Signaling Pathway Of Cspg4 Protein
The CSPG4 protein is expressed as a cell surface proteoglycan by basal breast carcinoma cells. Therapeutically, CSPG4 inhibition allows for efficient management of breast cancer . Monoclonal antibodies can block the CSPG4 protein, which hinders survival signaling pathways in tumor cells. In addition, controlling the overexpression of CSPG4 by targeting it therapeutically is seen in different TNBC cells .
Taking Care Of Yourself
After your treatment is over, your doctor will want to see you often to make sure the cancer doesn’t return. For the first 3 years, you’ll likely see them every 3 to 6 months. For 2 years after that, you’ll probably visit every 6 to 12 months. Once you’ve been cancer-free for 6 years, you’ll probably go back only once a year. Tell the doctor right away if you get any new symptoms or if you have pain or other problems that relate to your breasts.
What Are Symptoms Of Triple Negative Breast Cancer
TNBC symptoms are the same as other common breast cancers. And many breast cancer symptoms are similar to other less serious conditions. That means having certain symptom doesnt mean you have breast cancer. Possible breast cancer symptoms include:
- A new lump or mass.
- Swelling in all or part of a breast.
- Nipple retraction, when your nipple turns inward.
- Nipple or breast skin thats dry, flaking, thickened or red.
- Nipple discharge that is not breast milk.
- Swollen lymph nodes. This symptom happens when breast cancer spreads to the lymph nodes under your arm or near your collarbone.
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History Of Radiation Therapy
A history of radiotherapy can lead to the development of secondary tumors. This is mainly dependent on the patients state and age . Patients aged < 30 years are considered at higher risk , and radiotherapy treatments, such as multiple-field IMRT and double partial arc techniques can increase the chances of secondary tumors . Radiotherapy in patients with a family history of breast cancer is considered to be at a higher risk .
Stages Of Breast Cancer
The stage of breast cancer is based on the size and location of the tumor, as well as whether the cancer has spread beyond the part of the breast in which it originated. To determine the stage of breast cancer, healthcare professionals use a scale of stage 0 to stage 4.
Stage 0 breast cancers are isolated in one part of the breast, such as a duct or lobule, and show no sign of spreading into other tissue.
Stage 1 is typically localized, although further local growth or spread may cause the cancer to move into stage 2.
In stage 3, the cancer may be larger and has affected the lymph system. Stage 4 cancer has spread beyond the breast and nearby lymph nodes, and into other organs and tissues of the body.
In addition to stages, breast cancers are given grades based on the size, shape, and activity of the cells in the tumor. A higher-grade cancer means a greater percentage of cells look and act abnormal, or they no longer resemble normal, healthy cells.
On a scale of 1 to 3, with 3 being the most serious, TNBC is often labeled grade 3.
American Cancer Society , the symptoms of TNBC can be the same as those for other types of breast cancer. ACS recommends regular screenings such as mammograms to detect breast cancer before symptoms appear, the time when treatment is most effective.
Other signs of breast cancer include:
Any of these signs can be caused by other conditions. But it is always good to have them checked out by your healthcare professional.
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A Note About Statistics
Survival rates are statistics. As such, they tend to tell us how the average person will do with an average triple-negative breast cancer. But people and tumors arent statistics. Some people will do better, and some people will do worse.
Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior, and there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.
Survival Rates For Triple
Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found, and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as they are familiar with your situation.
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Moffitt Cancer Centers Approach To Triple Negative Breast Cancer
At Moffitt Cancer Center, we believe in a multispecialty approach to breast cancer diagnosis and treatment. Our Don & Erika Wallace Comprehensive Breast Program comprises highly specialized medical oncologists, radiologists, fellowship-trained surgeons, radiation oncologists and other health care professionals who work together to provide our patients with well-rounded care. Our patients also have access to our supportive care services, which include counseling, integrative medicine, nutritional help and much more.
We continue to make strides in developing our understanding of triple negative breast cancer. Treatments are being evaluated regularly by medical researchers and clinicians as more is being learned about triple negative cancers. Our extensive research efforts and innovative clinical trials help our patients lead healthy and productive lives.
If you are interested in learning more about triple negative breast cancer treatment at Moffitt, call or complete a new patient registration form online.
