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Breast Cancer - Metaplastic - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Metaplastic Breast Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Metaplastic breast cancer, also called metaplastic carcinoma of the breast, is a rare type of breast cancer. Cancer begins when normal cells in the breast change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread.

About the breast

The breast is mainly made up of fatty tissue. Within this tissue is a network of lobes, which are made up of tiny, tube-like structures called lobules that contain milk glands. Tiny ducts connect the glands, lobules, and lobes, carrying the milk from the lobes to the nipple, located in the middle of the areola, which is the darker area that surrounds the nipple of the breast. Blood and lymph vessels run throughout the breast; blood nourishes the cells, and the lymph system drains bodily waste products. The lymph vessels connect to lymph nodes, the tiny, bean-shaped organs that help fight infection.

About metaplastic breast cancer

Metaplastic breast cancer describes a cancer that begins in one type of cell, such as those from the glands of the breast, and changes into another type of cell. It is different from the much more common ductal or lobular breast cancer. Most often, metaplastic breast cancer starts in the epithelial cells, and then changes into squamous or nonglandular cells. Also, metaplastic breast cancer does not have estrogen receptors (ERs), progesterone receptors (PRs), or the HER2 receptor, which is a protein found in ductal and lobular breast cancers. When a breast cancer does not have these receptors it is called triple-negative breast cancer or TNBC. Metaplastic breast cancer is considered a subtype of triple-negative breast cancer.

Metaplastic breast cancer can spread to the lymph nodes and other parts of the body, especially the lungs. When it is first diagnosed, metaplastic breast cancer is considered an invasive cancer, meaning that it has already spread beyond the duct or lobe.

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Breast Cancer - Metaplastic - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Metaplastic carcinoma of the breast is rare, accounting for less than 1% of all breast cancers. Overall, more than 70% of patients with metaplastic breast cancer are diagnosed with stage II or higher (see Stages). The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. The five-year survival rate of people with metaplastic breast cancer ranges from 49% to 68%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with metaplastic breast cancer. Because survival statistics for breast cancer are measured in multi-year intervals, they may not represent recent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Source: Treatment Options for Metaplastic Breast Cancer, Oncol. 2012. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388429/)

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Breast Cancer - Metaplastic - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

It is not known what factors raise a person's risk of metaplastic breast cancer specifically. However, like all types of breast cancer, it is more common in women older than 50. There are inherited genes linked with an increased risk of breast cancer, including metaplastic breast cancer. The most common are breast cancer genes 1 or 2. These are commonly shortened and referred to as BRCA1 or BRCA2. In addition, new genetic changes, or mutations, are being identified that increase the risk of breast cancer, so it is important for women with strong family histories to seek genetic counseling and consider genetic testing.

Prevention

Research continues to look into what factors cause this type of cancer and what people can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your cancer risk. Talk with your doctor if you have concerns about your personal risk of developing breast cancer.

  • For women with especially strong family histories of breast cancer, as well as those with BRCA1 or BRCA2 genetic mutations, prophylactic mastectomy may be considered. A prophylactic mastectomy is the preventive removal of the breasts. This appears to reduce the risk of developing breast cancer by at least 95%. These women may also consider a prophylactic oophorectomy, which is the removal of the ovaries, to reduce the risk of developing breast and ovarian cancer.
  • Other ways to lower your risk of breast cancer include getting regular physical activity, staying at a healthy weight, and limiting the amount of alcohol you drink. Learn about more lifestyle changes to lower your risk of cancer.

Several breast cancer risk assessment tools have been developed to help a woman estimate her chance of developing breast cancer. The best studied is the Gail model (www.cancer.gov/bcrisktool). After entering some personal and family information, the tool provides a five-year and lifetime estimate of the risk of developing invasive breast cancer. Because it only asks for information about breast cancer in first-degree family members, such as your mother or sister, and doesn’t include their age at diagnosis, the tool works best at estimating risk in women who don’t have a strong inherited breast cancer risk.

For most women, regular mammography and clinical breast examinations can help find early signs of breast cancer. In addition, women should become familiar with their own breasts. Many metaplastic cancers are found on self-examination, in between mammograms. Checking your own breasts for lumps and changes with breast self-examination may help if performed correctly. Talk with your doctor for more information.

Screening guidelines

Mammography is the best tool doctors have to screen healthy women for breast cancer, as it has been shown to lower deaths from breast cancer. Like any medical test, mammography involves risks, such as additional testing and anxiety if the test falsely shows a suspicious finding; this is called a false-positive result. Up to 10% to 15% of the time, mammography will not see an existing cancer, called a false-negative result. Digital mammography may be better able to find cancers, particularly in women with dense breasts. A newer type of mammogram, called tomosynthesis or 3D mammography, when combined with standard mammograms may improve the ability to find small cancers and reduce the need to repeat tests due to false-positive results.

Different organizations have looked at the evidence, risks, and benefits of mammography and have developed different screening recommendations for women with an average risk of developing breast cancer:

  • The U.S. Preventive Services Task Force (USPSTF) recommends that women ages 50 to 74 have mammography every two years. They recommend that mammography be considered in women ages 40 to 49 after evaluating the risks and benefits of this test with a doctor.
  • The American Cancer Society (ACS) recommends yearly mammography beginning at age 40.

The controversy about screening mammography is related to the ability of early detection to lower the number of deaths from breast cancer. Breast cancers detected by mammography are often small, with a low risk of recurrence. In contrast, rapidly growing, aggressive cancers are more commonly found in between screening mammograms, are associated with worse chance of recovery, and are more frequently found in young women.

