What Isla Mae experienced is the kind of story that breaks hearts. Diagnosed with leukemia at the age of two and a half, at the beginning of the COVID-19 pandemic, the little girl was misdiagnosed by a doctor and fought leukemia until the age of 5. It turned out that Isla Mae had Acute Lymphoblastic Leukemia, a very aggressive type of cancer, and she underwent chemotherapy many times. When we consulted Pediatric Oncology Specialist Prof. Dr. Barış Malbora about Isla Mae's situation and asked if similar cases occurred in Turkey, he stated that unusual bruises and intra-articular and intramuscular bleeding must be investigated. He also explained that a fever that does not respond to medication is one of the situations that should be taken into consideration.
Isla-Mae (5), the daughter of the British couple Laura (31) and Reece Mae (34), described her symptoms of high fever and sore throat to her doctor via a video call in April 2020. The doctor said Isla-Mae had tonsillitis and prescribed antibiotics. However, the medication did not work.
THE DOCTOR INSISTED ON THE 'TONSILLITIS' DIAGNOSIS
Five days later, the family of the little girl, who had a very fast-beating heart and breathing problems, called an ambulance. The paramedics who arrived at the house said that Isla-Mae's condition was good and that it was very risky to go to the hospital due to COVID-19. So, her parents had another video call with the doctor. During the call, the doctor insisted on the diagnosis of tonsillitis but changed the antibiotic. However, the changed medication also didn't work.
A few days later, bruising and rashes appeared on the little girl's body. After Isla's symptoms continued to worsen, her family took her to the hospital. After about 7 hours of tests at the hospital, it was revealed that Isla had acute lymphoblastic leukemia and a tumor that was putting pressure on her spleen.
CHEMOTHERAPY TREATMENT WAS STARTED URGENTLY
Laura, who was pregnant with their third child, was devastated by the bad news. The doctors told the family that chemotherapy treatment should be started as soon as possible. The tumor in the little girl's spleen was very large. Chemotherapy sessions began to shrink the tumor of Isla, who was on a ventilator for 4 days. The mother, describing the treatment process, says that her daughter's heart stopped 3 times.
ISLA'S CANCER TURNED OUT TO BE A VERY AGGRESSIVE TYPE
The cancer was very aggressive and affected Isla in many ways. The girl lost her ability to walk, sit, and eat on her own. A few weeks later, the little girl was discharged from the hospital. However, she had to return to the hospital due to a blood clot in her heart. Her family's joy was very short-lived. This time, the little girl stayed in the hospital for three months. Isla celebrated her 3rd birthday in the hospital in June.
Her mother says that although she wanted to celebrate the arrival of her newborn baby, she didn't want to because Isla was sick. Isla was allowed to go home after another round of chemotherapy. She was also given blood-thinning injections as part of her treatment to prevent clots from forming anywhere in her body.
NOW SHE'S 5 AND HAS STARTED SCHOOL!
In January 2021, Isla had to return to the same hospital room where she had spent 12 months. She got coronavirus twice. Then, in February 2021, her white blood cell count dropped, and her body became unable to fight infections. Isla's mother, Laura, sadly recounts that this was when they started planning for her funeral. "We started talking about what we would do if the worst happened," she recalls. Fortunately, the little one's condition slowly improved, but she was in and out of the hospital throughout 2021. In June 2022, Isla started her final round of chemotherapy. On September 2nd, the girl was discharged after six blood tests for signs of infection came back negative.
On September 2, 2022, she was finally discharged after her last chemotherapy. Isla is now 5 years old and has started school. She is starting to get back to her old self. Isla loves to sing and dance.
WHEN SHOULD WE SUSPECT CANCER IN CHILDREN?
Such incidents can inevitably cause anxiety in parents. After this event, which went from tonsillitis to cancer, it is quite normal for parents to be worried. So, what should parents do when they think they are facing such a situation? Which symptoms should not be ignored? In which situations should we suspect cancer in children?
Pediatric Health and Diseases, Pediatric Oncology Specialist Prof. Dr. Barış Malbora made important statements on the subject.
"We can group childhood cancers into two main categories," says Prof. Dr. Barış Malbora. "Hematological cancers, such as blood cancer (bone marrow cancer, leukemia) and lymph node cancer (lymphoma), and organ cancers, such as those of the brain, liver, and kidneys. The symptoms of these cancers are often common during their development. However, some symptoms may be specific to certain types of cancer," he said, and explained the symptoms of organ cancers.
