Treatment for Stage 3 breast cancer is very similar to that of Stage 2 breast cancer. Surgery to remove the tumor, followed by radiation therapy as well as chemotherapy, hormone therapy and/or targeted therapy all are likely treatment options in one combination or another. More advanced Stage 3 breast cancers (referred to as Stage 3B and 3C) often are treated with chemotherapy, hormone therapy and/or targeted therapy prior to surgery.
- Surgery
- One of two types of surgery may be performed during Stage 3 breast cancer.
- Mastectomy
- A mastectomy removes an entire breast or both breasts, which may be followed by reconstructive surgery. Radiation therapy is usually given after the mastectomy especially if the tumor is on the larger side or if the tumor has spread to nearby lymph nodes.
- Breast-sparing surgery
- Also known as a lumpectomy or partial mastectomy, breast-sparing surgery removes only the area of the breast that is affected with cancer. Neoadjuvant therapy (meaning treatment prior to surgery) consisting of chemotherapy, hormone therapy and/or targeted therapy is usually given in order to try to shrink the tumor prior to performing breast-sparing surgery. However, if the tumor does not shrink enough with the neoadjuvant therapy then a mastectomy likely will be performed to help ensure that all the cancer is removed.
- Radiation Therapy
- Radiation therapy is usually given after surgery (known as adjuvant therapy) in order to kill and destroy any remaining cancer cells left behind from the surgery. It is commonly given externally five days a week over the course of six weeks.
- Hormone Therapy
- If the Stage 3 tumor is found to be hormone receptor-positive, hormone therapies such as tamoxifen (Nolvadex) or aromatase inhibitors (exemestane/Aromasin, anastrozole/Arimidex, or letrozole/Femara) may be recommended prior and/or after the surgical removal of the tumor.
- Used for more than 30 years to treat breast cancer, tamoxifen is given as a pill and works by blocking the activity of estrogen. Aromatase inhibitors are typically given to women who have already gone through menopause, and work by preventing the body from making estradiol, a form of estrogen.
- Chemotherapy
- Chemotherapy may be given prior to surgery in order to try to shrink the breast cancer tumor and/or after surgery depending on the size of the Stage 3 tumor and if the tumor has spread beyond the breast. There are many different types of chemotherapy agents and combinations of chemotherapy agents that are used to treat breast cancer. Some of the commonly used combinations include:
- AC
- Doxorubicin (Adriamycin) and Cyclophosphamide
- A – CMF
- Doxorubicin (Adriamycin) followed by CMF: cyclophosphamide (Cytoxan), methotrexate (Amethopterin, Mexate, Folex), and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil)
- AC – T
- Doxorubicin (Adriamycin) and cyclophosphamide followed by paclitaxel (Taxol) or Docetaxel (Taxotere). During this regimen, the targeted monoclonal antibody therapy trastuzumab (Herceptin) may be given if the tumor is HER2-positive tumor.
- CAF (FAC)
- Cyclophosphamide, doxorubicin (Adriamycin), and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil)
- CEF (FEC)
- Cyclophosphamide, epirubicin, and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil). This regimen also may be followed by docetaxel (Taxotere).
- CMF
- Cyclophosphamide (Cytoxan), methotrexate (Amethopterin, Mexate, Folex), and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil)
- EC
- Epirubicin (Ellence) and cyclophosphamide
- TAC
- Docetaxel (Taxotere), doxorubicin (Adriamycin), and cyclophosphamide
- TC
- Docetaxel (Taxotere) and cyclophosphamide
- TCH
- Docetaxel (Taxotere), carboplatin, and trastuzumab (Herceptin) for HER2-positive tumors
- Other chemotherapy agents
- Besides these commonly used treatment regimens, other chemotherapy agents also are used to treat breast cancer. These include: albumin-bound paclitaxel (Abraxane), capecitabine (Xeloda), cisplatin (Platinol), gemcitibine (Gemzar), ixabepilone (Ixempra), mitoxantrone (Novantrone), pegylated liposomal doxorubicin (Doxil) and vinorelbine (Navelbine).
- Targeted Therapy
- If the Stage 3 tumor is found to be HER2-positive, meaning the tumor is a more aggressive form of breast cancer, the use of the targeted monoclonal antibody trastuzumab (Herceptin) will likely be given in combination with the specific chemotherapy regimens listed above. It can be given prior to and/or after surgery as well in Stage 3 breast cancer.
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