There is a saying that when people reach old age, they are “weak, windy and susceptible to all kinds of diseases”, which refers to the gradual aging of the organs of the human body with age. Older people have weak resistance to diseases and poor repair ability, and are prone to diseases, which make them a high risk group for cancer.
I. Clinical characteristics of cancer in the elderly
1. Cancer in the elderly develops relatively slowly
Due to the poor biological activity, reduced cell growth function and low metabolic function of the elderly, the development of cancer in the elderly is relatively slower than that of the young, and the degree of cell differentiation is relatively good. The same cancer in the elderly and young people has a lower malignancy and slower progression than young people, and the survival period with tumor is longer.
2.Cancer in the elderly is easily combined with malignancy
Elderly people have less diet, less energy, lower basal metabolic rate, lower resistance to disease, increased consumption of the body in cancer, tumor cells need nutrition to grow, resulting in weakened digestive function, decreased nutrition level, negative nitrogen balance, electrolyte disorders, prone to cachexia, poor physical condition, and difficulty in tolerating chemotherapy and radiotherapy.
3.Cancer in the elderly is often accompanied by other diseases
Clinically, cancer in the elderly is often accompanied by cardiovascular and cerebrovascular diseases, chronic bronchitis, diabetes and prostate enlargement. Elderly people have fewer brain cells, reduced sensitivity to touch, hearing and vision, reduced reactivity and memory.
Reduced responsiveness, memory, and susceptibility to dementia. Degeneration of the kidneys, reduced kidney function, equivalent to 50% of that of young people, when blood loss, dehydration and hypotension occur, the inability to compensate and acute renal insufficiency results. Clinical signs and symptoms are not always compatible with the pathology. The pathological changes are heavier and appear earlier than the clinical manifestations, and when the disease is severe, multiple organs are easily involved and multi-organ failure occurs.
4. Cancer in the elderly is easily misdiagnosed
Due to the cover-up of other diseases, clinical symptoms are atypical or due to poor general condition and slow response, atypical symptoms and signs of cancer are easily ignored and delayed. The disease is only diagnosed when there are complications and the disease is advanced and there are no more indications for surgery, chemotherapy and radiotherapy. Commonly misdiagnosed diseases include chronic bronchitis, pneumonia, tuberculosis, hemorrhoids, enteritis and gastritis. The common reasons for misdiagnosis are: early symptoms are covered up by the original disease, atypical x-ray performance, prolonged anti-inflammatory time, etc.
5.More cancers in the middle and late stages in the elderly
However, if the lesion is small and independent, or if the tumor is well differentiated, growing slowly and in good general condition, we should try our best to fight for surgery, choose carefully and operate cautiously to achieve good curative effect.
6. Precancerous lesions in old age are easily transformed into cancer
Many benign lesions can be easily induced into cancer by carcinogenic factors in old age due to organ failure and low immune function, so it is very important to diagnose and treat precancerous lesions in the elderly. Common precancerous lesions include: long-lasting ulcers, leukoplakia of the external mucosa of the mouth, chronic proliferative inflammation of the esophagus, reflux bronchitis, superficial gastritis, gastric ulcer, cystic breast hyperplasia, chronic cirrhosis of the liver, and sudden enlargement of the prostate gland in men. Clinically common geriatric cancers such as recurrent focal locoregional pneumonia before diagnosis, gastrointestinal cancer with some gastrointestinal polyps, gastritis, ulcers and positive fecal occult blood for a period of time, and anal hemorrhoids should be actively treated, regularly examined and prevented from becoming cancerous.
7.High incidence of bone metastasis in elderly cancer
The metastatic sites of lung cancer are more common in the thoracic spine, and the distribution is centripetal. Prostate cancer is more common in the lumbosacral spine, and breast cancer bone metastasis is more common in women. Bone metastasis of prostate cancer has the highest incidence, followed by kidney cancer.
II. Treatment of cancer in the elderly
Most of them have complications and infections, and most of them do not have the chance of surgery, so comprehensive treatment should be adopted.
1.Western medical treatment
For those who can undergo surgery in the early stage, try to remove it as much as possible. For middle and late stage cancer without surgery, radiotherapy and chemotherapy should be used, depending on the patient’s physical condition and comprehensive consideration, and individualized treatment should be achieved. The physiological function of the organs of the elderly decreases, the excretion of drug metabolites is slow, the renal function of the elderly degenerates, the renal blood flow and glomerular filtration rate decreases, the detoxification function of the liver decreases, and almost all non-oral drugs increase the blood concentration and half-life of the elderly due to the long metabolic elimination time, which causes accumulation of poisoning.
Anti-cancer drugs have poor specificity and selectivity to cancer cells, which can kill cancer cells and cause great side effects to normal tissues of human body. Therefore, in the chemotherapy for elderly cancer, it should be different from person to person and should not use fixed drugs and doses in a uniform way. If the amount of radical chemotherapy is poor, such as poor heart and kidney function, the toxic side effects of chemotherapy will increase, and complications such as bone marrow suppression and infection will increase the possibility of death, so the dose of chemotherapy should be individualized, and it is recommended to use single drug chemotherapy, such as Jianzhi and Tysol. For elderly people with poor biological activity and slow cell proliferation compared with young people, oral chemotherapy drugs or intraperitoneal infusion chemotherapy drugs can be given to control tumor locally for palliative treatment. Radiotherapy for elderly cancer should be given as conformal intensity modulated radiotherapy to reduce radiation exposure to normal tissues and prevent radiation pneumonia, enteritis and cystitis.
