A little known side effect with a huge impact
What Is Triple-Negative Breast Cancer?
Because triple-negative cancer does not have hormone receptors or the HER2 protein, it won't respond to some of the commonly used treatments for breast cancer, such as hormonal therapy or HER2-positive targeted therapies. There are several treatment options that are available for triple-negative breast cancer depending on how advanced the cancer is and whether it's recurrent.
Surgery Some people may undergo surgery such as a lumpectomy — which removes the tumor and a small margin around the tumor, but leaves the rest of the breast intact — or a mastectomy, which removes the entire breast.[13]
Radiation Radiation therapy uses high-energy rays to destroy cancer cells, and may be used to treat some triple-negative breast cancers.[13]
ChemotherapyMost treatments for triple-stage breast cancer involve chemotherapy, which uses medication to kill cancer cells. Usually, these drugs are injected into the vein or given orally. People with triple-negative breast cancer are sometimes given chemotherapy before surgery (neoadjuvant chemotherapy) to shrink the cancer, whereas other people are given chemotherapy after surgery (adjuvant chemotherapy) to reduce the chances the tumor will recur.
Some of the types of chemotherapy that are given include:
Immunotherapy Immunotherapy is a type of cancer treatment that uses your body's immune system to fight cancer. The only immunotherapy that's able to treat triple-negative breast cancer is pembrolizumab (Keytruda), which targets a protein called PD-L1. Blocking this protein helps boost the body's immune defenses against breast cancer cells, which helps to shrink the tumors.[15]
Pembrolizumab is sometimes given to people with advanced triple-negative breast cancer who have the PD-L1, which is found in about 1 in 5 of these cancers, alongside chemotherapy.[13]
Targeted TherapyTargeted drugs use medications that directly target proteins on the breast cancer cells that allow them to grow and spread. The two types of targeted therapies that are used to treat to treat triple-negative breast cancer are:
[16]
Understanding Stage 2 Breast Cancer
Stage 2 breast cancer means the cancer hasn't spread beyond your breast tissue or nearby lymph nodes. The outlook for people with this diagnosis is good. The 5-year relative survival rate is 99%.
Cancer isn't a single disease. It's a group of diseases, and breast cancer is no different. Because there are various types of breast cancer, not all stage 2 breast cancers are the same or involve the same treatment.
This article explores how doctors define stage 2 breast cancer, along with treatment options and survival rates.
When you first receive a diagnosis of breast cancer, your doctor will assign a stage to your cancer. This is called clinical staging. It's based on:
If surgery is done to examine the breast tissue, laboratory test results on the tissue and lymph nodes can provide more information.
Based on these results, your doctor can determine the cancer's pathologic or surgical stage, which is more accurate than the clinical stage.
Breast cancer staging involves the TNM system, which provides specific details about:
These factors are combined to determine the cancer stage. Breast cancer is staged from 1 to 4.
Stage 2 breast cancer has two subcategories.
Stage 2A
Breast cancer is stage 2A if one of these is true:
Stage 2B
Breast cancer is stage 2B if one of these is true:
Breast cancer staging is complicated. A number of factors can affect the overall staging diagnosis, including a tumor grading system and the presence of certain receptors in breast cancer cells.
A tumor grading system indicates how fast cancer cells are likely to grow and spread. Higher grades indicate more aggressive cancer.
In addition, the tumor will be tested for receptors that can affect your treatment options and provide a better idea of what to expect.
These factors can also be used in staging because these cancers behave differently. For example:
The tumor's HR and HER2 status determines some of your treatment options. Your doctor will also consider:
Typically, treatment involves a combination of therapies. Here's a look at some of the most common types of treatment for stage 2 breast cancer.
SurgeryDepending on the size and location of the tumor, surgical options may include:
During both of these procedures, the surgeon also performs a sentinel lymph node biopsy to see whether the cancer has spread.
Radiation therapyRadiation therapy typically follows surgery, especially if you have a lumpectomy.
If you have a mastectomy, certain factors will help determine whether you need radiation treatment. These factors include:
Radiation is used to lower the chances of recurrence. Radiation therapy works by damaging the DNA of cancer cells. This helps destroy them.
