Restoring What Cancer Took Away

Stephanie Koutzoukis faced a tough recovery after her tongue cancer returned, but today, thanks to world-class care, she is back to normal.

At age 30, it seemed unlikely that Stephanie Koutzoukis could have anything seriously wrong with her. Koutzoukis, a middle school teacher, had found a tiny spot on the side of her tongue and it was bothering her. She turned to Google and “my search came up with tongue cancer. I was freaking out,” she recalls of the moment three years ago.

Still, it took a while for the Costa Mesa resident to get help. Her primary care physician referred her to a dentist, who then sent her to an oral surgeon for a biopsy. “Everyone had the same response: that I was young and had no risk factors like smoking. But I was persistent,” says Koutzoukis. “I wanted to know why it had hurt for two months. I was like, ‘Something is wrong.’”

When the biopsy results came in, the news wasn’t good. Koutzoukis’s research had proved right: The tiny spot was squamous cell cancer. She began looking for the right surgeon and, after a few consultations, found Quang Luu, MD, a board-certified specialist in otolaryngology and head and neck surgery at Providence Mission Hospital. “I liked Dr. Luu right away. I felt confident with him,” she recalls. “He does a lot of work with cancer patients, and that drew me to him.”

In November 2021, Dr. Luu removed the cancerous spot from Koutzoukis’s tongue and some lymph nodes in her neck so they could be biopsied. Because the margins of the surgery area were clear of cancer and it wasn’t found in the lymph nodes, she didn’t need radiation or chemotherapy. She returned to teaching a month later.

But within a year, Koutzoukis recalls, “I noticed another spot in pretty much the same area. Dr. Luu and I decided to do another biopsy. It came back as cancer.” Although squamous cell cancers are readily curable on the skin surface, on the tongue they can be aggressive, says Dr. Luu. “They kind of behave how they want to behave,” meaning that recurrence isn’t uncommon.

In June 2022, Dr. Luu, who has special training in microvascular reconstruction, performed a much more complex surgery, removing more of Koutzoukis’s tongue to get rid of the cancer and taking skin from her forearm to rebuild the tongue.

He also harvested skin from her thigh to patch her arm. The reason for the dual graft is that arm skin is thinner, Dr. Luu says, and works better for reconstructing the tongue. “If you used skin from elsewhere,” he explains, “you’d have less articulate speech.” He then grafted the thigh skin he had taken to minimize the possibility of visible scarring on Stephanie’s arm. “It’s an advanced surgery,” he says. “It’s done at comprehensive cancer centers like Mission, but not by most head and neck surgeons.”

Before the surgery, Koutzoukis was outfitted with a feeding tube, because it would be a month or more until she could eat normally again. She began seven weeks of chemotherapy and six weeks of radiation to get rid of any possible remaining cancer cells. She recalls the care team that surrounded her at Mission: “They were so kind and helpful and attentive,” she says. She worked with a speech therapist, a dietitian and a physical therapist.

Dr. Luu says he has been impressed with Koutzoukis’s strength and positive attitude. “Stephanie is a trooper,” he says. “I’m just grateful that we can meet with each other every month to make sure she stays healthy.”

Koutzoukis returned to teaching at the beginning of the year and is cancer-free. “Dr. Luu told me, ‘Live your life,’ and that sat with me. I am going to live my life; it’s getting better every day.”

Contact the Head and Neck Associates of Orange County by calling 949-364-4361.

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