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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2015; 7(10): 204-220
Published online Oct 15, 2015. doi: 10.4251/wjgo.v7.i10.204
Treatment of colorectal cancer in the elderly
Monica Millan, Sandra Merino, Aleidis Caro, Francesc Feliu, Jordi Escuder, Tani Francesch
Monica Millan, Aleidis Caro, Francesc Feliu, Jordi Escuder, Colorectal Surgery Unit, Department of Surgery, Joan XXIII University Hospital, 43005 Tarragona, Spain
Sandra Merino, Department of Medical Oncology, Joan XXIII University Hospital and St. Joan de Reus University Hospital, 43005 Tarragona, Spain
Tani Francesch, Department of Geriatrics and Palliative Care, Joan XXIII University Hospital (GiPSS), 43005 Tarragona, Spain
Author contributions: All authors contributed to the design of the article and review of the literature; Millan M edited the manuscript; all authors participated in the critical revision and approval of the final version of the article.
Conflict-of-interest statement: The authors declare that they have no conflict of interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Monica Millan, MD, PhD, Colorectal Surgery Unit, Department of Surgery, Joan XXIII University Hospital, Rambla Francesc Macia 2, Esc D, 2-3, 43005 Tarragona, Spain. monica.millan@ymail.com
Telephone: +34-638-107948 Fax: +34-977-505277
Received: April 29, 2015
Peer-review started: May 8, 2015
First decision: June 2, 2015
Revised: June 30, 2015
Accepted: August 30, 2015
Article in press: September 7, 2015
Published online: October 15, 2015
Processing time: 172 Days and 23.4 Hours
Abstract

Colorectal cancer has a high incidence, and approximately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients (> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are under-represented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.

Keywords: Colorectal cancer; Surgery; Chemotherapy; Radiotherapy; Elderly; Palliative care

Core tip: With the rise in the incidence of colorectal cancer and in the population > 70 years of age, the need to decide what type of treatment is most appropriate for patients > 70 with colorectal cancer will become more frequent. Age in itself should not be an exclusion criterion for radical treatment, but there will be many elderly patients that will not tolerate or respond well to standard therapies. These patients need to be properly assessed before proposing treatment, and a tailored, individualized approach should be offered in a multidisciplinary setting.