Radiation therapy is typically a localized type of treatment. This means it's only targeted at the specific area that is radiated. It doesn't target your whole body like chemotherapy or some types of medication.
There are various forms of radiation. Some regimens are 5 days, some are 3 to 4 weeks, and some are 5 to 6 weeks long.
The most common side effects include fatigue and redness, skin peeling, and swelling around the area that's being treated.
ChemotherapyChemotherapy can be used to shrink tumors before surgery or to lower the chance of recurrence after surgery.
Immunotherapy is also now offered before surgery along with chemotherapy for some stages of triple-negative breast cancer.
There are fewer treatment options for triple-negative breast cancer since it doesn't have HR or HER2 receptors. But it tends to respond well to chemotherapy. In 2021, the Food and Drug Administration (FDA) approved pembrolizumab (Keytruda) for high risk, early stage triple-negative breast cancer.
For breast cancer, chemotherapy drugs are usually given through a vein intravenously (IV). This may be as an injection that lasts several minutes or as an infusion that lasts for hours or longer.
Chemotherapy for breast cancer is typically given in cycles of about 1 or 2 to 3 weeks. You're given chemotherapy through an IV on one day of the week or for a few days in a row. You're then given time to recover from the drugs before starting your next cycle.
One of the disadvantages of chemotherapy is that these drugs can't tell cancerous cells from healthy cells. As a result, some healthy cells can get temporarily damaged in addition to cancerous ones. This can result in side effects such as:
Some types of chemotherapy may also cause early menopause.
Targeted therapyTargeted or biologic therapies involve the use of drugs that can tell the difference between cancer cells and normal cells a little better than chemotherapy. These drugs have the ability to affect cancer cells, sometimes with less harm to other cells.
Targeted therapies are a newer treatment approach. New drugs are being developed as scientists learn more about how cancer cells grow and multiply and what differentiates them from typical, noncancerous cells.
For stage 2 breast cancer, targeted hormone therapy can be effective for ER-positive or PR-positive cancers. Therapies may include:
Side effects of hormone therapy can include:
Other types of targeted therapy have the ability to detect certain proteins or enzymes associated with cancer cells. For instance, with HER2-positive breast cancer, targeted therapy can disrupt the high levels of growth-promoting protein on the surface of the cancer cells.
Some therapies for stage 2 HER2-positive breast cancer include:
Clinical trialsYou may be able to take advantage of innovative targeted therapies or chemotherapy drugs by participating in a clinical trial. Ask your doctor if there's a trial that's a good fit for you.
Side effects and complicationsAll treatments have some side effects. These can range from mild to severe. Most clear up when treatment ends, but some lasting complications can occur.
It's important to tell your care team about all symptoms, even if they seem minor. Your doctors will work with you to ease side effects and deal with complications.
Follow-up careOnce primary treatment ends, hormone therapy can continue anywhere from 5 to 15 years. Breast reconstruction, if you choose to have it, is a multistep process that may take many months.
Your first post-treatment visit will probably be within a few months. Your doctor will want to see how you're doing and if you need help with the side effects of treatment.
Eventually, you'll transition to visits every 6 months, then yearly visits. Yearly checkups will include breast imaging.
Your doctor will work out a schedule based on the level of care you need.
Emotional careComing to the end of your treatment can be a challenging transition. Emotions can range from relief and exhilaration to anxiety and sadness. Fear of recurrence is common. These emotions and fears are normal.
When your focus has been on treatment, side effects, and scheduling appointments, it can take a little time to get used to life on the other side of those details.
Also, loved ones may be so happy for you that they don't realize you're still dealing with the physical and emotional effects of your cancer treatment. You don't have to live up to anyone's expectations but your own. When or if you get back to your old routine depends on circumstances unique to you.
It's important to follow your own timetable and to do things at a pace that works for you.
Overall, the outlook for people with stage 2 breast cancer is generally good. According to the American Cancer Society, the 5-year relative survival rate is:
These figures represent people who received diagnoses between 2013 and 2019. These percentages vary somewhat based on ER/PR and HER2 status.
Certain types of breast cancer have a better outlook than others.
This may be because some, such as HR-positive and HER2-negative, are more responsive to hormonal therapy, and HER2-positive breast cancers are responsive to anti-HER2 targeted therapy. Some, like triple-negative breast cancers, have fewer treatment options and a higher recurrence rate in the first few years.
