Treatment For Locally Advanced Breast Cancer
Treatment for locally advanced breast cancer varies from person to person. The stage of your breast cancer is an important factor when making decisions about treatment.
However, other factors can also be important, such as where the cancer is in the breast, the cancers grade, and whether the cancer is hormone receptor positive, HER2 positive or triple negative. Your doctor will also consider your age, general health and preferences.
Treatment for locally advanced breast cancer will usually involve a combination of treatments, such as:
Treatments may be given in different orders and combinations. Learn more about different treatment options here.
What Are The Treatment Options For Stage 3 Breast Cancer
Another way a doctor may describe stage 3 breast cancer is if its operable or inoperable. This will determine further treatments.
If a cancer is operable, this means a doctor believes most or all of the cancer can be removed with surgery.
Inoperable cancer is still treatable with systemic therapy, but surgery isnt the right option because doctors feel they cant remove enough cancerous cells.
Treatment options for stage 3 breast cancer may include:
- Surgery: known as a mastectomy, to remove cancerous tissue and also to remove lymph nodes
- Hormone therapy: to slow or stop the growth of cancerous cells, if hormones are driving their growth
- Chemotherapy: involves taking medications to kill fast-growing cancer cells
- Targeted therapy: uses your genes to attack cancer cells without harming healthy cells
Your doctor may also recommend a combination of two or more treatments.
What Does Stage 3 Mean
Because stage 3 breast cancer has spread outside the breast, it can be harder to treat than earlier stage breast cancer, though that depends on a few factors.
With aggressive treatment, stage 3 breast cancer is curable however, the risk that the cancer will grow back after treatment is high.
Doctors further divide stage 3 cancer into the following stages:
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Triple Negative Breast Cancer
If you’d recall, this was the diagnosis my dear friend, Erica, received. A diagnosis of Triple Negative Breast Cancer means that the 3 most common types of receptors known to fuel most breast cancer growth estrogen, progesterone, and the HER-2 gene are not present in the cancer tumor. TNBC is known to be more aggressive and challenging to treat.
Staging And Grading Of Breast Cancer
Knowing the stage and grade of the cancer helps your doctors plan the best treatment for you.
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Your specialist doctor needs certain information about the cancer to advise you on the best treatment for you. This includes:
- the stage of the cancer
- the grade of the cancer
- whether the cancer has receptors for hormones or a protein called HER2.
This information comes from the results of all the tests you have had, including:
- the biopsy, when the tissue was examined
- other tests that were done on the cells.
Your specialist doctor and nurse will talk to you about this. They will explain how it helps you and your doctor decide on your treatment plan.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. We’re here if you need someone to talk to. You can:
Survival Rates For Breast Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
Breast Cancer May Be Cured If Diagnosed And Treated Early
Cure rates are given in terms of 5- and 10-year survival rates Stages I, II and III cancers weigh in at different percentages for years-of-life survival
Is cancer cured? Or is cancer in remission? Distinguishing between cure and remission is important. A patient is considered in full remission when all symptoms of breast cancer are gone. After a patient has been free of symptoms for 5 or more years, some oncologists consider their patients cured. However, it is possible that some cancer cells may stay in the body for many years following treatment.
American Cancer Society 2018 Statistics and Estimates
The 5-year survival rate for most breast cancer cases diagnosed at the localized stage, i.e., not having spread to lymph nodes or other places outside of the breast, is estimated at 99 to 100%. This is Stage I. About 62% of all breast cancer cases are diagnosed at this stage.
The 5-year survival rates for Stages II and III are estimated as follows:
Stage II 93%
Stage III 72%
The 10-year survival rate for breast cancer patients whose cancer has invaded other parts of the body is 83%. These percentages are quite good due to the advancements in cancer treatment over the past several years.
Increasing the Odds for Survival
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T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1 : Tumor is 2 cm or less across.
