Why This 15-Year-Old’s Treatment for Germ Cell Tumour Suddenly Stopped Working
What first appeared to be a germ cell tumour—one of the most common cancers found in teens—turned out to be something far more shocking.
What’s wrong with me?
The patient: Larisa*, 15, a high-school student in Ukraine
The symptoms: cough, abdominal pain
The doctor: Dr. Cynthia Herzog, deputy division head, division of pediatrics at the University of Texas MD Anderson Cancer Center in Houston, Texas
Seven years ago, Larisa began experiencing pain in her abdomen that would come and go. Concerned, her parents took her to their family doctor, who referred her to a gynecologist.
After an ultrasound detected a mass in Larisa’s pelvis, an oncologist took a biopsy. A week later, the results came back positive for a germ cell tumour, a type of cancer that occurs in the reproductive cells of the ovaries or testicles—and is one of the most common cancers in teens. Further testing showed that the disease had already spread to the lymph nodes around Larisa’s spinal cord.
Rather than seek treatment for their daughter near home, Larisa’s parents headed overseas to the MD Anderson Cancer Center in Texas, where Larisa became one of their many international patients. (In 2017, nearly 2,000 patients from 100 different countries arrived at the hospital.)
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Biographical details have been changed.
Treatment begins—but the disease returns
By the time Dr. Cynthia Herzog, who treats pediatric patients, saw Larisa, the teen was also complaining of a cough whenever she lay down to sleep. A pathologist verified the initial diagnosis, and Herzog put Larisa on the standard chemotherapy regimen for a germ cell tumour. When that caused inflammation in the teen’s bowel, as well as diarrhea and vomiting, she was switched to an alternative, and successful, course of drugs.
Three months later, a surgeon removed Larisa’s shrunken ovarian mass and a number of the affected lymph nodes and confirmed that the tumours were dead. New ones could always develop, but the prognosis was good. “Even with metastatic disease, the long-term survival rate is 50 per cent, which is fairly high,” Herzog says.
When Larisa arrived 10 weeks later for her first post-surgery scan, she mentioned that her cough had returned. Test results explained why that might be: the disease had grown in the lymph nodes around her heart.
Surprised by the about-face in her condition after treatment for the germ cell tumour had proved so effective, Herzog wanted to perform a biopsy of the chest mass, but Larisa’s parents refused. Their daughter’s cough would make it difficult to lie down for the procedure, and she would have to be put under. Larisa had already gone through so much, so they chose to continue the chemotherapy instead. After one cycle, however, scans revealed that the chest mass remained unaffected.
“It’s very odd for the disease to come back and not respond to treatment,” says Herzog. “That’s when we said that we really need a biopsy to see exactly what we’re dealing with before continuing.”
A one in 10 billion chance
A few days later, Herzog got one of the biggest surprises of her 33-year career. The hospital’s pathologists informed her that Larisa had a separate primary cancer—a lymphoma.
The doctor’s shock is understandable: a girl Larisa’s age has approximately a one in 100,000 chance of getting either one of those cancers, putting the odds of having both at one in 10 billion. “It’s the only time I’ve ever seen it,” Herzog says.
Treating lymphoma is a longer process than for a germ cell tumour—the standard regimen lasts a year and a half. Larisa and her family lived in Houston for most of that time, before moving back home to Ukraine for the remaining treatments.
Larisa’s last round of chemotherapy took place at the end of 2014. She returns to MD Anderson for follow-up scans once a year and so far remains cancer-free. The 21-year-old is living much like she did before her symptoms first appeared, with one notable change: she’s now planning to pursue a career in health care.
Next, this teacher’s back pain turned out to be a life-threatening condition.