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Case History

Image not available. A 19-year-old man presents with a high-grade synovial sarcoma in his left ankle. By the time a diagnosis is made the tumour is too advanced to allow resection without amputation. Staging investigations reveal no evidence of metastatic disease. The patient is studying music at university, his parents are separated but both attended with their son for the initial consultation. He has a younger brother aged 16 who is at school. During the consultation he is withdrawn and leaves the talking to his mother. She is confused and seems angry. They have been told he will probably need an amputation and chemotherapy lasting a year.

Where should 19-year-old patients be treated?

What are the special issues in the management of teenagers and young adults that are different from managing cancer in an older patient?

Is there any alternative to amputation in this case?

What is the evidence for giving adjuvant chemotherapy to this patient postoperatively?

Background

Where should 19-year-old patients be treated?

Image not available. Patients in this age group have been described in different ways. They are much younger than the average referral to an adult oncology service and yet would on the whole no longer consider themselves to be children. Young adults, older teenagers, adolescents and 'thresholders' are just some the terms that attempt to describe the transitional state between dependent childhood and independent adulthood. The relatively small number of patients in this group who are diagnosed with cancer each year might be better managed in an 'age appropriate' environment. Some cancer centres have dedicated beds for these patients to allow the focusing of support services. Some have 'virtual' teams that try to coordinate the support while the patients stay either on paediatric or adult oncology wards. The Teenage Cancer Trust (www.teenagecancertrust.org) has been instrumental in raising funds for and awareness of this group of cancer patients. In some cases it has provided funding to allow dedicated units to develop.

The medical expertise required to manage a patient's specific illness is critical regardless of where the patient is actually admitted for treatment. The consultant in charge of this case should work as part of a multidisciplinary team looking after sarcomas. This will mean coming to the local cancer network 'centre' for most of the care. It may also involve the supra-regional sarcoma surgical services. The additional appropriate support services should then be built up around the specific needs of the individual once the medical plan is in place. The extent and style of this will vary depending on the local factors.

What are the special issues in the management of teenagers and young adults that are different from managing cancer in an older patient?

Family dynamics

As a child develops into an adult the relationship between the child and the parents is renegotiated. The stock of ...

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