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

1. CANCER IN ADOLESCENTS AND YOUNG ADULTS Dr. T. Sujit , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre

4. CANCER IN ADOLESCENTS AND YOUNG ADULTS Dr. T. Sujit , DMRT Consultant Radiation Oncologist Thanjavur Cancer Centre

8. Why ? - 1 PAEDIATRIC CANCERS – NON EPITHELIAL TYPES ADULT CANCERS - EPITHELIAL TYPE CANCER IN AYA - A MIX OF BOTH

10. Male female . POPULATION BASED CANCER REGISTRY, CHENNAI Cancer Institute (WIA), Adyar, Chennai

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

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

20. Alcohol

21. Hiv

22. Hpv

23. Ebv - nasopharynx

24. ? genetic susceptibility - unproven

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.

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

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.

42. Organ function

44. Xerostomia

45. Trismus

48. 5 year survival for HPV + tumors = 82%

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

55. Delay in diagnosis

56. Availability of multi-modal , scientific approach

57. Cost of diagnosis, treatment & long term follow-up.

59. Recognise as a separate entity – collaborate data among institutions.

60. Etiologic research – possibility of prevention & risk reduction.

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