Triple negative breast cancer – (TRMG) is one of the varieties of malignant lesions of the gland, which is characterized by high aggressiveness. Cells of this tumor have receptors (sensitive structures) to estrogen, progesterone and epidermal growth factor – this means that cancer does not react to them.
Manifestations of the tumor – the presence of a large dense formations, discharge from the nipple, the deformation of the breast.
Pathology belongs to the category of those which are struggling with attracting combined treatment – a combination of radical mastectomy (complete removal of the breast), radiation and chemotherapy.
The disease is called triple-negative breast cancer (Triple negative).
General data
This disease occurs in 10-20% of all patients diagnosed with malignant neoplasms of the breast. It is a cancer with its own characteristics. In contrast to hormone-dependent cancer, TRMG is diagnosed mainly in women of young age. He also had other risk factors and less differentiated structure (i.e., cells are more “universal” structure).
The features of pathology of the following:
- high proliferative activity – this means that cancer cells multiply very quickly;
- aggressive course;
- very rapid growth;
- very fast visceral metastasis means that cancer cells quite early rush with a current blood or lymph in the internal organs, provoking the development of cancer metastatic foci and thereby disrupting their structure and function.
Due to the pronounced aggressiveness of the described pathology problems is still acute – namely, the timely diagnosis of the disease, the search for new, more effective forms of therapy, development of primary and secondary prevention.
Reasons
A unified theory of why there is this form of malignant neoplasia at the moment. Most of the data on the basis of which it can be argued that triple negative breast cancer develops due to a genetic glitch.
That the pathology is hereditary nature, indicate the following:
- the presence of triple negative breast cancer in female relatives in the family;
- high prevalence in certain ethnic groups;
- the so-called BRCA-mutations;
- the presence of an active oncogene.
Revealed many facts of the incidence of triple negative breast cancer in relatives. This kind of cancerous lesions belong to the category of so-called family of tumors.
Identified increased prevalence of triple negative breast cancer in certain ethnic groups is it most common in women of black race, especially for African Americans. These data demonstrate the activity of certain cancer genes that are inherited from generation to generation within the same ethnic group.
Women diagnosed with triple negative breast cancer, often identified mutations in the so-called BRCA-1 gene. This DNA segment is oncosuppressor – that is, inhibits the formation of atypical cells in the human body and, therefore, responsible for the synthesis of protective factors which prevent malignant transformation of normal cells. When mutated, the gene expression of these protective properties are sharply reduced.
In human DNA revealed an active oncogene, which is marked by numbers and letters as FAM83B. It is established that overexpression (expression properties) of this gene is affected in a negative way on the behaviour of normal cells – they start to show tumor activity. If the gene was removed, this led to the suppression of reproduction of cancer cells.
Identified several other, non-genetic factors in the background of the triple negative breast cancer developed faster.
These are contributing factors, as:
- breach of oral contraceptives – drugs preventing the occurrence of unwanted pregnancy.
- radioactive radiation;
- traumatic lesions of the breast;
- a number of somatic diseases.
To develop triple negative breast cancer may lead to uncontrolled intake of oral contraceptives for a long time.
Radioactive effects on the mammary gland that triggers the development of this pathology can be observed in cases such as:
- radiation therapy any cancer diseases (not necessarily from the side of the chest, but also others);
- contact with radioactive sources because of the labour needed (in particular, for violations of safety rules and disregard for personal protection);
- unauthorized access to radioactive sources.
Traumatic lesions of the breast, is able to trigger the development of described pathology does not have to be expressed – described cases, when triple negative breast cancer developed after minor injuries to her tissue.
Physical illness can be instigators of development triple negative breast cancer most often in case of chronic or severe course. Often, this pathology such as:
Direct proportion to the pathology described from dishormonal States have not been identified.
The development of the disease
The development of triple negative breast cancer differs from the growth and development of other cancers of this body, in this case the cancer cells have special receptors to female hormones and oncoprotein. This means that this form of cancerous lesions is not dependent on the cyclic changes in a woman’s body.
Most likely following a path of development of the tumor. Normally, the body’s destruction of cellular structures programmed it eliminates the old, sick or flawed cells. Including programmed is the so-called uncompressed – suppression of abnormal cells, which are inherently flawed. Triple negative cancer is more likely to occur when the mechanisms of getting rid of the atypical cells are broken. Oncosuppressor carries a special marking under the protein GDF11. For unknown reasons, his maturation of atypical cells in some point stops, and it accumulates in an inactive form, that is, can not suppress the growth and development of these cells. They get limitless possibilities to divide, reproduction and growth, such processes become uncontrolled.
