According to statistics, malignant breast tumors are the most common type of oncology in women. Thrice negative breast cancer is one of the most severe forms of cell mutation. This type of malignancy is observed in 25% of sick women diagnosed with breast cancer.
What is TNRM?
Thrice negative breast cancer (TNBC) is a dangerous form of malignant breast neoplasia. The disease is characterized by the absence in the tumor cells of receptors for steroidal female sex hormones produced by the ovaries, progesterone, a protein that activates the division, development and differentiation of epithelial cells. TNBC develops in most cases in young women. Trip-negative (Triple negative) breast cancer is characterized by high activity of cell division, in which the volume of tissues increases with their rapid growth and metastasis to internal organs. Malignant cells grow and produce thrice negative volumetric formations - hence the name.
In patients with this type of neoplasia, the GDF11 protein, which is able to suppress the phenotypic manifestations of some changes in the genome under the influence of others, is fully or partially inactive. The formation of the tumor is due to the inhibition of the process of cell death, in which they decompose into round, surrounded by the membrane of the body, and suppression of the BRCA1 anti-oncogen. Unripe protein in an inactive form accumulates in mutated cells that can grow into cancerous ones. This contributes to the rapid uncontrolled growth of the tumor. The most common type of thrice-negative breast cancer is low-grade ductal carcinoma.
Disease classification: forecasting for each type
The systematization of breast neoplasia continues to this day. Trip-negative breast cancer is classified by the presence of tumor sensitivity to various types of drug treatment. It’s worth saying right away that such a typology is extremely arbitrary.
- Luminal A or estrogen-dependent form is considered to be the most favorable according to forecasts. Malignant cells are susceptible to endocrine therapy.
- Luminal B. The prognosis for this type is not very favorable due to its aggressive formation and a tendency to regular relapses. It is mainly found in women before menopause.
- The HER-2 / neu type is characterized by aggressive, extra-genital, aggressive, large-sized malignant neoplasms and early lymphogenous metastasis. The prognosis for this form of thrice-negative breast cancer is usually poor, since carcinomas are resistant to hormone therapy.
- The basal-like type is 70% carcinomas with a trip-negative phenotype. Patients with this form of TNBC have poor prospects for recovery.
There is also a classification of TNRM by histological type.
- The medullary type has neoplasms in the form of cords and wide strips, proceeds hidden. He is often confused with fibroadenoma.
- Metaplastic - a group of tumors that have common morphological features. Unlike other types of breast cancer, it is diagnosed at a late stage and has a poor prognosis.
- Low-grade ductal ductus is a neoplasia of ductal epithelium that destroys its basement membrane and forms growths in the surrounding stroma.
- Adenocystic - is quite rare, has a low level of histopathological differentiation, which complicates the therapy.
In oncology, the appointment of therapy is based on all the characteristics of the disease presented to the doctor.
Oncology development stages
The histological classification of breast neoplasia makes it possible to establish the degree of malignancy. But the stage of triple-negative breast cancer is determined by the TNM system, where the index T is the size of the malignant neoplasm, N are the nodules indicating the defeat of regional lymph nodes, and M is distant metastases.
Stages of TNRMZH course:
- Stage 1 is characterized by tumors up to 3 cm in size, located in the thickness of the mammary glands. Malignant cells are not spread on the skin and do not have a remote secondary focus.
- Stage 2 of thrice-negative breast cancer is characterized by neoplasms up to 5 cm in size, which go to the fiber, without metastases. Also, the phases are characterized by tumors of the same size with the defeat of single lymph nodes.
- Stage 3 - neoplasia with a diameter of more than 5 cm with germination of the skin and penetration into the fascial muscle layers, but without secondary foci in the lymph nodes.
- Stage 4 - the spread of malignant cells throughout the body through the bloodstream and lymphoid system. Often it excludes the possibility of cure.
Reasons for the formation
There is currently no general theory of the origin of triple-negative neoplasia. Oncopathology is formed as a result of genetic abnormalities. According to statistical studies conducted by experts in the field of oncological mammology, one of the main factors in the occurrence of neoprocess is a hereditary predisposition. There are other factors that influence the formation of oncopathology.
- Prevalence in selected ethnic communities. Based on statistics, TNBC is more common among African Americans. This may indicate the activity of some inherited genes.
- Persistent change in the genome of BRCA-1. In patients affected by triple-negative cancer, mutations in the oncosuppressive protein are detected, which prevents the process of converting cells from benign to malignant.
- Excessive expression of the oncogen FAM83B. Elimination of the gene makes it possible to restrain the spread of neoplasia by cell division.
