Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old - Review

Sep 24, 2026

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Background: An increasing proportion of cancer patients present at advanced age, creating major obstacles to successful and well-tolerated therapy. In the geriatric group older than 80 years, the difficulties intensify due to comorbidities and reduced organ function reserve. Methods: Narrative review of literature on presentation, treatment, and prognosis, plus assessment of molecular attributes in genomic cohorts, with comparisons to younger patients. Results: Octogenarians show similarities to younger patients but more right-sided colon cancers; surgery can be feasible in selected patients, adjuvant chemotherapy is underused, combination regimens are often not advised, while fluoropyrimidine-based monotherapy can be feasible and effective. Conclusions: Optimized outcomes require standard treatments adapted to functional status and organ reserves, with enhanced support to reduce therapy-related adverse outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

1. Introduction

Epidemiology and age-related cancer burden

Screening and diagnostic delays

Treatment challenges in patients over 80 years

Surgery and perioperative risks

Chemotherapy tolerability and adverse effects

medicina Review Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old Ioannis A. Voutsadakis 1,2 Citation: Voutsadakis, I.A. Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old. Medicina 2023, 59, 1574. [https://](https://)[ ](https://)[doi.org/10.3390/medicina59091574](doi.org/10.3390/medicina59091574) Academic Editor: Ludovico Abenavoli Received: 1 August 2023 Revised: 23 August 2023 Accepted: 28 August 2023 Published: 29 August 2023 Copyright: © 2023 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Algoma District Cancer Program, Sault Area Hospital, 750 Great Northern Road, Sault Ste. Marie, ON P6B 0A8, Canada; ivoutsadakis@yahoo.com or [ivoutsadakis@nosm.ca](ivoutsadakis@nosm.ca) 2 Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada Abstract: Background: An increasing proportion of the population of patients with cancer presents at an advanced age, increasing the challenges of successful and well-tolerated treatments. In the older spectrum of the geriatric cancer patients, those older than 80 years old, challenges are even higher because of increasing comorbidities and decreasing organ function reserves. Methods: Studies regarding colorectal cancer presentation, treatment, and prognosis in patients older than 80 years old available in the literature were evaluated and were compiled within a narrative review. Molecular attributes of colorectal cancer in the subset of patients older than 80 years old in published genomic cohorts were also reviewed and were compared with similar attributes in younger patients. Results: Characteristics of colorectal cancer in octogenarians are in many aspects similar to younger patients, but patients older than 80 years old present more often with right colon cancers. Surgical treatment of colorectal cancer in selected patients over 80 years old is feasible and should be pursued. Adjuvant chemotherapy is under-utilized in this population. Although combination chemotherapy is in most cases not advisable, monotherapy with ﬂuoropyrimidine derivatives is feasible and efﬁcacious. Conclusions: Outcomes of colorectal cancer patients over the age of 80 years old may be optimized with a combination of standard treatments adjusted to the individual patient's functional status and organ reserves. Increased support for the older age group during their colorectal cancer treatment modalities would improve oncologic outcomes with decreasing adverse outcomes of therapies. Keywords: gastrointestinal; geriatric population; adverse effects; toxicity; disparities 1. Introduction Cancer is commonly a disease of the old, and median age at diagnosis considering all disease sites is 65 years according to U.S. Surveillance, Epidemiology and End Results (SEER) data [1] . Cancer registry data from Canada showed that 16% of cancer patients aged 45 to 99 years old were diagnosed at age 80 or older [2] . Several common cancers such as lung carcinomas, prostate cancer, and gastrointestinal carcinomas have a median age at presentation above 65 years old [3] . In 2018, colon and rectal cancers accounted for over 1.8 million cases worldwide and 860,000 deaths. Improvements in survival relating to metastatic colorectal cancer have been accomplished in recent decades with incremental beneﬁts obtained by the introduction of more effective chemotherapies, targeted therapies, and a decreasing mortality trend. Colorectal cancer presents at a median age of 66 and 54% of patients are diagnosed with colorecta

FAQs

What challenges make colorectal cancer treatment difficult for patients older than 80 years?

Older patients face more comorbidities and decreased organ function reserve. These factors increase risks during treatment and limit tolerability, especially for chemotherapy-related adverse effects.

How do octogenarians’ colorectal cancer features compare with younger patients?

Cancer characteristics are in many aspects similar to younger patients, but patients older than 80 years present more often with right-sided colon cancers.

What treatment approaches does the review suggest for patients over 80?

Surgical treatment can be feasible for selected patients. Adjuvant chemotherapy is under-utilized; combination chemotherapy is often not advisable, while fluoropyrimidine derivative monotherapy is feasible and effective.

Sep 24, 2026

Uploaded by Stanley