75% of colorectal cancers is diagnosed in elderly patients. Metastatic colon cancer treatment should be more aggressive in the elderly patients. It is not about biological age, but about patient’s fitness for surgery. Operative mortality in stage 4 colorectal cancer in patients over 80 years of age is just 2%. What is “pre-rehabilitation program”? How it helps to improve liver metastatic cancer resection results in elderly patients? Colon cancer treatment in elderly patients. Dr. Graeme Poston, MD. Colorectal cancer in patients over 70 years of age. Dr. Anton Titov, MD. Aggressive cancer treatment in the elderly should be done more often. Measuring fitness of the metastatic colon cancer patient is the main determinant of treatment aggressiveness. Video interview with leading British liver cancer surgeon specializing in colorectal cancer metastases resection. Increasing elderly patient with colon cancer and liver metastases fitness before the surgery is important. For stage 4 metastatic colon cancer patients with liver lesions under 70 years of age, mortality was 1%. operative mortality down to 2% in patients under 80 years of age. Suitability for aggressive stage 4 metastatic cancer treatment is not about the biological age. Colorectal cancer liver metastases treatment in old age. Dr. Graeme Poston, MD. Advanced stage 4 colon cancer surgery for liver metastases in elderly over 75 years of age. Medical second opinion confirms that stage 4 colorectal cancer diagnosis is correct and complete. Dr. Anton Titov, MD. Medical second opinion also confirms that liver metastases surgery is possible in stage 4 colon cancer in the elderly. Best treatment for advanced stage 4 colon cancer with liver metastatic lesions in elderly. Medical second opinion helps to choose the best treatment for elderly patients over 80 years of age for stage 4 colorectal cancer with liver metastases. Get medical second opinion on advanced colorectal cancer and be confident that your treatment is the best. Dr. Graeme Poston, MD. Best colorectal cancer treatment center for liver metastases in the elderly. Dr. Anton Titov, MD. Video interview with leading expert in colorectal cancer liver metastases treatment surgery. Colon cancer treatment in elderly patients. Advanced stage 4 colon cancer prognosis in elderly. Dr. Anton Titov, MD. 75% of colorectal cancer is diagnosed in elderly patients, patients between 65 and 85 years of age. There are nuances in treating colorectal cancer and Stage 4 metastatic colorectal cancer in elderly patients. Previously, treatment of colon cancer in elderly patients has not been aggressive. Dr. Graeme Poston, MD. Colon cancer therapy in the elderly has not offered the real chance of survival. Lack of aggressive cancer treatment in the elderly was true not only for colorectal cancer, but also for other cancers. The association of cancer with older age was a psychological block. Dr. Anton Titov, MD. It prevented oncologists to offer cancer treatment more aggressively in elderly patients. That is changing. Yes. What are the nuances of treating colorectal cancer and stage 4 metastatic colorectal cancer in elderly patients? Dr. Graeme Poston, MD. Leading liver cancer surgeon. This is a big pressure for us. As you rightly point out, the majority of our patients with colon cancer are elderly. More than half of colon cancer patients are over the age of 70. What's more, our population is getting older. We are going to have more older patients with colorectal cancer in the future. Dr. Graeme Poston, MD. We are having a much fitter older population than we used to have. We used to say "over the age of 60, we can't do anything to treat colon cancer aggressively". You are too old for surgery to resect primary colon cancer tumor. We can't offer you surgery to resect metastatic colon cancer lesions. Now we are saying that probably 80 years of age might be the cut-off for colorectal cancer surgery. Now we have done a lot of work on stage 4 metastatic cancer treatment in the elderly in my group. We looked at measuring fitness of the metastatic colon cancer patient. We did not look at birth dates at all. We looked at fitness. Dr. Anton Titov, MD. Sometimes patients come into the colorectal cancer treatment clinic. Is there a method that you could make elderly colon cancer patients fitter for the surgery? Dr. Graeme Poston, MD. Before you resect metastatic colon cancer lesions from the liver. A lot of work on improving patient fitness has already been done in cardiac surgery and vascular surgery. Initial work on increasing patient fitness before the surgery was done in those fields. Because cardiovascular patients in general are less fit for various reasons. Dr. Graeme Poston, MD. They smoke and they don't take exercise. But we are looking at ways of measuring fitness of elderly patients with advanced colorectal cancer. We are looking at a thing called the anaerobic threshold. We study anaerobic threshold through cardiopulmonary testing. We put elderly colon cancer patients on a bicycle. Dr. Graeme Poston, MD. We measure at what point their CO2 level becomes excessive in the blood circulation. Dr. Anton Titov, MD. That gives you an idea of how fit is the elderly patient. We prepare patients for the surgical operation to remove colon cancer metastases. Dr. Graeme Poston, MD. Leading liver cancer surgeon. We then do a program for elderly colon cancer patients we call “pre-rehabilitation". We try to get elderly colorectal cancer more fit before surgical operation. Dr. Anton Titov, MD. Not rehabilitation but PRE-rehabilitation, "rehabilitation before surgery". it is a recurrent topic actually that I hear in many surgical fields. The goal is to get the patients as fit as possible before surgical operation. "Because surgical operation is your olympics." Dr. Graeme Poston, MD. Leading liver cancer surgeon. Yes, and in fact it doesn't take very much for elderly patients to get more physically conditioned. They get fit before the surgery to remove colon cancer or metastatic colon cancer lesions. We have measured how much elderly patient needs to get more fit. To become more fit for the surgical operation, colon cancer patient needs three sessions a week of forty minutes on an exercise bike. Dr. Graeme Poston, MD. This fitness regimen needs to be done for four weeks. Often we have that luxury of that time. Because the elderly colon cancer patients come to us. They finish their chemotherapy first. Colon cancer elderly patients going to have to wait six weeks before surgery to remove primary or metastatic liver tumors. Dr. Graeme Poston, MD. We use that time productively to put elderly colon cancer patients on a bike. We get them exercising, we get their anaerobic threshold up. We get the elderly colon cancer patients fitter and stronger. We published our stage 4 metastatic colon cancer in the liver resection results ten years ago. Dr. Anton Titov, MD. But it is still the biggest single center series of liver resection for metastatic stage 4 colorectal cancer in patients over the age of 70. We removed colon cancer liver metastases in 180 patients over age of 70. But mortality was 5%. Only 1 in 20 patients died. Dr. Graeme Poston, MD. Leading liver cancer surgeon. for stage 4 metastatic colon cancer patients with liver lesions under 70 years of age, mortality was 1%. Mortality was 1 in 100. We have now repeated our clinical trial of stage 4 colon cancer treatment in elderly patients. We have now got operative mortality down to 2% in patients under 80 years of age. Operative mortality in stage 4 colorectal cancer patients over 80 years of age is just 2%. Dr. Anton Titov, MD. With pre-rehabilitation program to get patients more fit before surgery. You are checking elderly colon cancer patients' aerobic threshold. With pre-rehabilitation program, yes. Pre-rehabilitation program in elderly colon cancer patients changed everything. Dr. Graeme Poston, MD. We now say that patient's age doesn't matter. It is the fitness that matters for advanced colon cancer treatment by surgery. Dr. Anton Titov, MD. Patient's suitability for aggressive stage 4 metastatic cancer treatment is not about the biological age. There is more and more medical data that is coming in about this. It is all about the personal fitness. That is very important for colon cancer surgery. Dr. Graeme Poston, MD. Leading liver cancer surgeon. Absolutely, yes. Colon cancer treatment in elderly patients. Fitness is important, not biological age. Dr. Anton Titov, MD. "Pre-rehabilitation" program improves liver metastases surgery results.