Until 1940, gastric carcinoma had the highest mortality rate of all cancers; gastric cancer was the leading cause of cancer death. Despite the fact that the treatment and overall survival rate for gastric cancer patients in the United States of America has not changed appreciably in the past 50 years, the number of stomach cancer deaths has decreased considerably during this same period (Biondi et al., 2012). In other areas of the world, stomach cancer remains the most common form of cancer. In 2010, the age-standardized rate for stomach cancer deaths in Mexico in men was 5.27 per 100 000. In 2007, similar data from Venezuela showed a rate of 8.37 per 100 000 for men and 5.33 per 100 000 for women. In the UK the respective figures for 2010 are 10.48 and 3.61 per 100 000 (Cancer Mondial, 2013).

Ongoing studies are attempting to delineate the purported dietary factors that are believed to play a major role in the geographical differences in the incidence of stomach cancer. The role of Helicobacter pylori remains to be fully elucidated and described (Hunt, 2004). It was estimated that in 2013 there would 21 600 new cases of stomach cancer in the US and approximately 12 000 deaths (Siegel et al., 2013). Stomach cancer is now the third most commonly diagnosed gastrointestinal neoplasm, after colorectal cancer and pancreatic cancer. There is a slight male preponderance and the incidence is greater in older men, peaking between 50 and 70 years of age (Siegel et al., 2013).

Atrophic gastritis seems to be more common in countries that have a high incidence of gastric cancer, an association only partly explained by the natural progression of a dysplasia or inflammatory process to frank cancer. Similarly, there is a slight increase in the risk of gastric cancer in individuals who have undergone a partial gastric resection for peptic ulcer disease. The stimulus for this pathological chain of events has not been clearly defined. Although nitrosamines can produce carcinoma of the stomach in animal experiments, the synthesis of these compounds is blocked by normal stomach acid; however, this may explain the increased incidence of gastric carcinoma in individuals with pernicious anemia and the accompanying achlorhydria.

In the US, colon cancer is the third leading cause of cancer death for both men and women, with approximately 102 480 new cases per year and 50 830 deaths (Siegel et al., 2013). This is surpassed only by lung cancer and breast cancer in women, and lung cancer and prostate cancer in men. The average age at diagnosis is between 60 and 70 years (Bader, 1986). In patients with both gastric cancer and colon cancer, two-thirds of cases occur in individuals over the age of 65 (Enzinger & Mayer, 2004). The average survival rate for colorectal cancer is about 50%, and that figure has increased only slightly; older patients have an overall poorer survival (Patel et al., 2013).

There are several known predisposing conditions for colon cancer, the most common of which are ulcerative colitis and familial polyposis. In ulcerative colitis, length of disease is as important a factor as severity of symptoms in the progression of the disease to malignant transformation. If there is a strong predisposition to the development of colon cancer, a partial colectomy with preservation of sphincter function is possible and has been a rather remarkable clinical advance in recent years for the prevention of colon cancer. All patients with familial polyposis will eventually have malignant degeneration of one or more polyps. In the future, with major breakthroughs in the molecular biology of colon adenocarcinoma, medical genetics may be able to define a population of additional individuals with premalignant colon phenotypes to which model systems of genetics and screening can be applied, allowing polyps that are believed to presage colon cancer to be found and treated at an earlier stage.

Gastric cancer most often arises from the distal portions of the lesser curvature of the stomach. However, there seems to be an increasing trend towards a more proximal origin. In the US, by the time that gastric cancer has been diagnosed and the patient comes to surgery, the tumor has commonly already penetrated the muscular layers of the gastric wall and can frequently be seen on the outer serosal surface of the stomach (Donati & Nano, 2003; Dicken et al., 2005). The tumor frequently involves anatomical structures that are in close proximity to the stomach, with involvement of the pancreas and the transverse mesocolon being most frequent. In addition, gastric cancer spreads via the peritoneal surface of the abdominal cavity, making survival less certain if ascites or peritoneal tumor implants are present. In almost two-thirds of patients, gastric cancer will already have spread to the abdominal lymphatics when the patient is surgically explored; sentinel lymph nodes are usually involved and are therefore sampled (Donati & Nano, 2003). The gastric area is richly supplied lymphatically and this, along with an intricate mixture of vessels and nervous tissue, results in the rapid spread of the tumor and surgery that is risky and fraught with difficulty. Once regional lymphatics on the greater and lesser curvatures are involved, spread to the lymphatics along the hepatic and splenic vessels occurs and survival is much less certain.

