What Is Triple Negative Breast Cancer
A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growthestrogen, progesterone, and the HER-2/neu gene are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 , estrogen receptors , and progesterone receptors .
Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective. Using chemotherapy to treat triple negative breast cancer is still an effective option. In fact, triple negative breast cancer may respond even better to chemotherapy in the earlier stages than many other forms of cancer.
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Is Early Menopause A Risk Of Chemotherapy For Breast Cancer
Yes. If you have not gone through menopause, chemotherapy may stop your ovaries from producing estrogen. You may go into early menopause. If you want to have children in the future, discuss the risks of infertility with your healthcare provider.
Some womens ovaries begin working again after chemotherapy treatment. Women who want to bear children in the future may also choose fertility preservation before starting chemotherapy.
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New Medications For Metastatic Breast Cancer
Immunotherapy drugs called checkpoint inhibitors have led to a significant improvement in survival rates for lung cancer and melanoma.
In 2019, Tecentriq became the first immunotherapy drug to be approved for triple-negative breast cancer that is metastatic or locally advanced but unresectable . However, in August 2021, Tecentriqs manufacturer voluntarily withdrew that indication in the United States.
However, also in 2021, the Food and Drug Administration approved Keytruda for high-risk, early-stage, triple-negative breast cancer. It is used in combination with chemotherapy as a neoadjuvant treatment , and then continued as a single agent as adjuvant treatment .
PARP inhibitors are another class of medication that may alter survival rates in the future, particularly among women who have hereditary breast cancer .
For bone metastases, bone-modifying drugs may be effective in both treating metastases and possibly reducing the development of further metastases in bone.
Finally, for people who have only a single or a few metastases , treating these metastases locally may be an option. While studies are young, treating oligometastases may improve survival or even lead to long-term survival for a minority of people.
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How A Breast Cancers Stage Is Determined
Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.
Treatment To The Breast
Your surgeon might remove the cancerous area with a border of normal breast tissue. This is called breast conserving surgery or a wide local excision. After this you usually have radiotherapy to the rest of the breast.
Or you might have the whole breast removed. This is called a mastectomy. You can choose to have a new breast made . You might have radiotherapy to the chest wall after having a mastectomy. You might have treatment with radiotherapy to the lymph nodes under your arm or further surgery to remove the nodes if they contain cancer cells.
You can have a breast reconstruction at the same time as surgery to remove the cancer, or at a later time. Having a reconstruction at the same time should not affect you having radiotherapy after surgery if you need it. The plan to have radiotherapy after a reconstruction might affect the reconstruction options you have.
Your surgeon will discuss all the pros and cons with you.
You usually have other treatments too.
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Stages Of Breast Cancer
Your breast cancer stage indicates the severity of the disease upon diagnosis. Your breast cancer stage indicates the severity of the disease upon diagnosis. Your cancer stage will always stay the same, even if the cancer shrinks or spreads during or after treatment. For instance, if youre diagnosed with stage 1 breast cancer, but the tumor later grows and spreads, its not considered stage 3 or 4 breast cancer. To determine whether the cancer has responded to treatment, a new stage may later be assigned an r in front of it to show that its different from the original stage.
Breast cancer staging is classified by:
- The size and location of the tumor
- Whether the cancer has spread to nearby lymph nodes or other parts of the body
- The grade of the tumoror how likely it is to grow and spread
- Whether certain biomarkershormone receptors or other proteinshave been found
All these attributes help your care team determine how to treat your cancer.
To assess the location, size and spread of cancer, your care team will use the TNM Staging System, developed and updated for breast cancer by the American Joint Committee on Cancer .
- TNM stands for Tumor-Node-Metastasis, which are important factors in determining the severity of your cancer.
- All cancers may be evaluated by TNM markers, but breast cancer staging also uses a few extra criteria for a more detailed description.
- Ultimately, your specific combination of TNM and these other markers will determine your cancers stage.
What Is The Survival Rate For Stage Ii Breast Cancer
If you are diagnosed with stage II breast cancer, you have an excellent chance of being cured and living a long and healthy life. According to the Susan G. Komen Foundation, the five-year survival rate for stage II is 90-99%.
I always tell patients that there are certain things that we have to do to get the cancer treated. but overall, the goal for treatment for stage II breast cancer is to be disease-free and to live a long and healthy life afterwards and there is a very excellent chance that that can happen, says Dr. Maxwell.
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Tumor : What Is The Size Of The Tumor
In general, the higher the number, the bigger the tumor:
- TX: It is not possible to measure the main, or primary, tumor.
- T0: The tumor is too small to detect in the breast.
- T1: The tumor is 2 centimeters or less across at its widest point.
