NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
There are other mutated genes that may cause a
higher risk of a second breast cancer. Examples
these mutations do not worsen the side effects of
A mastectomy is an option for many women with
stage III breast cancer. It is often received after
preoperative treatment. It is sometimes received after
a lumpectomy that didn’t remove all the cancer.
Mastectomy is also an option for women who are
approved for but decline a lumpectomy. Some
women decline because of how they want their
breast to look. Others decline because cancer can’t
return in a breast that’s been removed. However,
breast cancer may still return elsewhere. If you have
a choice between surgeries, a decision aid may help.
Read Part 9 for more information.
Lymph node surgery
lists the deciding factors for lymph node
surgeries. Most women with stage III breast cancer
will receive an axillary lymph node dissection. The
cancer appears to have spread to enough lymph
nodes that thorough testing is advised.
An axillary dissection might not be needed for clinical
stage T3, N1, M0. Even though lymph nodes look
abnormal, needle biopsies may not find cancer. In
this case, a sentinel lymph node biopsy may be an
option. If sentinel nodes are cancer-free, no other
surgery is needed. The cancer will be re-staged
to stage II. If cancer is found in sentinel nodes, an
axillary dissection is advised.
For T3, N1, M0 cancers, needle biopsies may
confirm cancer in lymph nodes before preoperative
treatment. Afterward, the nodes may look and feel
normal. In this case, a sentinel lymph node biopsy
Guide 6. Lymph node surgery
Axillary lymph node
is an option if you:
• Have stage III breast cancer.
Sentinel lymph node biopsy
an option if you:
• Have stage IIIA (T3, N1, M0) and either of the following:
◦◦ Had a needle biopsy that found no cancer in nodes
before preoperative treatment, or
◦◦ Had a needle biopsy that confirmed cancer in nodes
before preoperative treatment but afterward they look
and feel normal.
No lymph node surgery
an option if you:
• Have stage IIIA (T3, N1, M0) cancer plus one or more of
◦◦ Have tubular or mucinous breast cancer,
◦◦ Will not have future treatment based on the results of
lymph node surgery,
◦◦ Are older in age, or
◦◦ Have major health problems other than breast cancer.