It's normal for anyone to be a little scared when they hear the word breast cancer. But the most important thing we need to know is that not all breast cancers are the same. There are different types of them. Today we are going to talk about a type that is a little rarer and requires special attention during treatment. We call this 'Triple-Negative Breast Cancer' (TNBC for short). Hearing this name may sound a little complicated to you, but don't be afraid. We will talk about this very simply, in a way that you can understand.
Why is this called 'Triple-Negative'?
Okay, let's start with the meaning of this name. To understand this, we need to have a little idea of how normal breast cancer cells work.
Imagine that the cells in our body are like doors. Those doors have locks that hold keys. In medicine, we call these keyholes 'receptors'. When the keys that match these receptors come and connect, those cells receive certain messages.
There are three types of receptors that are mainly important in breast cancer.
1. Estrogen Receptors (ER): These are associated with the female hormone estrogen.
2. Progesterone Receptors (PR): These are associated with another female hormone called progesterone.
3. HER2 Receptors: This is a receptor that binds to a protein called HER2. This protein controls the growth of breast cells.
In many types of breast cancer, one, two, or all three of these receptors are overexpressed. This means that these hormones and proteins help the cancer cells grow. It's like adding fuel to a fire. So when doctors treat these cancers, they target these receptors and give them drugs that block them (targeted therapy). These drugs close those 'keyholes'. Then the cancer cells don't get the messages they need to grow.
Simply put, 'triple-negative' means that these cancer cells do not have all three of the above-mentioned receptors (estrogen, progesterone, and HER2) . 'Negative' means 'no'. It is 'triple-negative' because it does not have all three.
Now you probably understand where the problem lies? The usual drugs that target receptors don't work for this type of cancer. Because there is no receptor to target. This is the main challenge with TNBC cancer. But that doesn't mean it can't be treated. There are other effective treatments for this, and we'll talk about that later.
What are the symptoms of this cancer?
The symptoms of triple-negative breast cancer are very similar to those of other breast cancers. If you notice anything unusual in your breasts, it's important to pay attention.
If you have one or more of the following symptoms, please don't panic and see a doctor as soon as possible. Having these symptoms doesn't necessarily mean it's cancer, but it's wise to get checked.
| Symptom | Simple explanation |
|---|---|
| A new lump or thickening in the breast | Something like a lump that was never there before, caught in the hand. |
| Breast or nipple pain | Frequent, unexplained pain. |
| Breast skin changes | Dimpling, redness, thickening, or dryness of the skin, similar to an orange peel. |
| Nipple inversion | A previously normal nipple sinks inward. |
| Nipple discharge | Blood or other fluid leaking from the nipple when you are not a breastfeeding mother. |
| Breast swelling | Swelling of the breast, either completely or partially. |
| Lumps in the armpit or near the collarbone | Lumps caused by swelling of the lymph nodes. |
Remember, a regular mammogram can detect cancer before any symptoms appear. Therefore, it is very important to get age-appropriate screenings on time.
What are the causes and risk factors for developing this cancer?
Researchers have not yet found a specific cause for this cancer, but they have found that there is a strong link between it and genes.
In particular, there is a strong link between mutations in the genes BRCA1 and BRCA2 and TNBC. Normally, these BRCA genes are responsible for controlling the growth of cancer in our bodies. Like the brake system of a car. When there is a defect or mutation in these genes, the ability to control cancer is lost. We can inherit these gene mutations from our parents.
Apart from this, there are several other factors that increase the risk of developing TNBC cancer.
| Risk factor | Description |
|---|---|
| Age | It is most common in young women under the age of 40. (But it can develop at any age.) |
| BRCA gene mutations | The risk is especially high if a BRCA1 gene mutation is inherited. |
| Race/ethnicity | According to research conducted around the world, this cancer is more common among women of African or Hispanic descent. |
How does a doctor diagnose this?
When you go to see a doctor about a breast lump, he or she will first examine your breasts. Then, they will ask you about your symptoms. In addition, they will order several tests to confirm the diagnosis.
