Management of Colorectal Cancers in Older People

180 Pages·2013·8.163 MB·English

by  Valery E. P. P. Lemmens Ph.D. (auth.), Demetris Papamichael, Riccardo A. Audisio (eds.)

Management of Cancer in Older People 3
Series Editor: Riccardo A. Audisio
Demetris Papamichael
Riccardo A. Audisio Editors
Management of
Colorectal Cancers
in Older People
Management of Colorectal Cancers in Older People

Demetris Papamichael (cid:129) Riccardo A. Audisio
Editors
Riccardo A. Audisio
Series Editor
Management of Colorectal
Cancers in Older People
Editors
Demetris Papamichael, MB, BS, FRCP Riccardo A. Audisio, MD, FRCS
Bank of Cyprus Oncology Centre University of Liverpool
Nicosia St Helens Teaching Hospital
Cyprus St Helens
UK
Series Editor
Riccardo A. Audisio, MD, FRCS
University of Liverpool
St Helens Teaching Hospital
St Helens
UK
ISBN 978-0-85729-983-3 ISBN 978-0-85729-984-0 (eBook)
DOI 10.1007/978-0-85729-984-0
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2013933444
© Springer-Verlag London 2013
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection
with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and
executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this
publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s
location, in its current version, and permission for use must always be obtained from Springer. Permissions
for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to
prosecution under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for
any errors or omissions that may be made. The publisher makes no warranty, express or implied, with
respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Contents
1 The Epidemiology of Colorectal Cancer in Older Patients ..................... 1
Valery E.P.P. Lemmens
2 Genetic Alterations in Colorectal Cancer in Older Patients .............. 9
Zenia Saridaki and John Souglakos
3 Comorbidity, Disability, and Geriatric Syndromes ............................ 21
Siri Rostoft Kristjansson
4 CRC: Diagnosis, Staging, and Patient Assessment ............................. 29
Siri Rostoft Kristjansson and Riccardo A. Audisio
5 Comprehensive Geriatric Assessment .................................................. 39
Margot A. Gosney and Priya Das
6 Surgical Treatment of Colorectal Cancer in Older Patients .............. 53
Harm J.T. Rutten, Gerrit-Jan Liefers, and Valery E.P.P. Lemmens
7 Palliative Surgical Approaches for Older Patients
with Colorectal Cancer .......................................................................... 65
Andrew P. Zbar and Riccardo A. Audisio
8 Surgery for Liver Metastases ................................................................ 81
Nicola de’ Liguori Carino and Luigi Bonanni
9 Rectal Cancer Radiotherapy and Older Patients:
Evidence-Based or Opinion-Based Treatment? .................................. 95
Rob Glynne-Jones and Kannon Nathan
10 Adjuvant Therapy of Colorectal Cancer in Older People .................. 111
Aimery de Gramont, Leila Bengrine-Lefevre, May Mabro,
and Elisabeth Carola
v
vi Contents
11 Chemotherapy in the Metastatic Setting ............................................. 129
Gunnar Folprecht
12 Targeted Therapies in Older Patients with Metastatic
Colorectal Cancer .................................................................................. 141
Javier Sastre, Jon Zugazagoitia, Aranzazu Manzano,
and Eduardo Díaz-Rubio
13 Palliation and Quality of Life ................................................................ 161
Bengt Glimelius
Index ................................................................................................................ 175
Contributors

