The fight to save Breanna
Play accident reveals tumour
BREANNA Thomas’s parents cannot stop their minds churning through the sequence of
Sliding Doors moments from the past six weeks that has led them to be beside their daughter’s hospital bed.
What if the storm that carried the trampoline across their paddock and into the neighbours’ yard happened a week earlier, so the kids couldn’t play on it that Wednesday afternoon?
What if the three youngest of the six children hadn’t all wanted to jump at once, with their exuberant play forcing the two girls to collide?
What if mum Carolyn hadn’t persisted with multiple doctor visits when her threeyear-old complained of stomach pains?
Mrs Thomas knew as soon as she saw the mass appear as the ultrasound wand glided across Breanna’s bloated abdomen six weeks ago at the Royal Children’s Hospital that this was serious.
With husband Stewart by her side, she had experienced her fair share of ultrasounds herself while pregnant. This time she was on her own.
“I think I shocked him (the doctor). Straight away I just went, ‘What is that?’,” she said.
“He was very thorough. I watched him measure it. I could see it was 15 by 13cm big. He said it was a tumour. My heart just stopped.”
RCH doctors believe that the fast-growing Wilms’ tumour — the size of a small soft-toy football — had been growing for three or four months.
It was simple to explain to Breanna why she was in hospital. She could understand that there was a “yucky in her tummy” that doctors needed to take out for her to feel better.
It was a harder conversation to have with the older children — aged 11, 14 and 15 — who remember their parents’ anguish at losing a daughter eight years ago, stillborn at full term.
“The bigger kids already know what it’s like to lose a sibling, so their first question was ‘is she going to get to the other end of it?’,” Mrs Thomas said.
“Most families wouldn’t face that question once, let alone twice.”
But Mrs Thomas had done her homework and could tell her children that a Wilms’ tumour originated from the kidneys and could be successfully treated in more than 90 per cent of cases.
Before it could be surgically removed, Breanna needed four weeks of chemotherapy aimed at shrinking the tumour.
HER strawberry blonde hair had just stopped falling out when she was booked for the surgery last Tuesday.
She arrives for the afternoon list, groggy from the hour drive from her Merrimu home. One arm is tightly wrapped around her father’s neck and the other around her pink Minnie Mouse doll.
Her nails are also painted pink, a prize she scored in the Children’s Cancer Centre lucky dip that all kids can dive their hand into after uncomfortable procedures, like blood tests or dressing changes.
Carolyn stays close to the surgery waiting room, but Stewart has an hour drive ahead to make the daycare and school afternoon pick-up, and preparing dinner for the other five children — one with gastro, another with a broken hand — before a friend arrives to babysit so he can return to his daughter’s side.
Paediatric surgeon Michael Nightingale said Breanna’s case was typical in that the tumour was usually found incidentally as a lump in the abdomen, and had commonly grown quite large by the time it was discovered.
It is a surgery performed on about eight children each year.
Recently the team has had success in performing it as a keyhole access, and also preserving some of the affected kidney.
But Breanna’s tumour is so large will require an incision across the entire width of her abdomen, and none of her left kidney can be saved.
The impact of the collision on the trampoline most likely caused the tumour to bleed.
And, while chemotherapy shrinks tumours, making them safer and easier to surgically remove, it has no impact on the 15cm-long blood clot, which was enclosed in the tissue sheath around the kidney.
Mr Nightingale likened his operating theatre task to getting a balloon out of a small hole. Breanna’s tumour is soft from the bleed, and rupturing it means automatic radiation treatment to ensure any spillage won’t lead to more tumours.
After exposing Breanna’s abdominal cavity, her bowel must be repositioned to reveal the kidney.
He then ties off and stitches the blood vessel between the heart and the kidney. From there it is a slow, painstaking four-hour series of measured cuts, followed by more checking to see if the tumour has been prised from the abdomen.
A board meeting was held this week to discuss the next stage of Breanna’s treatment.
Mr Nightingale presented the findings from the operation, the pathologists gave insight from what clues the tumour held, oncologists, nurses and radiation oncologists also presented their recommendations.
“We got it all out intact and no tumour was left that we could find,” he said.
“She will have more chemotherapy and maybe radiation, and she will need follow-up for some time to check there is no sign of the tumour coming back and to monitor the health of her sole kidney. There is no reason if you look after your health you can’t live a normal life with one kidney.”
BREANNA’S family are close-knit and the kids work on a buddy system. The eldest of the three older kids is the buddy of the oldest of the three younger kids, and then down the chain it works.
If you make your bed, you also make your buddy’s bed. When you fold your clothes, you sort those of your buddy, too. If one of the smaller children is missing from their bed in the morning, it is guaranteed they will be in the double bed of their bigger buddy.
Breanna’s buddy, 14-yearold Callum, visited his sister after the surgery last week. He had loaded his phone with
Dora the Explorer, so she could watch without leaving bed. “All the kids have been so good and the hospital has been amazing,” Mrs Thomas said.
“We’ve just told the kids that when we’re through this, we’ll just take out a loan and just bugger off together for a month on a family holiday. We’re going to take time away and relax, have a bit of fun.
“Our focus at the moment is getting her to the other end.”
She has been poked and prodded too many times, and clings to dad Stewart’s neck as she is carried towards the operating theatre.
Breanna is consoled by her parents as she
waits for surgery. Pictures: ALEX COPPEL
Surgeon Michael Nightingale marks the line for incision to remove the 15cm-long kidney tumour.
Scans show the tumour that had been growing for about three months in Breanna’s tiny pelvis.
Breanna recovers in hospital with the support of her five siblings (main); passing the time with Mum taking selfies during chemotherapy (below).