Isla Bennett
Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer that accounts for 15-20% of all breast cancer cases. TNBC tumours are likely to be grade 3, meaning they grow and spread faster than other types of breast cancer. While the exact cause of TNBC is unknown, it has been linked to mutations in the BRCA genes. Treatments for TNBC include chemotherapy, immunotherapy, surgery, and targeted therapy. As with all cancers, early detection of TNBC leads to a better prognosis. Certain changes in the nails can be indicative of cancer or cancer treatment, including nail thinning, discolouration, and pain in the nail beds.
| Characteristics | Values |
|---|---|
| Type of cancer | Triple-negative breast cancer (TNBC) |
| Occurrence | Accounts for 15-20% of all breast cancer cases |
| Symptoms | New lump or mass, swelling in all or part of a breast, dimpled skin, breast or nipple pain, nipple retraction, dry, flaking, thickened or red skin around the nipple or breast, nipple discharge that is not breast milk, swollen lymph nodes |
| Cause | Unknown, but linked to mutations in the BRCA genes |
| Treatment | Chemotherapy, immunotherapy, surgery, targeted therapy, clinical trials |
| Prevention | Maintain a healthy weight, exercise regularly, know your family medical history, monitor your breast health, consider genetic testing if there is a family history of certain cancers |
| Nail Changes During Cancer Treatment | Weaker nails, painful nail beds, dry or cracked skin around nails, colour changes, irregular marks, Muehrcke lines, Mees' lines, nail lifting or falling off, slower growth or no growth, nail infections |
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What You'll Learn
TNBC is a rare type of breast cancer
TNBC stands for Triple-Negative Breast Cancer, a rare form of invasive breast cancer. It accounts for 15% of all breast cancer cases and tends to be more aggressive than other types, meaning it grows and spreads faster. TNBC tumours are likely to be Grade 3, indicating that the cancer cells bear little resemblance to normal, healthy breast cells.
TNBC is characterised by the absence of three receptors usually found in breast cancer cells: estrogen receptors (ER), progesterone receptors (PR), and the human epidermal growth factor receptor 2 (HER2). These receptors or proteins facilitate the growth and spread of cancer. The absence of these receptors in TNBC makes the disease harder to treat.
The exact cause of TNBC is unknown, but researchers have linked it to mutations or changes in the BRCA genes. Women under 40 are more likely to be affected by TNBC, and it is important for those with a family history of breast, ovarian, pancreatic, or prostate cancer to consider genetic testing for the BRCA genes.
Some of the symptoms of TNBC are similar to other more common breast cancers and may include a new lump or mass, swelling in all or part of a breast, dimpled skin, breast or nipple pain, and nipple retraction. TNBC can also cause the skin of the nipple or breast to become dry, flaking, thickened, or red, and there may be nipple discharge that is not breast milk. Swollen lymph nodes can also indicate that the cancer has spread.
While there is currently no cure for TNBC, treatments such as chemotherapy, immunotherapy, surgery, and targeted therapy can help manage the disease and improve the prognosis, especially when caught in the early stages. Chemotherapy drugs are designed to destroy cancer cells throughout the body and can be used before or after surgery to shrink tumours and kill remaining cancer cells. Immunotherapy can also be used in combination with chemotherapy to shrink tumours and as a post-surgery treatment to prevent relapse. Surgery options include lumpectomy to remove a lump or mastectomy to remove the entire breast, followed by a sentinel node biopsy or axillary node surgery to check for spread to the lymph nodes. Targeted therapy combines chemotherapy and immunotherapy with treatments specifically targeting cancerous cells. Clinical trials are also ongoing to test new combinations of drugs and approaches to existing treatments.
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Treatments include chemotherapy, surgery, and immunotherapy
Triple-negative breast cancer (TNBC) is a rare form of invasive breast cancer, accounting for 15% of all breast cancer cases. TNBC is more likely to affect women aged 40 and younger. While the exact cause of TNBC is unknown, researchers have linked it to mutations in the BRCA genes.
Treatments
Chemotherapy
Chemotherapy is the most common treatment for TNBC. It involves using medicine to kill cancer cells throughout the body. Chemotherapy is often given before surgery to shrink a tumour and/or cancerous lymph nodes. If cancer is still found in the tissue after chemotherapy, doctors may recommend oral chemotherapy drugs like capecitabine (Xeloda) for 18 to 24 weeks.
Surgery
Doctors often recommend surgery to remove the cancer from the breast. A lumpectomy removes the tumour plus a small rim of normal tissue around it, while a mastectomy removes the entire breast. After a lumpectomy, radiation therapy is typically needed to kill any remaining cancer cells in the breast and sometimes in the underarm area. If cancer is found near the chest wall or lymph nodes, radiation may also be given after a mastectomy.
