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Sarah Pieper looks at her youngest son Elias, who she calls her "miracle baby," while playing at Central Creek Park on March 17, 2023, in Goose Creek. Pieper was diagnosed with stage 3 squamous cell carcinoma while pregnant with Elias. Doctors at Trident Medical Center developed a plan to keep her and the baby safe from surgical procedures and radiation treatment. Andrew J. Whitaker/Staff

SUMMERVILLE — On her daughter's sixth birthday party, Sarah Pieper did what she has grown accustomed to as a mom of four kids. She held it together, masking the devastation she felt after getting life-changing news just a few hours earlier. 

Pieper, a 33-year-old stay-at-home mom living in Summerville, kept busy during the party. Navigating through the maze of rambunctious 5- and 6-year-olds, she wondered what her world would look like and how the child gestating in her womb would be affected by it all. 

Earlier that morning, doctors at Trident Medical Center diagnosed Pieper with stage 3 squamous cell carcinoma, a rare form of head and neck cancer that affects the tongue. 

She was 14 weeks pregnant with a baby boy. 

"It was probably the hardest thing for me to do," Pieper told The Post and Courier. 

Her diagnosis came as a shock for her doctors at Trident, who had never seen a case like hers before. 

It's uncommon to be treated for cancer while pregnant, but it does happen. However, cancers developed during pregnancy range from breast and ovarian cancers to thyroid, colon and cervical cancers. 

"But not head and neck cancer," said Dr. Anand Sharma, radiation oncologist for a head and neck specialist group at Trident. 

Sharma said the odds of finding a young patient with cancer are low, especially a head and neck cancer, as the disease is commonly found in older patients around age 60. 

"And that person being pregnant is like a lightning strike," Sharma said. "It's very uncommon."

What is squamous cell carcinoma?

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Sarah Pieper and her son Elias help her other son Hayden Pieper, 4, cross a climbing wall while they play at Central Creek Park on March 17, 2023, in Goose Creek. Andrew J. Whitaker/Staff

Squamous cell carcinoma of the tongue develops from the flat squamous cells that line the surface of the tongue. It accounts for nearly 1 percent of newly diagnosed cancer cases in the U.S. according to the National Cancer Institute. 

However, it's one of the more frequently diagnosed forms of head and neck cancers. 

And while the disease primarily affects men over the age of 50, rates among women and young people have risen in recent decades. 

The cancer is associated with heavy tobacco and alcohol use as well as with the human papillomavirus (HPV), a common sexually transmitted disease linked to different cancers. 

According to a recent article by City of Hope, a national integrated cancer research and treatment center, HPV infections may cause 70 percent of oropharyngeal cancers, defined by the National Cancer Institute as cancers that forms in the (oropharynx), the middle part of the throat, behind the mouth, the tonsils and the back one-third of the tongue. 

No time to wait

Since she was diagnosed in spring 2022, just into her second trimester, Pieper's surgeon, Dr. David Neskey, was given a small window of time for him to operate on her without interrupting her pregnancy. 

He had a month to operate. And within 13 days of Pieper's first appointment, she saw five different specialists to prepare for surgery to remove part of her tongue that was causing her the most pain.

Pieper said that in January 2022 she started noticing it was getting harder to swallow food and water and was concerned that whatever was going on would affect the baby.

"He's actually the only reason I went to the doctor," Pieper said. 

Pieper underwent an eight-hour surgery with Neskey. The goal was to remove part of her tongue where the tumor was and replace it with muscles and blood vessels from her thigh. 

"My husband says it was actually a lot longer," she said, since with prep and check it took about 11.

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Sarah Pieper holds her son Elias while watching her daughter Addy Pieper, 6, play at Central Creek Park on March 17, 2023 in Goose Creek. Andrew J. Whitaker/Staff

Pieper had surgery on her sixth wedding anniversary. She wasn't able to talk, eat or drink but she said she leaned on her relationship with God. 

Neskey said there are certain risks associated with pregnant patients and going under the knife, but the biggest concern is understanding how long the patient can be under anesthesia without it affecting the fetus. 

"When I woke up I was so scared I had lost him," Pieper said. 

Still groggy from the anesthesia, she reached down to gently place her hand on her stomach. 

"For the first time I felt him kick," Pieper said. "I couldn't explain more of a perfect moment to know that God was speaking to me."

Radiation while pregnant

Normally, pregnant people are directed to stay away from radiation. People undergoing radiation treatment are instructed to steer clear of pregnant women, as the therapy can have adverse effects on the fetus. 

But not in this case. Pathology results after Pieper's surgery revealed she would need radiation therapy to ensure the cancer was completely eradicated. 

Sharma and his team were tasked with delivering therapeutic radiation, usually emitted in high doses, to a pregnant patient without endangering the fetus. 

As the fetus grows closer and closer to the head and neck area, it's increasingly more sensitive to radiation. And exposure to radiation during the different gestational phases poses risks to the fetus's organ and brain development. 

"It's a fine line and we had to use mathematical data derivations to come to the number that would satisfy the lowest permissible limit of radiation," Sharma said. "Thankfully, we were able to do that." 

Hitting close to home

While the road to recovery for Pieper was long, she remains grateful that she was able to give birth to her son Elias without any issues. 

She said he is always smiling, "like he never went through anything at all."

The same isn't true for Pieper, who after surgery and radiation experienced a lot of pain when talking, drinking water or swallowing food. 

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Sarah Pieper holds her son Elias while playing with her other kids Hayden and Addy at Central Creek Park on March 17, 2023 in Goose Creek. Andrew J. Whitaker/Staff

"Water felt like acid going down my throat," she said remembering the hard months of intensive radiation therapy. 

She even had to learn how to talk again, adjusting to her newly constructed tongue. 

It helps that she also homeschools her children, she told The Post and Courier, recalling how she and her 6-year-old daughter learned how to pronounce different words and sounds together. 

To learn more about head and neck cancer visit www.headandneck.org/south-carolina/.

Editor's Note: A previous version of this story incorrectly identified Dr. David Neskey.

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 Follow Zharia Jeffries on Twitter @Zharia_Jeffries.

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