locally advanced breast ca

1. LOCALLY ADVANCED BREAST
CARCINOMA
DR. ALEX ARTHUR EDWARDS.,
PROFESSOR AND HEAD OF THE DEPARTMENT OF GENERAL SURGERY

2. WHAT IS LABC ?
• Large primary tumors (>5cm)
• Tumors with chest wall (T4a) and skin (T4b) involvement
• Ulceration or satellite skin nodules
• Inflammatory breast carcinoma
• Fixed axillary nodes
• Clinically apparent internal mammary or ipsilateral supraclavicular nodes

3. IN SHORT..
• Stage II B , Stage III A and Stage III B disease are considered as locally
advanced breast carcinoma
• The concept is that the disease is advanced on the chest wall or skin
and/or in regional nodes with NO EVIDENCE OF METASTASIS to
distant sites

4. HOW SHOULD WE PROCEED ?
• First confirm the diagnosis
• Proceed with staging work up and investigations to exclude
metastasis
• Routine blood investigations and assessment of other systems when
surgery is planned

5. CONFIRMING THE DIAGNOSIS
• Core needle biopsy from the tumor
• FNAC from the axillary node
• Incision biopsy if the lump is > 4cm.

6. METASTATIC WORK UP
• Bilateral mammography
• FNAC of axillary nodes
• USG abdomen to rule out Liver mets
• Bone scan
• CECT abdomen, Chest and Pelvis
• Receptor status – ER/PR/HER-2/Ki 67