For 12 years she lived with a bump under the bone of her right ankle that would occasionally become irritated with contact. Her sophomore year of college, she reached a breaking point and scheduled an appointment to have it removed.
She had no idea that just one day before her twentieth birthday she would be diagnosed with synovial sarcoma.
Sam Preston, 22, first remembers noticing the lump below her ankle when she was in the second grade, she said. Her grandmother was painting her toenails and she advised her not to touch the spot on her foot because it hurt too bad.
“I lived with it for so long that I never thought much of it,” she said. “My sophomore year of college, I finally told my mom I didn’t want to live with it anymore because just the hot water from showers were painful.”
A surgery was scheduled for early May of 2019 to have what her podiatrist called a “nodule” removed from below her ankle bone. After the surgery was complete, he informed her it had a strange appearance, so they sent it to the lab for further testing.
“About a week later I got the call that it was a cancerous cell,” she said. “It was the day before I turned 20, so I had people telling me happy early birthday and asking what my plans were.”
Preston described her initial reaction as unphased.
“He said I had cancer and I honestly didn’t even think anything about it,” she said. “It wasn’t until I had to go into radiation that things became real for me.”
When radiation started, Preston’s mother had secretly reached out to friends and family to help her daughter get through the upcoming weeks. Each day of radiation, Preston had a card or a small gift to open from a loved one.
“It was so nice each day to wake up knowing I am not totally alone through it all,” she said.
Preston was sent to Indianapolis, Ind. to a sarcoma oncologist who explained the radiation process. She was ordered 25 rounds of radiation—every day for five weeks strapped to a table for 20 minutes with radiation shooting into her foot to kill off any remnant cancer cells, she said.
One day after radiation ended July, 2019. Preston's skin was severely damaged and burnt, forming blisters around the affected area.
“He ordered about half a dozen scans to make sure it had not spread anywhere else in my body because the podiatrist who originally treated me may not have known what to look for,” she said.
In mid-September, her oncologist performed another surgery to remove pockets of cells around the cancerous area. During this procedure, a plastic surgeon was brought in to do a skin flap on Preston’s foot.
A skin flap consists of one or more tissue components including skin, deep tissue and muscle and was placed on Preston’s foot because the skin on her foot would not stretch enough to reconstruct the damaged area from radiation, she said. A skin graft from her hip was also taken and placed around the ankle.
“I was told the surgery would take three hours but it ended up taking six,” she said. “They didn’t expect to have to do a skin flap.”
She stayed overnight in the hospital and awoke to find the skin flap had died and turned purple. Doctors ordered leach therapy, a procedure where leaches were placed on her foot to suck all of the blood out of the dead skin flap, she said.
They, again, reconstructed her foot which resulted in a six-day stay at the hospital. After the six days had passed, her doctors felt confident that she was on the mend, she said. Her scan results came back clear and cancer free, and the skin flap was looking successful. She was sent home to start physical therapy.
“At that point I thought all was good and my foot basically just needed to heal,” she said.
Three weeks into physical therapy, however, her therapist told her the foot looked the same as it did at the beginning and she feared it was not healing. Preston was sent to wound therapy to have a wound-vac on the skin-flap and graft; a procedure where a device is used to decrease air pressure on a wound, ultimately, allowing it to heal more quickly.
“During that appointment they looked at me and said I needed surgery right then because the skin flap failed again and I had bone exposed,” she said. “My parents were in Vegas and I was not going into surgery alone. I just called my grandma and started crying.”
A third surgery was scheduled upon Preston’s parents’ return home from their trip. In early November of 2019, doctors performed another skin flap; this time taking a long, skinny muscle from the inside of her left thigh to pack the foot wound with, she said.
“When I woke up this time, the scar on my foot was literally the size of a softball,” she said. “They kept me in the hospital for a week because they were so worried the flap would die again.”
The third surgery proved successful as Preston was sent home again, this time healing fully without complications. The area healed properly, though, in April of 2021 she had a fourth surgery to shave down some of the skin flap and graft that still bulged off the side of her foot, she said.
