Ashley Dodson and Buster, the family dog, sprinted up the stairs of their house in a race, a popular pastime for the owner and her companion. But in this particular competition, Dodson knocked her knee into the 116-pound Saint Bernard. Shortly after, she felt recurring knee pain, which she attributed to playtime jostling with man’s best friend.
Life was full and exciting for the then 22-year-old in 2012. She had just gotten married to Glen Dodson, who she had met at Tennessee Tech University where she was majoring in accounting. The two bought a house in her hometown of Baxter, Tennessee. She was enthusiastic about a new job at a bank and thoughts of having children weren’t far off for the newlyweds. Soon, that would all be put on hold.
When the pain in her knee didn’t subside, Dodson went to a local clinic where she thought they would diagnose her with a torn anterior cruciate ligament (ACL).
Unable to find the cause of the pain, the physician told her she needed to have magnetic resonance imaging (MRI) done on her knee and referred her to an orthopaedic oncology specialist at Vanderbilt University Medical Center.
At the bottom of the visit summary sheet from the local clinic was a list of possible diagnoses, among them, osteosarcoma, a cancerous tumor of the bone that most often affects teenagers and young adults. Only three months prior, Dodson had lost her grandfather to a form of bone cancer.
“At the local clinic, they told me they didn’t think it was cancer,” she said. “I was totally oblivious to the oncology part of it at the time. I just thought I was going to a general orthopaedic specialist.”
Jennifer Halpern, M.D., an orthopaedic oncology surgeon at Vanderbilt’s Orthopaedic Institute and assistant professor of Orthopaedic Surgery and Rehabilitation, diagnosed Dodson with osteosarcoma in May 2012, and told her she would receive her cancer care at Monroe Carell Jr. Children’s Hospital at Vanderbilt.
“When she told me, ‘it’s a pediatric cancer and we want to send you to Children’s Hospital,’ I asked ‘do they accept me?,’” Dodson recalls.
Sarcomas are rare malignant tumors which can emanate from bone, muscle, fat, nerve and connective tissue, and they can occur anywhere in the body. Some of the most common forms include: osteosarcoma (bone origin); Ewing sarcoma (bone or soft tissue origin); rhabdomyosarcoma (skeletal muscle origin); and synovial sarcoma (soft tissue origin).
Fewer than 1,000 children and young adults are diagnosed each year in the United States with sarcomas. Currently, Children’s Hospital serves as a large sarcoma referral center for the region and beyond, seeing about 40 new patients each year ranging in age from newborn to 30 years old. Treatment lasts about six months to one year, with follow-up care for 10 years. Adolescents and young adults are generally treated with chemotherapy protocols that have been extensively tested in children, adolescents and young adults.
Because sarcomas are rare, it is important for families to seek care at a facility like Children’s Hospital, where highly trained professionals are experts in this form of cancer, said Scott Borinstein, M.D., Ph.D., director of the Pediatric Sarcoma Program and the Adolescent and Young Adult Cancer Program.
“Care for patients of sarcomas requires expert, multidisciplinary care because these tumors are rare,” said Borinstein, assistant professor of Pediatrics. “You need specialists for the treatment depending on the location of the tumor. It often takes orthopaedists, otolaryngologists, urologists, thoracic surgeons, gastrointestinal surgeons, general surgeons, radiation oncologists, interventional radiologists and many more—all who help with making a diagnosis, with biopsies, with treatments and follow-up care.”
Osteosarcoma is one of the most common forms of sarcoma in teenagers and young adults. This cancer typically starts in long bones like the femur, tibia or humerus, or in the pelvis. Presenting symptoms can include new masses or new pain. Left untreated, the cancer cells can spread to the lungs or other bones, with dire consequences.
Once patients are diagnosed with sarcomas, the program’s team works closely with the patients and families to develop a personalized treatment plan, which depending on the type of sarcoma, can mean a combination of surgery, radiation therapy and chemotherapy. With osteosarcoma, a combination of chemotherapy and surgery is the mainstay of treatment.
Ashley’s case was reviewed by the Sarcoma Tumor Board—doctors including medical oncologists, pathologists, radiologists, surgical oncologists and radiation oncologists who provide expert multidisciplinary treatment recommendations.
“I spend my days collaborating and working with a team. It’s probably one of my favorite parts of my job. I get to work with really amazing and talented people to develop the best integrated care for every patient,” Borinstein said. “We take advantage of the many incredible physicians at Vanderbilt.
