According to the 8th edition AJCC staging for breast cancer, a patient with a 3 cm ER+/PR+/HER2− tumour with 4 involved ipsilateral axillary lymph nodes but no distant metastases has a clinical stage of:

• A IIB
• B IIIC
• C IIIA ✓
• D IIB with pathological upstaging possible

Explanation

Under AJCC 8th edition TNM staging, a T2 tumour (2–5 cm) with 4 involved axillary nodes (N2a: 4–9 axillary nodes) and no distant metastasis is classified as T2N2M0, which corresponds to stage IIIA. Stage IIB would require N1 (1–3 nodes) with T2, while IIIC requires N3 involvement (≥10 nodes, infraclavicular, supraclavicular, or internal mammary). This patient has 4 nodes making N2a and therefore stage IIIA.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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