- T2: The tumor is more than 2 cm but less than 5 cm across.
- T3: The tumor is more than 5 cm across.
- T4: Any size tumor is growing into the chest wall.
What Is The Survival Outlook For Breast Cancer
According to the National Cancer Institute , the percentage of patients surviving five years after diagnosis is:
- 99 percent for breast cancer that is still local to the breast
- 86 percent for breast cancer that has spread just outside the breast
- 29 percent for breast cancer that has spread to more distant parts of the body
The NCI also lists the five-year survival rate for breast cancer overall as 90.6 percent for women and 83 percent for men.
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Prognosis For Stage 2 Breast Cancer
Survival rates for breast cancer are determined based on whether the cancer is localized , regional , or distant . Metastatic breast cancer generally has a lower survival rate than localized breast cancer.
Stage 2 breast cancer exhibits regional spread and has an overall favorable prognosis, with a five-year survival rate of around 86 percent. This means people with this type of breast cancer are 86 percent as likely as those without cancer to live for at least five years after their diagnosis.
Early diagnosis may help improve outcomes. Also, its important that, along with the stage, your oncology provider assess the molecular features of the cancer. This ensures that youll receive the right therapies for your particular form of the disease.
How Is Dcis Diagnosed
DCIS is usually diagnosed by a stereotactic core needle biopsy. This is a biopsy of the breastthat is guided by mammography.
Same Day Results
At the Johns Hopkins Breast Center, we are sensitive to the anxiety a possible diagnosis of breast cancer creates for our patients. If the radiologist who read your mammogram suspects you have DCIS, he or she will arrange for you to have a stereotactic biopsy. The biopsy can sometimes be done the same day, but is always done within a week. On the day of your breast biopsy, you will be given the probability that the biopsy is a breast cancer. Firm confirmation will follow within 24 hours.
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Treatment For Early Stage Breast Cancer
If you are diagnosed with early stage breast cancer, the aim of treatment is to remove the breast cancer and any other cancer cells that remain in the breast, armpit or other parts of the body but cannot be detected.
Treatment for early stage breast cancer can vary from person to person. The stage of your breast cancer is an important factor when making decisions about treatment. However, the most suitable treatment for you also depends on other factors, such as where the cancer is in the breast, the cancers grade, and whether the cancer is hormone receptor-positive, HER2 positive or triple-negative. Your doctor will also consider your age, general health and preferences.
Treatment for early breast cancer may involve:
Usually more than one treatment is used. Treatment may be given in different orders and combinations. Learn more about different treatment options here.
Chemotherapy For Metastatic Breast Cancer
Advances in treatment are making it possible for women with metastatic breast cancer to live for many years. New drug therapies can not only slow down or stop a tumors growth but also keep symptoms at bay.
Which treatment your doctor recommends will vary based on your medical history, age, and breast cancer type, among other factors. Combinations of drugs are commonly prescribed for women with early-stage disease. Most women with advanced breast cancer generally receive only one drug at a time.
Chemotherapy drugs that MSK doctors commonly prescribe for advanced breast cancer include:
Women with advanced disease can also benefit from genomic testing. This is also called tumor sequencing or molecular profiling. It is offered to all MSK patients with metastatic breast cancer. Genomic testing involves looking at the cancer cells to see if there are any genetic mutations that could be linked to the specific type of breast cancer you have.
Our experts use a highly sophisticated testing approach developed by MSK researchers called MSK-IMPACT. The information gained from MSK-IMPACT can help us personalize your care. We can rule out drug therapies that may not work for you or sometimes recommend cutting-edge clinical trials designed to target the specific mutations in your tumor.
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Clinical Characteristics Epidemiology And Risk Factors
Triple-negative breast tumors have been characterized by several aggressive clinicopathologic features including onset at a younger age, higher mean tumor size, higher-grade tumors, and, in some cases, a higher rate of node positivity. A histologic study of basal-like tumors, of which all were ER/HER2negative, illustrated marked increases in mitotic count, geographic necrosis, pushing borders of invasion, and stromal lymphocytic response. The majority of triple-negative breast carcinomas are ductal in origin however, several other aggressive phenotypes appear to be overrepresented, including meta-plastic, atypical or typical medullary, and adenoid cystic.
In parallel with our understanding of the molecular basis of triple-negative breast cancer, our awareness of the epidemiology and risk factors associated with this disease process has matured, specifically related to age and race. Among approximately 500 women evaluated in the Carolina Breast Cancer Study, those with basal-like tumors were more likely to be African-American and premenopausal . These investigators observed a particularly high prevalence of basal-like tumors among premenopausal, African-American women compared to postmenopausal African-American women and nonAfrican-American women of any age . These findings are consistent with several large-scale, population-based studies indicating that triple-negative breast cancers are more likely to occur among premenopausal women of African-American descent.
