Advanced age patients generally have late detection of disease, less aggressive consultation, more comorbidities, and more aggressive thyroid cancer than younger patients. These factors contribute to poorer outcomes in advanced age compared to younger patients.
Surgical treatment is still preferred
Age itself is not usually an absolute contraindication to thyroid cancer surgery, but if you are an advanced patient, you may have experienced some degree of degeneration and often have some underlying cardiopulmonary disease, which makes surgery more difficult and risky. Thyroid cancer surgery is performed under general anesthesia, and if you are elderly and have some more serious cardiopulmonary disease, you may be at risk for anesthesia, such as unstable blood pressure, cardiac arrhythmias, vascular embolism, and airway obstruction.
Despite this, the preferred treatment is still surgery, and as long as the indications for surgery are met and there are no significant contraindications, physicians will generally seek surgical treatment.
To determine whether you can safely survive anesthesia and surgery, your doctor will do a preoperative anesthesia evaluation, which is a thorough assessment of your health during the perioperative period to determine your tolerance for anesthesia, surgical risks, and postoperative outcomes to minimize the risks of anesthesia.
What is the anesthesia evaluation?
During the anesthesia evaluation, your doctor will carefully analyze the results of a number of preoperative tests, such as routine blood, urine, and stool tests, coagulation, liver and kidney function, an electrocardiogram, an X-ray chest x-ray, and indicators of infectious diseases. If you have a history of lung surgery or respiratory disease, pulmonary function may also be checked. Your nutritional and developmental status will also be evaluated, as poor nutrition often increases the risk of anesthesia.
If you have severe hypertension, coronary artery disease, or coagulation disorders, the preoperative workup and anesthesia evaluation will be more rigorous. In patients with hypertension, damage to the heart, kidneys, brain, and blood vessels is evaluated, and if the damage to these vital organs is mild, surgery is possible with medications to control blood pressure smoothly. If you have coronary artery disease and have had a myocardial infarction within 6 months, surgery usually cannot be performed.
What if I can’t have surgery?
If, after an anesthetic evaluation, your doctor determines that you are temporarily unable to tolerate surgery, he or she will recommend that you go to a specialist for aggressive treatment, and then re-evaluate for anesthesia and surgery once your underlying disease is under control and you are feeling better.
If you are unable to tolerate surgery, your doctor will consider other treatment options depending on your condition. If the lesion is small, there is no compression of the esophagus or trachea, and you are psychologically comfortable with it, you can consider follow-up with a follow-up ultrasound every 3 months to see if the lesion has progressed.
If the disease progresses and surgery is not possible, your doctor may consider radiation therapy or other methods.
Co-written by Dr. Weibo Xu, Cancer Hospital of Fudan University