Adolescents with cancer have been described as a 'lost tribe' [1,2] when it comes to the treatment of cancer. It is well documented that their entry into clinical trials is lower than for children or older age groups [3]. Perhaps as a consequence of this, they have not seen so much of the benefit of improvement in survival that has been seen over the last two decades in children and adult cancers [3]. Not only do they occupy a hinterland when it comes to accessing clinical services, but there is increasing evidence that the biology of cancer in adolescents and young adults is different to the equivalent cancers seen in children and older adults. However, the impact of biology on survival needs to be assessed after controlling for treatment related factors, which may be difficult to dissect. Most 15- to 19-year-olds diagnosed with cancer are treated at adult facilities, although the majority of their cancers are typical of those that occur in the paediatric age range. The best choice may be to treat them according to their type of tumour, not according to their age. However, this requires familiarity with and experience of the 'best standard protocol' by the treating institution.
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