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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Acute lymphoblastic leukaemia, 15 to 39 | Paediatric-inspired regimen with asparaginase (CALGB 10403 model) and blinatumomab consolidation for MRD-negative B-ALL (E1910); Ph-like screening at diagnosis. | not mapped |
| Before any gonadotoxic treatment | Fertility preservation referral (sperm banking, oocyte or embryo cryopreservation, ovarian tissue) as a default step. | not mapped |
| Psychosocial and financial | Age-specific units or teams, distress screening, education and employment support, financial navigation. | not mapped |
| Survivorship | Treatment summary and risk-based follow-up for cardiac, second-cancer, endocrine and fertility late effects over decades. | not mapped |
| Hereditary risk | Germline testing in young-onset breast, colorectal, sarcoma and other cancers, with cascade testing of relatives. | not mapped |