A 6-year-old girl named Akshatha (name changed) from Gadag district in North Karnataka presented to HCG Cancer Hospital Bengaluru with symptoms of pain in the left side of the abdomen beneath the rib cage, with vomiting and loss of appetite lasting for about two weeks. Her parents noticed a mass in her abdomen region and consulted a pediatrician for a checkup and the doctor advised an ultrasonography scan and referred her to HCG Cancer Centre Gulbarga.
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Akshatha underwent a CT scan of the abdomen and was confirmed to have a mass lesion arising from her left kidney. The family was advised to consult the Pediatric Oncology department at HCG Bangalore. Her parents were daily wage laborers, and it was the first time they were visiting a big city like Bangalore. They sought help through a relative in Bangalore who was earlier treated at HCG. Post her admission at the hospital; she was referred to Dr. Intezar Mehdi and his team of doctors who advised for an initial staging scan- a whole-body PET CT. The results of the scan confirmed that the tumor was confined to her kidney and had not spread to any other parts of the body. This was a silver lining for Akshata’s family.
She had a large tumor measuring up to 10cms in one axis with solid and fluid-filled areas, the tumor thrombus was ascending the kidney blood vessel backward towards the inferior vena cava, a major blood vessel that takes blood back to the heart. It was inoperable, given the risks involved during surgery. Most kidney tumors are picked up incidentally during the routine clinical examination or scan done for some other problem or sometimes by the family members. Some kidney tumors may rarely present with abdominal pain, vomiting, fever, loss of appetite, blood in the urine, or high blood pressure.
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Akshata’s case was discussed in the pediatric multi-disciplinary team meeting and decided that it was best to treat the child with protocol-based chemotherapy SIOP 2001 before surgery to shrink the tumor. She responded well to the chemotherapy and underwent a CT scan which showed marked regression in the tumor size at the end of 4 weeks. She was taken up for surgery, the tumor thrombus in the IVC had regressed and the tumor was removed. The histopathology from the tumor in the kidney was Wilms tumor- blastemal predominant and showed good necrosis. Based on the protocol, and response to chemotherapy, she needed further chemotherapy post-operatively, along with radiation to the abdomen. This would achieve better success in her treatment; to ensure that this gives her the best chance to remain cancer-free for her life said Dr. Intezar Mehdi, Consultant Pediatric Hemato-Oncologist, HCG Cancer Hospital Bengaluru.
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He further added that ‘There are multiple challenges in treating childhood cancer. Firstly, the tumor must be staged appropriately, and the right diagnosis is very important. The treatment must be done in specialized centers that have experience in handling such complex cases. Childhood cancer treatment protocols are designed for treating only kids with cancer. A child’s age, understanding level, parent’s involvement in the treatment must be taken into consideration. Here in this case the determination of Akshata’s mother to save her daughter’s life is highly commendable. She is a daily wage laborer, with almost no support from the family, still insisted that her daughter gets treated in the best of centers. She came regularly for all follow-up chemotherapy schedules. Her belief and trust in our team and the hospital made us help her on humanitarian grounds. “We would like to heartfully thank Dr. Intezar Mehdi, Dr. Suma, and all the doctors here at HCG Cancer Hospital for saving my daughter’s life. We were financially exhausted and were not in a position to afford the treatment costs. My husband had also met with an accident during the same time, and we had no source of income back home. The hospital management helped us in a great way by waving off a huge amount of treatment costs, and her medicines were provided free from the HCG Foundation. Only through HCG support, we could complete the treatment successfully. Our daughter is now leading a normal life” said patient Akshata’s mother.
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