The dilemma of cancer in the elderly

Survival of advanced age females with cervical carcinoma

A retrospective study was undertaken to evaluate the outcome of elderly females treated for invasive cervical carcinoma. Three hundred three patients were treated for invasive carcinoma of the cervix. More than 45% of patients had advanced stages of disease. Squamous lesions were found in 90.7%, adenocarcinomas in 7.3%, and rare varieties in 1.9% of patients. Among patients with squamous lesions, the overall 5-year survival was 23.2%. Survivals were 26.9% in stage I, 26.3% in stage II, 26.1% in stage III, and 12.5% in stage IV. Advanced age females continue to experience invasive cervical carcinoma in large numbers, and our results indicate grave prognosis.

Optimal care of older women. An opportunity for both prevention and treatment

As the number of older women and their average life expectancy increase, physicians will need to focus as much on providing preventive, health-promoting care as on treating disease. Drs South-Paul and Woodson present a guide for multidimensional evaluation of asymptomatic older women that can serve as a framework for designing individualized care.

Cancer screening in the elderly

Cancer screening in the elderly presents several unique challenges. There are no prospective trials of any cancer screening exam that have conclusively demonstrated efficacy in this age group. Any assessment of cancer screening in the elderly must include measuring an improvement in quality of life and functional status as well as decreased mortality from early cancer detection. Older patients usually prefer improved quality over quantity of life; they may be less interested in a trade-off of months or years of life in exchange for the side effects of cancer treatment. The elderly may need more home assistance during the treatment of the detected cancers; physicians should arrange for this. All of these variables must be included in studies of cancer screening in the elderly; the need for these studies is great. The following recommendations are probably the most reasonable in view of the currently inadequate knowledge base. Screening for breast cancer has demonstrated efficacy, with growing evidence for a cumulative effect from monthly breast self-examination, yearly breast examination by a physician, and yearly or biennial mammography. There may be no need to screen for cervical cancer in women after age 65 who have had regular Pap smear screening; however, older women who have never had Pap smears should have regular Pap smears for several years. Finally, because of the high frequency of colorectal and prostate cancers in the elderly, physicians should probably perform yearly rectal examinations with stool guaiac and regular sigmoidoscopy in this age group until definitive data support continuing or discontinuing these screening examinations. Physicians should educate their elderly patients to the importance of regular cancer screening and cancer risk-factor modification and should offer cancer screening examinations and counseling to elderly patients on a regularly scheduled basis.