Advanced loco regional Regional breast cancer & Regional breast cancer

Locally advanced breast cancer (LABC) Large primary tumors greater than 5cm Associated with skin or chest wall involvement Or with fixed (matted) Axillary lymph node T3 and T4 and N2. Inflammatory BC is usually Inculde.

* In many other countries represent 30%-50% LABC STAGE III: in Mamography less than 5% in UN * In many other countries represent 30%-50%

Diagnosis Most LABCS are easily palpable and even visible. Some present with diffuse infiltration of breast and with out dominant mass and require Mamography.

LABC in mamography Often large area of calcification or parechymal distortion some times skin thickening is also present.

Core-needle biopsy usually establishes the histological diagnosis. Incisional biopsy are seldom required full thickness skin biopsy often obtain when IBC is suspected.

Experienced cyto pathologic FNAC Nuclear grade- flow cytometry -ES and prog receptor and other indicatr (PCNA- Ki 67- HER-2 /neu-P53 FNAC cannot differentiated from non invasive tumors.

Dia is established Biochemical survey Tumor markerassays CXR Bone scan complete PE complement

LFT or tumor marker assay are abnormal Abdominal CT or us is recommended increased radio nucleatide uptake on bone scan are assessed by radiography.

Contra lateral mamography for R/O synchronous bilateral cancer or contratateral metastase.

Treatment strategies Inculde induction chemotherapy or hormon therapy for down staging of primary tumor and regional lymph node metastases.

Induction chemotherapy (Neoadjuvant ) The majority (60% to 80%) achieved a major objective regression in primary tumor volume and enlarged LN clinical complete remission in 10% to 20%

Maximum response has great heterogeneity In some pt after only one cycle of thyerapy. In other require up to 8 months.

For assessment of max response Clinical measurements of breast mass are often inaccurate Imaging are often used more reliably Combining PE with either MG or US reduce error

Clinical complete remission require that no residual disease be present by PE or imaging in breast or regional LN.

With these criteria only 2/3 PT have pathologic complete response. 1/3 of PT with no residual disease on histological examination have residual clinical or imaging abnormality

Approach to local therapy For pt with operable (stage IIIA) LABC MRM followed by systemic adjuvant therapy . In recent years many PT treat with induction chemotherapy result in downstaging followed by surgery or RT or both.

Surgical therapy Total mastectomy or only a wide excision (lumpectomy or quadrantectomy )both accompanied by an axillary dissectin.

Role of radiation in LABC For stage III post.op chemotherapy and radiotherapy resulted in better local control and higher overal survival rate than the use of either adjuvant treatment alone.

Role of radiation therapy For LASBC this means treating The entire soft tissue of chest wall inculding Any residual breast tissue. Surrounding skin. Connective tissue. Regional lymphatic.