A Guide to the Diagnosis and Management of Triple Negative Breast Cancer

Triple negative breast cancer (TNBC) is a type of cancer that is deficient in the progesterone receptor (PR), estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). In typical bases of breast cancer, the cancer’s growth is fueled by one of these types of receptors, and the cancer’s aggressiveness is determined by the number of receptors present. Traditional therapies for the disease target the receptors, stopping the signal that allows the cancer to grow.

Since these receptors are absent in cases of TNBC, traditional hormonal and HER2 therapies cannot be used. Chemotherapy and radiation are the only therapies available.

Researchers have revealed that TNBC is more aggressive, morelikely to metastasize or spread to other organs than other types of breast cancer, and may reoccur after treatment. Most cases of TNBC area a basal-like cancer, which tend to be even more aggressive and recurrent.

Causes and Risk Factors

Two risk factors that can increase the possibility of this cancer include:

Mutations of breast cancer gene

You inherit BRCA1 and BRCA2 genes from your parents. If those genes work normally, they prevent your body from developing the cancer cells. Those born with a BRCA1 or BRCA2 gene mutation carry a higher risk of developing TNBC. A family history of breast cancer plays an important role to determine whether you have a chance of having gene mutations.

Ethnicity and age

Researchers have found that Hispanic, African-American, and Caribbean women are likely to suffer from TNBC or basal-like cancer in addition to being premenopausal. The cancer might happen to young women before age 40.

Signs and Symptoms

Possible signs and symptoms of the cancer include:

  • A new lump or mass
  • Nipple pain
  • Nipple retraction
  • Skin irritation
  • A discharge other than breast milk
  • Redness or thickening of the nipple

Diagnosis

Several tests are available to help to diagnose the presence of TNBC.

Mammogram

Mammography utilizes x-ray images to examine abnormal changes in the breast tissue. An image resulted from mammography is known as a mammogram.

Breast ultrasound

It is a medical procedure to determine whether a breast lump is a solid mass, which might be cancer, or a cyst, which is a fluid-filled sac and is not cancerous. Ultrasound images can explain any abnormality.

Breast MRI (Magnetic Resonance Imaging)

A breast MRI refers to a test that is applied to differ between cancerous (malignant) and non-cancerous (benign) areas in the breast. This test takes several images of your breast in which a computer combines resulting in more accurate images.

Treatment

Lumpectomy

Due to the lack of HER2 and hormonal receptors, this cancer does not respond to traditional hormonal therapies. That does not mean that the cancer is not treatable. There are several effective treatments to eliminate cancerous cells:

Surgery

Two types of surgery, lumpectomy and mastectomy, have proven effective in treating TNBC. A lumpectomy is a procedure when the surgeon removes the tumor and tissues around it. Mastectomy is a procedure to remove entire breast. Click on image to enlarge.

Radiation

Radiation is essential to eradicate any remaining cancer cells after lumpectomy or mastectomy. An external beam can help give radiation from outside of your body.

Chemotherapy

It refers to treatments with medications that block the growth of cancer cells. The drugs can kill any cancer cells in your body because they travel through blood. You can have chemotherapy before and after surgery.

Prognosis

The prognosis of this cancer depends on the tumor size, stage of the breast cancer and treatment strategies. A woman with TNBC might have a five-year survival rate or more after diagnosis.

References

Living Beyond Breast Cancer.org: Guide to Understanding Triple Negative Breast Cancer – https://www.lbbc.org/data/media/LBBCunderstandingguide_triplenegative.pdf

Cancerhelp.org.uk: Triple Negative Breast Cancer – https://www.cancerhelp.org.uk/about-cancer/cancer-questions/triple-negative-breast-cancer

Breatcancer.org: How Triple Negative Breast Cancer Behaves and Looks – https://www.breastcancer.org/symptoms/diagnosis/trip_neg/behavior.jsp

Photo Credit

Image courtesy of the National Library of Medicine.