Ageing by itself can be psychologically depressing when they have to depend on others for their needs.Cancer is more common as age advances and hence can shatter a life of the elderly. With advances in medicine and technololgy the fear of cancer as a death sentence can be done away with.

Doctors at MIOT have treated many elders above 80 years diagnosed with cancer at various stages who are able to continue their life with good quality as before. Given below are a few cases for patient above 80yrs, suffering from cancer treated at MIOT.

 Case 1: An 87 year old lady presented with difficulty in passing stools for one week.  She also had pain in abdomen.  Her blood tests revealed she was anaemic. Since she had difficulty in passing stools, a colonoscopy was done and it revealed a cancerous tumour in the large bowel. CT scan done showed the cancer was also invading into uterus, confirming a Stage 3 cancer. She was offered surgery at very high risk to life in yet another hospital. Fearing risk to life, they came to MIOT to save the patient.

She was re-evaluated thoroughly here. Though it was an advanced stage 3 cancer, the only way to save the patient was to do a surgery. If we do not perform a surgery on her immediately, she will present with complete obstruction of bowel by the cancer. Then it will be very difficult to manage her in an emergency setting. With advanced anaesthesia techniques, state of art operation theatres and skilled surgeons, surgery even in 80 and 90 year old is safe.

The patient was fit, except for her age and mild diabetes. She was taken for surgery by May 2017 and both the affected part of colon and uterus was removed with minimal blood loss. She was stable throughout the surgery and in the immediate post operative period. She was given excellent pain relief. She was started on normal diet within a week of surgery and was discharged on tenth day without any complications. The patient and family were extremely happy.She comes for regular check-ups. After 6 months of treatment, a recent US scan showed no remnants of cancer tissue

Case 2: An 84 year old lady presented to gynaecologist with post menopausal bleeding. On further tests, it was found that she had cancer in uterus (Stage I). MRI scans revealed, that the tumour was involving only the inner layers of uterus and showed no evidence of disease elsewhere. Though the cancer was in early stage both the patient and relatives were reluctant to undergo surgery.

When they at MIOT, they were sceptical about the surgery option.  They wanted to take the patient home, as the relatives did not believe that an 84 year old lady could withstand a cancer surgery. We explained them that the surgery will be a complete removal of uterus and lymph nodes around uterus. If unoperated, the old lady will land up with multiple episodes of bleeding and will become very weak. We reassured the patient and relatives in a very good manner, explaining the merits of surgery. The old lady gained full confidence in us and underwent the surgery in October 2017.

She had an uneventful surgery and a great post operative recovery.  She was discharged on 12th day after surgery. In view of her age we avoided chemotherapy. Two sittings of radiation were offered for the patient, but patient declined it. 1 month post surgery, MRI was taken which revealed a clear Uterus. The entire family was very happy with the excellent results even in 80 plus age group.

Patients with cancer in elderly age group (>60 years), is a challenge as most of them have other comorbidities like diabetes, hypertension, heart disease etc which makes cancer treatment more difficult, but not impossible.

Case 3: 81 year old lady with cancer of the uterine cervix came to us in August 2016 with vaginal bleeding which is a very distressing symptom at that age. We diagnosed her to be in Vaginal Cancer Stage 2. She was treated with Radiation using Tru Beam and chemotherapy. She also underwent two sessions of Intra Cavitary Brachytherapy which delivers a high dose to the tumour while sparing the normal structures.

Internal radiation is also called BRACHYTHERAPY. A radioactive implant is put inside the body in or near the tumor. During intra-cavitary radiation, the radioactive source is placed in a body cavity (space), such as the rectum or uterus.

Her treatment was completed in October 2017. She is asymptomatic at present leading a good quality of life.

Elderly in INDIA:

India is witnessing a demographic transformation from a younger society to an elderly one. By the year 2020, India will have 11% of the population in the age group of 60 years and above. The average life expectancy in India has increased from 47 years in 1970s to 68 in 2015.  Due to improvement in public health, now more individuals are living longer and the proportion of those living beyond 60 years has increased significantly and will increase further over the years.

Although more than 25% of cancers are diagnosed in people over 60 year, this group is less extensively investigated and probably receives less appropriate treatment than younger patients. Usually, the elderly cancer patients are considered not suitable for a curative treatment approach.

The choice of treatment modalities in term of radiotherapy, chemotherapy, or even surgery becomes a difficult decision both for the doctor and patients and their relatives. More often elderly patients are put on conservative or less aggressive treatment. Thus, a large proportion of patients are denied the benefit of aggressive treatment.

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