Young adult cancers

ALSO KNOWN AS: Youth cancers, adolescent cancer, teen cancer

DEFINITION: Young adult cancers are malignancies that occur in youth from their mid-teens through their twenties (ages fifteen through twenty-nine). Some sources include people in their thirties in this grouping as well.

Some common cancers diagnosed in young adults are as follows:

• Lymphoma: cancer of the lymph glands that help fight disease
• Melanoma: a malignant skin cancer
• Thyroid cancer: cancer in the butterfly-shaped endocrine gland in the front of the neck below the voice box that produces hormones to regulate growth, metabolism, and level of energy
• Leukemia: cancer of the blood and bone marrow
• Soft-tissue sarcoma: cancer in supportive or connective tissue; forms in muscle, nerves, tendons, blood vessels, fat, joints, and lymph nodes
• Germ-cell tumors: tumors of special cells that develop in an embryo that later become sexual organs, such as the male testes and female ovaries

Other common cancers in young adults include brain, breast, and colorectal cancer.

Risk factors: Researchers report no clear risk factors for cancer in young adults. Some research connects environmental factors or inheritance. Most cases of young adult cancer appear sporadic and spontaneous, with only 5 percent related to family history. Cancers that may be connected to environmental factors include melanoma, cervical cancer, Kaposi sarcoma, non-Hodgkin lymphoma, Hodgkin disease, and Burkitt lymphoma. Having cancer in childhood may increase the risk of developing a second cancer as a young adult.

Etiology and the disease process: Because increased cancer occurrence is usually noted in older adults, cancer is often regarded as a disease of older adults. However, cancer occurs in people of all ages. Historically, minimal research has been directed toward cancer in young adults, ages fifteen through twenty-nine, but that is changing. The National Cancer Institute (NCI) joined with the Lance Armstrong Foundation to identify barriers that face young adults with cancer and to develop approaches that can improve outcomes for this age group.

Young adults with cancer face many challenges because of their age and developmental tasks. In the teenage years, young people try to achieve mature relationships with others of both sexes, establish gender role identities, learn to accept their bodies, achieve emotional independence from their parents, prepare for marriage, gain education for a career, acquire values that govern behaviors, and become socially responsible. In early adulthood, young adults select a mate, establish a home, start a family, struggle to establish their identity, complete their education and training to work and provide financial support, express independence, and become comfortable with their sexuality. These milestones may be difficult with a chronic disease process that threatens financial security and brings changes in body image, social relationships, and sexuality. The stresses of the young adult differ from those of children or older adults.

Incidence: Young adult cancers account for only about 5 percent of all invasive cancers in the United States. However, each year, between five and six thousand adolescents aged fifteen to nineteen and about 84,000 young adults between fifteen and thirty-nine learn they have cancer. Young adults between fifteen and twenty-nine are six times as likely to develop cancer as they were before they turned fifteen. Young women between the ages of fifteen and twenty-nine have a rate of diagnosis but are just as likely to die as young men with cancer. The incidence of some cancers in young adults has experienced a steady increase—lymphoma, melanoma, sarcomas, cervical and ovarian cancers, thyroid cancer, testicular cancer, colorectal cancer, leukemia, and brain and spinal cord tumors.

Symptoms: Symptoms of young adult cancers are specific to the type of cancer. The following are some common young adult cancers and symptoms:

Lymphoma symptoms include painless lumps in the neck, armpits, or groin. Other signs include weight loss of up to 10 percent of total body weight, high infrequent fevers, loss of appetite, weakness and fatigue, generalized itchiness over the body, red, irritated patches of skin, excessive sweating at night, and coughing or breathlessness with swelling of the face and neck.

Melanomas present in moles that change in size (become bigger), shape (especially with an irregular edge), color (get darker or multicolored), become itchy or painful, bleed or become crusty, or appear inflamed or irritated.

Thyroid cancer symptoms include a lump or nodule on the neck, pain in the neck, jaw, and ear, difficulty swallowing, a tickle in the throat, or hoarseness.

Leukemia symptoms vary by type, but most are vague and nonspecific, such as fatigue or general weakness; malaise (a general uncomfortable feeling throughout the body); abnormal bleeding and excessive bruising; reduced tolerance for exercise; an enlarged spleen, liver, or lymph nodes; joint or bone pain; increased infection and fever; and abdominal pain or fullness. A blood test will likely show anemia, leukopenia (low white cell count), and thrombocytopenia (low blood clotting cell count).

Cervical cancer is a silent disease in its early stages, with later symptoms such as abnormal vaginal bleeding, heavy vaginal discharge, pelvic pain, pain during urination, or bleeding after intercourse, between menses, or after douching.

Brain tumors may present with signs of increased intracranial pressure, such as headaches, vomiting, especially upon waking, mental changes such as drowsiness or sluggishness, seizures, and loss of coordination with clumsy movement. Depending on the tumor location, symptoms can also include buzzing or ringing in the ears, dizziness, blindness on one side, language disorders, loss of smell, or impaired vision.

