Ashley Kuzma continues to teach at McDowell Intermediate High School while battling the disease.

ERIE, Pa. — Ashley Kuzma warned her students that she would probably sound quite different when she returned to McDowell Intermediate High School after having her voice box removed.

The 31-year-old teacher had battled for months to save her larynx after doctors found cancer on her vocal cords in June 2017. She had chosen to undergo a partial laryngectomy when radiation treatments failed to stop the cancer’s progression in an effort to keep her voice.

But cancer returned again and doctors told Kuzma in February 2018 that she needed to have her entire voice box removed.

“That was the first time I cried,” Kuzma said, pressing her fingers against the prosthesis covering the permanent opening in her neck so she could talk. “I was terrified about the surgery because I would have a hole in my neck.”

Kuzma, a Beaver County native whose parents now live in Erie, first taught social studies in the Millcreek Township School District as a long-term substitute in 2012. She later accepted a job as a gifted support teacher in the Lancaster School District before returning to Millcreek in February 2017 to take a similar position at MIHS.

At the time, Kuzma was suffering from a chronic throat problem that made her voice progressively hoarser.

“I saw allergy specialists in Lancaster and they confirmed that I did have an allergy,” Kuzma said. “I was prescribed a nose spray and a pill, but my voice only became worse.”

She went to an ear, nose and throat specialist in Erie who discovered growths on Kuzma’s vocal cords. A biopsy was performed in June 2017 and the growths were malignant.

Kuzma underwent 29 radiation treatments at UPMC Shadyside in Pittsburgh. The tumors went away but returned in February 2018.

“My ENT surgeon recommended a total laryngectomy but I got three other opinions, including (the singer) Adele’s doctor in Boston and the Cleveland Clinic,” Kuzma said. “They all had different opinions and I chose the one in the middle, the partial laryngectomy.”

The surgery was performed at the Cleveland Clinic in March 2018 and Kuzma was able to return to MIHS for the final day of school in June, despite still using a feeding tube.

Convinced the surgery had removed all of the cancer, Kuzma continued to recover over the summer. But a scan done in August showed the cancer had returned and that it was mucoepidermoid carcinoma, a cancer of the salivary glands.

“That’s when I knew I needed the total laryngectomy,” Kuzma said. “I had it done in September at the Cleveland Clinic, along with 30 radiation and five chemotherapy treatments.”

Kuzma stayed in Cleveland at the American Cancer Society’s Hope Lodge during her course of treatment, then lived temporarily with her parents. She spent weeks unable to eat, drink or talk while her throat and the opening in her neck healed.

“My mom got really good at lip reading and I used a text-to-speech app to communicate,” Kuzma said. “I also wrote on a Boogie Board (an LCD writing tablet).”

Her goal was to return to MIHS and teach. The school had made special accommodations for Kuzma’s condition, including transferring her out of regular classrooms because she couldn’t raise her voice loud enough to be heard by everyone.

She also talked with students before her surgery and prepared them for what could happen when she returned.

“They all knew I was having surgery and I said I will probably come back speaking differently,” Kuzma said. “One of them asked if I was going to be like those people in the (anti-smoking) commercials who hold the device up to their neck and talk like a robot. I said that I hoped I didn’t need the device.”

Kuzma didn’t need the device when she returned to MIHS in mid-January. She had worked on her speech and was able to communicate in a soft, slightly mechanical voice.

She spends part of each morning tutoring small groups of students on college and career planning and works with other teachers on classroom plans.

“I deal with ninth-graders, so as long as I act like everything is normal they don’t seem to react,” Kuzma said.

Kuzma’s new normal lasted until March when a scan and a follow-up biopsy showed the cancer had returned for the fourth time. Treatment options are limited because of the surgery, and all the radiation and chemotherapy Kuzma has received over the past two years.

She has discussed immunotherapy — using parts of Kuzma’s own immune system to target and fight cancer — with doctors at the Cleveland Clinic and has an appointment scheduled for April 19 at the Mayo Clinic in Rochester, Minnesota.

“This is the first time I’ve really been upset because my outlook is not good,” Kuzma said. “I see people live unhealthy lives and live to be in their 80s. I never smoked, I don’t drink, I exercise and eat healthily, and I’m only 31.”

Not only is Kuzma determined to pursue additional treatments, but she also continues to teach. It doesn’t surprise her friend, Rita Sajewski, a Walnut Creek Middle School teacher.

“I’d probably be an emotional basket-case but Ashley has been so positive,” Sajewski said. “She continues to go to work when it could be so easy for her to take disability or a leave of absence. Teaching is what she loves to do.”

Kuzma recently asked Sajewski and others in their group of friends what they would add to their bucket list of things they want to do before they die.

It’s a subject Kuzma has spent some time contemplating in recent weeks.

“The only thing I want to do is travel,” Kuzma said. “My current list includes Greece and Peru, of course. I’m a social studies teacher.”