- Mammogram: An X-ray examination of the breast.
- Breast Ultrasound: A procedure that uses sound waves to take images of the tissues inside the breast.
- Breast MRI: A procedure that uses a magnetic field and radio waves to produce clearer, more detailed images.
If these scans suggest cancer, the next most important test is a biopsy . This involves taking a very small piece of tissue from the suspicious lump using a small needle and examining it under a microscope.
A biopsy is the only way to 100% confirm whether this is cancer or not. Also, the only way to know for sure whether this is TNBC is to examine this piece of tissue and see if it has the three receptors we talked about (ER, PR, HER2).
Additionally, your doctor may also refer you for genetic testing to check for genetic mutations, such as BRCA. All of this information is used to determine the stage of your cancer and develop the most appropriate treatment plan for you.
What are the treatments for this?
Although there are challenges in treating TNBC cancer, there are now many highly effective treatments available. Your oncologist will recommend the best treatment plan based on your condition.
The main treatment is to remove the cancerous tumor through surgery. In addition, one or more of the following treatments may be used together.
- Chemotherapy: This is one of the main and most effective treatments for TNBC. Chemotherapy is given before surgery to shrink the tumor (neoadjuvant chemotherapy) and after surgery to kill any remaining cancer cells and prevent the disease from coming back (adjuvant chemotherapy).
- Radiation Therapy: After surgery, high-energy rays are directed at the area where the cancer was to destroy any remaining cancer cells.
- Immunotherapy: This is a relatively new treatment. It works by stimulating our body's own immune system to recognize and attack cancer cells. For some TNBC patients, this treatment can be given in combination with chemotherapy to achieve very good results.
- Targeted Therapy: For TNBC patients with BRCA gene mutations, specific drugs such as PARP inhibitors are used. These work by disrupting the ability of cancer cells to repair themselves.
There are currently many clinical trials underway around the world for TNBC. New drugs and new treatments are constantly being discovered. Therefore, we can have good hope for the future of this disease.
Things to consider after treatment
After surgery or other treatment, complications can sometimes occur. For example, the surgical wound may become infected or a blood clot may form. Therefore, if you experience any of the following symptoms, contact your doctor immediately.
| When to seek immediate medical advice | |
|---|---|
| Signs of an infection |
|
| Symptoms of a blood clot | Painful swelling of a leg, difficulty breathing. |
| Excessive side effects | If the side effects of treatment (e.g. vomiting, diarrhea) are too severe to bear. |
Things you can do to stay healthy during treatment
Cancer treatment is a very stressful experience, both physically and mentally. There are a few things that can help you feel a little more comfortable during this time.
- Light exercise: Light activities like walking and yoga can help reduce stress and also give your body a good boost of energy.
- Good diet: Eat a nutritious diet that includes lean proteins (fish, chicken), fruits, vegetables, legumes, and whole grains (brown rice, oatmeal). Drink plenty of water.
- Maintaining a healthy weight: Research has shown that maintaining a healthy weight that suits you is a good support for treatment.
- Psychological support: Talk to your family and close friends about your feelings, fears, and anxieties. If necessary, seek the help of a mental health counselor.
If the side effects of treatment are severe, don't be shy about talking to your medical team about it. They are committed to supporting you through this difficult time.
Take-Home Message
- Triple-negative breast cancer (TNBC) is a specific type of breast cancer that lacks all three receptors: estrogen, progesterone, and HER2.
- Therefore, conventional hormone therapy and HER2-targeted therapies are not effective for this.
- If you notice any unusual changes in your breast (a lump, pain, skin change), don't panic and see a doctor immediately. The sooner it is detected, the more successful the treatment.
- There are many effective treatments for this, including chemotherapy, surgery, radiation therapy, and modern treatments such as immunotherapy.
- Although this is a challenging disease, with the advancement of modern medicine, new treatments are constantly being discovered. So don't give up hope.
- Trust your medical team, answer their questions honestly, and ask them about your concerns. You are not alone in this journey.
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