to expect on your TNBC journey
*The following Q&A is for educational purposes only and should not replace consultation with a medical professional. The below information provides a rough guide about what to expect, but each and every TNBC patient is unique and will have an experience that is distinct from that of their peers.
A. What is TNBC?
TNBC stands for triple-negative breast cancer. It’s a type of breast cancer that lacks the three major receptors found in breast cancer cells - estrogen, progesterone, and HER2 or human epidermal growth factor receptor 2. This type of breast cancer does not respond to therapies that target these receptors such as hormone therapy and HER2 targeted therapy. TNBC accounts for approximately 15% of breast cancer cases and is often diagnosed at an earlier age – the average age of a TNBC diagnosis is 54. It also tends to be more aggressive than other types of breast cancer.
B. What does it mean for a cancer to be metastatic vs. non-metastatic?
A patient may be diagnosed with metastatic or non-metastatic breast cancer.
Non-metastatic breast cancer means that the cancer has not spread beyond the breast area. This type of breast cancer is typically treated with surgery, radiation, and possibly chemotherapy.
Metastatic breast cancer means the cancer has spread to other areas of the body outside the breast. This can include the liver, bones, lungs, brain, and other organs. When this happens treatments like surgery and radiation - which target the cancer in one area only - take on a smaller role, while treatments like chemotherapy and immunotherapy - which target the cancer throughout the body - take on a much bigger role and are the mainstay of treatment.
A. What are the first steps a patient might expect after diagnosis?
Diagnosis is typically made with a biopsy of the tumour in the breast. A biopsy is a procedure, usually performed by a surgeon or interventional radiologist, where a piece of tissue or sample cells are collected from the area where the cancer has been found. The specimen is then sent to a pathologist who will review the biopsy and run tests to confirm the breast cancer diagnosis and the type of breast cancer.
Once a patient has been diagnosed with TNBC, they can expect to have tests to determine the stage of the disease. This can include an MRI of the breast, and, if the patient qualifies for it, a PET CT scan to see if the cancer has spread outside the breast. Then, a patient will meet with a breast surgical oncologist to discuss the role of surgery.
It is important to note that a patient may start breast cancer treatment while waiting for the results of the biopsy. All the steps described above may not happen in order.
Magnetic Resonance Imaging (MRI) is a medical test that uses strong magnets and radio waves to create pictures of the inside of your body. It helps doctors see organs, tissues, and other soft-tissue structures without using radiation. It's especially good for looking at the breast in detail to give a more accurate assessment of the size and shape of the tumour. You lie down in a large machine which can make a loud noise and typically takes a bit longer than a CT scan.
A PET CT scan is a medical test that combines two types of imaging: a PET (Positron Emission Tomography) scan and a CT (Computed Tomography) scan.
- The PET scan uses a small amount of a radioactive substance (called a tracer) to show how your body's cells are working, often highlighting areas with disease, like cancer.
- The CT scan takes detailed pictures of the structure of your body, like bones and organs.
B. What kinds of specialists and HCPs might form part of a patient’s care team?
The care of someone who has been diagnosed with TNBC involves many medical professionals who collaborate with each other to make sure the person’s medical needs are taken care of. Healthcare professionals may include specialists in oncology, such as surgical oncologists, medical oncologists, radiation oncologists, oncology nurses, social workers, registered dieticians, and drug access navigators.
For more information on TNBC care providers, please click here to see the Meet Your TNBC Care Team Infographic.
C. What kinds of questions should a patient ask their care team early in their diagnosis?
Some questions that patients may wish to ask their care team are:
- What kind of breast cancer do I have?
- What stage of breast cancer do I have?
- Am I a good candidate for genetic testing?
- What are the treatment options available to me?
- Should I consider clinical trials based on my diagnosis?
- Will I have access to a care navigator to help me organize my appointments
- (If considering having children or expanding your family) Does my treatment affect my fertility and what are my options?
