Locally advanced breast cancer is a breast cancer that reaches a significant size or infiltrates nearby tissues. Locally advanced breast cancer does not form distant metastases - so it is an earlier stage compared to disseminated breast cancer. Patients with locally advanced breast cancer can be treated radically, unlike patients with disseminated cancer. Treatment of locally advanced breast cancer requires a combination of several treatments. Find out about the symptoms of locally advanced breast cancer, the diagnosis of locally advanced breast cancer and the treatment steps for locally advanced breast cancer.
Locally advanced breast cancermeets certain criteria that distinguish it from other cancer stages. Traditionally, the TNM classification is used to describe the stage of breast cancer. It is a scale concerning three basic parameters of the tumor: T (tumor) - the size of the tumor in the breast, N (nodes) - the presence of metastases in nearby lymph nodes and M (metastases) - the presence of distant metastases. Taking these features into account, according to the TNM classification, breast cancer is divided into four stages (from I to IV).
Locally advanced breast cancer is when the cancer is classified between IIB and IIIC. In practice, this means a fairly large group of breast cancers. Locally advanced breast cancer includes both large tumors (>5 cm) and tumors of any size but involving a large number of lymph nodes in the armpit. This group also includes all breast cancers whose infiltration covers the chest wall. A special form of locally advanced breast cancer is inflammatory breast cancer. The common feature of all locally advanced breast cancers is the lack of metastasis to distant organs. Their presence clearly indicates stage IV breast cancer, i.e. disseminated. The first symptom of locally advanced breast cancer may be a lump in the breast. Infiltration of the breast tissue by neoplastic cells can change the external appearance of the breast. The characteristic symptoms are a change in shape or retraction of the nipple,bloody discharge from the nipple and the so-called orange peel symptom (characteristic thickening and hardening of the skin covering the breast). Locally advanced breast cancer may be associated with infiltration of the chest wall. Then skin ulcers appear, as well as the so-called satellite nodules (tumor cells palpable by touch) A characteristic feature of locally advanced breast cancer is the infiltration of the surrounding lymph nodes. Mainly the lymph nodes in the armpit are affected. The first symptom of locally advanced breast cancer may therefore be an enlargement of the axillary lymph nodes. Lymph nodes suspecting a neoplastic process are hard, enlarged and not moveable in relation to the substrate. In most cases, the lymph nodes enlarged by neoplasms are painless (pain indicates a different cause of their enlargement, most often inflammation). A special form of locally advanced breast cancer is the so-called inflammatory cancer. The symptoms of inflammatory cancer appear as a result of the dynamic development of the tumor. The name of this form of breast cancer is due to its similarity to inflammation. There is swelling, breast pain, redness and increased breast warmth. In the course of inflammatory cancer, the symptom of "orange peel" is also common. Inflammatory cancer is one of the most aggressive variants of locally advanced breast cancer, requiring urgent diagnosis and prompt treatment. The diagnosis of locally advanced breast cancer is aimed at making a reliable diagnosis and planning an appropriate treatment. The diagnostic procedure begins with collecting a medical history and conducting a physical examination of the breast. A clinical examination may reveal the presence of characteristic symptoms of a neoplasm (a palpable lump in the breast, changes in the shape of the mammary glands, in more advanced cases - changes in the chest wall). A very important element of the physical examination is the assessment of the condition of the axillary lymph nodes in terms of the presence of metastases. The involvement of the lymph nodes by the neoplasm may be manifested by their painless enlargement, increased hardness and lack of displacement in relation to the substrate. Further diagnosis of breast cancer requires imaging. Depending on the patient's age and breast structure, it is recommended to have mammography or ultrasound examination of the breasts. In the case of locally advanced breast cancer, the above examinations usually make it possible to visualize the lesioncancerous. A breast ultrasound scan usually also includes an assessment of the lymph nodes in the armpit. Involvement of the axillary lymph nodes is one of the typical features of locally advanced breast cancer. The final diagnosis of breast cancer is possible after a histopathological examination of a fragment of the suspicious lesion is performed. The detection of a disturbing nodule in imaging tests is an indication for a biopsy, i.e. collecting material for