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Young Adults & Cancer
Dr. Marc Rappaport discusses the most common types of cancer in young adults and the associated risk factors, prevention methods, diagnosis and treatment.
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Learn more about Marc Rappaport, DO
Marc Rappaport, DO
Marc Rappaport, DO is a Board Certified Medical Oncologist.Learn more about Marc Rappaport, DO
Transcription:
Melanie Cole (Host): The number of young adult cancer survivors is growing rapidly as treatments become more effective. My guest today, is Dr. Marc Rappaport. He’s a board-certified Medical Oncologist with Montefiore St. Luke’s Cornwall. Dr. Rappaport, tell us some of the most common cancers that you see in young adults.
Marc Rappaport, DO (Guest): So, this is a great question. We are seeing a large population of patients that have a lot of unmet needs and my most common diagnoses for young adults appears to be breast cancer and colon cancer. And these could be aged from 18 to 40-45 years old.
Host: That’s fascinating, Dr. Rappaport, breast cancer and colon cancer. Why do you think that those are the types of cancers that you see? What would be the cause of colon cancer in such a young person?
Dr. Rappaport: So, unless it’s genetically based, it’s just bad luck for these young kids and I’ve seen as young as late 20s, plenty in their 30s and 40s. And it’s just unfortunate bad luck. And cancer in younger patients seems to be more aggressive, so their presentations may be with more lymph nodes, they possibly could be metastatic which is a stage 4 so, if they are not a genetic based cancer; then it’s just unfortunately bad luck.
Host: Any parent of young adults is going to ask this question right now Doctor, is how would you know then? I mean those of us over 50 get out colonoscopies, we get our mammograms. We get those screenings. But somebody in their early 20s, isn’t thinking about getting those kinds of things. How would we know?
Dr. Rappaport: Right. So, if we split it up into the two groups, so if there is a family history which is high risk; then hopefully the parents or grandparents would have educated the generations below to get early screening. If not, then the normal symptoms is how anybody would present with either bleeding, feeling a mass, or feeling a breast mass, and that would prompt them to see their doctor and that would prompt them to then get the imaging and or colonoscopy that would be required. So, those are the two types of ways that you either pick it up early surveillance because of a family history or they would have symptoms.
Host: And then diagnosis I assume is similar to that of any cancer patient if they come up with some of the symptoms of colon cancer or as you said a mass. Do you find that sometimes, people of that age group, that generation don’t pay attention to those symptoms and then it might be caught later?
Dr. Rappaport: It’s true. And then that’s why sometimes we do see these more advanced cases, specifically like with breast cancer you may find with more lymph nodes, a little more pain involved at presentation than with older adults who are already going for their imaging studies. So, yes, I do find that there’s a lot of denial in the younger patient population than in the older patients.
Host: So, while we’re speaking about specifically colon and breast, I’m sure you see some others; cancer treatments, especially in that age group can affect fertility. They want to have families at some point. Does fertility preservation become a discussion as you are starting to think about these treatments?
Dr. Rappaport: So, that’s an extremely important discussion. And this is part of the whole dynamic of the young adult population because just in comparison to older patients who have already had all their kids; if you have to discuss starting fast treatment for somebody say with breast cancer and they’ve never had a child and then they have to go see a fertility specialist, it’s a big, big issue and they are going to get nervous about delaying their treatment for their cancer and we are also saying it’s important to preserve your eggs because you are going to need chemotherapy. So, it’s a big complex question but it has to come up in anybody who is at fertility age.
Host: Are treatments different when you are dealing with a younger generation Doctor, as opposed to a man in his 60s or 70s with colon cancer or a woman with breast cancer; are treatments maybe a little bit tougher, are they able to handle a little bit more when you are talking about treatments? Because their bodies are still young and can maybe handle a little more or no, not really?
Dr. Rappaport: So, that’s a very interesting question. In general, all solid tumors, the answer is no. it’s all the same chemotherapy. The only caveat is the niche population of a certain type of leukemia called ALL where you actually use pediatric regimens for those patients. That’s been shown to have a better outcome. But other than ALL, the same chemotherapy regimens are use for all other cancers.
Host: When we talk about this type of cancer, one of the things that comes to mind is they have this feeling of immortality when they are that age and their social life is really one of their priorities. What does a cancer like this do to the social life for young adults? How does that change it and what do you do to help and support them through that?
