Hi, it depends on the size of the lump, glands and breast skin status. In early stages, usually we ask for upfront surgery then chemotherapy
. In locally advance cases, chemotherapy 4 cycles followed by surgery then 4 cycles of chemo of different type can be advised. In locally advanced cases, patient must undergo USG abdomen, bone scan and at least X ray
chest. ER PR will decide future hormonal
treatment. Keep me posted. Take care.