Ms Gladys Leow was just 18 when she discovered that a lump on her neck – which resurfaced even after being removed and found to be benign – was liposarcoma, a rare cancer that develops from fat cells and has a high risk of recurrence.
“I was overwhelmed because I really didn’t know what was going on at such a young age,” said Ms Leow, who is now 34. “I broke down and cried.”
Liposarcoma is a type of sarcoma, a group of cancers that start in the bones and soft tissues. It is a rare cancer that develops from fat cells, with a 2017 report suggesting that about 375,000 people worldwide were affected.
Between 2012 and 2021, the National Cancer Centre Singapore (NCCS) treated about 1,700 cases of sarcoma, including liposarcoma.
Potentially life-threatening, liposarcoma is characterised by a persistent, growing lump, pain and swelling, with the cancer in the jaw considered exceedingly rare.
Between 2007 and 2014, Ms Leow underwent several operations and radiation therapy to remove the tumours, which recurred incessantly as a result of the liposarcoma.
Though she was initially diagnosed with Stage 2 cancer in 2007, it progressed to Stage 3 when it recurred in 2012.
The treatments impacted her jaw, affecting her facial appearance as well.
Her mandible, or lower jaw, was severely deviated to the right while her maxilla, or upper jaw, had collapsed. She was despondent.
“I couldn’t eat well, I couldn’t bite well, I couldn’t talk well,” she said.
She approached six different surgeons to reconstruct her jaw, but all turned her down due to the complexity of her case.
But a ray of light came when Dr Rahul Harshad Nagadia, a senior consultant with the head and neck surgery department at NCCS, was assigned to take care of her, following her cancer treatments after her initial surgeon retired.
With his own background in dental surgery, Dr Rahul – who is also a senior consultant with the department of oral and maxillofacial surgery at the National Dental Centre Singapore (NDCS) – believed that a multidisciplinary approach, including dental surgery, would best help restore not just Ms Leow’s jaw, but also her well-being.
“I think the whole concept of treating patients now has changed from just making them disease-free to actually improving their quality of life and being able to rehabilitate them in society,” he said.
He brought Ms Leow’s case to Dr Benjamin Ng, a consultant with NDCS’ oral and maxillofacial surgery department.
It took almost a year to come up with the surgical procedures needed for the reconstruction of Ms Leow’s jaw, Dr Ng said.
Doing so required a big team of doctors – including head and neck surgeons, plastic surgeons, maxillofacial surgeons and prosthodontists – from various institutions working together to devise a plan, he noted.
Dr Rahul noted that the challenging nature of the case meant there were no guarantees of its success.
“When we planned the surgery, we had multiple sessions with Gladys to tell her that ‘we can try our best, but we cannot promise you, because we don’t know how the tissues are going to be and how they’re going to react’,” he said.
Describing Ms Leow’s procedures as “high stakes”, Dr Ng said the reconstruction posed many challenges.
A technique known as surgically assisted rapid maxillary expansion was used to expand her upper jaw, while mandibular distraction – where lengthening devices are inserted into the jaw – was employed for her lower jaw.
To reconstruct Ms Leow’s jaw, bone from her fibula, or calf bone, was harvested and shaped to meet the curve of the jaw.
A challenging procedure known as the “double barrel” technique, where the bone graft is stacked together, was also conducted on Ms Leow to ensure the proportions of her jaw’s height and width were restored.
The free flap technique was also employed, where tissue from one part of the body, such as skin, fat or muscle, is transferred to another part to correct a defect, with the blood vessels also reconnected in the process.
Muscle from Ms Leow’s calf was used to replace her lost gums, while the soft tissue of her mouth was reconstructed using tissue from her thigh.
Using 3D planning – where 3D imaging and modelling are used to visualise and simulate a surgical procedure before it is performed – made the entire process safer and more predictable, Dr Ng said.
Describing Ms Leow’s case as one of the most “challenging and unique” ones he had seen, he said the procedures were to prevent the worsening of her osteoradionecrosis – a potentially fatal complication of radiation therapy where bone tissue dies as a result of radiation damage.
Between January 2023 and March 2024, multiple operations were carried out to restore Ms Leow’s jaw.
Dr Ng noted that she is still undergoing treatment, using braces on her teeth to improve their alignment.
Describing the entire process as “long and arduous”, Ms Leow credited her family and church for supporting her and giving her strength during the years of treatment.
In 2024, Ms Leow was one of 28 people to be awarded SingHealth’s Inspirational Patient of the Year Award, which recognises patients for their strength, courage and resilience in the face of health challenges.
The experience changed Ms Leow’s life in other ways as well. Originally pursuing a diploma in design, her encounters with healthcare workers over the years spurred her to change her course of study.
“Throughout the nights during my hospital stay, I saw how the nurses and other healthcare workers showed their support and care for me, and that really inspired me to become one of them as well,” she said.
Inspired, she began her diploma course in nursing at Nanyang Polytechnic in 2016, and eventually graduated with a bachelor’s degree in nursing from the National University of Singapore in 2022.
She is now a nurse with NCCS, assisting, among others, Dr Rahul, who helped give her a new lease of life – kind of full circle, as the doctor said.
“Because of what I’ve been through, I feel like I can help others as well,” said Ms Leow.
“(Nursing) is really a platform for me to share (my experience) with others and encourage them to not lose hope, and to keep going on.”
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