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
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.
? 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
HPV in AYA with HNSCC <ul><li>31% of oral cavity cancers in india are HPV +ve
Types : 16,18, 31, 33, 35 associated with hnscc.
MC type : hpv type 16 ; 90 – 95 % of hpv +ve tumors
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.
HPV in AYA with HNSCC <ul><li>RISK FACTORS FOR HPV ASSOCIATED HNSCC: </li><ul><li>Multiple sex partners – oral & vaginal
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)
Distinct age group – unique medical & psychosocial needs.
Managing chronic / delayed sequelae of treatment
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
Availability of multi-modal , scientific approach
Cost of diagnosis, treatment & long term follow-up. </li></ul>
What is needed ? <ul><li>Challenge = Opportunity
Recognise as a separate entity – collaborate data among institutions.
Etiologic research – possibility of prevention & risk reduction. </li></ul>
What is needed ? <ul><li>Research & Surveillance on effects of cancer diagnosis & treatment </li><ul><li>Adverse health events
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>
In Conclusion <ul><li>AYA – most dynamic & very productive age group.
Cancer in adolescents & young adults should be recognised as a separate entity.
Programmes aimed at educating the public about risk factors and early diagnosis.