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National Cancer Institute

at the National Institutes of Health

Breast Cancer Treatment and Pregnancy (PDQ)

Patient VersionLast Modified: 09/19/2013

Table of Contents

General Information about Breast Cancer and Pregnancy

Stages of Breast Cancer

Inflammatory Breast Cancer

Recurrent Breast Cancer

Treatment Option Overview

Treatment Options by Stage

Early Stage Breast Cancer (Stage I and Stage II)

Late Stage Breast Cancer (Stage III and Stage IV)

Other Considerations for Pregnancy and Breast Cancer

To Learn More About Breast Cancer and Pregnancy

Changes to This Summary (09/19/2013)

About This PDQ Summary

About PDQ

Purpose of This Summary

Reviewers and Updates

Clinical Trial InformationPermission to Use This Summary

Disclaimer

Contact Us

Get More Information From NCI

General Information about Breast Cancer and Pregnancy

Key Points for This Section

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Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the

breast.

Breast cancer is sometimes detected (found) in women who are pregnant or have just

given birth.

Possible signs of breast cancer include a lump or change in the breast.

It may be difficult to detect (find) breast cancer early in pregnant or nursing women,

whose breasts are often tender and swollen.

Breast examination should be part of prenatal and postnatal care.

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

If cancer is found, tests are done to study the cancer cells.

Certain factors affect prognosis (chance of recovery) and treatment options.

Breast cancer is a disease in which malignant (cancer) cells form in the

tissues of the breast.

Thebreast is made up oflobes andducts.Each breast has 15 to 20 sections called lobes, which

have many smaller sections calledlobules.The lobes and lobules are connected by thin tubes

called ducts.

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Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes,

lobes, lobules, ducts, and other parts of the inside of the breast are also shown.

Each breast also containsblood vessels andlymph vessels.The lymph vessels carry an almost

colorlessfluid calledlymph.The lymph vessels lead to small, bean-shapedorgans calledlymph

nodes that help the body fightinfection and disease. Lymph nodes are found throughout the

body. Clusters of lymph nodes are found near the breast in theaxilla (under the arm), above

thecollarbone,and in the chest.

Breast cancer is sometimes detected (found) in women who are pregnantor have just given birth.

In women who arepregnant or who have just given birth,breast cancer occurs most often

between the ages of 32 and 38. Breast cancer occurs about once in every 3,000 pregnancies.

Possible signs of breast cancer include a lump or change in the breast.

Breast cancer may cause any of the following signs andsymptoms.Check with your doctor if you

have any of the following problems:

A lump or thickening in or near the breast or in the underarm area.

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A change in the size or shape of the breast.

A dimple or puckering in the skin of the breast.

Anipple turned inward into the breast.

Fluid, other than breast milk, from the nipple, especially if it's bloody.

Scaly, red, or swollen skin on the breast, nipple, orareola (the dark area of skin that isaround the nipple).

Dimples in the breast that look like the skin of an orange, calledpeau dorange.

Otherconditions that are not breast cancer may cause these same symptoms.

It may be difficult to detect (find) breast cancer early in pregnant or

nursing women, whose breasts are often tender and swollen.

Women who are pregnant, nursing, or have just given birth usually have tender, swollen breasts.

This can make small lumps difficult to detect and may lead to delays indiagnosingbreast cancer.Because of these delays,cancers are often found at a laterstage in these women.

Breast examination should be part of prenatal and postnatal care.

To detect breast cancer, pregnant and nursing women should examine their breasts themselves.

Women should also receiveclinical breast examinationsduring their routineprenatal and

postnatal examinations.

Tests that examine the breasts are used to detect (find) and diagnose

breast cancer.

A doctor should be seen if changes in the breast are noticed. The following tests and procedures

may be used:

Physical exam andhistory: An exam of the body to check general signs of health,

including checking for signs of disease, such as lumps or anything else that seems

unusual. A history of the patients health habits and past illnesses and treatments will

also be taken.

Clinical breast exam (CBE): An exam of the breast by a doctor or other health

professional. The doctor will carefully feel the breasts and under the arms for lumps or

anything else that seems unusual.

