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PREVENTION OF CANCER INELDERLY SUBJECTS

HL DHAR
Director, Medical Research Centre, Bombay Hospital Trust, Mumbai - 400 020.


Incidence of cancer increases as age advances, however, we can make real and significant improvement in our odds against cancer because between 80 and 90 per cent of all cancers are the result of things we do to ourselves. We eat much fat and drink alcohol. We douse the world with bug spray, we smoke and lie in sun till we blister.


INTRODUCTION


Cancer may occur at any age but it becomes more and more common as age advances because they are exposed more and more to carcinogenic environment as well as to internal irritants and genetic behaviour.

Elderly men suffer more from cancer of urinary system - bladder, prostate, etc. and from lung and colorectal cancer. Women on the otherhand are more prone to breast cancer, valvular cancer, endometrial and ovarian cancer.[1] Breast cancer is the most common cancer in old women, however, older women frequently are unaware of the increasing risk of breast cancer with age.

PREVENTABLE CANCERS

You can prevent cancer. You can make a real and significant improvement in your odds against cancer because between 80 and 90 per cent of all cancers are the result of things we do to ourselves. We eat too much of fat, we drink too much alcohol, we douse the world with bug spray. We smoke, we lie in the sun till we blister.[2]

Why do such activities cause cancer? There is no exact answer to this question till today. But scientists believe, it starts somewhere in our genes. Each and every cell contains genetic codes that determine so much of what the cell does.

We have thousands of genes, as per present knowledge goes at least 20 of them can be altered by a shaft of radiation, a blast of smoke or a viral attack that resets the intricate “grow/don’t grow” codes of a cell. And once those codes are reset, a single cell can grow uncontrollably. Like an alien inhabitant, it can grow and multiply and travel until it colonises your entire body. It can jam your body’s highways; eat its food and shut off its air. It can and does kill. There is not much we can do about our genes, but we can control many of the triggers that start them down the road to our destruction, tobacco smoke, for example.

Early detection, fruits, heredity, indoor polution, outdoor polution, prescription drugs, tobacco, vegetables, vitamin A, vitamin C and vitamin E, each one will tell you how to make changes in your life that will minimize your risk of cancer.

CANCER SPECIFIC TO ELDERLY MEN

Prostate cancer

It is a slow growing cancer in men; at advanced age survival rate over 78%, if detected early. One in 10 men seeks surgical relief from enlarged prostate and nearly 2% may develop cancer and most of them are left alone.

The majority of prostate cancer are ‘silent’ meaning they go unnoticed majority of them above the age of 80 year often detected at autopsy.

Symptoms : Frequency and difficulty in urinating (enlarged prostate cuts off urethra), blood in urine, back pain are common symptoms.

Prevention : Low fat diet, regular prostate examination, avoiding exposure to cadmium (if applicable) etc.

Testicular cancer

Testicular cancer is one of the most common malignancies in men aged between 18-32, however, men aged over 60 years have greater chance as those whose testicles did not descend properly into the scrotal sac shortly after birth.

Some men might be comforted by the fact that few men get the disease but if occurs it can spread quickly to other parts of the body and can be fatal.

Sign symptoms : First sign is usually a slight enlargement of one testicle along with a possible chance in its consistency, pain may be absent but often a dull ache is felt in the lower abdomen and groin.

Prevention : Testicular self examination every month for enlargement and pain on palpation.

CANCER SPECIFIC TO ELDERLY WOMEN

Ovarian Cancer

Ovarian cancer is the most serious gynaecological cancer a woman can have, survival rate is only about 40% largely because it is rarely detected early enough for effective treatment. Most ovarian cancers hit women between age 55 and 59 or who has a long history of ovarian dysfunction, however, it is rare below the age of 40 years.

Sign symptoms : Symptoms of ovarian cancer can be easily mistaken for symptoms of less serious illnesses like constipation, flatulence, water retention, frequent need to urinate, pain, swelling, nausea and abdominal discomfort.