Hematogenous dissemination of gastric cancer occurs late in the course of the disease; dissemination is most often to the liver via the portal vein but other distant sites may be involved. Spread may be asymptomatic; 25% of patients at autopsy show lung metastases, but they are not commonly detected clinically prior to death.

Clinically, gastric carcinoma presents most often with vague epigastric discomfort, postprandial pain or early satiety in eating. Because these somewhat nonspecific symptoms may be attributed to simple gastritis or dietary indiscretion, the elderly especially may delay seeking medical attention. Anemia, weakness and weight loss may all occur, alerting the patient to a more serious source of the discomfort. The physical examination of the elderly patient with gastric cancer may often be unrevealing, except when advanced disease is present (Sial & Catalano, 2001). A palpable tumor in the upper abdomen is not a common presentation but, when it does occur, it is usually a poor prognostic sign. A thorough workup is indicated in any elderly individual who exhibits persistent symptomatology. This is needed to evaluate the patient’s risk and optimize surgical, chemotherapeutic and palliative outcomes (Sial & Catalano, 2001). An upper gastrointestinal endoscopy accompanied by biopsy of the suspected lesion will provide the diagnosis in over 95% of cases. Endoscopic ultrasound evaluation is a relatively new technique that shows some promise in that it enables the clinician to visualize all the walls of the stomach (Dicken et al., 2005).

Diagnosis of colon cancer is difficult despite the more widespread use of the digital exam and sigmoidoscopy, and the use of complete colonoscopy for high-risk patients. Circumferential or ‘apple-core’ lesions of the lower colon are usually the cause of changes in bowel habits, where almost complete obstruction may lead to a paradoxical diarrhea. More proximal lesions may cause weakness because of anemia from slow blood loss. Melena, blood in the stool, is a frequent and sometimes presenting sign of colon cancer. Frank obstruction is most common in the left colon, where the pain may be colicky. In rectal cancer, the pain may be gnawing and constant, the melena is bright red and tenesmus may occur. Liver metastases may compromise hepatic function, causing the patient to become weak and moribund. Other sites of metastases produce symptomatology that is specific to their location and occasionally function. Aging is associated with alterations in clinical and pathologic characteristics and decreased survival (Patel et al., 2013).

In gastric carcinoma, surgery is the only effective method of treatment where cure is the goal, and this approach is utilized for palliation as well. Survival rates remain low except in those with early carcinoma, which is not frequently diagnosed. The mortality rate from surgery is the same for fit elderly patients and younger patients (Kemeny, 2004). Biondi et al. (2012) found that 5-year cancer-specific survival did not show any significant differences when younger and older patients were compared. And although there may be no differences in short-term outcome after surgery, the hospital stay might be longer and the major complications rate higher in the elderly (Kimes et al., 2012). All patients are carefully screened and newer noninvasive diagnostic imaging has done much to assist in selectively identifying curable patients as opposed to those who require a palliative procedure. Unfortunately, only 40% of patients can be considered potentially curable. Distal, proximal or total gastrectomy may be performed, with various methods and pouches used to restore or assure continuity of the alimentary tract. Resection of adjacent organs may be required, making cure less likely. Careful abdominal exploration at the time of surgery is necessary not only to avoid unnecessary radical procedures but also to confirm the histological diagnosis. For the 60% of patients who are not curable but potentially operable, some type of palliative resection is usually done to relieve symptoms and prolong survival.