All women should talk with their doctors about mammography and decide on an appropriate screening schedule. For women at high risk for developing breast cancer, screening is recommended at an earlier age and more often than the schedules listed above.

The USPSTF and ACS also differ on their recommendations for women to receive a clinical breast examination, which is a physical exam of the breast done by a health professional. The USPSTF recommends a clinical breast examination along with mammography. The ACS recommends a clinical breast examination every one to three years until age 40, then annually.

Finally, although breast self-examination has not been shown to lower deaths from breast cancer, it is important for women to become familiar with their breasts so that they can be aware of any changes and report these to their doctor. Cancers that are growing more quickly are often found by breast examination between regular mammograms.

Other ways to examine the breasts, such as ultrasound and magnetic resonance imaging (MRI), are not regularly used to screen for breast cancer. These tests may be helpful for women with a higher risk of breast cancer or when a lump or mass is found during a breast examination. According to the ACS, women with BRCA gene mutations, a strong family history of breast cancer, or precancerous changes on a biopsy have a higher risk of developing breast cancer and should receive regular MRI screening and mammography, usually in an alternating schedule. MRI may be better than mammography and ultrasound at finding a small mass in a woman’s breast, especially for women with very dense breast tissue. However, an MRI has a higher rate of false-positive results, which may mean more biopsies, surgeries, and other tests.

Ultrasound or MRI may also be used for women with a suspicious breast finding on physical examination or mammography. If a lump or mass is found during a physical examination, further testing is needed, even if the mammogram is reported to be normal. Women are encouraged to talk with their doctor about the method of screening recommended for them and how often screening is needed.  

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Breast Cancer - Metaplastic - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Women with breast cancer may experience the following breast changes or symptoms. Sometimes, women with breast cancer do not show any of these symptoms when diagnosed. Or, these symptoms may be caused by a medical condition that is not cancer.   

  • New lumps or a thickening in the breast or under the arm. However, many women normally have lumpy breasts.
  • Nipple tenderness, discharge, or physical changes, such as a nipple turned inward, a persistent sore, or a change in the size or shape of the breast
  • Skin irritation or changes, such as puckers, dimples, scaliness, or new creases
  • Warm, red, swollen breasts with a rash resembling the skin of an orange, which may be called peau d'orange
  • Pain in the breast. This is usually not a symptom of breast cancer, but should be reported to a doctor.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, in addition to treating the cancer, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose metaplastic breast cancer:

Imaging tests

Diagnostic mammography. Diagnostic mammography is similar to screening mammography except that more images of the breast are taken, and it is often used when a woman is experiencing signs, such as nipple discharge or a new lump. Diagnostic mammography may also be used if something suspicious is found on a screening mammogram.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. An ultrasound can distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer. Ultrasounds are not used for screening.

MRI. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given into the patient’s vein before the scan to help create a clear picture of the possible cancer. A breast MRI may be used after a woman has been diagnosed with cancer to check the other breast for cancer or to find out how much the disease has grown throughout the breast. It may also be used for screening, particularly along with mammography for some women with a higher risk of developing breast cancer (see Prevention).  

Surgical tests

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A biopsy is specified by the technique and/or size of needle used to collect the tissue sample.

  • A fine needle aspiration biopsy uses a thin needle to remove a small sample of cells.
  • A core needle biopsy uses a wider needle to remove a larger sample of tissue. This is usually the preferred biopsy technique for finding out whether an abnormality on a physical examination or an imaging test is cancer. A vacuum-assisted biopsy removes several large cores of tissue. Local anesthesia, which is medication to block pain, is used to lessen a patient’s discomfort during the procedure.
  • Image-guided biopsy is used when a distinct lump cannot be felt, but an abnormality is seen with an imaging test, such as a mammogram. During this procedure, a needle is guided to the location with the help of an imaging technique, such as mammography, ultrasound, or MRI. A stereotactic biopsy is done using mammography to help guide the needle. A small metal clip may be put into the breast to mark where the biopsy sample was taken, in case the tissue is cancerous and more surgery is needed. This clip is usually titanium so it will not cause problems with future imaging tests, but check with your doctor before you have additional imaging tests. An image-guided biopsy can be done using a fine needle, core, or vacuum-assisted biopsy (see above), depending on the amount of tissue being removed. Imaging tests may also be used to help do a biopsy on a lump that can be felt, in order to help find the best location.
  • A surgical biopsy removes the largest amount of tissue. This biopsy may be incisional, which is the removal of part of the lump, or excisional, which is the removal of the entire lump. Because surgery is best done after a cancer diagnosis has been made, a surgical biopsy is usually not the recommended way to diagnose breast cancer. Most often, non-surgical core needle biopsies are recommended to diagnose breast cancer. This means that only one surgical procedure is needed to remove the tumor and to take samples of the lymph nodes.

If cancer is diagnosed, surgery is needed to remove the cancer in the breast. It is also needed to evaluate the lymph nodes for cancer in a procedure called a sentinel lymph node biopsy. Sometimes, treatment may be given before surgery, called neoadjuvant therapy, to shrink the cancer; see Treatment Options. The goal of surgery is to achieve clear surgical margins, which means that there are no cancer cells at the edge of the tissue removed during surgery. If there is cancer in the lymph nodes, the cancer is called lymph node-positive breast cancer or node-positive; if there is no cancer in the lymph nodes, the cancer is called lymph node-negative breast cancer or node-negative. More information about lymph node evaluation can be found in the Stages section.

