Locally advanced breast carcinoma (LABC) refers to an aggressive form of breast cancer that has spread beyond the breast but has not metastasized to distant organs. It includes large primary tumors (greater than 5 cm), those involving skin or chest wall, and cases with extensive lymph node involvement. LABC requires a multimodal treatment approach, including chemotherapy, surgery, radiation, and targeted therapies.
Causes and Risk Factors
LABC can develop due to various genetic, hormonal, and environmental factors, including:
- Genetic predisposition: BRCA1 and BRCA2 mutations significantly increase the risk.
- Hormonal factors: Prolonged estrogen exposure due to early menstruation, late menopause, or hormone replacement therapy.
- Lifestyle factors: Obesity, smoking, excessive alcohol consumption, and lack of physical activity.
- Delayed diagnosis: Lack of routine screening and healthcare access contributes to late-stage presentations.
Symptoms of Locally Advanced Breast Carcinoma
Common signs and symptoms include:
- Large, palpable breast lumps
- Skin changes (redness, thickening, dimpling, peau d’orange appearance)
- Nipple inversion or discharge
- Swelling of the breast or chest wall
- Enlarged axillary (underarm) or supraclavicular lymph nodes
- Pain in advanced cases
Diagnosis and Staging
Diagnosis involves a combination of imaging and biopsy techniques:
1. Clinical Examination
- Palpation of breast mass and lymph nodes
- Assessment of skin and nipple changes
2. Imaging Tests
- Mammography: Identifies masses and calcifications.
- Ultrasound: Differentiates between cystic and solid lesions.
- Magnetic Resonance Imaging (MRI): Evaluates tumor extent and involvement of the chest wall.
- Positron Emission Tomography (PET) Scan: Detects regional and distant metastases.
3. Biopsy and Pathological Assessment
- Core needle biopsy: Confirms malignancy and receptor status (ER, PR, HER2).
- Lymph node biopsy: Determines nodal involvement.
4. Staging (TNM Classification)
- T3-T4: Tumor >5 cm or involving chest wall/skin
- N2-N3: Extensive lymph node involvement
- M0: No distant metastasis
Treatment Options
LABC requires a multidisciplinary treatment approach:
1. Neoadjuvant Chemotherapy (Pre-Surgical Treatment)
- Purpose: Shrinks the tumor before surgery
- Common Regimens:
- Anthracyclines (Doxorubicin, Epirubicin)
- Taxanes (Paclitaxel, Docetaxel)
- HER2-targeted therapy (Trastuzumab, Pertuzumab) for HER2-positive tumors
2. Surgery
- Modified Radical Mastectomy (MRM): Common surgical choice for LABC
- Breast-Conserving Surgery (BCS): Possible for tumors significantly reduced by chemotherapy
- Axillary Lymph Node Dissection (ALND): Removes affected lymph nodes
3. Radiation Therapy
- Applied to the chest wall, axilla, and supraclavicular region post-surgery to eliminate residual cancer cells
4. Hormonal Therapy (For ER/PR Positive Tumors)
- Tamoxifen: Used in premenopausal women
- Aromatase Inhibitors (Anastrozole, Letrozole, Exemestane): Used in postmenopausal women
5. Targeted Therapy
- HER2-positive cases: Trastuzumab and Pertuzumab improve survival rates
- CDK4/6 inhibitors (Palbociclib, Ribociclib): Used in hormone receptor-positive LABC
Prognosis and Survival Rates
Survival depends on response to treatment and early intervention:
- 5-year survival rate: Varies from 40% to 70%
- Better prognosis: Observed in HER2-targeted and hormone-responsive cases
Locally advanced breast carcinoma requires an aggressive and well-coordinated treatment strategy. Early diagnosis and access to comprehensive care significantly improve survival and quality of life. Patients should consult oncologists for a tailored treatment approach.
