Cancer in Adolescents and Young Adults

Man studying in dorm“Max” is 21 and starting his senior year of college. He just completed a summer internship and made such a positive impression that he was told he would have a job there when he graduates. He isn’t seeing anyone right now, having ended his relationship last year, but now he feels ready to get out there and start dating again. Max has the world on a string, right? The only thing that’s bugging him a little bit is the lump he felt on one of his testicles last month in the shower. He thought maybe it would go away on its own, but it hasn’t. The last thing he wants to do is talk to a doctor about it (what if it’s a woman doctor?), so he goes online. It can’t be anything bad. He’s too young for something like cancer, right?

As Max finds out, he’s not too young for cancer. Half of testicular cancer cases occur in men between the ages of 20 and 45, and most of the time they present with swelling, enlargement, or a painless lump on the testicle (American Cancer Society, 2012). Depending on the stage of the cancer, treatment may involve one surgery or a combination of chemotherapy cycles and surgeries (National Cancer Institute, 2012).

Max can’t even begin to wrap his head around the fact that he has cancer, especially of his testicle. Who even uses that word anyway? He doesn’t have time for this. He’s too young to die. The doctors reassure him that he won’t die, and he wants to believe them, but he’s still pretty freaked out. He has really enjoyed the independence he’s had from his parents during college. While he’s glad for their support now, he doesn’t want them to smother him. His mom is just going to worry too much and that drives him crazy. How is he supposed to tell his friends? How is he supposed to date? When does he tell girls about it? What will they say?

Adolescents and young adults (AYAs) have the important developmental task of separating from their parents and forming their own identities. This is a rocky road under the best of circumstances. Having cancer can completely disrupt this task and at a minimum change the trajectory of the path the individual was on towards forming an independent life. Most often, this change is temporary, but in fact it may be permanent.

Along those lines, there are five universal areas of stress and disruption for people with cancer (Santacroce & Zebrack, 2010):

  • Interpersonal relationships
  • Dependence/interdependence
  • Achievement
  • Body: sexual image and integrity
  • Existential issues

These issues are all especially salient in the life of AYAs, as they do not have adequate life experience to fall back on in any of these realms. They are in the midst, and perhaps even at the beginning, of pondering existential questions such as, “Who am I?” and “What is my purpose?” Needing assistance with daily functioning, even temporarily, challenges any burgeoning sense of independence. This certainly impacts relationships, and also achievement. People will need a reason why they are unavailable for a time, both in their personal and work and/or school life. How much and what information they share is up to them. This is not to discourage honesty; rather, it is to reinforce that while there are many things about cancer they cannot control, they can control the flow of information regarding their illness.

The AYAs will most likely have to depend on their parents in ways they would prefer not to. Ideally, there can be some negotiation of boundaries that have evolved as the AYAs have matured. These negotiations can be tricky and need to be respectful on both sides. Parents tend to underestimate what their AYA children are capable of and need to give them a chance to prove themselves.

The issues of sexual image, identity, and integrity are huge at this stage of life. For males and females both, hormone levels are high. Thus, one can see how devastating any insult to sexual organs or functioning can be for an AYA. It is essential for young men to be educated about sperm banking, prior to treatment, since certain treatments for testicular cancer can cause infertility that may be permanent.

In summary, cancer in adolescence and young adulthood can markedly impair the normal tasks of development for this age group: namely, to separate from their parents, form their own identities, and find their place in the world. Being aware of those tasks is the first step in knowing how to best support someone close to you. The next even more important steps are asking them what they need from you and then following through.

Please let me know what topics you would like to see in future posts.

There is no education like adversity.
–Benjamin Disraeli

American Cancer Society. (n.d.). Learn about cancer. Retrieved from
National Cancer Institute. (n.d.). Testicular cancer. Retrieved from
Santacroce, S. J., Zebrack, B. J. (2010). Adolescent and young adult patients. In: Holland, J., Breitbert, W., Jacobsen, P., et al (eds), Psychooncology, 2nd ed. New York, NY: Oxford University Press.

Related articles:
What Do I Say?
Cancer and Sexuality Part III
Managing Fear and Uncertainty while Living with Cancer

© Copyright 2012 All rights reserved. Permission to publish granted by Norma Lee, MA, MD, Cancer Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Samuel A

    July 11th, 2012 at 11:40 AM

    Whoa, I guess I am like so many others who thinks that cancer is not for young people, that this is an older person’s disease. Maybe I think that illogically, not like I don’t think that they can have cancer, but that they shouldn’t have to have cancer. If you are like me and have been fortunate enough to have lived a pretty full life already, even though it would be scary, I think that I could handle it at my age today. But if I had received that kind of diagnosis at the age of 20 or something like that, I think that I would have felt very cheated. Like, what had I done to deserve that kind of illness? Wasn’t I going to get to enjoy the rest of my life just like everyone else? That has to be rough on the young person and the family as well when they are all forced to look this in the eye probably much sooner than they would have ever imagined. You just don’t think that as a parent you should have to watch your child go through something like this.

  • m.gray

    July 11th, 2012 at 1:23 PM

    a friend’s friend was diagnosed with cancer a couple of years ago and he missed a year in college due to treatment.even after the treatment was completed,I do not know what was wrong with him but he hardly attended college and hence ended up discontinuing his course.he seems to have lost the taste for life.he is literally pushing it down the drain.

    the psychological horror that accompanied the diagnosis could have led him to where he is now but he really should have done better with himself.

  • simone

    July 11th, 2012 at 3:24 PM

    It must feel like life is being robbed from you when you are diagnosed with cancer at such a young age

    But those who will survive it the best are those who will not go down without a fight

    It is when you choose to give up and give in that it will take you down

  • Lance

    July 12th, 2012 at 4:15 AM

    It seems that the kids who are hit with cancer are the strongest fighters.
    They are the ones who always seem to be able to look on the bright side when many of us adults can’t ever find a way to do that.
    They are so inspiring and so willing to fight it until the end, and that is something that often moves me to tears.

  • jenny

    July 12th, 2012 at 9:14 AM

    Norma this is a great article thank you, and so true. My friend was diagnosed with cancer in her 20s and she had a really hard time coping with it–she didn’t even tell her friends until several months after the diagnosis because she was ashamed/in denail! I hope any young adults reading this will get screened and know that support is out there for you.

  • Cody M

    July 12th, 2012 at 9:49 AM

    Cancer at a young age could be devastating for anybody. There is nothing like being struck with news of cancer when you’re just trying to find your feet in the world.
    There’s no doubt that such youngsters need a solid support system in addition to the regular treatment of cancer.


    July 12th, 2012 at 5:14 PM

    We have to think about the families too who are having to deal with this.

    It has to be terribly painful to watch your child suffer from this and yet feel so helpless to don anything that will help.

    I think that too often the families are forgotten and not given the counseling that they need to be the most encouraging to their child.

  • Les

    July 13th, 2012 at 4:53 AM

    Never gonna be easy to take such a news.I think there should be some major support for people once they are diagnosed.this could be pushed by the places they give out the diagnosis reports actually.You never know,the person may be shocked and collapse right there!or the young person could contemplate suicide, it s a dangerous stage and anything is possible.

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