Breast cancer is a common disease, with millions of new cases diagnosed globally each year. Medical professionals classify breast cancer into various stages based on how much it has grown and spread. Understanding these stages is important as it guides treatment decisions and provides insight into the likely course of the disease.
Understanding Locally Advanced Breast Cancer
Locally advanced breast cancer (LABC) describes a stage where the cancer has grown larger or spread to tissues near the breast, such as adjacent lymph nodes or the chest wall, but has not yet traveled to distant parts of the body. This distinguishes it from early-stage breast cancer (smaller tumors with minimal lymph node involvement) and metastatic breast cancer (spread to distant organs). LABC is generally considered Stage III breast cancer, encompassing substages 2B, 3A, 3B, and 3C.
LABC characteristics often involve a tumor larger than 5 centimeters, or any size tumor grown into the chest wall or skin. This corresponds to T3 or T4 tumors within the TNM (Tumor, Node, Metastasis) staging system. LABC also frequently includes significant nearby lymph node involvement, such as those in the armpit or near the collarbone, often classified as N2 or N3 involvement, indicating extensive regional spread.
Signs and Identification
Signs of locally advanced breast cancer include a noticeable lump in the breast that may feel large or fixed. Changes to the breast skin can also occur, such as dimpling, redness, swelling, or thickening, sometimes resembling an orange peel (“peau d’orange”). The nipple might show alterations, including inversion, sores, crusting, or unusual discharge. Swollen lymph nodes, particularly in the armpit or above the collarbone, are another possible sign.
Comprehensive Diagnosis
Diagnosing locally advanced breast cancer involves a series of medical procedures and tests designed to confirm the presence of cancer, determine its type, and assess its extent. Initial steps include imaging tests like mammography, ultrasound, and magnetic resonance imaging (MRI) of the breast, which help visualize the tumor.
Following suspicious imaging, a core needle biopsy collects tissue samples from the breast lump and any enlarged lymph nodes. This tissue is then examined under a microscope to confirm the cancer diagnosis and identify its specific type.
Further analysis of the biopsy tissue includes testing for hormone receptor status (estrogen receptor, ER; progesterone receptor, PR) and HER2 status. These tests indicate whether cancer cells are influenced by certain hormones or a growth-promoting protein, guiding treatment decisions.
To determine the full extent of the cancer and confirm it is locally advanced, additional staging tests are conducted. These can include computed tomography (CT) scans of the chest, abdomen, and pelvis, bone scans, and positron emission tomography (PET) scans.
Treatment Strategies
Treatment for locally advanced breast cancer is a multi-pronged approach, often combining therapies. The initial phase frequently includes systemic therapy, such as neoadjuvant chemotherapy, targeted therapy, or immunotherapy, administered before surgery.
This upfront treatment shrinks the tumor, making it more manageable for surgical removal, and addresses microscopic cancer cells that may have spread. It aims to reduce the cancer burden throughout the body.
After initial systemic therapy, surgical removal of the tumor is performed. This may involve a mastectomy (removing the entire breast) or a lumpectomy (removing only the tumor and a margin of healthy tissue), along with dissection of affected lymph nodes.
Following surgery, radiation therapy is often recommended to target any remaining cancer cells in the breast area and regional lymph nodes, reducing local recurrence risk. For certain types of breast cancer, ongoing hormonal therapy may also be prescribed to prevent recurrence by blocking hormones that fuel cancer growth.