Preston after her third surgery, Nov. 2019. Having lost 10 pounds by day seven of being in the hospital.
“I would say the size of the area is mostly back to normal now,” she said. “The fourth surgery was simply to help with the size because once it healed, I couldn’t wear a lot of boots or shoes that came up past my ankle due to the size of the scar.”
Despite multiple complications, four surgeries and physical therapy, Preston still managed to graduate on time with her bachelor’s degree from Indiana University’s Teaching All Learners Elementary Program. She credits her strength to her support group made up of her family, friends and boyfriend, Clay.
She and Clay started dating in 2017 during their senior year of high school. When Preston found out about her cancer diagnosis, she gave him an out, she said.
“I just said ‘you know you don’t have to stay,’ because we didn’t know what was to come, or if I would even live,” she said. “God bless him, he just looked at me like I was stupid and said ‘what do you mean? I am not leaving.’”
Now, two years after the initial diagnosis, Preston is fully healed and cancer-free. Rather than spending weeks in the hospital, she now goes in every three months for an MRI on her foot and CT scans on her chest, checking for any cancerous cells that may reappear.
“As long as my scans continue to be good, I will be done with regular checkups after five years,” she said. “So, three more years because I have currently been in the clear for two years.”
Preston said that throughout the whole experience, her recovery was the most difficult part. Not because of the multiple surgeries and setbacks, she said, but because of survivor’s guilt.
“Even after seeing all that I lost and the things I can’t do now due to limited mobility, I am still so glad that this is how it ended,” she said. “And sometimes that is the hardest part because there are so many people who didn’t live through similar circumstances.”
Preston finds reciprocity in her grandmother who, also, was diagnosed with cancer at a young age and survived. In her early thirties, she was diagnosed with breast cancer and had shared with her granddaughter the same feelings of guilt for living.
“Her and I have become even closer than we already were because we can have those intimate conversations that nobody else in the family can really relate to,” she said. “In the moment, the cancer was cancer. But now that it isn’t there anymore, I almost feel guilty for surviving when another person didn’t.”
Preston’s cancer is gone, but the evidence remains.
Preston's foot is fully healed after four surgeries, radiation and physical therapy. She wears a compression sock mostly every day to keep the swelling down.
She explained that movements that were once simple are now harder, or even impossible to do. For example, the muscle removed from her thigh to fill the skin flap causes a pinching experience in her thigh when she squats.
Her right foot has limited mobility compared to the left due to nerve damage and scar tissue from the multiple surgeries and radiation, she said.
“My nerves are shot,” she said. “I’ve lost about 90% of the feeling I once had in my right foot.”
The feeling in her foot is so obsolete now that it took her over a week to notice a blister had formed, burst and scabbed over on her pinky toe, she said. The blister had formed, burst and scabbed over before Preston noticed its existence.
“I don’t pay much attention to it because I am so used to keeping busy as a distraction from it all,” Preston said.
Throughout her treatment she remained in college, receiving the best grades the semester of her surgery than the rest of her college career. Along with maintaining her studies, she nannied full time—putting the kids down for a nap, going to radiation and then returning back, she said.
“Once I got through radiation, I took on a mentality of recover, it was all I could do,” she said.
Now, fully recovered and graduated, Preston has spent this past summer decorating her classroom and preparing lesson plans for her first teaching position as a fourth-grade teacher at Amelia Earhart Elementary School in Lafayette, Ind.
She and Clay are still dating and he has accepted a position as a middle school wrestling head coach. Her cancer brought them closer, as well as her family and genuine friends, she said.
“This experience definitely helped me realize who will always be there for me and who was only there for convenience,” she said. “When I was first diagnosed everyone reached out, and as time went on, the texts and calls were nowhere as frequent.”
Preston strives to live her life with optimism, she said. Having always dreamt of being an elementary school teacher, her life is right on track despite a major obstacle.
Preston on the day of celebrating one year cancer free. She is now preparing to start her first year as a fourth-grade teacher.
