How Triple-Negative Breast Cancer Is Treated

The treatment options for triple-negative breast cancer (TNBC) include chemotherapy, surgery, and/or radiation. Home remedies, prescription medications, over-the-counter (OTC) 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

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. Radiation and chemotherapy may be used before and/or after surgery.

There are two major types of breast cancer surgery—including lumpectomy and mastectomy—either of which can involve axillary lymph node dissection.

Lumpectomy

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

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, the tumor is large, or there is a high risk of recurrence, 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 several different types of mastectomy procedures, and the right one for you depends on the extent of cancer in and around the breast. For example, with a partial mastectomy, the portion of the breast that is affected by cancer and some of the surrounding tissue are removed. With a radical mastectomy, the entire breast, underarm lymph nodes, and chest muscles are surgically removed.

There are also nipple-sparing procedures, which may be considered when breast reconstruction surgery is planned.

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. 

Axillary Lymph Node Dissection            

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

Breast Cancer Doctor Discussion Guide

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Therapies

Chemotherapy and radiation may be considered before and/or after surgery.

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.

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.

Chemo drugs can only be taken for a limited time (such as a few weeks or months), and the effects can linger for months after your treatment is completed.

Radiation Therapy

Radiation therapy can treat TNBC by killing cancer cells that may still remain in the breast, underarm area, or elsewhere in the body after surgery, protecting against recurrence. It may be given after a lumpectomy or a mastectomy.

Radiation is usually given using an external beam on the affected area of the breast. It carries several possible side effects, including damage to surrounding tissues, skin reactions (e.g., redness), breast pain, and low white blood cell counts.

Why Targeted Therapy Can't Be Used

Targeted therapies take aim at cancer cells by interfering with the activity of receptors that fuel cancer growth. For example, tamoxifen and aromatase inhibitors target estrogen receptors. Herceptin targets HER2 receptors. These treatments are effective—but only if a cancer tests positive for such receptors. As TBNC, by definition, is negative for them, the disease will not respond to targeted therapies.

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 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 help.
  • Massage: You may have pain, aches, or soreness. If approved by your doctor, using a massaging device may be soothing.
  • 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.
  • Fluids: Drinking fluids such as water, ginger ale, or electrolyte drinks can help replenish you when mild dehydration is a problem (such as with frequent vomiting). Ginger ale also counteracts mild nausea.

Over-the-Counter (OTC) Options

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 get your doctor's OK, 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 improve this.
  • 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 food down.
  • 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 help you practice self-care. Many of these therapies have their roots in Eastern medicine and focus attention on the mind and spirit, in addition to the physical body.

These approaches do not treat or shrink any 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.

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. 

A Word From Verywell

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. They 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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