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 2 in. (5 cm), 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 sometimes an implant or, alternatively, an optional 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 11/2 in. (4 cm)] 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.
Patient survival with Stage II cancer depends on controlling tumor cells that have likely already spread throughout the body. Starting adjuvant chemotherapy promptly after surgery is critical since the major risk to
