Metastatic Cancer and Triple Negative Breast Cancer, Put Simply

Cancer is a complex disease affecting various body parts, and understanding its different forms is crucial for effective treatment. In this blog, we delve into metastatic and triple-negative breast cancer concepts. This blog and short videos pulled from the IAWH-hosted webinar, “Breast Health, By Any Means Necessary,” with Dr. Geoffrey Ray, Radiation Oncology Specialist and Oncology Nurse Navigator Debra Rundles, are also included. View the entire webinar here.

What Does it Mean for Cancer to be Metastatic?

Cancer often begins in a specific organ or tissue, referred to as its "origin." For example, breast cancer typically starts in the breast tissue. However, when cancer cells break away from their primary site and travel to other body parts, it becomes metastatic cancer.

Metastatic cancer is especially concerning because it means the disease has spread to distant locations, making treatment more complex. Common sites where cancer cells metastasize include the bones and the brain, although metastasis can occur in different organs.

The process of metastasis involves cancer cells infiltrating the bloodstream or lymphatic system, allowing them to reach different areas of the body. Once cancer has metastasized, it requires a more aggressive treatment approach, often involving systemic therapies like chemotherapy.

The Unique Challenge of Triple Negative Breast Cancer

Breast cancer is a heterogeneous disease with various subtypes with distinct characteristics. One such subtype is triple-negative breast cancer (TNBC). To understand TNBC, we must first understand the role of hormone receptors. According to the American Cancer Society, triple-negative breast cancer (TNBC) accounts for 10-15% of all breast cancers. The term triple-negative breast cancer refers to the fact that the cancer cells don't have estrogen or progesterone receptors (ER or PR) and don't make any or too much of the protein called HER2. (The cells test "negative" on all three tests.) These cancers are more common in Black women younger than 40 (pre-menopausal) or those with a BRCA1 mutation. TNBC differs from other types of invasive breast cancer in that it tends to grow and spread faster, has fewer treatment options, and has a worse prognosis (outlook).

"BRCA" is an abbreviation for "BReast CAncer gene." BRCA1 and BRCA2 are two genes that impact a person's chances of developing breast cancer. Tests like BRCA1 and BRCA2 genetic testing identify mutations in genes associated with a higher risk of breast and ovarian cancers. However, understanding genetic testing and ensuring the accuracy of these tests is crucial.

Even small TNBC tumors are considered high risk due to their aggressive nature, emphasizing the importance of early detection and prompt treatment. Dr. Geoff and Nurse Debra advise that early precautions and testing should be prioritized, especially in families with a TNBC or metastatic cancer history.

Johns Hopkins Medicine states in their discussion about triple-negative breast cancer that “Surgery for triple-negative breast cancer does not always have to be a mastectomy. Effective chemotherapy done first opens up the possibility of less-invasive surgical options that are less of an ordeal for the patient. If the tumor is small enough after chemo, outpatient procedures or a lumpectomy may be possible.” The American Cancer Society provides treatment information for each triple-negative breast cancer stage that includes mastectomy as one of several interventions, which Dr. Geoff and Nurse Debra discusses in the video below.

Visit these links to help define symptoms and treatments of Metastatic and triple-negative breast cancer – each highlights the complexity of cancer, which is why understanding their intricacies is crucial for effective diagnosis and treatment. Research continues to advance in these areas, offering hope for improved therapies and outcomes for those facing these challenging diagnoses.

Resources

The Process of Metastasis

How Cancer Spreads

Triple Negative Breast Cancer Current Treatment Trends

Triple Negative Breast Cancer in African-American women

Mayo Clinic: Overview of Mastectomy

Navigating Breast Cancer: Radiation Indication and Genetic Test Accuracy

Breast cancer treatment often involves a combination of therapies tailored to specific circumstances. Two critical aspects of breast cancer care are radiation therapy indications and genetic testing accuracy. This blog and short videos pulled from the IAWH-hosted webinar, “Breast Health, By Any Means Necessary,” with Dr. Geoffrey Ray, Radiation Oncology Specialist and Oncology Nurse Navigator Debra Rundles, are also included. View the entire webinar here.

