Colorectal cancer in older adults: Challenges in radiological diagnosis for therapeutic decision-making

Colorectal cancer in older adults presents significant clinical and diagnostic challenges due to its atypical presentation and the frequent coexistence of comorbidities such as cardiovascular disease, diabetes, and cognitive impairment. These factors directly influence treatment selection and prognosis, highlighting the importance of comprehensive geriatric assessments, including frailty evaluation using tools like the FI-CGA-10. Frailty is highly prevalent in this population and affects both treatment tolerance and follow-up planning. Ethical considerations, including respect for autonomy and quality of life, are central when defining individualized therapeutic goals.Radiological imaging plays a crucial role in the diagnosis, staging, and therapeutic planning of colorectal cancer. Modalities such as contrast-enhanced computed tomography, virtual colonoscopy, magnetic resonance imaging, and endorectal ultrasound provide critical information, although their application in older adults is often limited by anatomical constraints, functional limitations, and contrast intolerance. Alternative techniques like video capsule endoscopy offer less invasive options with high diagnostic yield.Interpretation of imaging must consider age-related physiological changes and potential artifacts from prosthetic devices. Therapeutic decision-making should integrate radiological findings with functional assessments and comorbidity profiles, adopting a multidisciplinary approach that prioritizes patient safety and preferences.To enhance diagnostic accuracy, adapted imaging protocols, specialized training in geriatric radiology, and artificial intelligence tools are recommended. AI supports early frailty detection and personalized care planning. Interdisciplinary coordination among radiologists, oncologists, and geriatricians promotes a patient-centered care model that delivers tailored, clinically relevant interventions for older adults with colorectal cancer.