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Large Tumor / Locally Advanced
The size of the tumor is one of the things your doctor will look at in the staging process. Any tumor over 5cm is considered large in size and if combined with positive lymph nodes is considered locally advanced or Stage III. A tumor less than 5cm with a large palpable lymph node or with 4 or more positive lymph nodes, is also considered locally advanced and therefore will be treated the same as a large tumor. At this stage you will have two treatment options, either surgery first or chemotherapy first.
Any surgery recommended to remove cancer will depend on the size of the tumor, where the tumor is located, and the type of cancer. In a successful surgery, there will be no tumor cells in the margin and healthy non-cancerous cells around the cancerous tumor. If no cancer cells can be detected in this margin, then the cancer has been completely removed.
Additional surgery that rebuilds the shape of the breast is called reconstructive surgery and is done by a plastic surgeon or breast oncologist with experience in breast surgery. The surgery performed to remove the cancer may have an impact on your reconstruction options and it is important to speak up and communicate your desired end result as early as possible, when you may have the most options.
Your surgeon may want you to see a medical oncologist to shrink a large tumor using neoadjuvant chemotherapy before surgery. Neoadjuvant chemotherapy can shrink the tumor and stop the cancer from spreading. It may even kill the tumour entirely leaving no tumour cells visible on the final surgical pathology. This is called a pathological complete response (pCR). Some large tumors may shrink enough in size to allow for a lumpectomy when you previously required a mastectomy.
IMPORTANT: If you are interested in having children someday, you must speak to your doctors about fertility preservation as soon as possible after diagnosis. Some aspects of breast cancer treatment (for example chemotherapy and hormonal therapy) can affect your ability to have children. It’s very important that your medical team knows that you would like information about fertility preservation options and that this is included in any discussion about your treatment plan.