Treating Stage Iii Breast Cancer
In stage III breast cancer, the tumor is large or growing into nearby tissues , or the cancer has spread to many nearby lymph nodes.
If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. These cancers are treated slightly different from other stage III breast cancers. You can find more details in Treatment of Inflammatory Breast Cancer.
There are two main approaches to treating stage III breast cancer:
Stage Ia & Ib Treatment Options
Stage I describes invasive breast cancer . Stage I is divided into subcategories known as IA and IB.
In general, stage IA describes invasive breast cancer in which:
- the tumor measures up to 2 centimeters and
- the cancer has not spread outside the breast no lymph nodes are involved
In general, stage IB describes invasive breast cancer in which:
- there is no tumor in the breast instead, small groups of cancer cells larger than 0.2 millimeter but not larger than 2 mm are found in the lymph nodes or
- there is a tumor in the breast that is no larger than 2 cm, and there are small groups of cancer cells larger than 0.2 mm but not larger than 2 mm in the lymph nodes
Still, if the cancer is estrogen-receptor-positive or progesterone-receptor-positive, it is likely to be classified as stage IA.
How A Breast Cancers Stage Is Determined
Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.
The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.
In the past, stage number was calculated based on just three clinical characteristics, T, N, and M:
- the size of the cancer tumor and whether or not it has grown into nearby tissue
- whether cancer is in the lymph nodes
- whether the cancer has spread to other parts of the body beyond the breast
Numbers or letters after T, N, and M give more details about each characteristic. Higher numbers mean the cancer is more advanced. Jump to more detailed information about the TNM system.
Jump to a specific breast cancer stage to learn more:
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What Is Stage 0 Lcis
Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.
If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.
What Happens After Chemotherapy For Breast Cancer
Immediately after chemotherapy, you may feel sleepy or nauseated. Typically, the side effects of chemotherapy go away after you complete all prescribed cycles.
After all of your cycles of chemotherapy are completed, your healthcare provider may order imaging tests, such as CT scans or MRIs, to show whether the cancer is gone or the tumor has shrunk.
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Stage Iii: Locally Advanced
Locally advanced breast cancer includes tumors larger than 5 cm, extensive regional lymph node involvement, direct involvement of underlying chest wall or skin, tumors considered inoperable but without distant metastases, and inflammatory breast cancer. Induction chemotherapy followed by local therapy is becoming the standard of care. Five-year survival can be achieved in 55 percent of patients presenting with noninflammatory LABC.54 The most important prognostic factors are response to induction chemotherapy and lymph node status.
Dont Plan Your Chemo Response Until Youve Gone Through Your First Infusion
My reaction to a cancer diagnosis was to dive into what my husband calls âbiblio-therapy.â As a journalist, I researched it to death. As I drove to my first infusion, I felt armed with information to vanquish chemo. Iâd planned out everything.
I was sure Iâd get sick immediately. Instead, I went home from chemo and had dinner with friends. The second day, I felt tired. The third day, I felt completely sick and immobilized. That lasted for 3 or 4 days. Then, gradually, I got better. When I felt almost normal again, it was time for the next infusion.
I expected to throw up all the time but hardly did. I didnât expect chemo brain, but my thinking got so fuzzy, I could barely read a book. I imagined that I would end up in the hospital at some point during treatment, but I didnât.
Everyoneâs pattern is a little different. Wait to see what yours is before you make a lot of plans.
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How Soon After A Breast Cancer Diagnosis Should You Have Surgery
Breast cancer surgery is often the first course of treatment. In some cases, your doctor may recommend chemotherapy first to help shrink larger cancer cells.
Surgery should come within a few weeks of diagnosis. Research shows the sooner you receive surgery, the better the overall prognosis. For example, a study showed women ages 15 to 39 who had surgery within two weeks had a 84 percent five-year survival rate compared to a 78 percent five-year survival rate for women who waited six weeks or more until surgery. Overall, the optional time for surgery after diagnosis is less than 90 days.
Lumpectomy, mastectomy and lymph node removal are three common surgical procedures to treat breast cancer. A lumpectomy is a breast-conserving procedure in which only a part of the breast that contains cancer cells is removed. A mastectomy removes the entire breast. Some women also undergo a double mastectomy to remove both breasts.
Common Chemotherapy Drugs For Breast Cancer
Chemotherapy drugs used to treat early breast cancer include:
- Taxanes: This class of drugs includes docetaxel and paclitaxel .
