Breast cancer cells typically have receptors that can be targeted for treatment. These include estrogen, progesterone, and HER2 receptors. In Triple-Negative Breast Cancer (TNBC), none of these receptors are present. This absence means that TNBC does not respond to hormonal therapies or medications that target HER2 receptors, making its treatment more challenging.
Symptoms of Triple-Negative Breast Cancer (TNBC)
Lump or Mass in the Breast
One of the primary presentations of TNBC is a palpable lump or mass in the breast. These lumps are typically distinct from other benign breast lumps due to their irregular edges and firm consistency. They may not be movable under the skin and can be detected during routine self-examinations or mammograms.
Changes in Breast Size or Shape
TNBC can lead to visible alterations in the breast’s appearance. The affected breast may appear larger or differently shaped due to the tumour’s growth. This change can be subtle initially but may become more pronounced as the tumour progresses.
Skin Changes
The skin overlying the tumour may undergo changes such as dimpling, often resembling the skin of an orange. This dimpling effect occurs when the tumour blocks lymphatic drainage, causing skin inflammation and thickening. Additionally, the skin may become red or discoloured, indicating underlying inflammation or tumour growth.
Nipple Discharge
Some individuals with TNBC may experience a discharge from the nipple. This discharge can vary in consistency and colour, ranging from clear to green or bloody. While nipple discharge can occur due to various reasons, including infections or benign tumours, a spontaneous discharge that occurs without squeezing the nipple should be evaluated.
Nipple Inversion
TNBC can cause the nipple to turn inward or become retracted. This inversion happens when the tumour grows behind the nipple, pulling it towards the breast tissue.
Pain
While many women experience breast pain or tenderness due to hormonal changes, consistent pain that doesn’t subside and is localised to one area can be indicative of an underlying tumour.
Swollen Lymph Nodes
In the context of TNBC, the lymph nodes, especially those located in the armpit (axillary lymph nodes), may enlarge if cancer cells have spread to them. Swollen lymph nodes can feel like small, firm bumps under the skin.
While these symptoms can be indicative of TNBC, they can also be associated with other benign breast conditions. If any of these symptoms are observed, consult a breast cancer specialist for a proper diagnosis.
Treatment Options
Surgery
- Lumpectomy: This is a breast-conserving surgery where only the tumour and a small margin of surrounding healthy tissue are removed. It’s often chosen for early-stage cancers.
- Mastectomy: In this procedure, the entire breast is removed. There are different types of mastectomy, including total (or simple) mastectomy, skin sparing & nipple sparing mastectomy and radical mastectomy (breast, lymph nodes, and chest wall muscles).
Chemotherapy
Given the aggressive nature of TNBC and its lack of hormone receptors, chemotherapy is a primary treatment option. It can be administered before surgery to shrink the tumour or after surgery to kill any remaining cancer cells. The specific drugs and regimen duration vary based on the cancer stage and individual patient factors.
Radiation Therapy
This treatment uses high-energy rays to target and kill cancer cells. Radiation therapy is often recommended after a lumpectomy and sometimes after a mastectomy to ensure any remaining cancer cells in the breast or chest wall are eradicated.
Targeted Therapies
These are drugs designed to target specific molecules involved in cancer growth. While traditional targeted therapies (like those targeting HER2) are not effective for TNBC, new drugs are being developed and tested in clinical trials. PARP inhibitors, which target DNA repair mechanisms, have shown promise in treating TNBC patients with BRCA gene mutations.
Immunotherapy
Some TNBCs have shown to be susceptible to immunotherapy, especially those with high levels of a protein called PD-L1. Drugs that block PD-L1, known as checkpoint inhibitors, are being studied and have received approval for treating certain TNBC patients.
Patients should discuss with their breast cancer specialist to determine the most appropriate treatment plan tailored to their specific diagnosis and overall health. Regular follow-ups after treatment monitor for any signs of recurrence and manage potential long-term side effects.
Conclusion
TNBC is a unique breast cancer subtype lacking three primary receptors, complicating its treatment. Awareness and early detection of TNBC could assist in effective treatments and improved outcomes. Individuals are encouraged to undergo regular screenings and consult their breast cancer specialist if they notice any changes in their breasts.
