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People aged 15 to 39 get a different mix of cancers from children or older adults: leukaemia, lymphoma, testicular and thyroid cancer, melanoma, sarcoma and brain tumours in the younger years, then breast, cervical and bowel cancer towards 40. For decades their survival improved more slowly than anyone else's: they fell between children's and adults' hospitals and joined few trials.
The National Cancer Institute and LIVESTRONG Progress Review Group defined the adolescent and young adult (AYA) population as 15 to 39 in 2006 after Bleyer and colleagues showed that five-year survival for this age band had improved far less between 1975 and 1997 than for children or for adults over 40, and that fewer than one in ten were treated in a clinical trial against more than half of children. The cancers differ by age: acute lymphoblastic leukaemia, Hodgkin lymphoma, germ cell tumours, osteosarcoma and Ewing sarcoma, thyroid cancer, melanoma and gliomas dominate the teenage years; breast, cervical, colorectal and thyroid cancer take over through the thirties. Several behave differently from the same diagnosis at other ages: young-adult breast cancer is more often triple-negative or BRCA-associated, early-onset colorectal cancer is rising by about two percent a year, and AYA acute lymphoblastic leukaemia carries more Ph-like and fewer favourable genetic subtypes than childhood disease.
The clearest treatment lesson is in acute lymphoblastic leukaemia. Retrospective comparisons in France, the United States and the Netherlands found that 16 to 20-year-olds treated on paediatric protocols did far better than those on adult ones, and the prospective CALGB 10403 study of a paediatric regimen in 295 patients aged 17 to 39 gave three-year event-free survival of 59 percent and overall survival of 73 percent, roughly double the historical adult figures; paediatric-inspired therapy is now standard to age 40 and blinatumomab consolidation (E1910) adds to it. Ewing sarcoma and osteosarcoma outcomes fall with age partly through dose intensity and partly through biology; Hodgkin lymphoma in AYA is highly curable and the trial question is de-escalation; germ cell tumours have a cure rate over 90 percent but were the disease in which the survival gap was first documented in young men treated outside specialist centres. The United Kingdom built dedicated teenage and young adult units from 1990 through the Teenage Cancer Trust and made specialist referral national policy in 2005; the NCCN issued AYA guidelines in 2012.
The needs that cut across diagnoses are fertility preservation before treatment, which guidelines have required since 2006 and which is still offered unevenly; psychosocial support during education, early careers and young parenthood; financial toxicity in people with no savings and, in the United States, patchy insurance; and survivorship, since a 25-year-old cured of Hodgkin lymphoma has sixty years to develop the cardiac and second-cancer consequences of treatment. The research gaps are trial eligibility ages that exclude 12 to 17-year-olds from adult trials and over-18s from paediatric ones, which the FDA's 2019 guidance on including adolescents in adult cancer trials began to close; molecular studies of why the same cancer differs at different ages; and registries able to follow a population that moves house, hospital and country more than any other.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
No subtypes recorded beyond the ones named in the family strip above.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Paediatric-inspired regimen with asparaginase (CALGB 10403 model) and blinatumomab consolidation for MRD-negative B-ALL (E1910); Ph-like screening at diagnosis.
Fertility preservation referral (sperm banking, oocyte or embryo cryopreservation, ovarian tissue) as a default step.
Age-specific units or teams, distress screening, education and employment support, financial navigation.
Treatment summary and risk-based follow-up for cardiac, second-cancer, endocrine and fertility late effects over decades.
Germline testing in young-onset breast, colorectal, sarcoma and other cancers, with cascade testing of relatives.
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Query for this cancer: (TITLE:"Adolescent and young adult cancers" OR ABSTRACT:"Adolescent and young adult cancers" OR TITLE:"ages 15 to 39" OR ABSTRACT:"ages 15 to 39" OR TITLE:"AYA cancers" OR ABSTRACT:"AYA cancers" OR TITLE:"Teenage and young adult cancer" OR ABSTRACT:"Teenage and young adult cancer" OR TITLE:"TYA cancer" OR ABSTRACT:"TYA cancer" OR TITLE:"Young adult cancer" OR ABSTRACT:"Young adult cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Adolescent and young adult cancers (ages 15 to 39), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Fever of 38 C or higher, chills, low blood pressure, fast heartbeat or breathlessness, especially after a step-up dose. Boxed warning on teclistamab, epcoritamab, glofitamab, tarlatamab and blinatumomab.
Fatal if given intrathecally: label all syringes.
High-dose methotrexate requires normal renal function, hydration, urine alkalinisation and leucovorin rescue with level monitoring.
When engineered T cells or a bispecific antibody switch on, the immune system can overshoot. The first sign is a fever, and the treatment is a drug that blocks the main signal, given early. A smaller number of people become confused or drowsy, which is graded and treated separately.
Nerve damage from chemotherapy that causes numbness, tingling and pain in the hands and feet, and sometimes weakness or hearing loss. It builds up with each dose, can be permanent, and is the main reason oxaliplatin, taxanes and vincristine have to be stopped or reduced.
See all on the product pages:BlinatumomabDexamethasoneMethotrexateVincristine·Printable cards in the navigator
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