Cancer Flashcards

1
Q

The incidence of CA increases with age up to ____ at which point it levels off.

What is the single biggest risk factor in the development of cancer?

60% of all CAs occur in those age 65 or older, T/F?

70% of all cancer deaths occur in those age 65 or older, T/F?

A

75 years old

Aging is the biggest risk factor

True

True

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2
Q

The biological behavior of the cancer changes with aging. What are some ways this occurs?

A

Blunted T cell activity and decreased NK cell activity

CA growth factors differ with age

  • IL-6 increases with age
  • Angiogenesis is altered
  • chronic inflammation may promote tumor growth
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3
Q

What are some cancers that have a more indolent course in the elderly? (3)

More aggressive? (3)

Most common Cancers overall (4)

A

Indolent

  • some non-small cell lung adenocarcinomas
  • estrogen/progesterone responsive positive breast CA
  • Prostate CA

Aggressive

  • AML
  • Large cell non-hodgkin lymphoma
  • celomic ovarian cancer

Most common

  • breast
  • prostate
  • lung/bronchus (This is the most common CA in geriatric pts ages 55-74)
  • colon and rectum
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4
Q

Why are cancer death rates so high in elderly patients?

A
  • organ vulnerability
  • co-existing illnesses
  • more aggressive tumors
  • more likely to have advanced disease at presentation
  • age bias: under treatment, reduced participation in CA screening programs, under-representation in clinical trails, health care access issues
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5
Q

Treatment of CA

  • surgery: what are the risk factors for the elderly
  • radiation: what are the risks for the elderly
  • chemo: downfalls to this tx in the elderly
A

Surgical risk factors for elderly

  • emergency surgery or prolonged surgery
  • co-existing disease (especially CVD, COPD, DM)
  • poor nutritional status (wound healing, infections)
  • poor functional status

Radiation

  • overall very safe and convenient
  • major risks: mucositis (dehydration, malnourishment, sepsis) and radiation pneumonitis

Chemo

  • more SE than surgery or RT
  • increased susceptibility to toxicity
  • dose adjustments for reduced GFR or anemia leads to decreased treatment effectiveness
  • major risks: myelosuppression (anemia, neutropenia, thrombocytopenia), mucositis (dehydration, malnutrition, sepsis), drug specific toxicities
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6
Q

What is Ca tx based on?

A

The TUMOR CHARACTERISTICS, not the age of the patient

*include risk of tc vs benefit and effects on quality vs quantity of life

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7
Q

What is physiologic age?

A

good estimate of quality of life, life expectancy, and ability to tolerate CA tx

components include: co-morbidities, functional status (ADLs, IALDs), nutritional status, geriatric syndromes (dementia, delirium, depression, falls, spontaneous fx, neglect, abuse, incontinence, nutritional problems)

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8
Q

How do we treat CA if the elderly pt is frail?

A

If frail, palliative tx

If not, llife prolonging tx

intermediate, individualize tx

*treatment is not always warranted

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9
Q

Cancer in the elderly

-supportive care examples (things to treat their SE)

A
  • nutritional support: dietary counseling/supplements, G/J tube
  • anemia: epoetin alpha
  • Neutropenia: epogen or leukine
  • Thrombocytopenia: platelet infusion
  • Mucositis: supportive care, hydration, magic mouth wash
  • N/V: serotonin receptor antagonists (ondansetron)
  • Pain: often undertreated in the elderly*
  • -pt reluctance to report pain
  • -atypical presentation
  • -providers fear older pts wont tolerate opiates
  • -communication problems
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