Because the common reason for palliation is anatomical unresectability, radiation therapy is often employed where surgery has failed. Postsurgical external beam radiation therapy may be used to relieve obstruction or control bleeding. Although some surgeons are trying intraoperative radiation therapy, trials are pending or in progress and the results are inconclusive. Many chemotherapeutic trials of various preparations have taken place over the years, with most regimens including 5-fluorouracil (Enzinger & Mayer, 2004).

The patient with gastric cancer usually needs rehabilitation post surgery, including assistance in mobilization and ambulation to avoid complications and to get the alimentary tract functioning again. Barring serious complications, older patients should be mobilized out of bed gently but definitely on the first postoperative day. Mild exercise programs are also helpful in restoring muscle strength and functional mobility.

After recovery from gastrectomy, long-term sequelae are more important than short-term ones. The former includes the ‘dumping syndrome’, where gastric transit is greatly accelerated; this can result, for example, from the loss of pyloric function controlling food entry into the duodenum. This can usually be controlled by diet and the more frequent employment of gastric reservoirs during surgery. Anemia and accompanying weakness may occur if there is impairment of iron absorption or loss of intrinsic factor when large portions of the stomach are surgically resected.

Colon cancer also is primarily treated surgically, with the creation of a temporary or permanent colostomy if the distal colon or rectum is resected (Gingold, 1981). More proximal tumors may allow end-to-end colonic anastomosis, a less radical procedure. During the surgical procedure the entire lesion is removed, analysis of the depth of invasion through the colonic wall is performed and lymphatic drainage is analyzed (Sobrero & Guglielmi, 2004). Intraoperative ultrasonography allows observation of the adjacent and noncontiguous abdominal organs. When utilizing less extensive procedures for low rectal cancer, where a low anterior resection is common, a major limiting factor is the lack of adequate preoperative staging techniques. The inability to define microscopic lymphatic spread contributes to the failure rate of surgical intervention. Sphincter preservation approaches, especially desirable in the elderly, should not result in sacrifice of curative surgical principles. Elderly surgical patients seem to tolerate the surgery reasonably well and chronological age alone is not a deterrent to surgery (Sobrero & Guglielmi, 2004). However, elderly patients may present with a slightly higher incidence of comorbidities, which may affect the incidence rates of postoperative complications (Gross et al., 2012).

The creation of a temporary or permanent colostomy or ileostomy engenders loss of voluntary control of bowel function. Ostomy rehabilitation has become a specialty in its own right, and enterostomal therapists and wound care specialists are called upon to manage postcolostomy care and instruction. The diversification of collecting devices, skin adhesives and related appliances has been remarkable over the past few decades. A regular elimination schedule, skin protection and odor control are a few of the many issues addressed in the postoperative care of these patients. Like gastric cancer patients, the postoperative colon cancer patient needs gentle but persuasive out-of-bed mobilization and exercises as required. Liver metastases are common and the healthcare worker involved with these patients should be alert to the decreased exercise tolerance, generalized weakness and cachexia that can occur. Even patients with widespread metastases from colon cancer can benefit from a therapeutic program that emphasizes exercise, ambulation and pain control.

There have been many clinical trials of radiation therapy and chemotherapy in the treatment of colon cancer. Most recently, it has been shown that concurrent or subsequent radiation therapy and chemotherapy affords a survival advantage and more trials are under way (Wasil & Lichtman, 2005). Evidence suggests that chemotherapy has similar relative effectiveness and safety for patients over 65 versus younger patients in stage III colon cancer (Hung & Mullins, 2013). An interdisciplinary team approach is the best method for supporting and rehabilitating the patient. It is of interest that less than 10% of gastric and colon cancer cases are unresectable at surgery and more than 50% of patients will be alive and free of disease 5 years after treatment (Renouf et al., 2013). These results are encouraging and continue to improve.