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On my second day ever at Princess Marina Hospital (PMH), I met Polite, an always smiling and giggling 6-year-old girl. Polite had a tumor growing on her right thigh for several weeks. The tumor was removed at another hospital a few weeks before I met her. She was referred to PMH as it is the only hospital in Botswana that has an oncology ward and a pediatric oncologist. It took several weeks to finally get the pathology report on her biopsy which revealed that her tumor was an embryonal rhabdomyosarcoma, a malignant cancer of the muscle that requires aggressive treatment.
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MRI of Polite's tumor on the outside of her right thigh
When we were finally able to start her therapy, I was discouraged to find that the tumor had begun to grow again. Essential time had been lost waiting on the pathology report, but cure was still possible. After a meeting with surgeons and her mother, we decided to treat with chemotherapy to shrink the tumor then proceed to surgical removal of the mass. She was given 6 weeks of chemotherapy, and the tumor started to shrink. After several weeks in the hospital, she went home for a couple of weeks to recover in preparation for surgery.
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Polite’s tumor after a few weeks of chemotherapy. Note the surgical scar from her first surgery.
When she returned for surgery, the tumor had begun to grow again. After a gut-wrenching meeting with the mother and the surgeon, we decided a full amputation of the leg at the hip was her best chance of cure. In the words of the orthopedic surgeon, we would sacrifice the limb to try to save the life.
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Polite’s tumor before surgery. I am holding her right knee; her right hip is to the right of the picture.
Shortly before Christmas, Polite had an amputation of her right leg up to her hip. The first few days after the amputation were brutal! Polite, who is usually always laughing, cried continually from both the physical pain of the surgery and the emotional pain of the loss of her leg. She would beg us to put the leg back on. These days were especially devastating for her mother. However, the ever-resilient Polite quickly accepted her fate. Within a couple of weeks, Polite was hopping around the ward using a walker or crutches. Her distinctive laughter again fills the ward even when working hard to learn to “walk” again. She still has nearly a year of chemotherapy ahead of her to rid her body of any of the cancer cells that may have been left behind. She will eventually get a prosthetic leg. The story is far from over for Polite, but I am certain of one thing: she will keep laughing through it all!
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Polite learning to "walk" again
*All content and images used with consent of patient's mother.
Author
Dr. Jeremy Slone, Pediatric Oncologist
Polite’s tumor before surgery. I am holding her right knee; her right hip is to the right of the picture.
Shortly before Christmas, Polite had an amputation of her right leg up to her hip. The first few days after the amputation were brutal! Polite, who is usually always laughing, cried continually from both the physical pain of the surgery and the emotional pain of the loss of her leg. She would beg us to put the leg back on. These days were especially devastating for her mother. However, the ever-resilient Polite quickly accepted her fate. Within a couple of weeks, Polite was hopping around the ward using a walker or crutches. Her distinctive laughter again fills the ward even when working hard to learn to “walk” again. She still has nearly a year of chemotherapy ahead of her to rid her body of any of the cancer cells that may have been left behind. She will eventually get a prosthetic leg. The story is far from over for Polite, but I am certain of one thing: she will keep laughing through it all!
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