CANCER  IN  ADOLESCENTS AND  YOUNG  ADULTS Dr. T. Sujit  , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre
 
 
CANCER  IN  ADOLESCENTS AND  YOUNG  ADULTS Dr. T. Sujit  , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre
What is it ? <ul><li>Cancer in people in the age group of 15 – 29 years.
Terminologies : </li><ul><li>AYA – Adolesecents & Young Adults with cancer
TYA – Teenagers & Young Adults with cancer </li></ul><li>AGE -  ? 15 – 29  </li></ul>-  ?  15 – 39
Why ?  - 1 PAEDIATRIC CANCERS –  NON EPITHELIAL TYPES ADULT CANCERS -  EPITHELIAL TYPE CANCER IN AYA -  A MIX OF BOTH
Why ?  - 2 <ul><li>Uniqueness of epidemiology </li><ul><li>Age, race, gender,  </li></ul></ul>C H E N N A i 2000  - 2004
Male  female . POPULATION BASED CANCER REGISTRY, CHENNAI Cancer Institute (WIA), Adyar, Chennai
Why ?  - 3 <ul><li>Uniqueness of histology & tumor biology </li><ul><li>Non-epithelial and epithelial histologies in almos...
Chennai – males : nhl, brain & nervous    system, hnscc, </li></ul></ul>Females : breast, cervix, nhl <ul><ul><li>US & Can...
Limited response to treatment and poor prognosis suggest tumor biology is different from other age groups having the same ...
Uniqueness of h&n cancer in AYA <ul><li>Typical age group for HNSCC : 6 th  - 7 th  decade
Site : oral cavity & oropharynx , Npx, Thyroid.
Usually diagnosed in advanced stage
Early nodal metastases
? High grade histology </li></ul>1. Verschuur HP, Irish JC, O'Sullivan B, Goh C, Gullane PJ, Pintilie M. A matched control...
Risk factors for HNSCC in AYA <ul><li>Tobacco
Alcohol
Hiv
Hpv
Ebv - nasopharynx
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Cancer in Adolescents and Young Adults

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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

Published in: Health & Medicine
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Transcript of "Cancer in Adolescents and Young Adults"

