NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
Breast cancer basics
Cancers rated T0–T3, N2, M0 consist of breast
tumors of any size. Sometimes, no breast
tumor is found. The cancer appears to be in
axillary nodes or in internal mammary nodes.
The axillary nodes are stuck together or to the
These cancers involve the breast skin, chest wall, or
both. If in the skin, the skin has open sore(s), small
secondary tumor(s), or is swollen. Some stage IIIB
cancers have spread to nearby nodes.
Cancers rated T4, N0, M0 do not appear to
have spread to lymph nodes.
Cancers rated T4, N1, M0 appear to be in
axillary nodes. These nodes aren’t stuck
together or to the chest wall.
Cancers rated T4, N2, M0 appear to be in fixed
axillary or internal mammary nodes.
Tests suggest that the cancer has spread to a great
extent within nearby lymph nodes.
Cancers rated T0–T4, N3, M0 appear to have
spread to 1) many axillary nodes, 2) axillary
nodes plus internal mammary nodes,
3) infraclavicular nodes, or 4) supraclavicular
Treatment for stage III breast cancer has many parts.
More than one type of treatment is used. You will
likely have chemotherapy, surgery, radiation therapy,
and, as for many women, endocrine therapy.
Despite common treatment types, treatment differs
among women. For example, not everyone receives
the same chemotherapy or surgery. The order
of some treatments may differ, too. The order of
treatments may depend on the type of breast surgery
that is planned. However, your options may change
during the course of treatment.
Your doctor will plan your treatment based on
many factors. One such factor is the cancer stage.
Common treatment pathways by cancer stage are
briefly described next. More information is provided
throughout the book.
Stage IIIA (T3, N1, M0)
These cancers are confined to the breast and the
lymph nodes near the armpit. As such, they are
treated like large stage II cancers. In general, there
are two treatment pathways.
At the core of one pathway is a lumpectomy. This
surgery spares healthy breast tissue. Chemotherapy
is often the first treatment received in this pathway.
Before chemotherapy, your lymph nodes will be
assessed for cancer. At least some lymph nodes in
your armpit will be removed. After breast surgery,
radiation therapy will follow. Endocrine therapy may
The other pathway includes a mastectomy. Your
whole breast will be removed during this surgery.
Chemotherapy may be started before or after
surgery. If before, your lymph nodes will first be
assessed for cancer. At breast surgery, at least
some lymph nodes will be removed. After surgery