At 31 weeks pregnant, Anna Spiessbach and her husband Vernon Vavra were ready for their baby’s arrival. The nursery was nearly complete. The car seat installed. Diapers, impossibly tiny pink shoes and soft, delicate onesies were neatly organized.
The two of them should have been nesting together at home counting the minutes until their daughter made her way into the world.
Instead, Spiessbach was desperately trying not to cry while recording herself reading children’s books like Chicka Chicka Boom Boom and Goodnight Moon.
“I tried to read Love You Forever, but I couldn’t get through it,” said Spiessbach. “I wanted to make sure my daughter could hear my voice.”
Days earlier, she received a diagnosis of tongue cancer, specifically, oral squamous cell carcinoma of the tongue. It was aggressive despite the absence of any risk factors like a history of smoking, excessive drinking or chewing tobacco. She was 33 at the time.
Symptoms of tongue cancer
Spiessbach is an emergency medicine physician assistant. She works long, difficult hours on her feet. During a shift in the winter of 2020 she bit her tongue at work, and thought nothing of it. Then again in April. This time her tongue wouldn’t heal and she figured a course of antibiotics would do the trick. But by that Monday, a lymph node near her jaw was swollen – a sure sign of infection. She made an appointment with an otolaryngologist, an ear, nose and throat physician, who, to her surprise, ordered a biopsy after seeing her tongue.
The diagnosis of tongue cancer came on Thursday, May 14.
Oliver did not want to delay surgery.
April is head and neck cancer awareness month. Be sure and see your doctor if any of these symptoms persist:
- Lump, bump or mass in the neck.
- Red or white patch in the mouth.
- Persistent sore throat.
- Swelling or a sore that does not heal in nose, mouth, sinuses or throat.
“The lymph nodes were already cancerous and the risk of additional spread was high,” said Oliver. “We needed to make some tough decisions.”
Treating tongue cancer
It didn’t take long for a UCHealth Highlands Ranch Hospital multi-disciplinary team to form. Oliver and colleague Tracy Johnson, physician assistant; Dr. Ann Granadillo, OB-GYN; and Dr. Ryan Lanning, radiation oncologist, gathered to discuss the complex case; a tricky balancing act that involved surgery on a 31-week pregnant woman, radiation, chemotherapy, recovery and many follow-up appointments.
“We had to balance the timing of her cancer treatment with the development of her baby to maximize both their outcomes,” said Granadillo.
Despite the challenges, team Spiessbach was equal to the task.
“We don’t work in a vacuum,” said Lanning. “It helped that we were all together in one hospital with opportunities to talk about the case and make informed decisions about her care.”
“We were so ready to help Anna,” said Johnson.
Preparing for tongue cancer surgery
Anticipating a temporary loss of taste, Spiessbach worked through her “taste bud bucket list,” while the team planned the profound surgery.
“They were real with me,” said Spiessbach. “Dr. Oliver started out by saying, ‘ok let’s all admit: this sucks’, and then from then on they put me at ease.”
“Tracy was so amazing throughout the entire process answering questions and talking me through this terrifying experience.”
But still, it was cancer and Spiessbach has a medical background. She knew the risks. One that loomed large was the possibility she would need an emergency C-section during surgery. A fetus reacts similarly to anesthesia so she would need to be monitored closely. Granadillo also prescribed steroids prior to surgery to strengthen the baby’s lungs.
“Her mind was going a mile a minute,” said Granadillo. “She was worrying about her baby more than herself and it was stressful for her.”
It’s rare, too, to perform the surgery on pregnant women. When it is done, it’s often a simple procedure like an appendectomy. When it came time for Spiessbach’s surgery, the team didn’t take any chances.
“The number of people in the operating room added a little spice to the day,” said Oliver who was joined by labor and delivery nurses and an obstetric hospitalist who monitored the baby and stood ready with an incubator just in case. Oliver successfully removed the cancerous cells, about one-third of her tongue, along with 42 lymph nodes in her neck to reduce the risk cancer would return.
When Spiessbach woke up from surgery, her first thought was for her baby.
“The nurses smiled and said she was still in,” said Spiessbach, who sported a new accessory—a wicked 22-centimeter stapled scar running from the back of her ear, down her neck and curving under her chin.
Spiessbach soon went home with Vern, who she calls her “absolute rock” to recover from surgery. She returned June 18 to HRH where Granadillo delivered a healthy, beautiful 7-pound, 9-ounce girl named Rylie.
Family: Dealing with a diagnosis of tongue cancer
Lanning was anxious to begin radiation treatment. But as a father himself, he knew those first weeks of life were precious.
“I wanted them to have uninterrupted time with the baby,” said Lanning. About a month later, he started Spiessbach on 30 sessions of volumetric-modulated arc therapy (VMAT) radiation. Using a linear accelerator, VMAT delivers a highly targeted and effective dose of radiation on the cancerous tissue while sparing healthy tissue.
The side effects from the chemotherapy she was also receiving weren’t bad, Spiessbach said, but radiation was a different story.
“Radiation can be challenging,” said Lanning. “With advanced planning and the VMAT, we are able to spare the healthy tissue to reduce long term side effects.”
“It’s the gift that keeps on giving,” said Spiessbach. She endured painful mouth lesions, deep fatigue, soreness, nausea, loss of taste and dry mouth and hours of occupational, physical and speech therapy to help her learn to talk, swallow and chew again.
“Anna was a trooper,” said Lanning. “She’s recovered so well.”
Spiessbach gives credit to someone else.
“Rylie was the best cheerleader,” she said.
Almost a year old, Rylie is all rolls, cheeks, bright eyes and dark, wispy hair. She’s endless smiles and poops, funny noises and milestones that Spiessbach and her husband experience together.
It’s been almost a year since the cancer diagnosis. Rehab is ongoing but Spiessbach hopes to return to work in the ED soon. The scar is fading and Spiessbach can read to Rylie whenever she wants. Her voice is strong and steady, with just a hint of a lisp … but Rylie doesn’t seem to mind.