Risk factors are previous breast, intestinal or rectal cancer.

Prevention : Routine pelvic examination between the age of 40 and 60 years.

Breast Cancer


Breast cancer is the most common cancer in older women, however, older women frequently are unaware of the increasing risk of breast cancer.

Sign symptoms : Changes in the breast such as development of a hard lump are the most common sign of breast cancer (although lumpy breasts are often caused by problems other than breast cancer). Swelling, puckering, dimpling, redness, skin irritation that persists, pain or tenderness and nipple discharge or nipple that inverts or take a strange shape should be reported to doctor.

Drinking and late menopause are risk factors.

Prevention : To maintain optimum body weight, low fat diet, regular exercise, self examination every month, and early mammogram. Carcinoma of male breasts accounts for fewer than 1% of male cancers and most often afflicts men in the 40s to 70s.[3]

Uterine Cancer

Uterine cancer usually refers to cancer of the endometrium - the lining of the uterus which plays a key role in reproduction. Uterine cancer usually strikes women who are older than 50 and younger than 65.[4]

Sign symptoms : Bleeding between menstrual periods, excessive bleeding during periods, and bleeding after menopause, may be associated with pain.

Risk factors are overweight, diabetes and high blood pressure and earlier oestrogen therapy. Smoking is also a risk factor.

Prevention : Low fat diet and frequent check up.

Vulva Cancer

High predominance in older women has been reported in literature.[5]

CANCER AFFECTING BOTH SEXES

Bladder Cancer


Most of the people are white men over 65 years and it’s likely they are suffering from either papillary or transitional-cell carcinoma, the two kinds that have accounted for 88% of all bladder cancer.

Papillary type is most common and is most easily cured. This type develops as abnormal cells that grow out from the bladder wall reaching into bladder cavity. Transitional carcinoma on the other hand penetrates the bladder wall and is more likely to become ulcerated and infected and more deaths are due to infection rather than directly from the cancer itself.

Early symptoms : Blood in urine and repeated urinary infection.

Prevention : Early detection, avoiding chronic bladder infection and abstaining from smoking.

Colorectal Cancer

Colorectal cancer has been linked to high fat, high protein and low fibre diet, characteristic of industrilization, most common in developed countries, and usually occur after the age of 40 years. While no one knows exactly which carcinogens in the diet cause most colorectal cancer evidence suggests that it somehow involves dietary fat. Many experts now believe that the fats that we eat interact with bacteria that live in the large bowel, leading to either bacterial formation of carcinogens or a failure of the body’s ability to breakdown carcinogens. This process takes a long time. It is generally believed that reducing the overall fat in the diet will reduce a person’s chance of getting colorectal cancer. Calcium is another substance that people should be sure they are getting enough of it, if they want to reduce their risk of colorectal cancer.

Sign symptoms : Symptoms of colorectal cancer can be as dramatic as blood in the stools or as seemingly innocuous as constipation or a change in bowel habits that persists for more than a couple of weeks. Diarrhoea, abdominal pain, pain in the lower back and bladder symptoms can be other signs. Minor problems such as haemorrhoids (piles) and persistent changes in bowel habits should be brought to the notice of doctors.

Two big risk factors are history of ulcerative colitis and family history of polyps in the large bowel.

Prevention : Low fat diet and intake of more fibres e.g. vegetables, fruits whole grain bran etc. and digital rectal examination once in a year.

Pancreatic Cancer

Pancreatic cancer usually hits people between 50 and 70 years, and one fifth most common cause of cancer deaths in USA.

Pancreatic cancer is often inoperable by the time it is diagnosed and cure rate is less than 2 per cent.

Warning signs : Jaundice (yellow eyes and skin), abdominal pain, loss of weight and appetite.

Risk factors are cigarette smoking and excessive drinking.

Prevention : No smoking, less fat intake, less drinking, plenty of fruits and vegetables and early detection of tumour and removal.