What Is The Treatment For Triple Negative Breast Cancer
Healthcare providers and researchers are making significant progress on TNBC treatments. Recent clinical trials are testing new combinations of drugs and new approaches to existing treatments. Some existing treatments are:
- Chemotherapy: Providers might combine chemotherapy and surgery, with chemotherapy being used to shrink your tumor before surgery or after surgery to kill cancer cells throughout your body.
- Surgery: This could be a lumpectomy to remove an individual lump, or a mastectomy to remove an entire breast. Providers then perform a sentinel node biopsy or axillary node surgery to look for signs your breast cancer has spread to your lymph nodes.
- Radiation therapy: Post-surgery radiation therapy helps reduce the chances your cancer will return or recur.
- Immunotherapy: This treatment stimulates your immune system to produce more cancer-fighting cells or help healthy cells identify and attack cancer cells. Immunotherapy can be added to chemotherapy to before surgery to shrink the tumor. You might also receive immunotherapy for about a year after your surgery and post-surgery radiation therapy.
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Mammalian Target Of Rapamycin
The mTor pathway is responsible for poor prognosis due to the aggressive nature of the cancer and its good tissue invasion property . Errors in the mTOR pathway are strongly correlated with malignancy . The phosphorylation reactions of this pathway are also associated with proliferation, vascular endothelial growth factor, and angiogenesis, that enhance endothelial cell growth . Moreover, high expression of a protein kinase enzyme has been reported to be involved in tumor invasion and metastasis therefore, inhibiting the mTOR pathway can be an efficient anti-cancer strategy for several human malignancies . In general, inhibitors of the PI3K/AKT/mTOR network can be grouped as: 1) AKT blockers, 2) Pan-PI3K/mTOR blocker, 3) PI3K blocker, 4) Rapalogs , and 5) mTOR blocker . The mTor pathway and checkpoints where it can be blocked are presented in Figure 4.
FIGURE 4. The mTor pathway illustrating two distinct complexes . The pathway is stimulated by different growth factors. The mTORC2 activated Akt. Multiple cell functions are regulated by both mentioned complexes that are considered vital for cancer development. Also, in the figure different steps of the pathway that can be blocked by inhibitors are shown .
Treatment For Triple Negative Breast Cancer
The main treatments for triple negative breast cancer are surgery, chemotherapy and radiotherapy. The treatment you need depends on:
- where the cancer is
- the size of the cancer and whether it has spread
- how abnormal the cells look under the microscope
- your general health
You might have surgery to remove:
- an area of the breast
- the whole breast
When you have your surgery, the surgeon usually takes out some of the lymph nodes under your arm. They test these nodes to see if they contain cancer cells. The surgeon might check the lymph nodes closest to the breast using a procedure called sentinel lymph node biopsy. Testing the lymph nodes helps to find the stage of the cancer and decide on further treatment.
After breast conserving surgery you usually have radiotherapy to the rest of the breast tissue.
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What Are The Symptoms Of Triple Negative Breast Cancer
The symptoms of triple negative breast cancer are the same as any other type of breast cancer.
Symptoms can include:· A new lump in the breast, armpit area or around the collarbone.· A change in breast size or shape.· Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple.· Clear or bloody nipple discharge.· Changes to the skin including redness, puckering or dimpling .· Breast tenderness or pain
You can learn more about the symptoms of breast cancer here.
What Are The Mortality Rates For Triple
The overall five-year survival rate for TNBC is 77.1%. Broken down by stage for TNBC, it is as follows:
- Localized: 91.3%
- Regional: 65.8%
The survival rates may be related to the fact that TNBC is often diagnosed at a later stage when it is first found. Treatments are also more limited. Hormone therapies are not effective, as well as targeted therapy like Herceptin. Surgery, chemotherapy, and radiation are the only treatments available.
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Why Is Triple Negative Breast Cancer Harder To Treat
Many of the most effective breast cancer treatments work by targeting receptors. For example, the drug trastuzumab kills breast cancer cells by latching onto the HER2 receptor, while tamoxifen works by blocking the oestrogen receptor and stopping oestrogen from stimulating breast cancer cells. Because triple negative cancers lack receptors, its not possible to treat them using targeted drugs like these.
Treatment for triple negative breast cancer is therefore limited to surgery, radiotherapy and chemotherapy. Because chemotherapy is not as targeted as drugs like trastuzumab and tamoxifen, it can cause significantly more side effects.
