Pediatric, Adolescent and Young Adult (AYA) Surgery for Endocrine Tumors

General questions and answers

  • What is AYA?
    • AYA is a general title used to describe cancers among the Adolescents and Young Adult population ages 15 – 39.
    • Currently 65,000 – 70,000 AYA cancers are diagnosed each year in the U.S.
    • Thyroid cancer one of the top five AYA cancers. First for female ages 15-29 and second for females 30-39.
    • Thyroid cancer numbers are increasing.
  • What are some of the challenges and unique needs of AYA cancers and patients?
    • Life transitions, such as:
      • Shifts in family and peer groups
      • Changing and evolving sexual health and relationships
      • Growing independence
      • Highly-mobile population
      • New found Independence, self-awareness and feelings of invincibility and invulnerability
    • Reduced adherence to treatment and follow-up
    • Challenges in communication, such as:
      • AYA – family
      • AYA – physician
      • AYA – peers
      • Family - physician
    • Unique needs, such as:
      • Disruptions in education, employment, and social life
      • Questions about future fertility
      • Establishing financial independence
      • Navigating the health care system.
      • Very premature confrontation with mortality
      • Changes in physical appearance
      • “Long-term follow-up” is really long-term
      • Pregnant or a new parent
    • Survivorship – AYA cancer survivors, and especially AYA thyroid cancer survivors, will hopefully have a LONG life of follow-up care 
  • What is special about AYA thyroid cancers?
    • Mean age at presentation for all thyroid cancers is in the third decade (AYA).
    • Younger patients (less than age 20) (AYA) present with more extensive disease.
    • ONLY cancer where age (less than 45) is part of staging (AYA)  - most AYA thyroid cancer patients are classified as having Stage 1 disease and therefore potentially undergo less extensive treatment depends on the specifics of the cancer.
    • Excellent overall survival
  • What is the typical workup of a pediatric thyroid nodule?
    • Like adults, a neck ultrasound is the best initial test for a thyroid nodule. Occasionally, fine needle aspiration (FNA) or diagnostic thyroid lobectomy (surgery) will be required for a diagnosis.
  • Is thyroid cancer a common pediatric cancer?
    • Thyroid cancer is the most common endocrine cancer in the pediatric population, representing about 1 percent of all pediatric malignancies in pre-pubertal children to 7 percent in adolescents, with the incidence increasing by 1.1 percent per year.
  • What if I am a pediatric or AYA cancer survivor? Do I need to be screened for thyroid cancer?
    • Young cancer survivors that received head and neck radiation are at an increased risk of developing thyroid cancer.
    • At a minimum, patients should have a physical exam of their neck every year by a clinician. There is debate over if and how frequent a neck ultrasound should be performed for screening.