In the two decades from the mid 1970s to the mid 1990s, the proportion of 5-year survivors among children in North America with cancer has increased nearly 40%. Advances in otherwise fatal leukemias, lymphomas, sarcomas, brain tumors, germ cell neoplasms and cancer of the kidney account for much of the improvement. Unfortunately, older adolescents have not fared as well. Their epidemiological, medical, physical, psychological and social needs remain largely unmet despite their age juxtaposition with younger patients whose outcomes have so much improved. In the United States and Canada, cancer in adolescents 15 to 19 years of age occurs at nearly twice the rate observed in 5 to 14 year-olds. Many of the types of cancer that occur in older adolescents are unique to this age group, and the pattern of distribution occurs at no other age interval. Overall, the cancers in older adolescents are more similar to the spectrum of cancer in children than to the common types of cancer in adults, but they are also distinctly different and require an age-specific approach. There is evidence of a lower degree in reduction in cancer mortality in the United States and Canada in this age range than in younger or older persons. Moreover, the disparity appears to be increasing. The improvement in 5-year survival from diagnosis of cancer from the mid 1970s to the early 1990s was lower than the rate of improvement in the younger age groups. Survival rates of older adolescents with cancer in the general population have not improved as much, especially in comparison with results of the national pediatric cooperative cancer groups. In the United States and Canada, only about 5% of 15 to 25 year-olds with cancer are entered onto clinical trials, in contrast to 60% to 65% of younger patients. Thus, cancer during adolescence and early adulthood has been relatively neglected and merits enhanced national research programs and resources.