A. What might a patient expect when starting a treatment plan?
A treatment plan can be expected to start after the oncology team has the information necessary to create an appropriate plan for the individual patient, however in some cases treatment may start very quickly. This includes all the imaging, blood work, and molecular testing that is needed to determine the subtype and stage of the breast cancer. This information is important to be able to develop a personalized and effective treatment plan. How quickly a patient moves from diagnosis to treatment varies a lot by health region.
Molecular testing is a way to look at the genes and proteins in cancer cells to get more information about the disease. This testing can help doctors understand the specific characteristics of the cancer, such as how aggressive it is or how likely it is to respond to certain treatments helping to personalize treatment for each patient.
B. WHAT IS THE CURRENT TREATMENT LANDSCAPE FOR A TNBC PATIENT?
The treatment a TNBC patient will receive depends on the stage of their disease. There are typically three key categories of treatment a patient may receive:
Systemic therapy, which may be oral or intravenous (IV), and includes chemotherapy (medicine that attacks cancer cells to shrink tumours), targeted therapy (treatment that targets specific proteins or markers of cancer cells), and immunotherapy (which works by boosting or training the body’s immune system to recognize and attack cancer cells).
Radiation treatment works like a powerful beam of energy that focuses on tumors to destroy the cancer cells while trying to spare the healthy cells nearby. It can help shrink tumors or eliminate cancer that has spread to other areas.
Surgery which may include a lumpectomy (removing the tumour and surrounding area only), mastectomy (removing one or both breasts, and potentially some lymph nodes), and reconstruction to rebuild the breast which can be done at the same time as the mastectomy or later.
C. What kinds of things can a patient do to keep up their physical and mental strength during a prolonged illness like TNBC?
Strategies that TNBC patients can use to keep up their physical and mental strength during treatment include physical activity, which has been found to be helpful for cancer associated fatigue. It’s also important to eat a healthy, balanced diet, as well as leaning on social supports, whether friends or family or licensed professionals, such as a counsellor or psychologist, to help reduce anxiety and depression.
Relaxation and distraction strategies are also important to help patients cope with their cancer journey. Some patients experience “scanxiety”, which is anxiety around the results of an upcoming scan. Patients have found that being active or participating in activities that bring joy have helped them focus on other aspects of their life besides breast cancer.
D. Do you have recommendations for how patients can organize their schedules around treatment, appointments, work, childcare, and other activities?
Good organization helps with managing the TNBC treatment journey. Patients should ask their care team about what to expect from treatment in terms of visits, appointments, and types of treatment they may receive. For example, patients receiving chemotherapy should ask how it will be administered, how often, and for how long. They should also ask their care team how they can best organize their life around appointments while maintaining other responsibilities outside the hospital.
Understanding what to expect is important in terms of scheduling and planning for life outside treatment by asking lots of questions. And if you didn’t get a chance to ask questions during your appointment, you may be able to give your clinic a call for additional support.
A. What could a patient who is in remission expect in terms of ongoing care?
A patient who has completed their surgery and chemotherapy and who is in remission can expect to be under close surveillance of their breast cancer. There will be scheduled visits throughout the year, typically every 6-12 months, during which they would have a physical exam. A patient who has received a mastectomy would have a chest exam, whereas a patient who has had breast conserving surgery would expect to have a mammogram once a year. Patients should remain in close contact with their oncology providers and report any new symptoms that they may develop.
A. What would you like patients to know about advanced care planning?
Advanced care planning is an important component of a patient’s care. This is information that should be shared with the care team regardless of the stage of breast cancer.
Advanced care planning includes making decisions about what kind of care the patient would like to receive, especially in a situation where they would not be able to make a decision for themselves. This can include things like CPR status or intubation status. All this can be documented in different ways but should be shared with the care team and their loved ones and formally documented. It’s important for patients to know that they can discuss advanced care planning at any stage in their cancer journey. This helps the care team understand the wishes of the patient should they not be able to communicate.
In partnership with Jordan Rivera, a Toronto-based oncology nurse practitioner.
You may also be
interested in:
