At 2 ½, Connor Luke is always moving.
He’s especially adept at escaping his Mommy’s grasp. She lets out an unbridled laugh as she wrangles him into a clean shirt, throwing her head back in that way that reminds you of a carefree woman on the beach. As most days, she’s running a bit late getting him off to family home daycare. Finally, he scrambles up into her Jeep SUV and begs for the keys to start the engine; she easily obliges and waits patiently while he fumbles to coordinate his piercing blue gaze with still-clumsy baby hands.
She has a grinding day of work ahead as a mortgage broker in a down economy, and yet she and husband Pat, both clutching matching coffee to-go mugs, take time to swap silly stories from the night before about their bright and brisk son. It’s the picture of what every family should be: content, close, considerate ….
Except that, despite Robin Cordy’s buoyant mane of curls, her fresh and youthful glow and laid-back-yet-loquacious demeanor, she is not a woman without a care. In fact, she harbors a major burden in her heart — one that haunts her every day: Will her breast cancer return?
At age 40, Cordry thought she had it all: a devoted husband, a healthy 5-year-old daughter, successful career, steadfast family and friends, a well-stamped passport and a comfortable home. Although she’d suffered a disappointing miscarriage months earlier (they’d been trying for a second baby for two years), she and Pat were focused and excited about their upcoming trip to Kenya, Africa, to visit her sister.
One day, as she packed and tried on clothes for her voyage from her home in The Colony, she brushed the left side of her breast with her hand and felt something … it was a large, painless lump – like a plum, she recalls. Knowing she’d be out of the country for three weeks, she called her doctor, who urged her to come in right away.
That same day, Cordry realized something else that was off about her body: a late period. During the course of the following 24 hours, she confronted the unthinkable: she was carrying both a baby and cancer.
Her tumor was at the point where it might start traveling. There would be no trip to Africa.
One in 3,000 women will discover cancer during pregnancy. Rare, yes; though some experts say pregnancy-associated breast cancer is on the rise, it’s also the most common cancer diagnosed in expectant mothers. Women today, versus 150 years ago, remain fertile for a longer period of time — beginning anywhere from age 9 to 50. Could it be that an ever-increasing period of fluctuating hormones could actually ripen a woman’s chances for breast cancer? According to the American Cancer Society (ACS), women who are exposed to higher levels of estrogen over longer periods of time (including women who’ve had more menstrual periods) seem to have a slightly higher risk. Plus, women are waiting until later in life to give birth and the threat of cancer increases with age.
And then there is the pregnancy itself and its surge of hormones — possibly supercharging the growth of ER (estrogen-receptive) positive tumors. Cordry can’t help but wonder if both the miscarriage and her pregnancy hastened the growth of the 2.5-centimeter nodule that was spreading to her lymph nodes. “I’ll never know,” she retorts, acknowledging the medical community’s lack of scientific evidence on pregnant women and cancer.
But Cordry considers herself lucky in that she caught the malignancy early. According to the ACS, because pregnant women often experience enlarged and sore breasts, they are more likely to ignore early signs — that, and, as Cordry declares, pregnancy tends to make you feel invincible. “It’s the ultimate defense,” she adds. Studies show that pregnant women learn of their cancer two to 15 months later than non-pregnant women and are two and a half times more likely to discover their cancer is advanced. Dr. Michael Zaretsky, a maternal fetal medicine specialist at UT Southwestern Medical Center who treated Cordry, concurs: “Delay in diagnosis is the biggest problem.”
Cordry and her husband met and married later in life after years of reveling in the single life in the Lower Greenville area. Although she smoked for 20 years, the Dallasite countered her late-night habits by eating a diet high in fruits and vegetables and staying active with running and water sports. Once married and settled into the ’burbs, Cordry ditched the birth control pills she relied on for nearly two decades and found herself pregnant at 34. Her first child — a daughter named Rachel — was born and life went on.
The day her doctor confirmed the mass in her breast, a candid Cordry, who did not perform regular breast self-exams, recalls asking her husband incredulously, “Honey, how did you not feel this lump?”
She thought about the mammogram she never got around to scheduling. And she realized that she checked several risk factor boxes, including having her first child after 30, taking birth control pills and social drinking. “I knew alcohol could possibly cause breast cancer,” she surrenders in hindsight, referring to the ACS’s assertion that alcohol is clearly linked to an increased risk.
But the thought that kept her up at night? How could she be brimming with both life and death at the same time?
This isn’t the first time the family dealt with the “C” word. Fifteen years earlier, Cordry’s mother discovered she had kidney cancer; within a month she was gone. “She had ignored a few pains for just long enough that her cancer had metastasized to her lungs and brain,” recalls Cordry soulfully.