Immunotherapy
Immunotherapy boosts the immune system so that it can better recognise and fight cancer cells. It is often used in combination with chemotherapy, especially for advanced TNBC in which cancer cells have the PD-L1 protein. The immunotherapy drug pembrolizumab (Keytruda) targets the PD-1 protein and was approved for advanced PD-L1+ TNBC in 2020. Clinical trials are also investigating the safety and efficacy of combining immunotherapy with other chemotherapy agents.
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Symptoms are similar to other breast cancers
Triple-negative breast cancer (TNBC) is a rare form of invasive breast cancer, accounting for about 15% of all breast cancer cases. TNBC symptoms are similar to those of other breast cancers. TNBC symptoms may include:
- A new lump or mass
- Swelling in all or part of a breast
- Dimpled skin
- Breast or nipple pain
- Nipple retraction, when the nipple turns inward
- Nipple or breast skin that is dry, flaking, thickened, or red
- Nipple discharge that is not breast milk
- Swollen lymph nodes under the arm or near the collarbone
It is important to remember that many breast cancer symptoms are similar to less serious conditions, and having certain symptoms does not necessarily mean you have breast cancer. However, if you notice anything unusual about the look and feel of your breasts, it is important to see a doctor.
Treatments for TNBC include chemotherapy, immunotherapy, surgery, and radiation therapy. The earlier TNBC is diagnosed, the better the prognosis.
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Tumours are likely to be grade 3
TNBC stands for triple-negative breast cancer, a rare type of breast cancer that accounts for 15% of all breast cancer cases. TNBC is more likely to affect women aged 40 and younger.
Now, onto tumour grades. Tumours are typically graded on a scale of 1 to 4, with 4 being the most severe. Grade 3 and grade 4 tumours are considered high-grade, fast-growing, and can be referred to as "malignant" or "cancerous" growths. They are more likely to spread to other parts of the body and may recur even after intensive treatment. The grading is based on how abnormal the cells look under a microscope, with higher-grade tumours having more abnormal-looking cells.
Grade 3 tumours, such as astrocytoma, indicate a high-grade cancer that is likely to grow and spread more quickly than lower-grade tumours. This means that grade 3 tumours often require more aggressive treatment right away. Doctors use tumour grade, along with other factors like cancer stage, genetic features, age, and general health, to form a treatment plan and estimate the prognosis.
In the context of TNBC, the tumour grade is an important factor in determining the course of action. Since TNBC cells don't typically have the receptors or proteins that aid cancer growth and spread, chemotherapy is the most common treatment. However, recent clinical trials are testing new combinations of drugs and approaches, including immunotherapy, surgery, and targeted therapy.
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Relapse rates are high in the first five years
Triple-negative breast cancer (TNBC) is a rare form of invasive breast cancer that accounts for about 15% of all breast cancer cases. TNBC is more likely to affect women aged 40 and younger and is linked to mutations in the BRCA genes. While TNBC responds better to conventional chemotherapy than other breast cancer subtypes, it has a high recurrence rate, with the greatest risk of relapse within the first three to five years.
TNBC patients who relapse at different times are associated with distinct biological characteristics and prognoses. Factors that can increase the risk of relapse include being 35 years old or younger at diagnosis, having large tumours, unsuccessful surgery, the absence of radiation therapy after a lumpectomy, having inflammatory breast cancer, and having a high body mass index (BMI).
The good news is that there is a lower risk of recurrence after five years of being disease-free. One study found that among those with TNBC who did not experience a relapse within the first five years, 97% remained relapse-free a decade later, and only 5% had a relapse within 15 years. This sharp reduction in recurrence after five years means there are no long post-therapy regimens.
While there is currently no targeted treatment for TNBC, healthcare providers and researchers are actively investigating new ways to treat it. Some existing treatments include chemotherapy, immunotherapy, surgery (such as lumpectomy or mastectomy), and radiation therapy. Clinical trials are also testing new combinations of drugs and approaches to existing treatments.
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Frequently asked questions
TNBC stands for Triple-Negative Breast Cancer, a rare and aggressive type of breast cancer.
TNBC symptoms are similar to other breast cancers and may include a new lump or mass, swelling in the breast, dimpled skin, breast or nipple pain, and nipple discharge that is not breast milk.
Chemotherapy is the most common treatment for TNBC, especially when caught in the early stages. Immunotherapy, surgery, and targeted therapy are also used.
Nail changes during cancer treatment can include thinning, reduced strength, painful nail beds, dry or cracked skin, colour changes, irregular marks, and slowed growth.
Finger clubbing is when the ends of the fingers swell up, and it is often associated with lung cancer. It starts with a soft nail base and shiny skin next to the nail bed, followed by increased nail curvature, and finally, swelling of the fingertips.
