Cancer Flashcards
1
Q
Biggest RF for development for cancer?
A
- incidence of common cancers (breast, colorectal, prostate, lung) increases w/ age up to 75 at which pt it levels off
- Aging is the single biggest RF in development of cancer
- 60% of all cancers occur in those age 65 and older
- 70% of all cancer deaths occur in those 65 or older
2
Q
Cancer age distribution?
A
- age 55-64: 24%
- age 65-74: 26%
- age 75-84: 19%
3
Q
Cancer biology and aging?
A
- behavior of cancer changes w/ aging - cancers may have different genetics
- some cancers have a poorer prognosis in elderly and some have a better prognosis
- senescence of immune system w/ aging results in less surveillance for abnormal cells: blunted T cell and NK cell activity
- cancer growth factors differ w/ age:
IL-6 increases
angiogenesis is altered
chronic inflammation may promote tumor growth
4
Q
What cancers have a more indolent course in the elderly?
A
- some non-small cell lung adenocarcinomas
- estrogen/progesterone responsive positive breast cancers
- prostate cancer
5
Q
What cancers are more aggressive in elderly?
A
- AML
- large cell non-hodgkin lymphoma
- celomic ovarian cancer
6
Q
MC cancer types in elderly overall?
A
- breast
- prostate
- lung/bronchus
- colon and rectum
7
Q
MC site of cancer?
A
- digestive system (mostly colon and rectum) MC
- breast cancer
- cancer of respiratory system (mostly lung and bronchus) - lung cancer MC and MC cause of death overall - of all cancers
8
Q
Why are cancer death rates so high in elderly?
A
- organ vulnerability (reduced physiologic reserves)
- co-existing illnesses
- more aggessive tumors
- more likely to have advance disease at presentation
- age bias: under tx (“too dangerous), reduced participation in cancer screening programs (Resulting in delayed dx), under representation in clincal trials (exlusion of subjects older than 70), health care access issues
9
Q
Use of and Issues w/ surgery for tx of cancer in elderly?
A
- most effective therapy of many malignancies
- most elective surgeries assoc w/ relatively low mortality risk
surgical RFs for the elderly:
- emergency surgery or prolonged surgery
- co-existing disease (esp CVD, COPD, DM)
- poor nutritional status (wound healing, infections)
- poor fxnl status
10
Q
Use of, and Issues w/ radiation therapy for tx of cancer in elderly?
A
- safe and effective curative and palliative therapy for localized cancers - relatively little fxnl impairment compared to surgery and chemo
- short cours RT and brachytherapy very safe and convenient (esp for sick pts)
- major risks:
mucositis (dehydration, malnourishment, sepsis), radiation pneumonitis
11
Q
Issues w/ chemo for tx of cancer in elderly?
A
- more SEs than surgery or RT
- increased susceptibility to toxicity (oral chemo better tolerated than IV tx)
decreased fxnl reserves
co-existing disease
alt metabolism and distribution of drugs
poor stem cell recovery - dose adjustments for reduced GFR or anemia leds to decreased tx effectiveness
- major risks for elderly:
myelosuppression - cumulative, more severe: anemia (reduced O2 carring capacity), neutropenia (sepsis), thrombocytopenia (bleeding)
mucositis: dehydration, malnutrition, sepsis - drug specific toxicities: renal insufficiency (platinum containing drugs), cardiotoxicity (anthracyclines), neurotoxicity (platinum, taxanes, vincristine)
12
Q
Cancer tx decisions in older adults should be based on what?
A
- on tumor characteristics not age
- need an assessment of pt’s fxnl status
- include risk of tx vs benefit and effets on quality vs quantity of life
- guided by pt’s tx goals
- avoid undertx of curable disease
- avoid overtx of indolent cancers or cancers w/ poor prognosis
13
Q
What is physiologic age? Components?
A
- good estimate of quality of life, life expectancy, and ability to tolerate cancer tx
- components:
co-morbidites
fxnl status
nutritional status
geriatric syndromes
14
Q
What are co-morbidities that influence physiologic age?
A
- CVD
- respiratory disease
- thromboembolic disease
- DM
- renal insufficiency
- neuro disease
- anemia
15
Q
What is fxnl status?
A
self care and the ability to maintain an independent life:
- ADLs: bathing, dressing, eating, toileting, continence, and transferring
- IADLs: use of transportation, shopping, ability to take meds, provide one’s own meals, manage finances, do laundry and housekeeping
