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.

The Roadmap: Ready to Begin

Late November - Early December 2025. After weeks of diagnostic imaging, pathology results, cardiac workup, and genetics consultations, all the pieces are finally in place. The roadmap is drawn. The path is clear. It’s time to begin.

The Hand-Drawn Roadmap (November 25th)

Dr. Parton sat down with us and quite literally drew out the treatment plan. Hand-drawn. On paper. A visual roadmap from where we are now to the finish line.

There’s something powerful about seeing it sketched out - not just hearing it in words, but seeing the timeline, the phases, the decision points, the goal at the end.

The Route Map

Starting Point (Week 10 - approximately December 9-13, 2025):

Phase 1: EC Chemotherapy

  • E = Epirubicin (the red devil - anthracycline)
  • C = Cyclophosphamide
  • 4 cycles, every 2 weeks
  • Duration: 8 weeks total
  • With G-CSF support (Neulasta - stimulates white blood cell production)

Weeks: 10, 12, 14, 16

Phase 2: Weekly Taxol

  • T = Paclitaxel (taxane chemotherapy)
  • 12 weekly infusions
  • Duration: 12 weeks
  • Shorter infusion time than EC

Weeks: 18-30 (approximately)

Throughout: Phesgo

  • Pertuzumab + Trastuzumab (HER2-targeted therapy)
  • Subcutaneous injection (not IV - goes under the skin)
  • Starts with first chemo cycle
  • Continues throughout all chemotherapy
  • Keeps going after chemotherapy ends
  • Total: Approximately 18 cycles (about a year)
  • Every 3 weeks

Mid-Treatment Check-In:

  • After 2 cycles of EC (around 4-6 weeks in)
  • Ultrasound of breast and lymph nodes
  • At New Victoria Hospital
  • See if tumor is shrinking
  • Check response to treatment

Surgery:

  • After all chemotherapy complete
  • Around Week 30-32
  • Right breast surgery (type depending on response)
  • Right axillary lymph node surgery
  • This is the moment - pathology examination

Then the paths diverge…

Path A: No Residual Disease (pCR Achieved!) 🎯

If pathology shows NO cancer cells:

Treatment:

  • Continue Phesgo to complete 18 cycles total
  • Already got several during neoadjuvant phase
  • Complete the rest post-surgery

Radiotherapy:

  • Post-operative radiation (3-6 weeks)
  • To breast/chest wall
  • Potentially to lymph node areas

Outcome: Best possible scenario. pCR associated with excellent long-term prognosis.

Path B: Residual Disease Present

If pathology shows REMAINING cancer cells:

Treatment Switch:

  • Stop Phesgo
  • Switch to Kadcyla (T-DM1 / Trastuzumab emtansine)
    • Or another appropriate HER2-targeted drug
    • More potent antibody-drug conjugate
    • Delivers chemotherapy directly to HER2-positive cells
    • Standard for residual disease after neoadjuvant therapy
  • Complete remaining cycles

Radiotherapy:

  • Post-operative radiation (as planned)

Outcome: Still treatable. Kadcyla is effective for residual disease. But pCR is the goal.

Understanding the Timeline

Looking at that hand-drawn roadmap, you can see the journey:

  • ~8 weeks of EC - the tough part, dose-dense, every 2 weeks
  • ~12 weeks of Taxol - weekly, different side effect profile
  • ~30 weeks to surgery - approximately 7-8 months of chemotherapy
  • Then radiotherapy - 3-6 weeks
  • Phesgo continuing - to complete approximately a year total

From diagnosis in November 2025 to completion of all treatment: Roughly 1.5 years

That’s a long time. But there’s a path. There’s a plan. And at the end, there’s a goal: pCR.

The Genetics Consultation (November 28th)

Another piece of the puzzle: Why did I get breast cancer at 48?

Phone consultation with Dr. Zoe Kemp, Clinical Geneticist at Royal Marsden.

The Question

Most breast cancers are sporadic - bad luck, not hereditary.

But sometimes, faulty genes running through families can dramatically increase breast cancer risk.

Reasons to test me:

  • Young age at diagnosis (48 years)
  • Testing can explain why cancer occurred
  • Informs future cancer risk
  • May influence treatment (PARP inhibitors if BRCA positive)
  • Important for family members

The Test: 11-Gene Panel

Testing through Informed Genomics:

High-Risk Genes:

  1. BRCA1 - Breast and ovarian cancer
  2. BRCA2 - Breast and ovarian cancer
  3. PALB2 - Breast cancer partner to BRCA2
  4. TP53 - Li-Fraumeni syndrome (multiple cancer types)
  5. PTEN - Cowden syndrome
  6. STK11 - Peutz-Jeghers syndrome

Moderate-Risk Genes: 7. ATM 8. CHEK2 9. BARD1 10. RAD51C 11. RAD51D

If a mutation is found:

  • Explains cancer diagnosis
  • Defines future surveillance needs
  • Family members can be tested
  • May open treatment options (PARP inhibitors for BRCA)
  • Risk-reducing strategies available

If no mutation found:

  • Doesn’t rule out hereditary factor (could be untested gene)
  • More likely sporadic cancer
  • Standard surveillance

If “Variant of Uncertain Significance” (VUS):

  • A change detected but unclear if disease-causing
  • Cannot use for clinical decisions
  • May be reclassified as more data emerges

My Family History

Not particularly striking:

  • Mother: Deceased last year, no cancer (avoided doctors)
  • Father: 79 in January, no cancer (some prostate issues)
  • No siblings
  • One uncle with cancer in later life

Children: Son and daughter (both through egg donation)

So no obvious familial pattern. But young age at diagnosis warrants testing.

