For months, 16-year-old Ella was told her nagging pain was just a pulled muscle. Then she discovered she had this form of bone cancer that often gets overlooked... and it's not just young people at risk | Retrui News | Retrui
For months, 16-year-old Ella was told her nagging pain was just a pulled muscle. Then she discovered she had this form of bone cancer that often gets overlooked... and it's not just young people at risk
SOURCE:Daily Mail
Ella, then aged 16, felt a lump as she showered. 'I looked in the mirror and saw it was clearly visible - and once I'd noticed it, I couldn't unsee it,' she says. 'My stomach flipped.'
For six months, teenager Ella Cromack was repeatedly told by doctors the constant nagging pain deep in her right shoulder was 'just a pulled muscle' – and that it was nothing to worry about.
Even when the agony started running down into her fingertips, affecting her ability to do everyday tasks such as brushing her teeth and getting dressed, Ella left the GP surgery with nothing more than anti-inflammatory painkillers.
Weeks later, with the pain worsening, her GP again told her it was muscular and sent her for physiotherapy – which, 'if anything, it made it feel worse', university student Ella recalls.
It was as she was showering on New Year's Eve 2020 that, then aged 16, she felt a lump as she ran her hand over her shoulder.
'I looked in the mirror and saw it was clearly visible – and once I'd noticed it, I couldn't unsee it,' Ella says. 'My stomach flipped. I grabbed a towel and ran to show my mum.'
The next day, her dad took her to the nearby Sunderland Royal Hospital, where an X-ray revealed that the ball-and-socket joint in her shoulder – the glenohumeral joint – was lower than it should be and doctors told her with 'scary' urgency that she needed more detailed scans.
Days later Ella was asked to return for a biopsy of the bone in her shoulder and was warned she might have a tumour. Just hearing the word tumour was 'terrifying', she says.
A week later, she returned to the hospital to be told she had osteosarcoma – a rare type of bone cancer that most commonly affects teenagers and young adults.
Ella Cromack felt agonising pain deep in her right shoulder when she was 16, but the GP told her it was merely a strain caused by exercising at the gym
Ella during her chemotherapy treatment - where the mental toll of being in hospital five days at a time without her friends tested her most
'I couldn't believe it,' says Ella. 'I had been told for months it was just a pulled muscle and now I was being told I had cancer. I was only 16.'
While being a teenager isn't normally considered a risk for cancer, it can be for osteosarcoma, which is most often diagnosed among those aged 15 to 19, according to the Bone Cancer Research Trust charity.
Osteosarcoma accounts for about a quarter of the 600 primary bone cancer cases diagnosed each year in the UK (secondary bone cancer is where cancer spreads to the bone from other parts of the body). It forms in the bone-making cells and grows quickly to form a mass or tumour.
People with a family history or having had previous cancer treatment, such as chemotherapy and radiotherapy, are most vulnerable, but age is also a risk factor.
'There are two age peaks in the incidence – late teenage and then in later life, usually in people over 60,' explains Dr Jeff White, a retired oncologist from Glasgow and now an ambassador for the charity Sarcoma UK.
The disease is more common in men than women (though it's not clear why), and in teenagers typically affects the bones in the arms and legs. After the age of 40, however, it becomes more common in the skull, jaw and pelvis.
Delayed diagnosis, as in Ella's case, is worryingly common, says Dr White. 'That's because very often this cancer presents with non-specific symptoms such as vague pain. But pain in a bone at night is a more concerning feature.'
There may also be swelling or a lump, and as the cancer grows it can lead to fractures from minor impact.
Dr White says the condition can get mistaken for 'non-cancer conditions' such as growing pains and that patients may have to visit their GP on 'several occasions' before they get referred for investigations and a diagnosis.
'Sarcoma UK and Bone Cancer Research Trust are now supporting a trial, called the SPEED study, looking into ways to reduce these delays – and funding research into a blood test to detect genetic material from the osteosarcoma which could be used as an early diagnostic blood test,' says Dr White.
