A Little Red Flower (2020)

Wei Yihang is a withdrawn, sardonic teenager. Two years ago he had surgery for a brain tumor. Now he lives in remission, which means no sign of cancer for now. Nothing hurts. Every scan still feels like a verdict.

At the hospital he meets Ma Xiaoyuan. She is bolder and brighter, and she is also being treated for a brain tumor. She drags him into inventing elaborate imaginary journeys. For a while they get to pretend they are ordinary.

Around them the film follows the family. Parents ration money and sleep. A grandmother offers to sell her flat. Aunts and uncles volunteer to do the same. A father breaks down at the scale of it.

Wei is finally allowed to travel to a lake in Qinghai that he has seen again and again 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 to show him that they could survive his death, and it releases him. A year later he reaches the lake alone.

Spoilers throughout. This page says how A Little Red Flower ends.

Its best idea is that the family is the unit that gets ill. The film is honest about money. Savings go. Property is offered up. Relatives absorb the costs. It also catches the particular dread of remission, where the absence of symptoms brings no safety.

The parents make their video so their son will not die believing he destroyed them. That is anticipatory grief work, the kind palliative care teams try to support. Hair loss. The small social world of a ward. The flatness of a teenager whose adolescence has been medicalised. The gap between what doctors say and what families hear. The film handles all of it with restraint.

Ma Xiaoyuan gets worse fast, and she does it beautifully. Both characters stay verbal, alert and graceful far longer than advanced brain tumors allow.

NCI's list of what a brain tumor actually does is short and blunt. Headaches. Seizures. Visual changes. Loss of appetite, nausea and vomiting. Changes in personality, mood, mental capacity and concentration.

That last item is the one films avoid, because it costs them the character. Personality change is common, and it arrives before the ending does.

Treatment is skipped too. No steroids. No radiotherapy side effects. No repeat scans.

The film never says what kind of tumor either teenager has. In real practice that is the whole conversation.

NCI's grading scale runs from I to IV. Grade I covers lesions with low proliferative potential that may be cured by surgery alone. Grade II tumors infiltrate and recur more often. Grade III shows nuclear atypia and increased mitotic activity. Grade IV lesions are mitotically active, prone to necrosis, and generally associated with rapid progression.

Anaplastic astrocytomas and glioblastomas together make up 38% of primary brain tumors. Molecular results now sit alongside the grade. NCI names IDH1 and IDH2 variants and 1p/19q codeletion as powerful prognostic factors in diffuse glioma. In one exploratory analysis of 318 people with low-grade glioma, those with an IDH variant plus 1p/19q codeletion had the best prognosis, and IDH wild-type tumors the worst, regardless of treatment.

One caveat about the source itself. NCI's summary, updated in March 2025, still reprints a grade table credited to the 2007 WHO classification. The WHO reorganized central nervous system tumor classification in 2021 around molecular features. Anyone comparing that table with a current pathology report should expect the wording to differ.

Seizures do most of the work here. NCI reports that a seizure is the presenting symptom in about 20% of supratentorial brain tumors. In slow-growing tumors, seizures can precede the diagnosis by months or even years. Across all brain tumors, 70% of people with primary parenchymal tumors and 40% with metastatic tumors have a seizure at some point.

A first seizure in an adult needs prompt assessment. So does a genuinely new headache pattern that keeps worsening.

Imaging comes next, and the two scans do different jobs. CT is fast, which suits an unstable patient, and it is better for calcification, skull lesions and bleeding less than 24 hours old. MRI has better soft-tissue resolution and picks up swelling, enhancement and older bleeding. Brain tumors also have to be told apart from abscesses, arteriovenous malformations and infarctions, which can look similar at first.

Biopsy settles the type and grade. Nothing before it does.

There is no screening test for brain tumors in people at average risk. No expert body recommends routine brain imaging without symptoms.

NCI's evidence-based screening list covers breast, cervical, colorectal and lung cancer, with prostate treated as a shared decision. Brain is not on it, and no amount of worry changes that.

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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. A change that persists is worth a conversation, whatever a story led anyone to expect. A Little Red Flower cannot tell you what to watch for, but screening and possible warning signs can.

This page discusses A Little Red Flower for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.

• NCI PDQ — Central Nervous System Tumors Treatment (Health Professional Version)
• NCI — Cancer Screening Tests