Overview of Stage 3 Breast Cancer
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Stage 3 breast cancer is more advanced than stage 2, but it is not considered metastatic. For this diagnosis, cancer has not spread from the breast to organs or other distant sites in the body, but cancer cells will have traveled to nearby underarm (axillary) lymph nodes, or lodged in lymph nodes beneath your breastbone (sternum) or even under your collarbone.
A stage 3 breast tumor can range in size from less than 2 cm to over 5 cm, but sometimes no tumor is found in the breast tissue. This stage of invasive breast cancer may involve chest wall muscle beneath the breast, or it may affect breast skin. If breast skin is swollen or ulcerated by cancer, it could be inflammatory breast cancer (IBC).
Stage 3 is an invasive breast cancer that can be described by three scenarios: 3A, B, and C. These are further broken down by tumor size and node status, as described by the TNM system. Even though lymph nodes can be involved, stage 3 is not considered metastatic.
TNM Staging of Stage 3 Breast Cancer
Stage 3 breast cancer is broken down into stage 3A, 3B, and 3C. Since the treatment recommendations as well as prognosis can be significantly different between these substages, careful staging is needed. At first, the TNM system can be confusing. Yet having a description of T, N, and M, allows doctors to precisely determine the stage. TNM refers to:
T: tumor size. T0 refers to a breast cancer that has not yet been found in your breast tissue but have have been found elsewhere. T1 includes tumors that are 2 cm (around 1 inch) or smaller in size. T2 includes tumors that are between 2 cm and 5 cm in diameter. T3 tumors are larger than 5 cm. T4 tumors can be any size but have invaded the chest wall or skin. T4 includes inflammatory breast cancer.
N: nodes. N0 means the tumor has not spread to lymph nodes. N1 refers to tumors that have spread to nearby lymph nodes (up to 3). N1mi means there are micrometastases, or tumor cells which can only be seen under the microscope. N2 means that tumor has spread to 4 to 9 lymph nodes under the arm or there is significant spread to to the internal mammary lymph nodes. N3 can refer to several different scenarios, such as having 10 or more lymph nodes which are positive or if the cancer has spread to subclavicular nodes (under the collarbone).
M: metastases. M0 means there are no distant metastases. M1 refers to tumors that have metastasized (are stage 4) and have spread. When breast cancer spreads the most common sites of metastases are the bones, liver, brain, or lungs.
HER2-Positive Breast Cancer
HER2 genes cause breast cancer to grow, but multiple new treatments are evolving that can help fight the disease regardless of stage.
Stage 3A Breast Cancer
Stage 3A: T0, N2, M0: No tumor has been found in breast tissue, but cancer cells have lodged in lymph nodes in your underarm or in your breast.
Stage 3A: T1, N2, M0: The tumor is 2 cm or smaller, OR it has invaded very slightly out of breast tissue. In addition, cancer has spread to lymph nodes in your underarm or nodes in your breast.
Stage 3A: T2, N2, M0: The tumor is over 2 cm, but under 5 cm across. Cancer has traveled to lymph nodes in your underarm or nodes in your breast.
Stage 3A: T3, N1, M0: This tumor is bigger than 5cm across and has not invaded breast skin or chest wall muscles. Cancer has been found in underarm lymph nodes.
Stage 3A: T3, N2, M0: This tumor is bigger than 5cm across and has not affected breast skin or chest wall muscles. Cancer has been found in underarm lymph nodes or nodes in your breast.
Stage 3B Breast Cancer
Stage 3B: T4, N0, M0: The tumor may be any size and has affected breast skin, or has grown into your chest wall, without involving the pectoralis muscle. Sometimes cancer reaches both your breast skin as well as the chest wall. This tumor may also be inflammatory breast cancer.
Stage 3B: T4, N1, M0: This tumor can be any size and can be attached to skin or the chest wall, or it may be inflammatory breast cancer. Cancer has also been found in underarm lymph nodes near the affected breast.
