1. What is metaplastic breast cancer?
2. What are the symptoms of metaplastic breast cancer?
3. How is metaplastic breast cancer diagnosed?
4. How is metaplastic breast cancer treated?
5. Further support
Metaplastic breast cancer is a rare type of breast cancer accounting for around 1% of breast cancers.
A pathologist (doctor who examines tissue removed during a biopsy or surgery) looks at the cancer cells under a microscope to see what type of breast cancer it is.
Metaplastic breast cancer is an invasive cancer, which means it has the potential to spread to other parts of the body.
As with most types of breast cancer, the symptoms of metaplastic breast cancer can include:
- a change in the size of the breast
- a lump or thickening of the skin
- breast pain
- changes to the nipple
- puckering or dimpling of the skin
Routine breast screening can often pick up cancer before there are any symptoms. Therefore some women will be diagnosed with metaplastic breast cancer after attending breast screening without having any of the symptoms described above.
Metaplastic breast cancer is diagnosed using a range of tests, which may include:
- mammogram – a breast x-ray
- ultrasound scan of the breast and under the arm (axilla) – uses high frequency sound waves to produce an image
- core biopsy of the breast and/or lymph nodes – uses a hollow needle to take a sample of breast tissue to be looked at under a microscope
- fine needle aspiration (FNA) of the breast and/or lymph nodes – uses a a fine needle and syringe to take a sample of cells to be looked at under a microscope
Metaplastic breast cancer is more likely to be triple negative, which will also affect the treatment you will have. Find out more about triple negative breast cancer.
Breast surgery is usually the first treatment for metaplastic breast cancer. This may be:
- breast-conserving surgery, also known as wide local excision or lumpectomy – removal of the cancer with a margin (border) of normal breast tissue around it
- mastectomy – removal of all the breast tissue including the nipple area
The amount of tissue removed depends on the area of the breast affected, how big the cancer is in relation to the size of your breast, and whether more than one area in the breast is affected. Your breast surgeon will discuss this with you.
If you have breast-conserving surgery, it’s important that a clear margin of tissue is taken from around the cancer. If a clear margin of tissue is not seen when the area removed is examined under the microscope, sometimes a second operation is needed.
If you’re going to have a mastectomy, you’ll usually be able to have breast reconstruction either at the same time as your mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).
Surgery to the lymph nodes
Metaplastic breast cancer is less likely to spread to the lymph nodes (glands) under the arm (axilla) than other invasive breast cancers. However, your specialist team will want to check if your lymph nodes contain cancer cells. This, along with other information about your breast cancer, helps them decide whether or not you will benefit from additional treatment after surgery. To do this, your surgeon is likely to recommend an operation to remove either some of the lymph nodes (a lymph node sample or biopsy) or all of them (a lymph node clearance).
Sentinel lymph node biopsy is widely used if tests before surgery show no evidence of the lymph nodes containing cancer cells. It identifies whether the sentinel lymph node(s) (the first lymph node(s) that the cancer cells are most likely to spread to) are clear of cancer cells. If clear, this usually means the other nodes are clear too, so no more will need to be removed.
Sentinel lymph node biopsy is usually carried out at the same time as your cancer surgery but may be done before your surgery.
If the results of the sentinel lymph node biopsy show that the first node or nodes are affected, more surgery or radiotherapy to the remaining lymph nodes may be recommended.
Sentinel lymph node biopsy is not suitable if tests before your operation show that your lymph nodes contain cancer cells. In this case it is likely that your surgeon will recommend a lymph node clearance.
After surgery you may need other treatments. These are called adjuvant treatments and can include:
- hormone (endocrine) therapy
- targeted (biological) therapies
The aim of these treatments is to reduce the risk of breast cancer returning in the same breast or developing in the other breast, or spreading somewhere else in the body.
Sometimes chemotherapy or hormone therapy may be given before surgery. This is known as neo-adjuvant or primary therapy.
Chemotherapy will be recommended for many people with metaplastic breast cancer. Chemotherapy destroys cancer cells using anti-cancer drugs, and is given to reduce the risk of breast cancer returning or spreading.
If you have breast-conserving surgery you will usually be offered radiotherapy to the breast to reduce the risk of the cancer coming back in the same breast. Sometimes you may be offered radiotherapy to the nodes under your arm.
Radiotherapy is sometimes given to the chest wall after a mastectomy, for example if some lymph nodes under the arm are affected.
Hormone (endocrine) therapy
The hormone oestrogen can stimulate some breast cancers to grow. A number of hormone therapies work in different ways to block the effect of oestrogen on cancer cells.
Hormone therapy will only be prescribed if your breast cancer has receptors within the cell that bind to the hormone oestrogen, known as oestrogen receptor positive or ER+ breast cancer. Invasive breast cancers are tested for oestrogen receptors using tissue from a biopsy or after surgery. When oestrogen binds to these receptors, it can stimulate the cancer to grow.
If your cancer is oestrogen receptor positive, your specialist will discuss with you which hormone therapy they think is most appropriate.
If oestrogen receptors are not found it is known as oestrogen receptor negative or ER-.
Tests may also be done for progesterone (another hormone) receptors.
The benefits of hormone therapy are less clear for people whose breast cancer is only progesterone receptor positive (PR+ and ER-). Very few breast cancers fall into this category. However, if this is the case for you your specialist will discuss with you whether hormone therapy is appropriate.
Metaplastic breast cancer is more likely to be oestrogen receptor negative (ER–). If this is the case, then hormone therapy will not be of any benefit.
Targeted (biological) therapies
This is a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow.
The most widely used targeted therapy is trastuzumab (Herceptin). Only people whose cancer has high levels of HER2 (called HER2 positive) will benefit from having trastuzumab. HER2 is a protein that helps cancer cells grow.
There are various tests to measure HER2 levels which are done on breast tissue removed during a biopsy or surgery. If your cancer is found to be HER2 negative, then trastuzumab will not help you.
Metaplastic breast cancer tends to be HER2 negative. If this is the case, then trastuzumab will not be of any benefit.
When breast cancers are HER2 negative, oestrogen receptor negative and progesterone receptor negative, the cancer is referred to as being ‘triple negative’. Find out more about triple negative breast cancer.
Bisphosphonates are a group of drugs that can reduce the risk of breast cancer spreading in post-menopausal women. They can be used regardless of whether the menopause happened naturally or due to breast cancer treatment.
Bisphosphonates can also slow down or prevent bone damage. They’re often given to people who have, or are at risk of, osteoporosis (when bones lose their strength and become more likely to break).
Bisphosphonates can be given as a tablet or into a vein (intravenously).
Your specialist team can tell you if bisphosphonates would be suitable for you.
Being diagnosed with breast cancer can make you feel lonely and isolated.
Many people find it helps to talk to someone who has been through the same experience as them. Breast Cancer Care’s Someone Like Me service can put you in touch with someone who has had a diagnosis of breast cancer, so you can talk through your worries and share experiences over the phone or by email. You can also visit our confidential online Forum and join one of the ongoing discussions.
If you would like any further information and support about breast cancer or just want to talk things through, you can speak to one of our experts by calling our free Helpline on 0808 800 6000.