Editing Breast cancer (section)

=== '''Locally advanced (T3N0, and stage IIIA to IIIC)''' ===

** Neoadjuvant CTX and HER2-directed therapy if indicated and endocrine therapy may be indicated as well
*** If neoadjuvant CTX is happening, do USS-guided biopsy of axillary nodes (ask them to put a clip in any positive nodes so they can be selectively removed later), and then SLNB after neoadjuvant CTX even if negative, along with removing any previously positive nodes (this is the 'targeted axillary dissection'). Guidelines suggest attempting to get 3 sentinel nodes in this situation.
**** Ample evidence that the axilla can be down-staged (up to 40% of biopsy positive nodes will become negative after neoadjuvant ctx)
**** We don't really know whether patients with persistently positive axillas after neoadjuvant CTX truly need an ALND, but definitely safest to provide this based on current evidence. In fact, they probably also need axilla RTX after ALND.
*** Do MRI before and after neoadjuvant CTX to assess response
** Then surgery
*** If breast-conserving, get RTX
** Adjuvant CTX depends on response to neoadjuvant, and type of CTX given