How Triple Negative Breast Cancer Is Treated

Surgery, chemotherapy, radiation, and more

The treatment options for triple-negative breast cancer (TNBC) include chemotherapy, surgery, and/or radiation. Home remedies, over-the-counter (OTC) medications, prescription medications, and/or complementary alternative medicine (CAM) therapies can help alleviate symptoms of cancer and may reduce the side effects of treatment—but these approaches can't shrink the tumor or cure your cancer.

TNBC is a subtype of breast cancer in which the cancer cells don't have receptors to estrogen, progesterone, or HER2. Several factors, such as your tumor size, grade, and stage (whether cancer has traveled to lymph nodes and other parts of the body) are used to determine the best treatment combination for you. 

Surgeries and Specialist Driven Procedures

Your cancer will need to be treated with one or more method of removing, destroying, or shrinking tumor cells. Surgery can physically remove cancer from your breast. Your doctor may suggest a lumpectomy, mastectomy, and/or an axillary lymph dissection.

Chemotherapy is a type of powerful medication taken systemically (with effects throughout the body) to destroy tumor cells. Radiation therapy is the use of radiofrequency waves to shrink the tumor.

Lumpectomy

A lumpectomy is a limited surgery, also known as breast-conserving surgery. If you have a lumpectomy, your tumor and the tissue around it will be removed while preserving as much of your breast as possible. 

Lumpectomies are generally recommended when the cancer is not invasive.

Lumpectomies are associated with a higher risk of breast cancer recurrence than mastectomy and axillary dissection. Frequent surveillance (sometimes lifelong) is typically recommended after a lumpectomy.

Mastectomy

If cancer has spread throughout the breast or if the tumor is large, a mastectomy may be recommended as a way to remove the whole tumor. A mastectomy is the surgical removal of the breast, nipple, areola and most of the underlying skin.

There are five different types of mastectomy procedures.

  • Partial: A partial mastectomy is the next step up from a lumpectomy because it removes part of the breast affected by cancer and some of the surrounding tissue. More breast tissue removed in a partial mastectomy than in a lumpectomy.
  • Simple: This type of mastectomy involves removal of the entire breast but does not remove any lymph nodes from the underarm or any muscle underneath the breast.
  • Nipple-sparing: A nipple-sparing surgery removes the entire breast but preserves the nipple and, in some cases, the areola, for breast reconstruction surgery later down the road.
  • Modified radical: This type of mastectomy removes the entire breast and nearby lymph nodes. No muscle is removed. The lymph nodes are removed for examination to determine if the cancer has spread beyond the breast.
  • Radical: A radical mastectomy is the most invasive in that it involves removal of the entire breast, underarm lymph nodes, and chest muscles. This procedure is recommended when the cancer has invaded the chest muscles.

    A mastectomy has a greater chance of preventing recurrence than a lumpectomy. However, because a mastectomy is a more extensive surgery, it typically requires a longer hospital stay and recovery. 

    After a mastectomy, you may experience side effects, including:

    • Severe pain, tenderness and swelling
    • Numbness in the chest or arm
    • Nerve pain
    • Blood buildup at the surgery site

    A mastectomy involves the removal of the entire breast, which can have a psychological effect on some women. Some women opt for breast reconstruction following a mastectomy. Breast reconstruction is a major surgical procedure and entails additional costs, risks, and recovery time.

    Axillary Lymph Node Dissection            

    An axillary lymph node dissection is done when cancer has spread to nearby lymph nodes.

    Axillary lymph node dissection is usually done at the same time as a lumpectomy or mastectomy.  Your surgeon may remove some lymph nodes or all of the nodes located in the axilla (the rounded area beneath the shoulder where the arm and body meet). Samples of tissue from these nodes are sent to a pathology lab for testing. 

    The report will provide information about whether your lymph nodes have breast cancer cells. This will be helpful in determining the stage of your cancer and whether you will need more treatment.