These drugs are often used with others likecarboplatin, cyclophosphamide , and fluorouracil .
These drugs are often used with others like carboplatin , cyclophosphamide , and fluorouracil .
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For Metastatic Breast Cancer
Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.
Timing Of Chemotherapy Matters
The next study, Chavez-MacGregor et al, asked basically the same question, except that the authors looked at time to adjuvant chemotherapy after definitive surgery. Adjuvant chemotherapy is chemotherapy given after surgery with the intent of decreasing the chance of tumor recurrence. It is standard of care for many kinds of breast cancer. For instance, in two of the kinds of breast cancer with poorer prognosis, triple negative breast cancer and HER2 breast cancer, except in the case of very small node-negative tumors, nearly every patient who is healthy enough to handle it will be recommended adjuvant chemotherapy.
Not surprisingly, the authors found a correlation between prolonged time to chemotherapy and Hispanic ethnicity, non-Hispanic black race, lower socioeconomic status, and nonprivate insurance. This is similar to what Bleicher et al found with respect to time-to-surgery, namely that the proportion of patients with black race or Hispanic ethnicity increased with each interval delay. This is by no means a new finding disparities in health care of this sort have been documented in many previous studies. Indeed, these sorts of disparities are likely one reason why minorities and people of lower socioeconomic status experience worse outcomes in many cancers. Indeed, there are a lot of potential confounders, many of which couldnt be accounted for in either study, as Chavez-MacGregor et al note:
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What Is Stage 0 Breast Cancer
Also called carcinoma in situ, stage 0 is the earliest breast cancer stage. At stage 0, the breast mass is noninvasive, and there is no indication that the tumor cells have spread to other parts of the breast or other parts of the body. Often, stage 0 is considered a precancerous condition that typically requires close observation, but not treatment.
Stage 0 breast cancer is difficult to detect. There may not be a lump that can be felt during a self-examination, and there may be no other symptoms. However, breast self-exams and routine screening are always important and can often lead to early diagnosis of breast cancer, when the cancer is most treatable. Stage 0 disease is most often found by accident during a breast biopsy for another reason, such as to investigate an unrelated breast lump.
There are two types of stage 0 breast cancer:
Ductal carcinoma in situ occurs when breast cancer cells develop in the breast ducts. Today, stage 0 DCIS is being diagnosed more often because more women are having routine mammogram screenings. DCIS can become invasive, so early treatment can be important.
How Chemotherapy Is Given
Many chemotherapy drugs for breast cancer are given in liquid form, as intravenous infusions or injections , but some are available as pills or tablets.
Some drugs may be given alone, and other drugs are combined to work together. When chemo drugs are given in combination, the treatment is called a regimen.
Some of the common regimens are:
- AC: Adriamycin and Cytoxan
- ACT: Adriamycin and Cytoxan followed by a Taxol or Taxotere
- ECT: Epirubicin and Cytoxan followed by a Taxol or Taxotere
- CAF: Cytoxan, Adriamycin, and 5-FU
- CEF: Cytoxan, Ellence, and 5-FU
- CMF: Cytoxan, Trexall , and 5-FU
- TC: Taxotere and Cytoxan
- TAC: Taxotere, Adriamycin, and Cytoxan
Several types of targeted therapies have been approved for many cancer types, including breast cancer. For example, a therapy that targets the HER2 receptor is an antibody treatment called trastuzumab.
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Key Points To Remember
- Chemotherapy is sometimes used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
- Some types of cancer have a very small chance of coming back. Women who have those types of cancer may not need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
- Your age, type of cancer, tumor size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
- Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some aren’t.
- The drugs used for chemo can be very expensive. Insurance policies don’t always cover the whole cost. If you have no insurance, your doctor may be able to help you find drug companies or organizations that will help you pay for this treatment.
Treatment Option Overview For Locally Advanced Or Inflammatory Breast Cancer
On the basis of the available evidence, multimodality therapy delivered with curative intent is the standard of carefor patients with locally advanced or inflammatory breast cancer.
The standard treatment options for locally advanced or inflammatory breast cancer may include the following:
- Fungating/painful breast or chest wall lesions.
- After surgery for decompression ofintracranial or spinal cord metastases.
- After fixation of pathologicfractures.
Strontium chloride Sr 89, a systemically administered radionuclide, can beadministered for palliation of diffuse bony metastases.