Riccardo A. Audisio M.D., FRCS Department of Surgery , St. Helens
and Knowsley Teaching Hospitals , St Helens, Merseyside , UK
Leïla Bengrine-Lefevre , M.D. Oncology Department , Saint Antoine Hospital ,
Paris , France
Luigi Bonanni , M.D. HPB Unit , North Manchester General Hospital,
Pennine Acute Trust , Manchester , UK
Elisabeth Carola , M.D. Oncologie Médicale , GHPSO , Senlis , France
Priya Das , MBBS Royal Berkshire NHS Foundation Trust, Reading , UK
Aimery de Gramont , M.D. Department of Medical Oncology, GERCOR ,
Paris , France
Department of Medical Oncology , Hopital Saint-Antoine , Paris , France
Nicola de’ Liguori Carino , M.D. HPB Unit , North Manchester General
Hospital, Pennine Acute Trust , Manchester , UK
Eduardo Diaz-Rubio , Ph.D. Oncology Department , HC San Carlos ,
Madrid , Spain
Gunnar Folprecht , Ph.D. Medical Department I/University Cancer Center ,
University Hospital Carl Gustav Carus , D resden , Germany
Bengt Glimelius , M.D., Ph.D. Department of Radiology, Oncology
and Radiation Science , Uppsala University , Uppsala , Sweden
Rob Glynne-Jones , FRCP, FRCR Mount Vernon Cancer Centre ,
Middlesex , UK
Margot A. Gosney , M.D., FRCP Elderly Care Medicine ,
University of Reading/Royal Berkshire NHS Foundation Trust ,
Reading, Berkshire , UK
vii
viii Contributors
Siri Rostoft Kristjansson , M.D., Ph.D. Department of Internal Medicine ,
Diakonhjemmet Hospital , Diakonveien , Oslo , Norway
Valery E. P. P. Lemmens , Ph.D. Department of Research, Comprehensive Cancer
Centre South , Eindhoven , The Netherlands
Department of Public Health , Erasmus University Medical Centre ,
Rotterdam , The Netherlands
Gerrit-Jan Liefers , M.D., Ph.D. Department of Surgery ,
Leiden University Medical Center , Leiden , Netherlands
May Mabro , M.D. Oncologie , Hopital Foch , Suresnes , France
Aranzazu Manzano , M.D. Oncology Department , HC San Carlos ,
Madrid , Spain
Kannon Nathan , MRCP, FRCR, B.Sc. Clinical Oncology ,
Mount Vernon Cancer Centre , Middlesex , UK
Harm J. T. Rutten , M.D., Ph.D., FRCS (London) Colorectal Surgery ,
Catharina Hospital Eindhoven , Eindhoven, Noord Brabant ,
The Netherlands
Zenia Saridaki , M.D., Ph.D. Laboratory of Tumor Cell Biology ,
Medical School, University of Crete , Heraklion, Crete , Greece
Javier Sastre , Ph.D. Gastrointestinal Unit, Oncology Department ,
HC San Carlos , Madrid , Spain
John Souglakos , M.D., Ph.D. Medical Oncology , Medical School
University of Crete , Heraklion, Crete , Greece
Andrew P. Zbar , M.D. (Lond), MBBS, FRCS (ED), FRCS (Gen),
FRACS, FCCS, FSICCR (Hon) Surgery and Transplantation ,
Chaim Sheba Medical Center , Tel Hashomer, Ramat Gan, Tel Aviv , Israel
Jon Zugazagoitia , M.D. Oncology Department , HC San Carlos ,
Madrid , Spain
Chapter 1
The Epidemiology of Colorectal Cancer
in Older Patients
Valery E. P. P. Lemmens
Abstract One of the most commonly diagnosed types of cancer at an older age is
colorectal cancer (CRC). The median age at which CRC is diagnosed nowadays is
69 years. Due to the aging of the population and the fact that individuals between
80–89 years exhibit the highest risk of being diagnosed with CRC, the median age
at diagnosis will further increase in the near future. An important feature of elderly
cancer patients is the fact that they often present with comorbidity. Among patients
with CRC, the prevalence of comorbidity has been increasing over the last decades.
Among patients aged 80–89 years old the prevelance of comorbidity increased from
almost 60% in 1995–1998 to 80% in 2007–2010. Also tumor location shows a rela-
tion with age. With the exception of appendiceal tumours, older age is related to a
more proximal tumor location within the large bowel. Older patients are less often
diagnosed with node positive disease, as wel as synchronous distant metastases.
Also socio-economic status of patients with CRC shows a strong relation with age.
Of patients younger than 55 years, 18% of the patients is of a low socio-economic
status, while this amounts to 42% among patients aged 80 or above. Five-year ela-
tive survival of patients with CRC decreases by age, from 66% for patients younger
than 45 years old, to 55% for patients older than 75 years. Survival has been improv-
ing recently also for elderly patients. This, together with the increase in incidence,
will lead to an increased prevalence of elderly with CRC. This development will
increasingly ask for investments in clinicalresearch and infrastructure with a special
attention for the elderly patient with CRC.
Keywords Epidemiology (cid:129) Colorectal cancer (cid:129) Older patients (cid:129) Elderly (cid:129) Survival
(cid:129) Comorbidities
V. E. P. P. Lemmens , Ph.D.
Department of Research, Comprehensive Cancer Centre South ,
Zernikestraat 29 , P.O. Box 231 , Eindhoven 2600 AE , The Netherlands
Department of Public Health , Erasmus University Medical Centre,
Rotterdam , The Netherlands
e-mail: [email protected]
D. Papamichael, R.A. Audisio (eds.), Management of Colorectal Cancers in Older People, 1
DOI 10.1007/978-0-85729-984-0_1, © Springer-Verlag London 2013