According to statistics, breast cancer is the most common type of cancer in women. Triple-negative breast cancer is one of the most severe forms of cell mutation. This type of malignant neoplasm is observed in 25% of female patients diagnosed with breast cancer.
What is TNBC?
Triple-negative breast cancer (TNBC) is a dangerous type of breast cancer. The disease is characterized by the absence of receptors in tumor cells for steroid female sex hormones produced by the ovaries, progesterone, a protein that activates the division, development and differentiation of epithelial cells. TNBC develops in most cases in young women. Trip-negative (Triple negative) breast cancer is characterized by a high activity of cell division, in which the volume of tissues increases with their rapid growth and metastasis to the internal organs. Malignant cells grow and give triple negative volumetric formations -hence the name.
In patients with this type of neoplasia, the GDF11 protein, which is capable of suppressing the phenotypic manifestations of some genome changes under the influence of others, is completely or partially inactive. Tumor formation is due to suppression of the process of cell death, in which they break up into rounded bodies surrounded by a membrane, and suppression of the BRCA1 anti-oncogene. An immature protein in an inactive form accumulates in mutated cells that can develop into cancerous ones. This contributes to the rapid uncontrolled growth of the tumor. The most common type of triple-negative breast cancer is low-grade ductal carcinoma.
Disease classification: prediction for each type
The systematization of breast neoplasia continues to this day. Trip-negative breast cancer is classified by the presence of sensitivity of the tumor to various types of medical treatment. It should be said right away that such a typology is extremely conditional.
- Luminal A or estrogen-dependent form - is considered to be the most favorable according to forecasts. Malignant cells are susceptible to endocrine therapy.
- Luminal V. The prognosis for this type is not very favorable due to its aggressive formation and tendency to recur regularly. Mostly found in women before menopause.
- HER-2/neu type is characterized by aggressive, extragenically independent malignant neoplasms of large size and early lymphogenous metastasis. The prognosis for this form of triple-negative breast cancerglands are generally unfavorable, as carcinomas are resistant to hormone therapy.
- The basal-like type accounts for 70% of carcinomas with a trip-negative phenotype. Patients with this form of TNBC have poor recovery prospects.
There is also a classification of TNBC by histological type.
- Medullary type has neoplasms in the form of strands and wide stripes, flows hidden. It is often confused with fibroadenoma.
- Metaplastic - a group of tumors with common morphological features. Unlike other types of breast cancer, it is diagnosed at an advanced stage and has a poor prognosis.
- Poorly differentiated ductal - neoplasia of the epithelium of the ducts, destroying its basement membrane and forming growths in the surrounding stroma.
- Adenocystic - is quite rare, has a low level of histoatological differentiation, which complicates therapy.
In oncology, the prescription of therapy is based on all the characteristics of the disease presented to the physician.
Stages of development of oncology
Histological classification of breast neoplasia makes it possible to establish the degree of malignancy. But the stage of triple-negative breast cancer is determined by the TNM system, where the T index is the size of the malignant neoplasm, N is nodules indicating damage to regional lymph nodes, M is distant metastases.
Stages of TNBC:
- 1 stage is characterized by tumors up to 3 cm in size, located in the thicknessmammary glands. Malignant cells are not spread to the skin and do not have a distant secondary focus.
- 2 stage triple-negative breast cancer is distinguished by neoplasms up to 5 cm in size, which pass to fiber, without metastases. The phases are also characterized by tumors of the same size with lesions of single lymph nodes.
- 3 stage - neoplasia with a diameter of more than 5 cm with germination of the skin and penetration into the fascial-muscular layers, but without secondary foci in the lymph nodes.
- 4 stage - the spread of malignant cells throughout the body with the help of the bloodstream and lymphoid system. It often excludes the possibility of a cure.
Reasons for formation
There is currently no general theory of the origin of triple-negative neoplasia. Oncopathology is formed as a result of genetic abnormalities. According to statistical studies conducted by experts in the field of oncological mammology, one of the main factors in the occurrence of a neoprocess is hereditary predisposition. There are other factors that influence the formation of oncopathology.
- Prevalence in certain ethnic communities. Based on statistics, TNBC is more common in African Americans. This may indicate the activity of some inherited genes.
- Permanent change in the BRCA-1 genome. Triple-negative cancer patients have mutations in an oncosuppressor protein that prevents cells from converting from benign to malignant.
- Overexpression of the FAM83B oncogene. Removing the gene makes it possible to contain the spread of neoplasia through cell division.
