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Navigating Treatments and Prognosis for Stage 3 Breast Cancer
Editor’s Note: This resource, Navigating Treatments and Prognosis for Stage 3 Breast Cancer, was originally published by MyHealthTeam.
During a breast cancer diagnosis, your doctor will determine the stage of your cancer. Stages range from 0 to 4, based on the size of the breast tumor and whether the cancer has spread to other organs. If your doctor determines you have stage 3 breast cancer, that indicates you have advanced breast cancer that has begun to impact the tissue surrounding the breast.
Knowing the stage can help your doctor choose the best treatment and predict your prognosis (estimated outlook).
How Is Breast Cancer Stage Determined?
Breast cancer is staged using the TNM staging system, where TNM stands for tumor, node, metastasis. The system looks at the following:
- Tumor — How large is the primary tumor?
- Node — Are there cancer cells in nearby or distant lymph nodes?
- Metastasis — Has the cancer metastasized (spread) to other parts of the body?
A higher degree of cancer spread corresponds to more advanced-stage disease. Understanding the nature of the disease and determining the best treatment options also requires additional information, such as:
- Hormone receptor status — Does the cancer contain estrogen receptors (ERs) or progesterone receptors (PRs), which are types of proteins?
- Tumor grade — How do the abnormal cancer cells look compared to the normal cells?
- Human epidermal growth factor receptor 2 (HER2) status — How high are your levels of the protein HER2?
What Is Stage 3 Breast Cancer?
Also called locally advanced breast cancer, stage 3 breast cancer is a more advanced form of invasive breast cancer. Cancer cells have spread from the milk ducts into the nearby lymph nodes, the skin of the breast, or the chest wall.
Stage 3 breast cancer may further be classified into substages — stage 3A, 3B, or 3C — depending on the size of the breast tumor and the extent of the cancer spread. Notably, breast cancer stages are sometimes referred to using Roman numerals, such as stage III instead of stage 3.
Stage 3A Breast Cancer
Stage 3A breast cancer refers to one of the following situations:
- The doctor doesn’t find a tumor in the breast, or if there is a tumor, it may be of any size. Additionally, cancer is found in four to nine axillary lymph nodes (those that are in the armpit region) or in the lymph nodes closest to the breastbone
- The tumor is larger than 5 centimeters, and there are small groups of breast cancer cells between 0.2 millimeters and 2 millimeters in size in the lymph nodes.
- The tumor is larger than 5 centimeters, and the cancer has spread to one to three axillary lymph nodes or to the lymph nodes near the breastbone.
Stage 3B Breast Cancer
In stage 3B breast cancer, the cancer has spread to the lymph nodes and the chest wall, referring to the protective structures around the lungs. The cancer is also in the skin of the breast, resulting in ulcers or swelling.
Stage 3C Breast Cancer
In stage 3C breast cancer, there may be no sign of cancer in the breast. If there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast. Additionally, the cancer must have spread to one or more of the following places:
- Ten or more axillary lymph nodes
- Lymph nodes above or below the collarbone
- The axillary lymph nodes or lymph nodes near the breastbone
Inflammatory Breast Cancer
Stage 3 breast cancer is classified as inflammatory breast cancer (IBC) when the cancer cells block vessels in the skin of the breast, causing the skin to feel warm and change in appearance.
Treatments for Stage 3 Breast Cancer
Stage 3 breast cancer treatment often starts with chemotherapy, followed by surgery. For cancers with certain genetic mutations, targeted drugs are also used in treatment.
Chemotherapy
Chemotherapy is often the first approach for treating stage 3 breast cancer. Chemotherapy is usually administered as neoadjuvant therapy, meaning it is given prior to surgery. This approach is beneficial in that it can:
- Shrink the tumor to make it easier to remove
- Test that a particular chemotherapy is effective
- In some cases, allow for a less extensive surgical procedure
Mastectomy or Lumpectomy
A mastectomy, which is the removal of the breast tissue, is often required to treat stage 3 breast cancer. Alternatively, a lumpectomy — also referred to as breast-conserving surgery or partial mastectomy — involves the removal of only the breast tumor and some of the surrounding normal tissue.
Many people with stage 3 breast cancer are not eligible for a lumpectomy and likely need a mastectomy to get rid of the tumor completely. However, if neoadjuvant chemotherapy can shrink the tumor enough, a lumpectomy might become a viable option.
Following surgery, some people may choose to have reconstructive surgery to restore the appearance of their breasts.
Radiation
Radiation therapy is often administered following an operation to kill off any remaining breast cancer cells that may have been missed by treatment.
Lymph Node Dissection
Lymph nodes containing cancer cells must also be removed. An axillary lymph node dissection is done to remove the lymph nodes in the armpit. The procedure is usually performed at the same time as a mastectomy.
Hormonal Therapy
Some breast cancers contain proteins called hormone receptors on the surface of breast cancer cells. The hormone receptors that play a role in breast cancer progression are the estrogen receptors and progesterone receptors.
Hormone receptor-positive stage 3 breast cancers can be treated with hormonal therapy drugs such as tamoxifen or exemestane (sold as Aromasin), which specifically target the hormone receptors.
Targeted Therapy
Targeted therapy drugs work by stopping the function of a particular protein or group of proteins. HER2 is a protein that is present at high levels in some breast cancers and affects how the cancer grows. HER2-positive stage 3 cancers may be treated with drugs that specifically target the HER2 protein.
Immunotherapy
If breast cancer cells are negative for ER, PR, and HER2, the cancer is called triple-negative breast cancer. Triple-negative breast cancer is difficult to treat effectively with standard treatments, so newer forms of treatment like immunotherapy may be used to improve outcomes.