    Some women experience persistent arm swelling on the side where the axillary node dissection was done.

    Chemotherapy

    Chemotherapy is a type of medication that kills cancer cells. It can be taken intravenously (IV, by needle through a vein) or in pill form. While it is a prescription when taken in pill form, chemotherapy generally requires more medical supervision and careful dosing (such as taking at a certain time of day, with or without food or fluids) than most regular prescription medications. Also, you would only take chemotherapy for a limited time (such as a few weeks or months), and the effects can linger for months after your treatment is completed.

    If you take chemotherapy prior to having surgery, the purpose is to shrink your tumor and to make your surgery less of a major procedure. Chemotherapy is also commonly taken after surgery if the tumor is large or if it has spread to lymph nodes or other areas of the body. 

    Radiation Therapy

    Radiation therapy can treat TNBC by killing cancer cells that may still remain in the body after surgery. It can help protect against recurrence. Radiation is usually given using an external beam on the affected area of the breast.  It may be given after a lumpectomy or a mastectomy to kill any remaining cancer left in the breast, underarm area, or elsewhere in the body.

    Radiation can cause side effects including:

    • Damage to surrounding tissues
    • Fatigue
    • Breast pain
    • Low white blood cell counts
    • Skin reactions that may include itching, redness, and soreness

    Breast Cancer Doctor Discussion Guide

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    Home Remedies and Lifestyle

    If you have had any of the standard therapies for TNBC, you may experience symptoms due to your cancer or as side effects of the treatment.

    There are a number of strategies you can use at home to alleviate your symptoms.

    • Ice packs: Some women experience pain or swelling after breast cancer surgery or due to radiation. Ice packs, when used carefully, can relieve these symptoms.
    • Massage: You may have pain, aches, or soreness due to your cancer or your treatment. If approved by your doctor, a massaging device may help sooth these effects.
    • Exercise: Often, exercise can help reduce the swelling that follows a mastectomy or an axillary dissection. If swelling is a persistent problem for you, talk to your doctor about starting some regular exercises that you can do on your own. Often, keeping your arm lifted (above your heart level) while it is resting is also recommended.
    • Armband: For some women, a snug wrap around the hand or arm can help reduce the swelling that occurs after breast cancer surgery.
    • Diet: You can experience a loss of appetite due or nausea to chemotherapy. And sometimes, TNBC can be so aggressive that it causes malnourishment and weight loss. You may need to work with a dietitian to make sure that you are getting a healthy balance of nutrients and vitamins and minerals.
    • Fluids: If you have been nauseated or vomiting, it is important to stay hydrated. Drinking fluids such as water, ginger ale, or electrolyte drinks can help replenish you when mild dehydration is a problem. Ginger ale also counteracts mild nausea.

    Over-the-Counter (OTC) Therapies

    You may need medication for the management of some of your breast cancer symptoms or for managing the side effects of breast cancer treatment. Keep in mind that OTC medications have side effects that could be harmful to your health, so you should discuss their use with your doctor, even though they don't require a prescription.

    • Pain medication: Women who have breast cancer metastasis to the bones or elsewhere in the body can experience severe pain. You might benefit from an OTC like Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory like Advil (ibuprofen). Be sure to talk to your doctor, however. Acetaminophen is metabolized by the liver, and it may not be safe to take it if your breast cancer has spread to your liver or if your chemotherapy affects your liver function. Similarly, NSAIDs can increase the risk of bleeding and are not always safe after surgery when a wound is still healing.
    • Anti-nausea: Nausea is a common side effect of chemotherapy. OTC options such as Dramamine (dimenhydrinate) can usually help relieve nausea.
    • Multivitamins: Cancer can take a toll on the body, making you malnourished. And if you are experiencing a lack of appetite, you may benefit from OTC multivitamins.
    • Creams and lotions: Your skin can become tender, or you can develop a rash due to radiation. Your doctor may recommend that you use a gentle lotion or cream for comfort. Be sure not to use a lotion on an open wound.