T2: Tumor is more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
Is Inoperable Breast Cancer Still Treatable
Although stage 3C breast cancer is defined as either operable or inoperable, an inoperable diagnosis doesnt necessarily mean that it cant be treated.
The term inoperable may mean that all the cancer in the breast and surrounding tissue cant be removed through simple surgery. When breast cancer is removed, a rim of healthy tissue around the tumor, called a margin, is also removed.
For breast cancer to be successfully removed, there needs to be healthy tissue in all margins of the breast, from your clavicle down to a few inches below the breast mound.
It is possible for inoperable breast cancer to become operable following a treatment to shrink the cancer.
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How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Drug Treatment Before Surgery
You might have chemotherapy as a first treatment to shrink the cancer down.
You might have hormone therapy first if your cancer cells have hormone receptors. But you usually only have this if chemotherapy isnt suitable.
If your cancer cells have particular proteins called HER2 receptors you might also have a targeted cancer drug called trastuzumab .
These treatments might shrink the tumour enough to allow your surgeon to remove just the area of cancer. This is called breast conserving surgery or a wide local excision.
If the cancer doesnt shrink enough, you need to have the whole breast removed . You may be able to have a new breast made . Do speak to your surgeon about this.
Before your surgery the lymph nodes in the armpit are checked for cancer cells.
You usually have radiotherapy to the breast after surgery.
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Clinical Data And Tumor Characteristics
The surgeon identifying the cases and constructing the database also collected data regarding date of diagnosis, menopausal status, height, weight, parity, laterality, tumor location, and distant metastases through medical records and the Swedish Cancer Registry. Information concerning tumor size, histological type, and ALNI was retrieved from histopathological examinations. Tumor type was classified using a modification of the World Health Organization classification as proposed by Linell et al. . ALNI was divided into positive, negative, or unknown if no axillary dissection had been performed.
The Tnm System For Staging Breast Cancer
The AJCCs addition of the letters T, N, and M for anatomic breast cancer staging adds more information to a breast cancer diagnosis. Heres what they mean:
- T : The tumor grade shows a higher number for a larger size or density.
- N : Nodes refers to lymph nodes and uses the numerals 0 to 3 to give information about how many lymph nodes are involved in the cancer.
- M : This refers to how the cancer has spread beyond the breast and lymph nodes.
The AJCC also added clarifications in staging for ER, PR, and HER2 expression and also genetic information.
Ultimately, this means someone diagnosed with stage 3 breast cancer can receive more information from their breast cancer staging than ever before.
No matter the stage, the best source of information about your individual outlook is your own oncology team.
Getting the right treatment and the support you need can help you navigate the challenges of being diagnosed with stage 3 breast cancer.
Outlook For People With Stage 3 Breast Cancer
Its natural to want to know your outlook, but statistics dont tell the whole story. Your breast cancer type, overall health, and many more factors beyond your control may affect treatment outcomes.
Establishing open communication with your treatment team can help you best assess where you are in your cancer journey.
Support groups can be a great source of comfort as you navigate your diagnosis through your treatment and beyond. Your doctors office or hospital can offer some suggestions and resources in your area.
Understanding Breast Cancer Survival Rates
Prognosis varies by stage of breast cancer.
Non-invasive and early stage invasive breast cancers have a better prognosis than later stage cancers .
Breast cancer thats only in the breast and has not spread to the lymph nodes has a better prognosis than breast cancer thats spread to the lymph nodes.
The poorest prognosis is for metastatic breast cancer , when the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.
Learn more about breast cancer treatment.
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What Is Stage 2 Breast Cancer
Also known as invasive breast cancer, the tumor in this stage measures between 2 cm to 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage 2 breast cancer indicates a slightly more advanced form of the disease. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue, and the tumor is larger than in stage 1 disease. However, stage 2 means the cancer has not spread to a distant part of the body.
At stage 2, a tumor may be detected during a breast self-exam as a hard lump within the breast. Breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.