pathomorphological examinations. The result of the histopathological examination allows for a reliable diagnosis. Such a study also provides a lot of additional information that is of great importance in the treatment planning process. When examining a piece of breast cancer tissue, one looks for the characteristic features of neoplastic cells that can be used in later therapy. In the case of breast cancer, the possible properties of cancer cells are the presence of estrogen receptors (ER), progesterone receptors (PgR) and HER2 receptors. The positive or negative status of these receptors determines the tumor's susceptibility to certain types of therapy. Determining these features plays a special role in locally advanced breast cancer, where surgical treatment is often preceded by initial systemic therapy. The final result of the breast cancer diagnosis process should include the diagnosis of the neoplasm, determination of its biological features, and determination of the stage of its advancement. The TNM classification is used to assess the stage of breast cancer. The size of the primary breast tumor is assessed by imaging tests (feature T). The condition of the axillary lymph nodes (N feature) is determined on the basis of clinical examination, ultrasound examination and histopathological examination of the lymph nodes. To confirm the diagnosis of locally advanced breast cancer, the presence of tumor metastases in distant organs (M feature) should be excluded. For this purpose, imaging examinations of the abdominal cavity, chest and head are performed. Increasingly, positron emission tomography (PET) is also used to search for neoplastic metastases. Treatment of locally advanced breast cancer requires a combination of different treatments. The most effective method of cancer treatment is surgical removal with an appropriate margin of he althy tissue. Therapy of locally advanced breast cancer is to enable surgery to remove the tumor and then destroy any remains of it. Patients with locally advanced breast cancer do not always qualify for the early stageoperation. In many cases, extensive neoplastic infiltration makes it impossible to completely remove the tumor. For this reason, in the treatment of locally advanced breast cancer, the so-called neoadjuvant treatment. This is a type of preoperative therapy aimed at reducing the size of the tumor sufficiently to be operated on. The type of neoadjuvant therapy is selected individually for each patient. The choice of treatment method depends primarily on the biological characteristics of the neoplasm, in particular on estrogen, progesterone and HER2 receptors. As a neoadjuvant therapy, hormone therapy, chemotherapy and targeted anti-HER2 therapy can be used. The degree of response to neoadjuvant therapy determines the further treatment method. If sufficient tumor size reduction is achieved, the patient is qualified for tumor removal surgery. Intensive radiotherapy is usually instituted if initial treatment has not been successful. The scope of surgery in locally advanced breast cancer depends on many factors. In breast cancer surgery, mastectomy (removal of the entire breast) and the so-called breast conserving treatment. Sparing treatment is contraindicated in the case of large tumor sizes (>5 cm). In other cases, the decision to choose the type of surgery depends on the shape and extent of the neoplastic infiltration, the patient's preferences, and the effectiveness of the initial preoperative treatment. In some patients, locally advanced breast cancer can be successfully treated with breast conserving therapy. Postoperative management in locally advanced breast cancer is in the vast majority of cases adjuvant radiotherapy. Locally advanced breast cancer is associated with a large tumor burden. Usually, it is not possible to remove all cancer cells with surgery. The role of adjuvant radiotherapy is to destroy any tumor remnants. The irradiation can cover both the area of the tumor itself and larger areas of the front part of the chest or the armpit. The prognosis of locally advanced breast cancer depends on many factors. The most important factor is the clinical stage of the tumor, histological features of the tumor, as well as the response to preoperative (neoadjuvant) therapy. The prognosis of locally advanced breast cancer is better the lower the stage of breast cancerat the time of cancer diagnosis. Locally advanced breast cancer includes stage IIB to IIIC neoplasms. The five-year survival rate for this advancement of breast cancer ranges from 40% to even 75%. A major breakthrough in the therapy of locally advanced breast cancer was the introduction of preoperative systemic therapy. If, thanks to the initial therapy, it is possible to significantly reduce the size of the tumor, there is a good chance that it will be completely removed during surgery.Locally advanced breast cancer - symptoms
Locally advanced breast cancer - diagnosis
Locally advanced breast cancer - treatment
Locally advanced breast cancer - prognosis