Case Study | Sameena: A Tongue Cancer Survivor

Background & Early Signs

Sameena is a 32-year-old, mother of 5 children. She has fought a successful battle against advanced oral(mouth) cancer, enduring complex treatment consisting of Radical Surgery followed by Chemo radiotherapy. She is now free of cancer and back to her normal life.

Sameena had been a tobacco user (she consumed ‘Gutka’) for close to 15 years, consuming it intermittently without her family’s knowledge. In November 2018 she developed a blister in her mouth. It was irritating her, but she thought it would go away. A week passed. Then two. And it didn’t. She saw some Doctors locally who gave her symptomatic medicines, but the blister didn’t heal.

So, she took matters into her own hands and massaged it vigorously causing it to burst. It broke up into a thousand of fragments inside her mouth and spread in her mouth and throat and she started experiencing pain.

Till that time, she had not spoken about it to her husband. But when the problem spread and she was in pain and discomfort, she told her husband. They visited a government hospital in Delhi who took a skin swab from the affected area and did a biopsy. The results of the tests were not good. Sameena was told that she had oral cancer. Life stopped that day for Sameena and her family.

Oral Cancer

India has the largest number of Oral (Mouth) Cancer patients, due to the rampant habit of tobacco chewing. Oral Cancer is described as cancer occurring in Buccal (cheek), tongue, floor of the mouth, jawbone and palate. Rampant smoking and alcohol abuse also contribute to the occurrence of oral cancer. Majority of times the formation of oral cancer is preceded by certain changes like difficulty in mouth opening, white or red coloured patches and/or presence of ulcers that do not respond to conventional treatment. There is a myth hat if we touch the cancerous area by way of any surgical methods including even a biopsy, it will spread, “Ched diya to badh Jayega.” These leads to the patient seeking alternative or conservative treatment methodology leading to a delay in diagnosis and treatment and at times loss of life as well.

The cure in oral cancer is hardly possible without surgery. Oral cancer surgery has two components, first part is to remove the cancer along with its nodal basin which is the territory of its spread followed by reconstruction or putting back the removed part so that the patient can eat, speak and have a near normal appearance. Early stage oral cancer involves less extensive resection (removal) of the affected area with simple reconstruction measures. But as the stage advances the resection becomes more extensive and reconstruction becomes more complex. Also, at an early stage we can achieve cure with single modality whereas in advance stages, surgery has to be followed by radiation or chemoradiation to achieve cure or prevent recurrence, i.e. multimodality.

When she came to us

Sameena came to us when the ulcer had involved half of her tongue and spread to her neck in form of nodal metastases. Had it spread, beyond the neck, her chances of getting cured from the cancer would have been minimal.  To save her life, surgical intervention was the only way forward. On hearing this, the world crashed down around her and she lost consciousness. The family toiled hard to mobilise resources for her treatment. The disease played havoc with the family’s finances and the children’s education was also interrupted. We subsidised the expenses of the treatment at the CK Birla Hospital as far as possible to support the patient.

Watch the video below as Sameena talks about her journey to recovery.

Surgery

Sameena underwent radical resection of the left half of tongue including the posterior most limit alongwith removal of lymph nodes from both sides of the neck. We used the tissue from the left cheek to reconstruct the tongue. The tongue is a complex and sensitive organ of the body – contributing or directly providing various functions such as tasting, swallowing, breathing, and speaking. Therefore, a tongue surgery for cancer is a complex procedure. The task before the surgeons was not just to get rid of cancer with adequate margins not leaving anything behind but also to replace the lost tongue so that patient can speak and swallow food and get back a life as normal as possible.

The surgery lasted for more than six hours followed by two days in the ICU.  The surgeons did a tracheostomy, (an artificial opening was created in the windpipe) to secure the patient’s breathing during the recovery period. Also, a feeding tube was put through the nose to feed the patient.  The surgery was successfully performed by Surgical Oncologist leading Head & Neck and Breast Oncologist at CK Birla hospital and a Consultant, Surgical Oncology. Sameena was discharged six days after hospitalization. So, within a week, she was able to walk out of the hospital without any assistance and speak as well. For six weeks post-surgery Sameena was on a liquid diet administered through the nasal feeding tube.

Post-Surgery

It is now three months since Sameena has completed her radiation. She is cancer free, eating soft food with decent speech and back to regular daily routine and involved in raising her kids. She has now taken a strong vow to never touch Gutka again.