Uncertainty describes the next phase of Alana Cook’s cancer treatment regimen, chemotherapy.

The Northside Middle School seventh grader began the third — and possibly the last — leg of her treatment plan Thursday when she received her first round of chemotherapy at Riley Hospital for Children in Indianapolis.

Alana was diagnosed with a papillary tumor of the pineal gland, which is near the back of the base of the brain, last fall. Papillary tumors are extremely rare — in fact, Alana’s diagnosis is one of only 44 known cases.

Because of that rarity, Alana’s doctors at Riley are unsure of how the tumor will react to treatment or what effect the high dose of chemicals could have on the 13-year-old’s body.

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But despite that uncertainty, Alana said she remains optimistic that at the end of her six-month treatment at Riley, she’ll be able to say she’s cancer free.

“We don’t really focus on the negative. We try to focus on the positive,” said Holly Cook, Alana’s mother.

Although the discovery of Alana’s illness changed the Cooks’ lives, the family of three — including Alana’s dad, Alan Cook — has been able to find several positives to focus on in the four months since her diagnosis.

After undergoing a seven-hour operation to remove the tumor from her brain, the student and basketball player returned home to Columbus after spending only five days at Riley. Her doctors had expected her to remain in their care for up to three weeks.

Alana continued to impress her physicians when she and her parents relocated to Chicago just before Christmas for proton radiation therapy.

Every day for about eight weeks, Alana would put on a mesh mask exactly molded to fit the shape of her head and would lie on her back for about 20 minutes to receive proton radiation therapy.

While the actual treatment only took about one minute to complete, finding the precise location for the radiation beam took up the majority of the treatment time.

Other than one headache that resulted from a lack of fluids and a small amount of hair loss, Alana said she suffered no side effects because of the radiation.

“She was boring for (the doctors), but we’ll take boring,” Holly Cook said.

Radiation also was boring for Alana at times.

She spent many of her days lying in her room at the Ronald McDonald House, watching movies on the TV her father purchased for the family to use while they lived in the Chicago suburbs.

But ever the social butterfly, Alana was able to form strong friendships with other children living in the house.

One patient in particular — a boy named Sam — was just a bit older than Alana, and the two struck up a friendship that helped them through their slowest days.

“We both love basketball, and we would go down to the gym and play,” Alana said.

The aspiring WNBA player even found her way onto a professional basketball court when she had the opportunity to get in some practice shots with the Chicago Bulls.

Holly and Alan Cook also found their place at the Ronald McDonald House by lending a hand to other families. Alan became the go-to trash guy, while Holly would hit the kitchen every morning to cook bacon for as many people as she could feed.

The families living in the Ronald McDonald House were a tight-knit group, the Cooks said. The parents would often take their children to the Main Event arcade and activity center, where the youngsters could bowl, play laser tag and do all of the other things that adolescents love to do.

Alana formed a special bond with the youngest patients, some of whom were only 2 or 3 years old. She would spend time with them in the toy room, playing and making them feel special.

“She was the mother hen,” Holly Cook said.

Although she was happy to return to Columbus at the end of January, Alana said leaving behind her new friends in Chicago was a difficult task.

“I miss the kids,” she said.

The Cooks made the four-hour trip home to Columbus almost every weekend, allowing Alana to keep in touch with her hometown friends.

And when she returned home for a month-long break from treatment at the end of January, Alana headed straight through the Northside doors to spend a week going to school and living a more regular life with her friends.

“It felt a lot better going back this time than it did before,” she said.

During her treatment, Northside seventh grade language arts teacher Laura McCracken works with Alana to help her stay on top of her school work.

McCracken collects Alana’s homework from her various classes, monitors her completion progress and tries to help her through the concepts she struggles to understand.

Although Alana’s at-home schoolwork was supposed to be graded on a pass/fail system, she once again defied the odds by completing enough work to earn actual letter grades, Holly Cook said.

But doing her schoolwork outside of the classroom is hard at times, Alana said.

For example, keeping up with her peers’ daily reading schedule in language arts proved to be a difficult task, so McCracken would periodically send chapter summaries to Alana rather than asking her to read entire novels at the same pace as the students regularly in school.

All of her teachers have been accommodating through her treatment process and have allowed her to complete her work when she is able, rather than enforcing hard deadlines, Alana said.

Once she starts chemotherapy, Alana’s trips to school will have to end. The treatment will significantly weaken her immune system, and she cannot risk contracting an illness from one of her classmates.

Alana’s diet will also have to change because of her treatment. Fast food, fried foods and other items that are considered to be unhealthy will be cut from her diet in favor of fresh foods that are proven to be nutritious.

In preparation, the 13-year-old loaded up on her favorite junk foods — such as pizza and chili dogs — while she was still at home.

Alana will receive chemotherapy about once a month for six months through a central line that was placed in her body Feb. 11. Doctors will first have to gauge her body’s reaction to the treatment before deciding when she can return home to rest between treatments.

The next steps in Alana’s life after chemotherapy are still uncertain right now, the girl said.

If another tumor were to grow back in the same location, the proton radiation would no longer be an option, Holly Cook said. Instead, doctors would have to surgically remove any subsequent tumors located in that part of the brain. However, if a tumor were to grow in a different part of the body, proton radiation therapy could be used again, she said.

Timeline of illness/treatment

Oct. 3, 2015: Alana is hit in the head during a game of dodge ball and begins suffering from extreme headaches and fatigue.

Month of October: Holly and Alana spend nearly every other day in the pediatrician’s office trying to diagnose her illness. Doctors at Riley Hospital for Children find a brain tumor and insert a shunt into her brain to release fluid.

Oct. 29: Alana is diagnosed with choroid plexus carcinoma, a malignant tumor.

Nov. 4: Doctors at Riley complete a seven-hour operation to remove the tumor.

Nov. 12: Alana’s diagnosis changes to a papillary tumor, a rare form of brain cancer.

Dec. 7: Alana receives her first proton radiation therapy treatment. The Cook family relocates to Chicago for roughly eight weeks for the treatment.

Jan. 22, 2016: Alana completes her 33rd round of radiation therapy and returns to Columbus.

Feb. 11: Alana’s central line for chemotherapy is placed in her body.

Feb. 18: Alana receives her first round of chemotherapy at Riley. She will receive monthly treatments for six months.

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Olivia Covington is a reporter for The Republic. She can be reached at ocovington@therepublic.com or 812-379-5712.