Tumor features. The pathologist tests the tissue from the biopsy and the surgery to help guide treatment decisions. Looking at the tumor under the microscope helps the doctor learn if it is the metaplastic type of breast cancer and find out the tumor’s grade, which describes how different the cancer cells look from healthy cells, as well as whether the cancer has spread to the lymph nodes. The margins or edges of the tumor are also examined and their distance from the tumor is measured, which is called margin width.

Blood tests

The doctor may also need to do blood tests to learn more about the cancer.

Serum chemistry. These tests are often done to look at minerals in your blood, such as potassium and calcium, called electrolytes and specialized proteins called enzymes that can be abnormal if cancer has spread. However, it is important to note that many noncancerous conditions can cause variations in these tests, and they are not specific to cancer.

  • Alkaline phosphatase is an enzyme that can be associated with disease that has spread to the liver, bone, or bile ducts.
  • Blood calcium levels can be elevated if cancer has spread to the bone.
  • Total bilirubin count and the enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) evaluate liver function. High levels of any of these substances can indicate liver damage, a sign that the cancer could have spread to the liver.

Blood tumor marker tests. A serum tumor marker, also called a biomarker, is a protein found in a person's blood that can be associated with cancer. High levels of a serum tumor marker may be due to cancer or a noncancerous condition. Tumor marker testing is not recommended for early-stage breast cancer, but they may be useful in the follow-up care of recurrent or metastatic disease. Learn more about tumor markers for breast cancer.

Additional tests

The doctor may recommend additional tests to evaluate the stage of the cancer depending on your medical history, symptoms, how much the disease has grown in the breast and lymph nodes, and results of the physical examination. Read the Stages section for more information. These tests are not recommended for all patients.

  • An x-ray is a way to create a picture of the structures inside the body, using a small amount of radiation. A chest x-ray may be used to look for cancer that has spread from the breast to the lung.
  • A bone scan may be used to look for spread of cancer to the bones. A radioactive dye or tracer is injected into a patient’s vein, and then the scan is performed several hours later using a special camera. The tracer collects in areas of the bone that are healing, which occurs in response to damage from the cancer cells. The areas where the tracer collects appear dark, compared to healthy bone, which appears gray. However, some cancers do not cause the same healing response and will not show up on the bone scan. Also, areas of advanced arthritis or healing after a fracture will also appear dark.
  • A computed tomography (CT or CAT) scan may be used to look for tumors in organs outside of the breast, such as the lung, liver, bone, and lymph nodes. A CT scan creates a three-dimensional picture of the inside of the body with a special x-ray machine. A computer combines these images into a detailed, cross-sectional view that shows abnormalities, which includes most tumors. A CT scan can also be used to measure the tumor’s size and find out if it is shrinking with treatment. A contrast dye may be injected into a patient’s vein before the scan to provide better detail.
  • A positron emission tomography (PET) scan may also be used to find out whether the cancer has spread to organs outside of the breast. Similar to a CT scan, a PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into a patient’s vein. This sugar substance is then taken up by cells that use the most energy because they are actively dividing. Because cancer cells tend to use energy actively, they absorb more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Areas that are most active appear as bright spots, and the intensity of the brightness can be measured to better describe these areas. A combination PET/CT scan may also be used to measure the size of tumors and to more accurately determine the location of the bright spots. A PET/CT scan will also show any abnormalities in the bone, similar to the bone scan.

After diagnostic tests are completed, your doctor will review all of the results with you. If the diagnosis is metaplastic breast cancer, these results also help the doctor describe the cancer and determine the most appropriate treatment; this is called staging. If there are suspicious areas found outside of the breast, at least one area will be biopsied if possible to confirm the diagnosis of cancer.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, how much it has grown, and if or where it has spread. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

The most commonly used tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes, and if so, how many nodes are involved? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero), which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (one through four), which are used for invasive breast cancer. The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

There are two types of TNM staging for breast cancer. First, the clinical stage is based on the results of tests done before surgery, such as a physical examination, x-rays, and CT and MRI scans. Then, the pathologic stage is assigned after surgery based on the pathology results from the breast tissue and any lymph nodes removed. It is usually determined several days after surgery. In general, more importance is placed on the pathologic stage than the clinical stage.

Here are more details on each part of the TNM system for metaplastic breast cancer:

Tumor. Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are divided into smaller groups that help describe the tumor in even more detail.

TX: The primary tumor cannot be evaluated.

T0: There is no evidence of cancer in the breast.

Tis: Refers to carcinoma in situ. The cancer is confined within the ducts or lobules of the breast tissue and has not spread into the surrounding tissue of the breast. There are three types of breast carcinoma in situ:

Tis (DCIS): DCIS is a noninvasive cancer, but if not removed it can later develop into an invasive breast cancer. DCIS means that cancer cells have been found in breast ducts and have not spread past the layer of tissue where they began.

Tis (LCIS): Lobular carcinoma in situ (LCIS) describes abnormal cells found in the lobules or glands of the breast. LCIS is not cancer, but it increases the risk of developing invasive breast cancer.

Tis (Paget’s): Paget’s disease of the nipple is a rare form of early, noninvasive cancer that is only in the skin cells of the nipple. Sometimes Paget’s disease is associated with another invasive breast cancer. If there is also an invasive breast cancer present, it is classified according to the stage of the invasive tumor.

T1: The invasive part of the tumor in the breast is 20 millimeters (mm) or smaller in size at its widest area. This is a little less than an inch. This stage is then broken into three substages depending on the size of the tumor:

  • T1a is a tumor that is larger than 1 mm, but 5mm or smaller
  • T1b is a tumor that is larger than 5 mm, but 10 mm or smaller
  • T1c is a tumor that is larger than 10 mm, but 20 mm or smaller.