Other causes that increase the risk of a triple negative neoplasm include:
- Uncontrolled use of hormonal oral contraceptives.
- Exposure to radiation.
- Violation of the integrity of the breast.
- Breast diseases: mastopathy, galactorrhea, lactostasis.
- Repeated abortions.
Age plays no role in the development of triple negative breast cancer. Breast neoplasia can occur in both young women and women over 35.
Clinical signs
General symptoms practically do not differ from signs of other types of breast cancer, but the rate of development of the pathological process is much higher. At stage 1, triple-negative breast cancer almost never shows up.
The main sign of neoplasia is the presence of a dense volumetric neoplasm in the chest area, which a woman can feel for herself. Seal very quickly increases in size and becomes painful. Triple-negative cancer comes with other symptoms:
- Breast swelling.
- Nipple indrawing.
- Modification of the skin over the neoplasm.
- Yellow or bloody discharge from the nipples.
- Early enlarged lymph nodes.
As cancer progresses, cancerouscachexia.
Complications
Three-negative breast cancer rarely has a good prognosis. The reason for this is complications in the form of rapid metastasis in different organs. With the transition of oncopathology to the terminal stage, a serious deterioration in he alth is observed.
- Dramatic weight loss.
- Muscle weakness.
- Trophic changes in epithelial tissue.
- Severe CNS disorders.
- Liver failure.
- Pulmonary bleeding.
- Blindness.
Complications that occur after radiation, surgery and chemotherapy are separated.
Neoplasia Diagnosis
Early treatment of triple-negative breast cancer significantly increases the chances of a favorable prognosis. Therefore, it is very important to identify the tumor in the early stages. The purpose of diagnostics is to assess the size and location of the tumor, to identify regional and distant metastases. The examination includes the following methods:
- Mammography is an x-ray examination of the chest in direct and oblique projection. This type of diagnosis is prescribed from the age of 35.
- Breast ultrasound - ultrasound scanning of breast tissue. The study allows visualization and division of neoplasms smaller than 5 mm with an accuracy of up to 95%.
Both methods give non-specific results that correspond to the features of other cancers. To identify and diagnose TNBC, specific research methods are used: cytological andimmunohistochemical analyzes.
Treatment methods: chemotherapy
Detection of triple-negative breast neoplasia requires rapid selection of therapeutic methods. Treatment for each patient is selected individually, taking into account the growth and sensitivity of the tumor to drugs. The main difficulty is that the malignant cells of triple-negative breast cancer do not respond well to chemotherapy. New generation drugs are used for treatment: Bevacizumab, Nexavar, Iniparib, Eribulin.
Surgical treatments
According to doctors and based on statistical data, surgery allows us to give positive forecasts. There are several ways to surgically treat triple-negative breast cancer.
- Lumptectomy.
- Quadrantectomy.
- Modified radical mastectomy.
- Segmentectomy.
The choice of operation depends on the course of the pathology and the condition of the patient.
Forecast
For a good prognosis for triple-negative breast cancer, therapy should be started as soon as possible. A distinctive feature, which is also a problem of oncopathology, is the rapid increase and spread of malignant cells throughout the body.
Another characteristic feature of TNBC, which does not allow you to fully fight the disease, is hereditary predisposition. Close relatives of oncogenome carriers are at risk. But, on the otherOn the other hand, these women are under constant observation and their chances of recognizing neoplasia in the early stages, as well as a favorable prognosis, are increasing.
In general, a positive outcome depends on several factors:
- Early detection of neoplasia.
- Effectiveness of the applied drug therapy.
- No non-cancer breast disease.
- No BRCA mutations.
Survivability
Triple-negative breast neoplasia is an aggressive pathology with a high risk of secondary lesions. Most often, metastases grow into the lungs and brain, and the probability is especially high within five years from the onset of oncopathology.
Triple-negative breast cancer has a poor survival rate. This is due to the late detection of the disease and its tendency to relapse shortly after chemotherapy. According to statistics, about 68% of patients with this diagnosis have a three-year survival rate. Preliminary predictions are made during therapy - if the neoplasia becomes less aggressive, decreases in diameter, then a positive result is most likely.
Surgical therapies, in which the breast is removed partially or completely, increase the chances of survival.
Prevention of TNBC
To prevent trip-negative breast cancer, simple preventive measures should be taken.
- Regular breast self-examination.
- Implementation of adequate therapy for diseases of the mammary glands.
- The use of hormonal drugs only as directed and under medical supervision.
- Avoid chest injury.
- Women with blood relatives with "family cancer" should be screened for triple-negative breast cancer twice a year.
