are eliminated thanks to the robot with 4 hands (equivalent to 2 surgeons). Can move freely at 6 angles, so it is easy to intervene in difficult positions as well as enter small, deep cavities. The risk of complications is minimized, ensuring patient safety during surgery as well as limiting postoperative infection. Less pain than with conventional surgery. Small lesions, therefore quick recovery, shorten hospital stay. Small surgical scars, ensuring aesthetics for the patient. Vinmec International General Hospital with a team of dedicated and experienced experts, leading modern equipment facilities in Vietnam. Currently, the hospital is leading the way to treat colorectal cancer with robotic laparoscopic surgery. Coming to Vinmec, patients will be completely satisfied when experiencing international standards of examination, treatment, and care.