How To Know If Breast Cancer Has Spread
The only way to truly know whether cancer has spread is to consult with a trained medical provider. With that being said, certain symptoms can suggest that breast cancer has spread to another area of the body. These symptoms will vary depending on the body part being affected. For example:
- Bones If breast cancer has spread to the bones, it can cause sudden bone pain that persists or worsens even when treated with rest or conservative techniques, as well as numbness or muscle weakness within an arm or leg. Metastasis to a bone can also increase calcium levels within the blood, which can cause fatigue, dehydration, nausea and reduced appetite.
- Liver When breast cancer travels to the liver, it can lead to a host of issues, including pain and swelling , reduced appetite, nausea, vomiting, unexplained weight loss, persistent hiccups, yellowing of the skin or eyes , anemia, overwhelming fatigue, drowsiness and confusion.
- Lungs If breast cancer spreads to a lung, someone may experience lung pain, coughing , wheezing and shortness of breath.
If youve been diagnosed with breast cancer and you begin experiencing any of these symptomsor any other noticeable symptomsyou should reach out to your physician as soon as possible so that they can order any necessary diagnostic testing and confirm whether your cancer has metastasized.
What Is The Recurrence Rate Of Triple
A 2019 study found that roughly 40% of people with stage 1 to stage 3 TNBC will see their cancer return after standard treatment. The remaining 60% will have long-term survival without recurrence.
The outcomes of treatment vary. About 42% of those with this form of cancer will have a rapid relapse after standard treatment. This recurrence typically occurs within the first 23 years following the initial diagnosis.
It is not currently possible to predict who will experience a relapse in their cancer, even if they have had intensive chemotherapy.
On average,
Triple-negative breast cancer can recur in various areas of the body and at local, regional, and distant levels:
- Local means that the cancer remains in the breast and has not spread.
- Regional is when the cancer spreads from the breast to lymph nodes and other structures located nearby.
- Distant refers to cancer that has spread far from the breast to other organs, such as the liver or lungs.
A 2017 study examined the patterns of recurrence among 1,930 people with TNBC. The researchers divided the patients into two age groups: 15% were younger than 40 years at the time of their diagnosis, and 85% were 40 years or older.
The researchers found only a small difference between the two groups in terms of recurrence of the cancer on the local level: 6% of those under 40 versus 5% of those aged 40 or above.
The same study found that the rate of regional recurrence was 2% for both groups.
What Does ‘receptor Positive’ Mean
Normal breast cells have estrogen and human epidermal growth factor receptor 2, or HER2, receptors. In the case of receptor-positive tumors, there are a significantly increased number of these receptors. A mutation or an increased number of genes results in this overproduction.
When the hormone estrogen binds to estrogen receptors, it stimulates the growth of the cell. The same is true with progesterone. With HER2, growth factors bind to this receptor to stimulate growth.
With triple-positive breast cancer, all of these are at play. This may affect the treatment and prognosis of these breast cancers.
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What Is The Prognosis For Triple Negative Breast Cancer
Triple negative breast cancer can be more aggressive and difficult to treat. Also, the cancer is more likely to spread and recur. The stage of breast cancer and the grade of the tumor will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.
Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.
Material on this page courtesy of Johns Hopkins Medicine
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Where Do These Numbers Come From
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results Program database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the breast.
- Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver, or bones.
New Treatments Needed For Advanced Triple
Triple-negative breast cancer tends to be more aggressive, harder to treat, and more likely to recur than other forms of the disease, such as hormone receptorpositive or HER2-positive breast cancers.
Conventional chemotherapy drugs have not been effective against triple-negative breast cancer, and new treatment options are needed, said Jung-Min Lee, M.D., of the Womens Malignancies Branch in NCIs Center for Cancer Research.
In the KEYNOTE-355 trial, 847 patients with advanced triple-negative breast cancer were randomly assigned to receive chemotherapy plus placebo or chemotherapy plus pembrolizumab.
The study assessed the amount of time before the disease worsened and overall survival in all patients, in those with PD-L1 combined positive scores of 1 or more, and in those with combined positive scores of 10 or more. The trial was funded by Merck, the manufacturer of pembrolizumab.
The PD-L1 combined positive score is essentially a measure of the extent to which cells in a tumor produce PD-L1, the immune checkpoint protein that pembrolizumab targets. By blocking immune checkpoints, pembrolizumab and other immune checkpoint inhibitors unleash the immune system against cancer cells.
