EVERY cancer is different. You may be diagnosed with the same cancer as a friend or relative but that doesn’t mean that the outcome will be the same.
Consultant clinical oncologist Dr Ahmad Radzi says senior citizens diagnosed with cancer should not have a defeatist attitude by thinking that they will suffer the same fate as someone else who has the same cancer.
“I think that’s the wrong attitude because now we tend to go into what is called personalised treatment because your cancer is different from other people’s cancer. The behaviour of the cancer may be different, the stage may be different, and the treatment may be different. So, it’s not fair to start comparing your cancer with that of a friend’s. One person may be having a very aggressive cancer and the other may not,” he adds.
Ageing and cancer
According to Dr Ahmad Radzi, the incidence of cancer increases as a person ages. It could be part of the ageing process, whereby our cells may be mutating more as we age. This could be because we are exposed to more environmental factors, or it could be because we have some defective genes.
“For those with a family history, you can see that they start to have cancer earlier.
“However, there are multiple processes involved for cancer to happen. It doesn’t just happen with one mutation; it may take a number of mutations.
“Certainly, for somebody who has no family history, it takes a long time for the cancer to form. People who have no background mutation in their genes, have normal genes. When they are exposed to multiple factors including chemicals, carcinogens, too much sunlight, or even the kind of food that they take, the mutating genes may slowly increase.
“So, I would say it is part of the ageing process. On the whole, a majority of cancers start to appear in the fifth decade, when people are in their 40s and slowly it increases,” says Dr Ahmad Radzi.
Senior citizens aren’t the only ones who should watch out for symptoms of cancer. Dr Ahmad Radzi says people as young as their 40s should also start looking out for any unusual symptoms.
What to look out for? Any new symptoms which are prolonged. If you have any unusual and new symptoms, make sure you get it checked out by a professional healthcare provider.
“For example, lung cancer – again, this is something that occurs as people get older and some of them are smokers, but some are not.
“A person might have smoker’s cough. If the cough becomes more intense, or if there is now blood in the sputum, if he now gets short of breath, if he has chest pain that doesn’t go away or back pain that doesn’t go away … these may all suggest something is wrong.
“Every system, whether it is lung or digestion or something else, when you have something that is not supposed to be there and it’s prolonged, you should seek a medical opinion and do so early. What more when you are older and know that cancer is one of the common illnesses that the elderly get,” says Dr Ahmad Radzi.
He admits that it is harder to detect such symptoms as a person grows older because they may already have many other health issues and symptoms.
It would then be up to the doctor to find out the medical history and discern if it warrants further investigation.
“Treating senior citizens with cancer is often more challenging because they have other co-morbidities – they have heart disease, diabetes, hypertension, and sometimes they also present late. One of the reasons why they come in late is because they think the symptoms are normal for their age,” says Dr Ahmad Radzi, explaining that early detection can lead to treatment and even remission.
While there are more options in terms of treatment these days, the options become limited as a person ages because of complications due to other health issues.
While surgery is the best first option, it is not always possible because of the patient’s age and the risks involved.
Dr Ahmad Radzi says that if he has a a patient who is 80 years old, with colon cancer and uncontrolled hypertension and diabetes, the doctors would need to discuss with the family the risks involved in a surgery. Some medical centres and hospitals may even discourage surgery because the waiting list is long.
Surgery is not out of the question just because you are a senior citizen, however. For those with no co-morbidities (other health problems), it’s a lot easier. Age then becomes just a number.
Dr Ahmad Radzi gives the example of a senior citizen with COAD (chronic obstructive airways disease) who cannot walk far without oxygen and has rectal cancer.
“The doctor will probably say we can’t give you surgery, but maybe you can see the oncologist for chemo or radiotherapy.
“The oncologist may give some chemo and radiotherapy and hopefully it will shrink the tumour, but that is not the best treatment. The best treatment is still surgery, and perhaps followed by chemo and radiotherapy.
“On the other hand, if you have a 50-year-old lady who has gone through menopause and has early cervical cancer without any co-morbidity, we will recommend surgery or therapy, because in this case surgery for Stage 1 and chemo-radiotherapy are comparable. In this kind of situation it is okay, but not in a situation where the patient cannot undergo surgery without having a high risk of mortality happening on the operating table,” he explains.
Chemotherapy may not be the best option for all. For some patients, their liver and kidney may not be able to cope with certain types of chemotherapy, he informs.
Cancer sufferers often look for alternative treatment – whether it is fruit juices, acupuncture or teas.
Among the repeated questions Dr Ahmad Radzi gets is whether things like apricot seeds actually help cure cancer.
“I heard about it for the very first time in the 1980s when my cousin had cancer. When you do not want the standard treatment because it is associated with some side effects, you start searching for alternatives. When you start searching for alternatives, you are bound to come across these things and people will start recommending certain things but these are not proven to work,” he says.
Dr Ahmad Radzi advises senior citizens to be careful so as not to be taken in so easily.
“They should just leave it to the health professionals to handle this,” he says.
A senior citizen going in to see a doctor to relate his symptoms and get a diagnosis should be accompanied by family or friends. If it is cancer, having a support system will help the elderly cope with the news and make a decision on the next course of action.
“With the family around, the elderly will have all the support they need. But it’s not the same for somebody who is alone – they start thinking of who is going to pay the bill, whether they will be around next year, whether they will celebrate Christmas next year, if they are gone who is going to take care of the house …. There are a lot of things that start coming into their mind and it can lead to depression. That’s why family support is very important.
“Depression can be a real problem especially if there is no one to help or ease the burden of the diagnosis, bills and possible side effects from the treatment,” he adds.
Here are some things that Dr Ahmad Radzi wants senior citizens to know:
1) As you live longer, you stand a higher chance of getting cancer.
2) Cancer, if treated early, is still curable. The most important aspect about having treatment early is that you may need only one modality of treatment, for example just surgery. In such cases, the patient does not need to consider having radiotherapy or chemotherapy which have their own costs, side effects and survival chances.
3) Lung cancer – Often, by the time the symptoms start manifesting and the patient comes in, it is too late as it is in the advanced stage.
4) Now you can even take pills for certain cancers; you don’t necessarily have to go through radiotherapy or chemotherapy.
5) Sometimes, it may come down to making the choice of prolonging your life versus having quality of life. It all depends on the stage of the cancer, your fitness and age, and the options available.