Published: Oct. 17, 2006
Updated: May 19, 2010
Greg Maruzzella, just shy of 14, was getting ready to go out for the middle school football team in his hometown community of Greensboro, NC. Thanks to his frequent participation in team sports, Greg had already sustained a near-constant series of bumps and bruises. So the lump he noticed on his forearm one day didn't cause much concern. "My folks and I just figured I'd sprained it," Greg recalls.
Around the same time, about 50 miles away in Cary, 16-year-old Michi Nair was ready to seek a spot on her high school soccer team. Active and athletic, she had recently stepped up her already vigorous daily running routine to combat the extra weight that, despite frequent workouts and a sensible diet, she seemed to be accumulating in her midsection.
As their schools required, Michi and Greg both received sports physicals to clear them for team activities. The pediatricians who examined them noticed their odd symptoms and, rather than simply settle for the teens' outward appearance of glowing good health, decided to investigate a little further.
For Michi and Greg, that decision turned out to be a very lucky break -- because both youngsters turned out to have cancer. Just days after their sports physicals, both were being treated by Philip Rosoff, MD, of Duke Pediatric Hematology-Oncology. And both now have good prognoses for futures that -- if things had happened just a little differently -- could have been tragically cut short by virulent malignancies.
Looking back on those first days of diagnosis and treatment, what the Nairs and the Maruzzellas most vividly remember is the sudden, frightening sensation of their lives being turned utterly upside down. Greg was given an x-ray, sent to an orthopedist, then run through several tests at Moses Cone Hospital before being referred on to Duke. Michi's doctor, suspicious of the bulge in Michi's abdomen, ordered an ultrasound that revealed a sizable tumor. Michi's family took her to Duke that very day.
Within days, Greg was diagnosed with osteosarcoma. The most common bone cancer in children, it can, if not treated promptly, spread to other bones and the lungs. At Duke, orthopaedic surgeons removed the cancerous bone from Greg's arm and replaced it with bone from his fibula.
Greg then went through 32 sessions of chemotherapy -- and all of the debilitating side effects that often accompany it. But, when his treatment was over, the Duke team was able to report to Greg and his family that his response had been excellent.
Michi's cancer turned out to be a germ cell tumor, a usually benign form of ovarian cancer that affects young women. After the growth was surgically removed by Duke pediatric surgeon Henry Rice, MD, Michi and her family were devastated when pathology tests revealed that it was malignant. She went through four months of chemotherapy, and the treatment was so successful that she is now going back to Duke for checkups only twice a year.
"Catastrophic, life-threatening illness in youngsters is extremely rare," says Rosoff. "For example, there are about 18,000 cases of childhood cancer a year, compared to about half a million adult cancers. Because of their rarity, these conditions demand expert care from clinicians with experience in treating them and access to the very latest therapies. The good news is that, at leading academic medical centers like Duke, we can now cure more than 75 percent of all childhood cancers."
As teenagers, Michi and Greg were especially fortunate to be referred quickly to Duke. "One of the most underserved patient populations is older adolescents," says Rosoff. "This age group often doesn't get regular checkups, so they can fall through the cracks. And when they do see a doctor, teens are sometimes reluctant to see a pediatrician, feeling that they're now too 'grown-up.' Yet there's a whole family of serious illnesses that tend to affect young people, and physicians who primarily treat adults don't have the specialized training to fully meet their needs."
By contrast, says Rosoff, pediatricians are trained to provide youngsters from birth through the teenage years with thorough, age-appropriate health care. That training might just have saved Michi's and Greg's lives. "Both of these patients were referred to us because their pediatricians were alert enough to be suspicious of their symptoms and concerned enough to refer them for further tests," Dr. Rosoff explains.
Michi's father and mother, Kris and Etsu, were impressed by both the quality and the compassion of the care their daughter got at Duke. "The way Michi's doctors and nurses handled the whole thing was amazing," says Kris. "They're very busy people, but they took the time to answer every question." Adds Etsu, "We were especially struck by the way that Dr. Rosoff always addressed Michi directly. He treated her with great respect."
Greg and his parents, Carl and Kaye, express similar sentiments. "I don't think care can get any better than what we experienced at Duke," Carl says. Agrees Kaye: "The main thing is not to let a diagnosis like this overwhelm you, because when you're at Duke, you're in really good hands -- and they'll get you through it."
As for what Michi and Greg can expect down the road, Rosoff and his colleagues are taking steps to make sure that youngsters who survive cancer enjoy not just longer lives, but better ones.
Today, so many children and adolescents with cancer are being cured that, according to some estimates, one in 250 adults under the age of 45 will be a childhood cancer survivor by the year 2010. According to Rosoff, many of them will face delayed physical effects of treatment, as well as various social, financial, and emotional hurdles.
To help cancer survivors address these issues, Rosoff founded the Duke Long-Term Cancer Survivor Clinic. One of the only such programs in the country, the clinic follows hundreds of former pediatric cancer patients from childhood into adulthood, monitoring their health, providing ongoing support, and offering a seamless transition to follow-up care.
Former patients from years past (such as the woman in her 50s who is the program's oldest participant) are also encouraged to register with the program, which dovetails with national efforts such as the National Cancer Institute's recently created Office for Cancer Survivorship.
“Today's childhood cancer survivors are alive because of their predecessors," Rosoff says. "We owe it to those earlier children to continue the pioneer spirit that led to today's successful treatments, and ensure that survivors have the best quality of life possible."
As for Michi and Greg, both were inspired by their experiences at Duke to enter the health care field: Michi is a physician assistant and Greg is a nurse at Duke. "Now I know that every day is a gift," says Greg. "You just don't realize how cool everything is until it's almost taken away from you."