Upper gastrointestinal malignancies in the elderly

Upper gastrointestinal cancers occur most frequently in the later decades of life. All present with difficult treatment decisions in the elderly, because surgical resections, the only chance for cure, are associated with higher mortality in the elderly and still offer low chances for long-term survival. Although some patients may benefit, chemotherapy is unsatisfactory at present. Investigational trends, especially in esophageal cancer, favor combinations of radiation, chemotherapy, and surgery. While clinical investigators examine the best combinations of multiple modality therapy to improve survival, the many opportunities for better palliation with laser therapy, nutritional support, and surgical bypass procedures present the physician of elderly patients with many options to ease symptoms and prolong independence. The future role of immunotherapy, hyperthermia, radiation sensitizers, and other cancer treatment modalities offers new possibilities for cancer patients of all ages but will be particularly welcomed in the elderly.