Aerorespiratory tract cancer in older patients

Lung cancer and head and neck cancer present distinctive management challenges in the elderly population. Cumulative tobacco exposure is a risk factor for both types of cancer. Smoking-related comorbidities, including cardiovascular disease and chronic obstructive pulmonary disease, will also increase with cumulative tobacco exposure and can complicate surgical or radiotherapeutic management. Some differences in natural history, such as a greater tendency toward localized disease in non-small cell lung cancer and a lesser correlation with tobacco/alcohol exposure in head and neck cancer, have been noted for older patients. However, standard treatment modalities do appear to maintain efficacy in the elderly population. If comorbidities and physiologic age (rather than strict chronologic age) are taken into account, effective interventions can be devised with benefits similar to those seen in younger populations. Although prevention remains the mainstay of management of aerorespiratory cancers, carefully planned treatment can result in therapeutic benefit with maintenance of quality of life. © 2004 Elsevier Inc. All rights reserved.