Stage 2 or 3 – Locally advanced breast cancer

Locally advanced breast cancer (stage 3 and some stage 2) is breast cancer that has spread:

  • beyond the breast to the chest wall or the skin of the breast,
  • to lymph nodes in the underarm area (axillary nodes), and/or
  • to lymph nodes near the breastbones.

The cancer has not spread to other organs at this stage. However, without treatment; it could spread throughout the body to the brain, lungs, and bones (Stage 4).

The prognosis for each patient with locally advanced breast cancer varies greatly. It depends on how advanced the cancer is at the time of diagnosis, its molecular make-up and the available treatment options.

Treatment

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 to ensure all traces of the tumour are eliminated. Further chemotherapy and hormone therapy are potential follow-up therapies.

Inflammatory breast cancer

Inflammatory breast cancer is a rare form of invasive breast cancer which affects the lymphatic vessels in the skin of the breast. It causes the breast to become red and inflamed. It accounts for approximately 1-2 per cent of breast cancer cases and progresses rapidly.

At diagnosis, inflammatory breast cancer is either Stage 1 or 3, depending on whether the cancer cells have spread only to nearby lymph nodes or to other tissues as well. Symptoms may include: a red or inflamed breast, rash on breast, appearance of a bruise or infection, swelling, heavy, uncomfortable, warm or tender feeling in the breast, dimpling or pitting of the breast skin. Some people may also have a lump or pain in the armpit, discharge from the nipple or an inverted nipple.

Inflammatory breast tumours are frequently hormone receptor negative, which means they cannot be treated with hormone therapies. Surgery is almost always a mastectomy, followed by radiation therapy. Where possible, chemotherapy is given before surgery to shrink the tumour. If the tumour is HER2-positive, trastuzumab (Herceptin) may also be given beforehand.