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What is it ?
AYA Adolesecents & Young Adults with cancer TYA Teenagers & Young Adults with cancer - ? 15 39
AGE - ? 15 29
Why ?
-1
Why ?
-2
Uniqueness of epidemiology
C H E N N A i
2 0 0 0 2 0 0 4
Male female
. POPULATION BASED CANCER REGISTRY, CHENNAI Cancer Institute (WIA), Adyar, Chennai
Why ? - 3
Non-epithelial and epithelial histologies in almost equal distribution. Chennai males : nhl, brain & nervous system, hnscc, Females : breast, cervix, nhl US & Canada : lymphomas & leukemia,thyroid sarcomas, melanoma, 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
Typical age group for HNSCC : 6th - 7th decade Site : oral cavity & oropharynx , Npx, Thyroid. Usually diagnosed in advanced stage Early nodal metastases ? 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?.
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
1. Impact of HPV in Oropharyngeal Cancer Journal of Oncology Volume 2011 (2011), Article ID 509036, 6 pages doi:10.1155/2011/509036
Multiple sex partners oral & vaginal High number of open mouth kissing partners Young age of first sexual experience H/o genital warts Tobacco reduces local mucosal immunity ? alcohol
HPV - carcinogenesis
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 Probability of second primaries Socio-economic issues: marriage, fertility, career etc.
SURGERY
Organ preservation Vs cure Organ function Cosmesis Fibrosis Xerostomia Trismus Second primaries fertility
RADIATION THERAPY
CHEMOTHERAPY
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 5 year survival for HPV + tumors = 82% 5 year survival for HPV - tumors= 32%
Smokers with a HPV+ tumor - overall worst prognosis University of Michigan Comprehensive Cancer Center Recurrence rates :
Patients with HPV+ and current smokers = 35 % Patients with HPV+ and smoking history= 17% Patients with HPV+ and no smoking history= 6%
Distinct lack of progress in survival improvement even after 25 years in western countries
Presence of co-morbidities lesser compared to other age groups Delay in diagnosis Availability of multi-modal , scientific approach Cost of diagnosis, treatment & long term follow-up.
What is needed ?
Challenge = Opportunity Recognise as a separate entity collaborate data among institutions. Etiologic research possibility of prevention & risk reduction.
What is needed ?
Young persons more likely to adopt new habits than the old. Eg. Glue sniffing.
In Conclusion
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. Multimodal approach best chances of cure Pro-active , lifelong follow up Need for collaborative clinical trials all aspects.