Shattered Dreams: 24-year-old Battles a rare type of cancer

Herbert Mpiima is hopeless. No amount of convincing can make him believe that he will live and achieve any of his childhood dreams. He lies on bed number 11 in the General Ward at the Cancer institute where he has been admitted for the last two weeks.

Two cannulas are connected through his nose to an oxygen cylinder to aid his breathing after his lungs failed to support him. His lungs have been eaten up by a rare form of cancer which started from his left thigh bone four years back.
Mpima can speak and he is eager to share his rather painful story. He says that his troubles started in 2009 after he sat his senior six exams. A painless simple swelling developed in his thigh.

He could feel and touch it but because it was painless –like most cancer tumours, he ignored it.
However, eight months later, the inflammation intensified and the area became painful.
“This made me worry and I immediately went to Mulago hospital – Assessment centre. After examination, the doctor gave me drugs alongside a gel to rub around the area,” he says. “I followed the procedure like the doctor had instructed.” But after five months without change as the pain became more unbearable, he decided to go back.

Diagnosis of the cancer
Because the tumour had grown bigger, the 24-year-old says that the doctors who examined him recommended a biopsy – a medical test that involves removal of tissue in order to examine it for disease. So in May 2010, he was admitted, a biopsy done and the results came out positive for cancer of the bone – Osteosarcoma, a cancerous bone tumour that usually develops in teenagers.

“They said that my thigh born had cancer. The doctors recommended amputation – the removal of the leg which I consented to after thorough counselling. I was prepared and put to sleep,” says Mpiima, adding that when he woke up an hour later, he still had his leg. “I inquired why the leg had not been cut and the doctor explained that they had found out my leg’s physical features did not match with the biopsy report.”
Another tissue sample was drawn from his thigh and taken for further tests.

This time round however, part of the samples were given to Mpiima and his family to take to another hospital for an independent test. His doctor at Mulago on the other hand did separate investigations, while the other sample was taken to Kampala Hospital. Both tests yielded the same results. They ruled out cancer but rather indicated that he had a bone infection known as osteo-chondroma bone infection. He was given treatment for the infection and discharged.

Mpiima then enrolled for a diploma course in Business Education at Kyambogo University where he, unfortunately only studied for three months and could not sit his exams.
The swelling had worsened and so had the pain. “I abandoned school and pitched camp at Mulago hospital again. Another biopsy was done and the results were consistent with the previous ones. There was no cancer. The team of doctors who were handling my case became perplexed as it became difficult for them to identify what was ailing me.

Another test, CT scan was recommended and its results showed the root cause of the tumour. It was the mid-thigh bone from which the tumour had originated. From his account, the doctors worked on a plan to remove the bone hoping that the procedure would prevent the tumour from recurring.

More surgery done
The bone was removed and replaced with a nail - implant to act as a thigh bone. But, he was also required to use clutches so that his weight would not put too much pressure on the implant. Mpiima used the clutches for five months only and the tumor recurred.

The bone which was thought to be the genesis of the disease had been removed, but certainly not the disease.
At that point, a fourth biopsy was sought and immediately done. And this time, in 2012, the results were different. Mpima had a bone cancer called para osteosarcoma. He was immediately referred to the cancer institute.
“At the cancer institute, fresh investigations were done to confirm my disease. And in February, I was given my first dose of chemotherapy.”

Two months after, the team at the cancer institute carried out another medical investigation to assess the impact of the chemotherapy on the disease.
Unfortunately for him, the doctors found that the drugs given to kill the cancerous cells had no impact on Mpiima’s cancer. Instead, the disease had spread to his left lung.
He was asked to take a one month break from chemotherapy as he prepared for his next dose.

However, during that time, the pain in his thigh became too much that he asked for his thigh and leg to be removed.
“The leg was amputated, and I took a second dose of chemotherapy. And like the first time, tests were done to further assess the impact of the cancer treatment I was receiving. The results showed that both my lungs were affected,” he says, adding: “I lost all hope of ever getting cured. I had just sacrificed my leg hoping that the disease would be defeated.”

“I kept around, being monitored for at least two months, after which the doctor told me that the disease had spread to at least three quarters of my lungs. That was December last year.”

Admission to the hospital again
Because of the extent of his disease, his lungs could longer support him and on January 19, he was admitted again at the cancer institute.

At the moment, he is only receiving treatment to control infection and for pain relief - more like palliative care, since his body is too weak to handle chemotherapy, according to the nursing officer at ward who declined to be named.
His mother Loy Tusingwire looks on and constantly checks on her last born child to ensure that he is comfortable even though she confesses she has lost hope of her son recovering from the disease.

Records at the cancer institute also show that this is the first and only such cancer that has been documented at the facility since it was established. It is that rare.
According to the American Cancer Society, Osteosarcoma is a cancerous (malignant) bone tumour that usually develops in teenagers. It occurs when a teen is growing rapidly.

The cause is not known but information from the American Cancer Society shows that most osteosarcomas arise from random and unpredictable errors in the DNA of growing bone cells during times of intense bone growth.
It further says that there currently isn’t an effective way to prevent this type of cancer.

ABOUT OSTEOSARCOMA
Osteosarcoma is the most common bone cancer in children and it’s usually diagnosed at 15 years of age. The disease is most often seen in teenage boys, and evidence shows that teens who are taller than average have an added risk for developing the disease.

The cancer often starts near the ends of the long bones in the legs. The arm bone near the shoulder is the second most common place for this cancer to start. But it can start in other bones, too, like the hip bone (pelvis), shoulder, or jaw.
Symptoms

The most common symptoms are pain and swelling in a child's leg or arm. Pain may be worse during exercise or at night, and a lump or swelling may develop in the affected area up to several weeks after the pain starts.

In osteosarcoma of the leg, the child may also develop an unexplained limp. In some cases, the first sign of the disease is a broken arm or leg, because the cancer has weakened the bone to make it vulnerable to a break.
Treatment

Chemotherapy given before and after surgery will cure many people with this cancer. It may also allow some people to avoid having an arm or leg removed.
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