Some types of breast cancer have hormone receptors in their tissue. Triple-negative breast cancer (TNBC) does not have three of these receptors. Stage 4 TNBC means the cancer is advanced and has spread beyond the breasts and nearby lymph nodes.

Around 10–15% of all breast cancers are triple negative. TNBC tends to spread and grow faster than other types of breast cancer, and it has fewer treatment options. However, treatment may reduce symptoms and extend a person’s life.

Read on to learn more about stage 4 TNBC, including the symptoms, diagnosis, treatments, and support resources.

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Stage 4 means the breast cancer has spread outside of the breast and surrounding lymph nodes. Doctors may also refer to this as “metastatic” or “distant” breast cancer.

Common areas of the body that breast cancer may spread to include the liver, bones, or lungs. It is also possible for the cancer to spread to other organs, such as the brain.

The term “triple negative” means the tumors themselves do not have any of the following hormone receptors:

Stage 4 breast cancer is not curable. Additionally, TNBC often grows and spreads faster than other types of cancer and is more likely to return after treatment. It tends to have a worse prognosis than other forms of breast cancer.

The 5-year relative survival rate for people with a diagnosis of distant TNBC between 2011 and 2017 was 12%. This number comes from the Surveillance, Epidemiology, and End Results (SEER) database.

However, it is worth noting that this data comes from people who received a diagnosis and treatment at least 4–5 years ago, so the current outlook may be better due to advances in research. Survival rates also do not take into account other factors, such as age and overall health.

Treatment may extend a person’s life and reduce symptoms. Stage 4 cancers may require more intensive treatment than earlier stages of cancer.

The symptoms of stage 4 TNBC are similar to other types of breast cancer and may include:

  • a lump in or around the breasts
  • swelling of the breasts
  • swollen lymph nodes under the arm
  • discharge from the nipple
  • dimpling of the skin on the breast, which may resemble the texture of the skin on an orange, or other unusual skin changes
  • redness, in people with lighter skin
  • pain
  • an inverted nipple

To diagnose breast cancer, doctors will use imaging tests such as a mammogram, ultrasound, or MRI scan to look for any unusual changes in the breast. Doctors will then take a biopsy to analyze the breast tissue.

To diagnose the subtype of breast cancer, doctors will test cancer cells for estrogen and progesterone receptors, as well as how much HER2 protein they make. If the cells test negative for all three, it is TNBC.

To diagnose the stage of cancer, doctors will look at various factors, such as tumor grade and whether the cancer has spread to lymph nodes or other parts of the body. This involves medical imaging scans, such as CT, PET, or bone scans.

TNBC does not have as many treatment options as other types of breast cancer. This is due to the lack of hormone receptors on the tumors, which makes treatments such as hormone therapy ineffective.

Instead, treatment for stage 4 TNBC may include:

  • chemotherapy, with drugs such as anthracyclines, capecitabine, taxanes, gemcitabine, or eribulin
  • platinum chemotherapy drugs, such as cisplatin or carboplatin
  • targeted therapy with PARP inhibitors, such as olaparib or talazoparib
  • immunotherapy, with drugs such as pembrolizumab, in combination with chemotherapy
  • sacituzumab govitecan, an antibody-drug conjugate, for people who have already received two other types of drug treatments

In some cases, surgery and radiation therapy may also be options to remove or destroy cancer cells. However, at stage 4, the goal of these treatments is typically to alleviate symptoms or reduce the risk of certain complications. It is unlikely to remove all of the cancer.

People may want to talk with a healthcare professional about taking part in clinical trials to try new treatments.

When receiving a diagnosis and undergoing treatment, people may want to ask:

  • How much experience do you have in treating TNBC?
  • What is the goal of treatment?
  • Could it be helpful to get a second opinion?
  • Do I need further testing?
  • What are the treatment options?
  • Which treatments do you recommend, and why?
  • When can treatment start?
  • What are the side effects of treatment? How will it affect day-to-day life?
  • Do you have advice for diet, exercise, and managing mental health during treatment?
  • Which symptoms should I report to a doctor?
  • Will treatment affect my fertility?
  • Can I take part in any clinical trials?
  • What is the outlook? What are the options if the cancer returns?

People may find it helpful to write down any questions they want to ask, as well as noting down key points during any consultations. Taking another person along to appointments may also help people remember any important information.

Receiving a diagnosis of stage 4 TNBC may feel overwhelming. People may find it helpful to seek support from those around them, support groups, or mental health professionals.

Some support organizations include:

If a person requires financial help for the costs of stage 4 TNBC cancer, the following resources may provide useful information and support:

TNBC is a type of breast cancer that tests negative for three hormone receptors that can occur in other types of cancer. Stage 4 means that cancer has spread outside of the breast and surrounding lymph nodes to other areas of the body.

The outlook for those with stage 4 TNBC can depend on many factors, including how the cancer responds to treatment, as well as people’s age and overall health.

Treatments for stage 4 TNBC may include chemotherapy, immunotherapy, and targeted therapy. In some cases, people may also have radiation therapy and surgery. The goal of these treatments is typically to extend a person’s life or reduce their symptoms.