Dr. Rappaport: So, number one is the physical outward appearance is huge. When you don’t have hair, you are missing a breast, you have a colostomy bag; I mean who wants to date somebody like that. So, these are anxieties that these patients are going through. It’s a big, big issue, I don’t think it’s discussed at all. In fact, when I was in practice about five to six year ago, I started The Young Adult Support Group through a company called Ann’s Place in Connecticut and it was growing in popularity and we had a nice turn out and we had a lot of young people come and talk about their issues with relationships and sex and dating, fertility and it was very excellent to have to people share their own stories.
So, I think opening up the discussion is key to addressing everybody else’s anxieties.
Host: I certainly would think that that’s just so important and now the family of this young adult that has cancer. How are they involved in all of this? What do want the family members to know about helping this person, this young adult go through something that no person that age really, or any age, should have to go through?
Dr. Rappaport: So, it’s important to always bring the family in so that’s there no undue surprises. They should be all expectations set during treatment, before treatment and after treatment. And it makes very important sense to make a team and the family, the parents, the siblings, they should all be members of the team so that everybody is part of the experience.
Host: What else would you like us to know about young adults and cancer that we may not have covered in this as far as what do you see on the horizon, or the social and psychosocial aspects, what else would you like us to know?
Dr. Rappaport: Well I wish that there was more outreach and I wish there were more support groups for this population of patients. Because like I said, I think this is – whoever goes to these support groups is basically people in their 60s, 70s, and 80s. You never see a young person going. And so we need more outreach, we need more information about opportunities for patients to share their stories. And I think there needs to be more education in the physician’s offices about awareness of fertility and fertility preservation because a lot of times there is time to get patients’ eggs harvested. There is time to bank sperm and I don’t think that physicians necessarily have to rush their patients into treatment, of course unless it’s an emergency and there is some time to have these open discussions about these difficult situations.
Host: What an interesting topic and thank you so much Dr. Rappaport, as you said, outreach is so important. And it’s really interesting to hear when you say about those support groups and that young adults are not usually there so; we certainly hope this podcast is a way to reach out to the parents and siblings and to those young adults because they love podcasts. So, I hope that they get this message and are not afraid to ask for help when it’s needed and thank you so much for joining us and sharing your incredible expertise. Thank you again.
That wraps up this episode of Doc Talk presented by Montefiore St. Luke’s Cornwall. Head on over to our website at www.montefioreslc.org for more information and to get connected with one of our providers. If you found this podcast informative as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.
Melanie Cole (Host): The number of young adult cancer survivors is growing rapidly as treatments become more effective. My guest today, is Dr. Marc Rappaport. He’s a board-certified Medical Oncologist with Montefiore St. Luke’s Cornwall. Dr. Rappaport, tell us some of the most common cancers that you see in young adults.
Marc Rappaport, DO (Guest): So, this is a great question. We are seeing a large population of patients that have a lot of unmet needs and my most common diagnoses for young adults appears to be breast cancer and colon cancer. And these could be aged from 18 to 40-45 years old.
Host: That’s fascinating, Dr. Rappaport, breast cancer and colon cancer. Why do you think that those are the types of cancers that you see? What would be the cause of colon cancer in such a young person?
Dr. Rappaport: So, unless it’s genetically based, it’s just bad luck for these young kids and I’ve seen as young as late 20s, plenty in their 30s and 40s. And it’s just unfortunate bad luck. And cancer in younger patients seems to be more aggressive, so their presentations may be with more lymph nodes, they possibly could be metastatic which is a stage 4 so, if they are not a genetic based cancer; then it’s just unfortunately bad luck.
Host: Any parent of young adults is going to ask this question right now Doctor, is how would you know then? I mean those of us over 50 get out colonoscopies, we get our mammograms. We get those screenings. But somebody in their early 20s, isn’t thinking about getting those kinds of things. How would we know?
Dr. Rappaport: Right. So, if we split it up into the two groups, so if there is a family history which is high risk; then hopefully the parents or grandparents would have educated the generations below to get early screening. If not, then the normal symptoms is how anybody would present with either bleeding, feeling a mass, or feeling a breast mass, and that would prompt them to see their doctor and that would prompt them to then get the imaging and or colonoscopy that would be required. So, those are the two types of ways that you either pick it up early surveillance because of a family history or they would have symptoms.
Host: And then diagnosis I assume is similar to that of any cancer patient if they come up with some of the symptoms of colon cancer or as you said a mass. Do you find that sometimes, people of that age group, that generation don’t pay attention to those symptoms and then it might be caught later?
