The number of nonagenarians living an independent lifestyle is increasing and, with baby boomers growing older in a more healthy manner, is set to rise proportionally. Neoplastic change increases with age but many cancers in the elderly are occult until a clinically important event causes rapid decline. Drs Gavin Brigstocke, Moshkan Poormolkara and Jonathan Birns set out the social background and illustrate events with a likely case scenario.