Saving Limbs, Along With Lives: A Conversation On Bone Cancer In Children

September is Childhood Cancer Awareness Month. In this regard, we spoke to Dr Alina Sadaf, Consultant Paediatric Oncologist at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, to discuss the most pressing issues she observes related to bone cancer in children.

What are some common signs & symptoms of bone cancer in children and how is it diagnosed?

Some common signs of bone cancers are pain or swelling in a bone that increases in size over time. Children with these symptoms often go to their local doctor who recommends an x-ray of the limb. On an x-ray, we can notice that the cancerous bone looks abnormal. Next, the local doctor will often recommend that the child should get a biopsy of the tumour. There are two ways of doing this biopsy: by a needle (closed biopsy) performed by a radiologist or by cutting the skin (open biopsy) performed by an orthopaedic surgeon. The biopsy sample is sent to a laboratory for examination under a microscope. If the pathologist confirms that the sample has cancer, the parents often find their way to one of the Shaukat Khanum Memorial Cancer Hospital and Research Centres to seek cancer care.

Tell us about bone cancer treatment

One of the main principles of bone cancer treatment is to remove the tumour from the body without leaving any trace of tumour behind and to give medicines (chemotherapy) to prevent the disease from returning. Ideally, to remove the tumour, we try to reduce its size first by giving a few weeks of chemotherapy. Once the tumour has reduced in size, we try to remove it in a way that keeps the limb intact and functional.

In Pakistan, what are some of the challenges regarding treatment of bone cancer in children?

If the tumour is very large and involves the blood vessels and nerves in the leg or the tumour has grown through the skin or if the wound has become worse because of open biopsy, we have to amputate the limb. This is a heart-breaking situation and we try to prevent this by recommending early diagnosis and using needle biopsy instead of open biopsy.

Can you share a memorable case that highlights the importance of using needle biopsy for diagnosing childhood bone cancer?

I would like to describe the case of Sara, a 10-year-old girl from Afghanistan, who lost her leg to bone cancer. Her journey demonstrates the importance of using needle biopsy for diagnosing bone cancer in children. Sara had pain in her left thigh for several weeks. She was evaluated by a local orthopaedic surgeon who performed an open biopsy of her tumour under general anaesthesia. The pathology report confirmed the diagnosis of osteosarcoma, which is a type of bone cancer. During this time, Sara’s surgical wound failed to heal. The wound edges were pulled apart by the bone tumour and filled with pus. By the time Sara made it to Shaukat Khanum Hospital, she had severe pain, an infected wound and swollen leg. Despite strong pain-killers and antibiotics, there was little improvement in her wound. As giving chemotherapy would decrease the chances of wound healing and increase the risk of the infection spreading to her blood, Sara had to undergo amputation of her left leg. If Sara had had a needle biopsy of her tumour, she would have likely qualified for standard chemotherapy with increased chances of a limb-saving procedure.

The case shared by Dr Alina is not simply the story of any one patient. Together, we need to create awareness about fighting bone cancer in children in a way that also improves their quality of life. It is important for both, parents and doctors, to know that choosing needle biopsy for diagnosing bone cancer can save limbs of children along with saving their lives.