Statistics Don’t Account For Late Recurrences
When comparing triple-negative breast cancer to positive tumors, it’s important to keep in mind late recurrences. Most statistics are presented as five-year survival rate, and in this setting, triple-negative breast cancer can look more ominous. But looking at longer periods of time, say 20 years following diagnosis, this may be different.
The Ratio Of Spindle Cell Vs Epithelial Cell Elements Is Variable
The ratio of the spindle cell component to the ductal-carcinomatous component is variable. Sometimes they are in a 1:1 ratio, ranging right up to an 8:1 ratio or higher.
However, if the ductal carcinoma element is higher than 50%, the tumor might be named differently. Even though elements of ductal, lobular and squamous patterns are often present, sometimes there is a pure spindle cell pattern in spindle cell carcinoma tumors.
When this is the case, differential diagnosis become more difficult and more important. Pure spindle-cell presentations must be differentiated from:-
- primary sarcoma
Prognosis For Metastatic Breast Cancer
Metastatic breast cancer isnt the same for everyone who has it. According to the National Breast Cancer Foundation, your symptoms at stage 4 will depend on the degree to which the cancer has spread in your body.
Although metastatic breast cancer has no current cure, it can be treated. Getting the right treatment can increase both your quality of life and longevity.
Life expectancy for breast cancer is based on studies of many people with the condition. These statistics cant predict your personal outcome each persons outlook is different.
The following factors can affect your life expectancy with metastatic breast cancer:
- your age
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Living With Stage : The Breast Cancer No One Understands
Editor’s note: We’re bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.
A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.
âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â
An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent median survival is three years. Annually, the disease takes 40,000 lives.
A Case Series Of Metastatic Metaplastic Breast Carcinoma Treated With Anti
- 1Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
- 2Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, United States
Metaplastic breast cancer is a rare and often chemo-refractory subtype of breast cancer with poor prognosis and limited treatment options. Recent studies have reported overexpression of programmed death ligand 1 in metaplastic breast cancers, and there are several reports of anti-PD-1/L1 being potentially active in this disease. In this case series, we present 5 patients with metastatic metaplastic breast cancer treated with anti-PD-1-based therapy at a single center, with 3 of 5 cases demonstrating a response to therapy, and one of the responding cases being a metaplastic lobular carcinoma with low-level hormone receptor expression. Cases were evaluated for PD-L1 expression, tumor infiltrating lymphocytes , DNA mutations, RNA sequencing, and T-cell receptor sequencing. Duration of the response in these cases was limited, in contrast to the more durable responses noted in other recently published reports.
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Rna And Tcr Sequencing
Comparison of RNA sequencing did not demonstrate significant differences between metaplastic and non-metaplastic cases in multiple genes of interest, but did note multiple outlier genes, with an arbitrary cutoff of a modified z-score > 3 in 2 or more metaplastic cases selected to identify possible outliers: SOX8, CIC, COL9A3, ZFAND1, UBE2W, C2orf40, ENY2, RBM39, TGS1, DPY19L4, CLEC18A, ACAN, SLC25A32, VIRMA, IGF2, NOTUM, WWP2, NPIPB11, UPK1B, GABPB1, NR4A1, SLC25A42, FBXO25. RNA expression in pathways of interest in MBC are further presented in Figures 1, 2, 4, 5 and 8.
Figure 8 RNA Heat Map. RNA expression heatmaps with modified z-scores of expression vs non-metaplastics represented for each patient for 3 molecular pathways of interest in metaplastic breast cancer, RAS-MRK-ERK pathway, PI3K-AKT-mTOR pathway, TP53 pathway.
TCR sequencing did not find significant changes in T-cell diversity by richness or clonality at baseline or during treatment between metaplastics and non-metaplastics. Evaluating the clonotype structure, metaplastics as a group vs non-metaplastics did not have significant differences in the amounts of higher frequency or lower frequency clones . However, Case 2 and Case 4 had a greater proportion of high-prevalence clones compared to other cases at baseline with Case 2 being a responder and Case 4 being a non-responder.
Thermal Ablation Or Cryoablation
Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying cancer cells by either heating or freezing them. For example, radiofrequency ablation involves inserting a needle into individual tumours in the liver and destroying them with heat. RFA is a specialist treatment and not widely available. Your treatment team can tell you if it may be suitable for you.
