A Place to Belong: A Comprehensive Review of Adolescent and Young Adult Surgical Oncology Care.
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Adolescent and young adult (AYA) oncology has emerged as a distinct field in response to persistent disparities in outcomes among patients aged 15-39 years, who often experience fragmented care across pediatric and adult systems. For surgeons, these challenges are especially relevant because biopsy, resection, metastatic disease management, fertility-preservation procedures, and survivorship planning frequently hinge on the surgical pathway through which patients enter cancer care. This review summarizes the epidemiology, systems-level barriers, biologic considerations, and supportive care priorities that define comprehensive AYA surgical oncology care. AYA malignancies encompass both pediatric-type tumors and adult-onset carcinomas, creating ambiguity in referral patterns, trial access, and treatment setting. Current evidence supports care at specialized or hybrid AYA-focused centers that integrate pediatric and adult expertise, multidisciplinary coordination, psychosocial support, fertility counseling, and survivorship services. However, major gaps remain, including low clinical trial enrollment, inconsistent access to age-appropriate supportive care, financial toxicity, and inadequate coordination of fertility preservation and long-term follow-up. Emerging data also suggest meaningful age-associated differences in tumor biology across reinforcing the need for developmentally and biologically informed treatment planning. Given the rarity and heterogeneity of AYA malignancies, age-informed care pathways built on structured collaboration between pediatric and adult surgeons offer a realistic and scalable model to align surgical decision-making with the developmental and oncologic needs of this population.