2.TCM treatment
Based on the principles of dialectical treatment, examination of evidence to find the cause and treatment of the root of the disease, TCM treats cancer in old age by attaching importance to vital energy, advocating that elimination of evil should not harm the righteousness and support of the righteousness should not leave the evil behind, and that all drugs that can harm the spleen and stomach should not be overdone to harm their righteousness. Chinese anti-cancer drugs are mostly used to clear heat and detoxify, invigorate blood circulation and remove blood stasis, soften hardness and disperse knots, which can easily injure yin and consume qi, damage spleen and stomach, and involve liver and kidney, therefore, the treatment method is based on tonic method and both attack and supplement. Therefore, the treatment method is mainly based on tonic method, and both attacking and tonic methods are applied. Most of the tonic methods are mainly warm tonic, clear tonic and dietary tonic, and the tonic should be avoided or slowed down. Qi deficiency and blood stasis is the basic pathogenesis of cancer in the elderly.
Older people have weak spleen and stomach, premature kidney failure, qi deficiency and inability to unify blood, often manifesting as physical fatigue, soreness of tendons and bones, tooth marks on the tongue and petechiae on the tongue. Experimentally, it has been proved that the qi tonifying effect of dang ginseng, atractylodes, astragalus and reishi have the effect of enhancing the phagocytosis of reticuloendothelial system, astragalus also has the effect of promoting the body to produce interferon; the yin nourishing medicine saxifrage, yuan shen, maitong and roasted turtle nail have the effect of prolonging the survival time of the body cells; the aphrodisiac medicine cinnamon, Xianmao, Semen Cuscutae and Huangjing have the effect of promoting the survival of antibodies in advance.
On the basis of these tonic medicines, such as Salvia miltiorrhiza, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, etc., the effect of activating the blood and replenishing the blood will be better. The author believes that the method of attacking poison with poison is not suitable for old people with cancer. Elderly cancer takes care of the spleen and stomach as the first priority, while worm medicine stimulates the gastric mucosa and damages the spleen and stomach, which directly affects the patient’s appetite, leading to a decrease in appetite and weakened spleen and stomach function.
3.Immunotherapy for elderly cancer
Immunotherapy is an integral part of comprehensive cancer treatment. Immunotherapy, such as interleukin, interferon, tumor necrosis factor and other passive therapies, are given to elderly cancer with the aim of stimulating the natural immunity of the host to play the role of anti-tumor, which is less effective than surgery, chemotherapy and radiotherapy, but is still one of the effective measures.
4.Diet therapy for elderly cancer
TCM diet therapy is characterized by the fusion of food and medicine, which is a way to maintain health and prevent diseases. It is a method to combine medicine with diet to complement the shortcomings of other therapies to improve the efficacy.
The diet of elderly cancer patients should pay attention to the following points
1. Food should be administered according to different evidence of disease. For example, it is appropriate to use tonic food for deficiency, and to use food to dispel evil for solid evidence, to use warming and dispersing food for cold evidence, and to use clearing food for heat evidence. Yang deficiency should eat hot food, such as litchi, beef, dog meat, etc.; Yin deficiency should eat nourishing and clearing products, such as lily, silver fungus, etc.; regardless of cold and heat deficiency, all brutal supplementation, it is difficult to help patients recover. For example, snapper is a cool nourishing product, which is not suitable for those with cold stomach; eel is a warm tonic, which is suitable for those with cold stomach. Food includes yam, coix seeds, mountain hold, milk, red dates, millet, chicken, duck, fish, etc.
2, diet should be adapted to the four seasons of the climate. The four seasons of climate alternation, humans must comply with the laws of nature and not contrary. In spring and summer, the Yang energy is strong and everything is vibrant, so you should try to eat less dog meat, mutton and other warm products; in autumn, when everything is dry and depressed, patients often have dry mouth and epistaxis, so they should try to eat less hot and spicy food and eat more watery fruits; in winter, when it is cold, you should eat less cold food and it is appropriate to eat warm and tonic products, such as oranges, beef and mutton.
3.Adjust diet according to different treatments. Elderly cancer patients undergoing radiation treatment are prone to internal heat and yin deficiency, such as dry mouth and sore throat, mucous membrane ulcers, etc. They should supplement products that nourish yin and produce fluid, such as fresh vegetables and fruits, and avoid spicy and stimulating foods. After surgery, elderly cancer patients have suffered a major injury to their vital energy and their digestive and absorption functions have decreased. For elderly cancer patients who suffer from deficiency of qi and blood after chemotherapy, it is advisable to consume products that benefit qi and replenish blood, such as American ginseng, astragalus, wolfberry, etc., to restore physical strength and ensure the smooth progress of chemotherapy.
Foods related to cancer prevention, such as Ganoderma lucidum, shiitake mushroom, black fungus, Chinese wolfberry and Coix seed, contain polysaccharide substances, which can improve the immunity of the body and inhibit the growth of tumor. Vegetables such as carrots, cabbage, lettuce, jujube, sympathetic cabbage and bac choy contain essential nutrients, vitamins and trace elements, which are necessary in the process of enzyme metabolism and can improve the phagocytic function of reticulocytes and leukocytes and enhance the body’s ability to resist diseases. The volatile oil contained in garlic, onion and asparagus has the effect of inhibiting and blocking the transformation of nitrate into the carcinogenic substance amine nitrite. It is beneficial to the recovery of elderly cancer patients to eat more of the above-mentioned foods in normal times.
In conclusion, no matter what treatment methods are used, while eliminating the evil, attention should be paid to protect the positive energy. In the comprehensive treatment of cancer in the elderly, low-invasive surgery should be adopted, together with reasonable doses of radiotherapy, and based on the combination of evidence and disease identification, corresponding treatment rules of “supporting the righteousness and eliminating the evil” should be formulated to maximize the inhibition of tumor growth, while protecting the righteousness of the body, improving the clinical symptoms of patients, improving the quality of survival, and prolonging the The treatment method is based on the combination of diagnosis and treatment of disease.