MRI (magnetic resonance imaging): A procedure that uses a magnet,radio waves,

and a computer to make a series of detailed pictures of areas inside the body. This

procedure is also called nuclear magnetic resonance imaging (NMRI).

Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are

bounced off internaltissues or organs and make echoes. The echoes form a picture of

body tissues called asonogram.

Mammogram: Anx-ray of the breast. A mammogram can be performed with little risk

to thefetus.Mammograms in pregnant women may appearnegative even though cancer

is present.

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Mammography. The breast is pressed between two plates. X-rays are used to take

pictures of breast tissue.

Blood chemistry studies: A procedure in which a blood sample is checked to measure

the amounts of certain substances released into the blood by organs and tissues in the

body. An unusual (higher or lower than normal) amount of a substance can be a sign of

disease in the organ or tissue that makes it.

Biopsy: The removal ofcells or tissues so they can be viewed under amicroscopeby

apathologist to check for signs of cancer. If a lump in the breast is found, the doctor may

need to remove a small piece of the lump. Four types of biopsies are as follows:

Excisional biopsy: The removal of an entire lump of tissue.

Incisional biopsy: The removal of part of a lump or a sample of tissue. Core biopsy: The removal of tissue using a wide needle.

Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a

thin needle.

If cancer is found, tests are done to study the cancer cells.

Decisions about the best treatment are based on the results of these tests. The tests give

information about:

How quickly the cancer may grow.

How likely it is that the cancer will spread through the body.

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How well certain treatments might work.

How likely the cancer is torecur (come back).

Tests include the following:

Estrogen andprogesterone receptor test: A test to measure the amount

ofestrogen andprogesterone (hormones)receptors in cancer tissue. If there are more

estrogen and progesterone receptors than normal, the cancer may grow more quickly.

The test results show whether treatment to block estrogen and progesterone may stop the

cancer from growing.

Human epidermal growth factor type 2 receptor (HER2/neu) test: Alaboratory

test to measure how many HER2/neugenes there are and how much

HER2/neuprotein is made in a sample of tissue. If there are more HER2/neu genes or

higher levels of HER2/neu protein than normal, the cancer may grow more quickly and is

more likely to spread to other parts of the body. The cancer may be treated

withdrugs that target the HER2/neu protein, such astrastuzumab (Herceptin)

andlapatinib (Tykerb).

Multigene tests: Tests in which samples of tissue are studied to look at the activity of

many genes at the same time. These tests may help predict whether cancer will spread to

other parts of the body or recur (come back).

Oncotype DX: This test helps predict whetherstage I orstage II breast

cancer that isestrogen receptor positive andnode-negativewill spread to other

parts of the body. If the risk of the cancer spreading is high,chemotherapy may

be given to lower the risk. MammaPrint: This test helps predict whether stage I or stage II breast cancer

that is node-negative will spread to other parts of the body. If the risk of the

cancer spreading is high, chemotherapy may be given to lower the risk.

Certain factors affect prognosis (chance of recovery) and treatment

options.

Theprognosis (chance ofrecovery)and treatment options depend on the following:

The stage of the cancer (whether it is in the breast only or has spread to other places inthe body).

The size of thetumor.

The type of breast cancer.

The age of the fetus.

Whether there are symptoms.

The patients general health.

Stages of Breast Cancer

Key Points for This Section

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After breast cancer has been diagnosed, tests are done to find out if cancer cells have

spread within the breast or to other parts of the body.

Methods used to stage breast cancer can be changed to make them safer for the fetus.

There are three ways that cancer spreads in the body.

Cancer may spread from where it began to other parts of the body.

The following stages are used for breast cancer:

Stage 0 (carcinoma in situ)

Stage I

Stage II

Stage IIIA

Stage IIIB

Stage IIIC

Stage IV

After breast cancer has been diagnosed, tests are done to find out if

cancer cells have spread within the breast or to other parts of the body.

