While most three-year-olds are still navigating their way through treacherous parts of their environment, much to their fascination, Samkelisiwe Mkhonza had a different experience.
She had a 5cm tumour growing on her left kidney.
At first, doctors in her home town of Standerton weren’t quite familiar with what was causing her incessant pain. They brushed off her anxious mother, telling her: “It’s nothing, probably a minor infection.”
It wasn’t until her mother demanded they be referred to a specialist in Secunda for a second opinion that Samkelisiwe was diagnosed.
It was neuroblastoma, a type of cancer which, according to the American Cancer Society, starts in very early forms of nerve cells found in an embryo or foetus. It is mainly diagnosed in infants and young children - rarely in children over 10.
But that was 18 years ago.
Today, in light of September being Childhood Cancer Awareness Month, the bubbly 21-year-old proudly tells the tale of how she defeated cancer.
According to the US National Library of Medicine, the types of cancers that develop in children are often different from those diagnosed in adults.
Adults commonly suffer from lung, breast, colon and prostate cancer, whereas children suffer from leukaemia (cancer of the blood), brain tumours, retinoblastoma (cancer of the eye), Ewing's sarcoma (bone cancer) and many others.
They are often the result of DNA changes in cells and, unlike many cancers in adults, childhood cancers are not strongly linked to lifestyle or environmental risk factors, therefore no preventative measure can be taken. However, early detection creates a better chance of survival.
And fortunately for Mkhonza, because of her mother’s instinct and insistence, the cancerous tumour was found early enough for her to have a chance at life.
“The specialist told my parents they had to surgically take out my left kidney and that I would be transferred to a hospital in Pretoria for chemotherapy. I went through the whole process the pain, the hair loss,” Mkhonza said.
“My mom would sleep with me on the hospital bed, my dad would be on the seat next to the bed. I saw myself as normal, and didn’t understand why I couldn’t do the things other kids were doing. Later, after the surgery and chemo had ended, I would see my friends playing netball and I’d go home and ask my mom to join the school team, but she’d remind me I needed to be careful.”
Elize Joubert, the chief executive of the Cancer Association of South Africa (Cansa), said it was estimated that less than half of the children with cancer in South Africa are diagnosed. Many of those who are diagnosed are already in the advanced stages of the illness.
“Early detection will go a long way in reducing the fatality rate. However, this can only be done by creating greater awareness,” she said.
Professor Janet Poole, a renowned paediatric oncologist and board member of the Reach for a Dream NGO, also emphasised the importance of early detection. She said too few children were diagnosed early - or at all, with referral pathways from primary health care often inadequate and cumbersome.
Resource constraints in state facilities added to the problems.
“I would like to see more children diagnosed at earlier stages, so that fewer resources and less treatment are needed, and the risk of long-term complications is reduced. I would like to see every child with cancer being afforded the opportunity to be treated properly and to be able to live a normal life,” she said.
Poole said there was evidence that the best place for a child with cancer to be treated was in a paediatric oncology unit by a multidisciplinary team of specialists, including doctors, nurses, social workers, dietitians and physiotherapists.
“We should be treating all children - at least up to the age of 16 - in specialised paediatric oncology units. This has been shown worldwide to be the norm, that children treated in a paediatric oncology unit with a multidisciplinary team around them have better outcomes than those treated individually by a single doctor,” she said.
And if there is one thing Mkhonza says she learnt from surviving cancer as a toddler, it is is to be grateful for having life:
“Today I’m a third-year financial sciences student and I am living a normal life - in fact, I am living life to the fullest.”