Education And Debate

ABC of Breast Diseases: Locally Advanced Breast Cancer

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6966.1431 (Published 26 November 1994) Cite this as: BMJ 1994;309:1431
  1. A Rodger,
  2. R C F Leonard,
  3. J M Dixon

    J M Dixon acknowledges the support of the Cancer Research Campaign. Photographs of the patient treated by intra-arterial chemotherapy were provided by Mr J R C Sainsbury, consultant surgeon at Huddersfield Royal Infirmary. Other photographs were prepared by Mr D Dirom, Medical Illustration Unit, University of Edinburgh.

    A Rodger is director of William Buckland Radiotherapy Centre at Alfred Hospital and professor of radiation oncology at Monash University, Melbourne, Australia; R C F Leonard is consultant medical oncologist at Department of Clinical Oncology, Western General Hospital, Edinburgh; and J M Dixon is senior lecturer in surgery at Edinburgh Royal Infirmary and honorary consultant surgeon at Western General Hospital, Edinburgh. The ABC of Breast Diseases has been edited by J M Dixon.

    Locally advanced disease of the breast is characterised clinically by features suggesting infiltration of the skin or chest wall by tumour or matted involved axillary nodes. Large operable breast cancers and tumours fixed to muscle should not be considered as locally advanced. Depending on referral patterns and clinical definitions, between one in 12 and one in four patients with breast cancer present with locally advanced disease. Reflecting the differences in definition and the variable natural history of breast cancer, reported five year survival varies between 1% and 30%. Median survival is about 2-2.5 years, which is similar to that described for breast cancer in the late 19th and early 20th centuries.

    Clinical features of locally advanced breast cancer

    Skin

    • Ulceration

    • Dermal infiltration

    • Erythema over tumour

    • Satellite nodules

    • Peau d'orange

    Chest wall Tumour fixation to

    • Ribs

    • Serratus anterior

    • Intercostal muscles

    Axillary nodes

    • Nodes fixed to one another or to other structures

    Locally advanced breast cancer may arise because of its position in the breast (for example, peripheral), neglect (some patients do not present to hospital for month or years after they notice a mass), or biological aggressiveness (this includes all inflammatory cancers and most …

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