{"entity":{"id":"aya-cancers","kind":"cancer","name":"Adolescent and young adult cancers (ages 15 to 39)","aka":["AYA cancers","Teenage and young adult cancer","TYA cancer","Young adult cancer"],"tldr":"People aged 15 to 39 get a different mix of cancers from children or older adults: leukaemia, lymphoma, testicular and thyroid cancer, melanoma, sarcoma and brain tumours in the younger years, then breast, cervical and bowel cancer towards 40. For decades their survival improved more slowly than anyone else's: they fell between children's and adults' hospitals and joined few trials.","summary":"The National Cancer Institute and LIVESTRONG Progress Review Group defined the adolescent and young adult (AYA) population as 15 to 39 in 2006 after Bleyer and colleagues showed that five-year survival for this age band had improved far less between 1975 and 1997 than for children or for adults over 40, and that fewer than one in ten were treated in a clinical trial against more than half of children. The cancers differ by age: acute lymphoblastic leukaemia, Hodgkin lymphoma, germ cell tumours, osteosarcoma and Ewing sarcoma, thyroid cancer, melanoma and gliomas dominate the teenage years; breast, cervical, colorectal and thyroid cancer take over through the thirties. Several behave differently from the same diagnosis at other ages: young-adult breast cancer is more often triple-negative or BRCA-associated, early-onset colorectal cancer is rising by about two percent a year, and AYA acute lymphoblastic leukaemia carries more Ph-like and fewer favourable genetic subtypes than childhood disease.\n\nThe clearest treatment lesson is in acute lymphoblastic leukaemia. Retrospective comparisons in France, the United States and the Netherlands found that 16 to 20-year-olds treated on paediatric protocols did far better than those on adult ones, and the prospective CALGB 10403 study of a paediatric regimen in 295 patients aged 17 to 39 gave three-year event-free survival of 59 percent and overall survival of 73 percent, roughly double the historical adult figures; paediatric-inspired therapy is now standard to age 40 and blinatumomab consolidation (E1910) adds to it. Ewing sarcoma and osteosarcoma outcomes fall with age partly through dose intensity and partly through biology; Hodgkin lymphoma in AYA is highly curable and the trial question is de-escalation; germ cell tumours have a cure rate over 90 percent but were the disease in which the survival gap was first documented in young men treated outside specialist centres. The United Kingdom built dedicated teenage and young adult units from 1990 through the Teenage Cancer Trust and made specialist referral national policy in 2005; the NCCN issued AYA guidelines in 2012.\n\nThe needs that cut across diagnoses are fertility preservation before treatment, which guidelines have required since 2006 and which is still offered unevenly; psychosocial support during education, early careers and young parenthood; financial toxicity in people with no savings and, in the United States, patchy insurance; and survivorship, since a 25-year-old cured of Hodgkin lymphoma has sixty years to develop the cardiac and second-cancer consequences of treatment. The research gaps are trial eligibility ages that exclude 12 to 17-year-olds from adult trials and over-18s from paediatric ones, which the FDA's 2019 guidance on including adolescents in adult cancer trials began to close; molecular studies of why the same cancer differs at different ages; and registries able to follow a population that moves house, hospital and country more than any other.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Adolescent_and_young_adult_oncology","links":[{"label":"Wikipedia: Adolescent and young adult oncology","url":"https://en.wikipedia.org/wiki/Adolescent_and_young_adult_oncology"},{"label":"NCI: Adolescents and Young Adults with Cancer","url":"https://www.cancer.gov/types/aya"}],"tags":["umbrella","subtype-page","aya"],"related":["childhood-cancers"],"cancers":["all-leukemia","all-ph-like","hodgkin-lymphoma","testicular","paediatric-germ-cell-tumours","thyroid","melanoma","ewing-sarcoma","osteosarcoma","brain-tumours","breast-cancer","cervical","early-onset-colorectal"],"sections":[],"technologies":["fertility-preservation","survivorship-care-plan","psycho-oncology"],"targets":[],"drugs":[],"companies":[],"institutions":["teenage-cancer-trust","childrens-oncology-group"],"pathways":[],"terms":["aya-oncology","late-effects","financial-toxicity","cancer-in-pregnancy"],"trials":["e1910","ccss"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"adolescent