- For patients with operable stage 3 tumors, doctors should offer patients chemotherapy -- either primary chemotherapy with a localized surgical procedure, or surgical management of the cancer with postoperative chemotherapy. Chemotherapy should contain an anthracycline. The guidelines suggest six cycles of one of four "cocktails" of therapy available for breast cancer patients.
For patients with inoperable breast tumors (stage 3B or stage 3C), doctors should focus on primary chemotherapy; guidelines recommend between four and six cycles of one of four "cocktails" of chemotherapy drugs. Stage 3B patients whose tumors respond to chemotherapy should then go through surgery to get the remaining part of the tumor, with radiation therapy to follow. The guidelines recommend individualizing treatment for stage 3C patients whose tumors respond to chemotherapy. For patients whose tumors do not respond to primary chemotherapy, doctors can try experimental chemotherapy agents, or try radiation followed by a radical mastectomy, which is a procedure in which a surgeon removes the breast, underlying muscle and lymph nodes. - The guideline document recommends that patients with operable or inoperable tumors (that is, all stage 3 breast cancer patients) take tamoxifen for five years.
- Patients with operable tumors should undergo a modified radical mastectomy and localized radiation therapy. Chemotherapy may be an option before surgical treatment, depending on the individual patient's case. The guideline does not recommend breast-conserving surgery for these patients.
Patients with stage 3B breast cancer whose tumors respond to chemotherapy should undergo surgery plus radiation therapy. Doctors should individualize stage 3C breast cancer patients' treatment if their tumors respond to chemotherapy; surgery, radiation therapy, or both could be options. Depending on how well the tumor responded to chemotherapy (i.e., fewer than six cycles of the drug cocktail), the doctor could recommend additional chemotherapy instead.
Patients whose cancer does not respond to chemotherapy should undergo a radical mastectomy when possible, with localized radiation therapy following the surgery.