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39

NCCN Guidelines for Patients

®

:

Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017

4

Surgery

Treatment guide

There are other mutated genes that may cause a

higher risk of a second breast cancer. Examples

include

BRCA1

and

BRCA2

mutations. However,

these mutations do not worsen the side effects of

radiation.

Mastectomy

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

Guide 6

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

Surgery options

Deciding factors

Axillary lymph node

dissection

is an option if you:

ª

• Have stage III breast cancer.

Sentinel lymph node biopsy

is

an option if you:

ª

• 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

may be

an option if you:

ª

• Have stage IIIA (T3, N1, M0) cancer plus one or more of

the following:

◦◦ 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.