Previously reported large autopsy series have indicated that elderly patients who die of cancer are less likely to have metastatic disease than their younger counterparts. This observation could be explained if survival were shorter in the elderly population and patients died with smaller tumor burdens. The authors analyzed Medical Center Hospital of Vermont (MCHV) Tumor Registry data on primary lung cancer with respect to age. As in the reported autopsy series, at the time of diagnosis elderly patients were less likely to have metastatic disease. Further analysis was undertaken of the patients from this series who died and were autopsied at MCHV. Although the total numbers were small, survival was not shorter in the advanced age groups. The authors suggest that elderly patients have slower tumor growth and less metastatic disease, not because of earlier diagnosis and shorter survival, but because of senescent host factors that impede aggressive tumor growth and spread.