Strategic Financial Factors

In the United States and other countries without universal healthcare, the financial and insurance status of the patient (and family) may indeed influence access to medical care. Adolescence to young adulthood is an age range with great financial variance. Younger adolescents are usually covered by parental insurance plans. For working class families, there are programs (such as the Children's Health Insurance Plan, CHIP) that provide low-cost insurance for children up to their 19th birthday....

References

Creutzig U, Ritter J, Zimmermann M, et al (2001) Improved treatment results in high-risk pediatric acute myeloid leukemia patients after intensification with high-dose cytarabine and mitoxantrone results of Study Acute Myeloid Leukemia-Berlin-Frankfurt-Munster 93. J Clin Oncol 19 2705-2713 2. Stiller CA, Benjamin S, Cartwright RA, et al (1999) Patterns of care and survival for adolescents and young adults with acute leukaemia - a population-based study. Br J Cancer 79 658-665 3. Bleyer WA,...

Synovial Sarcoma

SS probably represents the most frequent malignant tumor of soft tissues in adolescents and young adults, accounting for about 15-20 of all cases. The optimal treatment approach to SS remains to be determined. As for other STSs of adult age, the standard treatment for localized disease is surgery. Complete surgical resection of the primary tumor is the unquestionable mainstay of treatment. Extensive surgery with histo-logically free margins is recommended compartment resection is the treatment...

Conclusions

Ovarian tumors are rare in children, adolescents, and young adults. As a result, relatively little information exists about incidence rates, treatment, and outcomes for specific ovarian tumors for these age groups. This chapter is designed as a guide for the evaluation and treatment of ovarian tumors in adolescents and young adults, with the goal of engendering interest in studies aimed specifically at this patient population. Ovarian neoplasms represent a diagnostic and therapeutic dilemma...

Genetic Predisposition and Genetic Susceptibility

In middle to late adult life, cancer occurs as a result of multiple, serially accumulated, genetic changes following decades of exposure to carcinogens like, for example, tobacco smoke. The occurrence of cancer at young ages, when the opportunity for such chronic environmental exposures has not had sufficient time to exist, suggests strongly that individuals are genetically predisposed to develop certain cancers or are genetically susceptible to the carcinogenic effects of environmental agents....

And Staging Considerations

Although invasive epithelial ovarian cancer is typically a disease of post-menopausal women, LMP tumors tend to occur in younger women, with 71 occurring in pre-menopausal women. The average age at presentation is 40 years, approximately 10 years younger than the average age of women with invasive disease 52 . If the diagnosis of LMP tumor is made post-opera-tively, the patient may need to undergo repeat exploration for a staging procedure, as up to 24 of patients with apparent stage I or II...

Clinical Symptoms and Evaluation

Testicular tumors most commonly present as a firm to hard painless mass. Occasionally, scrotal swelling and acute pain (10 ) may be present. The presence of acute pain increases the likelihood of infection, trauma, torsion, and infarction, but does not rule out tumor or tumor in addition to another diagnosis. A history of trauma is present in 30 of cases. Carcinoma in situ most commonly presents in patients being evaluated for infertility. Germ-cell tumors present more commonly in patients with...

Epidemiology Etiology

Overall, STSs are rare with an annual incidence of around 2-3 100,000 persons of all ages. STS incidence increases exponentially with age, but peaks as a percent of all cancers in 5- to 10-year-olds. At a rate of 8.2 cases per million, STS ties as the fifth most common cancer in 15- to 19-year-olds (7.7 of all tumors) in the 20- to 24-year-olds there are 17.9 cases per million - 6.6 of all tumors and the seventh most common. Although rates continue to increase with age and reach 62.3 per...

Special considerations for chemotherapy in cNS tumors

Drugs that penetrate the BBB have the capacity to produce neurotoxicity as a dose-limiting side effect, which may compound other treatment-related neurotoxicities (e.g., methotrexate and RT). The use of chemotherapy, especially in high doses, in patients with CNS tumors carries additional hazards linked primarily to the infectious risks of ventricular- or lumbar-peritoneal shunts, central venous lines, and frequent episodes of fever, which cause difficulties in discriminating between shunt...

Secreting tumors NGGcTs

MAKEI 86 and 89 studies utilized chemotherapy with PVB (cisplatin + vinblastine + bleomycin) after sur gery and before CrSp RT (36 Gy CrSp RT with 14 Gy tumor boost), followed by postradiation chemotherapy with etoposide and ifosfamide. Subsequently, MAKEI 89 used preoperative PVB (cisplatin + etoposide + bleomycin) followed by tumor resection, followed by further chemotherapy with PIV (cisplatin + ifosfamide + vinblastine) and RT (30 Gy CrSp, tumor boost of 20 Gy). Twenty-seven patients were...

General Surgical Guidelines

The absolute diagnosis of an ovarian malignancy can only be made by microscopic pathologic evaluation of a surgically obtained specimen. Detailed surgical approach recommendations are included in the Appendix. The importance of appropriate initial staging cannot be overemphasized, as a small percentage of patients have apparent early-stage disease but have positive lymph nodes on final review. This can then affect the stage, recommended treatment, and overall prognosis. Although the occasional...

Rhabdomyosarcoma

RMS is a distinct entity and clearly differs from NRSTS in regard to its natural history and its higher sensitivity to chemotherapy and radiotherapy 6 . During the past 30 years the 5-year overall survival (OS) rates of pediatric RMS has improved dramatically from 25-30 to approximately 70 1, 12-14 . These results are due largely to the development of Table 11.3 Rhabdomyosarcoma the histological subtypes and their more frequent characteristics. RMS Rhabdomyosarcoma Table 11.3 Rhabdomyosarcoma...

Von Hippel Lindau Syndrome

Von Hippel-Lindau VHL syndrome is an autosomal dominant disorder with an incidence of between Table 10.3 Genetic predisposing conditions. CHRPE Congenital hypertrophy of the retinal pigment epithelium, MPNST malignant peripheral nerve sheath tumor Table 10.3 Genetic predisposing conditions. CHRPE Congenital hypertrophy of the retinal pigment epithelium, MPNST malignant peripheral nerve sheath tumor Neurofibromas, optic nerve gliomas, astrocytomas, MPNST Caf au lait spots, axillary freckling...

General Treatment Consideration

Hodgkin lymphoma is highly curable in the adolescent and young adult patient population. The challenge faced by oncologists today is to find the balance between maximizing cure and minimizing the late effects in this population. Adolescents with Hodgkin lymphoma are not treated as a distinct patient population and are routinely placed on either pediatric or adult treatment regimens, without a strong foundation for the decision. Several studies, however, have reported a poorer outcome in...