Locally advanced breast cancer

Locally advanced breast cancer describes breast cancer that has spread in the breast and nearby lymph nodes but has not spread outside these areas.

Another name for it is Stage III (or Stage 3) breast cancer.

About locally advanced or stage 3 breast cancer

If you have a diagnosis of locally advanced breast cancer, it’s likely that your breast cancer has some or all of these features:

• a tumour that may be larger than 5cm
• cancer cells that may have spread to other tissues around the breast, such as the skin or the muscles of the chest
• cancer cells that may have spread widely to the lymph nodes (e.g. armpit, under the breast bone, near the collarbone)
• red and/or swollen breast (called inflammatory breast cancer).

Symptoms of locally advanced breast cancer

Signs of stage 3 breast cancer may include:

• skin that looks dimpled like an orange peel
• ulcers on the skin of the breast a large lump in the armpit that may not move freely away from the chest wall
• a large lump in the breast that doesn’t move freely away from the chest wall
• a large red, swollen breast (inflammatory breast cancer)
• a lump above the collarbone.

Treatments for locally advanced breast cancer

Treatments for locally advanced breast cancer are similar to treatments for other types of breast cancers. But you may have them in a different order than people with other types of breast cancer. The timing can depend on:

• the size of your breast cancer
• the way in which it has spread.

Your doctor will recommend the treatment that is best for your individual circumstances and the subtype of breast cancer. Subtypes can be:

• hormone receptor-positive
• HER2-positive
• triple negative breast cancer.

The best option may be one or a combination of the treatments.

If you have questions about any part of your treatment, don't be afraid to ask your doctor and treating team. For example, you may want them to explain:

• why they have recommended a particular approach
• whether you may be able to access a particular type of therapy.

Surgery for locally advanced breast cancer

Surgery is usually recommended for people with locally advanced breast cancer. If this is the best option for you, mastectomy is most common. Sometimes, breast-conserving surgery (lumpectomy) may be performed.

Radiotherapy for locally advanced breast cancer

Radiotherapy is often recommended for people with locally advanced breast cancer. You may be offered radiotherapy before, after, or without surgery. This depends on your individual treatment plan. If you have any concerns or questions about the timing of your treatment, it’s a good idea to talk to your doctor.

Chemotherapy for locally advanced breast cancer

You may be offered chemotherapy before surgery for stage 3 breast cancer. This is called neoadjuvant therapy.

Chemotherapy treats the whole body – it is a 'systemic treatment'. Systemic treatments reduce the chance of cancer coming back in the breast and other parts of the body.

Neoadjuvant therapy for locally advanced breast cancer
It is common to have treatment for locally advanced breast cancer before surgery. This is called neoadjuvant therapy.

Your treatment may start with:

• chemotherapy
• targeted therapy
• hormone-blocking therapy.

You usually have these treatments for several months before surgery.

Targeted therapy for locally advanced breast cancer

Targeted therapies are also 'systemic' – they treat cancer cells anywhere in the body.

They act by stopping particular types of cancer cells from growing.

Targeted therapies are only suitable for some cancers but may be used with other breast cancer treatments.

The most common targeted therapy is trastuzumab, which targets HER2-receptors on cancer cells. It treats HER2-positive breast cancer.

Hormone-blocking therapy for locally advanced breast cancer

Hormone-blocking therapy treats hormone receptor-positive breast cancers. It is also called endocrine therapy.

In these types of breast cancer, the breast cancer cells have receptors for the hormones oestrogen and/or progesterone on them. These cause the cancer to grow.

Hormone-blocking drugs used to treat early breast cancer include:

• tamoxifen
• anastrozole
• letrozole
• exemestane.

Hormone-blocking therapy is a ‘systemic’ therapy that treats the whole body.