Challenges of managing childhood cancers in resource-constrained settings: A case of sarcoma botryoides in a 3-year-old girl

Abstract

Sarcoma botryoides is a rare histological variant of rhabdomyosarcoma (RMS) found in the mucosal lining of body cavities of the bladder, vagina, nasopharynx, and biliary tract. Vaginal RMS typically affects young girls below 2 years of age but has also been reported in adolescents. Most patients present late when the tumor has already caused significant regional effects and complications. The management of such children usually poses numerous challenges in a resource-poor setting. A 3-year-old girl presented with a 1-year history of a progressive mass protruding through the vaginal introitus, associated with bleeding, progressive weight loss of 6 months, and abdominal swelling of 3 months duration. After 6 weeks of hospital stay, a diagnosis of sarcoma botryoides was made, and chemotherapy was commenced 2 weeks following the diagnosis. Delays were encountered due to financial constraints, laboratory stock-outs, and hesitance in accepting treatment by the parents. She completed one cycle of chemotherapy, comprising vincristine, actinomycin, and cyclophosphamide, with demonstrable reduction in the tumor sizes. Unfortunately, her management was complicated by severe measles infection acquired during admission; and she succumbed to the illness. Treatment of childhood cancers is bedevilled by the multiple levels of delays, and a host of co-morbidities that combine to produce an undesirable outcome. There is a need for a highly coordinated multidisciplinary approach that is hinged on a strong support for infection prevention and treatment access, in addition to good nutrition, adequate supply of blood, and blood products.