A Little Red Flower (2020)

Wei Yihang is a withdrawn, sardonic teenager two years past surgery for a brain tumour, living in the anxious space of remission where nothing hurts but every scan is a verdict. At the hospital he meets Ma Xiaoyuan, a bolder, brighter girl also being treated for a brain tumour, who drags him into inventing elaborate imaginary journeys and briefly pretending to be ordinary. Around them the film follows the family: parents rationing money and sleep, a grandmother offering to sell her flat to pay for treatment, aunts and uncles volunteering to do the same, and a father who breaks down at the scale of it. Wei is finally allowed to travel to a lake in Qinghai he has repeatedly seen in hallucinations. Xiaoyuan collapses on the train and is given a grim prognosis. He shaves his head and cares for her until she dies. His parents record a video showing him they could survive his death, which releases him. A year later he reaches the lake alone.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

Its best insight is that the family is the unit that gets ill. The film shows the financial machinery of cancer honestly, with savings gone, property offered up and relatives absorbing costs, and it captures the specific dread of remission, where the absence of symptoms brings no safety. The parents' video, made so that their son will not die believing he has destroyed them, is a recognisable piece of real anticipatory grief work of the kind palliative teams try to support. Hair loss, the small social world of a ward, the flatness and irritability of an adolescent whose adolescence has been medicalised, and the gap between what doctors say and what families actually hear are all handled with restraint rather than sentimentality.

Ma Xiaoyuan's deterioration is fast and photogenic, and both characters stay verbal, oriented and physically graceful far longer than advanced brain tumours usually allow. Real progression often brings seizures, one-sided weakness, speech and vision problems, personality change and increasing drowsiness, precisely the faculties the film preserves so the romance can continue. The tumour type and grade are never made clear, which matters enormously in real practice, and treatment itself, with its steroids, radiotherapy side effects and relentless repeat imaging, is largely elided.

Primary brain tumours are not one disease. They range from slow-growing, potentially curable types to aggressive gliomas, and type and grade drive prognosis far more than the phrase "brain tumour" suggests. NCI notes that symptoms depend on where the tumour sits, how large it is and what that part of the brain controls. The warning signs it lists include a headache that is worse in the morning or eases after vomiting, seizures, frequent nausea and vomiting, problems with vision, hearing or speech, loss of balance or difficulty walking, weakness, loss of appetite, unusual sleepiness or a change in activity level, and changes in personality, mood, concentration or behaviour. A first seizure in an adult, or a genuinely new and progressive headache pattern, warrants prompt assessment. There is no screening test for brain tumours in people at average risk, and no expert body recommends routine brain imaging in people without symptoms; NCI's evidence-based screening list covers breast, cervical, colorectal and lung cancer, with prostate as a shared decision. Diagnosis follows MRI or CT prompted by symptoms, with tissue from biopsy or surgery used to establish type and grade.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

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A Little Red Flower is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].