My name's Nick. I'm 15 and I love football! I'm in the school team, and every weekend, my dad and I will have a kick about as well.
One morning about a month ago, I woke up thinking I must have hurt my knee. It hurt when I ran and I couldn't even finish the match that day.
My coach told me to rest and I gave up football for that week, but my knee still hurt. It even started to wake me up at night. Dad got me a bandage for my knee and Mum took me to see a friend of hers who gave it a massage.
I tried to go back to football training, but it was so painful I had to stop. The coach even thought my knee looked a bit swollen.
When I woke up yesterday, I couldn't even get out of bed. I had to tell Mum and Dad because my leg was really sore. Dad took the day off work so he and Mum could take me to the doctor. I think they knew I wasn't feeling well.
The doctor was really nice. She asked me loads of questions and did some blood tests and scans. She then called us all into the room. I remember thinking that she wasn't smiling anymore.
The doctor said I have osteosarcoma. She said it's a type of cancer. I just sat there while Dad asked lots of questions. Mum was crying. For the first time, I felt scared.
What is osteosarcoma?
Osteosarcoma is the commonest bone cancer affecting children and adolescents. It tends to occur more frequently in boys, particularly around puberty when bones grow more quickly.
In Malaysia, about 800 children below the age of 18 are diagnosed with cancer each year, and osteosarcoma accounts for approximately 3 per cent of such cancer diagnoses.
The cause of this cancer is still unknown. In some cases, children who have inherited rare cancer syndromes are at higher risk of developing osteosarcoma.
It generally arises around the knee, shoulder or ankle joint within the long bones. A smaller percentage may arise from the flat bones such as the shoulder blade or the pelvis. It can occur in any bone and may spread to the lungs.
Patients usually present with swelling and bone pain, which worsens during exercise or at night, often waking the child up.
Children who develop a painful, swollen joint, an unexplained limp, or in some cases, a broken arm or leg from minimal trauma, are of particular concern.
The diagnosis of osteosarcoma includes a detailed medical history and physical examination performed by a paediatric oncologist or orthopaedic surgeon, and a combination of blood tests, imaging studies (X-ray, CT scan, bone scan and MRI) and biopsy of the tumour.
The doctor wanted me to see a friend of hers who worked in an even bigger hospital. She was saying I needed all sorts of tests and treatments. She said I would need surgery.
The doctors would try and get rid of this cancer in my knee but there were some risks involved.
Mum, Dad and I came home and we spent all afternoon searching on the computer and ringing everyone we knew with even the tiniest bit of medical knowledge.
A friend of Mum's told us how she knew someone who lost his leg because of cancer. Dad's workmate told us he knew a guy who could cure cancer with special herbs.
It was all pretty confusing. I cried myself to sleep for the next few nights.
Treatment of osteosarcoma
Given the rarity of osteosarcoma, it is important that treatment is provided by a team of doctors (paediatric oncologists and cancer-trained orthopaedic surgeons) and other healthcare professionals skilled in cancer care.
Treatment includes a combination of chemotherapy and surgery to remove the tumour.
Many parents have legitimate concerns about their child undergoing chemotherapy. The purpose of chemotherapy is to kill cancer cells, both within the bone tumour and the ones circulating in the bloodstream.
Chemotherapy is generally given before surgery to shrink the tumour, and after surgery to kill cancer cells circulating in the blood.
As with most medication, chemotherapy causes side effects. Side effects occur when chemotherapy damages healthy rapidly-dividing cells such as the hair follicles.
Nonetheless, most of these side effects are temporary and patients largely recover after completion of treatment.
Mum, Dad, my grandpa and I had a family meeting. We all agreed that my best chance was to trust the doctors, so we went back to the hospital the next day.
The specialist doctor had a plan for what treatment I should have to kill off the cancer cells. He also talked about this neat surgery where they would replace the cancerous bone with a special metal implant.
I'd be part-bionic boy! Nobody's cutting off my leg!
Before the 1970s, amputation was the only surgical treatment for limb sarcoma. With advances in chemotherapy, radiological imaging, surgical techniques and technology, most patients nowadays are able to retain their affected limb.
This technique is termed limb-salvage surgery.
In limb-salvage surgery, the bone affected with osteosarcoma is removed and replaced with a metal or titanium implant matched to the size of the bone defect to ensure continuity of normal limb function.
The challenge in growing children is to keep up with the length of the other normal-growing limb. Therefore, a specially-made implant can be custom-made to the patient's size and made expandable to match their normal growth.
In Malaysia, there are only a few hospitals that are fully equipped for the treatment of bone cancer. Surgery should only be performed by trained orthopaedic oncologists as it involves complex surgical and reconstructive techniques.
The decision for the appropriate type of replacement or reconstructive surgery depends on the individual clinical scenario and there is no 'one-size-fits-all' solution.
Survival and long-term prognosis
Medical and surgical advances have dramatically improved survival rates of children with osteosarcoma.
Today, children and adolescents diagnosed with osteosarcoma have a survival rate of nearly 70 per cent.
However, the prognosis for those with osteosarcoma that has spread to other bones or the lungs is very poor, hence early diagnosis and appropriate treatment at specialised centres is imperative to ensure a good chance of cure.
Hi, I'm Nick, and I'm 16 now. I have been in and out of hospital for a whole year. But not today. Today, I have my football boots on and I have a match to play.
Today, I'm showing the school their midfield maestro is back!