The Number Staging System
Breast cancer can also be divided into four number stages. We have put these into a table to make them easier to understand. You can .
This information is about stage 1 to 3 breast cancer.
Stage 1 breast cancer is when the cancer is 2cm or smaller. There may be no cancer cells in the lymph nodes in the armpit or tiny numbers of cancer cells are found. Sometimes the cancer cannot be found in the breast, but cancer cells have spread to lymph nodes in the armpit.
Stage 2 breast cancer is when the cancer is up to or bigger than 5cm. It may or may not have spread to the lymph nodes under the arm. Sometimes the cancer cannot be found in the breast. But cancer cells have spread to 1 to 3 lymph nodes in the armpit or near the breast bone.
Stage 3 breast cancer is sometimes called locally advanced breast cancer. The cancer has spread to the lymph nodes in the armpit and sometimes to other lymph nodes nearby. It may have spread to the skin of the breast or to the chest muscle. The skin may be red, swollen or have broken down. Sometimes the cancer cannot be found in the breast or is small but has spread to 4 to 9 lymph nodes in the armpit.
Stage 4 breast cancer is also called secondary or metastatic breast cancer. This is when the cancer has spread to other parts of the body, such as the bones, the liver or lungs. We have separate information about secondary breast cancer.
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Node : Has The Cancer Spread To The Lymph Nodes
More specifically, which lymph nodes and how many? Lymph node staging is very complex. For the purposes of this article, the higher the number, the greater the number of lymph nodes affected:
- NX: It is not possible to evaluate lymph node involvement, such as if the nodes near the breast have already been removed before formal staging.
- N0: There are no signs of cancer in the lymph nodes near the breast.
- N1: Cancer cells are in one to three lymph nodes close to the breast, such as under the arm.
- N2: Cancer cells are in four to nine underarm lymph nodes, or they have enlarged a lymph node in the breast.
- N3: Cancer cells are in 10 or more lymph nodes under the arm or in lymph nodes farther away from the breast, such as in the collarbone.
Survival Rates Of Stage 1 And Stage 2 Breast Cancer
According to data from the Australian Institute of Health and Welfare, the earlier breast cancer is first diagnosed, the better the outcome. The survival rates of people diagnosed with breast cancer have also improved over time due to earlier detection and improvements in treatment. Most people with early stage breast cancer can be treated successfully.
You may wish to discuss your prognosis and treatment options with your doctors. However, it is not possible to predict the exact course of your cancer and how long you will live. The length of survival can vary from person to person. Factors that influence this include:
- Response to treatment
- The type of breast cancer that you have
- The rate of tumour growth
- Other factors such as your age, medical history and overall health.
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First What Exactly Does Stage Ii Mean
Breast cancer has traditionally been classified in five stages, from 0 to IV, based on how large the tumor is and how far it has spread in the rest of your body. Stage 0 generally means you have noninvasive cancer or pre-cancer that has not moved outside the breast as you go up the scale, the tumor generally gets larger and the cancer becomes more invasive all the way to Stage IV, which means the cancer has spread to other parts of the body, such as the liver, bones or brain.
Breast cancer stages have historically been based on three different factors, Dr. Larkin. explains. The first is the size of the tumor, the second is whether or not the tumor has metastasized to any lymph nodes and the third is whether the tumor has spread to any other places in the body, which is known as metastatic breast cancer. This staging system is known as TNM, for Tumor, Nodes and Metastasis.
Stage II breast cancer is broken down further into stage IIA and IIB, with these criteria:
Stage IIA: Either there is no tumor found in the breast, or there is a tumor up to 2 cm AND cancer has spread to 1 to 3 lymph nodes
There is a tumor of 2 to 5 cm , but the cancer has NOT spread to the lymph nodes
There is a tumor of 2 to 5 cm, AND cancer has spread to between 1 and 3 lymph nodes
There is a tumor larger than 5 cm, but cancer has NOT spread to the lymph nodes or reached the chest wall or skin.
What else do I need to know about cancer staging?
How Grade Affects Treatment Options
Your treatment team will consider the grade of your cancer when deciding which treatment to offer you.
If you have grade 3 breast cancer, youre more likely to be offered chemotherapy. This is to help destroy any cancer cells that may have spread as a result of the cancer being faster growing.
Chemotherapy is less likely for grade 1 and grade 2 cancers.
The grade of your cancer alone will not determine what treatment youre offered. Your treatment team will consider the grade alongside all other information about your cancer when deciding on the best treatment options for you.
Find out more about breast cancer and prognosis.
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