College-Bound Teen Overcomes Rare Lymphoma

Mia Gatanaga, a happy, beautiful 17-year-old advanced placement honor student, loved to play competitive travel volleyball and serve as president of her church youth group. She was looking forward to finishing her senior year in high school, playing as defensive specialist on her varsity team, going to senior ball and prom, graduating with honors, and heading to college.

In a matter of minutes, a diagnosis of a rare cancer changed her life dramatically. The athletic teen had primary mediastinal large B-cell lymphoma, a non-Hodgkin form of the disease that affects less than 100 U.S. teens and young adults each year.

“When I breathed in, it would hurt,” said the Salinas teen.

She initially wasn’t too concerned, assuming that she had pulled a muscle during volleyball or a strenuous workout. “But when it became painful to lie down to sleep, I knew something was really off,” she said.

Her pediatrician immediately sent Mia for a chest X-ray at the local hospital. Before she had time to process what was happening, she found herself in an ambulance being transferred to Lucile Packard Children’s Hospital Stanford, over an hour away from home, where she would spend the next four months in treatment for a tumor pressing up against her lung.

“Just like that, on Oct. 13 we disappeared from our normal lives,” said her mother, Frances. “Mia never returned to school the next day, or me to my job. Mia’s dad and I just followed the ambulance to Palo Alto. I remember calling Mia’s brother, Brandon, who was attending college at UC Davis, letting him know we were on our way to Stanford.”

Thanks to Frances’s kind and caring colleagues, she was able to work remotely from the hospital, where she could support and advocate for her daughter during chemotherapy treatment. “I wasn’t going anywhere,” said Frances.

Dedicated pediatric lymphoma specialists

Luckily, Mia’s treatment plan was straightforward.

“This type of non-Hodgkin lymphoma in the chest responds very well to chemotherapy,” said Lianna Marks, MD, Mia’s oncologist. “A tumor can get quite large and compress the lungs and heart. Patients can be quite sick.”

Dr. Marks is one of two pediatric lymphoma specialists at Stanford. It’s unique for a hospital to have not one but two doctors dedicated to treating this type of rare cancer. “We have the luxury here of being able to focus just on lymphomas,” Dr. Marks said.

Surgery wasn’t needed to remove Mia’s tumor, which responded as planned to chemotherapy. Mia is now in remission and doing well, according to Dr. Marks.

“Intensive chemotherapy is the standard of care at this point in time,” she said. “It’s a lot to go through, but we’re always working to safely reduce side effects wherever we can.”

Dr. Marks worked closely with Emily Larimer, MD, a pediatric oncology fellow, who handled Mia’s day-to-day care.

“Dr. Emily would visit daily and sometimes even after her normal work day to make sure Mia was feeling OK,” Frances said. “Dr. Emily would always sit by Mia’s side, finding something of common interest to talk about as if it were a friendly visit more than a doctor asking medical questions, which made the experience much more pleasant.”

Dr. Larimer enjoyed her visits with Mia and her family just as much.

“Being a teen is hard enough as it is, and having cancer can feel isolating, as it sets patients apart from their peers through both physical effects and emotional effects,” Dr. Larimer said. “Friends often have trouble knowing how best to support a friend with cancer. My hope was to help support Mia by decreasing her sense of isolation and normalize the frustrations and worries of treatment. Also, it is always a pleasure to see Mia and her family! Mia is an incredibly kind person who showed amazing strength in her treatment course as she faced challenges with a calm perseverance.”

Four months of chemotherapy was difficult, and complications made it nearly impossible to go home when a round of treatment was complete.

Mia said her multidisciplinary care team made a bad situation better, helping manage pain, control nausea, and provide physical therapy. She also had support from child life specialists, including art therapy, to help pass the time in the hospital, and emotional and psychosocial support from Akilah Burford, an oncology social worker.

Burford and the child life specialists helped Mia address the frightening experience of cancer, being hospitalized for months, and missing school. Burford and Mia’s care team connected with community cancer services, partnered with her high school counselor, and arranged for a wish from the Make-a-Wish Foundation, which Mia initially wanted to pass on to a child who needed it more.

“A diagnosis like this was very disturbing news for a high-achieving student like Mia, who was taking almost all AP classes and got into every college she applied to,” Burford said. “I provided emotional and psychosocial care, and I supported the family around the toll that the treatment was taking on everyone.”

