As many as 70,000 young adults in their 20s and 30s are diagnosed with cancer each year. Doctors are learning that cancer in young adults is sometimes different than cancer in older adults, and young adults with cancer face a different set of challenges than older and younger people with cancer.  

Q: What are the most common types of cancer that are diagnosed in young adults? 

A: The ten most common types in the age group (defined here as ages 15 to 40), in order of frequency, are breast cancer, lymphoma (non-Hodgkin and Hodgkin), melanoma, sarcoma, gynecologic cancers of the ovary and cervix, thyroid cancer, testicular cancer, colorectal cancer, leukemia, and brain tumors. These cancers account for 90% of the cancers in this age group. Also, the types of cancer that are most common changes dramatically from age 15 to 40, so that the common cancers seen at the younger ages do not resemble the common cancers at the older ages. 

Q: What makes cancer in young adults different from other age groups? 

A: Cancer in this group is unique in the distribution of the types that occur. The variety of cancers described above does not occur at any other age. Moreover, there is evidence that the biology of the cancer differs from younger and older people with what seems otherwise to be the same cancer. In addition, and perhaps in part because of these differences, progress has been lacking in the age group relative to what has been achieved in younger and older people. The psychosocial changes are also extraordinary and further complicate one of the most difficult transitions in life. Finally, the total number of patient-years of life affected by cancer is high in young adults. 

Q: What are some possible late effects of treatment for young adults with cancer, and what are some ways to manage the risks? 

A: The late effects of cancer and its therapies are seen in nearly every organ and organ system in young adults. A few notable examples of late effects are the development of a second tumor, such as breast cancer in survivors of Hodgkin lymphoma, and the development of carcinoma and lymphoma after bone marrow transplantation; infertility (the inability to produce or bear children) in men and women after chemotherapy or radiation treatment to the genital tissue; lack of libido and sexual dysfunction; fatigue and depressive mood; weight gain and obesity; avascular necrosis (a disease in which bone tissue dies because of a disruption of the blood supply) of bones and joints in leukemia survivors; heart failure after anthracycline chemotherapy or radiation therapy to the chest; chemobrain (change in one's ability to think clearly, concentrate, or focus on one task after receiving chemotherapy), peripheral neuropathy (disabling hand and feet symptoms) and other neurotoxicities from chemotherapy; hearing loss from brain radiation or chemotherapy; kidney failure from chemotherapy; and liver dysfunction from hepatitis infection, radiation or chemotherapy. There is also the discovery of predisposition to other cancers in people with breast, thyroid, and colorectal cancer who learn that they have a genetic condition requiring further intervention (such as a bilateral mastectomy, thyroidectomy, or parathyroidectomy) and surveillance examinations (such as colonoscopy, mammography, and ovarian cancer surveillance). The most important way to minimize the risks are (1) to know what they are; (2) to make sure that physicians involved with future care are aware of them and know how to anticipate and detect them; and (3) to be willing have checkups annually and whenever warning signals occur. 

Q: The survival rate for young adults with cancer has held steady over the past few decades while it has improved for other age groups. What are some factors that may explain this? 

A: The most important factor is that the age group was largely ignored in deference to children, in whom the first advances in cancer therapy were achieved, and to older patients who represent the bulk of cancer diagnoses. Also, at the time, treatment results were better in young adults than in younger and older patients. Since then, translational research and clinical trials have been least conducted in young adults. Other factors include a national (and international) lack of awareness of the young adult cancer problem, a lack of health insurance coverage (which is lower in this age group than in any other), lack of experts in young adult oncology and of comfort in managing the psychosocial problems within the age group, and the societal history of separating pediatric and adult oncology training, practice, organization, education, research, and funding. 

Q. What are some common emotional and social concerns for young adults with cancer, and what are some resources available to them and their families? 

A: The range of emotional and social concerns is wider at this age than at any other, in part because the spectrum is broader and more challenging than at any other age under the best of circumstances, when health is not limiting. The concerns include independence, education, career choice/employment, body image, sexuality, peer pressure and social acceptance, marriage, dating, and pregnancy and parenthood. Many young adults are also coping with sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), alcohol and substance abuse, and other addictions. Health insurance may also be difficult to obtain. Resources are limited in comparison to other age groups, and for the most part, are under development. Some resources currently available to young adults and their families include websites (such as Planet Cancer, CancerCare, LiveSTRONG Young Adult Alliance, The Ulman Cancer Fund for Young Adults, Vital Options, ImTooYoungForThis.org, RealTime Cancer, Prepare to Live, National Collegiate Cancer Foundation, Young Cancer Spouses, Pregnant with Cancer, Mothers Supporting Daughters with Breast Cancer), and local experts such as young adult social workers and clergy, and psychologists and psychiatrists skilled in working with this age group. A bill of rights for young adults with cancer is now available as precepts for standards of care and a framework for expectations. 

Dr. Bleyer is a pediatric and young adult oncologist, Survivorship Director at the St. Charles Regional Cancer Center in Bend, Oregon, and Chair of the ASCO Patient Communication Subcommittee.