Locally Advanced Breast Cancer- Here's What You Need To Know About It

Locally advanced breast cancer is a potentially curable disease

Breast cancer has emerged as the most common form of cancer in Indian women over the last two decades. According to the Indian Council of Medical Research (ICMR) & National Center for Disease Informatic & Research (NCDIR), in 2018, India had 162468 new breast cancer cases and 87090 deaths from the disease. The rising incidence of breast cancer can be attributed to sedentary lifestyles, family history of the disease, smoking, consumption of alcohol and genetics. Breast cancer is a progressive disease and early screening and detection plays a crucial role in the management of the disease. As the stages of the cancer advance, the cure rate decreases.

What is locally advanced breast cancer

Locally advanced breast cancer (LABC) is a subset of breast cancer which refers to the spread of the disease in the nearby lymph nodes or tissues such as the breast or armpit. Unlike metastatic cancer, where the disease spreads to other parts of the body, LABC occurs only in the nearby lymph nodes and tissues. LABC is commonly referred to as Stage 3 breast cancer (breast cancer progresses across 5 stages- Stage 0 to Stage 4). The breast tumours in LABC are large, more than 5 cm in diameter and affects the internal mammary nodes through the skin of the breast and muscles of the underlying chest wall.

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Locally advanced breast cancer: Know the warning signs

LABC is a rapidly growing, inflammatory breast cancer which manifests itself through warning signs such as redness and swelling of the breast with significant pain. The other manifestations include lump or change in the size of breast, swelling of skin or hardening of breast, retraction of nipple or lump in the arm pit. In more severe cases, the symptoms can be accompanied by ulceration and bleeding.

Diagnosis

LABC is diagnosed through the regular imaging investigation for breast cancer i.e. mammography and ultrasonography of the breast. However, the most important procedure in the diagnosis process is core needle biopsy with tumour markers. Core needle biopsy is a medical test to remove the piece of affected tissue from a lesion or mass. The tissue is then tested to find out the stage of the cancer. Tumour markers are substances, usually proteins, that are produced by the body in response to cancer growth or by the cancer tissue itself. The process of diagnosing the cancer through this procedure helps in selection of particular drugs for treatment. The staging (stage at which the breast cancer currently is) of the cancer is detected through a PET-CT or PET-MRI.

Locally advanced breast cancer can be diagnosed via mammography and ultrasonography of the breast
Photo Credit: iStock

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Treatment

Majority of the cancerous tumours in LABC undergo drug treatment first such as chemotherapy, targeted therapy or hormonal therapy (particularly in very aged and hormone receptor positive patients) to shrink the size of the tumour for surgery. The surgery is followed by radiation therapy and in certain cases, hormone therapy may be administered post this in the form of tablets for 5-10 years depending upon the hormone receptor status of the patient.

Saving the breast post chemotherapy

Breast conservation surgery can be undertaken in select patients where the tumour is large and well-defined, thereby enabling significant reduction in the size. The process of conserving the breast can be achieved with the same cure rate in this case. In instances where the disease is more diffused, involving inflammatory breast cancer, total removal of the breast needs to be done.

LABC, though levelled as stage 3 cancer is a potentially curable disease and with proper planning and treatment, almost two-thirds of patients can be completely cured. For the rest, the disease can be controlled/ managed life-long through treatment.

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(Dr. Rajeev Agarwal, Director of Breast Services, Cancer Institute, Medanta)

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