The process used to find out if thecancer has spread within thebreast or to other parts of the

body is calledstaging.The information gathered from the staging process determines thestage of

the disease. It is important to know the stage in order to plan treatment.

Methods used to stage breast cancer can be changed to make them safer

for the fetus.

Standard methods for givingimaging scans can be adjusted so that thefetus is exposed to

lessradiation.The following tests and procedures may be used in the staging process:

Sentinel lymph node biopsy: The removal of thesentinel lymph node duringsurgery.The sentinel lymph node is the firstlymph node to receive lymphatic drainage from

atumor.It is the first lymph node the cancer is likely to spread to from the tumor.

Aradioactive substance and/or blue dye isinjected near the tumor. The substance or dye

flows through the lymphducts to the lymph nodes. The first lymph node to receive the

substance or dye is removed. Apathologistviews thetissue under amicroscope to look

for cancercells.If cancer cells are not found, it may not be necessary to remove more

lymph nodes.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas

inside the body, taken from different angles. The pictures are made by a computer linked

to anx-ray machine. A dye may be injected into avein or swallowed to help theorgans or

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tissues show up more clearly. This procedure is also called computed tomography,

computerized tomography, or computerized axial tomography.

Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells,

in the bone. A very small amount of radioactive material is injected into a vein and travels

through the bloodstream. The radioactive material collects in the bones and is detectedby ascanner.

PET scan (positron emission tomography scan): A procedure to

findmalignant tumor cells in the body. A small amount of radioactiveglucose (sugar) is

injected into a vein. The PET scanner rotates around the body and makes a picture of

where glucose is being used in the body. Malignant tumor cells show up brighter in the

picture because they are more active and take up more glucose than normal cells do.

MRI (magnetic resonance imaging): A procedure that uses a magnet,radio waves,

and a computer to make a series of detailed pictures of areas inside the body. This

procedure is also called nuclear magnetic resonance imaging (NMRI).

Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are

bounced off internal tissues or organs and make echoes. The echoes form a picture of

body tissues called asonogram.The picture can be printed to be looked at later.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of

energy beam that can go through the body and onto film, making a picture of areas inside

the body.

There are three ways that cancer spreads in the body.

Cancer can spread throughtissue,thelymph system,and theblood:

Tissue. The cancer spreads from where it began by growing into nearby areas.

Lymph system. The cancer spreads from where it began by getting into the lymph system.

The cancer travels through thelymph vessels to other parts of the body.

Blood. The cancer spreads from where it began by getting into the blood. The cancer

travels through theblood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is calledmetastasis.Cancercellsbreak awayfrom where they began (theprimary tumor)and travel through the lymph system or blood.

Lymph system. The cancer gets into the lymph system, travels through the lymph vessels,

and forms atumor (metastatic tumor) in another part of the body.

Blood. The cancer gets into the blood, travels through the blood vessels, and forms a

tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, ifbreast

cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The

disease is metastatic breast cancer, notbone cancer.

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The following stages are used for breast cancer:

This section describes the stages ofbreast cancer.The breast cancer stage is based on the results

of testing that is done on the tumor and lymph nodes removed during surgery and other tests.

Stage 0 (carcinoma in situ)

There are 3 types ofbreast carcinoma in situ:

Ductal carcinoma in situ (DCIS) is anoninvasivecondition in whichabnormalcells are

found in the lining of abreastduct.The abnormal cells have not spread outside the duct

to othertissues in the breast. In some cases, DCIS may becomeinvasive cancer and

spread to other tissues. At this time, there is no way to know whichlesions could become

invasive.

Ductal carcinoma in situ (DCIS). Abnormal cells are found in the lining of a breast

duct.

Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in

thelobules of the breast. This condition seldom becomes invasive cancer. However,

having LCIS in one breast increases the risk of developingbreast cancer in either breast.

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Lobular carcinoma in situ (LCIS). Abnormal cells are found in the lobules of the

breast.

Paget disease of the nipple is a condition in which abnormal cells are found in

thenipple only.

Stage I

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Stage I breast cancer. In stage IA, the tumor is 2 centimeters or smaller and has not spread outside the breast. In

stage IB, no tumor is found in the breast or the tumor is 2 centimeters or smaller. Small clusters of cancer cells

(larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes.

