11/15/2020
Twenty years ago, Renee Rizzi, 63, of Rhinebeck, New York, was diagnosed with oral lichen planus, a benign autoimmune disorder that affects the skin and mucosa. For Renee, the condition caused white patches to develop on her tongue.
Renee’s oral surgeon recommended that she have frequent dental checkups because oral lichen planus is associated with a small increase in oral cancer risk. Renee coincidently starting working at a dental office shortly after she was diagnosed with oral lichen planus; she had regular teeth cleanings and monitoring more than she normally would have. Renee was diagnosed with tongue cancer in February 2020. She had surgery to treat the cancer at the height of the COVID-19 pandemic.
Receiving a diagnosis
During Renee’s last few dental checkups, her care team noticed that the oral lichen planus was getting bigger. Then, Renee noticed a pea-sized bump on her tongue.
“I was scared to death to get it checked,” said Renee. “I kept telling myself, ‘It’s just the oral lichen planus,’ but I kept waking up at night with anxiety attacks, and I knew something was probably wrong.”
Renee went to see an oral surgeon who performed a biopsy of the lump.
“I knew the oral surgeon because we refer to him from our dental practice,” said Renee. “His receptionist said he wanted me to come and get my biopsy results at the end of the day so he could spend more time with me; at that point, I knew it probably wasn’t good news.”
As the United States became increasingly concerned about COVID-19, Renee was diagnosed with early stage tongue cancer.
An expert consultation
The day after receiving her biopsy results, Renee went to see Dr. Al Haitham Al Shetawi. Dr. Al Shetawi is board certified in oral and maxillofacial surgery and fellowship trained in head and neck surgical oncology and microvascular reconstruction. Dr. Al Shetawi specializes in the surgical treatment of oral and head and neck cancers and performs facial reconstructive procedures.
“There’s not much anyone with oral lichen planus can do to prevent it from turning into cancer,” said Dr. Al Shetawi. “The lichen planus was three centimeters on the right side of Renee’s tongue, and two centimeters of the lichen planus was cancerous.”
Dr. Al Shetawi recommended surgery to remove the cancer from Renee’s tongue.
Surgical care during the COVID-19 pandemic
Renee’s surgery, called a partial glossectomy, was scheduled for March 31, 2020, at Vassar Brothers Medical Center (VBMC) — the same hospital where Renee was born.
“The outcome for this type of surgery depends on the location of the tumor, how much reconstruction is required, the final shape of the tongue, and the tongue’s mobility,” said Dr. Al Shetawi. “There’s a risk of altered speech or swallow function impairment.”
Dr. Al Shetawi continued, “Renee and I talked about all of the surgical risks before moving forward with her surgery. We also talked about how we would minimize her exposure to COVID-19 during the entire process of her care by screening all patients and staff for COVID-19 risk factors, limiting visitors, and having her recover after surgery in a non-COVID-19 unit.”
Renee knew that surgery was her best choice — even during the pandemic.
Renee spent the week before her procedure getting preoperative testing, including a COVID-19 test, CT scan, and PET scan.
“That week was so stressful,” said Renee. “I was nervous about not having surgery because of the pandemic, but Dr. Al Shetawi assured me they were taking every precaution.”
When the day of surgery arrived, Renee — who is the oldest of five siblings and comes from a large, supportive family — said she felt a bit lonely due to the hospital’s COVID-19 safety precaution that limited visitors. However, Renee said that the nurses went out of their way to spend time with her.
“After I was in the pre-op area, the nurses went all-out trying to make me feel comfortable,” said Renee. “I felt better because of the people around me, and although I didn’t know them, I put my trust in them.”
During the three-hour surgery, Dr. Al Shetawi removed the entire tumor and one-third of Renee’s tongue. He also removed lymph nodes from her neck to see if the cancer had spread. Fortunately, it hadn’t.
‘A fantastic outcome’
Renee was in the hospital for two days after surgery. She received nourishment through a feeding tube through her nose, which is a normal part of recovery after a partial glossectomy.
“I woke up after surgery, and I felt like everything hurt,” said Renee. “It hurt to swallow, and I couldn’t really speak well.”
Although Renee said she felt groggy and was lisping and slurring her words at first, she was relieved when Dr. Al Shetawi told her that he got all of the cancer. Renee also learned that she wouldn’t need any postoperative treatment, such as radiation therapy.
“Renee had a fantastic outcome,” said Dr. Al Shetawi. “The location of the cancer and the residual tongue didn’t need reconstruction, and the shape and form of the tongue were good. Some patients may have a bigger speech defect, but Renee’s speech was excellent.”
For a few weeks, Renee could only eat very soft foods such as ice cream and yogurt. She then graduated to eating omelets and pasta. She could soon eat almost anything — although she still needs to cut her meat into smaller pieces and take smaller bites.
Renee said her speech eventually came back without the need for speech therapy. For her follow-up care during the pandemic, Renee liked that she could use Nuvance Health’s Virtual Visits.
“Renee’s experience is worth sharing because the perception is usually that patients won’t be able to eat or talk after tongue or jaw cancer surgery,” said Dr. Al Shetawi. “If reconstruction is necessary, we use tissue from the patient’s body to rebuild the tongue or jaw to preserve as much normal function as possible.”
A complete recovery
Now that Renee has fully recovered, she has returned to two of her favorite activities: cooking and gardening. In addition to making homemade mozzarella cheese, pasta, and sausage, Renee loves canning tomatoes with her family.
“We usually can 110 jars of tomatoes, but this year we canned 212!” said Renee.
Renee credits Dr. Al Shetawi for her fantastic surgical outcome. She also recognizes that her positive outcome was due to catching the cancer early. She encourages others to see their doctor if they’re noticing any unusual changes with their body.
“I was so afraid of what it might be, I didn’t want to find out,” said Renee. “But I dealt with it sooner rather than later, and the cancer was caught early.”
Learn more about head and neck surgery at Nuvance Health.
Disclaimer: The outcome of treatment for cancer will vary from person to person. No individual results should be seen as typical.