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Dr.

Vicente Spinelli Renes

Neoplasia (literally meaning new growth) is the uncontrolled proliferation of transformed cells. The term tumor, which was originally used to describe the swelling caused by inflammation, is now used interchangeably with neoplasm. Transformation is the multistep process in which normal cells acquire malignant characteristics. Each step reflects a genetic alteration that confers a growth advantage over normal cells. There are a number of essential alterations in cell physiology that collectively enable malignant growth [10] [11] : self-sufficiency in growth signals, evasion of programmed cell death (apoptosis), avoidance of immune detection and destruction, limitless replicative potential, sustained angiogenesis, and tissue invasion and metastasis. These characteristics are shared by most, if not all, human tumors

EPIDEMIOLOGY Incidence is the number of new cases within a specified time frame and is usually expressed as cases per 100,000 people per year. Prevalence is the number of patients with the disease in the population. A person's risk of contracting or dying of cancer is usually expressed in terms of lifetime risk (risk over the course of a lifetime) or, when describing the relationship of specific risk factors with a particular cancer, as relative risk (in comparison to those with or without a certain exposure or trait). About 1.4 million new cases of cancer are expected to be diagnosed in 2006, apart from the more than a million new cases of basal and squamous cell cancer ( Fig. 29-1 ). In men, the most common cancers involve the prostate, lung, colorectum, and urinary bladder ( Table 29-1 ). In women, the most common cancers are breast, lung, colorectal, and uterine (cervical and endometrial).

Cancer is the second most common cause of death in the United States and accounts for one in every four deaths ( Fig. 29-2 ). In 2006, about 564,800 Americans will die of cancer Global Burden of Cancer Worldwide, cancer is responsible for one in eight deaths. By 2020, 70% of all cancer-related deaths will occur in developing countries, where survival rates (20%-30%) are barely half that of developed countries. [3] Indeed, 80% to 90% of people in whom cancer is diagnosed in developing countries are initially found to have late-stage, terminal cancer. [3] It can therefore be seen that the vast majority of cancer deaths will occur in the countries least equipped to handle the burden.

Aging and Cancer Cancer disproportionately affects people 65 years and older. In the United States, this age group accounts for 56% of all newly diagnosed cancer patients and 71% of all cancer deaths. [4] The median age at death for cancers common to both males and females (including lung, colorectal, pancreas, stomach, and urinary bladder) ranges from 71 to 77 years. [4] The number of people in this age group will double to 70 million (or 1 in 5 people) over the next 25 years, driven by the so-called baby boom cohort born between 1946 and 1964. [4] This is a recognized trend throughout the developed world. With an increasingly older population, the incidence of cancer will increase, thereby increasing the overall cancer burden on society. Additionally, cancer care will be of increasingly greater complexity. Reasons for this include older people having more comorbid conditions of greater severity in the setting of declining physiologic reserve, difficulty with access to care, and lack of social support. Cancer treatment in the elderly is less well studied, and it has been shown that the elderly population is underrepresented in clinical trials. [14] [15] [16] There have been a number of reports of the underuse of adjuvant therapy, both chemotherapy and radiotherapy, in the aging population. O'Connell and colleagues [8] studied the Surveillance, Epidemiology, and End Results (SEER) database (1988-1997) and found that although elderly patients with colorectal or breast cancer had excellent rates of receiving cancer-directed surgery, rates were variable for many other neoplasms, including lung, esophagus, stomach, liver, and pancreas cancer. Surgical intervention being not recommended was the most common reason. Clearly, the surgeon must more carefully weigh the individual's operative risk in the context of the difficulty, length, and morbidity of the procedure and give greater consideration to quality of life and functional status, beyond just postoperative morbidity and mortality and long-term survival. .