What Is the Survival Rate for Locally Advanced Breast Cancer?

Locally advanced breast cancer (LABC) is breast cancer that has spread to adjacent lymph nodes or tissues such as the breast or armpit. 

Unlike metastatic cancer, which spreads to other areas of the body, LABC develops exclusively in the lymph nodes and surrounding tissues.

LABC is also known as stage II to stage III breast cancer. LABC tumors are large, measuring more than 5 cm in diameter, and may involve internal mammary nodes, skin of the breast, and muscles of the underlying chest wall.

Stage II

• Stage IIA: 
  • No tumor can be found in the breast, but cancer (larger than 2 mm) is found in 1-3 axillary lymph nodes (lymph nodes under the arm) or in the lymph nodes near the breastbone (found during a sentinel node biopsy). 
  • The tumor measures 2 cm or smaller and has spread to the axillary lymph nodes or the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes.
• Stage IIB: 
  • The tumor is larger than 2 cm but not larger than 5 cm; small groups of breast cancer cells (larger than 0.2 mm but not larger than 2 mm) are found in the lymph nodes or the tumor is larger than 2 cm but no larger than 5 cm. 
  • Cancer has spread to 1-3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) or the tumor is larger than 5 cm but has not spread to the axillary lymph nodes.

Stage III 

• Stage IIIA: 
  • The tumor is less than 5 cm in diameter and has spread to 4-9 lymph nodes in the armpit or behind the breastbone. 
  • Alternatively, the tumor is larger than 5 cm and has spread to 1-9 lymph nodes.
• Stage IIIB: 
  • Cancer has spread to the muscles and surrounding skin. 
  • Tumors can be of any size.
• Stage IIIC: 
  • Cancer has spread to at least 10 lymph nodes in the armpit or at least one node beneath the breastbone and one in the armpit or at least one node under the collarbone. 
  • Tumors can be of any size.

Inflammatory breast cancer (IBC) is a rare type of locally advanced breast cancer with distinct symptoms. 

IBC does not always cause a palpable lump in the breast. Instead, it produces thickening and swelling of the breast skin, which may be red and warm to the touch or have the feel of an orange peel. The breast is often swollen and irritated.

Some individuals with locally advanced breast cancer may not exhibit any symptoms. If symptoms do occur, they may include:

• Lump in the breast or armpit that does not move and is connected to the chest wall
• Swelling near the base of the neck
• Red or swollen breast (inflammatory breast cancer)
• Tenderness or discomfort in the breast
• Skin changes such as redness, puckering, or dimpling (an orange peel appearance)
• Breast ulceration and bleeding
• Breast thickening or hardening
• Change in the size or contour of the breasts
• Sores or crusting on the nipple 
• Inverted nipple
• Nipple discharge that is clear or bloody

Locally advanced breast cancer is often detected during routine breast cancer imaging tests, such as mammography and ultrasonography.

• Imaging tests: The breast and lymph-nodal regions are studied using computed tomography and dynamic magnetic resonance imaging. Positron emission tomography-computed tomography or positron emission tomography-magnetic resonance imaging scans are used to determine the cancer stage.
• Biopsy: Core needle biopsy or fine-needle biopsy can be used to confirm the diagnosis of locally advanced breast cancer or inflammatory breast cancer (IBC). A core needle biopsy is a medical procedure used to extract a portion of damaged tissue from a lesion or tumor. The tissue is then examined to determine the stage of cancer and characterize the tumor in terms of grade, hormone receptor (HR) status, and human epidermal growth factor receptor 2 (HER2) status.
• Mammography and ultrasonography: Mammography and ultrasound may not show the characteristic signs of primary breast cancer in IBC. Imaging tests, for example, may reveal nonspecific symptoms such as a widespread increase in breast tissue density and skin thickening rather than a localized lesion. It is fairly rare to detect severe clinical symptoms with minor radiological abnormalities, although the imaging results may be highly evident at other times.

Mammography may be contraindicated for individuals with gross manifestations of locally advanced breast cancer diagnosed (bleeding or fungating tumor), but ultrasonography is an important tool for determining tumor size and extent prior to therapy.

Surgery, chemotherapy, radiation, targeted therapy, or hormonal therapies are often used to treat locally advanced breast cancer. Treatment options will vary based on the factors such as:

• Type of breast cancer
• Extent and size of the tumor
• Location of the tumor
• Age and general health of the patient
• Treatment preferences of the patient

Surgery

There are two types of surgery for breast cancer:

• Breast conservative surgery: During breast conservative surgery, only the lump or small part of the breast is removed. This is the best option for individuals who do not have any signs of inflammatory breast cancer.
• Mastectomy: Mastectomy is the complete removal of the breast and surrounding tissues such as skin and underlying chest wall if necessary.

Chemotherapy

Chemotherapy refers to the use of medications to slow or stop the development of cancer cells. Chemotherapy is usually a combination of two or more drugs administered intravenously. Chemotherapy is administered in cycles, which normally last 2-4 weeks.

Sometimes, chemotherapy is used along with other treatments. Preoperative chemotherapy may be administered to shrink the tumor and make it easier to remove during surgery.

Radiation therapy

Radiation therapy is often recommended after surgery to lower the chances of the tumor returning in the remaining breast tissue.

Individuals who have had a mastectomy typically receive radiation therapy to the chest wall as well as to the lymph nodes. This is especially true if there is lymph node involvement or inflammatory breast cancer.

Combining surgery and radiation therapy reduces the likelihood of the cancer returning in the breast or the chest wall. Radiation therapy is administered 5 days a week for 6-7 weeks.

Endocrine therapy

Endocrine treatment is effective in treating breast tumors that generate hormone receptors. Endocrine therapy may be used instead of chemotherapy as the initial treatment for locally advanced breast cancer in some cases. This is also known as neoadjuvant therapy. 

Taking endocrine medication before surgery can successfully decrease hormone-responsive breast cancers. Endocrine treatment is considered as a first-line treatment for individuals who are too advanced in age or too sick to handle chemotherapy, as it has fewer side effects and is administered orally.

Neoadjuvant chemotherapy (NACT) has had a significant influence on the treatment of locally advanced breast cancer. During trials, a group of patients with a high risk of micro-metastasis burden was given NACT. While NACT did not result in a survival benefit, it did make breast conservation achievable in a subset of patients.

Trastuzumab

Trastuzumab is a unique drug that targets human epidermal growth factor receptor 2 (HER2), a protein identified in the cells of certain breast tumors. Trastuzumab appears to be effective only in individuals whose breast tumors express extremely high levels of HER2.