T2: The invasive part of the tumor is larger than 20 mm but not larger than 50 mm.

T3: The invasive part of the tumor is larger than 50 mm.

T4: The tumor falls into one of the following groups:

  • T4a means the tumor has grown into the chest wall.
  • T4b is when the tumor has grown into the skin.
  • T4c is cancer that has grown into the chest wall and the skin.
  • T4d is inflammatory breast cancer.

Node. The “N” in the TNM staging system stands for lymph nodes. Lymph nodes located under the arm, above and below the collarbone, and under the breastbone are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. As explained above, if the doctor evaluates the lymph nodes before surgery, based on other tests and/or a physical examination, a letter “c” for “clinical” staging is placed in front of the “N.” If the doctor evaluates the lymph nodes after surgery, which is a more accurate assessment, a letter “p” for “pathologic” staging is placed in front of the “N.” The information below describes the pathologic staging.

NX: The lymph nodes cannot be evaluated.

N0: No cancer was found in the lymph nodes.

N0(i+): When very small areas of “isolated” tumor cells are found in a lymph node under the arm, called the axillary lymph nodes. This is usually less than 0.2 mm or less than 200 cells. In this stage, the nodes are still called N0, but an “i+” is also listed.

N1mic: Cancer in the axillary lymph nodes is larger than 0.2 mm but less than 2 mm in size and can only be seen through a microscopic.

N1: The cancer has spread to one to three axillary lymph nodes under the arm. This category can include positive internal mammary lymph nodes if they are found during a sentinel lymph node procedure and not otherwise clinically detected. The internal mammary lymph nodes are located under the sternum or breastbone.

N2: The cancer within the lymph nodes falls into one of the following groups:

  • N2a is when the cancer has spread to four to nine axillary, or underarm, lymph nodes.
  • N2b is when the cancer has spread to or to internal mammary lymph nodes without spread to the axillary nodes.

N3: The cancer falls within one of the following groups:

  • N3a is when the cancer has spread to 10 or more lymph nodes under the arm or to those located under the clavicle, or collarbone.
  • N3b is when the cancer has spread to the internal mammary nodes and the axillary nodes.
  • N3c is when the cancer has spread to the lymph nodes located above the clavicle, called the supraclavicular lymph nodes.

If there is cancer in the lymph nodes, knowing how many lymph nodes are involved, and where they are helps doctors to plan treatment. The pathologist can find out the number of axillary lymph nodes that contain cancer after they are removed during surgery. It is not common to remove the supraclavicular or internal mammary lymph nodes during surgery. If there is cancer in these lymph nodes, treatment other than surgery, such as radiation therapy, chemotherapy, and hormonal therapy, is used to control the disease.

Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body.

MX: Distant spread cannot be evaluated.

M0: The disease has not metastasized.

M0 (i+): There is no clinical or radiographic evidence of distant metastases, but microscopic evidence of tumor cells is found in the blood, bone marrow, or other lymph nodes that are no larger than 0.2 mm in a patient without other evidence of metastases.

M1: There is evidence of metastasis to another part of the body, meaning there are breast cancer cells growing in other organs.  

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. Most patients are anxious to learn the exact stage of the cancer. However, it is important to keep in mind that tumor biology, including the diagnostic markers outlined above, has a significant impact on the type of treatment that is recommended, as well as on the prognosis. Your doctor will generally confirm the stage of the cancer when the testing after surgery is completed, usually about five to seven days after surgery. When treatment is given before surgery, called neoadjuvant therapy, the stage of the cancer will be determined from other tests.

Stage 0: Stage zero (0) describes disease that is only in the ducts and lobules of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called noninvasive cancer (Tis, N0, M0).

Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes (T1, N0, M0).

Stage IB: Cancer has spread only to the lymph nodes, and is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller (T0 or T1, N1mic, M0).

Stage IIA: Any one of these conditions:

  • There is no evidence of a tumor in the breast, but the cancer has spread to the axillary lymph nodes but not to distant parts of the body. (T0, N1, M0).
  • The tumor is 20 mm or smaller and has spread to the axillary lymph nodes (T1, N1, M0).
  • The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes (T2, N0, M0).

Stage IIB: Either of these conditions:

  • The tumor is larger than 20 mm but not larger than 50 mm and has spread to one to three axillary lymph nodes (T2, N1, M0).
  • The tumor is larger than 50 mm but has not spread to the axillary lymph nodes (T3, N0, M0).

Stage IIIA: The cancer of any size has spread to four to nine axillary lymph nodes, but not to other parts of the body (T0, T1, T2 or T3, N2, M0). Stage IIIA may also be a tumor larger than 50 mm that has spread to one to three lymph nodes (T3, N1, M0).

Stage IIIB: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to the lymph nodes under the arm, but it has not spread to other parts of the body (T4; N0, N1 or N2; M0).

Stage IIIC: A tumor of any size that has not spread to distant parts of the body but has spread to 10 or more axillary lymph nodes or the lymph nodes in the N3 group (any T, N3, M0).

Stage IV (metastatic): The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall (any T, any N, M1). Metastatic cancer spread is found when the cancer is first diagnosed about 5% to 6% of the time. Most commonly, metastatic breast cancer is found after a previous diagnosis of early-stage breast cancer.

