Breast cancer is one of the most prevalent forms of cancer worldwide, affecting millions of women and, in rare cases, men. Among its various stages, Stage 3 breast cancer represents an advanced but treatable phase of the disease.
What are the features of breast cancer?
These tumors have the ability to grow into surrounding tissues and travel to other areas of the body via the lymphatic system or bloodstream. These tumors can invade nearby tissues and spread (metastasize) to other parts of the body through the bloodstream or lymphatic system. The breasts are made up of lobules (glands that produce milk), ducts (tubes that carry milk to the nipple), and stromal tissue (connective and fatty tissue). The majority of breast cancers originate in the lobules or ducts.
At the stage 3 breast cancer is a malignant tumor of significant size that has spread to regional lymph nodes. At this stage, the locally advanced cancer poses a much greater threat to the patient’s health and life compared to earlier stages of breast cancer.
Types of breast cancer
There are several types of breast cancer, classified based on where they originate and their behavior:
- Ductal Carcinoma In Situ (DCIS): Non-invasive cancer confined to the milk ducts.
- Invasive Ductal Carcinoma (IDC): The most common type, originating in the ducts and spreading to surrounding tissues.
- Invasive Lobular Carcinoma (ILC): Starts in the lobules and spreads to nearby tissues.
- Triple-Negative Breast Cancer: A subtype lacking estrogen, progesterone, and HER2 receptors, making it harder to treat.
- HER2-Positive Breast Cancer: Characterized by excessive production of the HER2 protein, which promotes cancer growth.
Staging of breast cancer
Breast cancer staging is determined using the TNM system, developed by the American Joint Committee on Cancer (AJCC):
- T (Tumor size): Measures the size and extent of the primary tumor.
- N (Nodes): Represents whether the cancer has reached nearby lymph nodes.
- M (Metastasis): Determines if cancer has spread to distant organs.
Stage 3 breast cancer is characterized by lymph nodes that have fused together or adhered to surrounding fatty tissue, forming distinct conglomerates. The third stage is classified into the following subcategories:
- Stage 3A – The tumor can be of any size, with affected and fused axillary lymph nodes.
- Stage 3B – The tumor, regardless of size, has invaded the skin of the breast, involving fused axillary and intrathoracic lymph nodes in the malignant process.
- Stage 3C – The tumor can be of any size, with metastases detected in axillary, intrathoracic, supraclavicular, and subclavicular lymph nodes. In some cases, the tumor infiltrates the chest wall.
At stage 3, breast carcinoma exhibits rapid metastatic spread. Even after tumor removal, there is a high risk of recurrence due to malignant cells (micrometastases) entering the lymph nodes and distant organs, which may go undetected by standard diagnostic methods. In stage 2 breast cancer, metastatic lesions in the liver typically appear within 3.5 years, whereas in stage 3, they may develop in less than 1.5–2 years.
Symptoms of stage 3 breast cancer
At stage 3 symptoms are pronounced and cannot go unnoticed by the patient. This stage is characterized by:
- A well-defined nodular lump in the breast tissue
- Changes in breast shape
- Painless breast enlargement (in cases of an edematous-infiltrative malignant process)
- Enlarged axillary, intrathoracic, supraclavicular, and subclavicular lymph nodes, which may be fused with each other and surrounding tissues
- Difficulty palpating the irregular edges of the tumor
- Pathological skin changes on the breast, including thickening (known as “orange peel syndrome”), redness, ulceration, and swelling
- Retraction of the nipple and discharge, which may be bloody, greenish, or clear
In some cases, stage 3 breast cancer presents with inflammatory symptoms similar to mastitis:
- Redness
- Tenderness
- Swelling
- Increased local temperature
Additionally, this stage may feature erysipelas-like symptoms, where the skin appears swollen and reddened, resembling flame patterns.
Diagnosis
Stages 3 and 4 are considered late stages of breast cancer. The symptoms are easily noticeable and indicate the progression of the disease. One of the simplest and most accessible diagnostic methods is self-examination of the breasts, which women under 30–35 years should perform at least once every three to four months, while older women should do so monthly.
During an initial consultation, a doctor conducts a manual examination of both breasts and regional lymph nodes, collects a detailed medical history, and inquires about any family history of breast cancer or other oncological diseases.
If cancer is suspected, instrumental diagnostic tests are performed, including:
- Ultrasound of the breasts and mammography
- Computed tomography (CT) and magnetic resonance imaging (MRI) of the breasts
- Fine-needle biopsy followed by pathological and immunohistochemical analysis of the tumor tissue samples to determine the cancer stage, histological type, morphological structure, differentiation level, and the presence of estrogen, progesterone, HER2 receptors, and the Ki67 proliferation marker. These results help accurately classify the cancer, assess its aggressiveness, and determine its sensitivity to hormone therapy and targeted drugs. Treatment strategies, including drug selection and chemotherapy regimen, are tailored based on tumor type.
Treatment
Treatment strategy depends on tumor size, location, extent of spread, the patient’s age, and overall health. At this stage, a comprehensive treatment approach is required, including surgery, chemotherapy, hormone therapy, and radiation therapy.
