Adolescent and young adult cancers (ages 15 to 39)
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.
Overview
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.
The 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.
The 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.
State of the art
- 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.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowCytokine release syndrome
Fever of 38 C or higher, chills, low blood pressure, fast heartbeat or breathlessness, especially after a step-up dose. Boxed warning on teclistamab, epcoritamab, glofitamab, tarlatamab and blinatumomab.
- Check before combiningFood and drink: Vincristine
Fatal if given intrathecally: label all syringes.
- Check before combiningKidneys: Methotrexate
High-dose methotrexate requires normal renal function, hydration, urine alkalinisation and leucovorin rescue with level monitoring.
- Good to knowPeripheral neuropathy (chemotherapy-induced)
Nerve damage from chemotherapy that causes numbness, tingling and pain in the hands and feet, and sometimes weakness or hearing loss. It builds up with each dose, can be permanent, and is the main reason oxaliplatin, taxanes and vincristine have to be stopped or reduced.
See all on the product pages:BlinatumomabMethotrexateVincristine·Printable cards in the navigator
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
- Psycho-oncology and distress screeningEstablished
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Paediatric-inspired regimen with asparaginase (CALGB 10403 model) and blinatumomab consolidation for MRD-negative B-ALL (E1910); Ph-like screening at diagnosis.
Fertility preservation referral (sperm banking, oocyte or embryo cryopreservation, ovarian tissue) as a default step.
Age-specific units or teams, distress screening, education and employment support, financial navigation.
Treatment summary and risk-based follow-up for cardiac, second-cancer, endocrine and fertility late effects over decades.
Germline testing in young-onset breast, colorectal, sarcoma and other cancers, with cascade testing of relatives.
Subtypes & biomarkers
top- 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)
- 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
How often this target appears
- 1990Teenage Cancer Trust opens the first dedicated teenage cancer unit in the United Kingdom
- 2006NCI and LIVESTRONG Progress Review Group defines AYA oncology as ages 15 to 39 and documents the survival gap
- 2006ASCO guideline requires fertility preservation discussion before cancer treatment
- 2012NCCN publishes the first adolescent and young adult oncology guidelines
- 2019CALGB 10403: paediatric regimen in adults 17 to 39 published; FDA guidance on including adolescents in adult cancer trials
- 2024Blinatumomab consolidation approved for adults and children with B-ALL after E1910
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 9 changes by month →- 2026-09-17This recordAdolescent and young adult cancers (ages 15 to 39)Facts on this page last checked
When this page itself was last checked or edited.
- 2024Trial resultECOG-ACRIN E1910ECOG-ACRIN E1910 reported
3-year OS 85% vs 68%; HR 0.
- 2024MilestoneBlinatumomabBlinatumomab consolidation approved for adults and children with B-ALL after E1910
A milestone in how this cancer is treated.
- 2019MilestoneAsparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase)CALGB 10403: paediatric regimen in adults 17 to 39 published; FDA guidance on including adolescents in adult cancer trials
A milestone in how this cancer is treated.
- 2016Trial resultChildhood Cancer Survivor Study (CCSS)Childhood Cancer Survivor Study (CCSS) reported
15-year all-cause mortality among five-year survivors fell from 12.
- 2012MilestoneAdolescent and young adult cancers (ages 15 to 39)NCCN publishes the first adolescent and young adult oncology guidelines
A milestone in how this cancer is treated.
