A new breast cancer diagnosis can bring fear and uncertainty. Stage 2 triple-negative breast cancer (TNBC) is considered an early stage, and many people do well with treatment. Care often includes a mix of surgery, chemotherapy, radiation therapy, and sometimes immunotherapy. Earlier diagnosis and newer treatments continue to improve results for people with TNBC.

Have you been recently diagnosed with stage 2 TNBC? Keep reading to learn what to expect as you move forward.

What Is Stage 2 TNBC?

Stage 2 TNBC is an early stage of cancer. The tumor has grown within the breast and may or may not have spread to nearby lymph nodes. Doctors divide stage 2 TNBC into two substages:

• Stage 2A TNBC is diagnosed when the tumor is between 2 and 5 centimeters in diameter and hasn’t spread to the axillary (underarm) lymph nodes.
• Stage 2B means one of these is true: The tumor is 2 to 5 centimeters and has spread to the axillary lymph nodes, or the tumor is larger than 5 centimeters but has not spread to the lymph nodes.

Studies show that TNBC is often diagnosed at stage 2. In one study of 524 women with TNBC, published in the journal Breast Cancer Research and Treatment, 256 (48.9 percent) were diagnosed at stage 2. Researchers noted that, compared with other types of breast cancer, TNBC is more common in younger people. Among the 58 study participants under age 40, 37 (nearly 64 percent) were diagnosed with stage 2 TNBC.

What Are the Symptoms of Stage 2 TNBC?

Stage 2 TNBC usually doesn’t cause noticeable symptoms. Most tumors are found during routine mammograms. However, some people may notice breast changes. Symptoms of stage 2 breast cancer may include:

• New areas of thickening or lumps in the breast or the underarm
• Puckering or dimpling of the skin on the breast
• An inverted nipple (it turns inward)
• Unexplained changes in the shape and size of one breast
• Fluid or discharge from the nipple, which may be bloody or clear
• Changes in the breast skin’s texture or color, or pores that look more noticeable

Be sure to talk with your doctor if you notice any of these symptoms. You may need imaging tests or a biopsy to confirm or rule out breast cancer.

How Do Doctors Treat Stage 2 TNBC?

Many breast cancers are treated by targeting their hormone receptors (HRs). Cells in these tumors often rely on hormones like estrogen and progesterone to grow and divide. However, unlike other types of breast cancer, TNBC doesn’t have these markers:

• Estrogen receptors
• Progesterone receptors
• Human epidermal growth factor receptor 2 (HER2)

This means that TNBC doesn’t respond to hormone therapy or HER2-targeted treatments. Instead, oncologists (cancer specialists) use other approaches.

Compared with HR-positive and HER2-positive breast cancers, TNBC has fewer treatment options. Treatment usually includes a combination of surgery, chemotherapy, radiation therapy, and sometimes immunotherapy.

Surgery

Surgery is a common treatment for stage 2 TNBC. The type of surgery depends on factors such as tumor size. Smaller tumors may be removed with a lumpectomy, which saves most of the breast tissue. Larger tumors or those in smaller breasts may require a mastectomy — removal of the entire breast. The surgeon may also remove lymph nodes to check for or help control cancer spread.

Chemotherapy

Many people with TNBC receive chemotherapy, often along with surgery and sometimes radiation therapy. Chemotherapy may be given before surgery (neoadjuvant therapy) to shrink the tumor or after surgery (adjuvant therapy) to help lower the risk of recurrence.

Chemotherapy uses strong medicines that kill fast-growing cells, including cancer cells. These drugs stop cells from growing and dividing. Chemotherapy drugs used for stage 2 TNBC include:

• Anthracyclines, like doxorubicin and daunorubicin
• Carboplatin
• Gemcitabine (Gemzar)
• Taxanes, like paclitaxel and docetaxel (Taxotere)

Radiation Therapy

Radiation therapy is often used after surgery to kill any remaining cancer cells. This approach may also be used to treat nearby lymph nodes. Radiation therapy helps lower the risk of TNBC returning.

Immunotherapy

Immunotherapy helps the immune system recognize and attack cancer cells. Some immunotherapies are especially useful in treating TNBC.

Many cells in the body have a protein called PD-L1 on their surface. Immune cells have a related protein called PD-1. When these proteins interact, they help keep the immune system from attacking healthy cells. TNBC cells can use this protection system to hide from the immune system.

Some immunotherapies block PD-1 to activate immune cells. One example is pembrolizumab (Keytruda). Studies show that combining chemotherapy with pembrolizumab can improve outcomes in some people with stage 2 TNBC.

Poly (ADP-Ribose) Polymerase Inhibitors

People with BRCA gene mutations (changes) may also benefit from targeted therapy called poly (ADP-ribose) polymerase inhibitor (PARP) inhibitors. According to the American Cancer Society, some people with stage 2 TNBC and a BRCA mutation may be candidates for this treatment. One PARP inhibitor, olaparib (Lynparza), may be taken for one year after adjuvant chemotherapy. Studies suggest that adding olaparib may help improve the outlook for certain people with TNBC.

What’s the Prognosis With Stage 2 TNBC?

TNBC is considered an aggressive type of breast cancer because it tends to grow and spread faster than other types. TNBC also has fewer treatment options. Although the outlook for TNBC isn’t as favorable as that of some other breast cancers, outcomes continue to improve. Better breast cancer screening, earlier diagnosis, and newer treatments are helping people with TNBC live longer.

The National Cancer Institute (NCI) tracks survival rates for TNBC. They report the five-year relative survival rate, which compares how likely a person with cancer is to be alive five years after diagnosis compared to someone in the general population without cancer.

The NCI Surveillance, Epidemiology, and End Results (SEER) Program doesn’t use numbered cancer stages. Instead, SEER groups cancer as localized, regional, or distant. Localized cancer hasn’t spread outside the breast. Regional cancer has spread to nearby lymph nodes. Distant cancer has spread to other parts of the body.

Stage 2 TNBC can be classified as localized or regional, depending on whether lymph nodes are involved.

The five-year relative survival rates for TNBC are:

• Localized — 92 percent
• Regional — 67 percent
• Distant — 15 percent
• All stages together — 78 percent

These numbers mean that, five years after diagnosis, people with localized TNBC are about 92 percent as likely to be alive as people without TNBC. For regional TNBC, that number is about 67 percent.

Factors That Influence Stage 2 TNBC Prognosis

Limited studies have focused only on stage 2 TNBC. In general, research shows that tumor size, a person’s age, and whether the cancer has spread to lymph nodes influence prognosis. Larger tumors and cancer that has spread to lymph nodes are linked to a less favorable outlook.

Genetic changes in cancer cells also influence prognosis. People with inherited BRCA1 or BRCA2 gene mutations may develop more aggressive TNBC, which tends to have a worse outlook. Genetic testing can help determine whether a BRCA mutation is present and may guide treatment decisions.

Talk with your doctor about how these factors apply to your diagnosis. Survival statistics describe large groups of people and cannot predict what will happen in any one individual.

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