The little girl who could

For the last three years, little Daryna lived with pain.

It started from the time she was a year and 8 months old. When she did not urinate for three days and did not pass motion for two weeks, her mother Anna, 30, a computer programmer, and father Igor, 39, a mechanic, knew something was wrong.

They took her to a doctor in Ukraine, where they lived, and she was hospitalised.

But her condition only got worse, and soon, Daryna could not walk. Her parents took her to another hospital, where they were told the bad news: Their girl had cancer.

"We were all in shock," recalls Anna. Igor's parents both had cancer.

It turned out that Daryna was suffering from a malignant germ cell tumour at the coccygeal region, near the end of her backbone. Germ cells are embryonic stem cells found in the foetus that eventually go to the testis in boys and ovaries in girls for later reproductive functions. When their migration during the foetal stage fails, they have a potential to develop into cancer.

While the malignant germ cell tumour in Daryna could have been present from birth, it had taken some 18 months before it grew into a size that affected her bowel movements and urine function.

At the second hospital, doctors started her on chemotherapy, but after three cycles, she did not improve. They also told the parents that they were not able to perform surgery.

This is where Daryna's long journey round the world started, as her parents moved from country to country hoping for a cure.

 

First, they flew to Germany, where doctors said they could do the necessary surgery. But the cost turned out to be too high, and Anna and Igor had no choice but to fly back to Ukraine. By this time, however, the tumour had grown, and it had reached stage 4. Doctors told the parents that all they could do was hospitalise her and give her palliative care.

However, things had got worse for Daryna. She could not move, because the tumour was pressing on a nerve, leaving and the right side of her body in constant pain. By now, the tumour could also be seen clearly from outside.

Anna and Igor next took her to Moscow, where doctors could only advise that she have a stem cell transplant, as they, too, were unable to perform surgery.

 

Vain attempts

In April 2007, Daryna started receiving chemotherapy in Kiev, but this proved a vain attempt.

"There were terrible complications, and she was in CCU for three months. There were pneumonia and various other problems," recalls Anna.

Then Anna and Igor met some volunteers, who told them about Israel's medical expertise. Perhaps Daryna could get a cure there, they were told. Filled with this ray of hope, they headed there.

"We can do the surgery," said the doctors, offering Anna and Igor the first good news they had heard in many months. But they were told to come back a month later, when the doctors would be ready.

So four weeks later, filled with optimism for the very first time, Daryna's parents made their fourth trip out of the country. The doctors in Israel got her ready, putting her through various scans and drawing the lines on her little body in preparation for surgery the next day.

 

But when the day came, they came to Anna and Igor with devastating news.

“Sorry, we can’t operate. The cancer has spread and it’s too late,” they said. The tumour, it seemed, had already spread to Daryna’s liver, lungs and bones.

The news came as a second shock to her parents, and left them frustrated and angry as well. Says Anna: “We were so upset. They told us to come back one month later, and now they tell us it is too late? We didn’t know what to do.”

Daryna, it appeared, was running out of time, as well as hope.

Anna and Igor turned to their volunteer friends again, and this time, they heard about how their little girl might have a chance in Singapore. Doubtful but somewhat hopeful, they flew straight from Israel to Singapore, without even going home to Ukraine.

That was in October 2007, and it marked the beginning of real hope for Anna, Igor and Daryna.

Hope in Singapore

When they landed and headed straight to the hospital, they were given the good news straightaway: Yes, Daryna had a chance.

Anna will never forget that fateful moment: “Even if the doctors in Singapore had given us a 1 per cent chance, I was ready to kiss them. No one had given us any hope at all. And here, they were saying that it was a 30 per cent chance!”

The doctor who took care of the little girl was Dr Anselm Lee, a consultant paediatric haematologist-oncologist at the Children’s Haematology & Cancer Centre of East Shore Hospital.

Dr Lee recalls the day he met Daryna. “She was an impressive and lovely child on first sight. We shook hands and we talked even though we were complete strangers to each other.”

When the doctor went through her case, he found it heartbreaking to see that at her tender age, Daryna had spent more than half of her life struggling with cancer.

It made him even more determined to give Daryna a chance.

“In cancer treatment, we cannot promise anything more than we can actually deliver. After failing treatments in the past two years, Daryna’s chance of responding to a new treatment would be slim. However, it was definitely not zero,” he says.

“She deserved a chance to live her beautiful life.”

Dr Lee was indeed in a good position to help little Daryna. The oncologist had been treating children with cancers for the past 20 years, and had led the malignant germ cell tumour treatment protocol for the Hong Kong Paediatric Haematology & Oncology Study Group before he moved to Singapore.

His experience, as well as medical literature, told him that malignant germ cell tumours generally had a very good prognosis in children, because they responded well to chemotherapy.

Over 90 per cent of the cases he had treated had a chance of surviving more than 10 years and were considered cured, even though some were quite advanced in stage at the time of diagnosis.

While he knew Daryna’s chance was not so good compared to newly-diagnosed patients, he believed that the brave little girl still had a respectable chance, if she was put under the care of an expert team of doctors.

And so started Daryna’s treatment in Singapore.

The first thing that Dr Lee did was to put her under chemotherapy. This brought about severe side effects – the drugs increased her difficulty in passing urine and opening her bowels, while the tumour marker in her blood did not show a very good response.

A dramatic response, however, was seen on her CT scan. Before she had arrived in Singapore, a previous scan had showed that she had at least six nodules in her lung that were most probably tumours spread from the primary site. After the first chemotherapy regime, this number had dropped dramatically – to one.

A miracle takes place

Still, concern about the overall effectiveness of the first treatment regimen and the severe side effects prompted Dr Lee to change the drug after the first cycle, which fortunately proved to be effective as well as more tolerable. The tumour marker in Daryna’s blood started to show that the tumour was responding to the second type of drugs.

Daryna endured the treatment patiently and bravely throughout, says Dr Lee.

“Like most children, Daryna hated needles. But she was very forgiving, and understood that everyone was helping her and her parents.”

With her improvement also came a change in mood and a hidden liveliness.

“Nothing could stop her radiant charm,” recalls Dr Lee with a smile. “In the last few admissions to the hospital for chemotherapy, she just talked and talked to the staff when she came into the ward, showing people the plasters and the needle pricks she had gone through – in pride, not in pain.

“You could tell from the smiles of the staff in the ward that Daryna found comfort in the staff, as much as they found comfort in her.”

The treatment was so effective that Daryna was well enough to go for surgery in January, something she had been waiting for, for more than two years – and more than half of her young life.

By now, no longer bound to the stroller, she could even go shopping in Singapore.

The much-needed operation turned out to be a success. All the remaining cancer inside her pelvis and lung was removed, and apart from a small area of cancer cells found inside one of the many lung specimens, all the other tissues removed was found to contain only dead tumour cells. Daryna’s AFP level, the tumour marker in the blood, had also fallen to normal levels.

To Anna and Igor, her overjoyed parents, this was nothing short of a miracle.

Igor cannot stop telling how impressed he was with the doctors’ skill, as well as the level of medical care in Singapore. “We came on a Friday night and on Saturday morning, we had already started treatment. The doctors were really fast.”

As for Dr Lee, Daryna’s example strengthened his belief that children with cancer had a very good chance of survival if they received the right care and treatment.

The little girl’s joy,however, was his biggest reward.

“Daryna showed us her determination and will to live. If she had not lost her hair temporarily due to the chemotherapy, no one would have imagined she had cancer, because of her smiling face.”