Academic journal article Generations

Cancer in the Older Person

Academic journal article Generations

Cancer in the Older Person

Article excerpt

This article explores the challenges and opportunities related to the management of cancer in the older person. Cancer is a major cause of illness and mortality in older adults, and 50 percent of all tumors occur in the 12 percent of the population age 65 and over (Balducci and Ershler, 2005). As the older adult population expands, it is expected that, by 2030, some 70 percent of all cancers will occur in older individuals (Balducci and Ershler, 2005). Effective cancer control may allow elders to lead full, active lives, and it can have a major impact on cancer mortality. In addition to specific expertise related to the disease, management of cancer in the older person requires an understanding of the biological interactions between cancer and aging and an appreciation of age-related conditions that may affect treatment (Carreca, Balducci, and Extermann, 2005). Effective cancer treatment also requires an understanding of life expectancy, concurrent medical conditions that may be present, risk of treatment complications, functional status, and social support.

BIOLOGICAL INTERACTIONS

What are the biological interactions between aging and cancer? Why does cancer become increasingly common with age? Carcinogenesis, the process by which a normal cell gives origin to cancer, occurs through serial genomic changes, effected by different substances called carcinogens. It is customary to distinguish early- and late-stage carcinogens according to their time of action. The association of cancer and aging may be accounted for by three explanations, which are not mutually exclusive.

Duration ofcardnqgenesis. Because cancer may take decades to develop, it is more likely to appear in those who have lived a long time.

Susceptibility to environmental carcinogens. The second explanation is increased susceptibility of aging tissues to environmental carcinogens (Balducci and Ershler, 2005; Anisimov, 2005; Anisimov, 2006). Aging tissues, especially the epithelial and lymphatic ones, undergo genomic changes similar to those of early carcinogenesis, and the number of cells primed to the action of late-stage carcinogens increases with the age of an organism. This phenomenon has important clinical implications. Older adults may be ideal candidates for cancer chemoprevention that offsets or reverses late carcinogenic stages (Beghe and Balducci, 2005). The phenomenon has public health implications as well. Because they are more susceptible to environmental carcinogens, older people may represent a natural monitoring system for the appearance of new carcinogens in the environment. According to this assumption, after exposure to new environmental carcinogens, older adults will develop cancer earlier than younger people. A possible example of this occurrence is the increased incidence of malignant brain tumors that in 1990 affected only individuals 70 and older, and now seems to affect younger individuals as well (Gloecker Ries et al., 2003).

Changes in bodily environment. The third explanation is based on the following age-related changes in bodily environment that may favor carcinogenesis and cancer growth:

* Chronic and progressive inflammation, which may foster and accelerate carcinogenesis in the surrounding tissues (Ferrucci et al., 2005).

* Decline in cell-mediated immunity, which represents the weakening of the most formidable natural defense against cancer (Burns and Goodwin, 2004).

* Increased insulin resistance and increased circulating levels of Insulin-like Growth Factor (IGF), one of the most powerful stimulators of cancer growth (Popovich et al., 2005).

* The loss of the self-replicative ability of fibroblasts (connective-tissue cells), which is associated with increased production of tumor growth factors and metalloproteinases, enzymes that favor metastatic spread of cancer (Hornsby, 2005).

The biological behavior of a number of tumors appears to change with age (Carreca, Balducci, and Extermann, 2005). …

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