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.
How Do You Treat Triple
The treatment for triple-negative breast cancer depends on the stage. Options include surgery, chemotherapy, immunotherapy, and radiation therapy.
If the cancer is in stages 1 to 3, the primary treatment is surgery. This can be either a mastectomy or a lumpectomy . The surgeon usually performs a lymph node biopsy at the same time.
Chemotherapy is often used to shrink a tumor before surgery. In other cases, chemotherapy can be given after surgery to prevent the cancer from coming back. Chemotherapy medications used in triple-negative breast cancer include doxorubicin, carboplatin, paclitaxel, and cyclophosphamide.
Immunotherapy is a treatment that causes a persons own immune system to attack cancer cells. Like chemotherapy, immunotherapy can also help to shrink tumors before surgery. The two most common immunotherapies for triple-negative breast cancer are pembrolizumab and atezolizumab. Both of these medications are classified as immune checkpoint inhibitors.
After surgery for triple-negative breast cancer, most people also get radiation therapy. The goal of radiation therapy is to prevent the cancer from coming back. It is a standard treatment after a lumpectomy. Some people also get radiation after a mastectomy, depending on the surgerys findings.
The Prognosis For Patients With Triple
Prognosis refers to the likely outcome of treatment for patients with triple-negative breast cancer. Unlike other types of breast cancer that have a well-proven set of treatments, triple-negative breast cancer is still in the process of being researched for a more standardized treatment plan. Because of this, several treatments may be needed to find one that is effective. Studies have shown that triple-negative breast cancer is more likely to have metastasized , have a higher grade, and are more likely to recur after treatment.
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Treating Metastatic Breast Cancer
If you receive a diagnosis of breast cancer thats spread to your colon, your doctor will likely order additional tests to see whether the cancer has spread to other parts of your body.
Once you know exactly whats going on, you and your doctor can discuss the best options for treatment. This may include one or more of the following therapies.
Triple Negative Stage 1 Grade 3
I was diagnosed with stage 1 grade 3 Triple Negative breast cancer in October 2008 after a routine mammogram. I had a lumpectomy on the left breast and 6 weeks of radiation. The surgeon felt that chemo would be overkill. I did see an onocologist for a consultation and was told that chemo wouldn’t do any good anyway….The following day I saw the radiologist who said there was a 95% chance it wouldn’t reoccur. There were actaually 2 tumors, one tested negative, my own body had fought it off. After reading various articles I live in fear that it will come back. I have routine mammograms every 6 months and follow ups with the surgeon. I’m wondering if I should have gone in for a second opinion. Is chemo the normal protocol?
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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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Answers From The Community
I was told that there was no difference relative to recurrence between lumpectomy and mastectomy. I, too, chose lumpectomy, and I agree with cllinda about the faster healing and relative absence of discomfort. You’ll want to be a strong as possible for the treatment that follow, so why disadvantage yourself by undergoing a relatively radical surgery with a longer recovery?
I have triple negative bread cancer. I had a lumpectomy 5 years ago. My boobs look loped sided. Two weeks ago I found out my cancer returned. My body wont tolerate any more chemo or radiation Now I have no choice but to do the mastectomy. I wish I had done this before so I would not have to go through this again. Cancer doesnt give up
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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
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.
What Questions Should I Ask My Doctor
You will have lots of questions about your cancer, starting with your diagnosis. Here are some basic questions you might ask:
- What is triple negative breast cancer?
- How do you know my cancer is triple negative breast cancer?
- Why did I get this cancer?
- Do I need genetic testing?
- Has my breast cancer spread, and if so, how far has it spread?
- What is the stage of my cancer?
- What is my prognosis or expected outcome?
- What treatments do you recommend?
- Why do you recommend those treatments?
- What are those treatment side effects?
- Will I need surgery? If so, what surgery do you recommend and why?
- Im interested in participating in clinical trials. Are you able to help me find one?
- Do you know if there are any local support groups?