  1. 1. CANCER IN ADOLESCENTS AND YOUNG ADULTS Dr. T. Sujit , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre
  2. 4. CANCER IN ADOLESCENTS AND YOUNG ADULTS Dr. T. Sujit , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre
  3. 5. What is it ? <ul><li>Cancer in people in the age group of 15 – 29 years.
  4. 6. Terminologies : </li><ul><li>AYA – Adolesecents & Young Adults with cancer
  5. 7. TYA – Teenagers & Young Adults with cancer </li></ul><li>AGE - ? 15 – 29 </li></ul>- ? 15 – 39
  6. 8. Why ? - 1 PAEDIATRIC CANCERS – NON EPITHELIAL TYPES ADULT CANCERS - EPITHELIAL TYPE CANCER IN AYA - A MIX OF BOTH
  7. 9. Why ? - 2 <ul><li>Uniqueness of epidemiology </li><ul><li>Age, race, gender, </li></ul></ul>C H E N N A i 2000 - 2004
  8. 10. Male female . POPULATION BASED CANCER REGISTRY, CHENNAI Cancer Institute (WIA), Adyar, Chennai
  9. 11. Why ? - 3 <ul><li>Uniqueness of histology & tumor biology </li><ul><li>Non-epithelial and epithelial histologies in almost equal distribution.
  10. 12. Chennai – males : nhl, brain & nervous system, hnscc, </li></ul></ul>Females : breast, cervix, nhl <ul><ul><li>US & Canada : lymphomas & leukemia,thyroid sarcomas, melanoma,
  11. 13. Limited response to treatment and poor prognosis suggest tumor biology is different from other age groups having the same tumors. </li></ul></ul>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
  12. 14. Uniqueness of h&n cancer in AYA <ul><li>Typical age group for HNSCC : 6 th - 7 th decade
  13. 15. Site : oral cavity & oropharynx , Npx, Thyroid.
  14. 16. Usually diagnosed in advanced stage
  15. 17. Early nodal metastases
  16. 18. ? High grade histology </li></ul>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
  17. 19. Risk factors for HNSCC in AYA <ul><li>Tobacco
  18. 20. Alcohol
  19. 21. Hiv
  20. 22. Hpv
  21. 23. Ebv - nasopharynx
  22. 24. ? genetic susceptibility - unproven </li></ul>
  23. 25. HPV in AYA with HNSCC <ul><li>31% of oral cavity cancers in india are HPV +ve
  24. 26. Types : 16,18, 31, 33, 35 associated with hnscc.
  25. 27. MC type : hpv type 16 ; 90 – 95 % of hpv +ve tumors
  26. 28. Hpv +ve tumors - typically small 't' size but with large ,cystic nodes </li></ul>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.
  27. 29. HPV in AYA with HNSCC <ul><li>RISK FACTORS FOR HPV ASSOCIATED HNSCC: </li><ul><li>Multiple sex partners – oral & vaginal
  28. 30. High number of open mouth kissing partners
  29. 31. Young age of first sexual experience
  30. 32. H/o genital warts
  31. 33. Tobacco – reduces local mucosal immunity
  32. 34. ? alcohol </li></ul></ul>
  33. 35. HPV - carcinogenesis
  34. 36. Challenges in treatment of HNSCC in AYA <ul><li>“ 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)
  35. 37. Distinct age group – unique medical & psychosocial needs.
  36. 38. Managing chronic / delayed sequelae of treatment
  37. 39. Probability of second primaries
  38. 40. Socio-economic issues: marriage, fertility, career etc. </li></ul>
  39. 41. Challenges in treatment of HNSCC in AYA <ul><li>SURGERY </li><ul><li>Organ preservation Vs cure
  40. 42. Organ function
  41. 43. Cosmesis </li></ul><li>RADIATION THERAPY </li><ul><li>Fibrosis
  42. 44. Xerostomia
  43. 45. Trismus
  44. 46. Second primaries </li></ul><li>CHEMOTHERAPY </li><ul><li>fertility </li></ul></ul><ul><li>Limited neck dissections </li></ul><ul><li>Highly conformal radiation therapy – 3dcrt, imrt, tomotherapy, igrt, 3D brachytherapy </li></ul><ul><li>Sperm banking, surrogacy </li></ul>
  45. 47. Treatment of HPV +ve tumors <ul><li>HPV positive tumors much more radiosensitive than HPV negative tumors </li><ul><li>HPV infected cells not damaged as severely as cells that are repeatedly exposed to carcinogens
  46. 48. 5 year survival for HPV + tumors = 82%
  47. 49. 5 year survival for HPV - tumors= 32% </li></ul><li>Smokers with a HPV+ tumor - overall worst prognosis
  48. 50. University of Michigan Comprehensive Cancer Center </li></ul>Recurrence rates : <ul><ul><li>Patients with HPV+ and current smokers = 35 %
  49. 51. Patients with HPV+ and smoking history= 17%
  50. 52. Patients with HPV+ and no smoking history= 6% </li></ul></ul>
  51. 53. Outcome & Prognosis Distinct lack of progress in survival improvement even after 25 years in western countries
  52. 54. Outcome & Prognosis <ul><li>Presence of co-morbidities – lesser compared to other age groups
  53. 55. Delay in diagnosis
  54. 56. Availability of multi-modal , scientific approach
  55. 57. Cost of diagnosis, treatment & long term follow-up. </li></ul>
  56. 58. What is needed ? <ul><li>Challenge = Opportunity
  57. 59. Recognise as a separate entity – collaborate data among institutions.
  58. 60. Etiologic research – possibility of prevention & risk reduction. </li></ul>
  59. 61. What is needed ? <ul><li>Research & Surveillance on effects of cancer diagnosis & treatment </li><ul><li>Adverse health events
  60. 62. Psycho-socio-economic issues </li></ul><li>Ongoing surveillance of incidence </li><ul><li>Young persons more likely to adopt new habits than the old. Eg. Glue sniffing. </li></ul><li>Awareness & screening programmes </li></ul>
  61. 63. In Conclusion <ul><li>AYA – most dynamic & very productive age group.
  62. 64. Cancer in adolescents & young adults should be recognised as a separate entity.
  63. 65. Programmes aimed at educating the public about risk factors and early diagnosis.
  64. 66. Multimodal approach – best chances of cure
  65. 67. Pro-active , lifelong follow up
  66. 68. Need for collaborative clinical trials – all aspects. </li></ul>
  67. 69. Thank you

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