Renal cancer in the elderly

Abstract

The incidence of renal cell cancer is increasing worldwide. The longevity of the population is also increasing in the Western part of the world, and consequently, we are faced with more elderly patients harboring renal tumors. The consequence of the increased life span is that in older patients all treatment options have to be discussed. Surgery in the elderly can be associated with the potential for significant morbidity and mortality, not only associated with anaesthesia and surgery, but also from existing co-morbidity and reduced physiological reserve rather than cancer stage. The morbidity and mortality of surgery needs to be balanced against the risk posed by the tumor, which can be more aggressive in octogenarians compared to renal tumors in younger patients. The careful evaluation of patients' functional status and co morbidities is mandatory for treatment decisions. Expectant management for small renal masses is indicated only to patients with serious co-morbidities or to those who deny surgery. Minimal invasive techniques are the treatment of choice and nephron sparing surgery (NSS) has the advantage of preservation of the renal function. The oncological outcome from NSS seems not to be different between young and old patients. Open radical surgery is also an option in properly selected patients. Morbidity and mortality rates related to open surgery in older patients did not differ significantly from that of younger patients. Advanced age alone should thus not be used as a criterion to deny surgery for renal cell carcinoma. However, older patients should be counselled regarding a tendency for increased perioperative mortality related to co-morbidity.No differences were observed in the outcome from systemic treatments in advanced/ metastatic disease between the young and older patients groups. © 2011 Nova Science Publishers, Inc. All Rights Reserved.