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, Tecentriq’s 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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When Should I Go To The Emergency Room
You might also have unusually strong side effects from your cancer treatment. While your healthcare provider likely gave you medication to help control your side effects, you should go to the emergency room if your side effects continue despite medication.
Many cancer treatments affect your immune system, increasing the chance you will develop infections. Symptoms that might require an emergency room visit during treatment are:
- Fever of 100.5 and above.
- Persistent nausea and vomiting.
Cancer And The Female Breast
Figure: Breast and Adjacent Lymph Nodes
Figure: The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Inside a woman’s breast are 15 to 20 sections, or lobes. Each lobe is made of many smaller sections called lobules. Fibrous tissue and fat fill the spaces between the lobules and ducts . Breast cancer occurs when cells in the breast grow out of control and form a growth or tumor. Tumors may be cancerous or not cancerous .
Additional Information
Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone AM, Henley SJ, Eheman CR, Anderson RN, Penberthy L. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. 2015 Mar 30 107:djv048. doi: 10.1093/jnci/djv048. Print 2015 Jun.
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How Is Triple Negative Breast Cancer Diagnosed
The first step might be a mammogram to evaluate a suspicious mass or lump in your breast. Based on what they learn, healthcare providers might perform a biopsy to remove breast tissue. Then they examine the tissues cells to determine the cancer subtype. Identifying the cancer subtype is part of the staging process, which is when providers decide how to treat your cancer.
Sometimes providers use the following tests before treatment to check on your tumors size and whether it has spread, or after treatment to monitor response to treatment:
Treatment Of Triple Negative Breast Cancer
Standard treatment of early stage triple negative breast cancer typically consists of surgery, chemotherapy and usually a course of radiotherapy. Often chemotherapy treatment is given prior to breast surgery as can effectively reduce the size of the breast cancer while providing useful information about the effectiveness of the treatment being given.
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Immunosuppressive Immune Cells In The Tnbc Tumor Microenvironment
The tumor microenvironment involves the surrounding blood vessels, fibroblasts, immune cells, signaling molecules and the extracellular matrix around the tumor . Tumor Infiltrating Lymphocytes produce endogenous antitumor immune response for inhibiting tumor progression and improving free survival rate of TNBC patients . Tumor associated macrophages are important for immunosuppressive role by secreting inhibitory cytokines, regulatory T cells infiltration promotion, and reactive oxygen species reduction . Cancer-Associated Fibroblasts lower anti-tumor immunity, favor tumor cell proliferation and invasion and reshape the extracellular matrix . Tumor associated neutrophils aid in lysing tumor cells and induce antitumor function .
Symptoms Of Triple Negative Breast Cancer
The symptoms of triple negative breast cancer are similar to other breast cancer types.
Symptoms can include:
- a new lump or thickening in your breast or armpit
- a change in size, shape or feel of your breast
- skin changes in the breast such as puckering, dimpling, a rash or redness of the skin
- fluid leaking from the nipple in a woman who isnt pregnant or breast feeding
- changes in the position of nipple
Make an appointment to see your GP if you notice anything different or unusual about the look and feel of your breasts.
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Who Is At Risk Of Developing Triple Negative Breast Cancer
Anyone can be diagnosed with triple negative breast cancer and should be aware of their own personal risk factors. You can use the online iPrevent tool to better understand your breast cancer risk and act on it.
There are a number of known risk factors for triple negative breast cancer including:
BRCA Mutations
A BRCA1 gene mutation is associated with a higher risk of triple negative breast cancer. However, most triple negative breast cancers are not caused by a BRCA gene mutation. If you have a strong family history of breast cancer, you may wish to consider genetic testing. This is something to discuss with your doctor.
Being Pre-Menopausal
While the average age of first being diagnosed with breast cancer in Australia is 61, triple negative breast cancer occurs more often in patients who are pre-menopausal or under 50 years of age. The cause of triple negative breast cancer in this young age group is not yet completely known. However, it could be due to breasts of younger women in their childbearing and breastfeeding years is of a different composition to the breast of an older women who has been menopausal for a long time.
African American and African Women
Triple negative breast cancer is more likely to be diagnosed in African American and African women compared with white or Hispanic women. This is thought to be due to genes or mutations that pre-dispose this group of women, particularly pre-menopausal women, to triple negative breast cancer.