Diagnosis of triple negative breast cancer
There’s no way around the fact that triple negative breast cancer is a more aggressive form of the disease. Thus, the important of an early diagnosis of the tumor, if possible, cannot be overemphasised. Left to its own devices, this form of breast cancer will most likely spread to different body parts, and a patient whose body shows multiple tumors has a poor prognosis and is not curable through surgery.
With that being said, the diagnostic process begins with the patient explaining her complaints to the physician, including when she first started feeling any discomfort, the side where the symptoms are present, and any relevant family history, such as that of a close relative who had suffered from breast cancer.
Next, the patient’s top half is unclothed and the physician inspects the breast in question. He/She may palpate the breast thoroughly to detect the presence of a solid mass, and then note the specific characteristics of said swelling, including its approximate size, shape, consistency, surface, and whether it is tender or not among many other traits. This may be accompanied by a physical examination of the lymph nodes around the breast, such as those residing in the armpit. Since these lymph nodes constantly drain fluid from the affected breast, they are more likely to be diseased in the presence of breast cancer in the breast in question.
The third and most important aspect of triple negative breast cancer diagnosis are the investigations. We start with the least invasive and most basic procedure: An imaging study.
Like other cancers and even non-cancerous diseases, a plain X-ray, a CT (Computed tomography) scan, or an MRI (Magnetic resonance imaging) scan of the chest can be done. However, due to the importance and prevalence of breast cancer, a specific imaging modality was created to allow easier and more accurate diagnosis of this disease: The mammogram. This investigation entails the placement of the diseased breast between two curved acrylic plates that compress its tissue, then waves of electromagnetic radiation are aimed and fired at the breast from multiple angles. The compression of the breast, while it can cause some temporary discomfort, flattens and thins out the breast tissue, which helps the radiation to penetrate it more thoroughly, resulting in a clearer and more accurate final image. In addition, since the rays are shot from more than one angle, this gives the physician a view of the breast and its contents from multiple sides, allowing him/her to discern overlapping structures, and to visualize artefacts that may be difficult to find when looking from one viewpoint only. There are even new technological advances that improve the effectiveness of mammography, such as what is known as 3D mammography. Instead of taking two radiographic images of the breast from two angles, 3D mammography or digital breast tomosynthesis uses a revolving camera that shoots all around the breast, giving the radiologist an even better view of the potential mass.
A mammogram is a cheap, effective, and widely available diagnostic tool that has saved many women’s lives, however the other imaging studies do have some value as well. For example, an MRI is better than a mammogram when diagnosing a patient who has surgically augmented breasts (breast implants).
After the radiological study that has been used detects an abnormal mass within the breast, a part of the swelling must be extracted and studied under a powerful microscope. This can be done through a small incision in the breast, or through a tissue biopsy needle.
Whatever the method employed, the tumor tissue sample is sliced, stained, and put onto a small glass slide for microscopic examination. This allows the pathologist to look at the tumor cells in detail, noting any abnormal characteristics that may be found. This is a necessary step to determine the histological type of the cancer, which has a huge impact on the prognosis, survival rates, and treatment methods used.
Another important piece of information regarding the prognosis is the “stage” of the tumor. This is based on the tumor size, whether or not it has spread to the lymph nodes nearby, and whether or not it has spread to other sites beyond the original tumor location in the breast. For reference, this is a simplified version of the different stages of triple negative breast cancer:
Stage 0 triple negative breast cancer: The cancer cells are only present inside the mammary gland ducts, and show no evidence of invasion of the surrounding tissues. Thus, breast cancer of this stage is described as “non-invasive”. No distant metastases are present.
Stage 1 triple negative breast cancer: The cancer becomes invasive. It is no longer confined to the breast ducts, on the contrary it starts to encroach upon the other parts of the breast, but only minimally. The nearby lymph nodes may or may not be affected, and the tumor size does not exceed 2cm. No distant metastases are present.
Stage 2 triple negative breast cancer: The tumor size may become as large as 5cm, and/or more lymph nodes are involved and have larger tumor foci. No distant metastases are found.
Stage 3 triple negative breast cancer: The tumor size is greater than 5cm with no upper limit, and the cancer may have invaded the chest wall or the skin covering the area. More lymph node groups may be affected. No distant metastases are present.
Stage 4 triple negative breast cancer: Simply put, any breast cancer that has metastasized beyond its original location into other body parts is defined as a stage 4 cancer, regardless of its size.