Stage 2 breast cancer is divided into two categories:
Stage 2A: One of the following is true:
- There is no tumor within the breast, but cancer has spread to the axillary lymph nodes, or
- The tumor in the breast is 2 cm or smaller and cancer has spread to the axillary lymph nodes, or
- The tumor in the breast measures 2 cm to 5 cm but cancer has not spread to the axillary lymph nodes.
Stage 2B: One of the following is true:
- The tumor measures 2 cm to 5 cm and cancer has spread to the axillary lymph nodes, or
- The tumor is larger than 5 cm but cancer has not spread to the axillary lymph nodes.
At stage 2, TNM designations help describe the extent of the disease. Most commonly, stage 2 breast cancer is described as:
Is It Curable Or Not
Now the question arises whether 3 stage Colon cancer is curable or not. 40% chances are there that it is curable and a person can get back to their normal life. Doctors will suggest chemotherapy and other medications to treat it. But if the condition gets worse and a person is not paying attention to another factor, it is impossible to cure it.
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Breast Cancer Survival Rates
The overall 5-year relative survival rate for breast cancer is 90%. This means 90 out of 100 women are alive 5 years after theyve been diagnosed with breast cancer.
The 10-year breast cancer relative survival rate is 84% . The invasive 15-year breast cancer relative survival rate is 80% .
Relative Survival By Stage At Diagnosis
This measure comprises national data on relative survival by stage at diagnosis for invasive female breast cancer.
Stage at diagnosis indicates the extent to which a cancer has spread at diagnosis. It is an important prognostic factor for cancer outcomes. It also provides contextual information for interpreting cancer outcomes, including survival, at a population level.1
Relative survival refers to the probability of being alive for a given amount of time after diagnosis, compared with survival of the general population. Observed survival refers to the overall proportion of people who are alive following a specified amount of time after diagnosis of cancer. In this report, survival refers to relative survival unless otherwise stated. Examining survival by stage at diagnosis provides insights into how survival outcomes differ depending on extent of cancer spread at diagnosis.
To provide a better understanding of cancer stage at diagnosis at the population-level, Business Rules were developed to collect national data on Registry-derived stage at diagnosis using data sources that are routinely accessible to all population-based cancer registries. RD-stage is defined for invasive tumours only. More information on the capture and distribution of RD-stage at diagnosis can be accessed through the following measures:
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Adjuvant Therapy After Surgery
Following surgery, extensional adjuvant chemotherapy was administered to 13/22 pts who had numerous ALN metastases and/or poor pathological responses to NAC. Each regimen of extensional chemotherapy was selected by the clinician. Nine of the 22 pts , who had a positive HER2 status, were treated with adjuvant trastuzumab for 12 months. Subsequent to the completion of adjuvant chemotherapy, whole breast irradiation of 50 Gy was performed for the pts who underwent a lumpectomy, while chest wall and regional lymph node irradiation of 5060 Gy was performed for the majority of the pts. In addition, postmenopausal pts were treated with aromatase inhibitors for 5 years, whereas premenopausal pts were given tamoxifen until menopause, prior to being switched to aromatase inhibitors.
Stage 3b Breast Cancer
Stage 3B breast cancer means a tumour of any size that has spread to other tissues near the breast such as skin, muscles, or ribs. At this stage, the tumour may or may not have spread to the lymph nodes. However, the cancer has not spread to other distant parts of the body.
Cancer that has spread to the skin of the breast might be inflammatory breast cancer, a rare form of cancer which can be aggressive and challenging to treat.
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Inoperable Breast Cancer Is Often Still Treatable
Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term inoperable is not the same as untreatable.
If your physician uses the word inoperable, it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.
Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.
How Is The Stage Determined
The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:
- The pathologic stage is determined by examining tissue removed during an operation.
- Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.
In both staging systems, 7 key pieces of information are used:
- The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
- The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
- Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
- Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
- Her2 status: Does the cancer make too much of a protein called Her2?
- Grade of the cancer : How much do the cancer cells look like normal cells?
In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain circumstances.
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