Global growth of the elderly population is requiring health care providers to cater to an expanding elderly cancer subpopulation. Surgeons are called upon to provide optimal cancer management for this heterogeneous group in par with care provided for younger patients, an ethical dilemma that is compounded by an ill-understood tumor biology. Delivery of suboptimal surgical cancer treatment due to ageist attitudes and personal beliefs is no longer acceptable. Cancer surgeons have to offer optimal surgery in consideration of individualized operative risk. The need for a tool to assess operative risk and predict postoperative outcome is obvious. This article wishes to raise awareness among surgeons about epidemiology, physiologic changes, performance status and comorbidities, and patterns of care and ways to improve them. We visit existing tools to assess operative risk, reveal interim results from the Preoperative Assessment of Cancer in Elderly (PACE) study, and discuss the future of oncogeriatrics.