Immunotherapy drugs work by interacting with a person’s immune system so that it can recognize and fight the cancer cells. Pembrolizumab (sold as Keytruda) is an immunotherapy drug that can be used along with chemotherapy to treat triple-negative stage 3 breast cancer that has returned or spread after surgery.
Prognosis for Stage 3 Breast Cancer
Stage 3 breast cancer is an advanced stage disease, so prompt treatment is crucial for improving the prognosis.
Overall, stage 3 breast cancer has a somewhat favorable prognosis with a five-year survival rate as high as 86 percent. This means 86 percent of people with the condition live at least five years after being diagnosed. This rate can vary depending on the exact substage of cancer. For instance, IBC has a markedly lower survival rate, closer to 41 percent.
Hormonal therapy and other targeted drugs have helped to improve outcomes for cancers with specific genetic features. Some people may be encouraged to participate in clinical trials, which can advance the discovery of new effective treatments for stage 3 breast cancer.
Talk With Others Who Understand
MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.
Have you or a loved one been diagnosed with stage 3 breast cancer? Share your experiences in the comments below, or start a conversation by posting on MyBCTeam.
5 Things Newly Diagnosed Breast Cancer Patients Should Know
This was originally published by Cynthia Demarco on April 19, 2019 on MD Anderson Cancer Center here.
If you’ve just received a breast cancer diagnosis, you probably have a lot of questions: What type of breast cancer do I have? How advanced is it? Do I qualify for any clinical trials? Can my doctor provide the treatment I need?
Before you start making treatment plans and scheduling appointments, here are five things to know.
Get an accurate diagnosis before starting treatment
Not all breast cancers are the same, so it’s important to get an accurate diagnosis right from the start. This is particularly true if you have a rare or very aggressive form of the disease, such as inflammatory or triple-negative breast cancer.
That’s because the type of breast cancer, as well as its stage and location, can determine the types of treatment you’ll be offered, as well as those you’re not eligible for.
“We offer precise treatments based on precise diagnoses,” says Lavinia Middleton, M.D. “That’s why I believe everyone should get a second opinion. A second opinion can be a game-changer. About 25% of our patients will see a change in their diagnosis.”
Where you go first for breast cancer treatment matters
All patients who come to MD Anderson will have their diagnoses confirmed by our doctors. This ensures that your cancer is both correctly identified and accurately staged — two crucial steps in determining which treatment plans you’ll be offered.
“Your first shot is your best shot at beating cancer,” says Makesha Miggins, M.D. “So, when patients come to us after they’ve already been elsewhere, their cancer treatment is often more challenging. That’s why I tell people to come to MD Anderson first.”
“If my cancer had been just a little more advanced, it would have been considered stage IV, and my care would have been palliative instead of curative,” adds Jenée Bobbora, an inflammatory breast cancer survivor. “But my doctor insisted that my cancer was at stage IIIc, not IV, so my treatment included chemotherapy, a double mastectomy and radiation. And I’ve shown no evidence of disease since 2003.”
Seek out the experts for your breast cancer diagnosis and treatment
It’s also critical to choose a cancer center with extensive experience in treating your particular type of breast cancer.
MD Anderson sees thousands of breast cancer patients annually, and has entire teams of specialists focused on specific types of breast cancer, such as triple-negative and hereditary cancers.
“Not only can we identify rare types of cancer with confidence, we can also keep women from having invasive diagnostic procedures for conditions that are not cancer,” says Therese Bevers, M.D.
“Breast cancer can have so many different variables,” adds Kelly Hunt, M.D. “And each one influences our treatment recommendations, because each one can significantly impact a patient’s response to different therapies. It’s critical to know these things before leaping in, because often by doing chemotherapy or targeted therapy first, we’re able to shrink the tumor and eradicate cancer in the lymph nodes involved. That means we can do less surgery and still have excellent long-term results.”
Consider clinical trials for your breast cancer treatment
Clinical trial options exist for virtually every type and stage of breast cancer. But some clinical trials for breast cancer are limited to patients who have not yet begun treatment. That’s why it’s important to discuss your options with your physician as early as possible.
Over the past few years, clinical trials at MD Anderson have allowed our breast cancer patients to avoid double mastectomies, have tumors removed painlessly without general anesthesia, and explore more personalized treatment options.
“My trial was unique because I was able to start with traditional chemotherapy and move on to other treatments only if that didn’t work,” says breast cancer survivor Barbara Lewis, of the immunotherapy clinical trial she participated in. “Only seven months after diagnosis, there were no traces of cancer in my body. That’s about the best result you can get.”
Make multidisciplinary care mandatory
No matter what type of breast cancer you have, it’s crucial to seek treatment at a cancer center that offers multidisciplinary care. This approach, which was pioneered here at MD Anderson, brings together all of the specialists you’ll need for your care — such as oncologists, surgeons, radiation oncologists, etc. — to formulate your treatment plan.
Coordinating patient care as a team ensures that every aspect of an individual’s situation is taken into account from the start. It also makes it easier for your care team to adapt and make changes to your treatment as it evolves.
“It’s all about preserving options,” Hunt says. “I see patients all the time who were treated elsewhere with surgery first, when that might not have been the best approach. Now, they need more surgery or other treatments. And they’re painted into a corner, because they have fewer options. Our comprehensive approach means patients don’t have to go through multiple procedures to get the best results.”
Multidisciplinary care also gives patients easy access to any additional support services they might need, such as social work counselors, dietitians, physical therapists, lymphedema specialists and support groups.
“My gynecologist gave me the name of three Houston oncologists to choose from, but it was up to me to check them out,” adds Helen Vollmer, on the challenging start to her breast cancer journey. But once she got to MD Anderson’s Breast Multi-Team Clinic, “It was all confined to one, incredibly caring place with a team who talked to each other and, more importantly, to me.”