Most commonly, treatment begins with neoadjuvant (preoperative) chemotherapy or targeted radiotherapy, aimed at reducing the tumor size, making it operable, and enhancing surgical success. However, if the tumor has undergone necrotic breakdown, an abscess has formed, or there is bleeding, surgery is performed first, followed by chemo-radiotherapy.
Surgical treatment for stage 3 breast cancer involves a radical mastectomy (complete breast removal). The procedure includes the removal of the breast, underlying muscle tissue, and affected lymph nodes in the surrounding area.
To eliminate circulating tumor cells and prevent recurrence, adjuvant chemotherapy and radiation therapy are administered. Studies show that if a tumor is ≤5 cm, with minimal lymph node involvement and no distant metastases, forgoing adjuvant therapy results in a 35% recurrence rate within 10 years. If the tumor is >5 cm, with axillary and intrathoracic lymph node involvement, but without distant metastases, recurrence rates rise to 52–57%. If adjuvant chemotherapy is not performed at stage 3C, recurrence is inevitable (100% probability).
Chemotherapy for stage 3 breast cancer involves the following drugs:
- Taxanes (Paclitaxel, Taxan, Paxen, Paclitax)
- Platinum-based drugs (Cisplatin, Cytoplatin, Triplatin, Carboplatin)
- Fluoropyrimidine derivatives (Capecitabine)
- Vinca alkaloids (Vinorelbine, Vincristine, Vinblastine)
- Oxazaphosphorine derivatives (Trofosfamide, Endoxan)
For hormone-dependent tumors (expressing estrogen and progesterone receptors), hormone therapy with aromatase inhibitors (Letrozole, Anastrozole, Exemestane) is recommended.
For HER2-positive cancer, anti-HER therapy with the targeted drug Trastuzumab (Herceptin) is administered.
Cachexia and possible distant metastasis
Stage 3 breast cancer metastasizes rapidly, with bones being the most common site of metastasis. Therefore, patients should monitor their condition closely and pay attention to any bone pain, avoiding assumptions that it is due to sciatica or exposure to drafts. Immediate medical consultation is necessary to undergo diagnostic imaging (scintigraphy, CT, or X-ray of the affected area) to detect possible metastases. If metastases are found, the cancer is reclassified as stage 4, and additional chemotherapy drugs (such as Denosumab) may be prescribed.
Advanced breast cancer is often accompanied by significant weight loss due to chronic intoxication, chemotherapy side effects (which suppress appetite and cause various adverse effects), and the tumor itself consuming large amounts of nutrients, effectively “starving” the body. To counteract this, patients must maintain adequate nutrition, consuming at least 1.5 liters of fluids per day and ensuring that food is soft and easy to digest.
Prognosis
Since stage 3 is classified as an advanced form of breast cancer, the prognosis—especially for stages 3B and 3C—is poor.
- Stage 3A: With treatment, the five-year survival rate is 65–70%.
- Stage 3B: Comprehensive treatment allows 10–30% of patients to survive for five years.
- Stage 3C: Even with treatment, the five-year survival rate is below 10%.
Adequate and timely treatment significantly improves outcomes, but the disease remains challenging to treat at this stage.
Questions and answers
Can stage 3 breast cancer be cured?
According to statistics, tumor at this stage is still treatable and many patients can become cancer-free after successful treatment. The 5-year relative survival rate is 86%, according to the American Cancer Society. This means that 86% of people diagnosed with stage 3 cancer will survive for at least 5 years after diagnosis. With advancements in treatment options, including chemotherapy, biological targeted therapy, hormonal therapy, and newer drug classifications, the outlook for patients has improved significantly.
What is the survival rate for Stage 3 breast cancer at 10 years?
While specific 10-year survival rates are not provided in the search results, we can infer some information from the overall breast cancer statistics. The American Cancer Society reports that the 10-year relative survival rate for all stages of breast cancer combined is 84%. However, this rate includes all stages, so the specific survival rate may be lower. It’s important to note that survival rates have improved over time due to advancements in treatment and earlier detection.
Does grade 3 cancer need chemo?
The search results don’t specifically address whether grade 3 cancer always requires chemotherapy. However, treatment typically involves a combination of therapies, which often includes chemotherapy. The exact treatment plan depends on various factors, including the specific subtype of breast cancer, the patient’s overall health, and their response to treatment. Chemotherapy is frequently used to shrink tumors before surgery or to kill any remaining cancer cells after surgery.
Sources and publications:
- https://www.healthline.com/health/breast-cancer/prognosis-stage-3-breast-cancer
- https://www.nationalbreastcancer.org/breast-cancer-stage-3/
- https://nbcf.org.au/about-breast-cancer/diagnosis/stage-3-locally-advanced-breast-cancer/
- https://nbcf.org.au/about-breast-cancer/breast-cancer-stats/
- https://www.medicalnewstoday.com/articles/323177
- https://www.moffitt.org/cancers/breast-cancer/survival-rate/
- https://www.webmd.com/breast-cancer/breast-cancer-survival-rates
- https://ascopubs.org/doi/10.1200/GO.22.00354
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1344967/
- https://www.komen.org/breast-cancer/facts-statistics/breast-cancer-statistics/survival-rates/