Recurrent: Recurrent cancer is cancer that has come back after treatment, and can be either local or distant or both. If there is a local recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Because metaplastic carcinoma of the breast is rare, the best course of treatment has not yet been determined. As explained in the Overview, metaplastic breast cancer is a type of breast cancer called triple-negative. Therefore, metaplastic breast cancer is treated in the same way that other types of triple-negative breast cancers are treated. It has been suggested in multiple studies, however, that a woman’s prognosis is related to a combination of factors, including the size of the tumor, the number of positive lymph nodes under the arm, and the tumor biology as determined by molecular tests.

The biology and behavior of a breast cancer affects the treatment. Some tumors are small but grow fast, while others are large and grow slower. When planning the treatment for breast cancer, the doctor will consider many factors, including:

  • The stage and grade of the tumor
  • The patient’s age and general health
  • The patient’s menopausal status 
  • The presence of known mutations in inherited breast cancer genes, such as BRCA1 or BRCA2

Even though the doctor will specifically tailor the treatment for each patient and the breast cancer, there are some general steps for treating breast cancer.

For small, early-stage metaplastic cancers, doctors generally recommend surgery to remove the tumor. To make sure that the entire tumor is removed, the surgeon will also remove a small area of tissue around the tumor. Although the goal of surgery is to remove all of the tumor that can be seen, cancer cells that cannot be seen may be left behind in the breast or elsewhere.

After surgery for early-stage breast cancer, the next step is to lower the risk of recurrence and to get rid of any remaining cancer cells. This is called adjuvant therapy. Adjuvant therapies for metaplastic cancer include chemotherapy and radiation therapy. See below for more information on these types of treatment. Whether you need adjuvant therapy depends on the chance that cancer cells remain in the breast or elsewhere in the body. Although adjuvant therapy lowers the risk of recurrence, it does not necessarily eliminate all risk.

When surgery to remove the cancer is not possible, or the tumor is larger in size, chemotherapy is used to shrink the tumor before surgery. This is called neoadjuvant chemotherapy. Radiation therapy is usually only recommended after surgery. However, in some situations, radiation therapy may be used to control the tumor’s growth when surgery is not possible.

Descriptions of the most common treatment options for metaplastic breast cancer are listed below. Treatment options and recommendations depend on several factors, including the stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. It is also used to examine the surrounding axillary or underarm lymph nodes. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Generally, the smaller the tumor, the more options for surgery a patient has. Surgery for breast cancer includes the following:

  • A lumpectomy is the removal of the tumor and a small, cancer-free margin of tissue around the tumor. Most of the breast remains. Follow-up radiation therapy to the remaining breast tissue is generally recommended. A lumpectomy may also be called breast-conserving surgery, a partial mastectomy, or a segmental mastectomy.
  • A mastectomy is the surgical removal of the entire breast. There are several types of mastectomies. Talk with your doctor about whether the skin can be preserved, called a skin-sparing mastectomy, or the skin and the nipple, called a total skin-sparing mastectomy.

After a mastectomy or lumpectomy, breast reconstruction is an option; see below for more information on that type of surgery.

Lymph node removal and analysis

Cancer cells can be found in the axillary lymph nodes in some cancers; this information is used to determine treatment and prognosis. It is important to find out whether any of the lymph nodes near the breast contain cancer.

Sentinel lymph node biopsy. The sentinel lymph node biopsy procedure allows for the removal of one to a few lymph nodes, avoiding the removal of multiple lymph nodes in an axillary lymph node dissection (see below) for patients whose sentinel lymph nodes are free of cancer. The smaller lymph node procedure lowers the risk of swelling of the arm called lymphedema and decreases the risk of numbness, as well as arm movement and range-of-motion problems, which are long-lasting issues that can severely affect a person’s quality of life.

In a sentinel lymph node biopsy, the surgeon finds and removes about one to three sentinel lymph nodes from under the arm that receive lymph drainage from the breast. The pathologist then examines these lymph nodes for cancer cells. To find the sentinel lymph node, the surgeon injects a dye and/or a radioactive tracer into the area of the cancer and/or around the nipple. The dye or tracer travels to the lymph nodes, arriving at the sentinel node first. The surgeon can find the node when it turns color if the dye is used or gives off radiation if the tracer is used.

If the sentinel lymph node is cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer and no further surgery is needed. If the sentinel lymph node shows that there is cancer, then the surgeon may perform an axillary lymph node dissection to remove more lymph nodes to look for cancer, depending on the stage of the cancer, the features of the tumor, and the amount of cancer in the sentinel lymph nodes. It is recommended that patients with signs of cancer in the axillary lymph nodes receive an axillary lymph node dissection, regardless of whether a sentinel lymph node biopsy is done. Find out more about ASCO's recommendations for sentinel lymph node biopsy.

Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm, which are then examined by a pathologist for cancer cells. The actual number of lymph nodes removed varies from person to person. Recent research has shown that an axillary lymph node dissection may not be needed for all women with early-stage breast cancer with small amounts of cancer in the sentinel lymph nodes. Women having a lumpectomy and radiation therapy who have a smaller tumor and no more than two sentinel lymph nodes involved with cancer may avoid a full axillary lymph node dissection, which helps reduce the risk of side effects and does not decrease survival. If cancer is found in the sentinel lymph node, whether more surgery is needed to remove additional lymph nodes depends on each person’s situation.

Most patients with invasive cancer will have either a sentinel lymph node biopsy or an axillary lymph node dissection. A sentinel lymph node biopsy alone should not be done if there is obvious evidence of cancer in the lymph nodes before any surgery. In this situation, a full axillary lymph node dissection is preferred.

