Assoc Prof Ravindran Kanesvaran, Deputy Head and Senior Consultant of the Division of Medical Oncology at National Cancer Centre Singapore (NCCS), answers your questions about cancer in the elderly.
Cancer in the Elderly - Doctor Q&A
One in every four to five Singaporeans may develop cancer in their lifetime, and the number of people living with cancer will continue to increase.
According to a
National Cancer Centre Singapore (NCCS) study, elderly cancer patients in good mental and emotional health are likely to have a better chance of recovery than those who are not (click
here to read the article).
As the featured doctor for this month's 'Ask the Specialist' forum,
Assoc Prof Ravindran Kanesvaran, Deputy Head and Senior Consultant of the
Division of Medical Oncology at NCCS, a member of the
SingHealth group, and also an Associate Professor at
Duke-NUS Medical School and clinical senior lecturer at the Yong Loo Lin School of Medicine, National University of Singapore, will answer your questions about cancer in the elderly.
This Ask The Specialist forum has closed. Thank you for your interest and participation.
1. Question by J******
Hi,
I am 54 year old now, I have many pain from my neck, arm, knee and etc. I am still able play a soccer game until recently, I try to play half game now, due to after my game, it takes me longer to recover to my normal stage.
My pain in my body come and go, I have seen many doctors and went through many physiotherapy. It doesn’t help me much. I am a very active person and because of my pains, I worry that I can’t continue to be active.
Are all the pains that I have, will cause me to get cancer easier? I tried to eat healthy and exercise regularly. I am hoping that I will not die of cancer. Hope you can advise me what I should do to prevent getting cancer at early age. Thank you and hope to have your reply.
Answered by Assoc Prof Ravidran Kanesvaran:
Dear J******,
Thank you for the question. You have done the right thing in seeking professional medical help in trying to solve your problem of persistent pain. I hope that you will find a cause for this problem soon. However, pain on its own does not mean you have cancer nor does it increase the risk of getting cancer. With regards to cancer prevention, maintaining a healthy lifestyle by exercising ( like you regularly do) and eating a healthy diet would be the best way forward. You should also see a doctor to discuss cancer screening for certain cancers like colorectal cancer which is common and can be cured if detected early.
2. Question by P****
I have an elderly lady friend dying of cancer. Doctors said there's no hope and send her home for her last days. She can't eat and only take a bit of water. This is like starving her to death. Why is nutrition not given her by other means?
Answered by Assoc Prof Ravidran Kanesvaran:
Dear P****,
Thank you for the question. Am sorry to hear about your friend who is in her terminal stages of cancer. At this stage, the goal of her care is to palliate her symptoms and keep her comfortable. Usually at this stage, patient’s have very poor appetite and do not want to eat due to the cancer. In such a situation we should not force them to eat (as it will make them feel more miserable) or forcefully provide other forms of nutrition which will only prolong their suffering.
3. Question by M*****
Dear Dr,
1.How to prevent elderly patients from getting stroke during stage 2B womb cancer treatments and surgery?
2.What is the max age & minimum health status for elderly patients to be allowed for total womb removal surgery?
3.What is stage 2B womb cancer recovery success rate of elderly stroke patients of age above 80 to do total womb removal surgery and radiotherapy treatment?
Answered by Assoc Prof Ravidran Kanesvaran:
Dear M*****,
Thank you for your questions. Here are my replies:
1.Stroke risk (and risk of getting blood clots) is slightly higher in cancer patients compared to non-cancer patients. One way to reduce this risk is to keep ambulant. Being bed ridden or chair bound increases such a risk. It is also important to ensure blood pressure is controlled as well.
2.There is no maximum age for surgery. Fitness for surgery will depend on the physiological age of the patient (ie.their functional status and organ function). There are many elderly patients who are very fit and active , hence age should never be a factor when deciding on fitness for surgery.
3.This is a difficult question to answer as recovery from surgery and radiotherapy (RT) can only be assessed in person under the careful management of a surgeon and radiation oncologist respectively, before the procedure is done. In an elderly patient who had previous history of stroke, pre-op assessment is critical in deciding if the patient is fit to proceed with surgery or RT in the first place.
4. Question by N***
Hi Dr,
My mom just recently diagnosed with High Grade B cell Non Hodgkin's Lymphoma. She was advised by her doctor to have chemotherapy but she refused. Now we are having hard time thinking what alternative treatment i we can do for her as she seems reluctant to every treatment offered to her. Will proper diet and family support be enough? What are our hopes for her case?