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Stage 1 Or 2 Early Breast Cancer
Stage 1 and 2 breast cancer refers to invasive breast cancer that is contained within the breast, and may or may not have spread to the lymph nodes in the armpit. These stages are also known as early stage breast cancer.
At Stage 1 and 2, some cancer cells may have spread outside the breast and armpit area, but at this stage these cannot be detected.
Treatment For Stage 3 Breast Cancer
for stage 3 breast cancer may include the following, depending on the type of cancer and other factors:
stage 4 breast cancer , also called metastatic breast cancer, has cancer that has spread to nearby lymph nodes and also more distant lymph nodes and other organs in the body.
Stage 4 breast cancer is the most advanced stage. Stage 4 breast cancer also may be breast cancer that returned to affect other parts of the body. Cancer that has returned in other parts of the body is called recurrent metastatic breast cancer
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What Are The Chances Of Stage 1 Breast Cancer Returning
On average, 7 percent to 11 percent of women with early breast cancer experience a local recurrence during this time. For patients with a family history of cancer, or a BRCA1 or BRCA2 gene mutation, the cancer recurrence rate is higher. The risk of finding new cancers, such as ovarian cancer, may also be higher.
Youve Been Diagnosed With Breast Cancer How Soon Do You Need Treatment
Timely surgery for breast cancer is obviously better than delaying surgery, but how long can a patient safely wait for surgery once diagnosed. Because a randomized controlled clinical trial to answer this question would be unethical, this has been a difficult question to answer. Fortunately, a new study provides an estimate of how much of a delay it takes before outcomes start to suffer.
A new year is upon us yet again, and Science-Based Medicine has been in existence for eight years now. It seems only yesterday that Steve Novella approached me to ask me to be a contributor. Our part-serious, part-facetious predictions for 2016 notwithstanding, one thing about 2016 is certain: I will almost certainly encounter some form of cancer quackery or other and deconstruct it, probably multiple forms. In any case, a topic Ive been meaning to write about is based on a couple of studies that came out three weeks ago that illustrate why, even if a patient ultimately comes around to science-based treatment of his cancer, the delay due to seeking out unscientific treatments can have real consequences.
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Treatment For Stage 1 Breast Cancer
Doctors can offer a variety of for stage 1 breast cancer, although surgery is the primary treatment.
A lumpectomy or mastectomy are both viable surgical options for people with stage 1 breast cancer. A doctor will decide what surgery is most appropriate depending on the location of the primary tumor, how large it is, the size of the breast, family history, genetics, and the persons preference.
The doctor may also carry out a biopsy on one or more lymph nodes.
After removing the tissue, they will send it to a laboratory for further tests. The results will help inform decisions on the next stage of treatment.
Radiation therapy is a standard treatment for stage 1 breast cancer. However, the decision will depend on factors such the age of the person, the type of cancer, the size of the tumor, and whether there are cancer cells in the lymph nodes.
If the breast cancer is ER+ or PR+, hormone therapy may be effective. Hormone therapy works by preventing the growth of estrogen, which helps cancer grow, by blocking estrogen from attaching to tissue and fuelling cancer growth, or both.
Hormone therapy can reach cancer cells in the breast, as well as other areas of the body, and it can reduce the risk of cancer returning.
also has subcategories known as 2A and 2B.
Stage 2A breast cancer is invasive cancer:
Why Isnt A Cure The Goal
It can be painful and shocking when you come to understand the differences between what chemotherapy may offer for early-stage breast cancer and what it may accomplish for metastatic breast cancer.
It is not that healthcare providers dont want to attempt to cure advanced breast cancer with chemotherapy. They do. Its just that with the drugs we currently have, and the resistance which develops over time, the odds of chemotherapy curing an advanced cancer are very low. This is true even if you are treated with extremely high doses of several powerful drugs.
According to studies, many people who have breast cancer are expecting that chemotherapy will cure their metastatic cancer. There are some cancers that respond and continue to respond to chemotherapy for a long time. Still, its important to understand what chemotherapy can and cant do with the drugs we currently have.
If you are still hoping for a cure, talk to your healthcare provider. At this time there are not any approved medications that can cure metastatic breast cancer, though new medications are always being evaluated in clinical trials. For a few people, some of these newer medications, such as immunotherapy drugs, may offer a greater chance for long-term survivalbut we dont know for sure, and that is why theyre being studied.
Breast Cancer Healthcare Provider Discussion Guide
Get our printable guide for your next healthcare providers appointment to help you ask the right questions.
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