Dr. Rappaport: It’s true. And then that’s why sometimes we do see these more advanced cases, specifically like with breast cancer you may find with more lymph nodes, a little more pain involved at presentation than with older adults who are already going for their imaging studies. So, yes, I do find that there’s a lot of denial in the younger patient population than in the older patients.
Host: So, while we’re speaking about specifically colon and breast, I’m sure you see some others; cancer treatments, especially in that age group can affect fertility. They want to have families at some point. Does fertility preservation become a discussion as you are starting to think about these treatments?
Dr. Rappaport: So, that’s an extremely important discussion. And this is part of the whole dynamic of the young adult population because just in comparison to older patients who have already had all their kids; if you have to discuss starting fast treatment for somebody say with breast cancer and they’ve never had a child and then they have to go see a fertility specialist, it’s a big, big issue and they are going to get nervous about delaying their treatment for their cancer and we are also saying it’s important to preserve your eggs because you are going to need chemotherapy. So, it’s a big complex question but it has to come up in anybody who is at fertility age.
Host: Are treatments different when you are dealing with a younger generation Doctor, as opposed to a man in his 60s or 70s with colon cancer or a woman with breast cancer; are treatments maybe a little bit tougher, are they able to handle a little bit more when you are talking about treatments? Because their bodies are still young and can maybe handle a little more or no, not really?
Dr. Rappaport: So, that’s a very interesting question. In general, all solid tumors, the answer is no. it’s all the same chemotherapy. The only caveat is the niche population of a certain type of leukemia called ALL where you actually use pediatric regimens for those patients. That’s been shown to have a better outcome. But other than ALL, the same chemotherapy regimens are use for all other cancers.
Host: When we talk about this type of cancer, one of the things that comes to mind is they have this feeling of immortality when they are that age and their social life is really one of their priorities. What does a cancer like this do to the social life for young adults? How does that change it and what do you do to help and support them through that?
Dr. Rappaport: So, number one is the physical outward appearance is huge. When you don’t have hair, you are missing a breast, you have a colostomy bag; I mean who wants to date somebody like that. So, these are anxieties that these patients are going through. It’s a big, big issue, I don’t think it’s discussed at all. In fact, when I was in practice about five to six year ago, I started The Young Adult Support Group through a company called Ann’s Place in Connecticut and it was growing in popularity and we had a nice turn out and we had a lot of young people come and talk about their issues with relationships and sex and dating, fertility and it was very excellent to have to people share their own stories.
So, I think opening up the discussion is key to addressing everybody else’s anxieties.
Host: I certainly would think that that’s just so important and now the family of this young adult that has cancer. How are they involved in all of this? What do want the family members to know about helping this person, this young adult go through something that no person that age really, or any age, should have to go through?
Dr. Rappaport: So, it’s important to always bring the family in so that’s there no undue surprises. They should be all expectations set during treatment, before treatment and after treatment. And it makes very important sense to make a team and the family, the parents, the siblings, they should all be members of the team so that everybody is part of the experience.
Host: What else would you like us to know about young adults and cancer that we may not have covered in this as far as what do you see on the horizon, or the social and psychosocial aspects, what else would you like us to know?
Dr. Rappaport: Well I wish that there was more outreach and I wish there were more support groups for this population of patients. Because like I said, I think this is – whoever goes to these support groups is basically people in their 60s, 70s, and 80s. You never see a young person going. And so we need more outreach, we need more information about opportunities for patients to share their stories. And I think there needs to be more education in the physician’s offices about awareness of fertility and fertility preservation because a lot of times there is time to get patients’ eggs harvested. There is time to bank sperm and I don’t think that physicians necessarily have to rush their patients into treatment, of course unless it’s an emergency and there is some time to have these open discussions about these difficult situations.
Host: What an interesting topic and thank you so much Dr. Rappaport, as you said, outreach is so important. And it’s really interesting to hear when you say about those support groups and that young adults are not usually there so; we certainly hope this podcast is a way to reach out to the parents and siblings and to those young adults because they love podcasts. So, I hope that they get this message and are not afraid to ask for help when it’s needed and thank you so much for joining us and sharing your incredible expertise. Thank you again.
That wraps up this episode of Doc Talk presented by Montefiore St. Luke’s Cornwall. Head on over to our website at www.montefioreslc.org for more information and to get connected with one of our providers. If you found this podcast informative as I did, please share on your social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.