Breast Cancer Triple Negative

Breast Cancer Triple Negative

• Overview
• Staging
• Staging Illustrations
• Treatment
• Biomarkers and Genetic Testing
• Clinical Trials
• Supportive Care
• Mental Health
• Nutrition and Healthy Living
• Survivorship
• For the Caregiver
• Financial Considerations
• Survivors
• Resources
• Back to Breast Cancer

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Triple Negative Breast Cancer

Staging & Grading

Diagnosing and staging any breast cancer involves blood tests, imaging tests and a biopsy, but the definitive factor to determining a breast cancer diagnosis begins with genomic testing of the biopsy sample after surgery. 

Staging the disease helps your managing physician plan the best treatment. The staging system used for breast cancer was developed by the American Joint Committee on Cancer (AJCC). Known as TNM staging, this system uses the tumor (T), node (N) and metastasis (M) classification: 

• The T category provides information about the size and extent of the tumor within the breast. 
• The N category shows how many lymph nodes are involved and the amount of tumor cells found in the nodes when they are removed. Where the involved lymph nodes are located in the body is important because it shows the extent to which the disease has spread. 
• The M category indicates whether there is evidence that the cancer has metastasized, or spread, to another part of the body beyond the breast and local lymph nodes. Staging for the M category also takes into account the presence of tumor cells that can be detected only by microscopic examination or with molecular testing. The most common sites of distant metastasis in breast cancer are the bones, brain, liver and lungs.

When staging breast cancer in the United States, ER, PR, HER2, tumor grade, and multi-gene panels – including MammaPrint, Oncotype DX, PAM 50 (Prosigna), EndoPredict and Breast Cancer Index – are also considered and can modify the tumor stage.

After breast cancer is classified, an overall stage is assigned (see Figure 1). A grade, which is based on the microscopic features of tumor cell growth rate and aggressiveness, is assigned by a pathologist. Knowing the grade helps determine how fast a cancer is likely to grow and how likely it is to spread. TNBCs are often diagnosed as Grade 3, meaning they tend to grow quickly and spread.

If you are diagnosed with Stage IV disease, it is recommended that you get a biopsy of one of the sites where the cancer has spread. The ER, PR and HER2 receptors may be different in the location that your cancer spread, which can impact your treatment plan.

The tables included here share information based on the size and spread of disease. Your final stage will be determined after your doctor considers other factors, such as tumor marker expression and tumor grade. The most well-known tumor markers to guide breast cancer treatment are estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor-2 (HER2) status. As noted above, TNBC is negative for these three markers. The grade is assigned by a pathologist, a doctor who is specially trained to identify diseases by studying cells and tissues under a microscope. Based on the microscopic features of tumor cell growth rate and aggressiveness, the grade helps determine how fast a cancer is likely to grow and spread. Grades range from 1 to 3, and TNBC is often diagnosed as Grade 3, meaning it tends to grow quickly and may spread quickly.