May 6, 2015 | by Robin Heffler
On a spring day in 2013, 10-year-old Jackie Garcia of Whittier, California, noticed a lump in her jaw. Her mother suspected it was a minor problem, perhaps due to a fall, but made an appointment with a pediatrician, just to be on the safe side.
“He thought it was an infection that was dental-related, and told us to see the dentist,” said Norma Zavalza, Jackie’s mom. “The dentist said he hadn’t seen anything like it before, and sent us to an oral surgeon.” There, a biopsy showed that the then fourth-grader had cancer.
The tumor was diagnosed as Ewing’s sarcoma, an aggressive bone cancer that mainly strikes children and adolescents, but only accounts for about 1 percent of childhood cancers. In Jackie’s case, it affected the entire right half of her jawbone, extending into the soft tissue around it.
Her pediatrician immediately referred her to City of Hope, known for its expertise in highly complex tumors.
Complex treatment for a complex case
At City of Hope, Jackie was examined by Judith Sato, M.D., professor of pediatrics and director of the Musculoskeletal Tumor Program, who promptly started her on a chemotherapy regimen to shrink the tumor and reduce the chances of it spreading. Surgery would follow the chemotherapy.
The presurgery treatments were unavoidably taxing. Jackie experienced common side effects of the drugs, including infections and low blood counts that required several hospital stays. At one point, when the tumor began impinging on her airway, she needed a tracheostomy tube in her windpipe to help her breathe. She also had numerous radiation treatments.
Finally, on April 2, 2014, there was “a window of opportunity for surgery,” according to Ellie Maghami, M.D., chief of head and neck surgery. To avoid facial scars, Maghami removed the tumor by making an incision in Jackie’s neck, and Robert Kang, M.D., a facial plastic and reconstructive surgery specialist, rebuilt Jackie’s mandible, or jaw. Kang took a portion of the long and sturdy fibula, along with small blood vessels, from Jackie’s leg to reconstruct her jaw, with the help of a microscope.
“I am almost speechless when it comes to Drs. Kang and Maghami,” Jackie's mother said. “They did an amazing job. Jackie looks great. There’s just a fine line on the side of her neck. It was a long, 14-hour surgery, but the surgeons were very caring and comforting from the first time they met Jackie, and she adores them. During the surgery, they gave me details every three hours that were very reassuring.”
Back to a healthy child's future
Perhaps most reassuring is that the scans Jackie has taken every three months have shown no signs of cancer, and postsurgery chemotherapy was stopped in the summer of 2014.
“She feels great,” Zalvalza said. “She’s running around, playing with her sisters and going to the park – being free again. And her curly hair is growing back. Her dad calls her Shirley Temple.”
As for Jackie, she is unaware that in less-expert hands her surgery could have ended very differently. In medical centers that lack microvascular reconstructive expertise, soft tissue is used to close the wound created when the jaw is removed. As a result, the patient cannot speak and swallow normally, because one side of the jaw bone swings independently of the other. There is also significant facial deformity because there is no outline of a jaw bone on the surgical side.
Jackie, however, has returned to the life of a normal 12-year-old, doing the activities that most kids take for granted, like riding her bike.
That’s not to say she doesn’t appreciates her care at City of Hope. “I want to say ‘thank you’ to all the doctors and nurses,” Jackie said. “I’m grateful for everything they’ve done. They have a special place in my heart.”
Added her mother, “They are very special people to do their jobs with the great love that they do.”
Learn more about treatment and research of head and neck cancers at City of Hope.
Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.