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NCCN Guidelines for Patients



Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017


Radiation therapy

Treatment guide

Treatment guide

Radiation therapy is advised for most stage III breast

cancers. Areas of your body where the cancer may

return will be treated. Cancer staging is used to plan

radiation options.

Cancer stage

The clinical stage is the TNM rating given before

treatment. In your medical records, you may

see lowercase letters next to the cancer stage.

A lowercase “c” means the clinical stage. The clinical

stage is based on results from the physical exam and

some imaging.

Breast cancer is often staged twice. The pathologic

stage is based on lab tests on tissue. Thus, it is often

assigned after surgery and sometimes after biopsy.

A lowercase “p” next to TNM scores means the

pathologic stage.

Preoperative treatment is used for many

stage III cancers. In this case, you may see a

lowercase “y” next to TNM scores. The “y” means

you have received preoperative treatment.

TNM ratings may differ between the clinical and

pathologic stages. With no preoperative treatment,

more cancer may be found at surgery. Thus, a cN1

could be changed to pN2 or pN3. After preoperative

treatment, less cancer may be found because the

treatment worked. For example, cN1 could be rated

ypN0 after preoperative treatment.

Radiation planning

Radiation therapy is based on both the clinical

and pathologic stages. Both stages are especially

important if you received preoperative treatment. The

highest stage between the clinical and pathologic

stages is used for planning. For example, a cN1

score rather than ypN0 will be used to decide the

need for radiation. This also holds true for the

T stage.