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cancer in the young, cancer in AYA, cancer in TYA, yeenage and adolescent cancer, adolescent and young adult cancer...

cancer in the young, cancer in AYA, cancer in TYA, yeenage and adolescent cancer, adolescent and young adult cancer

Presentation date : 03-03-2012
CME - Head and Neck Oncology

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  • 1. CANCER IN ADOLESCENTS AND YOUNG ADULTS Dr. T. Sujit , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre
  • 2.  
  • 3.  
  • 4. CANCER IN ADOLESCENTS AND YOUNG ADULTS Dr. T. Sujit , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre
  • 5. What is it ?
    • Cancer in people in the age group of 15 – 29 years.
    • 6. Terminologies :
      • AYA – Adolesecents & Young Adults with cancer
      • 7. TYA – Teenagers & Young Adults with cancer
    • AGE - ? 15 – 29
    - ? 15 – 39
  • 8. Why ? - 1 PAEDIATRIC CANCERS – NON EPITHELIAL TYPES ADULT CANCERS - EPITHELIAL TYPE CANCER IN AYA - A MIX OF BOTH
  • 9. Why ? - 2
    • Uniqueness of epidemiology
      • Age, race, gender,
    C H E N N A i 2000 - 2004
  • 10. Male female . POPULATION BASED CANCER REGISTRY, CHENNAI Cancer Institute (WIA), Adyar, Chennai
  • 11. Why ? - 3
    • Uniqueness of histology & tumor biology
      • Non-epithelial and epithelial histologies in almost equal distribution.
      • 12. Chennai – males : nhl, brain & nervous system, hnscc,
    Females : breast, cervix, nhl
      • US & Canada : lymphomas & leukemia,thyroid sarcomas, melanoma,
      • 13. Limited response to treatment and poor prognosis suggest tumor biology is different from other age groups having the same tumors.
    1. Ca nce r Epidemiology in O lde r Adole sce nts a nd Young Adults 15 to 29 Ye a r s of Age INCLUDING SEER INCIDENCE AND SURVIVAL: 1975-2000 2. POPULATION BASED CANCER REGISTRY, CHENNAI Cancer Institute (WIA), Adyar, Chennai
  • 14. Uniqueness of h&n cancer in AYA
    • Typical age group for HNSCC : 6 th - 7 th decade
    • 15. Site : oral cavity & oropharynx , Npx, Thyroid.
    • 16. Usually diagnosed in advanced stage
    • 17. Early nodal metastases
    • 18. ? High grade histology
    1. Verschuur HP, Irish JC, O'Sullivan B, Goh C, Gullane PJ, Pintilie M. A matched control study of treatment outcome in young patients with squamous cell carcinoma of the head and neck. Laryngoscope. Feb 1999;109(2 Pt 1):249-58 2. Veness MJ, Morgan GJ, Sathiyaseelan Y, Gebski V. Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: should elective treatment to the neck be standard practice in all patients?. ANZ J Surg. Mar 2005;75(3):101-5
  • 19. Risk factors for HNSCC in AYA
  • 25. HPV in AYA with HNSCC
    • 31% of oral cavity cancers in india are HPV +ve
    • 26. Types : 16,18, 31, 33, 35 associated with hnscc.
    • 27. MC type : hpv type 16 ; 90 – 95 % of hpv +ve tumors
    • 28. Hpv +ve tumors - typically small 't' size but with large ,cystic nodes
    1. Impact of HPV in Oropharyngeal Cancer Journal of Oncology Volume 2011 (2011), Article ID 509036, 6 pages doi:10.1155/2011/509036 Linda Marklund and Lalle Hammarstedt Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, Sweden.
  • 29. HPV in AYA with HNSCC
    • RISK FACTORS FOR HPV ASSOCIATED HNSCC:
      • Multiple sex partners – oral & vaginal
      • 30. High number of open mouth kissing partners
      • 31. Young age of first sexual experience
      • 32. H/o genital warts
      • 33. Tobacco – reduces local mucosal immunity
      • 34. ? alcohol
  • 35. HPV - carcinogenesis
  • 36. Challenges in treatment of HNSCC in AYA
    • “ The improvements in outcomes for AYA lag behind those seen in cancer treatment for the very old and the very young” (Levi 2003, Thomas et al. 2006)
    • 37. Distinct age group – unique medical & psychosocial needs.
    • 38. Managing chronic / delayed sequelae of treatment
    • 39. Probability of second primaries
    • 40. Socio-economic issues: marriage, fertility, career etc.
  • 41. Challenges in treatment of HNSCC in AYA
    • SURGERY
      • Organ preservation Vs cure
      • 42. Organ function
      • 43. Cosmesis
    • RADIATION THERAPY
    • CHEMOTHERAPY
      • fertility
    • Limited neck dissections
    • Highly conformal radiation therapy – 3dcrt, imrt, tomotherapy, igrt, 3D brachytherapy
    • Sperm banking, surrogacy
  • 47. Treatment of HPV +ve tumors
    • HPV positive tumors much more radiosensitive than HPV negative tumors
      • HPV infected cells not damaged as severely as cells that are repeatedly exposed to carcinogens
      • 48. 5 year survival for HPV + tumors = 82%
      • 49. 5 year survival for HPV - tumors= 32%
    • Smokers with a HPV+ tumor - overall worst prognosis
    • 50. University of Michigan Comprehensive Cancer Center
    Recurrence rates :
      • Patients with HPV+ and current smokers = 35 %
      • 51. Patients with HPV+ and smoking history= 17%
      • 52. Patients with HPV+ and no smoking history= 6%
  • 53. Outcome & Prognosis Distinct lack of progress in survival improvement even after 25 years in western countries
  • 54. Outcome & Prognosis
    • Presence of co-morbidities – lesser compared to other age groups
    • 55. Delay in diagnosis
    • 56. Availability of multi-modal , scientific approach
    • 57. Cost of diagnosis, treatment & long term follow-up.
  • 58. What is needed ?
    • Challenge = Opportunity
    • 59. Recognise as a separate entity – collaborate data among institutions.
    • 60. Etiologic research – possibility of prevention & risk reduction.
  • 61. What is needed ?
    • Research & Surveillance on effects of cancer diagnosis & treatment
      • Adverse health events
      • 62. Psycho-socio-economic issues
    • Ongoing surveillance of incidence
      • Young persons more likely to adopt new habits than the old. Eg. Glue sniffing.
    • Awareness & screening programmes
  • 63. In Conclusion
    • AYA – most dynamic & very productive age group.
    • 64. Cancer in adolescents & young adults should be recognised as a separate entity.
    • 65. Programmes aimed at educating the public about risk factors and early diagnosis.
    • 66. Multimodal approach – best chances of cure
    • 67. Pro-active , lifelong follow up
    • 68. Need for collaborative clinical trials – all aspects.
  • 69. Thank you