While Mia attended school remotely as well as she could during treatment, she returned in person last March when treatment ended. Catching up on her studies was challenging and took an incredible amount of strength, willpower, and courage, but it was not insurmountable for a good student like Mia.

A positive attitude helps healing

“Mia and her mom were so positive,” said Dr. Marks. “Mia handled everything with grace, and her attitude throughout treatment helped her get through. Patients are going through something horrible, and the positive energy was really beneficial to her. It made caring for her very rewarding.”

Mia was inspired by the care she received at Packard Children’s Hospital, especially the physical therapy that helped her regain strength after months of inactivity.

“Mia has always been a caring and compassionate person and always hoped to find a career in a field that will help people,” said Frances.

A year before Mia’s diagnosis, she shadowed a physical therapist during her grandmother’s rehabilitation from a stroke. Mia found this very interesting, but her treatment at Stanford really sparked her interest in physical therapy.

She met weekly with a pediatric physical therapist, Lesley Jones, PT, DPT, who tried to keep Mia’s muscles active even though COVID-19 restrictions did not allow her to leave her small hospital room. Jones spent time explaining the exercises and even brought in a stationary bike.

“At her baseline, Mia is very sporty and strong, and so much of her identity was wrapped up in athleticism,” Jones said. “Seeing her lose that strength was seeing her lose a piece of her identity. She experienced a lot of general fatigue because of treatment, which was a huge shift from being an active teenager, and that was really affecting her emotional state. I spent a lot of time talking with her, figuring out a way we could turn the tide a little bit and add movement back into her life.”

After treatment was completed, Mia continued weekly physical therapy sessions with another physical therapist, Chao-Jung Hsu, PT, PhD, at Stanford’s Sunnyvale location, because her body was still weak, and she struggled to stand from a sitting position on the floor. Mia worked hard, and after 20-plus weeks of PT visits, she is able to lift 80 pounds, has agility to run ladders, can walk and jog without difficulty, and has a full range of motion.

“I really admire Mia because throughout treatment she never complained and always had an incredibly positive attitude,” said Frances. “After treatment was over, she would often be exhausted and discouraged from the rigorous PT sessions, but she fought through the exhaustion and continued working hard every week because she had confidence that the PT was helping her to return to her previous level of strength.”

Mia initially wanted to study athletics or sports medicine at college but changed her focus to physical therapy. She’ll attend California Polytechnic State University in San Luis Obispo this fall, her first choice among all 10 colleges that accepted her, to study kinesiology.

“My big dream is to return to Stanford someday and work there as a pediatric physical therapist to help children regain physical and mental strength after an experience like I went through,” she said with a big smile.

Mia seems to always have a smile, and she looks back on her patient experience with a lot of maturity for a young woman of 18.

“Stanford was great to me, and my care team made a terribly scary situation not as bad,” she said. “I had the best possible experience for what it was.”

She appreciated visits from Donatella, one of Stanford’s therapy dogs, whose calming presence is healing for children and teens. Because of Donatella, Mia recently got Abby, a mini-goldendoodle puppy, to help continue her healing.

“It was easy to be positive with all the positivity I got from family, friends, and health care professionals,” she said.

Her high school friends and volleyball teammates expressed their support during her treatment by wearing yellow armbands and ribbons with the words “Team Mia.” Since Mia was hospitalized during COVID-19 and visitors were restricted, friends and family would drop off packages in the lobby and gather in the parking lot across the street holding signs that read, “We love you, Mia,” and other fun messages.

Mia also received support from her family, including her dad and her brother, Brandon.

“I can’t be more proud of Mia for getting through this,” Brandon said. “Her bravery and perseverance through this inspires me every day.”

Mia also expressed gratitude for the nurses who kept her mind off things, talking about everyday topics like shopping, crafting ideas, volleyball, movies, TV shows, and attending college. Mia and her mom filled out college applications last fall while she underwent treatment, and they were encouraged by Mia’s doctors and nurses.

“In looking back, I’m not focusing on the sick feelings or the needles put into my body,” she said. “I’m focusing on how positive and nice everyone was. So many things that Stanford did made the situation so much better: art therapy and crafts projects, music therapy, a teen hangout area, and much more.”

Mia will continue to see Drs. Marks and Larimer several times a year for follow-up and wellness care.

“We’re so excited and happy that Mia is going to college, feeling good, and focusing on moving forward,” said Dr. Marks.