NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
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
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
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
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 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