Management of locally advanced breast cancer

Ummekalsoom R. Malik, Joseph A. Sparano

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

I. INTRODUCTION Locally advanced breast cancer (LABC) includes several clinical presentations associated with a high rate of local and systemic recurrence when treated with local therapy alone. This includes tumors that are very large but respectable, tumors that have technically difficult to establish tumor-free margins due to skin or chest wall involvement, and tumors of any size associated with extensive axillary adenopathy or regional nonaxillary lymph nodes. The definition of LABC generally includes the following clinical presentations and their corresponding stages (Table 1) as defined by the American Joint Committee on Cancer (Beahrs, 1992): Large primary tumors (5 cm) occurring without axillary lymph node metastases (stage IIB) or with ipsilateral movable axillary lymph node metastases (stage IIIA) Tumors of any size associated with axillary lymph node metastases that are fixed to one another or to other structures (stage IIIA) Tumors of any size that show extension to the chest wall or skin, including edema, ulceration, or satellite skin nodules (stage IIIB) Inflammatory carcinoma (stage IIIB) Tumors of any size associated with ipsilateral internal mammary nodes (stage IIIB) Tumors of any size associated with ipsilateral supraclavicular lymph nodes (stage IV) without other evidence of systemic metastases The approach to the patient with LABC generally includes the following: Diagnostic biopsy or fine-needle aspiration A workup to exclude the presence of occult systemic metastases Primary systemic chemotherapy (also called “neoadjuvant therapy”) 474 MALIK AND SPARANO Table 1 Clinical Staging of Breast Cancer Stage Tumor Nodes Metastases IIB T3 N0 M0 IIIA T0, T1, T2 N2 M0 T3 N, N2 M0 IIIB T4 Any N M0 Any T N3 M0 Surgical treatment of the primary tumor Additional systemic “adjuvant” chemotherapy Irradiation to the breast or chest wall and regional lymphatics Hormonal therapy (e.g., tamoxifen) for 5 years if the tumor is estrogen and/or proges- terone receptor positive In this chapter, the literature supporting this proposed treatment approach is reviewed, with a particular emphasis on randomized phase II and III trials and large single or multiinstitutional trials.

Original languageEnglish (US)
Title of host publicationBreast Cancer
Subtitle of host publicationPrognosis, Treatment, and Prevention
PublisherCRC Press
Pages473-496
Number of pages24
ISBN (Electronic)9780203909249
ISBN (Print)9780824707125
StatePublished - Jan 1 2002

Fingerprint

Breast Neoplasms
Neoplasms
Neoplasm Metastasis
Lymph Nodes
Thoracic Wall
Skin
Breast
Neoadjuvant Therapy
Progesterone Receptors
Tamoxifen
Therapeutics
Adjuvant Chemotherapy
Fine Needle Biopsy
Edema
Estrogens
Carcinoma
Recurrence
Drug Therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Malik, U. R., & Sparano, J. A. (2002). Management of locally advanced breast cancer. In Breast Cancer: Prognosis, Treatment, and Prevention (pp. 473-496). CRC Press.

Management of locally advanced breast cancer. / Malik, Ummekalsoom R.; Sparano, Joseph A.

Breast Cancer: Prognosis, Treatment, and Prevention. CRC Press, 2002. p. 473-496.

Research output: Chapter in Book/Report/Conference proceedingChapter

Malik, UR & Sparano, JA 2002, Management of locally advanced breast cancer. in Breast Cancer: Prognosis, Treatment, and Prevention. CRC Press, pp. 473-496.
Malik UR, Sparano JA. Management of locally advanced breast cancer. In Breast Cancer: Prognosis, Treatment, and Prevention. CRC Press. 2002. p. 473-496
Malik, Ummekalsoom R. ; Sparano, Joseph A. / Management of locally advanced breast cancer. Breast Cancer: Prognosis, Treatment, and Prevention. CRC Press, 2002. pp. 473-496
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