Instage I,cancer has formed. Stage I is divided into stages IA and IB.

Instage IA,thetumor is 2centimeters or smaller. Cancer has not spread outside

thebreast.

Instage IB,small clusters ofbreast cancercells (larger than 0.2millimeterbut not larger

than 2 millimeters) are found in thelymph nodes and either:

notumor is found in thebreast;or

the tumor is 2centimeters or smaller.

Stage II

Stage II is divided into stages IIA and IIB.

Instage IIA:

notumor is found in thebreast or the tumor is 2centimeters or

smaller.Cancer (larger than 2millimeters)is found in 1 to 3axillary lymph

nodes or in thelymph nodes near thebreastbone (found during asentinel lymph

node biopsy); or

the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer

has not spread to the lymph nodes.

http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45142&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45333&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=684435&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=304766&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=684439&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=444971&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46476&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44215&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=304766&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45146&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=413882&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=304766&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45333&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44215&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45607&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45607&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=549425&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46712&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46712&version=Patient&language=Englishhttp://www.cancer.gov/PublishedContent/MediaLinks/640077.htmlhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46712&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46712&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=549425&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45607&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45607&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44215&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45333&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=304766&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=413882&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45146&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=304766&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44215&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46476&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=444971&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=684439&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=304766&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=684435&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45333&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45142&version=Patient&language=English

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Stage IIA breast cancer. No tumor is found in the breast and cancer is found in 1 to 3 axillary lymph

nodes or lymph nodes near the breastbone (left panel); OR the tumor is 2 centimeters or smaller and

cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (middle panel); OR

the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the lymphnodes (right panel).

Instage IIB,thetumor is:

larger than 2centimetersbut not larger than 5 centimeters. Small clusters

ofbreast cancercells (larger than 0.2millimeterbut not larger than 2

millimeters) are found in thelymph nodes;or

larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to

1 to 3axillary lymph nodes or to the lymph nodes near thebreastbone (found

during asentinel lymph node biopsy); or

larger than 5 centimeters. Cancer has not spread to the lymph nodes.

http://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=413883&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=444971&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46476&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44215&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45607&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=549425&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46712&version=Patient&language=Englishhttp://www.cancer.gov/PublishedContent/MediaLinks/640078.htmlhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46712&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=549425&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45607&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=45762&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=44215&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46476&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=444971&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=354457&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=46634&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=413883&version=Patient&language=English

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Stage IIB breast cancer. The tumor is larger than 2 centimeters but not larger than 5 centimeters and

small clusters of cancer cells are found in the lymph nodes (left panel); OR the tumor is larger than 2centimeters but not larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or

lymph nodes near the breastbone (middle panel); OR the tumor is larger than 5 centimeters and has not

spread to the lymph nodes (right panel).

Stage IIIA

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Stage IIIA breast cancer. No tumor is found in the breast or the tumor may be any size and cancer is found in 4 to

9 axillary lymph nodes or lymph nodes near the breastbone (left panel); OR the tumor is larger than 5

centimeters and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are

found in the lymph nodes (middle panel); OR the tumor is larger than 5 centimeters and cancer is found in 1 to 3

axillary lymph nodes or lymph nodes near the breastbone (right panel).

Instage IIIA:

notumor is found in thebreast or the tumor may be any size.Cancer is found in 4 to

9axillary lymph nodes or in thelymph nodes near thebreastbone (found duringimaging

tests or aphysical exam); or

the tumor is larger than 5centimeters.Small clusters ofbreast cancercells (larger than

0.2millimeterbut not larger than 2 millimeters) are found in the lymph nodes; or

the tumor is larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes

or to the lymph nodes near the breastbone (found during asentinel lymph node biopsy).

Stage IIIB

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Stage IIIB breast cancer. The tumor may be any size and cancer has spread to the chest wall and/or to the skin of

the breast and caused swelling or an ulcer. Cancer may have spread to axillary lymph nodes or lymph nodes near

the breastbone. Cancer that has spread to the skin of the breast may be inflammatory breast cancer.

