The Journey

A chronological record of the patient's journey from diagnosis through treatment, with medical information translated into understandable terms.

1
treatment

Radiotherapy: The Next Chapter

First radiotherapy clinic, 19 June. Adjuvant radiotherapy planned to the right breast, undissected axilla, and internal mammary chain, with a tumour bed boost (15 fractions over 3 weeks, starting mid-July). The team are being thorough given the extent of initial lymph node involvement.

  • • Met with the clinical oncologist on 19 June (first radiotherapy planning appointment)
  • • Fields: right breast, undissected axilla, internal mammary chain, possible lower neck
  • • Tumour bed boost recommended despite pCR
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2
milestone

Surgery Done. Pathological Complete Response.

Surgery on 30 May: therapeutic mammoplasty and axillary clearance after months of chemo. Histology confirms a pathological complete response (pCR): no residual invasive cancer in the breast, 0/31 lymph nodes positive. A small finding at an inner margin required extra immunostaining before full sign-off; confirmed clear on 15 June.

  • • Surgery 30/05/26: Magseed-guided therapeutic mammoplasty + axillary clearance
  • • Histology: pathological complete response (pCR), RCB 0
  • • Breast: no residual invasive cancer or DCIS in the main specimen
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3
milestone

Chemo Finished. Surgery Next.

After months of treatment (EC then weekly Taxol) alongside Phesgo, imaging now shows very little enhancement where the cancer was, and previously abnormal lymph nodes look normal. With a good response and reassuring heart checks, the next step is surgery in May.

  • • Genetics: no germline mutation identified
  • • Imaging response: MRI shows very little enhancement at the previous tumour site; nodes now look normal
  • • Chemo completed 24/04/26; Phesgo continues
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4
consultation

Halfway Check-in: Surgery Planning Starts

A follow-up with the breast surgeon confirmed a mid-chemo response on ultrasound, discussed aiming for breast-conserving surgery if feasible, and made it clear that an axillary clearance will be needed because of the extent of node involvement at diagnosis.

  • • EC completed 16/01/26; now mid-way through weekly chemo phase
  • • Surgeon planning: breast-conserving surgery as the aim (if imaging allows)
  • • Axillary clearance required due to N3 presentation at diagnosis
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5
milestone

Phesgo Starts (and the Weekly Phase Begins)

A new chapter of treatment begins: Phesgo (HER2-targeted therapy) starts, alongside the move into weekly chemo. Different rhythm, different side effects, same goal — maximum response before surgery.

  • • Phesgo (pertuzumab + trastuzumab) started
  • • Start of the weekly treatment rhythm
  • • HER2-targeted therapy is the “guided missile” part of the plan
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6
treatment

Weekly Taxol (Paclitaxel): What It Involves

After EC, the next phase is weekly Taxol (paclitaxel), alongside HER2-targeted therapy (Phesgo). This page explains what a typical weekly Taxol appointment involves and what it’s trying to do before surgery.

  • • Taxol = paclitaxel, usually given weekly for 12 weeks
  • • Often paired with HER2 treatment in HER2-positive breast cancer
  • • Pre-meds reduce allergy reactions; observation during the infusion
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7
scan

January Ultrasound: Small Further Response

A mid-treatment ultrasound showed the main breast lesion and the marked axillary lymph node were smaller again, with no other abnormal axillary nodes seen. The radiologist’s conclusion: a small further response to treatment.

  • • Index tumour measured 14 × 14 × 14 mm (down from 19 × 14 × 15 mm)
  • • Marked axillary node measured 11 × 5 mm (down from 13 × 8 mm)
  • • Total extent including satellite ~30 mm (previously ~31 mm)
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8
milestone

EC Complete: The First Phase Done

Four cycles of dose-dense EC are done. It’s a quiet but huge marker in the middle of treatment — the first phase completed, before moving on to weekly Taxol and continuing HER2 therapy.

  • • Dose-dense EC x4 completed (last EC on 16/01/26)
  • • This marks the end of the “every two weeks” phase
  • • Next step: transition to weekly Taxol, with HER2 therapy continuing
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9
scan

The Neck Scan: A Reassuring Check

Specialist neck ultrasound to investigate PET/CT findings - one tiny node that might not even be involved, everything else completely clear

  • • Specialist neck radiologist review of PET/CT findings
  • • Only ONE small 3mm lymph node found in neck
  • • Does not look overtly cancerous on ultrasound criteria
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10
treatment

EC Chemotherapy: What It Involves

The first phase of chemo: dose-dense EC (epirubicin + cyclophosphamide) every two weeks. Here’s what a typical EC cycle involves, why it’s given first, and what it’s trying to achieve before moving on to weekly Taxol.

  • • EC = epirubicin + cyclophosphamide, usually given every 2 weeks (“dose-dense”)
  • • Goal: shrink the breast tumour and clear disease from lymph nodes before surgery
  • • Often includes anti-sickness meds and injections/support to protect white blood cells
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11
milestone

The Roadmap: Ready to Begin

With cardiac clearance received, the complete treatment roadmap is finalized. Genetics testing initiated. Consent forms ready to sign. After weeks of preparation, assessment, and planning, treatment is ready to commence with a clear path to pCR.

  • • Treatment roadmap hand-drawn by oncologist - visual journey from now to pCR
  • • EC x4 cycles (every 2 weeks) → Weekly Taxol x12 weeks → Surgery → Radiation
  • • Phesgo throughout and beyond - approximately 18 cycles total
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12
consultation

The Heart of the Matter: Assessment and Clearance

Six days of cardiac testing and anxiety. From coronary calcification concerns to discovering excellent heart function. The relief of receiving clearance to proceed with the preferred chemotherapy regimen.

  • • Comprehensive cardiac workup: echo, CT coronary angiogram, blood tests, ECG
  • • Started Atorvastatin 40mg for cholesterol and potential cardioprotection
  • • Results: LVEF 71% (excellent heart function), non-obstructive coronary disease
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13
consultation

The Treatment Plan and the Cardiac Pause

PET/CT scan reveals no distant disease - cancer is localized (huge relief!). Meeting the oncologist at Royal Marsden, receiving the treatment plan with pCR as the goal. But an unexpected finding on the PET/CT leads to an urgent cardiac referral and a pause before treatment can begin.

  • • PET/CT scan: whole-body imaging to check for distant metastases
  • • Results: No distant spread - cancer is localized (excellent news!)
  • • Extensive local lymph nodes identified (axilla, subpectoral, lower neck to C7)
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14
diagnosis

The Results: Diagnosis, Complete Picture, and the Path to pCR

A week after the diagnostic tests, all results are in: HER2-positive invasive ductal carcinoma with lymph node involvement. The surgeon presents the complete diagnostic picture and outlines the NACT strategy with a clear goal - pathological Complete Response.

  • • Pathology confirmed: Invasive ductal carcinoma, Grade 3, HER2-positive
  • • Lymph node involvement confirmed in right axilla
  • • MRI mapped full extent of disease - approximately 25mm primary tumour
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15
diagnosis

The Diagnostic Days: Tests, Scans, and Questions

First consultation with the surgeon on Friday afternoon, followed by whirlwind of diagnostic imaging - mammogram, ultrasound, core biopsies. MRI scan the following week completes the picture. From reassuring examination to mounting concerns.

  • • Initial physical examination suggested lump might not be cancer
  • • Mammogram, ultrasound, and core biopsies performed same afternoon (Friday)
  • • Radiologist expressed concerns during examination
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