Radiation Therapy Indication in Breast Cancer

Radiation therapy plays a vital role in the treatment of breast cancer, and the decision to recommend radiation therapy depends on various factors:

● Type and stage of breast cancer,

● Tumor size,

● Lymph node involvement, and

● Other individual patient characteristics.

Breast-conserving Surgery (Lumpectomy)

A radiation oncologist may recommend radiation therapy if a woman undergoes breast-conserving surgery to remove the tumor (lumpectomy), which is an effort to ensure any remaining cancer cells in the breast are destroyed, reducing the risk of local recurrence. This surgical procedure preserves as much of the breast tissue as possible.

Mastectomy

In some cases, radiation therapy is still indicated after a mastectomy if there is a high risk of cancer returning. This decision depends on factors such as tumor size, lymph node involvement, and adverse features in the pathology report. Your doctor may suggest you have radiation therapy because you have cancer cells in the armpit (axilla) lymph nodes, cancer cells are seen close to the removed breast tissue, or the cancer is large (Cancer Research UK).

Lumpectomy and Mastectomy follow different procedures and yield different results. While every breast cancer patient can undergo a mastectomy, not every patient is eligible for a lumpectomy. During lumpectomies, an axillary lymph node dissection or a sentinel lymph node biopsy may be carried out to check if the cancer has spread to nearby lymph nodes. If the cancer has spread to nearby lymph nodes, radiation therapy targets the breast and the lymph node areas to eradicate residual cancer cells.

Reconstruction

According to the National Breast Cancer Foundation (NBCF), "If you think you will opt for a breast reconstruction, you should speak with your medical team before you have the lumpectomy or mastectomy, even if you plan to wait until later to have your breast reconstruction. More in-depth and well-researched information on this subject is found here. "Whether you undergo breast reconstruction, wear a prosthetic breast, or choose to embrace the changes you have experienced by allowing the breast removal to remain obvious, you should feel free to make whatever decision is right for you. The goal is to prevent the discomfort of unwanted change while enabling you to accept what has occurred and continue with your life." (NBCF, 2023)

Genetic Testing Accuracy in Breast Cancer

Genetic testing has revolutionized breast cancer care by providing valuable insights into an individual's risk of developing the disease. Tests like BRCA1 and BRCA2 genetic testing identify mutations in genes associated with a higher risk of breast and ovarian cancers. However, understanding genetic testing and ensuring the accuracy of these tests is crucial. "BRCA" is an abbreviation for "BReast CAncer gene." BRCA1 and BRCA2 are two different genes that have been found to impact a person's chances of developing breast cancer.

Genetic testing for breast cancer susceptibility has become highly reliable with advanced laboratory techniques and stringent quality control measures. According to cancer care Dr. Geoff Ray, Radiation Oncology Specialist, and Oncology Nurse Navigator Debra Rundles, the key is to choose a reputable testing laboratory and work with a qualified genetic counselor who will interpret your results accurately.

Accurate genetic testing influences treatment decisions. For example, a positive BRCA mutation prompts women to consider preventive measures like risk-reducing surgeries or more frequent breast cancer screenings.

Familial Implications

Genetic testing results also have implications for family members, and sometimes, genetic experts may suggest relatives undergo testing to assess their cancer risk, i.e., if a mutation is identified, which may raise the chance of being susceptible in the future. Radiation therapy indication and genetic testing accuracy are pivotal components of breast cancer management. An individualized treatment plan that considers the unique characteristics of the cancer and the patient's genetic profile guarantees effective treatment and improved outcomes.

Resources

Lumpectomies vs Mastectomies

Breast-Conserving Surgery

Understanding Genetic Testing

National Breast Cancer Foundation, Inc.

Cancer Research UK