It is difficult, on the basis of the information made known, to be able to make predictions about the tumor that affected King Charles III, because the diagnosed neoplasm “could be of various nature, from blood tumors to bladder tumors. Nothing can be ruled out”. Certainly, the incidence of neoplasms increases with advancing age and “the false belief that tumors in the elderly always progress slowly or indolent must be dispelled”. On the other hand, it is possible to intervene with standard therapies even for subjects in this age group and, where this is not considered appropriate, the aim is to ‘cut a tailor-made therapy’. This was underlined by Antonella Brunello, interim director of the complex Oncology 1 operational unit at the Veneto Oncology Institute (Iov) in Padua and head of the Iov geriatric oncology clinic.
“The incidence of tumors increases with age and the progression of tumors even in the elderly is extremely variable. However – explains the oncologist – the preconception that tumors in the elderly necessarily have a slower, so-called ‘indolent’ course , is not true. Much depends on the biology of the tumor: some tumors have a slower course linked to biological characteristics, as in some prostate tumors which are OFTEN not operated on in elderly subjects because they do not have a high risk and therefore a decision is made for close surveillance. Other tumors, however, even in the elderly, have aggressive characteristics equal to those in young subjects, such as for some tumors of the lung, bladder or colon. The age of the subject alone is therefore not enough to characterize the neoplasm” . In the elderly there is also a prevalence of blood tumors: “Various can be indolent, such as chronic lymphocytic leukemia; others, such as some myeloid leukemias, are instead aggressive”.
The advice, he states, is however to “always pay close attention to the symptoms and carry out investigations in case of doubts, especially because, after the age of 70, population screening at a national level is no longer foreseen”. On the treatment front, however, in the over 70s “therapeutic decisions depend both on the guidelines for the treatment of the tumor from which the subject is affected, but also on the characteristics of the individual patient, with careful consideration of the risk-benefit balance. Just recently a guideline on the multidimensional evaluation of elderly patients has been published by the ISS, which involves the evaluation of various elements: from physical performance, to cognitive state, to mood, to medications taken, to social condition. Having a complete picture, one decides whether to proceed with the standard treatments of chemotherapy, radiotherapy and immunotherapy, or whether to plan the therapy based on the specific conditions of the subject”.
In the case of King Charles III, the message that the sovereign wanted to send remains “very positive”: “The official statement says that the king has chosen to make the diagnosis public to increase public awareness among all those who suffer in the world of cancer. This – concludes Brunello – is a positive message of hope”.
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