The study could make all the difference to those such as Ella who go back and forth to the doctor waiting for a diagnosis.
The first symptom she noticed was 'a sharp twang, as if my shoulder had popped out of place' when she was sitting on a swing, she recalls.
'I don't know how I didn't cry because it was agony. I was sure I'd dislocated my shoulder, but when I moved it gently, it felt like it was still in place.'
Her dad drove her to A&E, where a doctor 'asked if I had been exercising in the gym, which I had', says Ella. 'He suggested it was a pulled muscle and that I should stop going to give my shoulder some rest.'
'I remember feeling confused because I had only done leg exercises.'
Over the next few months Ella revisited her GP, but each time was told it was a muscular problem.
By the time her cancer was diagnosed it was 10cm – the size of an orange.
Processing the news she had cancer was, she says, 'surreal', adding: 'I think it helped being so young – the doctors seemed positive I would be fine, so this reassured me.'
She was grateful that despite the delays in her diagnosis, 'it was caught and hadn't spread'.
Treatment typically involves chemotherapy – usually a combination of the drugs methotrexate, adriamycin and cisplatin – 'to minimise the spread of cancer to other parts of the body and make the osteosarcoma smaller and easier to operate on', says Dr White.
Ella began hers in January 2021 and left her feeling 'sick and tired – but not as bad as I'd heard or expected', she recalls.
The mental toll was harder. Having to be in hospital without her friends for five days at a time left her feeling 'lonely and anxious, with too much time to think and worry about my health and future'.
Two weeks after starting treatment, Ella's hair started coming out in clumps.
'As a 16-year-old, that was the worst part for me,' she says. 'I hated looking in the mirror, seeing thinning hair and bald patches, so I asked my dad to shave it all off. I was holding back tears as he ran the clippers over my head.'
After ten weeks and two cycles of chemotherapy, in April 2021, Ella had an eight-hour operation at the Royal Victoria Infirmary in Newcastle. She underwent a full shoulder joint replacement to ensure the tumour and all the cancerous cells were removed.
'Afterwards, I was told the tumour was 10cm, so pretty big,' says Ella. 'They described it like a balloon, that if it had popped, the cancerous cells inside it would have spread, so they also needed to remove all the tissue and bone from around the tumour.
She had 40 staples put into her arm from the surgery and now has a 'massive' scar running across her shoulder
'They also took some of my arm muscle, which meant I couldn't fully lift my right arm. I still can't now, five years later.'
The aim of surgery, says Dr White, is to remove the cancer while 'preserving as much function in the affected bone as possible'.
'In many cases, this involves replacing the bone with a metallic structure,' he adds. 'Once the patient has recovered adequately from their surgery, most patients will undergo further chemotherapy.'
Ella spent two weeks in hospital recovering before having another four cycles of chemotherapy. She spent months adjusting to life without full use of her dominant right arm while it healed.
'Losing movement completely changed my life,' says Ella. 'I'm right-handed and it was my right shoulder that was replaced, so learning to write again took some getting used to. My hand and arm would start aching after a few minutes.
'I had to start eating and brushing my teeth with my left hand,' she adds. 'And now I've got my own way of doing certain tasks I usually do with my right hand, such as picking something up with my left, or leaning on the desk for support.'
In October 2021, Ella had her sixth and final cycle of chemotherapy and now has scans twice a year.
After finishing her treatment, she went back to her health and social care course at college after having a year off. She is now studying journalism at Manchester Metropolitan University.
'I had 40 staples in my arm from the surgery and now have a massive scar running across my shoulder and down my arm,' she says.
'And there is a noticeable difference between the shape of my shoulders, and I don't really like looking in the mirror.
'But I don't see cancer as the worst thing that ever happened to me because it's never stopped me from achieving what I wanted.'
She is speaking out to raise awareness of the disease.
'I kept being told it was a pulled muscle and to take painkillers, yet it turned out to be cancer,' she adds.
'It is so important to get checked when you have unexpected pain that doesn't go away.
'You know your own body and if something does not feel right, you should keep going back. Thankfully, my persistence paid off.'