Breast Cancer Team Combines Quality of Life With Quality Treatment
Eloise Orr had plenty on the horizon. As a 20-year-old junior at the University of Illinois in Champaign, she had finals coming up. Then she’d be off to Spain in the fall for a semester abroad. After graduating that spring with a degree in Spanish, she planned to celebrate with a vacation in Puerto Rico.
None of those plans included breast cancer.
Born and raised in the South Shore neighborhood, Orr had never feared breast cancer growing up, even though her mother died of the disease at age 35, when Orr was just 5 years old. Nor did Orr give much thought to the statistics: African-American women in Chicago are more than twice as likely as Caucasian women to die after being diagnosed, regardless of socioeconomic status.
It wasn’t until she was in bed in her dorm room in April 2002 that Orr had to face her risk. Orr felt a wetness under her shirt and in the bathroom noticed a heavy discharge from one of her nipples. Nora Jaskowiak, MD, discovered that Orr had ductal carcinoma in situ (DCIS), an early-stage cancer usually limited to the breast duct. But Orr’s breast cancer would be anything but limited. In fact, it would threaten her life again and again for the next five years.
Jaskowiak, surgical oncologist and director of surgery at the University of Chicago Medicine Breast Center, suggested that Orr either have a lumpectomy, followed by several weeks of radiation, or a mastectomy.
"I didn’t have time for radiation," Orr said. She had spent her college years studying Spanish and had been looking forward to developing her language skills by studying abroad since high school. "I was determined to go to Spain."
And go she did. Before she left, Orr suggested having a double mastectomy to further reduce the chance of recurrence. Plus, David Song, MD, said this would give the added benefit of more symmetry, which is often forfeited with lumpectomies. Also, when a lumpectomy is performed in the lower part of the breast, the surgical enclosure can collapse, causing the breast to look deformed.
"We tailored an entire regimen around her plans so this wouldn’t be an obstacle in her life fulfillment," said Song, chief of the Section of Plastic and Reconstructive Surgery. "Dr. Jaskowiak and I are very sensitive to that. If you let the treatment process take over, it can diminish the patient’s sense of hope."
For Orr, beating cancer was the only option -- and laughing at it along the way. The day of her mastectomy, Orr and her father were driving to the medical campus at 5 a.m. to meet Song and Jaskowiak for the four-hour surgery. The sun was just rising and only a handful of people were on the street.
"This is the last day you’ll have them," her dad teased, driving past the storefronts on 79th Street. "You want to flash someone before we go?"
Orr ignored her father’s suggestion -- until they stopped at a red light, and she noticed a man with dusty clothes and a raggedy beard standing outside a liquor store. She lifted her baggy t-shirt to her chin, giving him a full frontal view, and watched the man’s jaw drop. Then, the light turned green, and her father took off, both of them laughing.
After Orr recovered from surgery, she juggled summer school classes with weekly saline injections at the medical center to inflate her breast implants. These implants were temporary, designed gradually to expand the chest’s surrounding skin and tissue to accommodate the permanent implants Orr would have placed when she returned from her fall semester in Spain. However, the final surgical pathology came back showing some evidence of microinvasion, meaning some cancer cells had figured out how to escape the breast ducts.
"That’s when we knew we were potentially not out of danger," Jaskowiak said.
A War of Wills with Cancer
The first few weeks of her semester abroad were going fine, until Orr felt a sharp pain in her right armpit. She waited until returning home in January 2003 to have Jaskowiak check. By then, the tumor had grown large enough for Jaskowiak to detect by touch. A biopsy confirmed that the breast cancer had not only come back a second time but had metastasized to her lymph nodes. Surgery, followed by chemotherapy and radiation, was the only possible treatment. The surgery was scheduled for March, but Orr told Jaskowiak to put the chemotherapy and radiation on hold for three months until after her graduation trip to Puerto Rico.
The chemotherapy treatments during that summer in 2003 were the closest Orr came to hitting a low point. It also was the first time she realized how painful life was without her mother. "Chemo was the worst thing ever, ever, ever," she said. "Losing my hair was the easy part. I was so sick that at times I had to pray to my mom for strength to go to the hospital. I would say ‘Mom, I need you to get me there.’"
Orr recovered from the treatment, but the following year in 2004, the cancer came back a third time. A CT scan showed the tumor was the size of a golf ball -- in her brain. This malignancy was as stubborn about recurring as Orr was about beating it. In December 2004, not only was the tumor in her brain surgically removed, but also a smaller tumor on her right frontal lobe was detected and shrunk with three weeks of radiation therapy to her entire brain and then with stereotactic radiosurgery, a more precise, high-dose beam of radiation aimed squarely at the smaller tumor. A year later, that smaller tumor came back twice as large. In July 2006, it came back again -- her fifth cancer diagnosis.
But the recurring bouts with brain cancer didn’t stop Orr from returning to Spain in September 2006 to teach English. By this time, she had just turned 25 years old. Her job was supposed to last until June 2007, but cancer would interrupt her plans for the sixth time. A routine MRI during her visit home for Christmas revealed that one of the previously removed brain tumors had come back again. This tumor required another surgery and at least three weeks to recover.
At the end of three weeks, Orr was boarding a flight back to Spain.
"Her whole attitude is unbelievable," Song said, choking up. "Imagine you’re 20 years old, and you get diagnosed with the same disease your mother died from. But with Weezy -- that’s what I call Eloise -- there was never a down moment. Maybe she cried a couple of times, but she always picked herself back up. This kind of resilience is rare because most people don’t make it."
Song said the probability of mortality is exactly why accommodating a patient’s life plans during metastatic breast cancer treatment is standard practice at the medical center. "I have a patient in Brazil right now," Song said. "It’s all about quality of life. Imagine if Weezy had never gone to Spain and didn’t graduate from college. She would have survived the cancer, but she also would regret not having taken advantage of life."
Orr, now 28 years old, teaches English and Spanish at Francis M. McKay Elementary School on Chicago’s Southwest Side. She also is pursuing a graduate degree in elementary education from a Chicago-based program through Northern Illinois University, where she maintains a 4.0 grade point average.
After five years of consecutive cancer diagnoses, Orr shakes her fist in triumph when mentioning that in 2008, 2009 and so far in 2010 she has been cancer free.
"I am determined to live my life," Orr said. "I think that’s why I kept beating it. Some people say I’m just like my mom in that way. Whatever she wanted to do, she did, and you’d have to work around her schedule. I know she was with me to keep me strong."