Stage 2 or 3 – Locally advanced breast cancer
Locally advanced breast cancer (stage 3 and some stage 2) has spread beyond the breast to the chest wall or the skin of the breast, or to many lymph nodes in the underarm area (axillary nodes) or lymph nodes near the breastbones, but not to other organs.
Lymph nodes drain into the blood system which could allow the tumour to spread further afield. Without treatment these cancers could spread further throughout the body (stage 4) to the brain, lungs and bones, for which treatments are rarely effective. The prognosis for each patient varies greatly depending on how advanced the cancer is at time of diagnosis, the molecular type of breast cancer and treatment options available.
Treatment for locally advanced breast cancer usually begins with neoadjuvant (before surgery) therapy. This is generally a combination of chemotherapies to helps shrink the tumour(s) in the breast and lymph nodes to improve the success of removing the entire tumour during surgery. The surgery can be a lumpectomy if the tumours have shrunk, or a mastectomy. Radiation therapy usually follows surgery to ensure all traces of the tumour are eliminated. Further chemo and hormone therapy are potential follow-up therapies.
Inflammatory breast cancer
A rare form of invasive breast cancer that affects the lymphatic vessels in the skin of the breast, causing the breast to become red and inflamed. These account for approximately 1-2 per cent of breast cancer cases. Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. At diagnosis, inflammatory breast cancer is either stage 1 or 3 disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well. Symptoms may include: red or inflamed breast, rash on breast, appearance of a bruise or infection, swelling, heavy or uncomfortable feeling in the breast, breast feels warm or tender, dimpling or pitting of the breast skin (orange peel). Some people may also have a lump or pain in the armpit, discharge from the nipple or an inverted nipple.
Treatment: Inflammatory breast tumours are frequently hormone receptor negative, which means they cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fuelled by estrogen. Where possible, all the chemotherapy planned to treat inflammatory breast cancer is given before surgery to shrink the tumour. If the tumour is HER2-positive, trastuzumab (Herceptin) may also be given before surgery, which is almost always a mastectomy, followed by radiation therapy.
How research is helping
- Immunotherapies: Immunotherapy is still an emerging and experimental treatment area but is being heralded by many as the next big breakthrough in cancer research. It’s a type of cancer treatment designed to boost the body’s natural defences to fight the tumour. Researchers are investigating ways to use materials either made by the body or in a laboratory to improve, target, or restore immune system function.
- Treatment resistance: Current therapies have greatly improved survival rates for breast cancer, but resistance to these therapies is common and is a major cause of death as tumours multiply and spread unchecked. When treatment-resistance develops, there is little else to be done for the patient. However researchers are working on the problem, and NBCF funded Professor Des Richardson from the University of Sydney is looking into why cancer cells inexplicably develop resistance to the chemotherapy. Investigation into the so-called Breast Cancer Resistance Protein aims to provide a clear view of its molecular architecture to pave the way for the development of drugs that specifically target this protein and thereby radically improve the efficiency of chemotherapy treatments. Read more here.