"Especially in organ cancers, symptoms include weight loss, night sweats, and fever. Of course, it would not be a correct approach to immediately suspect cancer in a child who has any of these symptoms. For example, let's consider weight loss; for a child's weight loss to be associated with cancer, they must lose 10% or more of their body weight in a 6-month period. Some people sweat frequently due to their fast metabolism, even from infancy. Or many of us sweat at night during the summer. These two situations do not worry us as doctors in terms of cancer. However, it is important for someone who did not sweat at night to start doing so, regardless of the summer heat.
Prof. Dr. Malbora also stated that fever is a natural sign that our body is fighting germs. "Furthermore, we can get a fever in inflammatory conditions such as certain rheumatic diseases," he said.
WHEN SHOULD FEVER SUGGEST THE POSSIBILITY OF CANCER?
When we asked Prof. Dr. Malbora, "So when should fever suggest cancer?" he said that a fever that does not respond to medication poses a risk and explained that to understand if anemia is cancer-related, the patient's clinical history must be taken.
"A long-lasting, persistent fever that does not go down despite antibiotic treatment worries us. In this case, we must understand whether the source of the fever is cancer. In a situation where the fever does not go down despite appropriate antibiotic treatment, it would be appropriate for pediatricians to consult with pediatric hematology oncology specialists for a cancer investigation. To understand whether the problems in the patient's blood values are related to cancer, the patient's clinical history must be taken."
Prof. Dr. Malbora stated that in children, especially those aged 2 and under, bruises below the knee are caused by minor accidents due to play.
"Bruises that appear in unusual places, intra-articular and intramuscular bleeding must be investigated."
INFECTIONS CAN ALSO CAUSE LYMPH NODE SWELLING
Prof. Dr. Barış Malbora said that lymph node swelling can be seen in children after tonsillitis and upper respiratory tract infections. "If a lymph node is palpable during a physical examination, attention should be paid to the size of the lymph node, whether there is pain and tenderness, and its consistency," he said and explained what should be done for a diagnosis.
"To be able to say that lymph nodes have increased in size, it is necessary to determine which area the node is in. For example, a lymph node in the groin area that is larger than 1 cm indicates a problem, while it should be known that lymph nodes under the chin can be normal up to 2.5 cm. Even a very small lump found under the collarbone or behind the elbow can indicate a major problem, and these lumps should be investigated. A lymph node that grows quickly can cause pain. Although pain is usually caused by an inflammation and redness, it can also rarely be caused by bleeding into the center of a cancerous lymph node's dead tissue."
"Another important issue is the consistency of the lymph node. Hard lumps can typically be a sign of metastatic cancer," said Prof. Dr. Malbora. "Lumps with a rubbery consistency, on the other hand, suggest 'lymphoma,' or lymph cancer. Softer lumps indicate a reaction of the body to an infection or various microbial agents or their toxins."
IN WHICH CASES IS CLOSER MONITORING REQUIRED?
Prof. Dr. Malbora warned that if there is lymph node swelling, this swelling should be monitored even after the infection has passed, and explained the process.
"Although lymph node swelling is most often due to reasons we don't need to worry about, in some cases it requires careful monitoring. If the swelling is related to an infection and does not shrink within 6-8 weeks after the infection has passed, if it gradually grows without signs of infection according to examination and laboratory results, if it is painless, if the lumps are rubbery in consistency or hard and tend to merge with each other, if the lumps are located above the collarbone, in the chest cavity or abdomen and exceed a certain size, or if the swelling is accompanied by symptoms such as fever, weight loss, night sweats, and loss of appetite, we need to be careful and plan for further examination."
CAME IN WITH JOINT PAIN, TURNED OUT TO BE CANCER!
Prof. Dr. Barış Malbora, a Pediatric Health and Diseases, Pediatric Oncology Specialist, stated that children with long-lasting and unexplained symptoms like these must be investigated and recounted a case that happened to him 3 years ago.
"In childhood bone marrow cancers, patients can sometimes experience long-term joint pain and swelling. About 3 years ago, I encountered a similar patient. The patient, who was being monitored for long-term and unexplained pain and swelling in her knee joints, was evaluated by pediatricians and pediatric rheumatologists, and there were no abnormalities in her blood values that would suggest leukemia. However, the patient was referred to me. In my bone marrow microscopy examination and further tests, we found that she had bone marrow cancer, or leukemia. Therefore, in cases of long-lasting and unexplained joint pain and joint swelling, it is essential for a pediatric hematology and oncology specialist to evaluate the patient."
Source: Posta