New Approaches To Systemic Chemotherapy
As distant metastasis remains the major determinant of survival for patients with locally advanced breast cancer, new management approaches include the incorporation of novel chemotherapeutic agents, such as the taxanes, into combined-modality therapy and the use of dose-intensive chemotherapy
Incorporating New Agents
The proven activity of the taxanes docetaxel and paclitaxel in patients with advanced breast cancer, including women who have not responded to prior anthracycline therapy, has prompted various groups to investigate the potential role of taxanes administered either before or after surgery to patients with locally advanced breast cancer. The National Surgical Adjuvant Breast and Bowel Project is performing a study to evaluate whether patients with operable breast cancer who have received AC induction chemotherapy benefit from the addition of docetaxel before or after surgery. Other studies incorporating docetaxel as induction chemotherapy are now being designed.
The same Italian investigators have already reported preliminary data from a pilot study of doxorubicin/paclitaxel as induction chemotherapy in patients with locally advanced breast cancer that demonstrates the feasibility of this approach. Initial results are promising.
A feasibility study is also being conducted in the United States. It includes the incorporation of paclitaxel along with radiotherapy, then surgery, in patients with locally advanced breast cancer.
High-Dose Chemotherapy
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.
What Is Stage 3 Breast Cancer
Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage 3 breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.
Stage 3 breast cancer is divided into three categories:
Stage 3A: One of the following is true:
- No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breast bone, or
- The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
- The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breast bone, or
- The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage 3C:
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Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
- ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
- ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer. The booklet is available as a PDF, so it is easy to print.
- Cancer.Net Patient Education Video: View a short video led by an ASCO expert in metastatic breast cancer that provides basic information and areas of research.
Stages Of Breast Cancer: Stage Iiib
A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast. A stage IIIb designation also applies if there is evidence of either
- axillary lymph node metastasis
- internal mammary node metastasis
presenting in such a way as to suggest that total surgical removal is not possible.
There is a unique type of breast cancer, inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage IIIb at least.
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What Is This Breakthrough
A study published in Cancer Epidemiology, Biomarkers, and Prevention studied the effect that following both healthy and unhealthy plant-based diets could have on the development of breast cancer. The foods that were included in the definition of a plant-based diet included:
- Fruits
On the other hand, unhealthful plant-based diets were those that regularly included:
- Beverages with added sugar
- Refined grains
- Potatoes/fries
The study followed nearly 169,000 women who had to complete a survey detailing their food intake every four years. Once the study was completed, researchers found that women who followed a consistent plant-based diet particularly a healthful plant-based diet had an 11 percent decrease in their breast cancer risk, and a 23 percent lower risk of developing aggressive ER-negative breast cancer, in particular.
Treatment For Locally Advanced Breast Cancer
Every breast cancer is different. Depending on your individual circumstances, your doctor may recommend one or more of the following treatments: surgery , radiotherapy, or chemotherapy. Depending on your type of breast cancer, you may also be offered hormone therapy or Herceptin.
Treatments for locally advanced breast cancer are similar to the treatments for other types of breast cancers. Depending on the size of your breast cancer or the way in which it has spread, your treatments may be offered at different stages from other people.
If you have questions or concerns about any part of your treatment, its a good idea to ask one of your doctors. Dont be afraid to ask your doctors to explain why a particular approach has been recommended.
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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.
Hormone Therapy For Breast Cancer
Hormone therapy is sometimes used to treat breast cancer. It is a treatment that adds, blocks or removes hormones. Hormones are substances that control some body functions, including how cells act and grow. Changing the levels of hormones or blocking certain hormones can slow the growth and spread of breast cancer cells. Drugs, surgery or radiation therapy can be used to change hormone levels or block their effects.
Hormone therapy is only used for breast cancer that is hormone receptor positive. This means that the cancer cells have receptors for estrogen , progesterone or both. When cancer cells have these receptors, the hormones can attach to them and help them grow. Research has shown that giving hormone therapy after surgery and radiation therapy lowers the risk that the breast cancer will come back, and improves survival.
Breast cancer tissue is always tested to find out if it has hormone receptors or does not have hormone receptors . Find out more about .
You may be offered hormone therapy to:
- lower the risk that non-invasive breast cancer, or may lead to an invasive breast cancer
- lower the risk that invasive breast cancer can come back by destroying cancer cells left behind after surgery and radiation therapy
- shrink a large tumour before surgery
- treat locally advanced or recurrent breast cancer
- relieve pain or control the symptoms of advanced breast cancer
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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.
What Is Stage 3 Cancer
Stage 3 cancer is sometimes referred to as locally advanced cancer. In this stage, the tumor may have grown to a specific size, the cancer may consist of multiple tumors, and/or the cancer may have spread to adjacent lymph nodes, organs or tissue. In some cases, stage 3 cancers may be considered metastatic cancers, meaning they may have spread beyond their organ of origin.
Many stage 3 cancers have multiple subcategories, usually designated as stages 3A, 3B and 3C. These subcategories are often determined by the size of the tumors, whether multiple tumors are present and the degree to which the cancer has spread locally.
Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:
- The ratio of healthy blood cells to cancerous cells
- Whether cancer cells are found in lymph nodes or the diaphragm
- The degree to which lymph nodes, the liver or spleen may be swollen
Stage 3 cancer is determined in the five most common cancers this way:
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What Should A Person With Stage 3 Breast Cancer Expect From Treatment
Stage 3 treatment options vary widely and may consist of mastectomy and radiation for local treatment and hormone therapy or chemotherapy for systemic treatment. Nearly every person with a Stage 3 diagnosis will do best with a combination of two or more treatments.
Chemotherapy is always given first with the goal to shrink the breast cancer to be smaller within the breast and within the lymph nodes that are affected. This is known as neoadjuvant chemotherapy.
Other possible treatments include biologic targeted therapy and immunotherapy. There may be various clinical trial options for interested patients with Stage 3 breast cancer.
What Is Locally Advanced Breast Cancer
There is no single definition for locally advanced breast cancer. There are, however, some common elements which are identified during diagnosis. If your doctor has told you that you have locally advanced breast cancer, its likely that your breast cancer has some of the following features:
- a tumour that may be larger than five centimetres
- cancer cells that may have spread to other tissues around the breast, such as the skin, muscle or ribs
- cancer cells that may have spread extensively to the lymph nodes.
Its important to understand that locally advanced breast cancer is not the same as metastatic breast cancer. Metastatic breast cancer occurs where breast cancer has spread to other, more distant parts of the body. Read more about metastatic breast cancer here.
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Neoadjuvant Chemotherapy And Neoadjuvant Her2
With neoadjuvant chemotherapy, all the chemotherapy to treat the breast cancer is usually given before surgery . If the tumor doesnt get smaller with the first combination of chemotherapy drugs, other combinations can be tried.
If your tumor is HER2-positive, you may get neoadjuvant trastuzumab and neoadjuvant pertuzumab , but not at the same time as the chemotherapy drug doxorubicin .
Early Locally Advanced And Secondary Breast Cancer
Early breast cancer means the cancer hasn’t spread beyond the breast or the lymph nodes in the armpit on the same side of the body. So, the cancer hasn’t spread to any other part of the body.
Local recurrence means cancer that has come back in the breast, the armpit, or the chest wall after treatment.
Locally advanced breast cancer means the cancer has spread into the surrounding area, such as the lymph nodes, the skin or chest muscle. But it has not spread to other parts of the body.
Secondary breast cancer is also called metastatic breast cancer, advanced breast cancer, or stage 4 breast cancer. It means that the cancer has spread to other parts of the body, such as the liver or bones.
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What Is Locally Advanced Pancreatic Cancer
Many terms can be used to define the extent and severity of pancreatic cancer. As a patient, you may hear the term locally advanced used to describe your cancer. This means that your cancer has not spread far beyond your pancreas, but has advanced to the point where it cannot be surgically removed.
No two cases of pancreatic cancer are the same. Some patients with locally advanced pancreatic cancer may undergo surgery to remove a portion of the tumor, while others rely on nonsurgical therapies to help reduce symptoms and slow the spread of cancerous cells. Locally advanced pancreatic cancer is typically associated with patients in stage 3 of the disease as determined by the TNM grading system.
The Tnm Staging System
The TNM staging system gives the complete stage of the cancer:
- T describes the size of the tumour.
- N describes whether the cancer has spread to the lymph nodes and which nodes are involved. For example, N0 means no lymph nodes are affected. N1 means there are cancer cells in 1 to 3 of the lymph nodes.
- M describes whether the cancer has spread to another part of the body. For example, M0 means the cancer has not spread to other parts of the body.
Sometimes the final TNM staging may not be certain until after surgery to remove the cancer.
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Possible Symptoms Of Advanced And Metastatic Cancer
General signs and symptoms of advanced and metastatic cancer can include:
- Loss of energy and feeling tired and/or weak: This can get so bad that you may have a hard time doing everyday tasks like bathing or getting dressed. People with advanced cancer often need help with these things.
- Weight loss
- Pain
- Shortness of breath or trouble breathing
Advanced and metastatic cancers can cause many other symptoms, depending on the type of cancer and where it has spread.
What Is Metastatic Cancer
Metastatic cancer is a cancer that has spread from the part of the body where it started to other parts of the body. When cancer cells break away from a tumor, they can travel to other parts of the body through the bloodstream or the lymph system.
This image shows some parts of the lymph system, like lymph nodes and lymph vessels, as well as organs and tissues that contain many lymphocytes .
If the cells travel through the lymph system, they could end up in nearby lymph nodes or they could spread to other organs. More often, cancer cells that break off from the main tumor travel through the bloodstream. Once in the blood, they can go to any part of the body. Many of these cells die, but some may settle in a new area and start to grow.
Cancer cells must go through several steps to spread to new parts of the body:
- They must find ways to break away from the original tumor and enter the bloodstream or lymph system.
- They need to attach to the wall of a blood or lymph vessel and move into a new body part.
- They need to find ways to grow and thrive in their new location.
- They must be able to avoid attacks from the bodys immune system.
Sometimes the metastatic tumors have already begun to grow when the cancer is first found. And sometimes, a metastasis may be found before the original tumor is found. If a cancer has already spread to other parts of the body before its first diagnosed, it may be hard to figure out where it started.
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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.