What is in development for Adolescent and young adult cancers (ages 15 to 39), drawn from the whole corpus: 4 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Trials reported · 1
- ECOG-ACRIN E1910 · phase 3 · 2024 · positive
Ideas not yet in a trial · 3
Open problems and what is being done
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.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Bethesda, MD · government | United States | none recorded | 1 | 2,905 | 47,715 | - | |
Memphis, TN · cancer center | United States | 1 | 636 | 8,887 | - | ||
Philadelphia, PA · consortium | United States | none recorded | 1 | 15 | 142 | - | |
Beijing · hospital | China | none recorded | 0 | 1,784 | 18,230 | - | |
L'Hospitalet de Llobregat · cancer center | Spain | 0 | 988 | 14,310 | - | ||
Philadelphia, PA · cancer center | United States | 0 | 755 | 12,225 | - | ||
Philadelphia, PA · hospital | United States | none recorded | 0 | 695 | 9,931 | - | |
Nagaizumi, Shizuoka · cancer center | Japan | none recorded | 0 | 657 | 3,545 | - | |
Helsinki · cancer center | Finland | none recorded | 0 | 558 | 5,920 | - | |
Lund · hospital | Sweden | none recorded | 0 | 521 | 4,154 | - | |
Valencia · hospital | Spain | none recorded | 0 | 416 | 3,394 | - | |
Jerusalem · hospital | Israel | none recorded | 0 | 383 | 2,794 | - | |
São Paulo · cancer center | Brazil | none recorded | 0 | 352 | 2,396 | - | |
Kuala Lumpur · hospital | Malaysia | none recorded | 0 | 335 | 3,809 | - | |
Brisbane · research institute | Australia | none recorded | 0 | 281 | 3,430 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Adolescent and young adult cancers but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Adolescent and young adult cancers
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Germline testingin young-onset cancers, Ph-like signature screening in AYA acute lymphoblastic leukaemia, Mismatch repair status in early-onset colorectal cancer, Ovarian reservebefore gonadotoxic therapy), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include 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.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Acute lymphoblastic leukaemia, 15 to 39
- For my situation (acute lymphoblastic leukaemia, 15 to 39), which of the standard options do you recommend and why?Why: Guideline options include: Paediatric-inspired regimen with asparaginase (CALGB 10403 model) and blinatumomab consolidation for MRD-negative B-ALL (E1910); Ph-like screening at diagnosis.
- Am I a candidate for Asparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase), Vincristine, Dexamethasone or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ECOG-ACRIN E1910 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Before any gonadotoxic treatment
- For my situation (before any gonadotoxic treatment), which of the standard options do you recommend and why?Why: Guideline options include: Fertility preservation referral (sperm banking, oocyte or embryo cryopreservation, ovarian tissue) as a default step.
Psychosocial and financial
- For my situation (psychosocial and financial), which of the standard options do you recommend and why?Why: Guideline options include: Age-specific units or teams, distress screening, education and employment support, financial navigation.
Survivorship
- For my situation (survivorship), which of the standard options do you recommend and why?Why: Guideline options include: Treatment summary and risk-based follow-up for cardiac, second-cancer, endocrine and fertility late effects over decades.
- How do the results of Childhood Cancer Survivor Study (CCSS) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Hereditary risk
- For my situation (hereditary risk), which of the standard options do you recommend and why?Why: Guideline options include: Germline testing in young-onset breast, colorectal, sarcoma and other cancers, with cascade testing of relatives.
Any stage
- Are there clinical trials I could join, for example of Blinatumomab, ECOG-ACRIN E1910, A survivorship passport app for adolescent and young adult survivors, Default fertility preservation referral for every patient under 40 before treatment?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Trial enrolment in AYA remains far below that of children”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Fertility preservation is offered unevenly and paid for inconsistently”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Adolescent and young adult cancers, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
9targets
2drugs
5companies
4institutions
2terms
4trials
2ideas
3key papers
1Latest papers
topQuery for this cancer: (TITLE:"Adolescent and young adult cancers" OR ABSTRACT:"Adolescent and young adult cancers" OR TITLE:"ages 15 to 39" OR ABSTRACT:"ages 15 to 39" OR TITLE:"AYA cancers" OR ABSTRACT:"AYA cancers" OR TITLE:"Teenage and young adult cancer" OR ABSTRACT:"Teenage and young adult cancer" OR TITLE:"TYA cancer" OR ABSTRACT:"TYA cancer" OR TITLE:"Young adult cancer" OR ABSTRACT:"Young adult cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Adolescent and young adult cancers (ages 15 to 39), not a curated reading list.
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