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What Is Metaplastic Carcinoma Of The Breast
Metaplastic carcinoma of the breast is a subtype of invasive breast cancer. Metaplastic breast cancer is a very rare form of breast cancer, accounting for less than 1% of cases. Like invasive , metaplastic carcinoma starts in the milk ducts. Since it is invasive, it has grown through the wall of the milk duct into other breast tissues or beyond the breast.
Doctors call it metaplastic because of the way the cells look under a microscope. Instead of looking like ductal cells, metaplastic tumor cells look very abnormal. In fact, they look more like other tissues in the breast, such as connective tissue. This has lead scientists to believe the ductal cells went through some kind of unexplained changeor metaplasia.
Because the cells look so different, metaplastic breast cancer can be hard to diagnose. If your results suggest this cancer, consider getting a second opinion. You can do this by asking your doctor to send your biopsy specimen slides to a different pathologist. Consider sending the slides to a cancer center with experience diagnosing metaplastic breast and other rare breast cancers.
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Treatment By Breast Cancer Type
Most patients underwent oncologic breast surgery, including surgical evaluation of the axilla . Mastectomy was more commonly used in the metaplastic BC group , as was SLND . Regional nodal irradiation was more often used as a part of treatment for other BC than for metaplastic BC and TNBC , respectively.
With regard to systemic therapy, neoadjuvant chemotherapy was used nearly twice as often for metaplastic BC and TNBC than for other BC , and approximately one quarter of all women did not receive any chemotherapy. Hormone therapy was used the least often for TNBC but was part of the treatment paradigm for 11% of metaplastic BC and 55% of other BC cases.
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Adenoid Cystic Carcinoma Of The Breast
Less than 1 in 100 breast cancers are adenoid cystic cancer. This type of cancer is also sometimes called a cribriform cancer. It is a cancer type that is more often diagnosed in the salivary glands, but some develop in the breast tissue.
It is generally seen in older people but has been seen in people as young as 25.
Adenoid cystic breast cancer tends to be slow growing. Doctors usually recommend surgery. Most women dont need to have the whole breast removed . Instead, your doctor will just remove the area of the cancer. This operation is called breast conserving surgery.
The cancer rarely spreads elsewhere in the body. So you don’t usually need to have your lymph nodes removed. The risk of this type of tumour coming back is low, so the outlook is good.
Palliative And Supportive Care
Palliative and supportive care focuses on symptom control and support. Its an extremely important part of the care and treatment for many people living with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.
The palliative and support care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
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Histology Tied To Treatment Response Outcomes
byLeah Lawrence, Contributing Writer, MedPage Today April 12, 2021
Certain histological subtypes of triple-negative breast cancer were more aggressive with worse treatment response and clinical course compared with others, researchers reported.
A cohort study of 8,479 patients with rare breast cancers from the National Cancer Database between 2010 and 2016 indicated that metaplastic breast carcinomas had worse 5-year overall survival compared with two other rare TNBCs: medullary carcinoma and adenoid carcinoma. The 5-year OS rate for metaplastic carcinoma was 63.1% versus 91.7% for medullary and 88.4% for adenoid cystic carcinoma, according to Thomas A. Samuel, MD, of Cleveland Clinic Florida in Weston, and colleagues in JAMA Network Open.
The study appropriately interrogates the false monolithism of TNBC as a disease for which poor survival is universal, said Oluwadamilola “Lola” Fayanju, MD, MA, MPHS, of Duke University in Durham, North Carolina.
“Indeed, it appears that triple-negative adenoid cystic carcinomas have 5-year survival rates that rival hormone receptor-positive disease,” Fayanju, who was not involved in the study, told MedPage Today. “By examining outcomes among less common histological subtypes, the authors highlight the importance of more individualized investigation for ‘orphan’ breast cancers such as metaplastic carcinoma, for whom good outcomes — particularly for triple-negative cases — remain elusive.”
Disclosures
Recurrence Of Metastatic Breast Cancer
Metastatic breast cancer is considered a chronic disease, so it doesnt go away and recur.
But in recent years, people under age 50 have seen a particularly strong decline in death rates due to breast cancer, according to the Centers for Disease Control and Prevention .
