Triple-Negative Breast Cancer - Symptoms, Survival Rate, Diet, Treatment

Doctors generally use the TNM (tumour size, cancer in lymph nodes, metastasis) staging system to determine the stage of the disease. These stages are as follows: 

1. Stage 0: This is a non-invasive stage in which the cancer has not spread beyond the milk ducts. 

2. Stage I: In this stage, the malignant cells spread to the nearby breast tissue. 

3. Stage II: It is characterised by one of the following: 

1. A tumour smaller than 2 centimetres across that has spread to armpit lymph nodes.

2. A tumour larger than 5 centimetres across that has not spread to armpit lymph nodes. 

4. Stage III: The cancer spreads beyond the point of origin, invading nearby tissue and lymph nodes. However, it has not spread to distant organs like the bones, liver, lungs, and brain. 

5. Stage IV: In stage IV triple-negative breast cancer, also called metastatic breast cancer, the malignancy spreads to distant organs.

Triple-negative breast cancer symptoms are similar to those of other types of breast cancers. These may include the following: 

1. A new lump in the breast or underarm area 

2. Unexplained changes in the breast size or shape, including swelling or shrinkage on one side 

3. Dimpling or puckering of breast skin 

4. An inverted nipple 

5. Nipple discharge, especially clear or bloody fluid 

6. Changes in skin texture, discolouration, or enlarged pores resembling an orange peel 

7. Red, scaly, or swollen skin on the breast, nipple, or areola 

Consult a doctor if you experience any of the symptoms mentioned above.

The exact cause of triple-negative breast cancer is not known. However, various factors can increase the risk of the condition. These include: 

1. Age: The risk of TNBC is higher in premenopausal women and those under 50 years of age. 

2. BRCA Mutations: These are inherited genetic mutations linked to a greater cancer risk. Approximately 10% to 15% of women with this type of cancer test positive for BRCA1 mutations. BRCA2 mutations can also cause TNBC, though less commonly than BRCA1.

3. Personal or Family History: A personal history of breast cancer or having a family member with any breast cancer raises the risk of developing TNBC.

There are also various modifiable risk factors of TNBC that you can manage to lower your risk. These are mentioned below: 

1. Sedentary lifestyle 

2. Obesity 

3. Alcohol consumption 

4. Smoking

Performing a mammogram is the first step in diagnosing triple-negative breast cancer. It helps detect a lump or abnormalities in the breast tissue. 

Based on test results, the doctor may take a small sample of the breast tissue (biopsy) and examine it under a microscope. Pathologists check for the presence of oestrogen receptors, progesterone receptors, and HER2 proteins. TNBC is confirmed if all three are absent. 

The doctor may also order other evaluations, including the following: 

1. Magnetic Resonance Imaging (MRI): Provides detailed images of the breast to determine the exact size and location of cancer

2. Ultrasound: Uses sound waves to create images that detect cancer in different places such as the other breast, under the arms, and liver

3. Computed Tomography (CT) Scan: Usually used to check if cancer has spread to other organs like the lungs or liver 

4. Positron Emission Tomography (PET) Scan: Involves injecting radioactive sugar into the blood to see if cancer has spread to other body parts

Triple-negative breast cancer treatment depends on the location, size, and grade of cancer. Due to the absence of receptors that generally fuel breast growth, TNBC cannot be treated with hormone therapies or other drugs. However, other options can be used to manage the condition, such as: 

1. Surgery: It is a common treatment for TNBC and may include the following two options: 

1. Mastectomy: It is the surgical removal of one or both breasts. Mastectomy is recommended if the tumour is large or has spread to the lymph nodes. 

2. Lumpectomy: This procedure removes only the breast tissue with a cancerous tumour to leave clear margins around it. It is ideal for smaller tumours that have not spread to the lymph nodes. Radiation therapy usually follows to reduce the risk of recurrence. 

2. Chemotherapy: It is the most effective TNBC treatment. Depending on the size and spread of the malignant tumours, patients may receive either one of the following: 

1. Neoadjuvant Chemotherapy: Before surgery to shrink the tumour 

2. Adjuvant Chemotherapy: After surgery to reduce the chances of recurrence 

3. Biologic Targeted Therapy: Drugs called poly ADP ribose polymerase (PARP) block the growth of cancer cells. 

4. Immunotherapy: It is a type of triple-negative breast cancer therapy that stimulates the immune system of the body to fight cancer. 

When to visit a doctor?

Depending on your situation, you will have regular physical examinations with your doctor every three to six months for the first three years after treatment. These visits will be reduced to every six months in the fourth and fifth months post-treatment. 

However, if you develop triple-negative breast cancer chemotherapy side effects, you may need to consult your doctor immediately. These symptoms include: 

1. Fever above 100.5 F

2. Chills 

3. Wet cough 

4. Stomach ache 

5. Constant nausea and vomiting 

6. Diarrhoea

A study by Stewart et al., 2019, found that triple-negative breast cancer recurrence after mastectomy or other treatments occurs in about 40% of patients with stage 1 to stage 3 cancer. The remaining 60% achieve long-term disease-free survival. This type of cancer may return in about 19-40 months, compared to 35-67 months for other forms of breast cancer. 

The most common areas of recurrence include: 

1. Local (cancer remains in the breast)

2. Regional (cancer spreads to lymph nodes and nearby structures)

3. Distant (cancerous cells spread to organs like the liver and lungs)

According to the American Cancer Society, the overall five-year triple-negative breast cancer survival rate is 77%. This means that about 77% of patients with cancer are likely to live at least five years after diagnosis. The estimated survival rate for different stages is as follows: 

*SEER (Surveillance, Epidemiology, and End Results) is a summary staging system used by the National Cancer Institute for cancer statistics. 

*The TNM staging system classifies cancer based on three factors: tumour size (T), extent of lymph node involvement (N), and evidence of metastasis (M). 

Proper nutrition is essential before, during, and after cancer treatment. A balanced triple-negative breast cancer diet helps manage weight, preserve strength, and support overall health. It also decreases treatment-related side effects like nausea, fatigue, and mouth sores. 

Foods that one should include in their diet are as follows: 

1. Nutrient-Dense Options: Eat colourful fruits, vegetables, and whole grains to get the vitamins and minerals needed for your overall health. 

2. Phytochemicals: Add plant-based compounds with cancer-fighting properties to your diet. These may include the following: 

1. Folate (found in leafy greens)

2. Resveratrol (in grapes and berries)

3. Curcumin (from turmeric)

4. Sulforaphane (in broccoli)

5. Genistein (found in grains, soybeans, and legumes)

It is also important to avoid certain foods as they can increase the risk of developing TNBC. These include: 

1. Red and processed meats 

2. Sugar-sweetened beverages and refined grain products 

3. Highly processed foods and alcohol 

Triple-negative breast cancer (TNBC) is a challenging type of breast cancer to treat. Despite its challenges, several effective treatments, including chemotherapy, surgery, radiation, and immunotherapy, are available. Ongoing research continues to enhance treatment options, offering patients renewed hope for better outcomes.

If you have questions or concerns about your diagnosis, it is important to speak with your doctor. At HexaHealth, we offer personalised support and access to expert care for patients with TNBC. Connect with our experienced healthcare professionals to better understand triple-negative breast cancer symptoms, causes, and treatment.