Triple negative breast cancer is a subset of invasive ductal cancer (IDC) and is characterized by having no estrogen receptors or progesterone receptors and no excess of the HER2 protein on the cancer cell surfaces.
In this type of cancer, the tumor doesn't have the most common types of receptors that promote cancer cell growth — estrogen, progesterone, and HER2. That means that triple negative breast cancer doesn't respond to hormone therapy, such as tamoxifen, or targeted therapy, such as Herceptin.
Tests
Mammograms
Mammograms are the fastest, most accurate way of detecting an abnormal growth in your breast. With tomosynthesis, or 3-D mammography, radiology technologists can get breast images from multiple angles, enhancing the accuracy of a reading and reducing the potential need for repeat scans.
Breast Ultrasound and MRI
Your doctor may request a noninvasive imaging exam, such as breast ultrasound or breast MRI, if you have dense breasts and you’re at a higher risk of breast cancer — especially for those with a 20 percent or higher lifetime risk for breast cancer.
Ductoscopy
More than 80 percent of breast cancer growths arise in milk ducts. If your symptoms include a watery, blood-tinged discharge from the nipple, your surgeon will use ductoscopy to find the lesion to sample or remove it. It uses a fiber-optic scope less than a millimeter thick inserted into the milk duct at the nipple to send images to a computer monitor.
Estrogen and Progesterone Receptor Test
This test looks for estrogen and progesterone (hormone) receptors in your cancer tissue. If your breast cancer cells have estrogen and progesterone receptors, the cancer may grow more quickly. The test tells your doctor whether treatment to block estrogen and progesterone will be effective.
Human Epidermal Growth Factor Type 2 (HER2/Neu) Receptor Test
This test measures how many HER2/neu breast cancer genes there are and how much HER2/neu protein is made in a sample of breast tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer may grow or spread more quickly.
Multigene Tests
Because no tumor has a single mutation, genomic profiling allows the pathologist (cellular expert) to identify groups of mutations in your tumor tissue sample. We then can create a tumor profile for you. That profile helps us determine what type of treatment would be the most effective and how long you should have treatment.
Treatments
Chemotherapy
Chemotherapy is cancer-fighting medicine that's administered intravenously or by a pill. Chemotherapy also might be recommended before surgery, called neoadjuvant chemotherapy, to help reduce the size of the tumor and improve surgical results. Often, more than one chemotherapy medicines are used at the same time or one after the other to destroy different kinds of cancer cells that come from the same breast cancer.
Locations: If you need intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester’s main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables, and Deerfield Beach locations.
Clinical Trials
As a breast cancer patient at Sylvester, you have access to more novel or advanced treatments than anywhere else in South Florida. Your doctor will let you know if there's a clinical trial that’s right for you.
Triple negative breast cancer has been hard to treat in the past, but a novel clinical trial at Sylvester is changing that by targeting vitamin D and androgen receptors. When used in conjunction with chemotherapy, this treatment is showing great promise.
Lumpectomy
This procedure removes a tumor (lump) and a small amount of normal tissue around it. Sylvester cancer surgeons pioneered the technique for oncoplastic lumpectomy and now teach other surgeons around the country. During a lumpectomy, your surgeon removes the tumor and a small area of surrounding tissue. Your doctor sculpts the remaining breast tissue to give your breast a natural appearance, with touch-ups to the other breast to make them match.
Lumpectomy With Breast Reduction
For women with large breasts, the surgical oncologist and plastic surgeon can do breast-reduction surgery, starting with the cancerous breast to make sure the removed tissue contains the lump and a clean — or safe — margin around the lump. The plastic surgeon reduces the other breast to match.
Partial Mastectomy
This surgery, also called a segmental mastectomy, removes a larger part of the breast than a lumpectomy.
Skin and Nipple-Sparing Mastectomy
When appropriate and possible, this procedure preserves the skin and nipple to minimize scarring and improve your surgeon's ability to reconstruct your breasts.
Mastectomy
A mastectomy removes the entire breast that's affected by cancer. The surgeon may remove one or more of the lymph nodes under your arm during surgery, or as a separate procedure later, to see if cancer has spread.
If you have a mastectomy or a lumpectomy, you may choose to have breast reconstruction surgery during at the same time, or you can decide to do it later. Your surgeon may perform an oncoplastic lumpectomy, or your breast cancer surgeon and a plastic surgeon can work together to do reconstructive surgery. New techniques make it possible to create a breast that's close in form and appearance to your natural breast.
Sentinel Lymph Node Biopsy
Doctors use this minor surgery to determine if cancer has spread beyond a primary tumor into your lymphatic system. A sentinel lymph node is the first place cancer cells may move to when they begin to spread. During the biopsy, your doctor injects a special dye (tracer) to locate the nodes and remove them to look for cancer cells. If they're free of cancer, it means it's unlikely that cancer has spread and it's not necessary to remove more lymph nodes.
Sylvester offers a novel treatment that prevents taking more lymph nodes, even if the sentinel node is suspicious. Before surgery, an ultrasound scan of the armpit can highlight which lymph nodes are involved (they will appear enlarged or swollen). When chemotherapy is used before surgery (neoadjuvant chemotherapy), it can convert a previously positive lymph node to negative when biopsied, which means more lymph nodes don't need to be removed.
Venous Lymph Node Transfer and Lymphatic Grafting
Sentinel node biopsy was developed to reduce the need to remove most of the lymph nodes in the armpit, avoiding the debilitating problem of lymphedema, which causes painful arm swelling from a buildup of fluid that cannot drain into the lymph system. However, even if more lymph nodes must be removed, surgeons at Sylvester have developed a technique of reverse arm mapping with a special dye to highlight the drainage from the arm, so lymph channels can be re-implanted to preserve lymph drainage and prevent lymphedema.
Radiation Therapy
Sylvester’s radiation oncologists use the most advanced technology to deliver radiation therapy externally or internally to breast tumors.
Partial breast radiation therapy radiates only the area of the tumor for a significantly shorter period of time at a higher dose. For small tumors that haven't affected the lymph nodes, this allows qualified patients to receive an accelerated treatment — three weeks, as opposed to the full breast radiation therapy schedule of six weeks.
External-Beam Radiation
Most radiation therapy for breast cancer is delivered externally. Some advanced techniques allow for the radiation to be directed to your tumor with greater precision, with one-half to one-eighth the old treatment time and less damage to surrounding healthy tissue.
Internal Radiation Therapy
Also called brachytherapy, internal radiation is good for smaller primary tumors with clean, healthy skin around them and no evidence of cancer in the lymph nodes. Brachytherapy involves temporarily implanting a radiation applicator into the tumor site and delivering doses of radiation for five days, twice a day. This allows the radiation oncologist to keep the radiation dose away from your ribs, skin, and organs, and speed up treatment.
Why Choose Sylvester Comprehensive Cancer Center?
Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.
Renowned Braman Family Breast Cancer Institute at Sylvester. We offer treatments customized to your individual needs at one of the nation's best breast cancer diagnosis and care programs.
Breast Imaging Center of Excellence designation by the American College of Radiology. Thanks to imaging excellence, you receive a more precise diagnosis, which then guides a more effective treatment plan.
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