Reconstructive (plastic) surgery

Women who have a mastectomy may want to consider breast reconstruction, which is surgery to create a breast using either tissue taken from another part of the body or synthetic implants. Reconstruction is usually performed by a plastic surgeon. A woman may be able to have reconstruction at the same time as the mastectomy, called immediate reconstruction, or at some point in the future, called delayed reconstruction. In addition, reconstruction may be done at the same time as a lumpectomy to improve the look of the breast and to match the breasts, this is called oncoplastic surgery, and many breast surgeons can do this without the help of a plastic surgeon. Surgery on the healthy breast is also often done so both breasts have a similar appearance. Talk with your doctor for more information.

External breast forms (prostheses)

An external breast prosthesis or artificial breast form provides an option for women who plan to delay or not have reconstructive surgery. Breast prostheses can be made to provide a good fit and natural appearance for each woman. 

Summary of surgical options

To summarize, surgical treatment options include the following:

  • Removal of cancer in the breast: Lumpectomy or partial mastectomy almost always followed by radiation therapy or mastectomy, with or without immediate reconstruction
  • Lymph node evaluation: Sentinel lymph node biopsy and/or axillary lymph node dissection

Women are encouraged to talk with their doctors about which surgical option is right for them. More aggressive surgery, such as a mastectomy, is not always better and may cause more complications. The combination of lumpectomy and radiation therapy has a slightly higher risk of the cancer coming back in the same breast or near the breast and new cancers in the breast, but the long-term survival of women who choose lumpectomy is the same as those who have a mastectomy. Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time (see below for additional information).

After surgery, adjuvant radiation therapy is given regularly for a number of weeks to get rid of any remaining cancer cells near where the tumor was located or elsewhere within the breast. Radiation therapy after lumpectomy helps reduce the risk of cancer recurrence in the breast.

Adjuvant radiation therapy is also recommended for some women after a mastectomy, depending on the size of the tumor, the number of cancerous lymph nodes under the arm, and width of the cancer-free margin around the tumor removed by the surgeon.

Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove, although this option is not often used.

Radiation therapy can cause side effects, including fatigue, swelling of the breast, and skin changes. Other side effects may include upset stomach and loose bowel movements. Most side effects go away soon after treatment is finished. A small amount of the lung can be affected by the radiation, although the risk of pneumonitis, or a radiation-related inflammation of the lung tissue, is low. In the past, with older equipment and techniques, women who received radiation therapy to the left side of their chest had a small increase in the long-term risk of heart disease. Modern techniques are now able to spare most of the heart from radiation damage.

Many types of radiation therapy may be available to you; however, many of these methods have not been well-studied in women with metaplastic breast cancer. Talk with your doctor about the options, advantages, and disadvantages of each option.

Radiation therapy schedule

Standard radiation therapy after a lumpectomy is external-beam radiation therapy given Monday through Friday for five to six weeks. This often includes radiation therapy to the whole breast the first four to five weeks, followed by a more focused treatment to where the tumor was located in the breast for the remaining treatments.

This focused part of the treatment, called a boost, is standard for women with invasive breast cancer to reduce the risk of a recurrence in the breast. If there is evidence of cancer in the underarm lymph nodes, radiation therapy may also be given to the lymph node areas in the neck or underarm near the breast or chest wall. Usually, patients who have a mastectomy do not require radiation therapy. However, for patients with large cancers, several cancerous lymph nodes, or growth of cancer into the skin or chest wall, radiation may still be recommended after a mastectomy. Radiation therapy following a mastectomy can be given after reconstruction, and is usually given five days a week for five to six weeks.

There has been growing interest in newer regimens that shorten the length of treatment from six to seven weeks to periods of three to four weeks. In one method called hypo-fractionated radiation therapy, a higher daily dose is given to the whole breast each day so that the overall length of treatment is shortened to three to four weeks. This approach can also be combined with a boost to the tumor site either during or after the whole breast radiation treatments. Even shorter schedules have been studied and are in use in some centers, including accelerated partial breast radiation for five days, and others are researching a three-week schedule.

Partial breast irradiation

Partial breast irradiation (PBI) is radiation therapy that is given directly to the tumor area, usually after a lumpectomy, instead of the entire breast, as is usually done with standard radiation therapy. Targeting radiation directly to the tumor area more directly usually shortens the amount of time that patients need to receive radiation therapy. However, only some patients may be able to have PBI. Although early results have been promising, PBI is still being studied. It is the subject of a large, nationwide clinical trial, and the results on the safety and effectiveness compared with standard radiation therapy are not yet ready. This study will help find out which patients are the most likely to benefit from PBI.

PBI can be done with standard external-beam radiation therapy that is focused on the area where tumor was removed and not on the entire breast. PBI may also be performed using brachytherapy. Brachytherapy is the use of plastic catheters or a metal wand placed temporarily in the breast. Breast brachytherapy can involve short treatment times, ranging from one dose to one week, or it can be given as one dose in the operating room during surgery immediately after the tumor is removed. These forms of focused radiation are currently used only for patients with a smaller, less-aggressive, and node-negative tumor.

Intensity-modulated radiation therapy

Intensity-modulated radiation therapy (IMRT) is a more advanced way to give external-beam radiation therapy to the breast. The intensity of the radiation directed at the breast is varied to better target the tumor, spreading the radiation more evenly throughout the breast. The use of IMRT lessens the radiation dose and the possible damage to nearby organs, such as the heart and lung, and lower the risks of some immediate side effects, such as peeling of the skin during treatment. This can be especially important for women with medium to large breasts who have a higher risk of side effects, such as peeling and burns, compared with women with smaller breasts. IMRT may also help to lessen the long-term effects on the breast tissue that were common with older radiation techniques such as hardness, swelling, or discoloration.

