PREVENTION OF CANCER INELDERLY SUBJECTS
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.
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.
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.
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.
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,
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
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 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
CANCER SPECIFIC TO ELDERLY WOMEN
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 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.
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.
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.
High predominance in older women has been reported in literature.
CANCER AFFECTING BOTH SEXES
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
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 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
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.
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
Prevention : Abstention from smoking, consumption of fruits and vegetables,
exercise and medical check up.
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)
Prevention : Avoid drinking and smoking. If you have haemophilia, get regular
medical check ups to discover possible exposure to hepatitis B virus.
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.
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2. Carol Keough. The complete book of cancer prevention. Part
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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.