Recognising cancer in teenage patients

How to identify the signs of a possible cancer in young people and when to refer. By Professor John Radford.

Ewing’s sarcoma (orange) is a rare type of bone and soft tissue cancer more common among teenagers
Ewing’s sarcoma (orange) is a rare type of bone and soft tissue cancer more common among teenagers

For six young people in the UK every day, persistent and unexplained problems bring them to their GP. Their presentation is crucial, because for them symptoms of aches and pains, swelling or bruising are not every day ailments, sports injuries or growing pains. They are symptoms of cancer.

Teenagers can be a challenging patient group - sometimes hard to talk to and hard to understand. The growing pains of puberty play havoc and their youthful exuberance throws them in the path of physical mishap and sports injuries.

Despite all of this, the teenager is not a frequent face in the GP surgery. So when they do ask for advice, should we not roll out the red carpet?

Teenagers and young adults with cancer are a small patient population, accounting for less than 1% of all cancers diagnosed each year. The average GP might only see one case throughout their whole career.

However, this should only prompt increased vigilance in young people attending the GP surgery with persistent symptoms. It is important to recognise that 13- to 24-year-olds can have some of the rarest and most aggressive forms of cancer and their survival rates are poorer than rates for both children and adults.1 More has to be done to improve the speed of diagnosis so these patients have the best options for treatment.

Common cancers in young people3

Research in 2003 revealed that the most common cancers in young people aged 13 to 24 were: 

  • Lymphoma (Hodgkin and non-Hodgkin)
  • Carcinomas
  • Germ cell tumours
  • Leukaemia
  • CNS tumours
  • Melanomas
  • Bone tumours
  • Soft tissue sarcomas

Efficient diagnosis and referral

Teenage and young adult cancer follows the same unexplained and persistent signs and symptoms that older adults and children have, such as pain that does not go away with simple painkillers, an unusual lump, bump or swelling, extreme tiredness, significant weight loss and changes in a mole.

There are numerous examples of excellent practice but many health professionals still do not consider cancer as a possibility for young people.

Research indicates that delays in diagnosis are a widespread problem in teenagers and young adults. A recent Teenage Cancer Trust survey found that one in four (24%) teenage cancer patients visited their GP at least four times before they were referred to a specialist.2

One young person surveyed experienced severe stomach cramps, weight loss and problems with digesting her food.

After a year of repeated visits, she was diagnosed with Ewing's Sarcoma, a rare type of bone and soft tissue cancer but one that is more common among teenagers.

'Three strikes' approach

The two-week referral for suspected cancer is a major breakthrough for cancer patients but it won't benefit young people unless GPs seriously consider a diagnosis of cancer when symptoms persist.

The Teenage Cancer Trust advocates a 'three strikes' approach where the patient is referred for further investigation if, after three visits, there is no reasonable explanation for their symptoms.

Teenage Cancer Trust

Teenage Cancer Trust provides information and advice about cancer, prevention and healthy living, helping to empower young people to get to know their bodies, giving them the confidence to seek medical advice if they are worried.

Teenage Cancer Trust can also deliver sessions on teenage and young adult cancer for groups of GPs or as part of training programmes.

Spotting the early signs

The solution is not entirely in the hands of GPs whose vital role starts when the teenager presents for advice. Young people and their parents need to learn how to spot the early signs of cancer.

They also need help articulating their concerns so their GP fully understands what they are experiencing.

This could be the difference between 'my hip hurts' and 'my hip hurts so much I cannot sleep at night'. What may appear to be a lazy teenager is actually 'I'm so tired I haven't been able to get out of bed for days'.

There is never a good time to have cancer but for teenagers it is a devastating blow.

Just when life is starting to take off, it is put on hold while they deal with hair loss, the threat of mortality and cope with sometimes intensive treatment, the side-effects of which may be life long.

Significantly improving their experience of diagnosis will help ease this traumatic journey. For some it will be the difference between life and death, but for all, it will mean swift access to relevant specialists able to answer their questions, recommend and supervise appropriate treatment, provide the support needed and help them get their lives back on track.

  • Professor Radford is professor of teenage and young adult cancer medicine at The Christie NHS Foundation Trust, Manchester
  • The first Teenage Cancer Awareness Week takes place from 30 April to 6 May.
  • For further information www.teenagecancertrust.org

References
1. Survival analysis for TYA in England, Professor Jill Birch (University of Manchester) 2008.

2. Teenage Cancer Trust. Find Your Sense of Tumour Conference February 2011 - 400 former and current cancer patients aged 14-24.

3. Research done by Professor Jill Birch based on cancer registration data UK Office of National Statistics 2003.

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