The experience left her consumed with a desire to beat her own cancer — Stage II, histological grade III (aggressive). Of 16 nearby nodes removed, only two were found with cancer (the largest was 4 millimeters in size). Her cancer was ER-positive, which meant she was more likely to respond to chemotherapy.
She had a fighting chance. But did her baby?
Medical professionals find the dilemma troubling, and many of them may see only one or two cases like Cordry’s in their practices.
A self-described straight shooter, Cordry began wading through a minefield of choices. She quickly realized there isn’t a consistent protocol for defeating cancer during pregnancy, nor is there a leading expert in the field or large-scale scientific findings to answer all of the relevant questions when a woman faces both the happiest and scariest times of her life simultaneously.
There are voluntary registries that collect information, including the one Cordry consulted — Registry of Pregnant Women Exposed to Chemotherapeutic Agents at the University of Oklahoma Medical Center, which is comprised of retrospective cases found in published literature collected over a 20-year span (even citing cases back to the ’50s when treatments were very different).
Susan Hassed, co-director of the Master of Science in Genetic Counseling Program and Associate Professor of Pediatrics at the University of Oklahoma Medical Center, who runs the registry, notes that currently they have 700 cases on file. She’d like to see that number grow and expand to include “garden-variety” cases beyond the high-profile experiences typically found in literature — “to give us better data.” But the registry needs funding. What the registry’s information does offer women is “confidence” in moving forward with treatment, she asserts. They can search drug therapy outcomes based on records (albeit not definitive) of those who have gone before them. The most important thing the registry reveals? According to Hassed, it’s not as critical what chemo cocktail expectant mothers choose; it’s when they take it.
Dr. Robert Kirby, Cordry’s medical oncologist who specializes in breast cancer and practices at Texas Oncology in Plano, backs up that assertion. Pregnancy complicates the management of treatment, but doctors tend to “follow standard breast cancer protocols — the main issue is in the delay of treatment,” he explains. The risk for birth defects is higher if chemo is administered during the first trimester when fetal organs are forming.
The registry data shows that treatment given during the first trimester resulted in an 18 percent risk of the baby being born with a birth defect (compared to three to four percent in a normal pregnancy). “It’s remarkable the number is not higher, especially because a small amount of chemotherapy is passing through the placenta,” Hassed opines. Yet, after the embryonic period has passed (10 weeks), the exposure is “surprisingly well tolerated,” offers Zaretsky.
Cordry knew this was the last chance she’d have to bring another baby into the world; yet some of the medical experts she consulted recommended terminating the pregnancy to ensure the best chance of recovery. If she didn’t, one doctor told her, “It’s the equivalent of suicide.” She would either have to wait until the 13th week of pregnancy to start the toxic regimen (and risk the cancer spreading) or opt for a “therapeutic” abortion. It’s a time when “high-risk decisions need to be made,” notes Kirby.
“Time was my enemy and yet this was the only time I would ever have,” she recalls, her dark eyes still bubbling over with despair.
After many tearful discussions and counseling sessions with her priest, she decided that her best shot to survive meant letting go of the pregnancy. “I wanted a chance to live; everything in me said to fight. I had Rachel to raise,” she recounts.
Prophetically, she made the decision on a weekend and couldn’t act on it. That same night, she overheard her preschool daughter praying for a baby brother or sister (the young girl didn’t know her mom was pregnant).
Something changed inside Cordry and she picked up the fight for both of them — mother and baby.
Her first task? Cherry-pick a team of specialists in maternal and fetal health — no single one would lead the charge. She was determined to find experts who “gave a damn” (not an easy task) and who respected her right-to-life stance.
“One of the most challenging aspects of treating a pregnant woman with a medical or surgical condition is getting the treating doctors to do the right thing. The pregnant patient may not get the optimal therapy, because the doctor is fearful of harming the fetus,” informs Zaretsky, who became an integral part of Cordry’s medical consortium. “I often ask the oncologist or surgeon what they would do for treatment if the patient was not pregnant. I then help tailor it to optimize fetal safety and maximize maternal outcome.”
Instead of dreaming about baby names, Cordry began memorizing chemo drugs. Of course, she worried: If she shouldn’t even take over-the-counter meds during pregnancy, how could her baby withstand the blunderbuss of dripping poison? The Food and Drug Administration (FDA) outlines five categories of drugs that can be used during pregnancy — with category A offering the only safe choices (such as folic acid). Chemo drugs fall into category D (though the FDA is currently revamping its drug labeling to include more detailed, narrative descriptions to aid both doctors and patients).
“The problem with any drug is that it can never be studied systematically in the pregnant population and, therefore, there is a paucity of information,” notes Zaretsky.
M. D. Anderson Cancer Center in Houston is making strides with a small, observational clinical trial on chemotherapy drugs and their effects on the fetus. The early results offer hope: Of the 57 children of mothers followed to date who were treated in the second and third trimesters, only three had birth defects and none were related to chemotherapy.