and young adult","burden":"Cancer in people aged 15 to 39 is uncommon but not rare, about 90,000 diagnoses a year in the United States, and for decades survival gains in this age band lagged those in children and older adults.","subtypes":["Adolescents 15 to 19: acute lymphoblastic leukaemia, Hodgkin lymphoma, germ cell tumours, bone sarcomas, thyroid cancer, brain tumours","Young adults 20 to 29: testicular and ovarian germ cell tumours, Hodgkin lymphoma, thyroid cancer, melanoma, leukaemia and lymphoma","Young adults 30 to 39: breast cancer, cervical cancer, early-onset colorectal cancer, thyroid cancer, melanoma","AYA acute lymphoblastic leukaemia (paediatric-inspired regimens to age 40)","Cancer during pregnancy (breast, cervical, melanoma, lymphoma)"],"biomarkers":["Germline testing (BRCA1/2, Lynch syndrome, TP53) in young-onset cancers","Ph-like signature screening in AYA acute lymphoblastic leukaemia","Mismatch repair status in early-onset colorectal cancer","Ovarian reserve (anti-Mullerian hormone) before gonadotoxic therapy"],"standardOfCare":[{"setting":"Acute lymphoblastic leukaemia, 15 to 39","approach":"Paediatric-inspired regimen with asparaginase (CALGB 10403 model) and blinatumomab consolidation for MRD-negative B-ALL (E1910); Ph-like screening at diagnosis.","refs":["asparaginase","vincristine","dexamethasone","methotrexate","blinatumomab","e1910","ngs-mrd-clonoseq","paper-e1910-blinatumomab-mrd-negative-all-nejm-2024"],"guideline":{"version":"NCI: Adolescents and Young Adults with Cancer","url":"https://www.cancer.gov/types/aya"}},{"setting":"Before any gonadotoxic treatment","approach":"Fertility preservation referral (sperm banking, oocyte or embryo cryopreservation, ovarian tissue) as a default step.","refs":["fertility-preservation"],"guideline":{"version":"NCI: Adolescents and Young Adults with Cancer","url":"https://www.cancer.gov/types/aya"}},{"setting":"Psychosocial and financial","approach":"Age-specific units or teams, distress screening, education and employment support, financial navigation.","refs":["psycho-oncology","financial-toxicity","teenage-cancer-trust"],"guideline":{"version":"NCI: Adolescents and Young Adults with Cancer","url":"https://www.cancer.gov/types/aya"}},{"setting":"Survivorship","approach":"Treatment summary and risk-based follow-up for cardiac, second-cancer, endocrine and fertility late effects over decades.","refs":["survivorship-care-plan","late-effects","cardio-oncology","idea-acc-aya-survivorship-passport","ccss"],"guideline":{"version":"NCI: Adolescents and Young Adults with Cancer","url":"https://www.cancer.gov/types/aya"}},{"setting":"Hereditary risk","approach":"Germline testing in young-onset breast, colorectal, sarcoma and other cancers, with cascade testing of relatives.","refs":["germline-testing"],"guideline":{"version":"NCI: Adolescents and Young Adults with Cancer","url":"https://www.cancer.gov/types/aya"}}],"stateOfArt":["Paediatric-inspired regimens roughly doubled survival in AYA acute lymphoblastic leukaemia and are standard to age 40.","Dedicated teenage and young adult units are national policy in the United Kingdom and spreading elsewhere.","Trial eligibility is being widened to include adolescents in adult trials and young adults in paediatric ones."],"history":[{"year":1990,"title":"Teenage Cancer Trust opens the first dedicated teenage cancer unit in the United Kingdom","refs":["teenage-cancer-trust"]},{"year":2006,"title":"NCI and LIVESTRONG Progress Review Group defines AYA oncology as ages 15 to 39 and documents the survival gap","refs":["aya-oncology"]},{"year":2006,"title":"ASCO guideline requires fertility preservation discussion before cancer treatment","refs":["fertility-preservation"]},{"year":2012,"title":"NCCN publishes the first adolescent and young adult oncology guidelines","refs":[]},{"year":2019,"title":"CALGB 10403: paediatric regimen in adults 17 to 39 published; FDA guidance on including adolescents in adult cancer trials","refs":["asparaginase"]},{"year":2024,"title":"Blinatumomab consolidation approved for adults and children with B-ALL after E1910","refs":["blinatumomab","e1910"]}],"pipeline":["blinatumomab","e1910","idea-acc-aya-survivorship-passport","idea-acc-default-fertility-preservation-referral","idea-acc-national-late-effects-registry","fertility-preservation","ngs-mrd-clonoseq"],"openProblems":["Trial enrolment in AYA remains far below that of children.","Fertility preservation is offered unevenly and paid for inconsistently.","Why the same cancer behaves differently at different ages is largely unexplained."]