Brain tumour... at the age of 5
Wan Xuan’s family didn’t know what to do when she was diagnosed with brain cancer. But doctors were able to help her beat it with a new treatment
It started as just a squint.
Chang Wan Xuan was a lively girl who seemed to be perfectly normal in every way until she developed a squint.
Puzzled, her parents took her to an eye specialist at Gleneagles Hospital. Unable to see anything wrong with her eyes, he ordered an MRI scan and that’s when the devastating discovery was made – Wan Xuan – their lively youngest daughter, had a brain tumour.
Wan Xuan was only 5 years old.
“We were completely shocked,” recalled Mrs Tinaa Chang, Wan Xuan’s mother.
The diagnosis in 2000 sent the Changs from one neurosurgeon to another, hoping to find a way to fix the problem. They even went to Hong Kong to speak to an eminent neurosurgeon.
No one could agree on what the next step should be. There was no indication if the tumour was benign or not, and even doing a biopsy was dangerous.
This is because her tumour was located on the brain stem, a vital part of the brain which makes it very hard to operate because there is no room for error. The brain stem controls the body’s cardiac and respiratory functions, as well as its central nervous system.
One neurosurgeon told the Changs that if he were Wan Xuan’s father, he wouldn’t do anything.
“Surgery would do more damage than it would help,” he told them.
In the end, the Changs decided to take his advice. Apart from the squint, their daughter did not seem to be showing any effects from her tumour, and they felt that the risks outweighed the potential benefi ts of a biopsy or operation.
However, as Wan Xuan grew older, her tumour grew as well. No one knew the extent of the problem until she fell at home one day, some three years after the fi rst diagnosis.
Her parents rushed her to KK Women’s and Children’s Hospital where Wan Xuan needed an immediate operation to have a shunt inserted in her skull to remove fluid in the brain.
During the operation, surgeons discovered that the tumour had grown much bigger, and was probably the cause of her fall because she was losing control of her limbs.
That’s when the Changs spoke to Dr Timothy Lee, a neurosurgeon who recommended that they talk to Dr Edward Yang, the Senior Consultant Radiation Oncologist at the Gleneagles Hospital.
By then, it was August 2002 and Wan Xuan’s condition was dire. “She was almost unconscious. She stopped responding to me,” said Mrs Chang.
When Dr Yang first examined Wan Xuan, he felt that her prognosis was not good.
“A tumour in the brain stem is usually a death sentence,” he said. “When it happens to children, the life expectancy is about five years and usually, surgery is not possible. Most surgeons don’t want to operate because the risks are paralysis or death.”
However, by this stage, Wan Xuan’s options were limited.
Dr Yang proposed what was then a novel treatment, stereotactic radiotherapy using the BrainLAB system, together with a chemotherapy drug called temozolomide.
“At the time, there was no published data on the effects of using chemotherapy with radiotherapy for brain stem tumours,” he said.
Even though there were no studies showing the efficacy of this approach, Wan Xuan had little to lose, and the Changs, desperate for any chance to save their daughter, gave their approval.
Wan Xuan underwent fi ve and a half weeks of radiotherapy. She was warded in Gleneagles Hospital and every day, she underwent a 15-minute session with the BrainLAB system.
BrainLAB is a system that helps surgeons deliver precise doses of radiation to kill brain tumours. The system helps to plan the dosage amount and the location it is delivered to, so as to ensure accurate and precise delivery that minimises damage to healthy cells.
According to Dr Yang, the change was almost immediate.
“With every week, her neurology improved,” he said.
She suffered very few side effects as well. After the radiotherapy, she was put on a course of temozolomide for six months. She was discharged after her radiotherapy and was able to go to school within weeks.
Today, Wan Xuan is a normal teenager. She is a happy Secondary One student at Bedok South Secondary School.
According to her mother, she likes school so much that even when she is not feeling well, she still wants to go to class.
She has joined the National Police Cadet Corps (NPCC) where she is a cadet. She likes the marching and the smart uniform of the NPCC and wants to be a policewoman when she grows up.
She still has the shunt in her skull and she still goes for yearly check-ups with Dr Yang to check that the tumour has not grown.
But for all intents and purposes, Wan Xuan lives the life of any 13-year-old. Wan Xuan now gives her parents the kinds of problems that teenage daughters give their parents, and for this opportunity, her parents are eternally grateful.
Dr Edward Yang
Senior Consultant Radiation Oncologist
MBBS DMRT FRCR FAMS
Parkway Cancer Centre
6A Napier Road
Gleneagles Hospital
Singapore 258500
Tel: (65) 6470 5830
Fax: (65) 6470 5831