Your care team can review your complete medical profile to give you a better idea of what to expect.
There are many resources and support groups for people with breast cancer. There's no obligation to stick with a group. You can try it out and move on whenever you're ready. You might be surprised to learn that you also have a lot to offer others.
The American Cancer Society has a variety of support services and programs. You can call the 24/7 helpline at 800-227-2345, visit the website, or download the Life After Treatment Guide.
If you like having information at your fingertips, download the free Breast Cancer Healthline app. The app lets you connect with others who have a similar diagnosis and understand what you're going through.
Supporting someone with breast cancerIf you're reading this because there's a breast cancer survivor in your life, you're already being supportive.
Maybe you don't know what to say or fear saying the wrong thing. Say something anyway. Don't let breast cancer go unmentioned. The best thing you can do now is to be there and let them lead the way.
People with breast cancer may feel obligated to act with confidence and have a positive attitude. That may mask what's really going on. Let them know they can be real with you, then listen without judgment.
Offer to help in a concrete way. Can you prepare a meal? Do some chores? Share a movie night? Let them know what you're willing to do. But take them at their word. If they don't want help, don't push it. Just making the offer lets them know you care.
The end of treatment is not the end of the experience. There are many adjustments ahead. Some things may never return to the way they were, but change isn't always bad.
In stage 2 breast cancer, cancer cells have not spread beyond the breast or nearby lymph nodes. Knowing the HR and HER2 status of your stage 2 breast cancer can help your care team determine which treatments are most likely to be effective.
Stage 2 breast cancer is very treatable, and the overall outlook for someone with this stage is good. As with most types of cancer, the earlier your cancer is diagnosed and treated, the better the outcome.
Cancer Can Enter Life When Least Expected…
Ella Scown was preparing to move to Canada when she found a lump in her breast. Not confident about the prices of healthcare overseas, the 29-year-old lawyer booked a quick check-up.
"My GP said don't be worried," says Ella. "[She told me] people your age have less than a 2 per cent chance of getting breast cancer. But just to be careful, we'll do an ultrasound."
A few tests later, Ella and her partner Lewis were called in to see a specialist.
"We got put into a room and were made to wait for a very long time, about an hour by ourselves. So, you spiral. Eventually, three people walked in with this massive folder.
'I just went into shock' (sidehead)
"I was like: 'Oh no, this is not going to be good'. The first thing they said was: 'You have breast cancer'. After that, I don't remember anything. I just went into shock …"
The diagnosis – triple-negative breast cancer – came two days before her flight to Vancouver. Ella cancelled her flights and moved in with her parents.
"The first step was fertility preservation – a course of injections and a procedure to remove the eggs."
The first chemotherapy rounds were manageable, though Ella found losing her hair to be psychologically traumatic. The second round was brutal.
"It was so bad. It was this red liquid they call the 'red devil' and it was pumped through a port into my chest. I was taking 30 tablets every day to stop feeling sick…That lasted about eight weeks."
The Lion's Lodge
After chemotherapy Ella needed surgery to remove what was left of the cancer, then radiation treatments. While preparing for radiation, Ella realised the immense toll it would take travelling to Waikato Hospital each day for four weeks. Thankfully she was able to stay at the Cancer Society's Lions Lodge.
"Staying at the lodge changed a month of my life and made it a lot easier," she says.
"I felt less stressed because I wasn't having to sit in traffic for hours, and it removed the guilt associated with having a support person give up that much time Monday to Friday for four weeks.
"I spoke to so many people in the lodge who wouldn't have had access to their treatment if they had not had the lodge. It changes the whole experience being able to stay there."
Ella has finished treatment and is looking ahead to her future travels. "The outcome of the chemotherapy and surgery is good. Although my plans had to change, I'm still hoping to move overseas."
Chance to donate
On August 30-31, some 8000 yellow high-viz-clad volunteers will be on streets across NZ with daffodil pins and fresh daffodils to collect donations for Daffodil Day.
Donations can be made online at: daffodilday.Org.Nz, at any ANZ bank, and anywhere a daffodil day QR code is displayed.
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