Other causes that increase the risk of a triple negative neoplasm include:
- Uncontrolled use of hormonal oral contraceptives.
- Exposure to radiation.
- Breach of the breast.
- Diseases of the mammary glands: mastopathy, galactorrhea, lactostasis.
- Repeated abortions.
In the development of thrice-negative breast cancer, age does not play any role. Breast neoplasia can form in both young women and women over 35 years old.
Clinical signs
General symptoms practically do not differ from signs of other types of breast oncology, but the rate of development of the pathological process is much higher. At stage 1, three times negative breast cancer is almost not manifested.
The main sign of neoplasia is the presence of a dense volumetric neoplasm in the chest area, which a woman can grope on her own. Compaction very quickly increases in size and becomes painful. Triple-negative cancer is also accompanied by other symptoms:
- Breast edema.
- Retraction of the nipples.
- Modification of the skin over the neoplasm.
- Yellow or spotting from the nipples.
- Early enlargement of the lymph nodes.
As cancer pathology progresses, cancer cachexia occurs.
Complications
With thrice-negative breast cancer, the prognosis is rarely favorable. The reason for this is complications in the form of rapid metastasis in various organs. With the transition of oncopathology to the terminal stage, a serious deterioration in the state of health is observed.
- Dramatic weight loss.
- Muscle weakness.
- Trophic changes in epithelial tissue.
- Severe disorders of the central nervous system.
- Liver failure.
- Pulmonary bleeding.
- Blindness.
Separate the complications that arise after radiation, surgical and chemotherapy.
Diagnosis of neoplasia
Early treatment of thrice-negative breast cancer significantly increases the chances of a favorable prognosis. Therefore, it is very important to identify the tumor in the first stages. The purpose of diagnosis is to assess the size and location of the tumor, to identify regional and distant metastases. The survey includes the following methods:
- Mammography is an X-ray examination of the breast in a direct and oblique projection. This type of diagnosis is prescribed from 35 years.
- Ultrasound of the breast - ultrasound scanning of breast tissue. The study allows visualization and separation of tumors smaller than 5 mm with an accuracy of 95%.
Both methods give nonspecific results that match the characteristics of other cancers. To identify and diagnose TNBC, specific research methods are used: cytological and immunohistochemical analyzes.
Treatment methods: chemotherapy
Detection of triple negative breast neoplasia requires a quick selection of therapeutic methods. The treatment for each patient is selected individually, taking into account the growth and sensitivity of the tumor to drugs. The main difficulty is that in malignant cells of triple negative breast cancer, chemotherapy has a bad reaction. For treatment, new generation drugs are used: Bevacizumab, Nexavar, Iniparib, Eribulin.
Surgical Therapies
According to doctors and based on statistical data, surgical intervention allows you to give positive predictions. There are several methods for surgical treatment of triple negative breast cancer.
- Lumpectomy.
- Quadrantectomy
- Modified radical mastectomy.
- Segmentectomy.
The choice of operation depends on the course of the pathology and the condition of the patient.
Forecast
In order for the prognosis of triple negative breast cancer to be favorable, therapy should be carried out as soon as possible. A distinctive feature, it is also the problem of oncopathology - the rapid increase and spread of malignant cells throughout the body.
Another characteristic feature of TNRM, which does not allow to fully combat the disease, is a hereditary predisposition. Close relatives of oncogenoma carriers are at risk. But, on the other hand, these women are constantly monitored and their chances of recognizing neoplasia in the early stages as well as a favorable prognosis increase.
In general, a positive outcome depends on several factors:
- Identification of neoplasia in the early stages.
- The effectiveness of drug therapy.
- The absence of non-cancerous breast diseases.
- Lack of BRCA mutations.
Survival
Triple-negative breast neoplasia is an aggressive pathology with a high risk of secondary foci. Most often, metastases germinate in the lungs and brain, the probability is especially high within five years from the onset of cancer.
With thrice-negative breast cancer, survival is low. This is due to the detection of the disease in the later stages and its tendency to relapse soon after chemotherapy. According to statistics, about 68% of patients with this diagnosis have a three-year survival rate. Preliminary predictions are made during therapy - if neoplasia becomes less aggressive, decreases in diameter, then a positive result is most likely.
Surgical therapies, in which the breast is removed partially or completely, increase the chances of survival.
TNRM prophylaxis
To prevent trip-negative breast cancer, simple preventative measures are necessary.
- Regular self-examination of the chest.
- Implementation of adequate therapy for diseases of the mammary glands.
- The use of hormonal drugs only as directed and under the supervision of a doctor.
- Avoid chest injuries.
- Women with blood relatives with "family oncology" need to be screened for three times negative breast cancer 2 times a year.