Treatment of stage IIIA usually includes modified radical or radical mastectomy in combination with radiation, chemotherapy and possibly hormonal therapy. The chemotherapy may also be given preoperatively (neo-adjuvant) to reduce the extent of disease. Radical chemotherapy may also be indicated. Stage IIIB disease usually involves diagnosis by biopsy with systemic therapy playing the primary treatment role. Surgery may be done later to try and gain local control. Inflammatory breast cancer (T4d) is a grave, special case not classified by stage, but is also treated in this way.
Breast cancer most commonly spreads to bone, lungs, brain and liver. Diagnosis of metastasis may be made by bone scan, brain scan, X-ray, abdominal CT and lab tests. Stage IV disease is treated systemically with the goal of retarding the progress of the disease. Mastectomy may be used for local control.
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