Risk factors: Researchers report no clear risk factors for cancer in young adults. Few studies have found any connection to 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 a 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 the elderly. 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. In 2006, the National Cancer Institute 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 2 percent of all invasive cancers (excluding skin cancer) in the United States. However, each year about 70,000 young adults in the second or third decade of their lives learn they have some form of cancer. Young adults between the ages of fifteen and twenty-nine are 2.7 times as likely to develop cancer as they were before they turned fifteen. Young men between the ages of fifteen and twenty-nine have a higher incidence and a poorer prognosis than young women in this age group. The incidence of young adult cancers has experienced a steady increase. In 2011, over 69,000 adolescents and young adults between the ages of fifteen and thirty-nine were diagnosed with cancer.
According to the American Cancer Society in 2014, the three most predominant types of cancer in children and young adults is leukemia at 26 percent, brain and central nervous system cancers at 18 percent, and lymphoma at 14 percent.
Symptoms: Symptoms of young adult cancers are specific to the type cancer they have developed. The following are some common young adult cancers and symptoms:
Lymphoma symptoms include painless lumps in the neck, armpits, or groin; other possible signs are 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 are 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 (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 most 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 on 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 in 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 may 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-age or older adults, not for young adults. Health care providers may overlook cancer as a possibility because of the person’s youth and misdiagnose the disease.
Young adults in school or college may be covered by their parents’ health insurance or have school health insurance with limited coverage; some may have no health insurance due to limited financial resources. They may delay dealing with symptoms because of the costs associated with health care providers, clinics, and testing. When they do seek help, they may encounter a complicated health care system and become frustrated with the process.
Treatment and therapy: Cancer treatment for young adults will be specific to the location, type, and stage of the cancer. 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 level of energy 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 employed in certain cancers. Targeted therapy may be a treatment for metastasis of the cancer. A stem cell transplant might be useful in treatment. Joining a clinical trial directed to the 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, a doctor that specializes in cancer. Because cancer is less common in young adults, not all oncology physicians are familiar with this age-related specialty. They may not know about current 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 normal protocol for leukemia treatment in adults. Hence, 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. While overall survival rates for adults and children with cancer have improved over the past few years, the same is not true for young adults. The National Cancer Institute reports that in 2011, cancer was the leading causes of disease-related death among adolescents and young adults, with accidents, suicides, and homicides claiming more lives than cancer. Furthermore, it was reported that both cancer incidence rates and five-year survival rates were highest among white young adults, while African American young adults have moderate cancer incidence levels but low five-year survival rates. Asian/Pacific Islander young adults had the lowest cancer incidence rates.
Some studies suggest that young adult cancers can develop after previous childhood cancers. Research is currently 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 that treatments such as chemotherapy and radiation therapy used to treat the first cancer may suppress the patient’s immune systems as well as damage normal cells. Key to decreasing second cancers is determining the factors that might contribute and minimizing exposure.
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 from 10 a.m. to 4 p.m.
- Wear a hat, sunglasses, and clothes that cover the skin when 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 health care provider immediately if any suspicious spots or moles occur.
Young adult cancers
"Adolescents and Young Adults with Cancer." National Cancer Institute. US Dept. of Health and Human Services, n.d. Web. 29 Jan. 2015.
American Cancer Society. "Special Section: Childhood and Adolescent Cancers." Cancer Facts and Figures 2014. Atlanta: Amer. Cancer Society, 2014. 25–42.
Bleyer, A., M. O’Leary, R. Barr, and L. A. G. Ries, eds. Cancer Epidemiology in Older Adolescents and Young Adults Fifteen to Twenty-nine Years of Age, Including SEER Incidence and Survival: 1975-2000. Bethesda, Md.: National Cancer Institute, 2006.
Eden, T. O. B., et al., eds. Cancer and the Adolescent. 2d ed. Malden, Mass.: Blackwell, 2005.
Grinyer, Anne. Cancer in Young Adults: Through Parents’ Eyes. Philadelphia: Open University Press, 2002.
Robison, Leslie L., and Melissa M. Hudson. "Survivors of Childhood and Adolescent Cancer: Life-long Risks and Responsibilities." Nature Reviews Cancer 14.1 (2014): 61–70. Print.
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