Kirby recommended Cordry move forward with the most commonly used (and surprisingly safe, according to studies cited by Breastcancer.org) three-agent regimen that’s also supported by M.D. Anderson: 5-fluorouracil (5-FU), adriamycin and cytoxan. But, quick-study Cordry knew the more powerful (and highly toxic) taxotere had a better track record than 5-FU of beating the disease — but she could only find three cases of pregnant women taking it.
By then, she emphasizes, “I had reached a conclusion that no one would do anything ‘extra’ on a pregnant cancer patient. There would be no trial drugs. There would be no unusual regimen. And there were no experts. No one wanted me to take taxotere. But, I didn’t see any reason to have less of a chance for survival.”
“She felt strongly that she wanted to have taxotere,” says a supportive Kirby. “Many of these drugs are new and there isn’t a long track record. It’s a catch-22.”
The first-line of treatment began with a modified radical mastectomy (often suggested in pregnancy breast cancer cases to circumvent the need for immediate radiation), with removal of the other breast and reconstruction planned for later, after the pregnancy. Luckily, the baby tolerated the surgery well.
Losing a breast while she was pregnant seemed to be the least of her worries. Upon visiting her in the hospital, her daughter assured her: “It’s OK, Mom. Now you’re flat like me,” chuckles Cordry.
Then the countdown to her second trimester began.
Husband Pat gave Cordry a convertible sports car to take her mind off of the cancer. “I just wanted to explode and run,” she says. And she continued to work — how could she not? At the time of her diagnosis, the family’s only source of insurance came from a COBRA agreement from her husband’s previous job. With Pat now out of work, Cordry needed to continue paying those sky-high premiums.
The threesome also began building their dream home on Lake Lewisville and planning a trip to Galveston with extended family. “I had to not be in a dark place. I had a child who did not need a sick mama,” Cordry asserts. “Having a 5-year-old is good as you can’t wallow around in being a cancer patient. Although I did try to use that to get Pat to take out the garbage more often,” she admits puckishly.
At the start of her second trimester — known as the honeymoon period of pregnancy — Cordry began blasting her body with chemo, four cycles of each drug spaced three weeks apart. Zaretsky, who “gave me hope,” informed her that there was no literature to guide their course.
During her infusions, Zaretsky monitored the pregnancy with ultrasounds two to three times per week to ensure that Baby C (as he was now known) was tolerating the treatment. “That way, I would know if the baby was OK before I threw more poison in,” she stresses. Though the baby’s growth slowed slightly, he remained active and on target. The sessions proved to be her “greatest joy and my greatest boost of confidence in the whole process.”
In fact, she reports that chemo was not that bad; the ill effects lasted hours, not days. The pregnancy probably had little bearing on her tolerance, advises Kirby who explains that side effects are very individual.
Sixteen days into her treatment, as expected, Cordry’s beautiful black curls began to fall out in hunks the size of Twizzlers. She met the challenge head on and let her daughter cut her hair off. Rachel, who had only recently been disciplined for taking scissors to her own mane, declared it “one of the best days of my life.” She also assured her newly shorn mother, in a way only a daughter can, “Mom, you are kind of ugly, but your voice is still the same.”
Cordry proudly boasted her burgeoning bump and bald pate in the land of big hair. She resisted donning a wig because she didn’t have anything to hide. “I thought, ‘why should I do it? So everyone else can be comfortable with my situation?’” Instead, the mama-to-be dressed up in combat boots, temporary tattoos and army pants to attend one of her husband’s business affairs: “It was my coming-out party: bald, lopsided and pregnant,” she laughs.
Eventually, chemo, especially taxotere, claimed its ransom and Cordry succumbed to swelling — a “caterpillar” tongue — and her white blood cells began to plunge. For the first time, she realized that maybe she wasn’t “bulletproof.” She also decided to walk the Komen Race for the Cure 5K, but that, too, took a toll. The working mom ended up in the hospital with pleurisy (fluid around the lungs) at the end of her pregnancy.
And, she wrestled demons. Was the chemo working or was the cancer spreading? She couldn’t find out because doctors don’t recommend MRIs that use contrast dye or bone or computed tomography (CT) scans of the chest, abdomen or pelvis during pregnancy, according to the ACS. That, they do know, is too dangerous to the fetus.
Cordry’s water broke 19 days before her due date. She completed her chemo arsenal the recommended six weeks prior to delivery to aid in the recovery of her white blood cells. She and Pat had just relished a nice night with friends — one in which there was no mention of cancer.
Connor Luke Cordry was born on November 6, 2005 at 5:39am — 5 lb. 6 oz., 18.5 inches. Small, but healthy.
Cordry has few pictures from those early days with her baby boy. She deleted them all because she couldn’t bear to see how bad she looked. “There is nothing normal about a bald, pregnant broad with no eyelashes or eyebrows,” she declares.
