Triple-Negative Breast Cancer During Pregnancy: A Patient's Journey

Regarding triple-negative breast cancer and pathology reports, thank you, doctor?

Due to my pregnancy, I am currently almost 7 months along.
I was diagnosed with breast cancer at five months.
On August 22, 2016, I underwent surgery to remove the tumor, which was later classified as stage II.
An abdominal ultrasound on October 5, 2016, showed no abnormalities.
My gynecologist has decided to perform a cesarean section at 32 weeks to allow me to receive treatment.
I have searched online, and many sources indicate that chemotherapy for triple-negative breast cancer is not very effective, and once it recurs, it is just a matter of waiting for death.
I have started to reject chemotherapy...
I even feel that chemotherapy will only bring discomfort...
Additionally, as I am pregnant, there are many tests I cannot undergo, so is this staging accurate?
Pathology report tissue description: Breast, NOS (excludes Skin of breast C44.5), Sentinel lymph nodes of breast.
Clinical diagnosis: Malignant neoplasm of unspecified site of left female breast.
Tumor code: (M-8500/3).
Pathologic Diagnosis: Breast, left, BCS, negative carcinoma of no special type (95%), grade 3, and ductal carcinoma in situ (5%).
Invasive component: 2.5 cm, pathological stage: pT2N0.
Skin, breast, CBS, negative for malignancy.
Breast, deep margin, left, BCS, negative for malignancy.
Breast, circumferential margin, left, partial mastectomy, negative for malignancy.
Lymph node, Sentinel, left, lymphadenectomy, negative for malignancy (0/2).
Gross Examination: I.
Specimen submitted in fresh state.
Tissues included: left breast and "sentinel lymph nodes." Size of breast: 7.3 x 5.2 x 4.5 cm.
Dimensions and description of skin: Dimensions: 4.2 x 1.2 cm.
Lesion Number: single.
Size (single greatest size): 2.5 x 2.0 x 1.5 cm.
The specimen labeled as "margin" consists of one tissue fragment measuring 4.0 x 3.2 x 1.5 cm in size.
Grossly, grayish and elastic.
Representative parts are taken for sections, and labeled as: A1-A7: left breast tumor.
B1: skin.
C1: deep margin.
E1-E2: sentinel lymph nodes.
D1-D3: "margin."
Microscopic Examination: Tumor Size of invasive tumor: 2.5 cm in greatest diameter.
Histologic type: invasive carcinoma of no special type (95%).
Histologic grade (Nottingham histologic score): grade 3.
Ductal carcinoma in situ: - Minor: 5%.
- Nuclear grade: III (high).
- Architectural patterns: solid.
- Tumor necrosis: absent.
- Microcalcification: absent.
- Lobular carcinoma in situ: not identified.
Lymph-vascular invasion: not identified.
Peripheral invasion: present.
Involvement of other tissues: absent.
Skin involvement: absent.
Chest wall invasion deeper than pectoralis muscle: absent.
Breast at the deep margin: negative for malignancy (distance from closest margin: 0.3 cm).
Breast tissue labeled as margin: lactating adenoids.
Breast at the circumferential margin: negative for malignancy (closest margin: 0.6 cm).
Lymph node status: Sentinel lymph nodes: negative for malignancy (0/2).
Treatment effect (response to presurgical therapy): no known presurgical systemic therapy.
Additional pathologic findings: lactating adenoids.

Results of immunohistochemical study: Progesterone receptor (Ab: Leica, clone 16): negative.
p53 (Ab: Dako, clone DO-7): aberrant loss, indicating mutant genotype.
Ki-67 labeling index (Ab: Dako, clone MIB-1): 40%.
HMW-CO and EGFR both show diffuse staining.
The features suggest invasive carcinoma with basal-like characteristics.
The malignant nature has been confirmed by peer slide review.

Thank you, doctor.
I really feel so sad...
I thought I could have a good life, but then I got sick...
I was originally waiting to get married after giving birth...
I don't know if I can endure chemotherapy...
Every time I go to the hospital, I feel so scared...

Wúzhù de yùnfù, 30~39 year old female. Ask Date: 2016/10/07

Dr. Li Zhonghuai reply Surgery

Hello! Your cancer recurrence index is as high as 136 (>30 indicates a high recurrence rate).
It is recommended that you undergo chemotherapy and radiation therapy after giving birth.
For chemotherapy, it is suggested to start with European paclitaxel combined with cisplatin; if you have insurance, you can opt for carboplatin out of pocket, and then proceed with E+C.
Wishing you well! Changhua Hospital cares about you!

Reply Date: 2016/10/07

More Info

Facing a diagnosis of triple-negative breast cancer (TNBC) during pregnancy can be an incredibly challenging experience, both emotionally and physically. Your situation is particularly complex due to the unique considerations that arise when dealing with cancer treatment while pregnant.
Firstly, it’s important to understand what triple-negative breast cancer is. TNBC is a subtype of breast cancer that lacks three common receptors known to fuel most breast cancer growth—estrogen, progesterone, and the human epidermal growth factor receptor 2 (HER2). This means that TNBC does not respond to hormonal therapies or therapies that target HER2, which can make treatment options more limited. However, it is crucial to note that while TNBC is often associated with a higher risk of recurrence compared to other types of breast cancer, many patients do respond well to chemotherapy, especially when the cancer is detected early.

In your case, the pathology report indicates that you have a stage II cancer (pT2N0), which suggests that the cancer has not spread to the lymph nodes, a positive sign in terms of prognosis. The fact that your sentinel lymph nodes were negative for malignancy is also encouraging. However, the grade 3 classification indicates that the cancer cells are more aggressive, which is a concern that needs to be addressed with appropriate treatment.

Regarding your concerns about chemotherapy, it is understandable to feel apprehensive, especially with the stigma surrounding TNBC and the fear of recurrence. Chemotherapy is often recommended for TNBC, particularly in cases like yours where the cancer is at a higher stage. The treatment plan typically involves a combination of chemotherapy agents, which may include drugs like doxorubicin and cyclophosphamide, followed by a taxane such as paclitaxel.
During pregnancy, the timing and type of chemotherapy can be adjusted to minimize risks to the fetus. Generally, chemotherapy is considered safe after the first trimester, and many oncologists recommend starting treatment after the 32nd week of pregnancy to allow for the baby to develop further. Your healthcare team will work closely with you to ensure that both your health and the health of your baby are prioritized.

It is also important to address the emotional toll that this diagnosis can take. Feelings of fear, anxiety, and sadness are completely normal. Seeking support from mental health professionals, support groups, or counseling services can be beneficial. Connecting with other women who have faced similar challenges can provide comfort and understanding.

In terms of monitoring your cancer and the health of your baby, regular ultrasounds and check-ups will be essential. Your healthcare team will likely recommend a tailored approach to imaging and monitoring that considers both your cancer treatment and your pregnancy.

Lastly, while it is natural to search for information online, it is crucial to rely on your healthcare team for guidance tailored to your specific situation. They can provide the most accurate information regarding your prognosis and treatment options based on the latest research and clinical guidelines.

In summary, while the journey ahead may be daunting, it is essential to stay informed, seek support, and maintain open communication with your healthcare providers. They are there to help you navigate this challenging time, ensuring that both you and your baby receive the best possible care.

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