Locally advanced breast cancer (LABC) refers to a stage where the disease has grown extensively within the breast or spread to nearby lymph nodes, such as those in the armpit or collarbone. LABC is not considered metastatic, meaning it has not yet traveled to distant parts of the body like the bones, lungs, or liver. This classification indicates the cancer requires comprehensive treatment focused on controlling the disease locally and regionally.
Defining Characteristics and Symptoms
LABC often presents with specific clinical features. The primary tumor is typically large, often exceeding five centimeters, and may be fixed to surrounding tissues.
The cancer frequently involves axillary lymph nodes in the underarm, which may feel enlarged, firm, or matted. Skin involvement can lead to changes like ulceration, small nodules, or generalized swelling and dimpling, often described as an “orange peel” texture. Tumors may also grow into chest wall muscles, causing the breast to become fixed and less mobile.
Inflammatory breast cancer (IBC) is an aggressive form of LABC, characterized by rapid onset and distinct symptoms. Unlike other breast cancers that often present as a palpable lump, IBC causes the breast to appear red, swollen, and warm, resembling an infection. This is due to cancer cells blocking lymphatic vessels in the skin, leading to widespread inflammation and rapid enlargement of the affected breast.
The Diagnostic and Staging Process
Confirming LABC and determining its extent involves systematic steps. Initial evaluation includes imaging studies like mammography, ultrasound, and MRI of the breast. A biopsy confirms cancer cells and identifies characteristics, such as hormone receptor status and HER2 protein expression.
Staging ascertains if the cancer has spread to distant organs. Imaging tests evaluate metastatic sites. Common staging tests include CT scans of the chest, abdomen, and pelvis. Bone scans detect cancer cells in bones. PET scans provide a comprehensive view of metabolic activity, identifying cancer spread.
Multimodal Treatment Approach
The management of LABC involves a multimodal treatment approach, combining different therapies in a specific sequence to achieve the best possible outcome. This strategy often begins with neoadjuvant therapy, administered before surgery. The primary goal is to shrink the tumor within the breast and any involved lymph nodes, making subsequent surgery more feasible and potentially less extensive.
Neoadjuvant regimens include chemotherapy, which uses powerful drugs to destroy cancer cells throughout the body. For cancers with specific characteristics, targeted therapies (e.g., those that block the HER2 protein) or hormone therapies (which block estrogen’s effect) may also be incorporated. This initial treatment phase also provides information about how the cancer responds to specific drugs, guiding subsequent treatment decisions.
Following neoadjuvant therapy, surgery is a standard component of treatment. Given LABC’s extensive nature, a mastectomy is often the preferred surgical option over a lumpectomy. An axillary lymph node dissection is also commonly performed to remove lymph nodes in the armpit that may contain cancer cells, helping to prevent local recurrence and further assess the disease’s extent.
After surgery, patients undergo adjuvant therapy to eliminate any remaining cancer cells and reduce the risk of recurrence. This includes radiation therapy directed at the chest wall and regional lymph node areas, aiming to destroy microscopic cancer cells that might have been left behind. Depending on the cancer’s characteristics and the response to neoadjuvant therapy, additional rounds of chemotherapy, long-term hormone therapy, or targeted therapy may also be prescribed to further reduce the risk of the cancer returning.
Understanding Prognosis
The outlook for individuals with LABC is influenced by several factors. The biological characteristics of the cancer, such as its hormone receptor status (estrogen receptor-positive, progesterone receptor-positive) and HER2 status, play a significant role in predicting treatment response and long-term outcomes. The patient’s overall health and the presence of any other medical conditions also contribute to their ability to tolerate and benefit from intensive treatments.
A strong indicator of prognosis is the degree of response to neoadjuvant therapy. If the neoadjuvant treatment leads to a “pathologic complete response,” meaning no residual invasive cancer is found in the breast or lymph nodes at the time of surgery, it is generally associated with a more favorable long-term outlook. This outcome suggests the cancer was highly sensitive to the initial systemic therapy.
While treatment aims for complete eradication, the possibility of recurrence exists. Local recurrence refers to the cancer returning in the breast area or nearby lymph nodes. Distant recurrence, or metastasis, occurs if cancer cells spread to distant organs. Regular follow-up care, including imaging and clinical examinations, is therefore an ongoing and important part of managing LABC, allowing for early detection and intervention if recurrence occurs.