Triple-negative Breast Cancer: What Is Known About It?

Lisa L. Ferguson, DNP, RN, WHNP-BC; Britne Curran, MSN, RN, WHNP-BC; Mary Martinez, MSN, RN, WHNP-BC; Peggy Mancuso, PhD, RN, CNM

Disclosures

Clin J Oncol Nurs. 2014;18(1) 

In This Article

Outcome of Interventions

R.D. underwent a left axillary lymph node biopsy prior to treatment. Methylene blue dye and a radiotracer were injected into the right breast using the peri-areolar approach one hour prior to surgery. During surgery, six nodes were identified by their blue hue and the readings on a gamma probe. These nodes were harvested and sent for histologic review. Only one of these sentinel nodes was positive with metastatic disease, giving R.D. a staging classification of IIB, T2N1M0. Stage IIB is considered early breast cancer (National Cancer Institute, n.d.).

R.D. experienced seroma, a surgical complication, which persisted for two months. It was large and caused significant discomfort as she performed the activities of daily living. This lesion was drained five times of blood-tinged serous fluid in amounts ranging from 20–90 ccs. The first two aspirates were sent for culture and sensitivity, but no pathogens were present. Nevertheless, R.D. was treated with cephalexin for seven days and then amoxicillin and clavulanate for five days. These antibiotic therapies did not serve to resolve the seroma. R.D.'s breast health navigator suggested a compression bra. Within three days, she experienced relief from the pain of the seroma; however, the breast remained enlarged and red until surgery.

Four weeks after the final round of chemotherapy, R.D. had a double mastectomy. She was discharged from the hospital within 24 hours with Jackson Pratt (JP) drains drawing fluid from each surgical site. She was instructed to begin slowly exercising her arms, not to lift anything heavier than five pounds, and to document the amount of fluid each JP collected. R.D. was told that once the drain output was less than 20 ccs in a 24-hour period, they would be removed. She was given hydrocodone and acetaminophen for pain and was told she could take ibuprofen for lesser pain. The left JP drain was removed 17 days after surgery, and although the right site continued to drain 33–35 ccs per day, it was removed 24 days after surgery to mitigate the risk of infection. Her mastectomy incisions healed well.

With removal of the breast tissue, pathology can determine if any residual tumor exists after neoadjuvant chemotherapy. In R.D., pathologic complete response of the cancer occurred from chemotherapy, which means that no disease was detected in the affected breast tissue under microscopic examination. According to von Minckwitz and Martin (2012), TNBC patients with pathologic complete response to neoadjuvant chemotherapy have survival rates that are comparable to non-TNBC patients.

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