The Elderly Patients With Colorectal Cancer: Epidemiology Characteristics, Clinical Features Characteristics And Treatment Strategies

Colorectal cancer is one of the most commonly diagnosised cancers wordwide,and it is the third most common cancer and the fourth most common cancer cause of death globally accounting for roughly 1,200,000 new cases and 600 000 deaths per year.The proportion of patients with colorectal cancer is rising year by year, and as the ageing of the population,the burden of colorectal cancer is rising among older patients. In our country,the incidence of colorectal cancer also increased year by year, and with the improvement of technology and living standars, the elderly patients gradually become the main population of colorectal cancer. Approximately 60% of cases develop over the age of 70, 43% of patients in total are 75 years or older,and the median age of diagnosis is 70 years old. The cornerstones of therapy are surgery, adjuvant chemotherapy(for patients with stage III/IV and high-risk stage II colorectal cancer), adjuvant radiotherapy(for patients with rectal cancer) and targeted therapy.With the decrease of physiological function and the increase of complications, elderly patients become the special group of people.So far, exclusion of elderly patients from randomized clinical trials has resulted in a lack of evidence-based guidelines. In this paper, the currently published datas were reviewed in terms of the epidemilogical characteristics,clinical features and treatment strategies of the elderly,aimed to provide the evidence-based guidelines for the elderly.Through a systematic literature review,we found that there is gender differences in elderly patients with colorectal cancer.The clinical features include more right-colonic carcinoma,low malignant degree,advanced stage and more multiple primary colorectal carcinoma(MPCC). As to the treatment strategies,following initial screening and CGA,the fit patients also recommend the same treatment like the younger. For stage I-IV elderly patients, surgery is still the first choice,and the minimally invasive surgery like laparoscopic surgery has the advantage. For patients with high-risk stage II and stage III elderly patients, the 5-FU based adjvant chemotherapy is recommend to use, but not recommended in combination with oxaliplatin.The unresectable stage IV elderly patients, the reduction combination chemotherapy is recommended,and the fit patients also recommend target drugs combined with chemotherapy.For elderly patients with rectal cancer,the choice of preoperative radiotherapy need to follow the individual clinical condition, but not recommend postoperative radiotherapy.