It started as an itch
Dec 19, 2006
Fourteen-Year-Old Bira Nambafu of Sironko district has been forced out of school due to a bone tumour that has rendered her immobile within six months.
By Halima Shaban and Alice Kingi
Fourteen-Year-Old Bira Nambafu of Sironko district has been forced out of school due to a bone tumour that has rendered her immobile within six months.
Nambafu, a pupil of Bochabo Primary School in Bunamwamba village, suffered itching on her right leg one day when she came back from school, but mistook it to be a mere skin rush.
Dr Yahaya Katumba, an orthopaedic officer at Mulago Hospital, says Nambafu suffers from a bone cancer called osteosarcoma (also called osteogenic sarcoma), one of the most common type of bone cancer in children.
It occurs in the ends of the bones. The bones most frequently involved are the upper arm (humerus) and the leg (femur and tibia).
Osteogenic sarcoma usually occurs between the ages of 10-25 and is more common among males than females. This is probably because of the rapid growth rate at that age.
Joshua Wosozi, Nambafu’s brother, says the condition started in July when she started scratching the area that was itching her.
“We initially ignored it but when it started swelling, a relative took her to a herbalist in the area. The herbalist treated her for a month but the swelling continued growing steadily,†Wosozi said.
He explained that the herbalist would make cuttings around the swelling and smear herbs into the cuts. “A month later, we took her to Mbale Referral Hospital but there, she only got painkillers.â€
They decided to abandon medical treatment and go to another herbalist. After this, a relative brought her to Musoke Domiciliary Clinic in Ntinda. Imelda Musoke, a clinician at the centre, referred her to Mulago Hospital.
Katumba says that in most cases, some tumours, when poorly managed, develop into cancers yet with proper medical attention, such complications can be curtailed.
“Diagnosis can be difficult because the disease is easily confused with local infections, effects of injury, arthritis and vitamin deficiencies,†he explained.
For this cancer at this stage, surgery (amputation) is the primary method of treatment, followed by a course of chemotherapy using one or more anti-cancer drugs. Later, a prosthesis (artificial limb) and physical rehabilitation may be required.
Although osteogenic sarcoma may be suspected from the way the bone looks on X-ray, diagnosis can be confirmed only by a cancer test. Katumba says when identified early, osteosarcoma can be cured. “If you notice any of the signs associated with the disease, it is better to go for a check up,†he stressed.
WHAT IS THIS CANCER?
Osteosarcoma usually occurs in the long bones like the arms, legs and pelvis. But its cancer cells can also spread (metastasise) to other areas of the body, most commonly, the lungs, kidneys, the adrenal gland, the brain, and the heart.
In 2002, doctors Jennifer Nabaweesi, Elsie Kiguli-Malwadde and Michael G Kawooya carried out a research in Mulago Hospital and found osteosarcoma to be the bone tumour, commonest in the age range 10 and 19 years. Most of these patients came from the central and western region of Uganda.
Causes
It has been suggested that repeated injuries to a certain area of the bone may lead to an increased production of osteoid tissue to repair the damaged area and this rapid production may lead to cancer. People with other hereditary abnormalities, have an increased risk for developing it. Some studies have linked it to exposure to ionising irradiation associated with radiation therapy for other types of cancer.
Symptoms
Each child may experience symptoms differently. They may include, but are not limited to, the following:
* Pain (stationary or with activity like lifting)
* Swelling and/or redness at the site of the tumour
* Limping if it is in the leg
* Decreased movement of the affected limb
Consult a doctor for a diagnosis.
How to avoid it
When identified early in most children, osteosarcoma can be cured. Sometimes, the first sign may be a bone fracture after the tumour has caused weakness in the affected area of the bone. So, if your child gets a fracture during routine play, test to ensure there is no underlying bone problem, such as a tumour or cyst. Have suspicious tumours examined at three to six month intervals especially when osteosarcoma presents in your family.
Treatment
Specific treatment depends on a child’s age, overall health and medical history; extent of the disease and child’s tolerance for specific medications and your opinion or preference. It may include one or more of the following: surgery, amputation, drugs, radiation therapy, supportive care (for the side effects of treatment), antibiotics (to prevent and treat infections) and continued follow-up care (to determine response to treatment, detect recurrent disease, and manage the side effects of treatment).