The most common TRMG is poorly-differentiated (low “specialization” of cells) ductal carcinoma.
There are several types of the described diseases, which are characterized by different degree of aggressiveness. They differ in cellular structure.
These are the types of triple negative breast cancer, such as:
- baselinestudy. This species is found in 70-75% of all cases described of the disease;
- Nebuzaradan. This pathology develops in 25% of all cases of this disease.
Symptoms triple negative breast cancer
The clinical picture of triple negative breast cancer in General is very similar to the clinic of other varieties of its cancerous lesions. On the other hand, the rate of development of tumor process described in pathology of the higher.
Symptoms triple negative breast cancer are:
- the presence of the tumor;
- retraction of the nipple;
- the increase of the breast volume;
- seal skin covering it;
- discharge from the nipple;
- swollen lymph nodes;
- signs of violation of the General condition of the body.
The presence of tumors in the breast tissue – the primary symptom of pathology (although not specific). Characteristics of tumors the following:
- the shape – approaching the rounded shape, but it is wrong;
- the size of 2-3 cm and more. A distinctive feature of triple negative breast cancer is that the size of the formation to increase rapidly;
- consistency – dense, non-flexible;
- sensitivity during the early stages of pathology painless. The growth of the tumor begins to compress the surrounding tissues to grow into them – which causes painful sensations that are not associated with phases of the menstrual cycle.
Often this lesion a woman finds herself in the breast accidentally during any procedures or during self-examination, which is conducted consciously.
Retraction of the nipple from the affected side is observed in the progression of triple negative breast cancer.
The increase in cancer develops due to reactive edema.
Seal the skin of the breast occurs due to the violation of the lymph outflow, which, in turn, arises and progresses due to the compression of the lymphatic pathways of the tumor or swollen breast tissue.
Changes in the skin over the tumor is often manifested in the form of sign of “lemon peel” – the skin becomes edematous and porous.
Nipple discharge appear in the majority of patients, but not all. Their characteristics:
- the number – scarce;
- color – yellowish or bloody;
- the consistency is liquid.
The observed increase in axillary lymph nodes. They are usually identified by the doctor during examination, but the patient may also find themselves under one arm round tight painful balls.
Signs of violation of the General condition of the body develop as the progression of this disease – they appear due to the fact that the products of the metabolism (exchange) and the disintegration of cancer cells get into the bloodstream and spread throughout the body and poison the organs and tissues.
These include:
- weakness;
- lethargy;
- quite a pronounced feeling of malaise;
- fatigue in the absence of any reason;
- deterioration, and then the lack of appetite;
- the dramatic weight reduction.
In a number of patients may experience itching skin and joint pain.
When metastasis of a tumor there are signs of violations of organs and tissues affected by metastasis.
Diagnosis
A diagnosis of triple negative breast cancer is put on the basis of complaints of patient, anamnesis (history of disease), results of additional methods of examination (physical, instrumental, laboratory). As described, the disease is an extremely aggressive form of cancer lesions, is extremely important early diagnosis of triple negative breast cancer.
Data examination the following:
- at the General survey – with the progression of the disease is marked deterioration of the General condition of the patient, pale skin and visible mucous membranes;
- in a local survey – defined swelling of breast tissue, a symptom of “lemon peel”, nipple discharge;
- palpation (feeling) – reveals sensitive heavy-weight education. Also found enlargement of axillary lymph nodes.
Metastatic lesions reveal the disorders of the affected organs – increasing the liver, decreased breath sounds in the lungs, soreness in the joints, and others.
When performing a mammography is drawn to such methods of diagnostics as:
- x-ray mammography – make x-ray images of the breast in two or three projections;
- ultrasound mammography – with the help of ultrasound in breast tissue detected lesion;
- tomosynthesis creates a two-dimensional image of the breast, it is assessed according to the structure of its tissues;
- magnetic resonance ( MRI) mammography – a method for tomographic imaging of the breast;
- optical mammography – a study of the condition of the breast with involvement of optic equipment.
TRMG may be suspected by a large tumor size (3-5 cm or more).
