ABSTRACT
This chapter discusses locally advanced breast cancer (LABC), which is a subset of breast cancer presenting as a large (>5 cm) mass with or without skin involvement or chest wall involvement and fixed axillary lymph nodes without any demonstrable systemic metastasis. The diagnosis and evaluation of LABC include clinical breast examination, radiology, core biopsy, and systemic staging. The standard of care for LABC is neoadjuvant systemic therapy followed by surgery. This approach has several advantages, such as the management of systemic micrometastasis, downstaging of the mass, increased incidence of breast conservation surgery, in vivo assessment of the effectivity of the particular systemic therapy, and appropriate endocrine therapy in hormone receptor–positive cancers. The chapter also discusses the principles and different treatment options available for LABC, including neoadjuvant systemic therapy, neoadjuvant endocrine therapy, and surgery, and the response patterns associated with these treatments. Overall, LABC is a complex clinical problem requiring a multidisciplinary team approach for optimal management.