      Prescriptions

      Several prescription medications may be helpful for you throughout the period of your TNBC treatment. Depending on your symptoms, your doctor may prescribe one or more of these medications.

      • Steroids: Swelling can occur in a visible location (such as the arm) or it can involve edema (fluid build-up) deeper in the body. Prescription steroids can help reduce both types of swelling, and your doctor may prescribe a short course of steroids for you if you are experiencing edema. Steroids can suppress your immune system, so they are often used temporarily.
      • Antiemetics (anti-nausea): If nausea and vomiting are a major problem for you, your doctor may prescribe a prescription antiemetic like Zofran (ondansetron) to help you keep down food.
      • Blood thinners: Sometimes cancer is associated with an increased risk of blood clots. If this is your situation, your doctor may prescribe a blood thinner to help prevent blood clots such as deep vein thrombosis (DVT).

      Complementary Alternative Medicine (CAM)

      CAM treatments can help lessen the side effects of TNBC radiation and chemotherapy and can also help you practice self-care. Many of these therapies have their roots in Eastern medicine and they often focus attention on the mind, emotions and spirit, in addition to the physical body.

      These approaches do not treat or shrink aby type of breast cancer, including TNBC.

      CAM therapies include:

      These may be effective for managing side effects of cancer treatment, relieving pain, and improving your quality of life. Ginger is an herb that can relieve mild feelings of nausea, a common side effect of chemotherapy.

      Sometimes, CAM therapies involve intervention. For example, acupuncture may help relieve symptoms of breast cancer and the side effects of treatment. The practice is done by a licensed practitioner and involves the use of sterile, thin needles which are placed in specific points on the skin to stimulate the nervous system. 

      According to the National Center for Complementary and Integrative Health, acupuncture may help with relieving fatigue, controlling hot flashes, and reducing vomiting, nausea, and even pain. Acupuncture is not without it risks, and side effects may include infection, bleeding, and swelling.

      While CAM treatments are effective and helpful, not all are safe. Further, it is important to keep in mind these therapies are complementary and should not replace your doctor’s treatment plan. 

      Targeted Therapies and TNBC

      Targeted therapy has not been successful in improving treatment outcomes for people with TNBC. This is because the treatment for breast cancer is based on the subtype. For example, hormone receptor cancers can be successfully treated using hormone therapies.  

      Receptors that can be found on breast cancer cells include the estrogen receptor (ER), the progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2)  

      Drugs such as tamoxifen and aromatase inhibitors target the estrogen receptor. The target drug for HER2 is Herceptin. TNBC cells do not have recognizable receptors that can be targeted.

      Triple negative is a breast cancer subtype that does not have any of the three receptors that are used as targets in cancer treatment. Its name comes from the fact that it is negative for ER, PR, and HER2 receptors. Because triple-negative doesn’t have any of these receptors, this subtype of breast cancer does not respond to targeted therapy.

      A Word From Verywell

       Most TNBC relapses occur in the first five years after diagnosis, with the peak time being three years after surgery. Relapse rates significantly decline after that.

      Some women who have breast cancer for which there is no effective treatment opt for enrolling in a clinical trial to be able to get access to experimental therapy. You might want to discuss this option with your doctor. Your doctor may have more information on clinical trials you may qualify for or you can check the National Cancer Institute's searchable database

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      Article Sources

      1. Triple Negative Breast Cancer Foundation. Treatment Options. https://www.tnbcfoundation.org/living-with-tnbc/treatment-options

      2. Susan G. Komen Foundation. Lumpectomy. Updated May 2, 2018. https://ww5.komen.org/BreastCancer/Lumpectomy.html

      3. National Center for Complementary and Integrative Health. Acupuncture: In Depth. Updated January 2016. https://nccih.nih.gov/health/acupuncture/introduction

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