},"route":"/cancers/aya-cancers/","neighbours":{"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"brain-tumours","kind":"cancer","name":"Brain and spinal cord tumours (all types)","route":"/cancers/brain-tumours/"},{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"childhood-cancers","kind":"cancer","name":"Childhood cancers (all types)","route":"/cancers/childhood-cancers/"},{"id":"early-onset-colorectal","kind":"cancer","name":"Early-onset colorectal cancer (under 50)","route":"/cancers/early-onset-colorectal/"},{"id":"ewing-sarcoma","kind":"cancer","name":"Ewing sarcoma","route":"/cancers/ewing-sarcoma/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"osteosarcoma","kind":"cancer","name":"Osteosarcoma","route":"/cancers/osteosarcoma/"},{"id":"all-ph-like","kind":"cancer","name":"Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL)","route":"/cancers/all-ph-like/"},{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","route":"/cancers/testicular/"},{"id":"thyroid","kind":"cancer","name":"Thyroid cancer","route":"/cancers/thyroid/"}],"technology":[{"id":"cardio-oncology","kind":"technology","name":"Cardio-oncology","route":"/technologies/cardio-oncology/"},{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"},{"id":"ngs-mrd-clonoseq","kind":"technology","name":"NGS-based MRD (clonoSEQ and molecular MRD)","route":"/technologies/ngs-mrd-clonoseq/"},{"id":"fertility-preservation","kind":"technology","name":"Oncofertility and fertility preservation","route":"/technologies/fertility-preservation/"},{"id":"psycho-oncology","kind":"technology","name":"Psycho-oncology and distress screening","route":"/technologies/psycho-oncology/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"}],"institution":[{"id":"childrens-oncology-group","kind":"institution","name":"Children's Oncology Group (COG)","route":"/institutions/childrens-oncology-group/"},{"id":"teenage-cancer-trust","kind":"institution","name":"Teenage Cancer Trust","route":"/institutions/teenage-cancer-trust/"}],"term":[{"id":"aya-oncology","kind":"term","name":"Adolescent and young adult (AYA) oncology","route":"/terms/aya-oncology/"},{"id":"cancer-in-pregnancy","kind":"term","name":"Cancer during pregnancy","route":"/terms/cancer-in-pregnancy/"},{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"}],"trial":[{"id":"ccss","kind":"trial","name":"Childhood Cancer Survivor Study (CCSS)","route":"/trials/ccss/"},{"id":"e1910","kind":"trial","name":"ECOG-ACRIN E1910","route":"/trials/e1910/"}],"drug":[{"id":"asparaginase","kind":"drug","name":"Asparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase)","route":"/drugs/asparaginase/"},{"id":"blinatumomab","kind":"drug","name":"Blinatumomab","route":"/drugs/blinatumomab/"},{"id":"dexamethasone","kind":"drug","name":"Dexamethasone","route":"/drugs/dexamethasone/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"idea":[{"id":"idea-acc-national-late-effects-registry","kind":"idea","name":"A national late-effects registry linking treatment exposures to outcomes decades later","route":"/ideas/idea-acc-national-late-effects-registry/"},{"id":"idea-acc-aya-survivorship-passport","kind":"idea","name":"A survivorship passport app for adolescent and young adult survivors","route":"/ideas/idea-acc-aya-survivorship-passport/"},{"id":"idea-acc-default-fertility-preservation-referral","kind":"idea","name":"Default fertility preservation referral for every patient under 40 before treatment","route":"/ideas/idea-acc-default-fertility-preservation-referral/"}],"paper":[{"id":"paper-e1910-blinatumomab-mrd-negative-all-nejm-2024","kind":"paper","name":"ECOG-ACRIN E1910: adding blinatumomab to chemotherapy for adults with B-cell ALL already in MRD-negative remission","route":"/key-papers/paper-e1910-blinatumomab-mrd-negative-all-nejm-2024/"}]}}