We have amazing resources, one of the many benefits of our Cancer Center. We have an expert in most anything.”
Dodson’s case is unique, though not unheard of, for sarcomas. She falls into the category of adolescent and young adult oncology patients, also known as AYA, a population of patients that requires integrated, highly-specialized care that crosses the adult and pediatric disciplines of medicine.
Borinstein leads the Adolescent and Young Adult (AYA) Cancer Program, a partnership between the Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt and Vanderbilt-Ingram Cancer Center.
“We collaborate with our medical oncology colleagues to develop the best therapy, and also to determine where they will be best treated,” he said. “The patients and the families make the final decision where they are most comfortable to receive treatment.”
Dodson’s initial visit at Vanderbilt was with Halpern, the orthopaedic surgeon, but that consult quickly spun off into visits with Borinstein and chemotherapy at Children’s Hospital. She had a large and aggressive tumor in her right tibia, the bone that runs from the knee down the leg. At its greatest dimension the tumor was 8 centimeters (a little more than 3 inches) in size.
She began immediately on three months of chemotherapy. Then, as with many osteosarcoma patients, Halpern had to surgically remove Dodson’s affected bone. The top part of the tibia was removed and then a large knee replacement (megaprosthesis) was performed.
Two weeks after surgery, just enough time to heal her incision, Dodson had to re-start her chemotherapy. By the end, Dodson went through 29 weeks of chemotherapy at the Children’s Hospital oncology clinic.
“My chemo wasn’t bad compared to others. I lost all my hair, which emotionally was the hardest part. I had only been married seven months before I was diagnosed. We took our vows through sickness and in health and Glen was there for me every day,” she said.
Halpern and Borinstein coordinated Dodson’s care to ensure she was getting the best treatment approach for her case. For patients like Dodson, the two doctors hold a joint multidisciplinary clinic in the Doctors’ Office Tower at Children’s Hospital as a one-stop location for patients with sarcoma to receive therapy and unified, convenient care.
“Scott and I can see patients together, which saves them a separate clinic visit/wait, but also allows us to talk in real time about surveillance planning and to generate a coordinated and consistent plan with the patient,” said Halpern. “Our goal is to create a system that attends to all aspects of our patients’ lives.”
Beyond treating the aggressive nature of sarcomas like osteosarcoma, the team helps patients through the emotions of dealing with cancer.
“When first diagnosed, many teenagers and young adults are initially concerned about what they will not be able to do because of the diagnosis or the surgical interventions needed. ‘Can I play soccer? Can I go to prom? Can I run?’ I think that there is a difficult mourning time apart from just being devastated by the cancer,” Halpern said. “They think about the activities and dreams that have defined them thus far, and they wonder who they will be if those things are not possible…Then there is an evolution—as families begin their journey, the focus shifts with the realization that these patients are fighting for their lives. And as the fight starts, it is amazing and awe-inspiring to see how they revolutionize themselves. They push back against their disease through the medical therapies—like chemo or surgery, but probably more importantly they push back with the love of their families and with their own perseverance and creativity.”
Dodson was admitted to the hospital during her chemotherapy doses, with her stay ranging anywhere from three to nine days. While the chemotherapy was psychologically draining, being at Children’s Hospital helped her through.
“It was wonderful. I was included (in activities and events) just as much as the 3-month-old or the 6-year-old. If I was treated too much like a child, they told me to let them know. You can have fun and be in the hospital,” she said. “Being at Children’s took away from the feeling of being at the hospital.”
She was so inspired by Children’s Hospital that she has returned to school to major in psychology. “(My major) change had everything to do with my Child Life specialist,” she said, referring to the trained professionals at Children’s Hospital who have expertise in helping children and their families overcome life’s most challenging events. “I loved what they did and how they try to help the patients have as much of a normal childhood possible while they’re going through their treatment.”
The road to recovery has been arduous. Unable to walk, Dodson spent time in a wheelchair until she could be more mobile, and still she can’t climb stairs well or jump.
But now she is back on track with the family and career journey she began more than three years ago, and children are no longer just a thought. In June 2014 she had a son, Tripptin.
“We always knew we wanted to have children, but we had to wait six months following treatment. We had no problems, obviously,” Dodson said chuckling. “And I had the most perfect pregnancy. Tripptin was born through water birth weighing 9 pounds, 10 ounces.”