The vast entity of the aging process must be well thought out while considering optimal management for elderly patients with cancer. Co-morbidity and functional status are the key factors which determine the overall survival of patients. Multidisciplinary approaches to patient management must be emphasized and stressed to deal with end- of-life issues. Researchers need to identify elderly people who are most susceptible to treatment toxicities and must deal with palliation and hospice care for these patients. One approach to the issue of aging as a variable in treatment outcome would be to utilize programs and facilities supported by cancer institutes to address age-related questions in clinical trials. Academic oncologists, geriatricians and pathologists can create realistic and imminent goals to achieve victory against cancer and provide optimal treatment that includes adequate supportive care and reduces the burden of post- treatment morbidities that compromise quality of life in these patients. This review focuses on the basis of cancers that affect the elderly and how momentous advances can be obtained to expound the pathways most critically involved in tumor development and progression. Through this review, an attempt has been made to explain the impact of peculiar mutations and altered cell behavior underlying geriatric oncogenesis.