When a patient is diagnosed with what is known as a “malignant neoplasm” but is given no other information, it is necessary to be creative in your approach as a nurse navigator. What is this tumor? How will it be treated? Who has already consulted with the patient? And what role will the navigator take when information is pending to specialty labs for further analysis?
A patient came to me recently having been referred by a local surgeon. She had just been through several imaging studies including MRI, CAT scan, and chest x-ray. Although the diagnosis was not well established, she was scheduled for surgery and had a mastectomy. When checking back on her imaging studies, I noted that this had all occurred since the beginning of July, which did not allow her much time to absorb the impact of a diagnosis. With the obvious dread of having to face the loss of a breast without a clear diagnosis, planning her upcoming surgery was daunting. The final pathology was most unusual, and while rare, it has a rather bleak prognosis.
Metaplastic breast cancer (MBC) is a malignancy characterized by the histologic presence of two or more cellular types, commonly a mixture of epithelial and mesenchymal components. MBC is rare relative to invasive ductal carcinoma (IDC), representing less than 1% of all breast cancers. MBC tumors display poorer prognostic features when compared to IDC. Due to its low incidence and pathological variance, the ideal treatment paradigm for MBC is not well understood. Despite similar treatment regimens, however, patients with MBC have worse outcomes, similar to patients with triple-negative disease.1 In this case, the patient’s prognostic analysis indicated a triple-negative histology.
I spoke at great length with the patient and described only the most important elements of the pathology report. She most certainly will be referred to a medical oncologist for consultation, and potential targeted therapies will be reviewed. The statistics for 5-year survival is less than 70%.2 We will all do our part as a group of dedicated individuals in varying specialties to maximize her potential for survival. At the end of the day, we will not know how she responds to treatment until we start—it is at that point that her journey will really begin.
Has anyone had patients with this diagnosis? Did they do well in treatment? How did you counsel them?
1. Salimoğlu S, Sert İ, Emiroğlu M, et al. Metaplastic breast carcinoma: analysis of clinical and pathologic characteristics—a case series. J Breast Health (2013). 2016; 12:63-6.
2. Edenfield J, Schammel C, Collins J, et al. Metaplastic breast cancer: molecular typing and identification of potential targeted therapies at a single institution. Clin Breast Cancer. 2017;17:e1-e10.