Cancer poses special problems in children
Greenville News

In the kitchen of her home, Rhonda Green uses an eyedropper to squeeze a single drop of morphine into her daughter's bowl of applesauce.

As she does each day, she swirls the mixture around to mask the potent painkiller. She wants her 5-year-old's taste buds to savor the apple flavor, not the narcotic.

Because like any other day, Rhonda wants Abbigail to think about life and not about the leukemia that could soon end it.

Fearing she wouldn't live to her birthday on April 29, the family celebrated it last month, complete with presents, cake and a videotape her 6-month-old brother, Troy, can watch when he's old enough so he can remember the older sister he once had.

Abbigail is unusual, not only because most children survive cancer, but because cancer in children is so rare to begin with.

In South Carolina, 29 children reportedly died of cancer in 1997, though officials say the actual figure could be higher. The Upstate will probably see 50 new cases of cancer in children this year.

"Contrast that to adult oncology, where any group will see 50 people a week," said Dr. William Schmidt, medical director of the Children's Hospital of the Greenville Hospital System.

But because cancer is so rare in children, discovering it can prove challenging.

"It's a very difficult diagnosis," Schmidt said. "It all starts out just like anything else. The worst part is, the diagnosis is such a tough one that nobody wants to make it."

Typically, a family doctor prescribes an antibiotic or chalks up sore limbs to growing pains.

Then things get worse.

The first symptoms of cancer are as varied as the types of cancers themselves.

The most common cancers in children are the leukemias, which take over the bone marrow.

Some children with leukemia bruise easily. Others turn pale because red blood cells are crowded out by leukemia cells, or have leg pain because the leukemia cells grow and push on nerve endings in the lining of the bone.

Other leukemia cells gravitate toward spinal fluid and affect neurological functions, or enlarge the liver or spleen.

"Some of those symptoms are so general," Schmidt said. "Usually, when it's clearly evident that a child has cancer, the cancer is fairly far along."

In cases of solid tumors, symptoms range from vomiting in the morning and looking at a television cross-eyed to seizures and severe headaches.

"It's not the cancer cells that hurt you," Schmidt said. "They don't give off any poison and are not toxic by themselves. What happens is they either fill up space and give you problems there, or they replace normal cells so that normal function in one of the organs doesn't work anymore."

Once cancer has spread, more symptoms appear - anything from fever and night sweats to weight loss.

"But again, they're all general things that can be associated with almost anything else, including a typical virus," Schmidt said.

Usually, it takes one doctor who is suspicious to run blood tests or take a bone marrow sample to discover the cancer.

Denise Blackwell's 6-year-old daughter, Hope, was diagnosed with leukemia in September. The Inman girl had red bumps on her eyes and throat. A doctor said they might be caused by coughing or crying.

Then a fever set in, and a doctor prescribed an antibiotic.

"She was tired all the time," Denise said. "I kept thinking first grade must be really stressing her out."

Her daughter's skin also had a yellowish tint.

A few weeks later, Hope's teachers at the Village School in Spartanburg grew concerned. Hope wasn't playing on the playground, and was withdrawing from her friends.

A blood test revealed the culprit.

But for the spunky girl with brown bobbed hair, chemotherapy appears to have worked. In two weeks, she'll start a two-year maintenance plan-chemotherapy shots in a leg once a week. Doctors will label her "cured" if the cancer hasn't returned in five years.

For Abbigail Green, flu-like symptoms were the first signs she wasn't well.

"She was very tired and would say 'Mommy, my legs hurt,' " said Rhonda, 26, from a waiting room at the Children's Hospital.

Two years ago, when Abbigail first began playing with Barbies and watching her father play softball, Rhonda never imagined that a fever and sore legs meant her first-born daughter had cancer.

Her hair pulled back in a ponytail and a flannel shirt tied around her waist, Rhonda choked back tears as she recalled the progression of symptoms.

Red dots began to appear on her daughter's chest. That's when she took her to an Easley hospital, and from there doctors directed her to Greenville Memorial.

"It could be this, or it could be that," doctors continued to say, until finally, blood tests revealed the truth.

In the 64th week of chemotherapy treatments, Abbigail relapsed. Doctors changed the treatment but eight months later she relapsed again.

Now, nothing is working. Keeping Abbigail out of pain is her mother's No. 1 priority.

"We're just waiting," Rhonda said.