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Adjuvant therapy for resected colon cancer in elderly patients

Hanna K Sanoff, MD, MPH
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD


Approximately 135,430 new cases of large bowel cancer are diagnosed each year in the United States, of which 95,520 are colon cancers; the remainder arise in the rectum [1]. Global, country-specific incidence rates for colorectal cancer are available through the World Health Organization GLOBOCAN database.

Age is a major risk factor for colorectal cancer (figure 1) [2]. The median age at diagnosis is 71. Approximately 70 percent of cases develop over the age of 65; 40 percent are 75 years or older. The United States Census bureau projects that by the year 2030 the number of Americans over age 65 will double [3]. As a result, the number of patients over the age of 70 presenting for colorectal cancer care is expected to rise.

Surgical resection is the only curative treatment for locoregional colon cancer, and outcome is most closely related to the extent of disease at presentation (table 1 and figure 2) [4]. For patients who have undergone potentially curative resection, disease recurrence is thought to arise from clinically occult micrometastases that are present at the time of surgery. Postoperative (adjuvant) systemic chemotherapy is recommended for high-risk patients to eradicate these micrometastases, thereby increasing the cure rate.

This topic review will cover the benefits, risks, and choice of adjuvant chemotherapy for elderly patients with resected colon cancer. A general discussion of the benefits of adjuvant chemotherapy for resected colon and rectal cancer, surgical management and prognosis of colon cancer, chemotherapy considerations in older individuals with advanced colorectal cancer, a compilation of chemotherapy protocols for colorectal cancer, and recommendations for posttreatment follow-up are discussed separately. (See "Adjuvant therapy for resected stage III (node-positive) colon cancer" and "Adjuvant therapy for resected rectal adenocarcinoma" and "Overview of the management of primary colon cancer" and "Therapy for metastatic colorectal cancer in elderly patients and those with a poor performance status" and "Treatment protocols for small and large bowel cancer" and "Surveillance after colorectal cancer resection".)


The essential principles of treating colon cancer in the elderly are the same as in younger patients. However, for older patients, who may have age-related organ function decline and comorbid conditions that may limit life expectancy, special attention must be paid to the risks of chemotherapy, including both treatment-related toxicity and quality of life issues.

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Literature review current through: Nov 2017. | This topic last updated: Jul 13, 2017.
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