Introduction

Cancer affects elderly persons more often than younger persons and is second only to heart disease as the leading cause of death in the elderly. Gastrointestinal (GI) tumors account for > 25% of all cancer deaths. The causes of GI cancer remain elusive, and incidence involving specific sites varies enormously worldwide. In the elderly, environmental factors seem to play a much greater role than genetic factors, but clearly genetic factors (eg, DNA hypomethylation, activation of oncogenes, inactivation of tumor suppressor genes, alterations in DNA mismatch repair genes) are important.

Medical decisions regarding GI tumors in the elderly involve consideration of the patient's limited life expectancy, risk of complications from treatment, and overall effects of cancer and its therapy on quality of life. GI endoscopic procedures are discussed in Ch. 103 and end-of-life issues for elderly patients in Ch. 13.