A note from Cleveland Clinic
Triple negative breast cancer is one of the more challenging breast cancers to treat. You might be discouraged by what you have read about triple negative breast cancer. But there are a number of very effective treatments for triple negative breast cancer, including immunotherapy, chemotherapy, surgery and radiation. And every day researchers learn more about this rare cancer. Their knowledge is your power. If youre concerned you arent getting the straight story about your cancer, ask your healthcare provider to walk you through your diagnosis and treatment options.
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Definitions And Molecular Features
It is important to clarify the relationship between triple-negative breast cancer and the basal-like phenotype. Triple-negative is a term based on clinical assays for ER, PR, and HER2, whereas basal-like is a molecular phenotype initially defined using cDNA microarrays. Although most triple-negative breast tumors do cluster within the basal-like subgroup, these terms are not synonymous there is up to 30% discordance between the two groups. In this review we will use the term basal-like when microarray or more comprehensive immunohistochemical profiling methodology was used, and triple-negative when the salient studies relied on clinical assays for definition.
Early Stage Clinical Trials
In a proof of concept study published in the Lancet, authors investigated olaparib in patients with advanced metastatic breast cancer with germline BRCA1/BRCA2 mutations. They investigated two doses of olaparib at 400 mg BD and 100 mg BD. Approximately half of patients in this study had TNBC with the remainder having other histological subtypes. Patients were heavily pretreated with a median of 3 prior chemotherapy regimens and platinum sensitivity was not needed for trial enrolment. Overall response rates were impressive in this heavily pre-treated population at 41% in the group receiving the higher dose and 22% in the group receiving the lower dose.
Kaufman et al investigated olaparib further in a large phase 2 basket trial with 298 patients in a single-arm study. Patients with any advanced solid-organ malignancy were included if they harboured a gBRCA mutation. In the breast cohort, patients may have received multiple lines of treatment and there was no requirement for platinum sensitivity. Response rates were modest with only 8 of 62 patients responding in this unselected population.
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Survival Rates And Prognosis
The outlook for breast cancer is often described in terms of relative survival rates.
Relative survival rates are an estimate of the percentage of people who will survive their cancer for a given period of time after diagnosis. Survival among people with cancer is compared to survival among people of the same age and race who have not been diagnosed with cancer.
Five-year relative survival rates tend to be lower for triple-negative breast cancer than for other forms of breast cancer.
According to the American Cancer Society, the overall 5-year relative survival rate for TNBC is 77 percent. However, an individuals outlook depends on many factors, including the stage of the cancer and the grade of the tumor.
Your healthcare professional will be able to give you a more precise outlook based on:
- the stage of your TNBC
- your age
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.
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Phase Iii Keynote 355 Trial
The much anticipated KEYNOTE-355 trial was presented at the inaugural virtual ASCO annual meeting in June 2020. This trial investigated pembrolizumab/chemo vs chemo in patients with treatment-naïve, metastatic TNBC. Patients were excluded if they had active brain metastases or recurrence of disease < 6 mo prior to primary treatment. PD-L1 was assessed with the IHC 22C3 pharmDx CPS assay in a central laboratory. The primary outcome measure was pre-defined as OS and PFS in the PD-L1 positive population and the ITT population. In this trial, a hierarchial statistical testing method involved statistical testing of OS and PFS in the CPS > 10 group initially, followed by CPS > 1 and then the ITT population. The trial included 566 patients in the chemotherapy/IO arm vs 281 in the chemotherapy arm. In patients with a CPS score of 10 or greater, the median PFS favoured pembrolizumab with a PFS of 9.6 mo vs 5.6 mo . In patients with a CPS score of 1 or greater, the median PFS favoured the pembrolizumab arm with a PFS of 7.6 mo vs 5.6 mo . This was not statistically significant. This was similar to the ITT population where the PFS was 7.5 mo in the pembrolizumab arm and 5.6 mo in the placebo arm . OS data is awaited. This progression free survival improvement led to accelerated FDA approval for pembrolizumab in combination with chemotherapy in the first-line setting in November of 2020.
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What Are Breast Cancer Subtypes And Why Do They Matter
Your breast cancer subtype is one factor healthcare providers take into account when theyre deciding how to treat your cancer. Thats because not all cancer treatments are successful with all breast cancer subtypes.