Laboratory methods of examination are crucial in the diagnosis of triple negative breast cancer. This:
- General analysis of blood – about the presence of cancer indicates a significant increase in ESR. With the progression of the disease are determined by the signs of anemia – a decrease in the number of erythrocytes and hemoglobin;
- cytological examination under a microscope studying the biopsy, it is determined abnormal cells (mostly immature);
- immunohistochemical analysis it is determined that the membranes of tumor cells lacking estrogen, progesterone and HER-2 receptors.
To detect metastases examined other organs and tissues using techniques such as:
and others.
In most cases (especially with the development of complications) will need the advice of a therapist, gastroenterologist, pulmonologist, hematologist, neurologist, ophthalmologist, and neurosurgeon.
Differential diagnosis of
Differential diagnosis of triple negative breast cancer is carried out with such diseases and pathological conditions, such as:
- benign tumors of the breast;
- other forms of malignant lesions, in particular hereditary and hormone-dependent cancer;
- some forms of mastitis – changes in breast tissue that occur due to hormonal imbalance.
Complications
The described pathology is one of the most adverse types of malignant tumors, which are very often accompanied by complications.
The most typical of them are:
- metastasis – cancer cells entering the blood or lymph to other organs and tissues with the formation of secondary metastatic lesions;
- cancer intoxication – poisoning of the organism by waste products and disintegration of cancer cells;
- cancer cachexia – extreme exhaustion of the patient;
- hydrothorax – appearance of fluid in the pleural cavity;
- pulmonary hemorrhage;
- gross violations of the Central nervous system, paresis, paralysis, and others;
- liver failure;
- blindness.
Also complications can develop as a result of the treatment.
Complications of radiation and chemotherapy that can occur is:
- violations of the skin – dryness, itching, peeling;
- disorders due to failure of digestion, nausea and vomiting;
- osteoporosis is a leaching of calcium salts from bone structures, which increases their fragility;
- blood clots – clots from forming in blood vessels is associated with impaired blood coagulation;
- the loss of eyebrows and hair.
During surgery to remove the tumor may be damaged lymphatic system. The result is:
- lymphorrhea is the leakage of lymph from lymphatic vessels;
- the creation of obstacles to the outflow of lymph;
- lymphedema is a stagnation of lymph in the tissues associated with the violation of the outflow.
Many patients develop mental disorders:
- depression;
- isolation;
- obsessive fear of death.
Treatment of triple negative breast cancer
In identifying the patient has triple negative breast cancer requires a quick selection of methods to destroy tumors and metastatic lesions. Note that the tumor is characterized by aggressive growth and low sensitivity to chemotherapeutic drugs. For the treatment are surgery, radiation, chemotherapy treatments.
Surgical treatment is to perform a radical mastectomy – removing:
- mammary gland;
- regional lymph nodes, as they are often affected by cancer metastasis.
Surgical intervention with triple negative breast cancer is traumatic, but it reduces the likelihood of relapse.
Radiation therapy is used postoperatively. Its purpose is to destroy cancer cells that might remain in the body after surgery. During radiotherapy treatments affect the tumor bed (the place in the tissues in which it was located) and the regional ways of outflow of lymph.
Chemotherapy in the treatment of such patients is usually carried out with the use of several chemotherapeutic agents.
Since the cells three times negative breast cancer lack receptors for sex hormones, it has a low sensitivity to traditional hormone therapy.
Prevention
As suspected genetic nature of the disease, the specific methods of primary prevention not.
Recommendations to reduce the risk of development of this pathology are the following:
- the passage twice a year a preventive examination by a mammologist for those women who have a relative with diagnosed family cancer;
- regular breast self-exams;
- controlled intake of oral contraceptives;
- avoidance of any forms of radioactive radiation;
- avoidance of traumatic lesions of the breast;
- prevention of somatic diseases, which contribute to the development of triple negative breast cancer, and in their development – early diagnosis and adequate treatment.
The prognosis of triple negative breast cancer, survival
The prognosis of three times negative breast cancer worse than for other forms of malignancies.
When selecting polihimioterapia regimens with the purpose of modern cytostatics three-year survival rate is 65 to 68% (this means that at the time of diagnosis of 65 to 68 of the 100 patients with the disease live for three years).
If triple negative breast cancer recurrence was not seen for 5 years, the forecast becomes the same as with other types of breast cancer.
Prognosis worsens if treatment was initiated at later stages.