Spinal cord tumors manifest with symptoms such as neck, arm, or leg pain; weakness; muscle wasting; spasms; sensory changes; or decrease in bowel and bladder control.

Screening and diagnosis: Because young people are generally healthy, screening and diagnosis of cancer in young adults may be delayed. Young people may not recognize symptoms or ignore their body’s signs of illness. They may think that symptoms are related to their lifestyle choices. Most screening procedures are recommended for middle-aged or older adults, not for young adults. Healthcare providers may overlook cancer as a possibility because of the person’s youth and misdiagnose the disease.

Their parent's health insurance may cover young adults in school or college, or they may have school health insurance with limited coverage. They may delay addressing symptoms because of the costs associated with healthcare providers, clinics, and testing. When they seek help, they may encounter a complicated healthcare system and become frustrated.

Treatment and therapy: Cancer treatment for young adults will be specific to the cancer's location, type, and stage. If there is a malignant tumor or mass, surgery may be the best option. With or without surgery, chemotherapy (the use of drugs to kill cancer cells) may be used by the oncology physician to treat the cancer. Some cancers respond to radiation therapy, in which a high energy level targets the cancer site to kill cancer cells. Immunotherapy may be used to stimulate the immune system to fight the cancer. Hormone therapy might be useful in specific cancers. Targeted therapy may be a treatment for metastasis of the cancer. A stem cell transplant might be helpful in treatment. Joining a clinical trial directed to a young adult’s specific cancer may prove beneficial.

Choosing a physician to provide cancer treatment and therapy is critical for young adults. The first consideration is to contact an oncologist. Because cancer is less common in young adults, not all oncology physicians are familiar with this age-related specialty. They may lack knowledge of modern treatment options and available support groups or resources for young adults. One example is that young adults with leukemia sometimes have better outcomes when treated with a regimen designed for children rather than the standard protocol for leukemia treatment in adults. Young adults may need to consult specialists in pediatric oncology. However, practitioners who treat adults for cancers like breast, colon, or melanoma may provide the best treatment for young adults with these cancers.

Prognosis, prevention, and outcomes: The prognosis for young adults varies with their specific cancer. The overall five-year survival rate for young patients with cancer is around 87 percent. While overall survival rates for adults and children with cancer have improved, some cancers in young adults remain deadly.

Some studies suggest that young adult cancers can develop after previous childhood cancers. Research is examining lymphoma, leukemia, and testicular cancer, as these are diseases that affect children and young adults. Though no study has established why the second cancer occurs, some scientists believe treatments such as chemotherapy and radiation therapy used to treat the first cancer may suppress the patient’s immune system and damage normal cells. Determining factors that might contribute to minimizing exposure is critical to decreasing second cancers.

One cancer on the rise among young adults is nonmelanoma skin cancers, which are preventable. Simple precautions can prevent skin cancer in young adults. The American Cancer Society has several recommendations to prevent skin cancer:

• Avoid extended exposure to sunlight during peak hours.
• Wear a hat, sunglasses, and clothes covering the skin in direct sunlight.
• Use sunscreen with a sun protection factor (SPF) of at least 15.
• Avoid tanning booths.
• Check skin often for any unusual moles, spots, or blemishes. Note any change in size, shape, or color.
• See a healthcare provider immediately if any suspicious spots or moles occur.

Bibliography

"Adolescents and Young Adults with Cancer." National Cancer Institute, US Dept. of Health and Human Services, 6 June 2024, www.cancer.gov/types/aya. Accessed 20 July 2024.

Armenian, Saro H., and Chun Chao. "Burden of Morbidity and Mortality in Adolescent and Young Adult Cancer Survivors." Journal of Clinical Oncology, vol. 42, no. 6, 2024, pp. 735-742. doi.org/10.1200/JCO.23.017.

Bleyer, A., et al., editors. Cancer Epidemiology in Older Adolescents and Young Adults Fifteen to Twenty-nine Years of Age, Including SEER Incidence and Survival: 1975-2000. National Cancer Institute, 2006.

"Cancer in Young Adults." American Cancer Society, www.cancer.org/cancer/cancer-in-young-adults.html. Accessed 20 July 2024.

Eden, T. O. B., et al., editors. Cancer and the Adolescent. 2nd ed., Blackwell, 2005.

Grinyer, Anne. Cancer in Young Adults: Through Parents’ Eyes. Open University Press, 2002.

Katella, Kathy. "What to Know About Rising Rates of 'Early-Onset' Cancer." Yale Medicine, 30 Apr. 2024, www.yalemedicine.org/news/early-onset-cancer-in-younger-people-on-the-rise. Accessed 20 July 2024.

Robison, Leslie L., and Melissa M. Hudson. "Survivors of Childhood and Adolescent Cancer: Life-Long Risks and Responsibilities." Nature Reviews Cancer, vol. 14, no. 1, 2014, pp. 61–70.

Ryder-Burbidge, Charlotte, et al. "The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review." Cancers, vol. 13, no. 19, 2021. doi.org/10.3390/cancers13194870.