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NCCN Guidelines for Patients



Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017


Breast cancer basics

Treatment pathways



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

chest wall.

Stage IIIB

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.

Stage IIIC

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 pathways

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

be received.

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