The Process

Simple:

  1. Review information and insurance implications
  2. Sign digital consent form (via MyMarsden)
  3. Call genetics team to request saliva kit
  4. Kit sent to home
  5. Spit in tube, mail back
  6. Results in about 4 weeks

Insurance considerations: Genetic testing results can affect future insurance applications. But this is diagnostic testing (not predictive), done after diagnosis.

Status: Consent signed. Kit requested. Awaiting results.

The Oncology Confirmation (December 3-4th)

Back to Dr. Parton. Everything is aligned.

Checklist:

✓ Cardiac clearance received from Dr. Lyon
✓ Preferred treatment regimen approved (EC → Taxol + Phesgo)
✓ Genetics testing initiated
✓ MDT (Multi-Disciplinary Team) review complete
✓ All imaging and pathology reviewed
✓ Port-a-Cath arrangements (central line for chemotherapy)
✓ Baseline blood tests
✓ Atorvastatin 40mg started (cardiac protection)

Today’s Tasks

Sign consent forms for:

  • EC chemotherapy (Epirubicin + Cyclophosphamide)
  • Taxol (Paclitaxel)
  • Phesgo (Pertuzumab + Trastuzumab)

Discuss:

  • What to expect
  • Side effects
  • Management strategies
  • Emergency contacts
  • Support services

Plan ultrasound assessment:

  • After 2 cycles EC
  • At New Victoria Hospital
  • See how tumor responding

Next appointment: In 2 weeks Treatment start: Approximately December 12th, 2025

The Weight of It All

Looking at that roadmap, seeing the phases laid out, understanding the timeline…

It’s a lot.

8 months of chemotherapy. Then surgery. Then radiation. Then continued HER2-targeted therapy.

Side effects:

  • Hair loss
  • Nausea
  • Fatigue
  • Neuropathy (nerve damage causing tingling)
  • Low blood counts (infection risk)
  • Cardiac monitoring
  • Potential long-term effects

Life on hold:

  • Young children (5 and 3 years old)
  • Normal activities limited
  • Energy depleted
  • Appearance changed
  • Plans postponed

But.

The Hope in the Plan

That hand-drawn roadmap doesn’t just show the hard parts. It shows the destination.

pCR.

No remaining cancer cells. Complete response. The best possible outcome.

And for HER2-positive breast cancer with this treatment combination: 70-80% achieve it.

That’s not wishful thinking. That’s medical evidence. That’s what modern targeted therapy has done for HER2-positive disease.

Twenty years ago, HER2-positive was one of the worst breast cancer subtypes. Today, with Herceptin, Perjeta, and others - it’s one of the most treatable.

The roadmap shows hard work ahead. But it also shows a realistic path to being cancer-free.

The Support System

Medical team:

  • Dr. Marina Parton (Medical Oncology, Royal Marsden)
  • Dr. Alexander Lyon (Cardiac Oncology, Royal Brompton)
  • Dr. Zoe Kemp (Genetics, Royal Marsden)
  • Mr. Paul Thiruchelvam (Breast Surgery, New Victoria)
  • Multidisciplinary team behind the scenes

Personal:

  • Alex (husband) - attending every appointment
  • Children - too young to understand but the reason to fight
  • Family and friends
  • Support services available through Royal Marsden

Ready to Begin

After all the waiting, testing, assessing, and planning…

All systems go.

The cardiac detour is complete. The heart is cleared. The treatment is planned. The roadmap is drawn.

Pre-treatment checklist:

✓ Imaging complete (mammogram, ultrasound, MRI, PET/CT)
✓ Pathology confirmed (HER2-positive, Grade 3, node-positive)
✓ Staging complete (localized disease - no distant metastases)
✓ Cardiac assessment (LVEF 71% - excellent function)
✓ Cardiac clearance (approved for EC chemotherapy)
✓ Genetics testing (in progress)
✓ MDT review (treatment plan endorsed)
✓ Treatment plan (EC x4 → Taxol x12 + Phesgo → Surgery → Radiation)
✓ Consent forms (ready to sign)
✓ Support in place (medical team, family, resources)

Goal clearly defined: Pathological Complete Response (pCR)

Path clearly mapped: Neoadjuvant chemotherapy with HER2-targeted therapy, surgery, radiotherapy

Timeline established: Starting ~December 12th, 2025. Treatment lasting approximately 8 months to surgery, then radiation, then continued Phesgo.

The Final Thoughts Before Starting

This is happening.

In about a week, poison will be pumped into my body to kill cancer cells.

My hair will fall out. I’ll feel sick. I’ll be tired. My hands and feet might tingle. I’ll need to be careful about infections.

For months.

But.

That poison is also the weapon that gives me a 70-80% chance of complete response.

That roadmap, as daunting as it looks, leads to a place where the cancer might be completely gone.

That hand-drawn timeline shows not just hardship, but hope.

Looking at That Roadmap

EC EC EC EC → T T T T T T T T T T T T → Surgery → ?

That question mark after surgery is the moment of truth.

Did we achieve pCR? Are the cancer cells gone?

We won’t know until we get there. All we can do is walk the path, follow the roadmap, endure the treatment, and aim for that goal.

But now we have:

  • The best medical team
  • The most effective treatment regimen for HER2-positive disease
  • Cardiac monitoring to keep me safe
  • A clear plan from start to finish
  • A realistic shot at being cancer-free

Ready or not, it’s time to begin.

Date: Late November - Early December 2025
Treatment Plan: Finalized and approved
Consent: Ready to sign
Genetics: Testing in progress
Cardiac: Cleared and monitored
Goal: Pathological Complete Response (pCR)
Start Date: Approximately December 12, 2025
Status: Ready to fight