Providers look at your cancer cells to identify subtypes. Specifically, they look for molecules on your cells surfaces. These molecules, called receptors, are built to order so only certain substances can climb on and start affecting what your cells do.
Breast cancer cells receptors are open to estrogen and progesterone. Understanding if your breast cancer cells have receptors and if theyre housing hormones helps providers determine how your breast cancer might spread and what treatment might be most effective.
The other type of breast cancer that has another receptor is called her-2 neu. This receptor makes the cells more active, but allows healthcare providers to treat the cancer with specific medicines that target her-2 proteins. If your breast cancer doesnt have her-2 neu and hormone receptors, its called triple negative.
What Is Triple Negative Breast Cancer And How Is It Treated
Big Changes Coming in Treatment of Triple-Negative Breast Cancer Refining Chemotherapy for TNBC. In a phase 3 trial, 1 labeled Study 301, Halaven was compared with the chemotherapy capecitabine in previously treated patients with locally advanced or Novel Strategies in TNBC. Androgen Receptor Signaling.
Questionable Issues In Tnbcs
TNBCs are known to metastasize via hematogenous routes and this may be in contradiction with the study of Liu previously mentioned, a study which clearly stated that TNBCs have an active lymphangiogenic process which, normally may favour lymphovascular but not hematogenous dissemination. Currently, the molecular features that differentiate or are able to differentiate lymph node positive TNBCs from lymph node negative TNBCs still remain at a hypothetical level and none of them proved to be useful in the clinical and therapeutic approach of TNBCs patients. But most of the TNBCs cancers have preferentially hematogenous metastases. Besides the high mitotic rate and increased nuclear grade, TNBCs also include pushing border of invasion, frequent tumor necrosis and a large central acellular zone . TNBCs usually exhibit a solid/sheet-like growth pattern and may be associated with an increased lymphocytes infiltrate . Despite the fact that these tumors do not usually metastasize through the lymphatic pathways, TNBCs may be characterized by lymphatic invasion and by an increased LVD . However, not all TNBCs are associated with a poor long term survival, although in a low percentage . EGFR, Src kinase pathway and Cdc42-interacting protein 4 are known to promote TNBCs metastasis . CIP4 inhibition seems to decrease the rate of lung metastasis .
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Risk Factors For Triple
Doctors aren’t sure what makes you more likely to get triple-negative breast cancer. Not many women do — it only affects up to 20% of those who have breast cancer. You’re most at risk for triple-negative breast cancer if you:
- Are African-American or Latina
- Are under 40
- Have what your doctor will call a BRCA mutation , especially the gene BRCA1
Diagnosing Triple Negative Breast Cancer
In many women the cancer is found during breast screening. But symptoms such as a breast lump can be a sign of breast cancer. So it is important to get any symptoms checked by your doctor.
If you have symptoms and see your GP they refer you to a specialist breast clinic. At the breast clinic the doctor or breast care nurse takes your medical history and examines your breasts. They also feel for any swollen lymph nodes under your arms and at the base of your neck.
You have some of the following tests:
- a mammogram
- an ultrasound
- a biopsy your doctor or nurse take a small sample of cells or tissue from your breast to look at under a microscope
Depending on your age and whether other family members have had breast cancer, your doctor might refer you for gene testing. This is to find out if there is a fault in the BRCA cancer gene.
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How Effective Is Immunotherapy In Treating Triple
In stage 1 to 3 triple-negative breast cancer, immunotherapy is sometimes used to shrink a tumor before surgery.
In stage 4 breast cancer, immunotherapy is often combined with chemotherapy. For some people, adding immunotherapy to chemotherapy improves outcomes. A recent clinical trial studied immunotherapy treatment in women with advanced triple-negative breast cancer. In this trial, half of the group got chemotherapy, and the other half got both chemotherapy and immunotherapy. On average, it took longer for the cancer to progress in the people who got immunotherapy.
Immunotherapys side effects are different from those of other cancer medications. The most common ones are fatigue, rash, and diarrhea.