Needle biopsy key to saving limbs of children in bone cancer: Dr Alina

LAHORE:As the month of September is commemorated as the Childhood Cancer Awareness Month, which highlights challenges faced by the children with bone cancer and the need to save limbs along with saving lives.

“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,” says Dr Alina Sadaf, Consultant Paediatric Oncologist at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

While discussing with ‘The News’ the issues about childhood bone cancer, Dr Alina says, “We see children with bone cancer from all over Pakistan as well as neighbouring Afghanistan and Iran. Some common signs of bone cancers are pain or swelling in a bone that increases in size over the 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 treatment.

Dr Alina says that one of the main principles of treating bone cancer 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 is reduced in size, we try to remove it in a way that keeps the limb intact and functional. However, 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.

Dr Alina describes the case of Sara, a 10-year-old girl from Afghanistan, who lost her leg to bone cancer. 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, 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 painkillers 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 qualified for standard chemotherapy with increased chances of a limb-saving procedure.