The incidence of treatment-related side effects, including serious side effects, was similar between the two groups of patients in the study.
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Understanding Her2+ Status And Survival
Doctors use three markers to help define breast cancers and guide treatment. One of those is the HER2 protein. The other two are hormone receptors . When a cancer has none of these, doctors call it triple negative. Until recently, there wasnât much information about how these markers changed survival rates for breast cancer.
A recent study looked at the National Cancer Institute data to see if there were differences in survival for women based on these markers. The study shows there are. Overall, women who have HR+ and HER2- breast cancer do best. But in the later stages, those who have the HER2+ type have better survival rates than those with HER2-. Breast cancers that are triple negative have the lowest survival rates. The 4-year survival rates are as follows:
- HR+/HER2-: 92.5%
- HR-/HER2-: 77.0%
What Are Causes And Risk Factors For Triple
Although there are known risk factors for the development of any kind of breast cancer, doctors do not understand the exact cause of breast cancer.
- Normal cells become cancer cells due to changes or mutations in the DNA.
- While people inherit some DNA changes, others acquire these DNA changes during a person’s life.
The following are causes and risk factors for any type of breast cancer, including triple-negative breast cancer:
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Statistics Dont Account For Late Recurrences
When comparing triple-negative breast cancer to positive tumors, its 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.
Genetic Risks Of Triple
The main demographics for triple-negative breast cancer diagnosis are younger women , African-American and Hispanic women, and people with a BRCA1 mutation. About 15% to 20% of women with a triple-negative breast cancer prognosis have a genetic mutation. That means these women are at risk for other cancers and their family members could be at risk for cancers as well. Our team encourages women to talk with their providers about genetic counseling and testing.
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Palliative And Supportive Care
Living with advanced TNBC is often difficult, emotionally and physically. Its important to identify and make use of the support that is available, whether it be family, friends, therapists, support groups, financial counselors, social workers or members of the community. Let people know your concerns and what you need from someone, whether it is to watch the kids, provide a ride to your appointment, be another set of ears or a friend who can listen.Its also important to know what services are available to help deal with any physical symptoms that you have. Request a referral to Palliative Care as soon as you get your diagnosis. Palliative Care is there to help with the full range of emotional and physical issues you may encounter throughout the course of your illness.If you are experiencing financial problems, either related to your treatment or to your life, let your health care team know. There are resources that can help with those issues as well.
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Triple Negative Breast Cancer Stages
Triple negative breast cancer stages are assigned based on the extent of the cancer at the time of diagnosis, including the size of the tumor and whether it has spread to other areas of the body. Approximately 15 percent of all breast cancer cases are classified as triple negative, or hormone receptor negative, which means that the cancer cells lack receptors for estrogen, progesterone and HER-2/neu hormones. While triple negative breast cancers are sometimes treated differently than hormone-receptor-positive cancers, the staging process is the same for all types of cancer.
Breast cancers are typically staged using a numerical scale that ranges from zero to four, with higher numbers indicating progressively larger and more invasive cancers. Triple negative and other types of breast cancer stages include:
- Stage 0 Abnormal cells are confined to the milk ducts or lobes
- Stage 1 Small, localized cancers that have not spread beyond a single, nearby lymph node
- Stage 2 Moderate, regional cancers that have not spread beyond the lymph nodes in the underarm area
- Stage 3 Regionally advanced cancers that have spread beyond the breast but have not metastasized to distant organs
- Stage 4 Metastatic malignancies that have spread to distant organs
For more information about triple negative breast cancer stages, call or request to schedule an appointment online. No referrals are necessary to meet with Moffitts oncologists who specialize in breast cancer.
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What Is Stage 3 Triple Negative Breast Cancer
Typically, triple-negative breast cancer patients will receive a combination of surgery, radiation therapy, and chemotherapy.
Research shows that survival rates are higher when chemotherapy is used to shrink the tumor before surgery. Doing chemotherapy before surgery usually means fewer cancer cells in the body at the time time of surgery. This makes it less likely for cancer cells to spread to other areas of the body during the surgery.
Another option to treat triple-negative breast cancer is using drugs that inhibit the poly ADP-ribose polymerase enzyme. Particularly in patients that also test positive for BRCA mutation, PARP inhibitors make it harder for the cancer cells to survive.
Finally, a combination of immunotherapy and chemotherapy may treat advanced triple-negative breast cancer that tested positive for the PD-L1 protein. Immunotherapy helps the patients immune system work harder to fight the cancer cells, in this case also fighting the PD-L1 protein.
