Bump, Set, Spike.
A volleyball player aces osteosarcoma
- By Leslie Hast | Photography by Joe Howell
Camille Fraser was a healthy, active 13-year-old, playing her second season of volleyball at David Lipscomb Campus School, when she began to have pain in her right knee.
A local orthopaedic clinic diagnosed her with tendonitis and Osgood-Schlatter disease, an inflammation of the knee common in active children. She was told it would get better with time and Advil. But the pain persisted.
A few weeks later, Camille took a tumble down the front steps of her house. “It wasn’t like a normal trip. I totally lost control,” she recalled.
Knowing a strong and fit teenager shouldn’t lose control of her leg, her parents took her for an MRI. They were told something wasn’t right and referred to the Monroe Carell Jr. Children’s Hospital at Vanderbilt.
In an instant, Camille’s diagnosis went from sports injury to cancer.
Camille had osteosarcoma, a bone tumor that is one of more than 200 bone and soft-tissue tumors that make up a family of cancers known as sarcomas. These are some of the rarest tumors in medicine, accounting for approximately 1 percent to 2 percent of all cancers diagnosed each year. They occur most often in children and young adults, but older adults can also develop sarcomas.
Camille’s tumor formed at the upper end of the fibula, the small bone in the lower leg. She began chemotherapy just after Christmas in 2004, and in February 2005, had surgery to remove the top six inches of her fibula. She continued chemo until that September and has been cancer-free since.
That was not at all how Camille expected to spend her seventh-grade year, and she said the worst part was being isolated from friends who were too young to visit the myleosuppression unit.
“I usually went in the hospital on Tuesday and came out on Friday. If there were complications, I would stay until Saturday or Sunday. It was like I lived there. It got to be a routine,” she said.
Her friends sent cards, sometimes 20 per day, and her grandparents would bring whatever food she was craving, even when she went on a 12-day shrimp binge.
While her father, Stuart, worked to support the family, Camille’s mother, Melissa, stayed by her side.
“It’s surreal and devastating, especially in a child who had been so healthy,” Melissa said. “I felt like we were on a different planet. Life was so different than what everyone else was doing. You feel like you don’t belong because no one knows what you’re going through.”
The only outward sign of Camille’s illness is long pink scar on her leg, but she says she will never be the same.
“Before my treatment, I was into anything. I was crazy and loud. But I got used to being by myself and became quiet. You would think that when you’re done, you’re done, but the emotions are still there,” she said.
Camille is back to playing volleyball thanks to a procedure called limb-sparing surgery. In this technique, patients start with chemotherapy to shrink the tumor, then the cancerous bone and soft tissue are removed and more chemotherapy follows.
Reconstruction of the skeleton can be done with allografts (bone transplants) or metal implants. The implants use a metal alloy originally engineered for fighter aircraft. They have a rough surface that bone fuses onto, and within six weeks a permanent bond has formed between metal and bone.
Though implants or allografts can return patients to their active lifestyle in a matter of months, Herb Schwartz, M.D.,
professor and chair of Orthopaedics and Rehabilitation, cautioned that it is not always the best option. In some cases, amputation and prosthetics are more functional.
“Limb-sparing surgery is even more complicated in children or in the peripheral appendicular skeleton because skeletal loss may cause severe limb length inequalities and the reconstruction has trouble with durability and growing with the child,” Schwartz said. “In tough cases, sometimes the function of the limb is worse with limb-sparing surgery than with amputation.”
In Camille’s case, the fibula was an “expendable” bone, and she had no reconstruction. “Her function without it is better than anything we can construct in its place,” Schwartz explained.
Another worry is the durability of the metal implants, and Ginger Holt, M.D., assistant professor of Orthopaedics and Rehabilitation, is performing research to determine how long they will last.
“If you put metal in, you get back function much quicker (two to three months), but since it’s not biologic, it’s more likely to fail at 15 to 20 years out,” Schwartz explained. “The converse is if you replace it with an allograft. It could take you a year or more to have it grow together to a point where it is strong enough to support your weight. So you’re spending a year or two on crutches, but 10 to 12 years from now, you’re better off because you’re not going to need as many surgeries in the future.”
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