Even though IMRT has fewer short-term side effects, many insurance providers may not cover IMRT. It is important to check with your health insurance company before any treatment begins to make sure it is covered.

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

Chemotherapy may be given before surgery to shrink a large tumor and reduce the risk of recurrence, called neoadjuvant chemotherapy. It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy. Chemotherapy is also given if a patient has a metastatic breast cancer recurrence.

A chemotherapy regimen (schedule) consists of a specific treatment schedule of drugs given at repeating intervals for a set period of time. Because it is unknown if metaplastic carcinoma of the breast behaves like ductal or lobular cancer, some doctors will recommend slightly different chemotherapy.

For early-stage cancer, chemotherapy is usually given as a combination or drugs or as one drug after another. Chemotherapy after surgery is recommended for almost all women with metaplastic cancer, because the disease often grows quickly and chemotherapy works well for this type of breast cancer. Currently, researchers are looking at adding carboplatin (Paraplatin) or cisplatin (Platinol) to improve how well standard chemotherapy works for metaplastic and other triple-negative breast cancers.

Common drugs for breast cancer include:

  • Capecitabine (Xeloda)
  • Carboplatin
  • Cisplatin
  • Cyclophosphamide (Neosar)
  • Docetaxel (Docefrez, Taxotere)
  • Doxorubicin (Adriamycin)
  • Pegylated liposomal doxorubicin (Doxil)
  • Epirubicin (Ellence)
  • Eribulin (Halaven)
  • Fluorouracil (5-FU, Adrucil)
  • Gemcitabine (Gemzar)
  • Paclitaxel (Taxol)
  • Protein bound paclitaxel (Abraxane)
  • Vinorelbine (Navelbine)
  • Ixabepilone (Ixempra)
  • Methotrexate (multiple brand names)

Common chemotherapy regimens for the treatment early-stage, triple-negative breast cancer include:

  • Doxorubicin/cyclophosphamide (AC) followed by paclitaxel or docetaxel
  • Docetaxel/cyclophosphamide (TC)
  • Docetaxel/doxorubicin/cyclophosphamide (TAC)

The side effects of chemotherapy depend on the individual and the drug and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Rarely, long-term side effects may occur, such as heart damage, nerve damage, or secondary cancers, but studies have shown that these side effects do not shorten a person’s life.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Remission and the chance of recurrence

A remission is when no cancer is seen after imaging studies such as CT and bone scans and there are no symptoms. This may also be called “no evidence of disease” or NED. 

After treatment for early-stage breast cancer, there is always a risk for recurrence. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. Metaplastic cancer, as well as other types of triple-negative breast cancer, is most likely to come back within the first five years after diagnosis. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the breast, which is called a local recurrence; in the chest wall, called a regional recurrence; or in another part of the body, including distant organs such as the lungs, liver, and bones.

Generally, a recurrence is found when a person has symptoms. These symptoms depend on where in the body the cancer returns and may include:

  • A lump under the arm or along the chest wall
  • Bone pain or fractures, which may be a sign that the cancer has spread to the bone
  • Headaches or seizures, which may be a sign that the cancer has spread to the brain
  • Chronic coughing or trouble breathing, a sign that the cancer has spread to the lungs
  • Abdominal pain or yellow skin and eyes from a condition called jaundice, which is a sign that the disease may have spread to the liver

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. A biopsy of the recurrent site is often recommended to be certain of the diagnosis and to check for tumor characteristics that might have changed from the time of the original diagnosis. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

The treatment of recurrent breast cancer depends on the previous treatment(s), the time since the original diagnosis, and the characteristics of the tumor. A local recurrence is usually considered curable with further treatment.

  • For women with a local recurrence within the breast after initial treatment with lumpectomy and adjuvant radiation therapy, the recommended treatment is mastectomy. Usually the cancer is completely removed with this treatment.  Chemotherapy is often given as well to increase the chance that the cancer will not recur in other places in the body.
  • For women with a local or regional recurrence in the chest wall after an initial mastectomy, surgical removal of the recurrence followed by radiation therapy to the chest wall and lymph nodes is the recommended treatment, unless radiation therapy has already been given because radiation therapy cannot usually be given at full dose to the same area more than once. Again, chemotherapy is often given as well to try to prevent further recurrences.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

Metastatic breast cancer

If cancer has spread to another location in the body, it is called metastatic cancer or metastatic recurrent cancer. Symptoms of metastatic breast cancer may be related to the location of metastasis and may include changes in vision, changes in energy levels, feeling ill, or extreme fatigue. A metastatic recurrence is generally not considered curable, but it is often treatable. Some patients live years after a metastatic recurrence of breast cancer.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

The goal of treatment for advanced disease is to lengthen a patient’s life and maintain or improve a patient’s quality of life for as long as possible. Your health care team may recommend a treatment plan that includes chemotherapy, which is generally the primary treatment for metastatic triple-negative breast cancer. Targeted therapies in clinical trials (see Latest Research) should always be considered, and are preferred over standard therapy in most situations. Radiation therapy and surgery may be used in certain situations for women with a distant metastatic recurrence. Often radiation is used to treat painful bone metastases. Supportive care will also be important to help relieve symptoms and side effects.

