Dr Ajesh Raj Saksena. (DC)

Some patients stay with us long after they leave, not because their illness was rare, but because their trust stays with us. “An 85-year-old man came from Lucknow to Hyderabad after nearly six months of severe anaemia. His haemoglobin kept falling; transfusions offered temporary relief. By the time I met him, he had needed almost seven,” says Dr Ajesh Raj Saksena, Senior Consultant Surgical Oncologist, Apollo Cancer Centres. “The transfusions were replacing the blood he had lost. But no one had stopped the bleeding.” The cause was a right-sided colon cancer, slowly bleeding and beginning to obstruct the intestine. “What struck me was that the anaemia had become the problem being treated, rather than a clue to its cause.”

When ‘Age’ Hides The Warning

“Colon cancer does not always announce itself dramatically. With right-sided tumours, bleeding can remain hidden, and repeated anaemia, fatigue, breathlessness or reduced activity may be the only clues,” he says. As the tumour grows, it can narrow the intestine, causing abdominal distension, vomiting and difficulty passing stools. “In older patients, these symptoms can easily be attributed to age. That can allow a serious illness to remain hidden.”

There was no easy decision

At 85, surgery was high-risk. His kidneys were weak, there was fluid around his lungs and his ejection fraction was about 30 per cent. “Doing nothing was not safe either. The bleeding and transfusions would continue, while the tumour could progress to complete obstruction,” says Dr Saksena. “I explained both the risks of surgery and the risks of not operating. I could not promise an easy recovery, only an honest assessment and our best possible care.” The family chose surgery. “Their trust moved me, but it also placed a profound responsibility on my shoulders.”

It takes a team

“High-risk surgery in an elderly patient is never the work of one surgeon. It requires close coordination between surgery, anaesthesia, cardiology, nephrology, pulmonology, critical care, nutrition and physiotherapy,” says Dr Ajesh. With multidisciplinary support, the team optimised the 85-year-old and removed the tumour. “There was no risk-free choice. Their trust placed a profound responsibility on us.”

More memorable patients

An octogenarian with a tumour blocking the sigmoid colon and invading the bladder underwent keyhole surgery. “Seeing him return to my clinic and tell me he had resumed his work and law practice was deeply satisfying,” says Dr Saksena. A frail 78-year-old woman with a bleeding tumour and recurrent anaemia also underwent surgery. “Her family became her strength.”

Listen to the signs

“Blood in the stools, persistent bowel changes, unexplained weight loss, worsening constipation or recurrent anaemia deserve evaluation,” says Dr Saksena. “If haemoglobin keeps falling, we must ask why.” The oldest patient he has operated on was 95. “Elderly patients bring fears, experiences and a strong desire for independence. They need to be heard, reassured and involved in every decision.”

Treat Person, Not age

“Not every elderly patient needs major surgery. But no one should be denied thoughtful cancer care because of their age.

Highlight: “We must treat the person-not merely the birth date.” For him, that remains one of the enduring lessons of caring for elderly cancer patients: the goal is not simply adding years to life, but helping patients live those years with comfort, confidence and dignity.

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