Instage IIIB,thetumor may be any size andcancer has spread to thechest wall and/or to the

skin of thebreast and caused swelling or anulcer.Also, cancer may have spread to:

up to 9axillary lymph nodes;or

thelymph nodes near thebreastbone.

Cancer that has spread to the skin of the breast may also beinflammatory breast cancer.See the

section onInflammatory Breast Cancer for more information.

Stage IIIC

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Stage IIIC breast cancer. No tumor is found in the breast or the tumor may be any size and may have spread to

the chest wall and/or the skin of the breast. Also, cancer has spread to 10 or more axillary lymph nodes (left

panel); OR to lymph nodes above or below the collarbone (middle panel); OR to axillary lymph nodes and lymph

nodes near the breastbone (right panel).

Instage IIIC,notumor is found in thebreast or the tumor may be any size. Cancer may havespread to the skin of the breast and caused swelling or anulcer and/or has spread to thechest

wall.Also, cancer has spread to:

10 or moreaxillary lymph nodes;or

lymph nodes above or below thecollarbone;or

axillary lymph nodes and lymph nodes near thebreastbone.

Cancer that has spread to the skin of the breast may also beinflammatory breast cancer.See the

section onInflammatory Breast Cancer for more information.

For treatment, stage IIIC breast cancer is divided intooperable andinoperable stage IIIC.

Stage IV

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Stage IV breast cancer. The cancer has spread to other parts of the body, most often the bones, lungs, liver, or

brain.

Instage IV,cancer has spread to otherorgans of the body, most often the bones,lungs,liver,or

brain.

Inflammatory Breast Cancer

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Ininflammatory breast cancer,cancer has spread to the skin of the breast and thebreastlooks

red and swollen and feels warm. The redness and warmth occur because the cancercellsblock

thelymph vessels in the skin. The skin of the breast may also show the dimpled appearance

calledpeau dorange(like the skin of an orange). There may not be any lumps in the breast that

can be felt. Inflammatory breast cancer may bestage IIIB,stage IIIC,orstage IV.

Inflammatory breast cancer of the left breast showing peau dorange and inverted nipple.

Recurrent Breast Cancer

Recurrentbreast cancer iscancer that hasrecurred (come back) after it has been treated. The

cancer may come back in thebreast,in thechest wall,or in other parts of the body.

Treatment Option Overview

Key Points for This Section

There are different types of treatment for patients with breast cancer.

Treatment options for pregnant women depend on the stage of the disease and the age of

the fetus.

Three types of standard treatment are used:

Surgery Radiation therapy

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Chemotherapy

New types of treatment are being tested in clinical trials.

Hormone therapy

Ending the pregnancy does not seem to improve the mothers chance of survival.

There are different types of treatment for patients with breast cancer.

Different types of treatment are available for patients withbreast cancer.Some treatments

arestandard (the currently used treatment), and some are being tested inclinical trials.A

treatment clinical trial is aresearch study meant to help improve current treatments or obtain

information on new treatments for patients withcancer.When clinical trials show that a new

treatment is better than the standard treatment, the new treatment may become the standard

treatment.

For some patients, taking part in a clinical trial may be the best treatment choice. Many of today's

standard treatments for cancer are based on earlier clinical trials. Patients who take part in a

clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the

future. Even when clinical trials do not lead to effective new treatments, they often answer

important questions and help move research forward.

Some clinical trials only include patients who have not yet received treatment. Other trials test

treatments for patients whose cancer has not gotten better. There are also clinical trials that test

new ways to stop cancer fromrecurring (coming back) or reduce theside effects of cancer

treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials is

available from theNCI Web site.

Treatment options for pregnant women depend on the stage of the

disease and the age of the fetus.

Three types of standard treatment are used:

Surgery

Mostpregnantwomen with breast cancer havesurgery to remove thebreast.Some of thelymph

nodes under the arm are usually taken out and looked at under amicroscope to see if they

contain cancercells.