The same considerations for selection of the surgical procedure apply as in Stage I, including the size of the cancer, the size of the breast and concerns about breast preservation. The indications for axillary dissection are similar to those in Stage I. Surgical options are also similar, namely:
• Excisional biopsy or lumpectomy , with an axillary node dissection, followed by radiation therapy to the
  breast. For tumors larger than 5 cm (2 in.), chemotherapy may be given before surgery (neoadjuvant 
  chemotherapy).
• A wedge or partial breast resection , again with axillary node dissection and postoperative radiation. The 
  limitations on tumor size and tumor-free margins again apply. Radiation therapy consists of external radiation 
  and a booster dose of external radiation. Local recurrence rates are lower than with lumpectomy alone.
• Modified radical or total mastectomy. In a few patients with large tumors (larger than 4 cm/11/2  in.) or 
  extensive tumors (invasion of the chest wall muscles, for example), a modified radical or even a Halsted radical
  mastectomy may be required to remove all of the tumor. Postmastectomy chest wall radiation is given in 
  selected patients with muscle invasion, residual tumor in the chest wall, or a high risk for tumor cells close to 
  the surgical margins. Some physicians irradiate patients with more than four positive axillary nodes with very 
  large tumors, or if lymphatic vessels within the breast are involved.