Câncer idoso

European Journal of Cancer 36 (2000) 1741±1754

www.ejconline.com

Geriatric oncology: challenges for the new century
L. Balducci *
University of South Florida College, Division of Medical Oncology and Hematology, H. Lee Mott Cancer Center, 12902 Magnolia Drive,
Tampa, FL 33612-9497, USA
Received and accepted 7 April 2000

Abstract
The management of cancer in the older aged person represents one of the major immediate challenges of medicine. The response to this challenge involves answers to the following questions:
1. Who is old? Currently, 70 years of age may be considered the lower limit of senescence because the majority of age-related changes occur after this age. Individual estimates of life expectancy and functional reserve may be obtained by a comprehensive and time-consuming multidimensional geriatric assessment. The current instrument may be ®ne-tuned and new instruments, including laboratory tests of ageing, may be developed.
2. Why do older persons develop more cancer? It is clear that ageing tissues are more susceptible to late-stage carcinogen. Older persons may represent a natural monitor system for new environmental carcinogens, and may also represent a fruitful ground to study the late stages of carcinogenesis.
3. Is cancer di€erent in younger and older persons? Clearly, the behaviour of some tumours, including acute myeloid leukaemia, non-Hodgkin's lymphoma and breast cancer change with the age of the patient. The mechanisms of these changes that may involve both the tumour cell and the tumour host are poorly understood.
4. Can cancer be prevented in older individuals? Chemoprevention o€ers a new horizon of possibilities for cancer prevention; older persons may bene®t most from chemoprevention due to increased susceptibility to environmental carcinogens. Screening tests may become more accurate in older individuals due to increased prevalence of cancer, but may be less bene®cial due to more limited patient life expectancy.