These declines are due in part to improved screening and treatment for the disease.
There are a few general facts that are helpful to know about breast cancer outlook:
- Breast cancer is the most common cancer diagnosis in the United States, according to the
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Poor Appetite And Weight Loss
Sometimes people with secondary breast cancer cannot eat as much as usual. This means they may have difficulty maintaining their weight as well as providing the body with energy.
Poor appetite can be due to the effects of the cancer, treatment or anxiety. You might find it easier to eat little and often instead of having set meals. If you still feel youre not eating enough, or are losing weight, talk to your doctor or nurse about dietary supplements or ask to speak to a dietician for specialist advice. In some circumstances you may be prescribed medication to help stimulate your appetite.
What Are The Potential Complications Of Metaplastic Breast Cancer
Metastasis or cancer spread is the main complication of breast cancer. This is more likely to happen with metaplastic breast cancer than other more common forms. Metaplastic breast cancer is also more likely to recur after treatment.
Metaplastic breast cancer prognosis depends on the stage and grade of the tumor. Less aggressive and lower stage cancers generally have a better outlook. Metaplastic breast cancer is usually at a higher stage and grade at diagnosis than other invasive breast cancers. However, there are other factors that can influence prognosis and survival, such as your age, your general health, and the cancers response to treatment. Ask your doctor how these factors affect your prognosis.
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How Life Expectancy And Relapse Differ From Positive Tumors
Questions about the survival rate and recurrence rate are very common when someone is diagnosed with triple-negative breast cancer . While prognosis is, on average, poorer than with hormone receptor or human epidermal growth factor receptor 2 positive tumors, triple-negative breast cancer is a very heterogeneous disease. On a positive note, and unlike hormone-positive tumors that commonly recur late , late recurrence is less common with triple-negative tumors. The recent approval of immunotherapy only for triple-negative disease is also optimistic.
We will look at factors that may affect survival or recurrence as well as the statistical rates of both. We will also look at life expectancy with stage 4 triple-negative breast cancers and recent case reports of a few long-time survivors.
Genomic Profiling And Pi3k Inhibition
Within previously identified genes of interest, 4 of 5 cases in our cohort had mutations of TP53, and 3 of 5 patients had mutations in the PI3K pathway, with Case 1 and Case 3 with PIK3CA mutations and Case 4 with a PIK3R1 mutation . This is particularly of interest in the context of immunotherapy as activating mutations of the PI3K pathway and loss of its antagonist PTEN have been found to have multiple effects on the tumor microenvironment. Loss of PTEN has been associated with increased expression of immunosuppressive cytokines, decreased tumor infiltration by T-cells, decreased T-cell mediated cell death, and increased PD-L1 expression . Activating mutations of the PI3K pathway have been associated with resistance to PD-1/PD-L1 inhibition, by decreased expression of IFN- and granzyme B, and decreased CD8+ T-cell infiltration . Use of PI3K inhibitors has been found to result in decreased PD-L1 expression, increased CD8+ T-cells, and inhibition of regulatory T-cells, restoring the anti-tumor immune response . Murine mammary models have suggested improved response to anti-PD-L1 therapy when used in combination with PI3K inhibitors . Given the potential synergy of PI3K inhibition and immune therapy, a combination approach may warrant further investigation in this group of patients with high incidence of PI3K pathway alterations.
Table 6 Patient Characteristics.
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What Type Of Cancer Is Breast Cancer
Invasive ductal carcinoma , sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. The abnormal cancer cells that began forming in the milk ducts have spread beyond the ducts into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body.
Comparative Biomarker Assessment Of Metaplastic Versus Non
The small sample size in this series prohibited extensive characterization of MBC. However, because data in MBC are limited due to the rarity of this disease, it was of interest to conduct an informal, hypothesis-generating descriptive comparison of immunoprofiles using MBC versus non-MBC specimens from the aforementioned phase Ib trial.
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Symptoms Of Metastatic Breast Cancer
The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.
- If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
- If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
- Breast cancer that has spread to your lungs or liver usually causes no symptoms.
The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.
These treatments may include:
- hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
- chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
- immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
- a combination of these therapies
In some cases, surgery or radiation therapy may be used to treat stage 4 breast cancer.
The following are the common treatment options for different types of stage 4 breast cancer.
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