Locally advanced breast cancer includes cases with T4 disease, that is infiltration of the chest wall or skin or N2 or N3 disease, that is, fixed or matted axillary lymph nodes.
This figure shows T4 disease, with infiltration into the chest wall or skin, and N2 or N3 disease, with the presence of matted or fixed axillary lymph nodes. These cases are not upfront resectable.
That is why, neoadjuvant chemotherapy, that is, chemotherapy before surgery, is required in almost all the cases of locally advanced breast cancer.
One exception is T3N1 disease, that may be upfront resectable, but neo adjuvant chemotherapy may be required in these cases if planning for breast conservation surgery, in these cases.
In locally advanced disease also, the decision to do BCS or MRM is taken after neoadjuvant chemotherapy, depending upon the response to chemotherapy, as we have discussed previously for localized disease.
So the decision to add neoadjuvant or adjuvant chemotherapy is taken in an individual basis, after discussion in the tumor board.
The decision to add hormonal therapy or targeted therapy depends upon the ER, PR and HER-2 status, as we discussed previously for localized disease.
Radiation therapy is required in almost all cases of locally advanced diseases but final decision is taken by the radiation oncologist by completely assessing the patient.
This brings us to the end of treatment for locally advanced breast cancer.
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