Although metaplastic breast cancer most often spreads to organs such as the liver or lung, it may spread to the bone, as well. The medications discussed below are available to help control bone destruction and reduce bone pain associated with cancer that has spread to the bone.

Drugs that block bone destruction

  • Bisphosphonates are drugs that block the cells that destroy bone, called osteoclasts. Bisphosphonates are commonly used in low doses to prevent and treat osteoporosis. Osteoporosis is the thinning of the bones. In women with breast cancer that has spread to bone, higher doses of bisphosphonates have been shown to reduce the side effects of cancer in the bone, including broken bones and pain. Pamidronate (Aredia) and zoledronic acid (Zometa) are two intravenous bisphosphonates used to treat breast cancer bone metastasis. These drugs may also be able to reduce breast cancer recurrence, particularly in bone, when given after treatment in postmenopausal women, although the research on this effect is conflicting.
  • Denosumab (Xgeva) is another osteoclast-targeted therapy called a RANK ligand inhibitor. Recent studies have shown that denosumab works well to treat breast cancer bone metastases, and may be better than bisphosphonates at controlling the symptoms of bone metastases. Denosumab is also effective at treating osteoporosis and is being studied as a cancer treatment for early-stage breast cancer.

Learn more about drugs that block bone destruction.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with breast cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating breast cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with breast cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options, so that the person understands the standard treatment, and how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for breast cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about metaplastic breast cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease.

Most current clinical trials require a tumor sample to check if the specific treatment being studied has a higher chance of targeting the specific cancer. Testing of the tumor sample is usually needed to look for specific proteins, receptors, or genetic changes in the tumor cells. When making treatment decisions, talk with your health care team to make sure your original tumor sample is available in case you eventually choose to participate in a clinical trial. If you are diagnosed with recurrent cancer, check that a biopsy of the recurrent cancer is performed and saved for future possible testing.

The following areas of research include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Researchers are studying drugs that target a number of different receptors or proteins, which when mutated or changed may be involved in the development of cancer.

Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Researchers are looking at drugs that target the immune system to help the body respond appropriately to the cancer.

Surgery. New surgical methods that save tissue or prevent scarring are being tested in clinical trials.

Radiation therapy. Improved ways to give radiation therapy are being studied as a way to lower the risk of side effects.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current breast cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More about the Latest Research?

If you would like additional information about the latest areas of research regarding breast cancer, explore these related items:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - Coping With Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for metaplastic breast cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with metaplastic breast cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for breast cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO’s recommendations for breast cancer follow-up care include regular physical examinations and mammograms, among other recommendations. In addition, ASCO offers cancer treatment summaries and a survivorship care plan to help keep track of the breast cancer treatment you received and develop a survivorship care plan once treatment ends. In some instances, patients may be seen at survivorship clinics that specialize in the post-treatment needs of people with cancer.

Breast cancer can come back in the breast or other areas of the body. The symptoms of a cancer recurrence include a new lump in the breast, under the arm, or along the chest wall; bone pain or fractures; headaches or seizures; chronic coughing or trouble breathing; extreme fatigue; and/or feeling ill. Talk with your doctor if you have these or other symptoms. The possibility of recurrence is a common concern among cancer survivors; learn more about coping with fear of recurrence.

After a mastectomy or lumpectomy for breast cancer, the breast may be scarred and may have a different shape or size than before surgery. Or, the area around the breast may become hardened. If lymph nodes were removed as part of the surgery or affected during treatment, lymphedema may occur, and this is a life-long risk for patients.

Some patients experience breathlessness, a dry cough, and/or chest pain two to three months after finishing radiation therapy because the treatment can cause swelling and a hardening or thickening of the lungs called fibrosis. These symptoms are usually temporary. Talk with your doctor if you develop any new symptoms after radiation therapy or if the side effects are not going away.

Patients who received certain types of chemotherapy called anthracyclines may be at risk of heart problems. Talk with your doctor about the best ways to check for heart problems.

In addition, women recovering from breast cancer have other symptoms that may persist after treatment. Learn about ways of coping with cancer-related fatigue, a drop in cognitive function that is sometimes called "chemo brain", and other late effects of cancer treatment.

Women recovering from breast cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level and may lower the risk of cancer recurrence. Your doctor can help you create a safe exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of breast cancer do I have?
  • Can you explain my pathology report (laboratory test results) to me? Is the sample of my tumor being saved for possible future testing?
  • What is the size of my tumor?
  • What is a sentinel lymph node biopsy? What are the benefits and risks? Would you recommend it for me?
  • What is the risk of lymphedema with a sentinel lymph node biopsy? With axillary lymph node dissection?
  • How many lymph nodes contain cancer?
  • What stage is my breast cancer? What does that mean?
  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • Do I need additional surgery?
  • Should I consider chemotherapy before surgery?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?What are the expected timelines for my treatment plan?
  • How much time will each treatment take? 
  • Will each treatment be the same? Does the dose change throughout the period of treatment?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • Would breast reconstruction be an option for me? If so, what are my options?
  • What are the advantages and disadvantages of each type of breast reconstruction?
  • What follow-up tests will I need, and how often will I need them?
  • How will you determine if the cancer comes back?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

For additional questions, see the Guide to Breast Cancer.

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Breast Cancer - Metaplastic - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Metaplastic Breast Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a cancer specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

- Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

- Read more about the first steps to take when newly diagnosed with cancer.

- Find out more about clinical trials as a treatment option.

- Learn more about coping with the emotions that cancer can bring, including those within a family or a relationship.

- Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with this type of cancer.

- Explore next steps a person can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Metaplastic Breast Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.