| There are several indications of a locally advanced | | | | lumpectomy (the surgical removal of a small tumor or |
| breast cancer: a stage 3 cancer, with a size larger | | | | a lump); if there is no change, surgeons resort to a |
| than two inches and lymph node metastasis; swelling | | | | surgical technique known as mastectomy, or surgical |
| of the skin, or a big, matted cluster of lymph nodes | | | | removal of the breast. Even when the tumor seems |
| in the armpit; or it might be stuck to the chest | | | | to have disappeared, there may still be some cancer |
| muscle, or ulcerating through the skin. | | | | cells present. Most doctors always want to at least a |
| These are all indications that the breast cancer is | | | | lumpectomy on the spot where the tumor where |
| likely to have spread to elsewhere in the body, at | | | | the tumor had been to see what's actually left. If the |
| least microscopically and so when they are | | | | lumpectomy is clear or shows clean margins, you are |
| discovered, surgery isn't always the first step taken. | | | | a candidate for radiotherapy. Similarly, if doctors can |
| Lymph node sampling isn't necessary. There is | | | | do a lumpectomy and clear margins because the lump |
| frequently a question whether a wide excision is | | | | is small, that in addition to radiation is a sensible |
| even possible. If you've got very large breasts, it | | | | treatment. If there is still a large lump or a lot of |
| might be, but if your breasts are small, surgeons may | | | | cancer at the margins, the best option might be to |
| not be able to get enough surrounding tissue out | | | | do a mastectomy with or without immediate breast |
| without a mastectomy. It the tumor is stuck to the | | | | reconstruction. In the case of an ulceration that |
| chest muscle or ulcerating through the breast skin, an | | | | doesn't have enough skin to sew back together, |
| immediate local treatment might not be feasible at all; | | | | breast reconstruction has not only a cosmetic but |
| removing the muscle or all the skin that is ulcerated | | | | also a medical advantage: reconstruction provides skin |
| might not leave sufficient tissue to sew back | | | | from another part of the body. |
| together again. | | | | After lumpectomy or mastectomy, some women |
| All this generally suggests that it would be wise to | | | | with stage 3 breast cancer receive high-dose |
| start a systemic rather than local treatment, usually in | | | | chemotherapy and stem cell rescue (bone marrow |
| the form of chemotherapy and this is now fairly | | | | transplantation). Knowing that many of these locally |
| generally agreed on in the medical community. | | | | advanced cancers are very aggressive, many doctors |
| Normally, the drugs used are Adriamycin and Cytoxan | | | | feel that a higher dose of chemotherapy is advisable. |
| and/or Taxol or Taxotere. This may not eradicate | | | | Different hospitals have different preferences in |
| the whole tumor, but if it doesn't, it can still do two | | | | treatment order and combinations. Most centers do |
| things: it can destroy the cancer cells that have | | | | chemotherapy first and many of them will then do a |
| spread to various organs and it can shrink the tumor | | | | mastectomy. Some of them will consider breast |
| size to a size that can be more easily managed with | | | | conservation surgery, if the lump becomes small |
| surgery or radiation. Oftentimes, chemotherapy is | | | | enough and they usually follow up with radiation |
| continued for three to four cycles and then the | | | | therapy. Combinations of treatments in this kind of |
| situation is re-evaluated. If the tumor has shrunk, a | | | | breast cancer produce better response rates. |