Children Cancer Stories by Rukh Yusuf - Blog # 17
Two years old Shaban is one of the twins from a family of
Burewala. He has five siblings, three sisters and two brothers. One is fifteen
years old eldest brother and the other is two years old Shaban’s twin brother.
Shaban was a healthy, normal child till the age of one and
half year until he got fever which did not settle with routine treatment. He
seemed pale with distended abdomen. Parents were worried and consulted
physician again. Doctor said Shaban’s liver is enlarged and was not working
properly and referred Shaban to Lahore in a tertiary care Children’s Hospital.
Shaban was diagnosed as case of high risk Hepatoblastoma. Poor child’s
treatment was started in November 2020. He has got six chemotherapy cycles so
far.
Hepatoblastoma is the most common liver cancer of childhood,
it affects 2 to 3 people in a million. It affects children during the first
three years of life and usually presents as an abdominal mass which causes pain
and discomfort. A large percentage of these tumors occur in children who are
born premature. The tumor can be cured with surgical removal. If surgical
removal is hazardous because of size and location of this tumor inside the
liver, cure is still possible with liver transplantation.
Hepatoblastoma
diagnosis starts with child's symptoms and medical history. Tests may include: Blood tests –X-rays of the
chest and abdomen, Angiograms – X-rays of blood vessels, MRI scan ,
Ultrasound,
CT scan and
liver Biopsy.
Liver
cancer "staging" is done to find out the stage to plan the best
treatment for the child. The following stages are used for pediatric liver
cancer: Stage I Liver Cancer – The cancer can be removed with
surgery. Stage II Liver Cancer – Most of the cancer may be removed
but very small (microscopic) amounts of cancer are left in the liver following
surgery. Stage III Liver Cancer – Some of the cancer may be
removed, but some of the tumor cannot be removed and remains either in the abdomen
or in the lymph nodes. Stage IV Liver Cancer – The cancer has
spread from the liver to other parts of the body. Recurrent Liver Cancer –
The disease has come back (or recurred) after having been treated. It may
reappear in the liver or in another part of the body.
Pediatric
liver cancer treatments depend on the type (hepatoblastoma or hepatocellular
carcinoma) and stage of child's disease, as well as child's age and general
health.
Chemotherapy is started immediately upon diagnosis and is also
given after liver transplantation. Up to 80 percent of children treated with
liver transplantation survive longer than 20 years without experiencing recurrences
if the tumor is confined to the liver.
If the tumor has spread outside the liver, eliminating it with
surgery or chemotherapy before transplantation can still cure in up to half of
such children.
Relapse can occur in 16 percent of children after
transplantation. Recurrences are most common during the first two years, and
rarely occur thereafter. Hepatoblastoma most commonly spreads to the lungs.
This little brave warrior has received five chemotherapy
cycles before surgery and his one lobe was removed couple of months ago. He is
again on chemotherapy cycle to fight his disease. Shaban is doing fine so far
as per his mother. But He has stage three disease, he is under observation and
follow up.
Shaban belong to a lower middle-class family of Burewala. His
parents are first cousins. His maternal and paternal Uncles and aunts are the same
due to strictly following cousin marriage in family. As per his mother,
Shaban’s eldest brother who is fifteen years old is unable to walk. Three
daughters are school students and doing fine. Poor parents are fighting with
the disease of their son, they must travel to Lahore again and again for his
treatment and follow up but both of them are hopeful for cure of Shaban.
We all pray for ease for Shaban and his family. Aameen
Note: Names have been changed to protect identity.
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