Prompt medical attention and aggressive therapy are important. Follow-up care is also essential. New methods are continually being discovered to improve treatment.
Fourteen-Year-Old Bira Nambafu of Sironko district has been forced out of school due to a bone tumour that has rendered her immobile within six months.
Nambafu, a pupil of Bochabo Primary School in Bunamwamba village, suffered itching on her right leg one day when she came back from school, but mistook it to be a mere skin rush.
Dr Yahaya Katumba, an orthopaedic officer at Mulago Hospital, says Nambafu suffers from a bone cancer called osteosarcoma (also called osteogenic sarcoma), one of the most common type of bone cancer in children.
It occurs in the ends of the bones. The bones most frequently involved are the upper arm (humerus) and the leg (femur and tibia).
Osteogenic sarcoma usually occurs between the ages of 10-25 and is more common among males than females. This is probably because of the rapid growth rate at that age.
Joshua Wosozi, Nambafu’s brother, says the condition started in July when she started scratching the area that was itching her.
“We initially ignored it but when it started swelling, a relative took her to a herbalist in the area. The herbalist treated her for a month but the swelling continued growing steadily,†Wosozi said.
He explained that the herbalist would make cuttings around the swelling and smear herbs into the cuts. “A month later, we took her to Mbale Referral Hospital but there, she only got painkillers.â€
They decided to abandon medical treatment and go to another herbalist. After this, a relative brought her to Musoke Domiciliary Clinic in Ntinda. Imelda Musoke, a clinician at the centre, referred her to Mulago Hospital.
Katumba says that in most cases, some tumours, when poorly managed, develop into cancers yet with proper medical attention, such complications can be curtailed.
“Diagnosis can be difficult because the disease is easily confused with local infections, effects of injury, arthritis and vitamin deficiencies,†he explained.
For this cancer at this stage, surgery (amputation) is the primary method of treatment, followed by a course of chemotherapy using one or more anti-cancer drugs. Later, a prosthesis (artificial limb) and physical rehabilitation may be required.
Although osteogenic sarcoma may be suspected from the way the bone looks on X-ray, diagnosis can be confirmed only by a cancer test. Katumba says when identified early, osteosarcoma can be cured. “If you notice any of the signs associated with the disease, it is better to go for a check up,†he stressed.
WHAT IS THIS CANCER?
Osteosarcoma usually occurs in the long bones like the arms, legs and pelvis. But its cancer cells can also spread (metastasise) to other areas of the body, most commonly, the lungs, kidneys, the adrenal gland, the brain, and the heart.
In 2002, doctors Jennifer Nabaweesi, Elsie Kiguli-Malwadde and Michael G Kawooya carried out a research in Mulago Hospital and found osteosarcoma to be the bone tumour, commonest in the age range 10 and 19 years. Most of these patients came from the central and western region of Uganda.
Causes
It has been suggested that repeated injuries to a certain area of the bone may lead to an increased production of osteoid tissue to repair the damaged area and this rapid production may lead to cancer. People with other hereditary abnormalities, have an increased risk for developing it. Some studies have linked it to exposure to ionising irradiation associated with radiation therapy for other types of cancer.
Symptoms
Each child may experience symptoms differently. They may include, but are not limited to, the following:
* Pain (stationary or with activity like lifting)
* Swelling and/or redness at the site of the tumour
* Limping if it is in the leg
* Decreased movement of the affected limb
Consult a doctor for a diagnosis.
How to avoid it
When identified early in most children, osteosarcoma can be cured. Sometimes, the first sign may be a bone fracture after the tumour has caused weakness in the affected area of the bone. So, if your child gets a fracture during routine play, test to ensure there is no underlying bone problem, such as a tumour or cyst. Have suspicious tumours examined at three to six month intervals especially when osteosarcoma presents in your family.
Treatment
Specific treatment depends on a child’s age, overall health and medical history; extent of the disease and child’s tolerance for specific medications and your opinion or preference. It may include one or more of the following: surgery, amputation, drugs, radiation therapy, supportive care (for the side effects of treatment), antibiotics (to prevent and treat infections) and continued follow-up care (to determine response to treatment, detect recurrent disease, and manage the side effects of treatment).
Prompt medical attention and aggressive therapy are important. Follow-up care is also essential. New methods are continually being discovered to improve treatment.