Cancer surgery is safe for older patients and should not be denied on the basis of chronological age. The curability of cancer in the elderly is predicated on the individual's tolerance of major surgery. We present the physiologic changes that occur with aging and focus on their influence upon surgical decision making, the risk factors associated with cancer surgery in the elderly, the preoperative assessment, and perioperative care of the elderly cancer patient, as well as surgical considerations for specific neoplasms.