Stage 3B: T4, N2, M0: This tumor can be any size, affecting breast skin or the chest wall, or it may be Inflammatory breast cancer. Cancer has also been found in underarm lymph nodes or nodes within the breast.
Stage 3C Beast Cancer
Stage 3C: T(any), N3, M0: This tumor is any size, but is contained within breast tissue only. Your chest wall and breast skin should be unaffected. Lymph node status will vary as follows: cancer may be found in nodes under your arm, within your breast, over your collarbone, or beneath your collarbone. Likewise, cancer may show up on several of these node locations.
The overall 5-year survival rate for stage 3 breast cancer is 73 percent, but this can vary based on the substage and many other factors..
Oncologists talk about breast cancer survival rates in terms of 5-year survival rates. That doesn’t mean that the average patient will have a maximum of 5 years to live after diagnosis! It means that those patients survived at least 5 years beyond diagnosis, and most of them lived much longer. Not all patients will succumb to breast cancer, but they may die from other things.
Your doctor will talk with you about your unique outlook for survival, based on your general health, age, other conditions, and your cancer’s hormone status. The numbers that doctors work with are based on statistics from a large group of people, but may not fit your case exactly. In addition, these numbers reflect past performance of these treatments; values have been climbing in the last several years.
Your treatment plan will likely include surgery, chemotherapy, and in most cases, radiation. If your tumor was HER2-positive, you will also be given Herceptin, and if it was hormone-sensitive (estrogen and/or progesterone-positive), you can expect to take hormonal therapies for at least 5 years after primary treatment ends.
Smaller tumors that have not broken into skin or muscle may be removed with a lumpectomy, and a sentinel node biopsy will be needed to find out if cancer cells have traveled beyond your breast. Larger tumors, including those that have invaded the chest wall, will require a mastectomy as well as a lymph node biopsy. Breast reconstruction may be offered to you, but it sometimes has to be delayed due to radiation therapy.
Chemotherapy is given to chase down any stray cancer cells in your body; this helps prevent a recurrence. But chemo can also be given before surgery to shrink the tumor. When chemotherapy is given after surgery in early stage breast cancer it is referred to as “adjuvant chemotherapy.” When given before surgery it is called “neoadjuvant chemotherapy.”
Sometimes when breast skin is involved with cancer, it is called inflammatory breast cancer. Systemic therapy like chemotherapy is usually the first course of treatment for inflammatory breast cancer; this both shrinks the main tumor, making it easier for the surgeon to remove it, and also kills tumor cells floating around in the margin and the area not clearly involved with cancer cells. Without clearing these margins of cancer cells, the margins tend to keep showing up positive, often resulting in repeat surgeries and a very bad post-op appearance. Inflammatory cancer of the breast almost always requires a mastectomy and axillary lymph node dissection.
Follow-up therapies will depend on your hormone and HER2 status. Once active treatments are complete, you will have a 5-year follow-up period of checkups with your oncologist, during which you may need to take hormone therapy if your tumor was hormone sensitive. You will still have your annual mammogram and should stay current with your breast self-exams, provided that you still have breast tissue following surgery. Based on having had breast cancer, your doctor may recommend periodic MRIs of your other breast. Go on a healthy diet plan, and talk with your doctor about a good exercise routine that will rebuild your stamina and well-being.
A Word From Verywell
Stage 3 is the most advanced early stage of breast cancer but it is still very treatable. And treatments are improving. For example, in 2017 the addition of bisphosphonates were added to estrogen positive breast cancers to reduce the risk that the cancer would spread to bones. Keep in mind that the statistics you hear when reading about survival do not take into account these newer treatments. Reaching out to others has also been shown to improve survival rates. Join a support group or find an online cancer community. Most of all, be your own advocate in your health care, not just with regard to breast cancer, but to maintain your overall health after treatment.
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