If you or someone you know has been diagnosed with triple-negative breast cancer, request an appointment to meet with one of our breast cancer specialists located in the Denver area, Colorado Springs, Boulder, and other areas throughout the Colorado Front Range. We are also happy to quickly schedule a second opinion to help you with making the cancer treatment decision youre confident in.
Signs And Symptoms To Know
The signs and symptoms of triple-negative breast cancer are the same as with all breast cancers. It may present as a lump, which is more commonly hard, painless and irregular, but can also be soft, round and painful. Other signs include:
- Breast swelling
- A nipple that turns inward
- Skin changes on the breast or nipple, including redness, dryness, thickening or flaking
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Triple Negative Breast Cancer Clinical Trial
Ongoing clinical trial tried to investigate effectiveness and safety of different possible treatment for future use and also has several clinical trials in the pipeline. The patient can also enroll their name in these trials to get novel therapies and also assist in research by providing the data to the research team. The different research aim is different, some are investigating new therapies to treat the patient, whereas some drugs may use in preventive therapy. Name registration for a clinical trial is the first step to enrolling name to the research3,4.
References
A New Era Of Hope For Patients With Triple
Triple-negative breast cancer is a particularly devastating subtype of breast cancer, as it is often diagnosed in young women and is associated with an exceptionally poor prognosis. The triple-negative designation indicates that the three key features driving most breast cancers are lacking, but it provides no clues as to potential biologic drivers. In the absence of any biologic insights, tailored, targeted treatment decisions have historically not been possible.
Consequently, until as recently as 2018, we have relied exclusively on nonselective cytotoxic agents, with modest success. For example, conventional neoadjuvant chemotherapy confers a pathologic complete response in just 50% to 55% of patients with early-stage triple-negative breast cancer,1-4 and among those who do not achieve a pathologic complete response, approximately one-third will die within 3 years.5 Moreover, patients with metastatic triple-negative breast cancer treated with conventional chemotherapeutics have a median survival of 12 to 18 months and an estimated 5-year overall survival of 11%.6 Thus, therapeutic innovation for early and late triple-negative breast cancer has been desperately needed.
Biologic Insight Leads to Therapies
From biologic insight springs hope for therapeutic innovation. Heather L. McArthur, MD, MPHTweet this quote
Immune Modulation Via Checkpoint Blockade
Antibody-Drug Conjugates
Forecast Finally Changing in Triple-Negative Disease
REFERENCES
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A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms male, female, or both to refer to sex assigned at birth. .
An individuals life expectancy depends on various factors besides the cancer stage.
Some life expectancy measures assess the size of present tumors and how far the cancer cells have spread. However, advancements in tumor biology have changed life expectancy calculations.
Treatment For Locally Advanced Breast Cancer
Treatment for locally advanced breast cancer varies from person to person. The stage of your breast cancer is an important factor when making decisions about treatment.
However, other factors can also be important, 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 locally advanced breast cancer will usually involve a combination of treatments, such as:
Sara, diagnosed 2019
I was diagnosed with triple positive breast cancer at the age of 36. I was the healthiest and fittest I had been in a long time, and simply living my best life with my husband and two young children. But in an instant, I became a statistic.
When you are diagnosed with breast cancer you join a special club, a club no-one actually wants to be a member of, but a club that exists invisibly all around us. Weve all been touched by cancer somehow, be it a friend or loved one.
Since my diagnosis, my outlook is one of positivity and learning to accept the path my life is now on. I wont lie, my diagnosis broke me, but only for a moment, because Im now busy rebuilding my life and living my new normal.Sara, diagnosed 2019
Treatments may be given in different orders and combinations. Learn more about different treatment options here.
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How Is Tnbc Diagnosed
Imaging tests are usually the first tests done:
- Mammography, the most common screening tool for breast cancer, uses X-rays to take images of the breast and can uncover tumors that may be too small to feel.
- MRI uses a magnet, radio waves and a computer to make detailed images of the breast with a much greater resolution than a mammogram offers.
The next step is a biopsy to remove a sample of suspicious cells from the breast to analyze them. Techniques include:
The appropriate type of biopsy for you depends on factors such as the size and location of the tumor. You may also have a biopsy of your underarm lymph nodes at the same time to see if any cancer is there.
Breast cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your breast cancer in a way that fits your individual needs and goals.