Still, the hospital staff gave her rock star treatment. “They took the time to tell me that they admired what I had done,” she recalls. “I didn’t know how to tell everyone that I don’t feel I deserved any special commendation. I did everything I could to survive and only hoped this child would do the same.”
While getting the hang of breastfeeding from one breast (considered safe since she had been clear of chemo drugs for several weeks), she finally had a PET scan. No one gave her the results before she left the hospital. “I had a bad feeling,” she shares.
Eventually, the answers came. Expecting A or B, Cordry got something in between: There were rice nodules in her lungs and liver. But the doctor encouraged her, saying it was probably nothing and the breast cancer had been quelled. She didn’t have her prayed-for “all clear.” But, “they will never call me ‘cured,’” she explains.
Kirby says the size and stage of her tumor dictated a six-week course of radiation following chemo (so, therefore, no delay). Cordry, ever the good patient, took it in stride, as she remembers saying: “Excuse me, how will I know if it is the radiation or the newborn wearing me out? Who cares … it shall all pass.”
Reconstruction was the most difficult part, according to Cordry. But since it was the last leg of the journey, it was manageable. When Connor Luke was nearly 5 months old, Cordry found yet another specialist who guided her through 12 hours of surgery to remove her remaining breast and undergo a bilateral DIEP-flap reconstruction (using her body’s own skin and fatty tissue versus implants).
“I thought, ‘this will be the final step to closing the door on this chapter in our lives.’ Except it will never be closed,” she quickly counters. Cordry will take tamoxifen for five years to aid in the prevention of a recurrence. She’ll also need to submit to regular scans and checkups. And, of course, she’ll always have the scars of a surgically altered body.
She’ll forever be a survivor.
As Connor Luke approached his first birthday, the family finally made the trek to Africa. But, on that voyage, Cordry began to experience lower abdominal pain. She immediately suspected a tumor had taken up residence on one of her ovaries. “Metastatic breast cancer,” she worried to herself, even as she tried to fight off the thought.
She came home and requested a full hysterectomy — she couldn’t afford, in her mind, to wait for testing. Ten days later, the pathology report came back: it was nothing.
“There is a line between being proactive and paranoid. [But] I don’t know where it is,” she confesses.
She has camaraderie — women who know what it’s like to live with cancer. Though it’s unusual to encounter others who are also expecting, it’s common to find support, whether through the Pregnant with Cancer group or Gilda’s Club (among many). But, Cordry didn’t discover consolation among the familiar.
“It’s hard to see anyone at Stage 3 or 4; they’ve crossed over to the other side where you don’t want to be,” she divulges. As Cordry’s own cancer went into remission, her neighbor died of breast cancer at age 35. “I didn’t know what to say. We’re in this together, but I don’t want to be in this club,” she laments.
“I’m afraid of being her,” she explains. “Imagine having to leave your kids.”
Troubled by the motherless babies she met at Komen races (children of women who staved off treatment during pregnancy only to succumb to cancer soon after) and inspired by her mother, who served her community, Cordry admits she feels she was spared in order to make a difference. She is committed to walking 60 miles in the Breast Cancer 3-Day challenge Nov 7-9 in Dallas. “Every three minutes there is another reason to walk,” she notes, acknowledging the sobering statistic that every three minutes a woman is diagnosed with breast cancer. “As long as I’m making a difference, God will leave me here.”
And Cordry is clear about her mission: “Women need to know they don’t have to abort,” she says simply, emphatically. Studies suggest a woman’s chance of survival has no bearing on whether the pregnancy is terminated, according to the ACS (something Cordry’s team of doctors also confirm). Additionally, cancer cannot be spread to the baby in utero; it’s the treatment that hasn’t been effectively researched.
Zaretsky sees Cordry as a trailblazer. “She did not settle,” he affirms. “The physicians involved in her care were in communication with each other and she enjoyed the benefits of a multi-specialty team. Not every patient is this fortunate and that is the challenge women face. If maternal treatment is not optimal or delayed, the fetus may benefit at the expense of decreased maternal survival and increased recurrence risk. If therapy is started too early and the drugs are not appropriate, then the fetus may be harmed.”
And that remains a looming question: Will the chemo that helped his pregnant mother survive affect Connor Luke’s development as he grows up?
“There is a minimal amount of information on the long-term outcome of children exposed to chemo in utero. The information out there, however, paints a positive picture,” offers Zaretsky.
It has now been three years since Cordry’s sojourn to survival began. It’s not easy dealing with menopause at such a young age. And, one of her arms will never be the same due to drainage problems caused by lymphedema — the inevitable result of surgery to remove her lymph nodes. But it doesn’t stop her from doing the things she loves, like waterskiiing. Or carrying her boy wonder.
At 43, Robin Cordry is “afraid to stop moving.”