Lung Cancer


Each year about 140,000 people get lung cancer and about 125,000 people die from it. The vast majority of these deaths could be considered just a slow form of suicide, because more than 90 per cent of deaths due to lung cancer could be prevented, if people would take just one simple step : giving up smoking.

Lung cancer has now become the leading cause of death owing to cancer death in women,[1,6] and now lung cancer has surpassed breast cancer as the leading cause of deaths.

Certain cells in the bronchi (air passages to the lungs) produce mucus to wash out foreign matter and keep the lungs clean. Other cells are equipped with cilia-little hair that sweep the mucus towards the throat. Cigarette smoke causes the cilia to disappear, when that happens, mucus collects in the bronchi.

A “smoker’s cough” is really an attempt to force out the mucus and clear the lungs, but it does not clear them well enough. Continued smoking causes the cells to grow abnormally and eventually turn into cancer cells.

Smoking is not the only thing that harms your lungs. A small percentage of lung cancers are probably related to occupational hazards such as asbestos (among smokers especially), radiation and various chemicals. And while some research shows that people who live in polluted cities may get more lung cancer than people who don’t, the increased risk is found only among smokers.

Sign symptoms : Early symptoms of lung cancer include coughing, loss of appetite and weight loss. Others are harder to ignore - blood in the sputum, bout after bout of pneumonia, fever, weight loss and weakness.

There are three basic treatments for lung cancer, surgery, chemotherapy and radiation therapy. But in general these treatments are ineffective. The prognosis for lung cancer is dismal. Only 5-10 per cent are alive and well, five years after treatment.

Prevention : Abstention from smoking, consumption of fruits and vegetables, exercise and medical check up.

Liver Cancer

Although liver cancer can occur in younger age group, elderly men and haemophiliacs are at greater risk for liver cancer and that 50-60 per cent of all cancers may spread to the liver eventually.

Cirrhosis of the liver is linked closely to liver cancer. Some one with cirrhosis is 40 times as likely to get liver cancer as some one who has never had cirrhosis. Cirrhosis commonly results from alcohol abuse. But can also come from viral and parasitic infections, hepatitis, nutritional deficiencies and other illness. If you drink alcohol in excess, you are increasing your chances for cirrhosis and liver cancer. Elderly women who have a history of liver disease and oral contraceptives are at greater risk. However, greatest influence on the development of liver cancer in the world is hepatitis B virus which remains a serious problem for haemophiliacs and intravenous drug abusers.

If detected at an early stage surgical removal has good prognosis.

Sign symptoms : May vary depending on the cause and whether it is primary (rare) or secondary.

Prevention : Avoid drinking and smoking. If you have haemophilia, get regular medical check ups to discover possible exposure to hepatitis B virus.

Oral Cancer

Cancer of the tongue, pharynx, tonsils and oral cavity or mouth can be especially frightening because the mouth is so visible and so useful. However, some oral cancers respond well to treatment. Seventy per cent of oral cancers occur after the age of 45 years and elderly men (compared to women) are more vulnerable.

Prevention : Abstaining from using tobacco in any form and excessive drinking and consumption of vitamins A and B.

REFERENCES

1. Dhar HL. Gender, aging, health and society. JAPI 2001;49 : 1012-20.

2. Carol Keough. The complete book of cancer prevention. Part I. Rajendra Publishing House Pvt. Ltd., Mumbai. 1988; 1-3.

3. Crichlow RW, Galt SW. Male breast cancer. Surg Clin North Am 1990; 70 : 1165.

4. Carol Keough. The complete book of cancer prevention. Part I Rajendra Publishing House Pvt. Ltd., Bombay. 1988; 59-61.

5. Fried LP. Older women. Health status, knowledge and behaviour. In Falik MM, Collins (eds.). Women’s health, the common wealth health fund survey. Baltimore. Johns Hopkins Univ. Press. 1996.

6. Emster VL. Female lung cancer. Annu Rev Public Health 1996; 17 : 97-114.


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