Cancer in children is dangerous, and often deadly. But at Children's Hospital, surgeons are having success with new ways to treat it. My associate in this year's Children's fund-raising campaign, Lynn Ryzewicz, has the story of a cancerous leg -- and a positive attitude.
If it weren't for orthopedic oncologist Martin Malawer, Monte Gardner would have lost his leg.
On April 27, Monte, a sixth-grader at the time, broke his left femur while playing kickball at Blue Ridge Middle School in Purcellville. When he went to an emergency room in Leesburg, Michael Kavanagh thought Monte might have bone cancer because his leg had broken so easily. Kavanagh had served his residency under Malawer. He recommended that the Gardners see him.
After a CAT scan, Malawer concluded that Monte, who lives in Round Hill, Va., had osteosarcoma, a malignant form of cancer found primarily in patients ages 10 to 20. A tumor the size of an egg was encased in the middle of Monte's bone. He started chemotherapy and was scheduled for surgery at the end of August.
Each year, osteosarcoma is diagnosed in as many as 2,000 Americans. It is most commonly found around the knee. Before 1984, the only treatment was amputation.
Malawer is one of the founding fathers of a pioneering limb-sparing surgery. It replaces a patient's arm or leg with a titanium rod or a bone donated from someone who has died. Only half a dozen hospitals in the country perform the procedure regularly.
Although some doctors still recommend amputation for children with osteosarcoma, Malawer thinks it is no longer necessary. Of the 300 patients he sees each year, he performs only one or two amputations, he said. About one-third of those patients are, like Monte, patients at Children's. Malawer spends most of his time next door, as chief of oncology at Washington Hospital Center.
Monte's surgery was postponed twice because his white blood cell count was low, but on Oct. 6, it proceeded. "I had fear for Monte, but I had no fear in Dr. Malawer and his team," said Monte's mother, Lorna, a teacher in the Loudoun County public schools.
"I was really scared," said Monte, who is now 13. "I thought I'd wake up in the middle of the surgery bleeding. Whenever I talked to [Malawer], I would get a relieved feeling."
Malawer used prostheses he designed in 1984 with Howmedica Osteonics, an orthopedic implants manufacturing company. In 1988, the team developed a variety of sizes to accommodate any patient. If a patient is younger than 10, Malawer installs a prosthesis that he can expand through subsequent surgeries as the child grows.
Monte's entire tumor was removed. His chance of survival is 95 percent, according to Malawer. Monte has six more rounds of chemotherapy before treatment is completed. But he still has his leg.
Part of Malawer's approach is positive thinking. He pairs current patients with others who have been cured, giving them hope for a successful outcome. Malawer told the Gardners that if they ever met a Children's employee who didn't have a positive attitude, they should ask that the person be removed from Monte's case.
Malawer likes to show off former patients. He points to a wedding picture, taken in 1997 and displayed prominently outside his office. The bride is his first patient. Nearby is a photo of Haley Wetsel, now 16. Malawer explains that she survived osteosarcoma in 1996 with her leg intact and recently went bungee jumping.
Rita Bergmann, now 15, benefited from Malawer's limb-sparing surgery five years ago and is now interested in surgical medicine. When asked whether she wants to be an oncologist like Malawer, she said: "I've thought about it. It's so incredible . . . but it's a lot of responsibility. It takes a lot of courage."
Monte Gardner is still homebound. He spends his days e-mailing friends and building model planes in his basement. He plans to go back to school next fall as an eighth-grader.
For the next 18 months, Monte's leg needs to be monitored closely to see whether the tumor returns. But the prognosis is promising, Malawer said. Monte hopes to play football when he goes to high school, although his mother is wary.
Monte now is a mentor to other patients he meets at Children's who suffer from osteosarcoma. He is working on a book about his experience.
"Even if it's just a small book or a pamphlet, I want to put into words what I felt like," Monte said. "I will never look at life the same. I'll never be miserable to wake up on a rainy day."
Our goal by Jan. 21: $650,000.
In hand as of Dec. 10: $98,576.32.
TO CONTRIBUTE TO THE CAMPAIGN:
Make a check or money order payable to Children's Hospital and mail it to Bob Levey, The Washington Post, Washington, D.C. 20071.
BY VISA OR MASTERCARD:
Call Post-Haste at 202-334-9000 on a touch-tone phone. Then punch in K-I-D-S, or 5437, and follow instructions.