Answered by Assoc Prof Ravidran Kanesvaran:
Am sorry to hear about your mother. She has an aggressive form of lymphoma which will respond quite well to chemotherapy if she is fit to receive it. In fact, a proportion of patients even in the late stage of the disease can attain long term disease control with chemotherapy. However, it is her choice and it has to be respected. In general, supportive care as you described will not be able to treat her cancer or improve her survival.
5. Question by S**
Dear Prof Ravindran,
I had a Prostatectomy done in 2013 to get rid of my prostate stage 1 cancer a moderately aggressive.
1.I am now aged 72 and my PSA blood test is around 0.05, hope this not a sign of cancer cell spread
2.What are the top 5 types of common cancers that afflict elderly Chinese males?
(I have come across elderly friends of my age died of cancers of Prostate, Colon, Brain, Lymphoma, Pancreatic, etc.)
3.Early detection, better chance of a cure:
◾What are the specific symptoms I need to look out for? (for each of the 5 common Cancers in the elderly).
◾What specific cancer blood marker test would you suggest?
(I have polyps and diverticula diseases had colonoscopy done 5 years ago).
Thank you very much Prof Ravindran, for your loving care and advice.
Answered by Assoc Prof Ravidran Kanesvaran:
Thank you for writing to us. Based on the description provided you are fortunate to have your cancer diagnosed in an early stage and attain cure.
1.Regarding the PSA, it is detectable now (I presumed it was not before), and hence you should consult your urologist about the next best steps.
2.The most common male cancers are colorectal cancer, lung cancer and prostate cancer
3.Usually it will be constitutional symptoms like loss of weight, loss of appetite and symptoms specific to the system involved (e.g. cough and shortness of breath for lung cancer). Cancer blood markers are poor markers for cancer screening because of its lack of specificity and I would not recommend doing it (guidelines do not recommend this too). Instead see a medical professional for a full examination should you suspect you have symptoms I described above or feel unwell.
6. Question by T**
Dear Doctor,
For a 70-year-old patient with enlarge Prostate, if he chooses not to seek any treatment (either by medication or any surgery), will it lead to cancer one day?
Answered by Assoc Prof Ravidran Kanesvaran:
Thank you for your question. If it was diagnosed as benign prostatic hyperplasia (BPH), then you just need to treat it to alleviate your symptoms and to continue follow up with your doctor. The treatment for BPH does not prevent the development of cancer in the future and is only for symptom relief.
7. Question by J**
Dear Assoc Prof Ravindran,
My husband’s aunt was diagnosed with diabetes during her 20+ and had been taking diabetes medicine ever since. Just last year, she was diagnosed with pancreatic cancer. She was 73 years old. Is there correlation between her being diagnosed with diabetes at such young age and the eventual failure of her pancreas which is the organ responsible for producing hormone insulin? Should one who is at risk of being diabetic be more cautious and go for regular checks due to higher risk of pancreatic cancer at old age?
Answered by Assoc Prof Ravidran Kanesvaran:
Dear J**,
Am sorry to hear about your husband’s aunt and her diagnosis if pancreatic cancer. Yes, there is an association between diabetes and pancreatic cancer. By having good control of diabetes ( type 2), one can mitigate the risk of pancreatic cancer to some extent. Currently there is no screening test for this cancer, hence the best way to reduce the risk is by having good glucose control.
8. Question by J**
Hi Doctor,
My Mother In Law has liver cancer that is spread from her salivary gland cancer. At her age of 90, we wonder if immunology works for her.
Answered by Assoc Prof Ravidran Kanesvaran:
Am sorry to hear this. The key thing at this age and having advanced cancer is to determine her functional status and establish her life goals. She needs to be aware that treatment (even with immunotherapy) may just prolong life and will not cure her. Hence the focus should be on quality of life.
About Assoc Prof Ravindran Kanesavaran
Associate Professor Ravindran Kanesvaran is Deputy Head and Senior Consultant of the Division of Medical Oncology of the National Cancer Centre Singapore, and he is also an Associate Professor at Duke-NUS Medical School and clinical senior lecturer at the Yong Loo Lin School of Medicine, National University of Singapore.
His research interests include GU oncology and geriatric oncology, and he has published in a number of well-known peer reviewed journals including Journal of Clinical Oncology and Lancet Oncology. He is the National Representative and also the first Asian to be President-Elect for the International Society of Geriatric Oncology (SIOG).
Ref: M19
