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Colorectal Cancer

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Geriatric Gastroenterology
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According to the World Health Organization (WHO), colorectal cancer (CRC) is the second most common tumor among both men and women, after lung tumors. CRC is one of the most common age-related cancers and a common cause of cancer-related deaths. Approximately 60% of individuals with CRC are >70 years of age at the time of diagnosis, and 43% are >65. The risk is higher in women, with 27% of cases over age 80 years. It is not surprising that the incidence is increasing since there is a global increase in the number of older adults. Rectal cancer predominantly affects persons >70 years, with a peak incidence at age 80–85 years.

There is a marked difference in the incidence of CRC between the affluent nations with a High Developmental Index (HDI) with a high incidence and low incidence in developing nations. The modifiable risk factors are many for the sporadic type of CRC, which accounts for over 90% of the cancers in older adults, in contrast to genetic types of CRC.

Many screening options are available. Colonoscopic screening for CRC is advocated for all healthy adults above the age of 50 and even for healthy older adults irrespective of chronological age but based on anticipated life expectancy.

Treatment modalities, in general, are surgery for stage I or II; surgery followed by adjuvant chemotherapy for stage III colon cancer, and in cases of metastatic CRC (mCRC) systemic chemotherapy alone or with targeted biologics. The goals of surgery in rectal cancer include removal of the tumor, avoid local recurrence, and, if possible, preserve sphincter function. With appropriate geriatric and nutritional assessment, the prognosis of CRC in the older adult has improved. Solely based on older age, a patient should not be excluded from any advanced treatment options available to the younger patients.

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Correspondence to C. S. Pitchumoni .

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Pitchumoni, C.S. (2021). Colorectal Cancer. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham.

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