Surgery for Locally Advanced Breast Cancer
Key points
- Surgery plays a less important role in Stage III breast cancer.
- The primary aim of surgery in this setting is to achieve local control.
- Occasionally, incisional biopsy is needed, and skin biopsy will confirm the diagnosis of inflammatory breast cancer.
- Primary chemotherapy has the advantage that the response to treatment can be monitored.
Surgery plays a less important role in Stage III breast cancer. A large majority of patients with Stage III breast cancer will have axillary lymph node involvement, and a significant proportion will have distant metastases present at the time of diagnosis.
The primary aim of surgery in this setting is to achieve local control. Surgery alone has a high failure rate for locally advanced breast cancer, and the long-term survival rate is dismal. Features predicting poor outcome with surgery alone include skin edema, fixation and ulceration, and chest-wall fixation. The diagnosis is usually made using core needle biopsy.
Occasionally, incisional biopsy is needed, and skin biopsy will confirm the diagnosis of inflammatory breast cancer. Currently, the usual treatment involves the use of induction chemotherapy with an adriamycin-based regime, followed by surgery.
Primary chemotherapy has the advantage that the response to treatment can be monitored.
In addition, BCT may become possible after tumor downstaging. Further chemotherapy is used following the surgery if there was good response to the chemotherapy, and once the chemotherapy is complete, adjuvant radiation therapy may be used.
The best local control rates are seen with surgery and radiation therapy following induction chemotherapy.
Patrick I. Borgen and Bruce Mann
Breast conservation therapy for invasive carcinoma of the breast. Current Problems in Surgery 1995; 33:189-256.
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Written and revised by
Andrey Nailor, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
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